Acid base imbalance

951

Published on

Published in: Health & Medicine
2 Comments
1 Like
Statistics
Notes
No Downloads
Views
Total Views
951
On Slideshare
0
From Embeds
0
Number of Embeds
1
Actions
Shares
0
Downloads
70
Comments
2
Likes
1
Embeds 0
No embeds

No notes for slide

Acid base imbalance

  1. 1. Acid-Base Imbalance Nabilah binti Dato’ Ayob 060 100 814
  2. 2. Acid Base Balance and pH • Homeostasis of the body fluids at a normal arterial blood pH ranging between 7.35 and 7.45 (7.38-7.42) • Is the regulation of H+ • The acidity or alkalinity of a solution which is measured by pH • ↑ H+ , ↑ acidic, ↓ pH • ↓ H+ , ↑ alkaline, ↑ pH
  3. 3. Homeostatic Regulators of [H + ] Chemical Buffer System • 1st to respond • Take < 1 sec. • Temporarily “tie up” excess acids & bases • Bicarbonate- Carbonic acid , Phosphate, Protein buffer systems Respiratory Mechanism • 2nd to respond • Takes 1-3 minutes • Respiratory centre involved • Removes CO2 & therefore H2CO3 Renal Mechanism • 3rd to respond but most potent • Takes hours to days • Kidneys remove metabolic acids • Eg; phosphoric, uric & lactic acids, ketone bodies
  4. 4. Bicarbonate-Carbonic Acid CO2 +H2O • Carbon Dioxide • Respiratory component H2CO3 • Acidic H ++HCO3 – • Basic • Renal Componen t
  5. 5. Factors Effecting Balance Age • especially infants and the elderly Gender and Body Size • amount of fat Environmental Temperature Lifestyle • stress
  6. 6. Four Basic Types of Imbalance Respiratory Acidosis Respiratory Alkalosis Metabolic Acidosis Metabolic Alkalosis
  7. 7. Respiratory Acidosis • pH < 7.35, PaCO2 > 45mm Hg • Hypoventilation • Excess CO2 production What and how? • Lung disorders, such as emphysema, chronic bronchitis, severe asthma, pneumonia, or pulmonary edema • Sleep-disordered breathing • Diseases of the nerves or muscles of the chest that impair breathing, such as Guillain-Barré syndrome or amyotrophic lateral sclerosis, myasthenia gravis • Overdose of drugs such as alcohol, opioids, and strong sedative • Sepsis or burns What cause?
  8. 8. Respiratory Acidosis • Dyspnea, Disorientation or coma • Headache and drowsiness • Hyperkalemia or Hypoxemia Symptoms • Treat underlying cause • Monitor ABGs • Support ventilation • Correct electrolyte imbalance • IV Sodium Bicarbonate Treatment
  9. 9. Respiratory Alkalosis What and How? • pH > 7.45; PaCO2 < 35 mm Hg • Alveolar Hyperventilation What cause? • Pain, Fear, Stress, Anxiety • High altitude residence • Pregnancy • Anaemia • Hysterical hyperventilation syndrome • Brain injury • Hyperthyroidism
  10. 10. Respiratory Alkalosis Symptoms • Tachypnea • Complaints of SOB, chest pain • Light-headedness • Numbness ,tingling or weakness of extremities • Difficult concentrating, tremors, blurred vision Treatment • Treat underlying cause/disease • Monitor ABGs • Ask pt. to breathe more slowly or help pt. to breathe in a paper bag • Apply rebreather mask • Sedation
  11. 11. Metabolic Acidosis What and How? • pH < 7.38; HCO3 - < 22 mEq/L • Acid accumulation from increased acid production or acid ingestion; decreased acid excretion; or GI or renal HCO3 − loss. • Metabolic acidoses are categorized as high(hyperchloremic) or normal anion gap based on the presence or absence of unmeasured anions in serum. High anion gap acidosis: (most common ) • Ketoacidosis (Diabetes, Chronic alcoholism, Undernutrition, Fasting) • Lactic acidosis • Renal failure • Toxic ingestions (Alcohol, Methylene glycol, Methanol)
  12. 12. Normal anion gap acidosis: (most common) • GI or renal HCO3 − loss (Diarrhea, Colostomy, Enteric Fistula) • Impaired renal acid excretion (Tubulointerstitial renal disease, Renal tubular acidosis;types 1, 2, and 4, Hyperparathyroidism) Signs & Symptoms • Kussmaul’s respiration (slow and deep) • Lethargy, confusion, headache, weakness • Nausea and Vomiting • Hypotension and shock, ventricular arrhythmias; and coma. • Chronic acidemia causes bone demineralization disorders (rickets, osteomalacia, osteopenia)
  13. 13. Metabolic Acidosis • Treat Underlying cause • Monitor ABGs • Hemodialysis is required for renal failure and sometimes for ethylene glycol, methanol, and salicylate poisoning • NaHCO3 is clearly indicated only in certain circumstances (normal anion gap) Treatment
  14. 14. Metabolic Alkalosis What and How? • pH > 7.45; [HCO3 -] > 26 mEq/L • body loses too much acid or gains too much base Causes? • Acid loss due to vomiting or gastric suction • Loss of potassium due to steroids or diuretics • Ingestion of exogenous alkali • Adenoma of the colon • Overactive adrenal gland (cushing’s syndrome)
  15. 15. Metabolic Alkalosis Symptoms • Dysrhythmias, dizziness, irritability • Muscle twitching, muscle cramps • Prolonged contraction and spasms of muscles (tetany) • Hypoventilation (compensatory) • Paresthesia, numbness, tingling of extremities Treatment • Fluid administration is the foundation for treatment for saline- responsive metabolic alkalosis. • In cases of extreme alkalosis, the patient may be given dilute hydrochloric acid. • Saline-resistant alkalosis is treated by addressing the underlying etiology
  16. 16. Acid-Base Disturbance Primary Disturbance Compensatory Response Compensatory Mechanism Respiratory acidosis Increased pCO2 Increase [HCO3 -] Acidic urine Respiratory alkalosis Decreased pCO2 Decreased [HCO3 -] Alkaline urine Metabolic acidosis Decreased [HCO3 -] Decrease pCO2 Hyperventilation Metabolic alkalosis Increased [HCO3 -] Increased pCO2 Hypoventilation
  1. A particular slide catching your eye?

    Clipping is a handy way to collect important slides you want to go back to later.

×