Acid base balance
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    Acid base balance Acid base balance Presentation Transcript

    • Acid-Base Balance By M.H.Farjoo M.D. , Ph.D.Shahid Beheshti University of Medical Science
    • Acid-Base Balance  Introduction  Determining the Disturbance  Respiratory Acidosis  Metabolic Acidosis  Respiratory Alkalosis  Metabolic Alkalosis  ExerciseM.H.Farjoo
    • Introduction  pH: This measures hydrogen ions, Normal pH = 7.35- 7.45.  pCO2 : Partial Pressure of CO2: is the concentration of CO2 in the blood. A high pCO2 indicates acidosis and vise versa.  HCO3 or Bicarbonate: measures the concentration of HCO3 ion only. High values indicate alkalosis and vise versa.  CO2 : Carbon Dioxide Content: is a measure of both carbon dioxide dissolved and bicarbonate ions and is an older test.M.H.Farjoo
    • Introduction (Cont’d)  The lungs regulate the amount of Co2 in the blood and the kidneys regulate the bicarbonate.  Both acidosis and alkalosis can be of two different types: respiratory and metabolic.  Respiratory disturbances are caused by various malfunctions of the lungs.  Metabolic disturbances are caused by metabolic disorders which result in an excessive build up or loss of acids or bases.M.H.Farjoo
    • Determining the Disturbance  To Determine about acidosis or alkalosis: look at the pH value.  To Determine about metabolic or respiratory: look at the pCO2 and bicarbonate ion value.  To Determine Whether the Condition is Compensated or not: look at the H+, HCO3- and CO2 values.  Try to get the best match of values for the above conditions.  Finally check all Lab. results to see if they are consistent.M.H.Farjoo
    • Respiratory Acidosis  Example: pH =7.2, pCO2 = 60, CO2 = 24.  pH = 7.2: acidosis  pCO2 = 60: respiratory  CO2 = 24: uncompensated  So it is: uncompensated respiratory acidosis.M.H.Farjoo
    • Metabolic Acidosis  Example: pH =7.1, pCO2 = 42, HCO3- = 12.  pH =7.1: acidosis  HCO3- = 12: metabolic  pCO2 = 42: Uncompensated  So it is: Uncompensated metabolic acidosis.M.H.Farjoo
    • Metabolic Acidosis (Cont’d)  Metabolic Acidosis with a Normal Anion Gap:  Longstanding diarrhea (bicarbonate loss)  Uretero-sigmoidostomy  Pancreatic fistula  Renal Tubular Acidosis  Intoxication (ammonium chloride, acetazolamide, bile acid sequestrants)  Renal failureM.H.Farjoo
    • Metabolic Acidosis (Cont’d)  Metabolic acidosis with an elevated anion gap:  Lactic acidosis  ketoacidosis  Chronic renal failure (accumulation of sulfates, phosphates, uric acid)  Intoxication (salicylates, ethanol, methanol, formaldehyde, ethylene glycol, paraldehyde, INH, toluene, sulfates, metformin).  RhabdomyolysisM.H.Farjoo
    • Respiratory Alkalosis  Example: pH =7.58, pCO2 = 27, HCO3= 24.  pH =7.58: alkalosis  pCO2 = 27: respiratory  HCO3 = 24: uncompensated  So it is: Uncompensated respiratory alkalosis.M.H.Farjoo
    • Metabolic Alkalosis  Primary Metabolic alkalosis may occur from various causes including:  Loss of acid via the urine, stools or vomiting  Transfer of hydrogen ions into the cells  Excessive bicarbonate administration (alkali given to patients with renal failure)  Contraction of the extracellular space due to excessive diuretic treatmentM.H.Farjoo
    • Metabolic Alkalosis (Cont’d)  Prolonged metabolic alkalosis may be caused by a number of different mechanisms:  Decrease in renal perfusion stimulates the renin-angiotensis system which increases sodium reabsorption.  Chloride Depletion (vomiting, use of loop diiuretics) which enhances bicarbonate reabsorption with associated hydrogen ion loss.  Metabolic alkalosis may be associated with hypokalemia which maintains metabolic alkalosis by various mechanisms.M.H.Farjoo
    • Exercise  Use the following lab results to determine the patient condition: CO2 = 39; pCO2 = 40; pH = 7.6; K = 3.0 and the patient has been vomiting.  pH = 7.6 and K = 3.0 both indicate alkalosis.  The pCO2 = 40 is normal and indicates a metabolic condition.  The CO2= 39 value is measuring HCO3 and indicates an uncompensated condition.  Therefore it is Uncompensated metabolic alkalosis.M.H.Farjoo
    • Summary In English
    • Thank you Any question?