08 Acid Base Principles

  • Equilibrium constantly in plasma
  • pH at set point

  • low bicarb, drive equation right, make more H, acidic

  • don't memorize
  • bicarb up, pCO2 down, increase pH
  • bicarb down, pCO2 up, lower pH

  • sample taken in arterial sys, radial a, for accurate pCO2

Acidosis

  • blow CO2 off
  • drop CO

  • high CO2 = narcotic (people with pneumonia die painless death from high CO2 in older times)

Bohr effect:

  • less saturation at any level
  • H push O2 off hemoglobin
  • O2 more easily leave

Alkalosis

  • shift curve to left

Acid Base Problems

Examples

Compensation

  • buffers prevent low pH from killing kidney

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  • vomiting: alkalotic. Diarrhea: acidotic

Mixed Disorders

Metabolic Acidosis

  • any kind of meta acidosis, compensation is respiratory alka

  • simple metabolic acidosis with no secondary disorder

Metabolic Alkalosis

Respiratory acidosis

  • acute: within minutes, intracellular buffer soaks up acid via hemoglobin, more HCO3

  • low yield. Don't memorize

Respiratory alkalosis

  • high altitude, respiratory alkalosis

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  • special: respiratory acidosis and metabolic alkalosis or metabolic acidosis and alkalosis