ABGs or VBGs interpretation made simple straight forward easy to remember and easy to apply. The presentation is designed to help the residents and junior ER physicians. The second part will discuss the oxygenation and the third part will review the "Stewart Approach" while fourth and last part is meant for the Experts.
ABGs or VBGs interpretation made simple straight forward easy to remember and easy to apply. The presentation is designed to help the residents and junior ER physicians. The second part will discuss the oxygenation and the third part will review the "Stewart Approach" while fourth and last part is meant for the Experts.
one can learn the step by step approach of ABG interpritation and its analysis from basics with the help of different case scenarios,Ref-NEJM article regarding physiological approach to acid base disbalance
one can learn the step by step approach of ABG interpritation and its analysis from basics with the help of different case scenarios,Ref-NEJM article regarding physiological approach to acid base disbalance
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
Follow us on: Pinterest
Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
12. As required for ECG
interpretation,
a systematic approach to
ABGs enhances accuracy.
There are NO short-cuts!
A Systematic Approach
13. The Anatomy
of a Blood Gas
Report
----- XXXX Diagnostics ------
Blood Gas Report
248 05:36 Jul 22 2000
Pt ID 2570 / 00
Measured37.0
o
C
pH 7.463
pCO2 44.4 mm Hg
pO2 113.2 mm Hg
Corrected38.6
o
C
pH 7.439
pCO2 47.6 mm Hg
pO2 123.5 mm Hg
Calculated Data
HCO3 act 31.1 mmol / L
HCO3 std 30.5 mmol / L
BE 6.6 mmol / L
O2 CT 14.7 mL / dl
O2 Sat 98.3 %
ct CO2 32.4 mmol / L
pO2 (A - a) 32.2 mm Hg
pO2 (a / A) 0.79
Entered Data
Temp 38.6 oC
ct Hb 10.5 g/dl
FiO2 30.0 %
Measured Values
Temperature Correction:
Is there any value to it?
Calculated Data:
Which are the useful ones?
Entered Data:
Derived from other sources
14. Traditional Measurements
pH electrode
pCO2 electrode (Severinghaus)
pO2 electrode (Clark)
Additional options include:
Co-oximeter; measures O2 saturation
Na
+
, K
+
, Ca
2+
, Cl
-
Haematocrit
15. ----- XXXX Diagnostics ------
Blood Gas Report
Measured37.0
o
C
pH 7.463
pCO2 44.4 mm Hg
pO2 113.2 mm Hg
Corrected38.6
o
C
Calculated Data
HCO3 act 31.1 mmol / L
HCO3 std 30.5 mmol / L
BE 6.6 mmol / L
O2 CT 14.7 mL / dl
O2 Sat 98.3 %
t CO2 32.4 mmol / L
pO2 (A - a) 32.2 mm Hg
pO2 (a / A) 0.79
Entered Data
Temp 38.6 oC
ct Hb 10.5 g/dl
FiO2 30.0 %
Bicarbonate is calculated on the basis of
the
Henderson equation:
[H
+
] = 24 pCO2 / [HCO3
-
]
or
for the mathematically inclined…
Bicarbonate:
Henderson-Hasselbach equation:
pH = pKc + Log [HCO3
-
]
a pCO2
16. Steps of evaluation
• Step 1:- Check the validity of the report
• Step 2:- Identify the most obvious disorder
• Step 3:- Apply the formulae to determine
whether compensation is adequate. If not a
second disorder coexists.
• Step 4:- Calculate the anion gap
17. Checking the Reports Validity.
• Calculate H+ ion concentration from the
formula.
• H+ = 24 X pCO2/HCO3
-
• This should correspond to the H+ ion
concentration of the pH in the ABG report.
21. Appropriate compensation in simple acid
base disorders
• Metabolic acidosis-
Pco2=(1.5XHCO3)+8-/+2
• Metabolic alkalosis
Pco2= o.7x HCo3+21+_1.5
anand tiwari
22. Change in Ph
• For every increase in Paco2 of 20 mm Hg (2.6
kPa) above normal-
• mal the pH falls by 0.1
• x For every decrease of Paco2 of 10 mm Hg
(1.3 kPa) below normal
• normal the pH rises by 0.1.
• *Any change in pH outside these parameters
is therefore metabolic in origin.
23. Respiratory acidosis: < 24 hrs: D [HCO3] = 1/10 D PCO2
> 24 hrs: D [HCO3] = 3/10 D PCO2
Respiratory alkalosis: 1- 2 hrs: D [HCO3] = 2/10 D PCO2
>2 days: D [HCO3] = 6/10 D PCO2
REF-Text book of Hall criticare
anand tiwari
24. Case 1.
• 51 yr old found unresponsive at home past
history of D.M,HT.medications-
Metformin,hydrochlorothiazide,Lisinipril.
• b/p-120/70,HR-96/min.
• ABG-7.11,Paco2-28.4,pao2-86,room air
• Na 137,hco3-9,cl-90,BUN-116,CRE-
7.2mg%,Albumin-3.9gm%,bl gl-906mg%
25. ----- XXXX Diagnostics ------
Blood Gas Report
Measured 37.0
o
C
pH 7.301
pCO2 76.2 mm Hg
pO2 45.5 mm Hg
Calculated Data
HCO3 act 35.1 mmol / L
O2 Sat 78 %
pO2 (A - a) 9.5 mm Hg D
pO2 (a / A) 0.83
Entered Data
FiO2 21 %
Case 2
60 year old male smoker
with progressive
respiratory distress
and somnolence.
D CO2 =76-40=36
Expected D pH = 36/10 x0.08=0.29
Expected pH = 7.40-0.29=7.11
Chronic resp. acidosis
pH <7.35 ; acidemia
pCO2 >45; respiratory acidemia
Limits:
DHCO3 = 3/10 of D pCO2
=3/10x36=10.8
Limits of HCO3 = 24+11=35
Pure Resp Acidosis
Hypoxia
Normal A-a gradient
Due to hypoventilation
26. Case -- 1
• A middle aged female leukemia admitted to Intensive
care with respiratory failure required invasive
ventilation.
• ABG sample collected after one hour of ventilation
on Fio21 MV-8.0
lits, R.r-16/min on siemens ventilator.SpO2 on pulse
ox-96%
anand tiwari
27. Treat the patient!!!
• Ph-7.293
Pco2-39.2mm of hg
Po2-11.1mmof hg
Hco3-act-18.6mmol/l
Hco3-std-16.6mmol/l
Tco2-19.8mmol/l
BEvt=-7.4mmol/l
BE vv=-8.0
anand tiwari
Sr Electrolytes-Na+=127.3
mmol/l
K+=5.16
cl-=88mmol/l
How will you explain low po2
disparity with spo2?
–
LAB
WBC—297000/ul
Hgb-10 gm/dl
Hct-23.4%
Plt--108
29. Learning point---
• Be aware of “leukocyte larcency” (aka
pseudohypoxemia)—phenomenon of
artificially
• low pO2 on ABG due to markedly increased
O2 consumption by malignant leukocytes
• -in these instances, pulse oximetry often a
better measure of oxygenation
Majhail NS, Lichtin AE. Acute leukemia with a very high leukocyte count: confronting a medical
emergency. Cleve Clin J Med. 2004 Aug;71(8):633-7.anand tiwari
30. Case 2
18yr old asthmatic 3 days of
cough,dyspnea,orthopnea,not
responding to bronchodilators.
ABG-Ph-7.24
PCO2-49.1
PO2-66
HCO3---18 sat 92%
Calculate A-a Gradient
32. Case 3
• A 29-year-old previously healthy female, is
admitted in semiconcious state. She has c/o
fever,sweating and vomitting for last one day.
Following is her ABG (Fio2-.21) and biochemical
report.
anand tiwari
PH - 7.38
> PCO2- 24
> PO2 - 96
> HCO3- 16
> Sr.Sodium - 138 meq/l
> Sr.Potassium - 3.7 meq/l
> Sr.Chloride - 102 meq/l
> Blood Sugar - 48 mg%
> BUN -32 meq/l
> Sr.Creatinine - 1.5 meq
33. • Causes of metabolic acidosis with
hypoglycemia are:
Alcohol intoxication, seizures, Advanced liver
failure, acute adrenal insufficiency, myxedema coma,
severe malaria, starvation ketoacidosis and drug
intoxication such as metformin, salicylates,
anand tiwari
34. Learning point
• the abnormalities here are: High AG Metabolic
acidosis with respiratory alkalosis with
Hypoglycemia In given scenario the likely causes are:
1. severe malaria/cerebral malaria.
2. Quininie toxicity.
3. Salicylate toxicity
anand tiwari
35. Case 4
• ABG was taken from patient who presented
with abdominal pain and vomiting.
• Ph-7.31
• Pco2-45.7 Na-142,k-3.7,cl-91
• Po2-98.1
• Hco3-22.3
• Base excess=3
36. Case 5
• Young male patient of recurrent seizures was
on regular intravenous doses of
benzodiazepine lorazepam for control of
convulsion dose was reduced on day 7 as
spasm came under control
anand tiwari
37. • Biochemical profile of above patient
anand tiwari
Measured
serum
osmolarit
Day1
290
Day4
300
Day7
315
Day10
298
calculated 285 281 284 286
Plasma
lactate
2.1 4.9 2.9
“
Likely explanation for change in osmolar gap
39. Case -- 5
• 63 year old female with history of CHF presented to
ER with c/o
• shortness of breath over preceding 2 days
• Fever
• Cough with thick yellow sputum
• Past history hypertension and chf treated with furosemide
20mg/day digoxin 0.25mg/day
anand tiwari
40. • Lung right sided basilar crackles
B.P 140/80
HR-100/MIN
R;R-30/MIN
TEMP 39*
Lab-TLC 14000
HGB 13
NA 139
K-3.4
CI-98
ABG
PH-7.59
PCO2-30
PO2-58
HCO3-29
Chest x ray –lobar infiltrate in right lobe
Sputum exam stain – gpc diplococci and
anand tiwari
41. • Initial presentation is alkalemia pc02 decreased but
bicarbonate is at upper end of normal so combined metabolic
alkalosis +respiratory alkalosis
• History gives a clue that chronic metabolic
alkolosis due to diuretics and acute respiratory
alkalosis is due to pneumonia
anand tiwari
42. • She is started on antibiotic therapy with o2 supplementation
• 12 hours later she complains of increased shortness of breath
ABG
Ph-7.40
Pco2 48
P02 44
Intubate and ventilated tidal vol 600 R.r 16
Fio2 1
Peep-5
ABGg
Ph-7.24
Pco2 38
Po2-86 hco3 16
Anion gap 23
Sr lactate 8 mmol/lit
anand tiwari
43. • As patient developed ventilatory failure ABG showed
normal Ph and respiratory acidosis ie balanced by
chronic increase in bicarbonate level.
• As sepsis developed acidemia with decreased
bicarbonate level and increased anion gap
anand tiwari
44. • Over a period clinical condition improved a she was started on
TPN,dobutamine dicontinued and furosemide 40mg/day
• Her oxygenation continued to improve but
ABG
PH-7.55
PCO2-44
HCO38
Furisemide dicontinued
Acetozolamide begun
ABG
PH-7.6
PCO2 46
HCO3 44
anand tiwari
45. • Her final acid base disorder is severe alkalemia
of metabolic origin
• Was initially thought to be due to diuretic but
found after searching all medication and
substances administrated that patient
parental nutrition contained 70 meq of
acetate /litre
• Acetate –biacarb load –na avidity –
hypochloremia –vol deficit
anand tiwari
46. Final word
Effects of preexisting disease state may exacerbate
or mitigate degree of Ph change
Acid base equilbrium in ICU is dynamic system and
multiple disorders may occur simultaneously.
Look for the underlying cause
Unexplained disorder should prompt through search
of all administrated substances
anand tiwari