Question Answer
what is the state called in which arterial blood is more acidic than normal? aka increased concentration of hydrogen ions. acidemia
what is the difference called between the normal buffer base and the actual buffer base in a whole blood sample? base excess (BE)
what is alkalemia? decreased hydrogen ion concentration in the blood; blood pH greater than 7.45
how is BE expressed? mEq/L
what is the normal BE? +2 mEq/L
what is the buffer base? the total blood buffer capable of binding hydrogen ions
what is the normal blood buffer base (NBB) range? 48-52 mEq/L
what is a titrable, nonvolatile acid called? fixed acid
what does a fixed acid represent? the by-product of protein catabolism
what kind of acids are phosphoric acid and sulfuric acid? fixed
what is the Henderson-Hasselbalch (H-H) equation? the specific equation for calculating the pH of the bicarbonate buffer system of the blood
what does pH = 6.1 + log HCO3-/(PaCO2 x 0.03) represent? H-H equation
what is the importance of the H-H equation? it equals the pH of blood plasma, and since all buffer systems in the blood are in equilibrium, the pH of one system equals the pH of the entire plasma solution.
what is hypercapnia? excess amounts of CO2 in the blood (PaCO2)
what is the presence of lower than normal amounts of CO2 in the blood (PaCO2)? hypocapnia
define metabolic acidosis? non-respiratory processes resulting in acidemia
what is called when non-respiratory processes, such as losing fixed acid or gaining HCO3-, result in alkalemia? metabolic alkalosis
define respiratory acidosis. hypoventilation, the loss of HCO3- or gaining fixed acids resulting in acidemia
define respiratory alkalosis? hyperventilation, resulting in alkalemia
the plasma concentration of HCO3- that exists if PCO2 is normal is known as ____ standard bicarbonate
how is standard bicarbonate expressed? mEq/L
What is the PCO2 baseline for standard bicarbonate? 40 mm Hg
what is an acid that can be excreted in its gaseous form? volatile acid
what is a physiological example of a volatile acid? carbonic acid
how much CO2 does normal ventilation eliminate everyday? 24,000 mmol/L total 13,000 mmol/L of volatile
effect of small changes in the hydrogen ion concentration? failure of vital metabolic processes
what continuously generates H+? normal metabolism
H+ regulation is of utmost biological importance? T or F true
various physiological mechanisms regulate ____ in a range compatible with life ( aka acid-base balance). the H+ concentration of body fluids
what property of H+ is the reason for the need to regulate its concentration? it reacts readily with the protein molecules of vital cellular catalytic enzeymes
why can H+ be dangerous? its reactions with proteins can change their physical contour, rendering the enzyme inactive
wat is the normal, life sustaining, pH range of the body? 7.35-7.45
what would be the results of an ABG if patient is hypoventilating? (uncompensated) pH – less than 7.35 PaCO2 – greater than 45 HCO3 – 22-26 respiratory acidosis
what gas is carbonic acid (H2CO3) in equilibrium with? dissolved CO2
what would be the results of an ABG if the patient is hyperventilating? (uncompensated) pH – greater than 7.45 PaCO2 – less than 35 HCO3 – 22-26 respiratory alkalosis
HHb= Hb- + H+ Hb buffering/transporting H+
H+ + HCO3-= H2CO3 carbonic acid, bicarbonate + hydrogen ion
interpret the ABG: pH- 7.2 PaCO2- 30 HCO3- 15 partial compensated metabolic acidosis
what are the 2 major mechanisms responsible for maintaining a stable pH despite CO2 production? isohydric buffering and ventilation
interpret the ABG: pH- 7.52 PaCO2- 40 HCO3- 30 uncompensated metabolic alkalosis
on a pH-CO2 diagram showing the hydration reaction between CO2 and H2O, if there’s is an increase of CO2 from 40 to 80 what happens to the value of the HCO3? it increases from 24 to approximately 28.5
what disease can increases fixed acid production? diabetes
how does the respiratory system compensate for increased fixed and volatile acid production? ventilation
how do the kidneys compensate for respiratory acidosis? by reabsorbing HCO3 back into the blood
what can be done to correct respiratory acidosis and improve alveolar ventilation? bronchial hygiene,lung expansion, non-invasive PPV, intubation, mechanical ventilation
what are some signs of respiratory alkalosis? paresthesia, dizziness, headache, hyperventilation
how do the kidneys compensate for respiratory alkalosis? by excreting HCO3 in the urine
what is a buffer solution? a mixture of acids and bases that resist changes in pH when an acid or a base gets added to it
how are blood buffers classified? as either bicarbonate (open) or non-bicarbonate (closed) buffer systems
what does the bicarbonate (open) buffer system consist of? H2CO3 and a conjugate base of HCO3-
what does the non-bicarbonate (closed) buffer system consist of? phosphates and proteins, including Hb
what is the main function difference in between an open and closed buffer system? open- removes components of acid-base reactions through ventilation closed- all components of acid-base reactions remain in the system
in a closed buffer system, when does buffering activity stop? when Hbuf reaches equilibrium with the reactants
what can be done to correct respiratory alkalosis? O2 therapy
examples of open buffer systems plasma erythrocytes
examples of closed buffer systems Hb, organic and inorganic phosphates, and plasma proteins
what acids acids does a closed buffer system buffer? volatile and fixed
what acids acids does an open buffer system buffer? fixed, only when ventilation is not impaired, plus any individual H+ regardless of origin
which has the greater buffering capacity, a closed or open system? open
open and closed buffer systems function in isolation. T or F false, they are intermingled in the same solution (whole blood) and are equal in pH (isohydric principle)
in which 2 ways can metabolic acidosis occur? acid accumulation in the blood or excessive loss of HCO3
what is the normal anion gap range? 8-16
what does the buffering of a fixed acid produce? CO2
what is the most important non-bicarbonate buffer system? why? Hb it is the most abundant
what is the common blood fluid compartment that both open and closed buffer systems function? blood plasma
what are the primary acid excreting organs? lungs and kidneys
which is faster at removing acid, lungs or kidneys? lungs
if one acid-excretion system fails, the other will compensate. T or F true; especially in diseased individuals
why is CO2 elimination crucial? it reacts with H2O to form large quantities of H2CO3
what is the anion gap? the calculation of 4 electrolytes (Na+, Cl-, K+, and HCO3-)
why is the H-H equation useful in a clinical setting? you can use it to see if the pH, PCO2, and HCO3 values for an abg are compatible; prevents transcription errors and analyzer inaccuracies; also, to predict the result of changing the value of one or more of the variable
what is the purpose of using the anion gap? to eliminate the effects of respiratory involvement; aka to see what’s going on at the metabolic level
what is indicated by an anion gap >16? metabolic acidosis
what are some of the causes on high anion gap metabolic acidosis? lactic acidosis, ketoacidosis, renal failure. aspirin, formic acid, ethylene glycol
what are some of the causes of normal anion gap metabolic acidosis? diarrhea, pancreatic fistula. renal tubular acidosis. ammonium chloride, hyperalimentation intravenous nutrition
what are some of the symptoms of metabolic acidosis? dyspnea,hyperpnea, Kussmaul’s breathing, lethargy, coma
at what pH are severe cardiac arrhythmias likely? below 7.2
what are ways to correct metabolic acidosis? if above 7.2, nothing, dr. will need to treat underlying condition if below 7.2, intravenous infusion of NaHCO3
how do the lungs compensate for metabolic acidosis? hyperventilation
what factor determines how much H+ is removed by the kidneys? blood pH
how much fixed acid is excreted per day by the kidneys? <100 mEg
the kidneys also regulate HCO3 levels. T or F true; when large amounts of H+ are excreted, the HCO3 is reabsorbed back into the blood and vice vera
in what 2 ways can metabolic alkalosis occur? loss of fixed acids or gain of blood buffer base; either one increases plasma HCO3
what is the most complicated acid-base imbalance to treat? metabolic alkalosis; it involves fluid and electrolyte imbalances
what is the goal of secreting less H+? to increase the amount of HCO3- in the urine, increase the amount of H+ in the blood
what is the goal of secreting more H+? to increase the amount of HCO3- in the blood, decrease the amount of H+ in the blood
what happens when filtrate pH reaches 4.5? secretion ceases to function and H+ secretion stops
what are some of the causes of metabolic alkalosis? vomiting, hypokalemia
how do the lungs compensate for metabolic alkalosis? by hypoventilating
what is the normal range of arterial bicarbonate? 22-26 mEq/L
What maintains bicarbonate levels? kidneys
what maintains CO2 levels? lungs
what is the ratio of HCO3- buffer/dissolved CO2 that maintains a normal pH? 20:1
when ___ increases or ___ decreases, it leads to alkalemia.(ratio greater than 20:1) HCO3- PCO2
a decrease in ___ or an increase in ___ leads to acidemia. (ratio less than 20:1) HCO3- PCO2
pH changes caused by PaCO2 are referred to as what? primary respiratory disturbances
what are some ways to correct metabolic alkalosis? increased intake of fluids containing Cl-; in hypokalemia- administering KCl (potassium chloride) if severe- HCl or ammonium chloride
how does the hydration reaction produce HCO3? CO2 and H20 create H2CO3, Hb snatches the H+, thus resulting in HCO3 CO2+H2O–>H2CO3–>HCO3- | Hb+H–>HHb
how much does plasma HCO3 increase with acute increase in PCO2? about 1 mEq/L for every 10 mm Hg increment over 40
what is the first step to analyzing acid-base problems? categorizing pH pH scale
what is the second step in analyzing acid-base problems? determining respiratory involvement PaCO2
what is the third step in analyzing acid-base problems? determine metabolic involvement plasma HCO3-
what is the last step in analyzing acid-base problems? assess for compensation
what are some of the causes of respiratory acidosis? anesthesia, narcotics, and sedatives poliomyelitis, myasthenia gravis, guillian-barre syndrome trauma to spinal cord, brain, chest wall, kyphoscoliosis, obesity COPD, airway obstruction
what are some of the causes of respiratory alkalosis? anxiety, fear, stimulant drugs, CNS lesion, pain, sepsis hypoxemia, asthma, pneumonia, pulmonary edema, pulmonary vascular disease latrogenic hyper ventilation
how do u calculate base excess? add all positive ions (cations) then add all negative ions (anions) then find the difference between the two (in mEq/L)

Egan’s Chapter 13 Practice Questions:

1. Aleveolar air equations account for both the ________ associated with Dalton’s Law AND the rate at which _______ enters the lung and _______ exits the lung.: partial pressures, O2, CO2

2. Are pH and CO2 values in blood DIRECTLY or INVERSELY related?: INVERSELY. As PaCO2 levels INCREASE, the blood’s pH go DOWN toward the acidic side of 7.40. I.e. – A pH of 7.4 with a PaCO2 of 40 mmHg becomes a pH of 7.3 at 60 mmHg

3. Do lungs operate at the perfect V/Q ratio level of 1 to 1 (1)? Why?: No, in reality the ratio is < 1 (approx .66). Blood flow is 20 times GREATER at the bases of the lungs BUT ventilation is NOT 20 times greater creating a difference.

4. How is pH determined?: Through a RATIO of HCO3- (bicarbonate conjugate base) to dissolved CO2. A 20:1 ratio of HCO3- to CO2 results in a pH of 7.4 (NORMAL)

5. How much less is the PaO2 value than the PAO2 value? Why?: 5 – 10 mmHg. Due to the presence of anatomic cardiac shunts

6. How much oxygen can one GRAM of Hemoglobin (Hb) bind?: 1.34 mL of oxygen

7. If a Pt’s blood pH is normal (7.40) what would the pH do, increase or decrease if the (HCO3-) increased 10 mEqv/L?: It would INCREASE to pH 7.55 because an INCREASE in the (HCO3-) of 10 mEqv/L produces a change inthe pH of 0.15.

8. An INCREASE in the concentration of H+ ions promotes the following:: A – The lungs INCREASE their CO2 excretion (FAST), B – Kindnys ACCELERATE excretion of H+ (SLOW)

9. An increase in the PaCO2 of 20 mmHg results in an increase or decrease in pH by what amount?: A DECREASE in the pH value by 0.1.

10. In the lungs, what dilutes the PAO2 values?: Water vapor and CO2

11. _______________ is the percentage of hemoglobin (Hb) that is carrying oxygen in the blood COMPARED to the TOTAL Hb. What is the normal percentage value?: SATURATION, 95 – 100%

12. What are some causes of METABOLIC acidosis?: LACTICacidosis, KETOacidosis, renal failure, severe diarrhea. BOX 13-5

13. What are some causes of METABOLIC alkalosis?: Vomiting, Nasogastric drainage or Sx, hypokalemia, hypochloremia, steroids, diuretics. Box 13-6

14. What are some causes of RESPIRATORY acidosis?: HYPO ventilation, neuromuscular disease, drug OD, renal HCO3- retention. Box 13-3

15. What are some causes of RESPIRATORY alkalosis?: HYPER ventilation, hypoxemia, fever, pain, renal ELIMINATION of HCO3-. Box 13-4

16. What are some hazards of arterial puncture sampling?: Hematoma, Inspection, Pain, Thrombosis, Bleeding

17. What are some major components of QC for maintaining ABG accuracy?: Record keeping, Policies & procedures, Performance validation, Preventative maintenance & function checks, Automated calibration & verification, Internal & external statistical QC

18. What are the barriers to diffusion?: 1 – Alveolar membrane, 2 – Interstial space and it’s structures, 3 – Capillary endothelium

19. What are the indications for arterial sampling?: ACUTE SOB, ABNORMAL SOB, Cyanosis, HEAVY use of ACCESSORY muscles, CPR, Changes in ventilator settings, Diffuse infiltrates in chest radiograph

20. What are the partial pressure values of CO2 in the atmosphere and intracellularly to create the DIFFSSION GRADIENT from the cell to the atmosphere?: Intracellular Pressure – approx 60 mmHg, Atmosphere – less than 1 mmHg

21. What are the pH, CO2 and HCO3- readings for FULLY compensated blood?: pH is NORMAL, CO2 and HCO3- are NOT normal

22. What are the pH, CO2 and HCO3- readings for PARTIALLY compensated blood?: pH, CO2 and HCO3- – NOT normal BUT are MOVING in the right direction.

23. What are the pH, CO2 and HCO3- readings for UNCOMPENSATED blood?: pH – NOT normal, CO2 and the HCO3- IS normal

24. What are the pressures values in the atmosphere and the body’s tissue that create the DIFFUSION GRADIENTS for OXYGEN CASCADE (gas exchange)?: ATMOSPHERIC – 159 mmHg, TISSUE – approx 5 mmHg

25. What are the three degrees of acid-base blood compensation?: 1 – FULLY, 2 – PARTIAL, 3 – UNCOMPENSATED

26. What are the TIME limits to pulmonary diffusion?: 1 – Normal exposure time for pulomnary blood is .75 seconds BUT may fall s low as .25 seconds during excercise, 2 – Equlibrium takes .25 seconds, 3 – Equilibrium may NOT be acheived if the blood exposure time is <.25 seconds

27. What are the two forms O2 is transported in?: 1 – DISSOLVED, 2 – BOUND

28. What does PAO2 stand for?: Pulmonary Arterial Oxygen Tension

29. What formula describes the saturation percentage of oxygen in the blood?: SaO2 % = HbO2/Total Hb x 100

30. What has PROBABLY occurred when, after drawing blood from your Pt, the PaO2 reading is 159 mmHg?: You tapped into an AIR BUBBLE that is registering ATMOSPHERIC pressure O2 levels.

31. What is Fick’s Law?: The GREATER the SURFACE AREA, DIFFUSION CONSTANT and PRESSURE GRADIENT, the greater the diffusion.

32. What is the Allen test?: A test used to determine if collateral circulation exists in the hand near the radial artery being considered for sampling.

33. What i sthe approximate ratio of BOUND oxygen to DISSOLVED oxygen in human blood?: 70:1

34. What is the BASE EXCESS?: It is the DIFFERENCE between the NORMAL buffer base (NBB) and the ACTUAL buffer base (BB) in a whole blood sample.a NORMAL BE is +/- 2 mEq/L

35. What is the definition of RESPIRATION?: The process of moving OXYGEN to tissues for AEROBIC metabolism and REMOVAL of carbon dioxide (CO2).

36. What is the normal pH range for human blood?: 7.35 to 7.45, with 7.40 as NORMAL

37. What is the normal range for PaCO2 (arterial carbon dioxide partial pressure)?: 35 – 45 mmHg, with 40 mmHg as NORMAL

38. What is the normal range for PaO2 (arterial oxygen partial pressure)?: PaO2 is 80-100 mmHg, with 100 mmHg as PERFECT

39. What is the PRIMARY artery used for arterial blood sampling and WHY?: The RADIAL artery BECAUSE it is: NEAR the surface, has COLLATERAL circulation (USUALLY), NO large veins nearby, radial puncture is relatively PAIN FREE

40. What is the SECONDARY artery used?: BRACHIAL

41. What law allows us to calculate the amount of O2 dissolved into the blood?: Henry’s Law Dissolved Oxygen (DO) mL/dL = PO2 x 0.003

42. What pH TREND does HYPER ventilation move the body toward, acidotic or alkalotic?: ALKALOTIC by EXCRETING CO2 and REDUCING the formation of carbonic acid (H2CO3).

43. What pH trend does HYPO ventilation move the body toward, acidotic or alkalotic?: ACIDOTIC by INCREASING the buildup of CO2 in the blood and INCREASING the number of free H+ ions.

44. What term is used for a Pt with a PaO2 of 60 – 79 mmHg?: MILDLY Hypoxic

45. What term is used for a Pt with a PaO2 of between 40 and 59 mmHg?: MODERATELY hypoxic

46. What term is used for a Pt with a PaO2 of less than 40 mmHg?: SEVERELY hypoxic

47. What THREE bodily actions combine to maintian the OPTIMAL pH in the body?: 1 – BUFFERS – TEMPORARY measure, 2 – LUNGS – EXCRETE CO2, CRUCIAL, FAST, 3 – KIDNEYS – Remove H+, < 100 mEqv daily, SLOW

48. What value is NORMAL for PaO2?: A range between 80 and 100 mmHg. ABOVE 100 mmHg is considered HYPERoxic

49. When the body uses the LUNGS to compensate for a pH imbalance, it is termed a __________ compensation. When the body uses the KIDNEYS, it is termed a ____________ compensation.: A – REPISRATORY, B – METABOLIC

50. Whne is an Arterial (“A”) line indicated?: Repeated ABG’s, Pt is in ICU, BP issue that requires close monitoring

51. Why must you ice the ABG blood sample “post stick”?: Metabolism continues “post stick” and therefore degredates if not iced.

Egan’s Chapter 13 Test Bank:

1. Bicarbonate buffer system can only function if…: Bicarbonate (HCO3-) can continue to buffer fixed acid (H+) as long as ventilation is adequate to exhale volatile acid CO2
***HCO3 (bicarbonate)- cannot buffer H2CO3 (Volatile) acid

2. The body must maintain the pH of fluids within a narrow range of…: 7.35-7.45

3. Boyle’s Law: P1 x V1=P2 x V2

4.Charles’ Law: V1/T1 = V2/T2

5. CO2 is mostly transported as HCO3-… what’s up with the ratio?: CO2 increases so… HCO3- increases (and vice versa)

6. The combination of lung and kidney acid-base balance is…: pH 7.35-7.45

7. Combined Gas Law: (P1 x V1)/T1 = (P2 x V2)/T2

8. Decreased HCO3- (bicarbonate) results in…: metabolic acidosis

9. determining alkalosis and acidosis for pH, HCO3- & CO2: pH & HCO3- :determined the same way (increase= alkalotic, decrease=acidic), (increase=acidic, decrease=alkalotic)

10. Gas law formula variables…: P: Pressure (Torr), V: Volume (ml), T: Temperature (degrees Kelvin), 1: original value, 2: New value

11. Gay Lussac’s Law: P1/T1 = P2/T2

12. Henderson-Hasselbach equation (H-H equation): purpose: to predict ideal pH levels based on values given. **pH= 6.1 + log [(HCO3-)/(PaCO2 x 0.03)], {TO CALCULATE pH VALUES MUST BE GIVEN}

13. How does the kidney function?: Renal glomerulus filters the blood by passing H20, electrolytes, and nonproteins through semipermeable membrane. HCO3 is filtered through membrane while CO2 diffuses into tubule cell where it is hydrolyzed into H+ which is pee’d out.

14. Hydrogen regulation differences: Ventilation: CO2+H2O <== H2CO3 <== HCO3- + (H+) Metabolism: HHb ==> (H+) +HCO3-, Ventilation=faster balance/faster fatigue, Metabolism=slower balance (3 days)/No fatigue

15. Hyper/Hypoventilation and PaCO2…: Hyper= lower PaCO2 (respiratory alkalosis), Hypo= increased PaCO2 (respiratory acidosis)

16. Increased HCO3- (bicarbonate) results in…: metabolic alkalosis

17. Initial steps of interpreting ABGs: **inspect the pH (acidemia, alkalemia, or normal), **if abnormal inspect the PaCO2 to see if it explains the pH, **Inspect the HCO3- in relation to the pH, **check for compensation… was the response appropriate?

18. Metabolic acidosis is…: Low HCO3- with a low pH

19. Metabolic ventilation is controlled by…: The kidney

20. Non-Anion Gap acidosis causes: , Hyperalimentation, Acetazolamide, Renal tubular, Acidosis, Diarrhea, Uretero/pelvic shunt, Post hypocapnea, Spironolactone

21. Normal lung range of CO2: 35-45 Torr

22. Normal range for Bicarbonate: 22-26 mEq/L

23. A primary disturbance to normal pH results in…: COMPENSATORY RESPONSE, Respiratory disorder is compensated for by the kidney (process occurs in hours/days) *after body attempts to hyperventilate/hypoventilate…improvement can take hours/days before improvement is documentable*, Metabolic disorder is compensated for by the lungs (process occurs in minutes) *lungs take over immediately however are subject to fatigue until metabolic corrective actions are taken ie. insulin*

24. Respiratory Alkalosis is…: Alveolar hyperventilation. Lowers arterial PaCO2 decreasing carbonic acid resulting in increased pH

25. Tissue Metabolism Formula: CO2 +H20 ==> H2CO3 ==>(H+) + HCO3-

26. What are symptoms of Metabolic acidosis?: Kussmaul’s respiration, and lethargy.

27. What are the causes of anion gap?: , Methanol, Uremia, Diabetic ketoacidosis, Paraldehyde, Isoniazid, Lactic Acidosis, Ethyl Alcohol (ETOH), Rhabdomyelitis, Salicylates

28. What can cause Respiratory Acidosis: Anesthesia, sedative drugs, narcotic analgesics, polio myelitis, myasthenia gravis, Guillain-Barre syndrome, trauma to the trunk, severe restrictive disorders, obesity, kyphoscoliosis, abnormalities in the lungs (COPD, Airway obstruction)

29. What happens if the respiratory/metabolic compensatory system makes an attempt at correcting any disorder.: Compensation is considered as having occurred. Even though its partial compensation rather than full.

30. What is a buffer for Acid-Based Balance: A solution that resists changes in pH when an acid or base is added. Composed of a weak acid and its conjugate base
EXAMPLE: Bicarbonate (HCO3)

31. What is any process that raises PaCO2> 45mm Hg and lowers pH below 7.35?: Respiratory acidosis (alveolar hypoventilation)

32. What is carbonic acid dissociation pKa H2CO3: 6.1

33. What is medical intervention to correct metabolic acidosis?: When pH is below 7.2, administer NaHCO3 via IV

34. What is metabolic acidosis caused by?: Increased fixed acid and accumulation and excessive loss of HCO3- (ie. diarrhea)…. often identified by Anion Gap

35. What is normal anion gap?: formula: (Na+) – (CL- (+) HCO3-)
<16 mEQ/L of “stuff” 36. What is PaCO2 controlled by and what is it associated with: Controlled by lungs and associated with VENTILATION not oxygenation 37. What is paresthesia?: numbness of the fingers (usually a clinical sign of alkalosis) 38. What is the drawback of compensating metabolic acidosis via hyperventilation?: Even though it happens quickly, respiratory muscles (diaphragm) fatigues. 39. What is the kidney filter system: Renal glomerulus 40. What is the main compensation for metabolic acidosis?: Hyperventilation. Acidosis activates CNS receptors, signaling need to increase exhalatory minute ventilation 41. What is the main compensation for metabolic alkalosis?: HYPOVENTILATION despite the ensuing hypoxemia 42. What is the medical intervention for severe metabolic alkalosis?: give dilute HCl via central lines, then restore normal fluid volume K+ and Cl- levels. 43. What is the most common cause of respiratory alkalosis?: HYPOXEMIA (other causes include anxiety, fever & pain) 44. What is the ratio of HCO3- to dissolved CO2 to determine pH?: 20:1 will provide pH of 7.40, >7.40 = Alkalemia (Alkaline batteries power UP), <7.40 = Acidemia (Acid burns things DOWN)

45. what is the ultimate goal of respiratory acidosis compensation?: To improve VA (Alveolar minute ventilation)
includes: improved bronchial hygiene & lung expansion, non invasive positive pressure ventilation, ET tube snd mechanical ventilation.

46. what is WNL: within normal limits

47.What keeps H+ (hydrogen ion) in normal range? (pH 7.35-7.45): Acid-Based balance

48. What role do the kidneys play in Acid Excretion: Kidneys physically remove H+ from the body and also control excretion or retention of HCO3-
(metabolic regulation)

49. What’s up with that metabolic alkalosis?: Increased HCO3- with elevated pH. Caused by increased buffer base or loss of fixed acids (vomiting)