Clinical Aspects of Acid-Base Disturbance

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Questions and Answers

What indicates respiratory alkalosis in a blood gas analysis?

pH greater than 7.45 and PCO2 less than 35 mmHg (correct)

Bicarbonate greater than 25 mEq/L

pH less than 7.35

PCO2 greater than 45 mmHg

Which of the following is a common cause of respiratory alkalosis?

Hypoventilation from respiratory failure

Psychogenic hyperventilation (correct)

Chronic obstructive pulmonary disease

Inadequate oxygen supply

Which symptom is associated with respiratory alkalosis due to low ionized calcium?

Tingling sensation (correct)

Headache

Nausea

Bradycardia

What would be considered appropriate compensation in the case of respiratory acidosis?

Increasing bicarbonate levels Signup and view all the answers

What is a common clinical finding in a patient with respiratory alkalosis?

Increased respiratory rate Signup and view all the answers

What is the primary cause of metabolic acidosis in the presented case?

Diabetic ketoacidosis Signup and view all the answers

What indicates that the patient is experiencing partial compensation for the metabolic acidosis?

Decreased PCO2 levels Signup and view all the answers

What is the normal range for the anion gap in a healthy individual?

12 +/- 4 Signup and view all the answers

Which of the following laboratory findings is consistent with metabolic acidosis?

PCO2 level of 20 mmHg Signup and view all the answers

In which condition would you expect an increased anion gap?

Diabetic ketoacidosis Signup and view all the answers

What is the result of the calculated anion gap based on the given serum electrolytes?

30 Signup and view all the answers

Which clinical manifestation is associated with metabolic acidosis?

Kussmaul breathing Signup and view all the answers

What electrolyte abnormality is noted in this patient that is often seen in metabolic acidosis?

Elevated potassium levels Signup and view all the answers

What defines acidemia in terms of pH?

pH < 7.35 Signup and view all the answers

What is the primary method of compensation for metabolic acidosis?

Hyperventilation to decrease Pco2 Signup and view all the answers

Which physiological change occurs to compensate for respiratory alkalosis?

Decrease in bicarbonate concentration Signup and view all the answers

Which of the following is a characteristic of alkalemia?

pH > 7.45 Signup and view all the answers

During the compensation of metabolic alkalosis, what physiological change occurs?

Decreased respiratory rate Signup and view all the answers

What is the primary role of bicarbonate in acid-base disturbances?

To buffer excess acids Signup and view all the answers

What is the normal range for arterial blood gas pH?

7.35 – 7.45 Signup and view all the answers

Which type of acid-base disturbance is characterized by high Pco2 levels?

Respiratory acidosis Signup and view all the answers

What is one of the first compensatory responses to respiratory acidosis?

Increased hemoglobin buffering Signup and view all the answers

What is indicative of respiratory compensation occurring after acute metabolic acidosis?

Decreased Pco2 level Signup and view all the answers

How does the body respond to respiratory alkalosis within the first 10 minutes?

Shifting of H ions from extracellular to intracellular Signup and view all the answers

Which is a common compensatory mechanism for metabolic disorders?

Increasing bicarbonate secretion Signup and view all the answers

What happens to Pco2 during metabolic acidosis compensation?

It decreases Signup and view all the answers

In which condition is hypoventilation primarily used as a compensation mechanism?

Metabolic alkalosis Signup and view all the answers

What condition is indicated by a pH of 7.49, elevated PCO2, and high HCO3 levels?

Metabolic alkalosis Signup and view all the answers

Which of the following is a common cause of metabolic alkalosis?

Loss of hydrogen ions due to vomiting Signup and view all the answers

What is a characteristic clinical effect of respiratory acidosis?

Headaches and increased intracranial pressure Signup and view all the answers

In a patient with fully compensated respiratory acidosis, what would be a typical blood gas finding?

pH 7.35 Signup and view all the answers

What causes respiratory acidosis related to neuromuscular disorders?

Inadequate ventilation due to muscle weakness Signup and view all the answers

A characteristic feature of metabolic alkalosis is that it is mostly:

Asymptomatic or mildly symptomatic Signup and view all the answers

What might you expect in the blood gas results of a 65-year-old man with respiratory distress and asthma?

Normal pH with high PCO2 Signup and view all the answers

Which of the following factors could lead to increased renal reabsorption of bicarbonate?

Hyperaldosteronism Signup and view all the answers

Study Notes

Acid-Base Disturbance Overview

Acid-base balance is crucial for physiological function, determined by hydrogen ion concentration.
The equation: [H] = 24 * Pco2 / [Hco3] gives the relationship between hydrogen ions, carbon dioxide, and bicarbonate.

Definitions

Acidemia: pH < 7.35 indicates increased acidity in blood; implies high hydrogen ions and possibly high Pco2 or low Hco3.
Alkalemia: pH > 7.45 indicates increased alkalinity in blood; implies low hydrogen ions and possibly low Pco2 or high Hco3.

Types of Acid-Base Disturbances

Respiratory Disturbances: Affect Pco2 levels, leading to respiratory acidosis or alkalosis.
Metabolic Disturbances: Affect Hco3 levels, leading to metabolic acidosis or alkalosis.

Compensation Mechanisms

Compensatory responses aim to restore pH balance through renal (altering bicarbonate) or respiratory (altering Pco2) mechanisms.
Metabolic Acidosis: Compensated by decreased Pco2 (hyperventilation).
Metabolic Alkalosis: Compensated by increased Pco2 (hypoventilation).
Respiratory Acidosis: Compensated by increased Hco3 through buffering and renal excretion.
Respiratory Alkalosis: Compensated initially by H ions moving from intracellular to extracellular spaces, followed by renal adjustment in H secretion.

Diagnosis of Acid-Base Disturbances

Diagnosis involves patient history, physical examination, and arterial blood gas (ABG) analysis.
Normal arterial blood gas ranges:
- pH: 7.35 – 7.45
- Hco3: 20 – 28 mEq/L
- Pco2: 35 - 45 mmHg

Case Interpretations

Newborn Case: Respiratory alkalosis identified in a newborn under mechanical ventilation; high pH and low Hco3.
Child Case: Partial compensation in metabolic alkalosis; loss of hydrogen from vomiting; symptoms include weakness.
Man Case: Fully compensated respiratory acidosis due to asthma; indicated by low pH and moderate hypoxia.
Newborn Case: Partial compensation in metabolic acidosis due to poor feeding; deep rapid respiration noted.

Anion Gap

Anion gap reflects unmeasured anions in the blood, typically 12 ± 4.
Calculated as: Anion gap = Na – (Hco3 + Cl).
Increased anion gap indicates conditions like renal failure, diabetic ketoacidosis, and lactic acidosis.

Clinical Signs of Acid-Base Disturbances

Metabolic Acidosis: Kussmaul breathing, cardiac dysfunction.
Respiratory Alkalosis: Tingling due to low calcium, paresthesia.
Respiratory Acidosis: Increased cerebral blood flow, headaches, increased intracranial pressure.

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Description

This quiz focuses on the clinical aspects of acid-base disturbances in medicine. It covers concepts such as acidemia and alkalemia, along with related blood pH values and their implications. Test your understanding of how these disturbances impact patient care.