Respiratory regulation of Acid-Base Balance DR. SUMREENA MANSOOR ASSISTANT PROF OF BIOCHEMISTRY DEPT OF BIOCHEMISTRY & MOL...
Arterial Blood Gas (ABG) pH, pCO 2 , pO 2  – Measured directly HCO 3 - , O 2  saturation (usually) – Calculated from pH, p...
Normal Arterial Blood Gas Values <ul><li>pH   7.35 - 7.45 </li></ul><ul><li>PaCO 2  35-45 mmHg(4.7-6.0kpa) </li></ul><ul><...
Arterial Blood Gases <ul><li>Condition  State of </li></ul><ul><li>PaCO 2   in blood   alveolar ventilation </li></ul><ul>...
Practical Approach <ul><li>1. Check the pH </li></ul><ul><li>If the pH < 7.35 acidemia is present. </li></ul><ul><li>If th...
Practical Approach <ul><li>2. Check the pCO 2 </li></ul><ul><li>pH < 7.35 and pCO 2  > 40    respiratory acidosis </li></...
<ul><li>17 year-old female patient while hyperventilating (frequent, deep, sighing respiration to sustained, obvious, rapi...
<ul><li>Respiratory alkalosis </li></ul>
54 year-old man becomes critically  unwell with confusion and hypotension <ul><li>Test  Results  Normal Range  </li></ul><...
<ul><li>Respiratory acidosis with renal compensation </li></ul>
<ul><li>A 25 year-old patient has acute exacerbation of bronchial asthma.   Which abnormality on the arterial blood gas ev...
<ul><li>High pH suggesting low Hydrogen [H + ] ions * </li></ul>
17 year old w/severe kyphoscoliosis, admitted for pneumonia <ul><li>pH:  7.37 </li></ul><ul><li>pCO 2 :  25 mmHg </li></ul...
<ul><ul><li>Compensated respiratory alkalosis due to chronic hyperventilation secondary to hypoxia </li></ul></ul>
9 year old with H/O asthma, audibly wheezing x 1 week, has not slept in 2 nights; presents sitting up and using accessory ...
<ul><li>pH:  7.51 </li></ul><ul><li>pCO2:  25 mmHg </li></ul><ul><li>pO2  35 mmHg </li></ul><ul><li>HCO3:  22 mEq/L </li><...
<ul><li>Uncompensated respiratory alkalosis with severe hypoxia due to asthma exacerbation </li></ul>
57-year-old male with COPD, home oxygen dependence, daily chronic sputum production, is treated with several types of mete...
<ul><li>Chronic respiratory acidosis </li></ul>
The patient described in above problem develops increasing shortness of breath, purulent sputum production, and increased ...
<ul><li>Acute respiratory acidosis and  </li></ul><ul><li>chronic respiratory acidosis </li></ul>
MALE, AGED 70 YEARS, WITH RESPIRATORY AND METABOLIC FAILURE DUE TO COPD. HE WAS  ADMITTED TO ICU AND MECHANICALLY VENTILATED
<ul><li>ON ADMISSION THIS PATIENT HAD A PARTIALLY COMPENSATED RESPIRATORY ACIDOSIS, i. e    PCO 2  AND   [HCO - 3 ]. VEN...
<ul><li>THANKS </li></ul>
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Respiratory regulation of acid base balance by Dr. Samreena

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Respiratory regulation of acid base balance by Dr. Samreena

  1. 1. Respiratory regulation of Acid-Base Balance DR. SUMREENA MANSOOR ASSISTANT PROF OF BIOCHEMISTRY DEPT OF BIOCHEMISTRY & MOLECULAR BIOLOGY
  2. 2. Arterial Blood Gas (ABG) pH, pCO 2 , pO 2 – Measured directly HCO 3 - , O 2 saturation (usually) – Calculated from pH, pCO 2 , and pO 2
  3. 3. Normal Arterial Blood Gas Values <ul><li>pH 7.35 - 7.45 </li></ul><ul><li>PaCO 2 35-45 mmHg(4.7-6.0kpa) </li></ul><ul><li>PaO 2 70-100mmHg(11.3-12.6kpa) </li></ul><ul><li>SaO 2 93 - 98% </li></ul><ul><li>HCO 3 ¯ 22 - 26 mmol/L </li></ul>
  4. 4. Arterial Blood Gases <ul><li>Condition State of </li></ul><ul><li>PaCO 2 in blood alveolar ventilation </li></ul><ul><li>> 45 mm Hg Hypercapnia Hypoventilation </li></ul><ul><li>35 - 45 mm Hg Eucapnia Normal ventilation </li></ul><ul><li>< 35 mm Hg Hypocapnia Hyperventilation </li></ul>
  5. 5. Practical Approach <ul><li>1. Check the pH </li></ul><ul><li>If the pH < 7.35 acidemia is present. </li></ul><ul><li>If the pH > 7.45 alkalemia is present. </li></ul>
  6. 6. Practical Approach <ul><li>2. Check the pCO 2 </li></ul><ul><li>pH < 7.35 and pCO 2 > 40  respiratory acidosis </li></ul><ul><li>pH > 7.45 and pCO 2 < 40  respiratory alkalosis </li></ul>
  7. 7. <ul><li>17 year-old female patient while hyperventilating (frequent, deep, sighing respiration to sustained, obvious, rapid, deep breathing) fell unconscious to the floor. An attending Physician diagnosed her condition as &quot;hyperventilation syndrome&quot; caused by her anxiety and mental stress. He successfully treated her by rebreathing expired CO 2 from a paper bag and she completely recovered. What happened to the acid-base balance in her body? </li></ul>
  8. 8. <ul><li>Respiratory alkalosis </li></ul>
  9. 9. 54 year-old man becomes critically unwell with confusion and hypotension <ul><li>Test Results Normal Range </li></ul><ul><li>PaO 2 7.9 kPa 11.3-12.6 </li></ul><ul><li>PaCO 2 12.8 kPa 4.7-6.0 </li></ul><ul><li>pH 7.16 7.36-7.44 </li></ul><ul><li>HCO - 3 42 mmol/l 20-28 </li></ul>
  10. 10. <ul><li>Respiratory acidosis with renal compensation </li></ul>
  11. 11. <ul><li>A 25 year-old patient has acute exacerbation of bronchial asthma. Which abnormality on the arterial blood gas evaluation does this patient most likely have? </li></ul>
  12. 12. <ul><li>High pH suggesting low Hydrogen [H + ] ions * </li></ul>
  13. 13. 17 year old w/severe kyphoscoliosis, admitted for pneumonia <ul><li>pH: 7.37 </li></ul><ul><li>pCO 2 : 25 mmHg </li></ul><ul><li>pO 2 : 60 mmHg </li></ul><ul><li>HCO 3 : 14 mmol/L </li></ul>
  14. 14. <ul><ul><li>Compensated respiratory alkalosis due to chronic hyperventilation secondary to hypoxia </li></ul></ul>
  15. 15. 9 year old with H/O asthma, audibly wheezing x 1 week, has not slept in 2 nights; presents sitting up and using accessory muscles to breath with audible wheezes
  16. 16. <ul><li>pH: 7.51 </li></ul><ul><li>pCO2: 25 mmHg </li></ul><ul><li>pO2 35 mmHg </li></ul><ul><li>HCO3: 22 mEq/L </li></ul>
  17. 17. <ul><li>Uncompensated respiratory alkalosis with severe hypoxia due to asthma exacerbation </li></ul>
  18. 18. 57-year-old male with COPD, home oxygen dependence, daily chronic sputum production, is treated with several types of metered dose inhalers. No other medications. He is in his usual state.
  19. 19. <ul><li>Chronic respiratory acidosis </li></ul>
  20. 20. The patient described in above problem develops increasing shortness of breath, purulent sputum production, and increased weakness requiring emergency room visit. He appears to be in moderate respiratory distress peripheral cyanosis.
  21. 21. <ul><li>Acute respiratory acidosis and </li></ul><ul><li>chronic respiratory acidosis </li></ul>
  22. 22. MALE, AGED 70 YEARS, WITH RESPIRATORY AND METABOLIC FAILURE DUE TO COPD. HE WAS ADMITTED TO ICU AND MECHANICALLY VENTILATED
  23. 23. <ul><li>ON ADMISSION THIS PATIENT HAD A PARTIALLY COMPENSATED RESPIRATORY ACIDOSIS, i. e  PCO 2 AND  [HCO - 3 ]. VENTILATION WAS OVER-ENTHUSIASTIC AND PRODUCED A RESPIRATORY ALKALOSIS (P CO 2 <35). </li></ul>
  24. 24. <ul><li>THANKS </li></ul>

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