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Acid-Base Disorders and Physiology (*Practical Acid-base determination…

- - - - *respiratory Alkalemia
        
        due to HYPERVENTILATION and V/Q mismatch
        
        most common and MUST NOT MISS = PE
        
        can have V/Q mismatch from
        --> PE
        --> ARDS secondary from pneumonias and pulmonary edema and infiltrates
        
        *V/Q mismatch - respiratory Alkalemia
        
        can have V/Q mismatch from
        --> PE
        --> ARDS secondary from pneumonias and pulmonary edema and infiltrates
        
        *ARDS - V/Q mismatch - respiratory Alkalemia
        
        can have V/Q mismatch from
        --> PE
        --> ARDS secondary from pneumonias and pulmonary edema and infiltrates
        
        *HYPERVENTILATION - respiratory Alkalemia
        
        can be due to high altitude
        
        *HAS = high altitude sickness
        
        3 natural body responses to HAS
        
        1 = hyperventilation = tries to increase the O2
        
        2 = increased 2,3- BPG in RBCs
        --> fromt he glycolysis pathway
        
        3 = the hyperventilation gives a low CO2 and hence hypokalemia
        --> thus the kidney will excrete excess bicarbonate to lower the pH
        
        recover to normal usually in 2 days on your own
      - *metabolic Alkalemia
        
        metabolic Alkalemia from 2 casues:
        --> LOSS of HCl from UPPER GI = stomach (emesis or PPIs)
        --> GAIN of BICARB from LOWER GI = (hypovolemia /diuretics or hyperaldosterone)
        
        RELATIVE gain of bicarb = HYPOVOLEMIA
        --> from diuretics
        --> from
        
        INDIRECT gain of bicarb = PRIMARY ALDOSTERONISM
        --> icnreases the BP and increases BICARB in blood how?
        
        Check Chloride levels
        
        LOW Cl- = LOSS of HCl from UPPER GI = stomach
        --> emesis or PPIs
        
        HIGH Cl- = GAIN of BICARB from LOWER GI =
        --> (hypovolemia /diuretics or hyperaldosterone)
    - - *respiratory Acidosis
        
        due to HYPOVENTILATION
      - *metabolic Acidosis
        
        either Normal or raised Ion gap
        
        Check Ion Gap
        
        normal AG = 12 +/- 2
        
        Raised Anion Gap
        
        MUDPILES
        
        *MUDPILES
        -
        
        2 more items...
        
        Normal Anion Gap
        
        HARDASS
        
        *HARDASS Harley Davidson
        -
      - *Compensation to Acidosis
        
        this would be if you had a DKA
        --> in DKA you can get pulmary edema due to the acute CO failure
        --> thus you get hypoventilation and lose the ability to compensate with breathing off CO2 to try and raise the pH back up
        
        look at the general equation and see if compensation
        
        Compensation?
        
        pH = HCO3- / CO2
        
        NO compensation = MIXED
        
        *Mixed Resp and Metabolic Acidosis
        
        this would be if you had a DKA
        --> in DKA you can get pulmary edema due to the acute CO failure
        --> thus you get hypoventilation and lose the ability to compensate with breathing off CO2 to try and raise the pH back up
        
        look at the general equation and see if compensation
        
        YES compensation
        
        7/8 rules for CO2 compensation
        DKA = CO2 compensation
        
        CELCIUS RULE = x1.5 + 8
        
        Alkylosis = H+ loss vomitting - CO2 compensation
        
        +0.7 for every +1 bicarb gain
        
        BICARB repsonse
        --> note it is easier to excrete bicarb than it is to make it!!
        --> +1 vs -2 for every 10 increase/decrease in CO2
        ACUTE little bicarb production response
        
        +1 for every +10 CO2 gain
        
        ACUTE little bicarb production response
        
        -2 for every -10 CO2 loss