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Questions and Answers
What is the normal range for blood pH?
Which condition is associated with low levels of bicarbonate?
Which buffer system controls hydrogen ions in the blood?
Hypovolemia can lead to which type of acid-base imbalance?
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What is respiratory alkalosis primarily caused by?
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Which alteration in respiration is likely to cause acidosis?
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In which situation would you expect to see symptoms of hypokalemia?
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What typically occurs during metabolic acidosis?
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What physiological change represents respiratory acidosis?
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How does metabolic alkalosis typically manifest in a patient?
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Which of the following scenarios is LEAST likely to cause metabolic acidosis?
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What role do chemical buffers play in acid-base balance?
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Which condition is associated with hyperventilation?
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What can lead to a state of hypokalemia?
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What is a major indicator of the need for renal compensation in acid-base imbalances?
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In which condition would you expect to see a high carbon dioxide level?
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Study Notes
Basics of Acid-Base
- Water is an essential component of maintaining acid-base balance.
- Oxygen levels are inversely proportional to acidity, low oxygen increases acidity.
- Carbon dioxide (CO2) levels directly increase acidity.
- Electrolytes like potassium (K+), sodium (Na+), and calcium (Ca2+) play a role in regulating acid-base balance.
- Glucose from food is metabolized and can contribute to acid production.
Acid-Base Basics
- Water dissociates into hydrogen ions (H+) and hydroxyl ions (OH-).
- Hydrogen ions (H+) represent acidity, while hydroxyl ions (OH-) represent alkalinity.
- pH measures the concentration of hydrogen ions, with a normal pH of 7.35-7.45.
- A solution with a high hydrogen ion concentration is acidic, resulting in a low pH.
- Acidosis is a state of low pH, below 7.45.
- Any disruption to homeostasis, including fluid balance, respiration, gastrointestinal function, etc., can lead to acid-base imbalances.
Factors Influencing Acid-Base Balance
- Airway: Obstruction leads to hypoventilation, increasing CO2 and resulting in acidosis.
- Breathing: Hypoventilation (CO2 retention) increases acidity, hyperventilation (CO2 removal) lowers acidity.
- Circulation: Hypovolemia (dehydration) leads to acidosis, while hypervolemia (overhydration) can lead to alkalosis.
- Nutrition: Upper GI tract (acidic, HCL): Vomiting results in metabolic alkalosis. Lower GI tract (alkaline, KOH): Diarrhea results in metabolic acidosis.
- Renal Function: Kidneys regulate bicarbonate (HCO3-) levels, low levels cause acidosis, high levels cause alkalosis. Oliguria (low urine output) can lead to acidosis, while polyuria (increased urine output) can lead to alkalosis.
Arterial Blood Gases (ABGs)
- ABGs are a blood test to measure acid-base balance.
- pH: 7.35 – 7.45 (Indicates acidosis if below 7.45)
- Partial pressure of carbon dioxide (PaCO2): 35 – 45 (Indicates respiratory component)
- Partial pressure of oxygen (PaO2): 80 - 100 (Indicates oxygen levels)
- Oxygen saturation (SpO2): 95-100 (Indicates oxygen saturation)
- Bicarbonate (HCO3-): 22 – 26 (Indicates metabolic component)
Acid-Base Equation
- Homeostasis: H2O + CO2 ⇌ H2CO3 ⇌ HCO3- + H+
- Respiratory Component: H2O + CO2 ⇌ H2CO3
- Metabolic Component: H2CO3 ⇌ HCO3- + H+
Causes of Acid-Base Imbalances
-
Respiratory Acidosis/Alkalosis: Caused by imbalances in CO2 levels.
- Hypoventilation: Increased CO2 above 45 mmHg (hypercapnia) leads to respiratory acidosis.
- Hyperventilation: Decreased CO2 below 35 mmHg leads to respiratory alkalosis.
- Metabolic Acidosis: Low pH, low bicarbonate. Often caused by diarrhea.
- Metabolic Alkalosis: High pH, high bicarbonate. Often caused by vomiting.
- Mixed Acid-Base Imbalance: When two or more acid-base imbalances occur simultaneously.
Acid-Base Control Systems
- Chemical Buffer : Blood buffers regulate hydrogen ions.
- Respiratory Buffer: Lungs regulate carbon dioxide levels.
- Renal Buffer: Kidneys regulate bicarbonate levels through urine.
Interpreting ABGs
-
Example 1: ABG = 7.32/50/25.
- pH below 7.45 = Acidosis
- PaCO2 = 50 indicates increased CO2, thus, respiratory acidosis.
- HCO3 = 25 is within normal range.
-
Example 2: ABG = 7.55/43/32.
- pH above 7.45 = Alkalosis
- PaCO2 = 43 is within normal range.
- HCO3 = 32, increased bicarbonate, indicating metabolic alkalosis.
Basic Rules of Acid-Base Imbalances
-
Increased pH (Alkalosis): Most vital organs (brain, heart, lungs, kidneys, liver, pancreas) function increase, except for potassium concentration (hypokalemia).
- Brain: Hyperreflexia (overactive reflexes), seizures.
- Heart: Increased heart rate, arrhythmias.
- Lungs: Increased respiratory rate.
- Kidneys: Increased urine output.
- Liver: Decreased liver function.
- Pancreas: Decreased insulin production.
Basics of Acid-Base
- Water is essential for acid-base balance
- Sources of acid and base:
- Water (H2O): fluids
- Oxygen (O2): low levels mean acidosis
- Carbon dioxide (CO2): directly proportional to acid increase
- Electrolytes (K+, Na+, Ca2+)
- Food (glucose)
- Basic formula: H2O = H+ + OH-
- H+ = acid
- OH- = base
- pH = Power (concentration) of hydrogen ion
- Normal pH = 7.35 – 7.45
- Acidosis = pH < 7.35
- Alkalosis = pH > 7.45
- Any changes in homeostasis (fluid, respiration, GIT) can lead to acid-base imbalance
Respiratory Influences
- Airway obstruction leads to hypoventilation, increased CO2, and acidosis.
- Hypoventilation (CO2 retention) results in acidosis.
- Hyperventilation (CO2 removal) results in alkalosis.
Circulatory Influences
- Hypovolemia (dehydration) results in acidosis.
- Hypervolemia (overhydration) results in alkalosis.
Nutritional Influences
- Upper GIT (acid = HCL): vomiting leads to metabolic alkalosis.
- Lower GIT (base = KOH): diarrhea leads to metabolic acidosis.
- Renal system:
- Bicarbonate: low levels lead to acidosis, high levels lead to alkalosis.
- Oliguria (reduced urine output) leads to acidosis.
- Polyuria (increased urine output) leads to alkalosis.
ABGs
- Arterial Blood Gases (ABGs) measure:
- pH (7.35 - 7.45)
- PaCO2 (35 - 45) = Respiratory
- PaO2 (80 - 100)
- SpO2 (95 - 100)
- HCO3- (22 - 26) = Metabolic
Acid-Base Equation
- H2O + CO2 = H2CO3 = HCO3- + H+ = Homeostasis
- H2O + CO2 = H2CO3 = Respiratory
- H2CO3 = HCO3- + H+ = Metabolic
- Causes:
- Respiratory disorder = Respiratory acidosis/alkalosis = CO2 imbalance
- Hypoventilation = CO2 > 45 (acidosis)
- Hyperventilation = CO2 < 45 (alkalosis)
- Hypoxia = SpO2 low
- Metabolic acidosis = low pH = low bicarbonate = diarrhea
- Metabolic alkalosis = high pH = high bicarbonate = vomiting
- Mixed acid-base imbalance
- Respiratory disorder = Respiratory acidosis/alkalosis = CO2 imbalance
Acid-Base Control
- Chemical buffer: controls hydrogen ions in the blood (blood)
- Respiratory buffer: carbon dioxide ions in the blood (lungs)
- Renal buffer: bicarbonate ions in the urine (kidney)
ABGs Interpretation
-
Example: ABG = 7.32 / 50 / 25
- pH < 7.35 = Respiratory acidosis
- CO2 > 45 = Respiratory component
- HCO3 = Normal
-
Example: ABG = 7.55 / 43 / 32
- pH > 7.45 = Alkalosis
- CO2 = Normal
- HCO3 = High = Metabolic Alkalosis
Basic Rules of Acid-Base Imbalances
- When pH increases (alkalosis), the function of vital organs (brain, heart, lungs, kidneys, liver, pancreas) increases, except for potassium concentration (hypokalemia).
- Brain: hyperreflexia, seizures
- Heart: increased rate and contractility
- Lungs: increased respiratory rate
- Kidneys: increased urine output
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Description
Test your knowledge on the fundamentals of acid-base balance. This quiz covers essential concepts like pH, hydrogen and hydroxyl ions, and the role of various electrolytes. Understand how these factors influence bodily functions and homeostasis.
