Mark Klimek Lecture Notes
LECTURE 1: Acid Base Balance & Ventilator
Interpreting blood gases
(remember the rules of the B’s)
• If the pH and the
... [Show More] bicarb are both in the same direction then it’s metaBolic
(Bicarb Both Bolic), if they are in different directions then it is respiratory
• If bicarb is normal and the pH is low or high then its respiratory
• You will be given 8 values for arterial blood gas, always first look at the pH
and the bicarb first
• You get acidosis and alkalosis from the pH
LABS: ABG’s
The normal pH is 7.35-7.45
The normal bicarb is 22-26 (the bicarb years where you make all the decisions
[22-26 years old], or 2+2+2=6)
The normal CO2 is 35-45 (same as pH)
Signs and Symptoms with ABG’s
• As the pH goes up so does my patient
o If the pH goes up, every system in your body gets more
irritable/hyperexcitable
• As the pH goes down so does my patient
o If the pH goes down, systems in your body shut down
• Except for potassium- When pH goes down, potassium goes up
• If the pH goes up (alkalosis): you will find irritability, hyperreflexia (3&4),
tachypnea, tachycardia, borborygmi (increased bowel sounds), seizure (need
suctioning at the bed side because they can seize and aspirate)
• If pH goes down (acidosis): hyporeflexia, bradycardia, lethargy, obtunded,
paralytic ileus, coma, respiratory arrest (need bag-mask ventilation bag at
bedside for respiratory arrest), +1 reflexes
• MACkussmal- compensatory and respiratory pattern for only acid base
disorder: MAC- Metabolic ACidosis
Respiratory Acidosis multiple choice example: What would you see with a
patient who is in respiratory acidosis?
a. +1 reflex,
b. diarrhea,
c. adynamic ileus (no movement),
d. spasm,
e. urinary retention,
f. paraxysmol atrial tachycardia,
g. second degree lovitz, type 2 heart block (impulse is being slowed),
h. hypokalemia
LAB: REFLEXES
0&1-hyporeflexia
2-normal
3&4- hyperreflexia
EXAMPLE: (In general what do pain meds do?
ANSWER: They sedate you, they are CNS depressants: lethargy, lucidity, reflexes at
+1, hyporeflexia, obtundent
Causes of Acid Base Imbalance
• Don’t get signs and symptoms mixed up with causation!!!
• What causes something is the opposite of what the signs and symptoms are
o EXAMPLE: diarrhea will cause a metabolic acidosis but once you get
acidotic, it will shut your bowels down and you will get a paralytic ileus.
• The first question you should ask yourself if the scenario involves a lung
problem.
o Is it a respiratory problem? BUT remember it can still be respiratory
acidosis/alkalosis…
• Next question you ask yourself…
o is the client overventilating or underventilating?
o If the patient is overventilating pick alkalosis
o If they are underventilating pick acidosis
• If the client is overventilating.. it has an attachment to the word- alkalosis
(because they are both OVER)… ventilating OVER becomes respiratory
ALKALOSIS
• If the client is undeventilating.. it has an attachment to the word- acidosis
(because they are both UNDER)- ventilating UNDER becomes respiratory
ACIDOSIS
Examples:
1) A woman is overzealously using her breathing techniques during labor, what
acid base disorder will she exhibit? Overventilation
o Respiratory Alkalosis
2) A child is near drowning, what acid base disorder would it be?
Underventilating
o Respiratory Acidosis
3) Your patient has emphysema, what acid base disorder would it be?
Underventilating [Show Less]