Other
Nursing 216 Acid base disorders Worksheet
- Course
- NURSING 216
- Institution
- Essex County College
This is a comprehensive and detailed worksheet on Acid base disorders. *Essential Study Material!!
[Show more]
Content preview
Acid-Base Disorders WorksheetAdapted from Joshua Steinberg MD
Step #1: Gather the necessary data (Na+, Cl-, HCO3-, pH, pCO2)
Preferably, all obtained from the same blood sample.
Step #2: Look at the pH. Patient has primary:
If pH >7.4 the patient has a primary alkalosis proceed to Step 3a acidosis | alkalosis
If pH < 7.4 the patient has a primary acidosis proceed to Step 3b
Step #3: Look at the pCO2.
3a: If pCO2 is >40 patient’s alkalosis is metabolic; Primary process is:
If pCO2 is <40 patient’s alkalosis is respiratory respiratory | metabolic
3b: If pCO2 is >40 patient’s acidosis is respiratory;
If pCO2 is <40 patient’s acidosis is metabolic
Step #4: Look for disorders revealed by failure of compensation.
- If 1o process is metabolic alkalosis pCO2 should be >40 but <55* Additional disorder:
* There are several metabolic alkalosis PCO2 prediction formulas, but fraught with clinical inaccuracy/unreliability
resp. resp.
o
- If 1 process is metabolic acidosis calc. predicted pCO2 = (1.5 x HCO3) + 8 +/- 2 acidosis alkalosis
In either case above: -or-
- If actual pCO2 is too high there is additional respiratory acidosis no additional disorder
- If actual pCO2 is too low there is additional respiratory alkalosis
- If 1o process is respiratory skip to steps 5 & 6 (where further metabolic disorders revealed)
Step #5: Check if the patient has a significant anion gap (>12-18). (AG = Na-Cl-HCO3) Patient
If AG is significantly elevated the patient has an anion gap metabolic acidosis has|does not have:
in addition to (or in confirmation of) whatever Steps 2 through 4 yielded AG met. acidosis
Step #6: Calculate the corrected bicarb. (Pt’s gap – 12 + pt’s serum bicarb) Patient has
In addition to whatever disorders Steps 1 through 5 yielded, underlying metabolic:
- If corrected bicarb >30 the patient has an underlying metabolic alkalosis; non-AG alkalosis
- If corrected bicarb <23 the patient has an underlying non-AG metabolic acidosis acidosis
Step #7: Make the diagnosis(es) using the differentials below and knowledge of the patient
Anion Gap Non-Anion Gap Acute Respiratory Metabolic Respiratory
Metabolic Acidosis Metabolic Acidosis Acidosis Alkalosis Alkalosis
"MUDPILERS" "HARDUPS" anything that causes "CLEVER PD" anything that causes
Methanol Hyperalimentation hypoventilation, i.e.: Contraction hyperventilation, i.e.:
Uremia Acetazolamide CNS depression (drugs/CVA) Licorice* CNS disease
DKA/Alcoholic KA Renal tubular acidosis Airway obstruction Endo: Conn's/Cushing's/ Hypoxia
Paradehyde Diarrhea Pneumonia Bartter's)* Anxiety
Isoniazid Uretero-Pelvic shunt Pulmonary edema Vomiting, NG suction Mechanical ventilators
Lactic acidosis Post-hypocapnia Hemo/Pneumothorax Excess alkali* Progesterone
EtOH/Ethylene glycol Spironolactone Myopathy Refeeding alkalosis* Salicylates/Sepsis
Rhabdo/Renal failure Post-hypercapnia
Salicylates ( Chronic respiratory acidosis Diuretics*
is caused by COPD and
restrictive lung disease) *assoc w/high urine Cl levels
Step #8: Fix it!
The benefits of buying summaries with Stuvia:
Guaranteed quality through customer reviews
Stuvia customers have reviewed more than 700,000 summaries. This how you know that you are buying the best documents.
Quick and easy check-out
You can quickly pay through credit card or Stuvia-credit for the summaries. There is no membership needed.
Focus on what matters
Your fellow students write the study notes themselves, which is why the documents are always reliable and up-to-date. This ensures you quickly get to the core!
Frequently asked questions
What do I get when I buy this document?
You get a PDF, available immediately after your purchase. The purchased document is accessible anytime, anywhere and indefinitely through your profile.
Satisfaction guarantee: how does it work?
Our satisfaction guarantee ensures that you always find a study document that suits you well. You fill out a form, and our customer service team takes care of the rest.
Who am I buying these notes from?
Stuvia is a marketplace, so you are not buying this document from us, but from seller anyiamgeorge19. Stuvia facilitates payment to the seller.
Will I be stuck with a subscription?
No, you only buy these notes for $10.99. You're not tied to anything after your purchase.
Can Stuvia be trusted?
4.6 stars on Google & Trustpilot (+1000 reviews)
67096 documents were sold in the last 30 days
Founded in 2010, the go-to place to buy study notes for 14 years now