08 Acid Base Principles

Overview

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• 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

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

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Acidosis

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• 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

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• shift curve to left

Acid Base Problems

Examples

[](. <img src='images/EaOaAtZ.jpg' alt='' /> .)..

[](. <img src='images/5hb7jar.jpg' alt='' /> .)..

Compensation

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• buffers prevent low pH from killing kidney

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• vomiting: alkalotic. Diarrhea: acidotic

Mixed Disorders

Metabolic Acidosis

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• any kind of meta acidosis, compensation is respiratory alka

[](. <img src='images/JqAnE9t.jpg' alt='' /> .)..

• simple metabolic acidosis with no secondary disorder

[](. <img src='images/QelIbe3.jpg' alt='' /> .)..

Metabolic Alkalosis

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[](. <img src='images/KEMbbst.jpg' alt='' /> .)..

Respiratory acidosis

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

[](. <img src='images/Ocz38yW.jpg' alt='' /> .)..

• low yield. Don't memorize

Respiratory alkalosis

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• high altitude, respiratory alkalosis

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