Download Respiratory or Metabolic Objectives Respiratory acidosis.

Respiratory or Metabolic
Acidosis or Alkalosis
Objectives
• Discuss causes of respiratory and metabolic
acid base disturbances.
y ppH values, CO2 values and HCO3
• Identify
values in acid base imbalances.
• Identify the acid base imbalance based on
clinical conditions.
• Define supportive treatment of acid base
disturbance.
Respiratory acidosis.
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Causes Respiratory Acidosis
• Any condition that impairs pulmonary ventilation
and the removal of CO2. Leads to an increase in
CO2 circulating in the blood..
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respiratory depression
respiratory arrest
Medications (narcotics)
cardiac arrest
neuromuscular impairment
chest wall injury - flail chest, pneumothorax
pulmonary - obstruction, COPD, asthma, pulmonary
edema
S/S Respiratory Acidosis
• SOB, chronic cough, or wheezing
• Confusion, irritability, or lethargy
Respiratory Acidosis
• Treatment
– Improve ventilation
• assist ventilation
d
se
• administer
oxygen(hypoxemia
leads to acidosis)
– Consider causes and
initiate treatment
• Bronchodilators
• narcan
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Respiratory acidosis.
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Metabolic acidosis.
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Metabolic Acidosis
• Four common forms of metabolic acidosis
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Lactic acidosis
Diabetic ketoacidosis
Renal failure
Diarrhea
Ingestion of toxins
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S/S Metabolic Acidosis
• Confusion, lethargy, stupor or coma
• Kussmaul’s respiration, deep, rapid
respiration
• Dysrhythmia’s
Lactic Acidosis
• Lactic acid is produced when a large number of
cells are inadequately perfused with oxygen,
anaerobic metabolism.
– The end product of anaerobic metabolism is lactic acid.
• Causes of Lactic Acidosis
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Seizure
ischemia to large muscles or organs
circulatory failure
shock
S/S Lactic acidosis
• Cardiovascular compromise:
– Cyanosis, cold extremities, tachycardia,
hypotension
• Dehydration
– Thirsty, dry oral mucosa, warm, dry skin
• Hyperventilation
• Lethargy, stupor or coma
• Abdominal pain, vomiting
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Lactic Acidosis
• Treatment
– reestablish tissue
perfusion and cardiac
output
p
– ventilation
– rehydration to support
circulation
– sodium bicarbonate
administration if the
patient is in cardiac
arrest
Diabetic Ketoacidosis (DKA)
• Usually a complication of diabetes.
• Insulin is needed for cells to metabolize
glucose for immediate use, or store it in the
liver for future use.
don t have glucose available
• When the cells don’t
the cells use fatty acids for energy.
• When the fatty acids breakdown they
produce ketones, a strong acid.
• The acidosis results when a patient fails to
take adequate insulin or when the need for
insulin increases(infection, trauma).
Diabetic Ketoacidosis
• The respiratory system will respond by
increasing rate and depth of ventilation.
(Kussmaul) Increasing the amount of CO2
being blown off in an attempt to bring the pH
within normal range.
• Treatment
– Administration of normal saline for volume
replacement
– Administration of insulin
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Renal Failure
• The kidneys help maintain acid base balance by
reabsorbing bicarbonate or excreting hydrogen
ions. Renal failure affects the kidneys ability to
function.
function
– Acidosis can result because the kidneys are unable to
excrete the excess H+ ions that are produced by normal
metabolism and ammonia is not being excreted.
– The bicarb buffer system is disrupted because the
kidneys are not dumping HCO3 back into the blood
stream.
Ingestion of Toxins
• Causes of metabolic acidosis
– Ingestion of: Ethylene glycol(antifreeze),
methanol(windshield washer fluid), salicylate(aspirin)
• Treatment
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GI evacuation
Hemodialysis
Diuresis
Hydration to promote excretion
Antidote therapy
Metabolic acidosis.
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Respiratory alkalosis.
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S/S Respiratory Alkalosis
• Muscle twitching, tingling and numbness of
the fingers
• Nervousness,
Nervousness irritability,
irritability agitation
• Convulsions, coma
Respiratory Alkalosis
• Treatment
– place patient on low concentration oxygen
– provide calming measures
– treat underlying problem
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Metabolic alkalosis.
Metabolic Alkalosis (rare)
• Causes
– Ingestion of large amounts of absorbable base
sodium bicarbonate or calcium
carbonate(antacids)
b t ( t id )
– Excessive IV administration of alkali(NaHCO3)
– Diuretic use(excrete too much Hydrogen ion)
– Vomiting(gastric acid lost) – only initially as
vomiting becomes severe dehydration develops
and you see acidosis.
Metabolic Alkalosis
• Treatment
– aimed at correcting the underlying condition
– if volume depleted rehydrate
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Arterial Blood Gas (ABG’s)
• Blood gases measure the pH, O2, CO2 (acid)
and HCO3 (base) content of the blood.
• The test is used to evaluate respiratory
diseases and conditions that affect the lungs.
• The test also gives information on how well
the kidneys are functioning.
ABG’s
• Normal Values at sea level:
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PaO2 – 75-100mmhg
PaCO2 – 35
35-45mmhg
45mmhg
pH – 7.35-7.45
HCO3 – 22-26meq/L
Acid - Base
If you have a CO2 of 55
What do you expect your pH to be?
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Correct answer
pH<7.35
What is the state of acid base balance?
Correct answer
Acidosis
Is your patient in respiratory arrest or
hyperventilating?
Correct answer: Arrest
Is this metabolic or respiratory acidosis?
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Correct answer: Respiratory acidosis
Acid - Base
If you have a pH <7.35, what do you
expect your CO2 to be?
Correct answer: CO2 >45mmhg
What is the state of acid base balance?
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Correct answer: Acidosis
Your patient is a diabetic, is this
metabolic or respiratory acidosis?
Correct answer: Metabolic acidosis
Acid - Base
You arrive to find your patient
leaning forward breathing rapid c/o
cramping and pain in fingers, and
hands. What do you expect her pH to
be?
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Correct answer: pH >7.45
Is your patient in respiratory or metabolic
alkalosis?
Correct answer: Respiratory
Why is she in respiratory alkalosis?
Correct answer: Blowing off too much CO2
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Acid - Base
Your patient is in cardiac arrest.
What do you expect the pH to be?
Correct answer:
pH <7.35
What is the acid base state of this patient?
Correct answer:
Acidosis
Why is this patient acidotic?
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Correct answer: Anaerobic metabolism
with increased production of acids and no
circulation for buffer systems to do their
work, maintaining homeostasis.
Is this patient in metabolic or respiratory
acidosis?
Correct answer: Metabolic and
respiratory acidosis, because there is no
circulation and no ventilation
H2O
HCO3
H2CO3
CO2
H+
O2
Cl
H+
Cl
CO2+H20
H2CO3
H+HCO3
CO2
H2CO3
O2
H2CO3
H2O
HCO3
H2O
O2
H2CO3
HCO3
H+
Cl
CO2
Angie Brindowski, RN, EMT P, MCEMS
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