GUD AFTERNOON EVERYBODY….the next 20 min ll be a seminar on “ “….
The data to be presented here are being quoted from these books….
THE MOST IMP. FXN OF THE HUM AN BODY IS TO MAINTAIN EQUIL. WHAT WE CALL “ INTERNAL MILIEU”….ACID BASE BALANCE FORMS AN IMPORTA. PART OF THIS INTERN MILIEU….THE CORNER STONE OF ACID BASE BALANCE IS THIS EQUATION QUITE FAMILIAR TO EVERYBODY.. “THE HENDER HESSEL”….tell abt the acid and base compensation and organs inv….the other buffer systems of the body…I AM NOT GOING INTO THE PHYSIOLOGY OF THESE,THOUGH ONE MUST BE AWARE OF THE PHYSIOLOGY IN ORDER TO UNDERSTAND ACID BASE BALANCE….
Egs…likewise there are various clinical examples for each of these mixed disorders…..
NOW LET US START ANALYSING THE ABG S……These are the abgs that were analysed and discussed in our medicine icu….SO WHEN WE COME ACROSS SUCH AN ABG SLIP,THESE ARE THE QUESTIONS THAT SHOULD BE ANSWERED…questions…to remember….BUT WITHOUT A SYSTEMATIC APPROACH IN HAND,IT IS NOT POSSIBLE FOR US TO COME TO A CONCLUSION OF THE UNDERLYING ACID BASE IMBALANCE…
So here is the approach….and at the end of these 5 steps with the patient’s history and clinical exam.findings in mind,we ld be able to narrow our diagnosis…and there lies the importance of a proper assessment of the abg…
We are quite familiar with these normal values…rather they are normal ranges…..
Having said that,confusions start arising now…..the important thing to remember is though the norma l range is……technically anythging below 7.4 is and above 7.4 is….
here comes the googly…explain….that is why the ancestral rule that all investigations are to be read in the context of the patient….
VAR.FORM. AVAIL. IT S IMP. FOR US TO REMEMBER AT LEAST ONE OF THEM…
We must practise these formulae so that we remember them…..
Why 2 formulae for metabolic compensation?
There are many more examples of mixed acid base disturbances in the next slides…but am not explaining them……just would like to highlight that all the possible acid base distur. Are seen in our daily abg s that we have…it just lft in our hands to decipher them…
Here is the algorithmic form of what we had seen over the past few min….am not going into that again…
…In the context of acid base balance it s imp. For us to understand these gaps, cos they are going to help us unearth a hidden acid base disorder…we ll see how….
THE IMPORATANCE OF ANION GAP IN CONTEXT OF ACID BASE BALANCE will be ILLUSTRATED IN THE FORTHCOMING SLIDES….Thiselectroneutrality is maintatined by a normally functioning kidney….
A VERY IMPORTANT PARAMETER IN ACID BASE BALANCE….THIS INCORPORATES THE DEVIATION OF AG AND BICARB FROM NORMAL…..I AM NOT GOING INTO THE COMPLEXITIES OF THIS FORMULA…THE INTERPRETATION OF THIS FORMULA IS RATHER MORE IMPORTANT…AND IS BEST UNDERSTOOD BY THE FOLLOWING EXAMPLE…
THAT’S WHY RIGHTLY SAID A NORMAL ABG DOES NOT RULE OUT AN ACID BASE DISTURBANCE…unless we know how to interpret it….
Important to take into account the albumin co0nc. In the serum cos,
AM AGAIN NOT GOING INTO THE EXPLANATION OF THIS PHENOMENON……
Imortant when we approach a case of metabolic acidosis….
…..Am not going into the details of each of these disorders,well explained in detail in the books.
