- Correct Answer - Serum bicarb rise and a process that prevents the
kidneys from excreting it usually must occur.
-Increased binding of Ca++ to plasma proteins causing ionized calcium
concentrations to decrease and the cells become more excitable causing
easier initiation of the action potential.
Alkalemia- hydrogen ion concentration in blood is decreased
-hydrogen ions are redistributed from intracellular to extracellular space
-potassium moves to intracellular space to preserve electroneutrality
Clinical implications of metabolic alklalosis
- Correct Answer - Rate and depth of ventilation is decreased, causing
CO2 retention to combine with water to form carbonic acid for
compensation. (not very efficient and severe alkalosis must be treated.)
Diuretic use (thiazide and loop especially) promote H+ loss through the
distal tubule = contraction alkalosis.
,Hyperchloremic metabolic alkalosis- acid loss caused by vomiting, gastric
suctioning with depletion of ECF sodium, chloride, potassium
respiratory acidosis
- Correct Answer - A drop in blood pH due to hypoventilation (too little
breathing) and a resulting accumulation of Co2.
etiology of respiratory acidosis
- Correct Answer - {Failure of the lungs to remove enough CO2}
◦Respiratory depression
◦Obesity hypoventilation syndrome
◦Disorders of the lungs
◦ARDS
Clinical manifestations of respiratory acidosis
- Correct Answer - ◦r/t acuity of onset & severity of PaCO2 retention
- Correct Answer - ◦Decreased myocardial contractility, which decreases
cardiac output. Catecholamine hypotension (decreased binding of
norepinephrine to receptors.)
◦Oxyhemoglobin curve shifts right and ↓ hemoglobins affinity for O2
◦hyper-chloremic metabolic acidosis- occurs with renal failure, prolonged
diarrhea (GI losses) with bicarbonate loss, large volumes of saline
administration, meds (NSAIDS, ACE inhibitors, trimethoprim)
, Metabolic alkalosis
- Correct Answer - pH >7.45
bicarb >28
etiology of metabolic alkalosis
- Correct Answer - {Results from excess serum bicarb or decrease in H+}
◦Most common causes are from gastric stomach content losses or diuretic
use.
◦Vomiting causes loss of hydrochloric acid. The stomach releases H+ that
goes to the small intestine decreasing the pH in the small intestine and
signaling the pancreas to secrete bicarb. When H+ ions are lost in vomit,
the pancreas does not get signaled to release bicarb, creating alkalosis.
◦Hyper-aldosteronism- excess aldosterone causes sodium retention & loss
of hydrogen & potassium
-leads to mild volume expansion
-bicarbonate is retained with sodium leading to alkalosis
Clinical manifestations of metabolic alkalosis
- Correct Answer - Usually accompanied by hypokalemia and its
associated symptoms.
-Cardiac arrythmias d/t the hypokalemia, hypokalemia, hypoventilation and
elevated pCO2.
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