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ACID-BASE DISORDERS

ACID-BASE DISORDERS. Ismail M. SIALA. Acid-base disorders. Blood Pressure. Pulse. Hydrogen Ion Concentration. Haemoglobin. Temperature. Ca, K, …. Acid-base disorders. Blood Pressure. Pulse. Proper Cell Function. Abnormal Cellular Function. Hydrogen Ion Concentration. Hemoglobin.

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ACID-BASE DISORDERS

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  1. ACID-BASE DISORDERS Ismail M. SIALA

  2. Acid-base disorders Blood Pressure Pulse Hydrogen Ion Concentration Haemoglobin Temperature Ca, K, …

  3. Acid-base disorders Blood Pressure Pulse Proper Cell Function Abnormal Cellular Function Hydrogen Ion Concentration Hemoglobin Ca, K, … Temperature

  4. Acid-base disorders Hydrogen Ion Concentration H+ H+ Alkalosis Acidosis

  5. Compensatory Mechanisms H+ should be normal for normal cellular function. The body will try to restore the H+ to normal

  6. Compensatory Mechanisms • Kidney • Lung • Body Buffers • CO2-HCO3 System • Hydroxyapatite-Bone • Haemoglobin

  7. Body Buffers • Kidney CO2-bicarbonate system H+ + HCO3 H2CO3 H2O + CO2 • Lung

  8. pH and H+ concentration • The blood pH represents the H+ concentration • pH = - log10aH+ • aH+ = 10 (-pH) ) • where aH+ is activity of H+ Alkalosis Acidosis

  9. Acid-base disorders Hydrogen Ion Concentration H+ H+ pH pH Alkalosis Acidosis

  10. Acid base disturbances Arterial blood sample Normal values • A 2 ml syringe • Heparinized • Radial/ femoral artery • Draw 1 ml of blood • Send for analysis immediately or send in an ice pack Heparinized syringe Radial artery

  11. Acid-base disorders Acidosis Alkalosis

  12. Acid-base disorders • Acidosis • Metabolic • Respiratory • Alkalosis • Metabolic • Respiratory

  13. ACID PaCO2 ALKALI HCO3 Metabolic acidosis a pH< 7.36 characterized by low plasma HCO3-. PaCO2 will  secondary to hyperventilation . HCO3 Definition: H+ + HCO3 H2CO3 H2O + CO2

  14. Mechanisms of Excess H+ in metabolic acidosis •  H+ +HCO3   HCO3 • Loss of HCO3  more production of H+ • Kidney • GIT • Small intestine • Pancreas H++ HCO3 H2CO3 H2O + CO2 H++ HCO3 H2CO3 H2O + CO2

  15. Anion Gap

  16. ANION GAP Unmeasured Anions: albumin, phosphate, sulphate, lactate, ketoacids, others. Unmeasured Cations: calcium, Mg, globulins, K. + - Anion Gap HCO3_ Na+ Cl- “Anion gap represents the difference between readily measured anions and cations” Anion gap = Plasma Na+ - (Cl- + HCO3-) N= 8 – 14 mmol\l

  17. Aetiology of metabolic acidosis Increased Anion gap acidosis: Lactic acidosis Ketoacidosis Diabetic Alcohol Toxins Methanol Ethylene glycol Salicylate UraemiaARF CRF + - Anion Gap Anion Gap HCO3_ Na+ Cl- Normal Anion gap acidosis Hyperchloremic acidosis GIT HCO3- loss Diarrhea Pancreatic drainage Renal tubular acidosis Drugs CA inhibitors + HCO3_ - Anion Gap Na+ Cl-

  18. Metabolic acidosis Clinical Features:

  19. Metabolic acidosis Investigations:

  20. Arterial blood gas findings Metabolic acidosis Compensated

  21. Treatment of Metabolic Acidosis

  22. ACID PaCO2 ALKALI HCO3 RESPIRATORY ACIDOSIS Definition: a pH < 7.36 due to retention of CO2 as a result of  alveolar ventilation CO2 H+ + HCO3 H2CO3 H2O + CO2

  23. Respiratory Physiology RC Air RN Br Lu Pl S Inspiration ACTIVE Expiration PASSIVE Ribs Ms

  24. Aetiology (CO2 Retention)

  25. Respiratory acidosis Clinical Features:

  26. Respiratory acidosis Investigations:

  27. Arterial blood gas findings respiratory acidosis Compensated

  28. Respiratory failure

  29. Treatment of Respiratroy Acidosis

  30. ACID PaCO2 ALKALI HCO3 METABOLIC ALKALOSIS Definition: a pH > 7.44 characterized by high plasma HCO3 PaCO2 may  . In normal renal function it is rare, why? HCO3 H+ + HCO3 H2CO3 H2O + CO2

  31. Aetiology

  32. Metabolic Alkalosis Clinical Features:

  33. Metabolic Alkalosis Investigations:

  34. Arterial blood gas findings Metabolic Alkalosis Compensated

  35. Treatment of Metabolic Alkalosis

  36. ACID PaCO2 ALKALI HCO3 RESPIRATORY ALKALOSIS Definition: pH>7.44 due to CO2 washout as a result of hyperventilation CO2 H+ + HCO3 H2CO3 H2O + CO2

  37. Aetiology • Hypoxia • Voluntary • CNS Disease • CVA • Infections • Trauma • Tumours • Drugs Aspirin • Hepatic Failure • Gram Negative Septicaemia • Heat Exposure • Mechanical overventilation

  38. Respiratory Alkalosis Clinical Features:

  39. Respiratory Alkalosis Investigations:

  40. Arterial blood gas findings respiratory Alkalosis Compensated

  41. Treatment of Respiratory Alkalosis

  42. Summary

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