Patho 3

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Author:
cgordon05
ID:
17729
Filename:
Patho 3
Updated:
2010-05-04 10:51:23
Tags:
respiratory metabolic alkalosis
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Description:
respiratory metabolic alkalosis
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  1. What common conditions decrease pCO2 and cause respiratory alkalosis?
    (p.7)
    Some causes --> hyperventilation --> alkalosis
  2. What is the mechanism of respiratory alkalosis?
    CO2 deficit --> decreased pCO2 --> increased ratio of base/acid --> increased pH
  3. Causes of hyperventilation:
    • hypoxic conditions
    • psychological disturbances
    • pulmonary embolus
    • CNS disorders/lesions - meningitis, CVA
    • epinephrine --> stimulates chemoreceptors --> hyperventilation
    • salicylate intoxication
    • = initially respiratory alkalosis from chemoreceptor stimulation
    • = then metabolic acidosis from salicylate accumulation
  4. Causes of metabolic acidosis due to increased H+ ion.
    • lactic acidosis (increased plasma volume, increased O2)
    • DKA
    • ingestion (ASA, methanol, ethylene glycol)
  5. Causes of metabolic acidosis due to HCO3- loss
    • diarrhea (pooping base) - pancreatic, biliary, intestinal fistulas
    • renal tubular acidosis (does not generate bicarb)
    • = type I - distal, decreased ability to secrete H+ and decreased NH4 excretion
    • = type II - proximal, decreased ability to reabsorb HCO3-
  6. Mechanism of metabolic acidosis
    HCO3- deficit --> decreased ratio of base/acid --> decreased pH
  7. Mechanism of metabolic alkalosis.
    HCO3- excess --> increased ratio of base/acid --> increased pH and usually compensatory hypoventilation --> increased pCO2
  8. Compensation for metabolic acidosis.
    increased metabolic acidosis --> increased respirations --> decreased pCO2

    Kidneys directed to reclaim all filtered HCO3- plus generate new HCO3- by forming titratable acid and ammonium (NH4)
  9. Compensation for metabolic alkalosis.
    • increased pH --> stimulates chemoreceptors --> decreased ventilation --> increased pCO2
    • Respiratory compensation:
    • - not as effective in metabolic alkalosis as in metabolic acidosis
    • - with decreased ventilation, may also decrease pO2
    • Renal response:
    • - decreased HCO3- reabsorption and H+ ion retention by decreasing Na+/H+ exchange
    • - decreases ammonium formation and new HCO3-
  10. Clinical effects of metabolic acidosis.
    dilation of arterioles (contribute to increased respiration for pulmonary response of hyperventilation) --> vascular collapse, systemic venous constriction, decreased cardiac output --> pulmonary congestion and edema
  11. Clinical effects of metabolic alkalosis
    • if pH = 7.5 or greater may have:
    • - tetany with cramping
    • - convulsions
    • - neuromuscular irritability
    • - confusion
    • - stupor
    • - coma

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