|
Acid
|
CO2; proton donor
|
|
Base
|
HCO3-; proton acceptor
|
|
Acidemia
|
pH < 7.35
|
|
Alkalemia
|
pH > 7.45
|
|
Acidosis
|
Process that results in decreased blood pH
|
|
Alkalosis
|
Process that results in increased blood pH
|
|
Respiratory regulation
|
Regulates CO2; compensation occurs in min to hrs
|
|
Renal regulation
|
Regulates HCO3-; compensation takes up to 1wk
|
|
Hypokalemia
|
Arteriolar constriction
|
|
Reduced coronary blood flow
|
Decreased plasma ionized [Ca]
|
|
Decreased Mg and PO4
|
Reduced cerebral blood flow
|
|
Tetany, seizures
|
|
|
Hyperkalemia
|
Impaired cardiac contractility
|
|
Reduced ATP synthesis
|
Impaired response to catecholamines
|
|
Reduced cardiac output
|
Insulin resistance
|
|
Coma
|
|
|
pH
|
PaCO2
|
HCO3-
|
|
|
Respiratory Acidosis
|
decreased
|
increased
|
normal
|
|
Respiratory Alkalosis
|
increased
|
decreased
|
normal
|
|
Metabolic Acidosis
|
decreased
|
normal
|
decreased
|
|
Metabolic Alkalosis
|
increased
|
normal
|
increased
|
|
pH
|
PaCO2
|
HCO3-
|
|
|
Respiratory Acidosis
|
decreased
|
increased
|
increased
|
|
Respiratory Alkalosis
|
increased
|
decreased
|
decreased
|
|
Metabolic Acidosis
|
decreased
|
decreased
|
decreased
|
|
Metabolic Alkalosis
|
increased
|
increased
|
increased
|
|
pH
|
PaCO2
|
HCO3-
|
|
|
Respiratory Acidosis
|
Normal, but < 7.40
|
increased
|
increased
|
|
Respiratory Alkalosis
|
Normal, but > 7.40
|
decreased
|
decreased
|
|
Metabolic Acidosis
|
Normal, but < 7.40
|
decreased
|
decreased
|
|
Metabolic Alkalosis
|
Normal, but > 7.40
|
increased
|
increased
|
|
pH
|
7.35-7.45
|
|
PaCO2
|
35-45mmHg
|
|
PaO2
|
80-100mmHg
|
|
HCO3-
|
22-26 mEq/L
|
|
SaO2
|
>95%
|
|
Definition
|
Concentration of unmeasured anions in plasma
|
|
Unmeasured anions
|
Sulfates, phosphates, blood proteins such as albumin
|
|
Use
|
Determines type of metabolic acidosis
|
|
Equation
|
[Na+] - ([Cl-] + [HCO3-])
|
|
Normal AG
|
12 mEq/L; range of 8–16 acceptable
|
|
Elevated AG
|
>20 mEq/L
|
|
Metabolic alkalosis
|
Excess AG+HCO3 > normal HCO3-
|
|
Metabolic acidosis
|
Excess AG+HCO3 < normal HCO3-
|
|
Methanol
|
Uremia
|
Diabetic ketoacidosis
|
Propylene glycol
|
|
Isoniazid
|
Lactic acidosis
|
Ethylene glycol
|
Renal Failure
|
|
1. Determine if patient is acidic or basic
|
|
2. Determine if it is an anion gap acidosis (normally due to MUDPILER)
|
|
3. Determine if metabolic alkalosis or non-anion gap acidosis
|
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