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Metabolic Acidosis

Part 2:

12/19/2013 1:26:00 PM

Definition: Any change that causes a decrease in bicarbonate in blood, decreasing pH. (<7.35) Pathophysiology Ischemia (d/t decreased perfusion, etc)>Decreased O2>Forces body to use glucose>pyruvate via glycolysis>Lactate (H+) d/t no O2 (Anaerobic metabolism) o Lactate Acid is buffered by bicarbonate in blood>Hydrogen Bicarbonate>dissociates in H2O & CO2 Causes of Metabolic Acidosis 1) Increased Anion Gap (AG) o Anion Gap (Amount of ions in blood that we cannot meausure) o Na+ - (Cl- + HCO3-) Normal: 8-12 pH= HCO3-/PaCO2 o MUDPILES Methanol Uremia DKA Iron ingestion/INH Lactic Acidosis (Sepsis, shock, hypoxic) Ethanol (aceeldhyde>acetic acis) Salicylates (Aspirin) 2) Normal Anion Gap (Low Bicarb & normal Metabolic Acidosis o Hyperchloremic Metabolic Acidosis o HARDUP Hyperalimentation/hyperventilation Acetylozolamide Renal Tubular Acidosis


Diarrhea Ureter Sigmoidostomy (Bicarb from colon moves into ureter and gets pissed out) Pancreatic Fistula (Pancreas holds bicarb rich fluid)

Manifestations Deep Rapid Breath Kussmauls Respirations Hyperventilation

Treatment NaHCO3 (Sodium Bicarbonate) o Respiratory Compensation Winters Formula Expected PaCO2= 1.5 (HCO3) + 8 (+/-) 2 36-40 Higher=combined problem (Metablic and respiratory) Lower= Respiratory Alkalosis (aspirin)

12/19/2013 1:26:00 PM Ask for Core Measures/Standards of practice (Recipe book) For pts with DVT, Heart attack, etc DAR Data Action Response Pt has pain D: OPQRST Onset, provokes, quality, radiate, severity, time A: Interventions, medications, EKG, reporting to doctor, advocate R: or , then return to action T, HR, BP, RR, SPO2 Temp: 98.7 (97.5-99.1) Infection Sepsis (blood borne pathogen) Hypothalamus shuts down thermoregulation when body reaches max temp>huge decline in temperature No rectal on chemo pts (rectal lining very thin, especially after chemo) BP: 120/90 () Systolic of vessel (squeeze>afterload of heart) pressure Diastolic of vessel (Decompress>preload of heart) relaxation Lane Closers Increased platelet congregation Increased Stress (Increase SNS>vasoconstriction) Increased Injury (smoking, diabetes increases insulin, which is corrosive to the lining of vessels) Fatty Deposits>Plaque Volume (# of Cars) WBC RBC Platelet NA

Cholesterol: Tc: >200 Triglycerides: >150 LDL: >100 HDL: <40 Metabolic Acidosis: Decrease in HCO3

12/19/2013 1:26:00 PM pH: 7.35-7.45 RO/ME (Respiratory: opposite) (Metabolic: Equal) CO2 and HCO3 Na: 135-145 K: 3.5-5.5 CO2: 35-45 HC03: 24-26 02: >95 Chlorine: 95-105 Crt: 0.6-1.2 Calcium: 8-12 Protein: 6-8 BUN: 7-22 Albumin: 3.5-5.5 Dig: 1-2 Lithium: 1-2 Dilantin: 10-20 Theop: 10-20 BP: 120/80 RR: 12-20 HR: 80-100 Glucose: 70-110 Hemoglobin: Women:12-16/Men 14-18 WBC: 5,000-10,000 RBC: 200,000-400,000 Plt: 4-5 million Coumadin/Warfarin: Pt, 10-15, Antidote: Vitamin k Heparin: Ptt, 30-45, Antidote: Protamine sulfate ABC Specific Gravity: 1.01-1.03


12/19/2013 1:26:00 PM Time Management

People give up on the slightest sense of failure Failures are practice shots Scratch the surface of an expert, and under you will find thousands and thousands of hours of dedication, passion, and willingness and perseverance to succeed The world ONLY recognizes when you have become successful o Self Discipline o Time is the most expensive currency in the world 168 Hours in a week

Repetition is the mother of all accomplishment; which makes it the father of all accomplishment Dont confuse activity done over and over as accomplishment o So Try something new Think outside the box 1) Thought 2) Goal 3) Passion