Lecture 1 Acid-Base Balance

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Lecture 1Ñ Acid-Base Balance Ventilators

Lecture 2Ñ Alcohol Wernicke Overdose and Withdrawal S/Sx Aminoglycosides Peak and Trough

Lecture 3Ñ Drug Toxicities (Lithium, Lanoxin, Dilantin, Bilirubin, Aminophylline) Kernicterus Dumping/HH

Electrolytes: K+, CA, MG,

and NA TX for HyperKalemia

Lecture 4Ñ Crutches Canes Walkers Delusions Hallucinations Psychosis Psychotic and Non-Psychotic Hallucination Illusion Delusion

Lecture 5Ñ Diabetes Mellitus Diabetes Insipidus SIADH Insulin DKA HHNK

Lecture 6Ñ Drug Toxicities (Lithium, Lanoxin, Dilantin, Bilirubin, Aminophylline) Kernicterus Dumping/HH

Electrolytes: K+, CA, MG,

and NA TX for HyperKalemia

Lecture 7Ñ Thyroid (Hyper-, Hypo-) Adrenal Cortex (Addison Disease, Cushing) Toys Laminectomy

Lecture 8Ñ Lab Values Five Deadly Ds Neutropenic Precaution

Lecture 9Ñ Psych Drugs Tri Benzo MAOI Lithium Prozac Haldol Clozaril Zoloft

Lecture 10Ñ Maternity and Neonatology

Lecture 11Ñ Fetal Complications Stages of Labor Assessments Variations for NB Maternity Meds Medication Hints Psych Tips Operational Stages

Lecture 12Ñ Prioritization Delegation Staff Management Guessing Strategies

GUIDE ¥ Mark KlimekÕs Lecture

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Acid/Base Balance (Start times: 30:00)

In order to solve acid-base disorders, it is important to know the normal values for pH, CO2 and HCO3 (bicarbonate), which are shown below ¥ pH 7.35 to 7.45 ¥ CO2 35 to 45 ¥ HCO3 22 to 26

The first value to look at in an acid-base disorder is the pH ¥ If pH is <7.35, the acid-base imbalance is acidotic ¥ If pH is <7.45, the acid-base imbalance is alkalotic

Now, to determine if the imbalance is metabolic or respiratory, determine whether HCO3 goes in the same or opposite direction with pH ¥ Rule of the Bs: If pH and Bicarb move both in the same direction, then the acid-base imbalance is metabolic É Otherwise, it is respiratory

Example #1 ¥ pH 7.3 Acidotic ¥ HCO3 20 Metabolic ¥ This is an example of metabolic acidosis

Example #2 ¥ pH 7.58 Alkalotic ¥ HCO3 32 Metabolic ¥ This is an example of metabolic alkalosis

Example #3 ¥ pH 7.22 Acidosis ¥ HCO3 35 Respiratory ¥ This is an example of respiratory acidosis

As the pH goes, so goes my patient, except for Potassium É That means ¥ If pH is low, everything is low, except potassium ¥ If pH is high, everything is high, except potassium

Lecture 1 ¥ Mark Klimek ¥ 92:21

Page 4 of 92 If pH goes over 7.45, this is alkalosis ¥ Therefore everything is up: tachycardia, tachypnea, HTN, seizures, irritability, spastic, diarrhea, borborygmi (increase bowel sounds), hyperreflexia (3+, 4+) ¥ However, potassium is opposite. Therefore, hypokalemia ¥ What is the nursing intervention?

• Pt need suctioning because of seizures

If pH goes below 7.35, this is acidosis ¥ Therefore, everything is down: bradycardia, constipation, absent bowel sounds, flaccid, obtunded, lethargy, coma hyporeflexia (0, 1+), bradypnea, low BP ¥ However, potassium is high (hyperkalemia) ¥ What is the nursing intervention?

• Pt needs to be ventilated with an Ambu bagÑrespiratory arrest

So, remember that ÒMAC KussmaulÓ is the only acid-base imbalance to cause Metabolic ACidosis with Kussmaul respirations

Causes of Acid/Base imbalance

First ask yourself, ÒIs it LUNG? É If yes, then it is respiratory ¥ Then ask yourself, ÒAre they overventilating or underventilating?

• If UNDERventilating, then pick acidosisÑpH is under 7.35
• If OVERventilating, then it is alkalosis, pH is over 7.45

What type of acid-base derangement is present in the following condition?¥ In labor?

• Respiratory alkalosis É OverventilatingÑpH increases É Alkalosis)

¥ Drowning?

• Respiratory acidosis É UnderventilatingÑpH decreases É Acidosis

¥ Pt is on PCA (patient-controlled anesthesia) pump?

• Ventilation is down É Respiratory acidosis

If it is not LUNG, then it is metabolic. If the patient has prolonged gastric vomiting or suction (sucking out acid), pick alkalosis ¥ For everything else that isnÕt lung, pick metabolic acidosis ¥ So, when you donÕt know what to pick, pick metabolic acidosis

Tip ¥ Set your default setting to Metabolic Acidosis ¥ Always pay attention to modifying phrase rather than original noun

Figure 1. Patient- controlled anesthesia (PCA) pump.