diabetestalk.net

Partially Compensated Respiratory Acidosis Example

Share on facebook

Changes In Arterial Blood Gas Values

CONDITION: Acute Alveolar Hyperventilation Acute Alveolar Hyperventilation is ventilation in excess of needs and the blood gas values would show the following: We can use the formulas given on the previous page to determine if the following blood gas changes are appropriate for acute alveolar hyperventilation / respiratory alkalosis RULE: Each 1 mm Hg in PaCO2 should give 0.01 in pH When the PaCO2 < 40 mmHg the expected pH = 7.40 + (40 mm Hg measured PaCO2)0.01 Expected change matches actual. This indicates that the changes in the blood gas would be primarily due to PaCO2 and therefore would be an acute respiratory or ventilatory disturbance. RULE: Each 5 mm Hg in PaCO2 should HCO3 by 1 mEq Verifying that the changes in bicarb are tied to the changes in PaCO2 and not due to renal compensation by elimination of bicarb. pH IN NORMAL RANGE BUT ON ACID SIDE OF 7.40 (7.35 - 7.39) Would be identified as a fully compensated respiratory acidosis We can evaluate the following for compensation by looking at the expected pH in relation to the measured PaCO2 RULE: Each 1 mm Hg in PaCO2 should give 0.006 in pH When the PaCO2 is > 40, the expected pH = 7.40 - (measured PaCO2 40 mm Hg)0.006 This Continue reading >>

Share on facebook

Popular Questions

  1. Carolyn B

    High fasting blood sugar on keto

    Hi. I was diagnosed with pre-diabetes in November 2016. My brother has Type 2 so I knew I had to do something to stop my pre-diabetes from progressing I started to eat low carb and saw a slow reduction in my BS numbers. Then a month or so ago I started adding fat to my diet and am now eating keto. I am in low ketosis (urine test). My daily carb intake is approximately 40-60 grams.
    The results have been nothing short of miraculous! I've lost 17 pounds, my triglycerides have plummeted from 240 to 60, BP is way down, cholesterol dropped. All of my numbers look better than they have my entire adult life. My body seems to love this way of eating. It's been amazing and not difficult at all!
    My A1C went from 5.9 to 5.4. I am guessing it's around 5.2 now but I haven't tested since I went full keto. My only problem is that my morning fasting number has inched up. It was 95-99 when I was diagnosed. Then when I started to change my diet it dropped to the 88-95 range. After I started keto it's moved up to the 100-105 range. I'd like to work on getting this number down. My one and two hour post meal numbers are good, usually in the 100-120 range. Any suggestions on how I can lower the fasting number?
    Thanks so much.

  2. jdm1217

    Originally Posted by Carolyn B
    Hi. I was diagnosed with pre-diabetes in November 2016. My brother has Type 2 so I knew I had to do something to stop my pre-diabetes from progressing I started to eat low carb and saw a slow reduction in my BS numbers. Then a month or so ago I started adding fat to my diet and am now eating keto. I am in low ketosis (urine test). My daily carb intake is approximately 40-60 grams.
    The results have been nothing short of miraculous! I've lost 17 pounds, my triglycerides have plummeted from 240 to 60, BP is way down, cholesterol dropped. All of my numbers look better than they have my entire adult life. My body seems to love this way of eating. It's been amazing and not difficult at all!
    My A1C went from 5.9 to 5.4. I am guessing it's around 5.2 now but I haven't tested since I went full keto. My only problem is that my morning fasting number has inched up. It was 95-99 when I was diagnosed. Then when I started to change my diet it dropped to the 88-95 range. After I started keto it's moved up to the 100-105 range. I'd like to work on getting this number down. My one and two hour post meal numbers are good, usually in the 100-120 range. Any suggestions on how I can lower the fasting number?
    Thanks so much. I've been there at times and I don't even worry about it, especially if your A1C is still good.

  3. Nicoletti

    Originally Posted by Carolyn B
    My one and two hour post meal numbers are good, usually in the 100-120 range. Any suggestions on how I can lower the fasting number? Give it more time. Fasting numbers are usually the last to come down. It took me about a year of low-carb eating to get fastings in the 80s, and that's common for others here, too; it takes time.

  4. -> Continue reading
read more
Share on facebook

Using Abgs To Optimize Mechanical Ventilation

Using ABGs to optimize mechanical ventilation June 2013, Volume 43 Number 6 , p 46 - 52 This article has an associated Continuing Education component. AN ARTERIAL BLOOD GAS (ABG) analysis can tell you about the patient's oxygenation (via PaO2 and SaO2), acid-base balance, pulmonary function (through the PaCO2), and metabolic status. This article focuses on translating ABG information into clinical benefits, with three case studies that focus on using ABGs to manage mechanical ventilation. Endotracheal (ET) intubation and mechanical ventilation may be prescribed for patients who can't maintain adequate oxygenation or ventilation or who need airway protection. The goal of mechanical ventilation is to improve oxygenation and ventilation and to rest fatigued respiratory muscles. Mechanical ventilation is supportive therapy because it doesn't treat the causes of the illness and associated complications. However, ventilator support buys time for other therapeutic interventions to work and lets the body reestablish homeostasis. When using this lifesaving intervention, clinicians should take steps to avoid or minimize ventilator-induced lung injury (VILI), which will be discussed in detai Continue reading >>

Share on facebook

Popular Questions

  1. unrnick

    The pKa of water is 16, while the pKa of a ketone, HC3(CO)CH3, is closer to 20. The lower the pKa the stronger the acid. When a ketone loses a hydrogen, the NBE are resonance stabilized into the carbonyl group, lowering their energy, increasing the acidity. When a proton is removed from water, the NBE have no resonance structures. Yet it has a lower pKa, so it is a stronger acid.
    Why is this?

  2. electronpusher

    As I'm sure you know, (p)Ka is a measure of the equilibrium between an acid and its conjugate base (what you're calling NBE?). Both the conjugate bases of water (hydroxide) and a ketone (enolate) have a negative charge on the oxygen. I'm summarizing your question as: If both conjugate bases have a negative charge on the same atom type, but one base (the enolate) is stabilized by resonance, shouldn't that corresponding acid (ketone) be more acidic? (Correct me if I'm misreading you.)
    I think the key here is what (p)Ka really represents. Fot water, with room temp pKa 15.7, the equilibrium favors water but some dissociation is present. For acetone, pKa 19.2, the equilibrium lies further on the non-dissociated side than for water. We take this to mean that acetone is a weaker acid that water. If we only looked at the stability of the conjugate bases, we might conclude the opposite (previous paragraph). But as pKa measures a balance between a conjugate pair, we must consider the acid forms as well.
    The ketone contains the very "stable" (energetically favorable) C=O carbonyl bond. When a ketone donates an alpha proton to become the enolate conjugate base, the carbonyl bond is disrupted. This is an extra energetic cost that is not present in the water equilibrium, and I propose it is the reason why the ketones tend to dissociate less than water.
    By this logic, water is a better acid than a ketone because acting as an acid requires a ketone to disrupt an energetically preferable C=O bond. Thus the balance lies closer to the undissociated side for a ketone (lower Ka, higher pKa) than for water (lower pKa), so we say that water is a stronger acid and a ketone is weaker.
    (One might argue that the carbonyl need not be disrupted, the lone pair could localize on the alpha carbon, but I hope we can agree such a carbanion is quite unstable, and a carbanion not preferable to breaking the carbonyl and localizing on the more electronegative oxygen.)

  3. -> Continue reading
read more
Share on facebook

Respiratory Acidosis

Respiratory acidosis is an abnormal clinical process that causes the arterial Pco2 to increase to greater than 40 mm Hg. Increased CO2 concentration in the blood may be secondary to increased CO2 production or decreased ventilation. Larry R. Engelking, in Textbook of Veterinary Physiological Chemistry (Third Edition) , 2015 Respiratory acidosis can arise from a break in any one of these links. For example, it can be caused from depression of the respiratory center through drugs or metabolic disease, or from limitations in chest wall expansion due to neuromuscular disorders or trauma (Table 90-1). It can also arise from pulmonary disease, card iog en ic pu lmon a ryedema, a spira tion of a foreign body or vomitus, pneumothorax and pleural space disease, or through mechanical hypoventilation. Unless there is a superimposed or secondary metabolic acidosis, the plasma anion gap will usually be normal in respiratory acidosis. Kamel S. Kamel MD, FRCPC, Mitchell L. Halperin MD, FRCPC, in Fluid, Electrolyte and Acid-Base Physiology (Fifth Edition) , 2017 Respiratory acidosis is characterized by an increased arterial blood PCO2 and H+ ion concentration. The major cause of respiratory acido Continue reading >>

Share on facebook

Popular Questions

  1. One of our CDI noted an elevated lactic acid and queried the physician for a diagnosis. The patient did not have Sepsis. Our physician advisor said not to do that because the next lactic acid was normal. She said we should also be looking for the underlying cause of the lactic acidosis and not querying for the diagnosis. A diagnosis of lactic acidosis will give us a CC. Other CDI's have said that if the elevated lactic acid was treated, monitored or evaluated we should be querying for the diagnosis. Does anyone have any direction on how this should be handled?
    Is lactic acidosis always inherent in other conditions and that's what we should focus on?
    What can we pick up the diagnosis by itself as a CC / when should we query to get to documented in the chart?
    Are there any other clinical parameters we should be looking at when evaluating whether we should query such as the anion gap?
    Is there a specific treatment for metabolic acidosis?
    Thank you,
    Christine Butka RN MSN
    CDI Lead
    CentraState Medical Center
    Freehold, NJ

  2. What a timely comment. Recently, our coding auditor suggested that we should always keep an eye out for the cc "acidosis". It seems to me that lactic acidosis could be inherent to the disease process of sepsis and therefore should not be captured. Any thoughts?
    Yvonne B RN CDI Salinas, CA.

  3. Hello all! I agree, I believe lactic acidosis is inherent to sepsis. It is one of the most important indicators that gives the clnician a clue that sepsis may be present. Our fluid administration policy was actually developed on the lactic acid result: the higher the number, the more fluid we bolused (in non-CHF patients, of course). In cases were Sepsis is determined not to be present, we will query the provider, providing they treated or monitored the acidosis in some manner
    Shiloh

  4. -> Continue reading
read more

No more pages to load

Related Articles

  • Partially Compensated Metabolic Acidosis

    When it comes to acids and bases, the difference between life and death is balance. The body’s acid-base balance depends on some delicately balanced chemical reactions. The hydrogen ion (H+) affects pH, and pH regulation influences the speed of cellular reactions, cell function, cell permeability, and the very integrity of cell structure. When an imbalance develops, you can detect it quickly by knowing how to assess your patient and interpret a ...

    ketosis Apr 1, 2018
  • Partially Compensated Metabolic Acidosis Causes

    Page Index Metabolic Acidosis. Metabolic Alkalosis Emergency Therapy Treating Metabolic Acidosis Calculating the Dose Use Half the Calculated Dose Reasons to Limit the Bicarbonate Dose: Injected into Plasma Volume Fizzes with Acid Causes Respiratory Acidosis Raises Intracellular PCO2 Subsequent Residual Changes Metabolic Acidosis. The following is a brief summary. For additional information visit: E-Medicine (Christie Thomas) or Wikepedia Etiolog ...

    ketosis Apr 1, 2018
  • Partially Compensated Respiratory Acidosis

    ABG values can be very intimidating! Its hard to remember all the different normal values, what they mean, and which direction theyre supposed to be going. With so much information, its super easy to get mixed up and make a stupid mistake on an exam, even when you really DO know how to interpret ABGs. In this article, Im focusing more on the How to, rather than understanding whats going on with the A&P, which Ive already done in previous article ...

    ketosis Mar 31, 2018
  • Partially Compensated Metabolic Acidosis Example

    Approach Considerations Treatment of acute metabolic acidosis by alkali therapy is usually indicated to raise and maintain the plasma pH to greater than 7.20. In the following two circumstances this is particularly important. When the serum pH is below 7.20, a continued fall in the serum HCO3- level may result in a significant drop in pH. This is especially true when the PCO2 is close to the lower limit of compensation, which in an otherwise heal ...

    ketosis Apr 1, 2018
  • What Is Partially Compensated Metabolic Acidosis?

    Patient professional reference Professional Reference articles are written by UK doctors and are based on research evidence, UK and European Guidelines. They are designed for health professionals to use. You may find one of our health articles more useful. See also separate Lactic Acidosis and Arterial Blood Gases - Indications and Interpretations articles. Description Metabolic acidosis is defined as an arterial blood pH <7.35 with plasma bicarb ...

    ketosis Apr 1, 2018
  • Partially Compensated Respiratory Acidosis Example

    By Cyndi Cramer, BA, RN, OCN, PCRN RealNurseEd.com 3.0 Contact Hour Self Learning Module Objectives: Identify the components of the ABG and their normal ranges Interpret ABG values and determine the acid base abnormality given Identify the major causes of acid base abnormalities Describe symptoms associated with acid base abnormalities Describe interventions to correct acid base abnormalities Identify the acceptable O2 level per ABG and Pulse Oxi ...

    ketosis Apr 2, 2018

More in ketosis