This document defines and discusses acid-base disorders. It begins by defining terms like acidosis, alkalosis, and the normal ranges for pH, PCO2, and HCO3-. It then discusses the bicarbonate-carbonic acid buffer system and how acid-base disorders are classified based on initial chemical changes and compensatory responses. Etiologies of different acid-base disturbances are provided along with examples. Guidelines for interpreting arterial blood gases are outlined in a step-wise manner. Several case examples of acid-base disorders are then presented.
Presentation by Dr. Mishal Saleem on Topic: Step wise approach to abgs interpretation.
Use of delta ratio and delta gap
Use of Anion Gap
Use of Urinary anion gap
Presentation by Dr. Mishal Saleem on Topic: Step wise approach to abgs interpretation.
Use of delta ratio and delta gap
Use of Anion Gap
Use of Urinary anion gap
This presentation discuss about acid-base-gas normal ratio and its indication in relation to varying abnormal level and how to manage it. This includes clinical analysis practice.
ABG test measures the blood gas tension values of the arterial partial pressure of oxygen, and the arterial partial pressure of carbon dioxide, and the blood's pH
This presentation discuss about acid-base-gas normal ratio and its indication in relation to varying abnormal level and how to manage it. This includes clinical analysis practice.
ABG test measures the blood gas tension values of the arterial partial pressure of oxygen, and the arterial partial pressure of carbon dioxide, and the blood's pH
biology of evil, basic understanding of the neuropsychological basis of evilmusayansa
gives a biological understanding of the evil side of mankind.
trying to lay down the neuropsychological basis of evil.
fun to read and easy to understand.
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.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
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.
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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
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
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!
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
2. Definitions
• An acid base disorder is a change in the normal value of
extracellular pH that may result when renal or respiratory
function is abnormal or when an acid or base load overwhelms
excretory capacity.
• Normal acid base values
pH PCO2 HCO3-
Range: 7.35- 7.45 35-45 22- 26
Optimal value 7.40 40 24
• Acid base status is defined in terms of the plasma pH.
3. Definitions cont’d
• Acid
Substance that contains H+ ions
that can be released (H2CO3)
Carbonic acid releases H+ ions
• Base
Substance that can accept H+ ions
(HCO3)
Bicarbonate accepts H+ ions
4. Definitions cont’d
Acidemia - decrease in the blood pH below normal range (i.e.PH
<7.35)
• Alkalemia - Elevation in blood pH above the normal range of
(i.e. pH >7.45)
• Clinical disturbances of acid base metabolism classically are
defined in terms of the HCO3- /CO2 buffer system.
• Acidosis – process that increases [H+] by increasing PCO2 or
by reducing [HCO3-]
Alkalosis – process that reduces [H+] by reducing PCO2 or by
increasing [HCO3-]
16. Below is table summarizing compensatory
responses and their mechanisms
Primary
disorder
Initial chemical
change
Compensatory
response
Compensatory
Mechanism
Expected level
of
compensation
Metabolic Acidosis ↓HCO3- ↓PCO2 Hyperventilation
PCO2 = (1.5 ×
[HCO3-]) + 8 ± 2
↓PCO2 = 1.2 ×∆ [HCO3-]
PCO2 = last 2 digits of pH
Metabolic Alkalosis ↑HCO3- ↑PCO2 Hypoventilation
PCO2 = (0.9 × [HCO3-]) +
16 ± 2
↑PCO2 = 0.7 × ∆ [HCO3-]
Respiratory Acidosis ↑PCO2 ↑HCO3-
Acute
Intracellular Buffering
(hemoglobin, intracellular
proteins)
↑[HCO3-] = 1 mEq/L for
every 10 mm Hg ∆PCO2
17. Primary
disorder
Initial chemical
change
Compensatory
response
Compensatory
Mechanism
Expected level
of compensation
Chronic
Generation of
new HCO3- due
to the increased
excretion of
ammonium.
↑[HCO3-] = 3.5
mEq/L for every
10 mm Hg
∆PCO2
Respiratory
Alkalosis
↓PCO2 ↓HCO3-
Acute
Intracellular
Buffering
↓[HCO3-] = 2
mEq/L for every
10 mm Hg
∆PCO2
Chronic
Decreased
reabsorption of
HCO3-, decreased
excretion of
ammonium
↓[HCO3-] =4
mEq/L for every
10 mm Hg
∆PCO2
21. • Normal Anion Gap (8-16 meq)
• Loss of Bicarbonate:
Diarrhea
Carbonic anhydrase inhibitors
Type 2 RTA (proximal)
Pancreatic ileostomy
Pancreatic, biliary, intestinal fistula
22.
23.
24.
25. Metabolic Alkalosis
• 1) Loss of hydrogen
A. Gastrointestinal loss
1. Removal of gastric secretions: Vomiting or
nasogastric suction
2. Chloride-losing diarrhea
3. Gastrocolic fistula
4. Villous adenoma
5. Antacid therapy, particularly if combined with cation
exchange resin
26. • B. Renal loss
1. loop or thiazide diuretics
2. Mineralocorticoid excess (Primary Aldo, Cushings,
steroids, licorice)
3. Post chronic hypercapnia
4. Hypercalcemia, including the milk of alkali syndrome
C. H+ movement into cells
1. Hypokalemia
27. • 2) Exogenous Alkali
A. Administration of NaHCO3, sodium citrate, gluconate,
acetate, antacids
B. Massive blood transfusion
C. Antacids - Milk alkali syndrome
• 3) Contraction alkalosis
A. Loop or thiazide-type diuretics
B. Sweat losses in cystic fibrosis
C. Gastric losses in achlorhydria
37. Stepwise approach to interpreting the arterial blood
gas.
• 1. History &Physical exam. The most clinical useful information
comes from the clinical description of the patient by the history and
physical examination. The H&P usually gives an idea of what acid base
disorder might be present even before collecting the ABG sample
• 2. Look at the pH. Is there an acid base disorder present?
- If pH < 7.35, then acidemia
- if pH > 7.45, then alkalemia
- If pH within normal range, then acid base disorder not likely
present.
- pH may be normal in the presence of a mixed acid base
disorder, particularly if other parameters of the ABG are abnormal.
38. Steps cont’d
• 3. Look at PCO2, HCO3-. What is the acid base process (alkalosis vs
acidosis) leading to the abnormal pH? Are both values normal or abnormal?
- In simple acid base disorders, both values are abnormal and direction of
the abnormal change is the same for both parameters.
- One abnormal value will be the initial change and the other will be the
compensatory response.
• 3a. Distinguish the initial change from the compensatory response.
- The initial change will be the abnormal value that correlates with the
abnormal pH.
- If Alkalosis, then PCO2 low or HCO3- high
- If Acidosis, then PCO2 high or HCO3- low.
• Once the initial change is identified, then the other abnormal parameter is
the compensatory response if the direction of the change is the same. If not,
suspect a mixed disorder.
39. Steps cont’d
• 3b. Once the initial chemical change and the compensatory
response is distinguished, then identify the specific disorder.
- If PCO2 is the initial chemical change, then process is
respiratory.
- if HCO3- is the initial chemical change, then process is
metabolic.
41. Steps cont’d
• 4. If respiratory process, is it acute or chronic?
- An acute respiratory process will produce a
compensatory response that is due primarily to rapid
intracellular buffering.
- A chronic respiratory process will produce a more
significant compensatory response that is due primarily to
renal adaptation, which takes a longer time to develop.
- To assess if acute or chronic, determine the extent of
compensation.
42. Below is table summarizing compensatory
responses and their mechanisms
Primary
disorder
Initial chemical
change
Compensatory
response
Compensatory
Mechanism
Expected level
of
compensation
Metabolic Acidosis ↓HCO3- ↓PCO2 Hyperventilation
PCO2 = (1.5 ×
[HCO3-]) + 8 ± 2
↓PCO2 = 1.2 ×∆ [HCO3-]
PCO2 = last 2 digits of pH
Metabolic Alkalosis ↑HCO3- ↑PCO2 Hypoventilation
PCO2 = (0.9 × [HCO3-])
+ 16 ± 2
↑PCO2 = 0.7 × ∆ [HCO3-]
Respiratory Acidosis ↑PCO2 ↑HCO3-
Acute
Intracellular Buffering
(hemoglobin, intracellular
proteins)
↑[HCO3-] = 1 mEq/L for
every 10 mm Hg ∆PCO2
43. Primary
disorder
Initial chemical
change
Compensatory
response
Compensatory
Mechanism
Expected level
of compensation
Chronic
Generation of new
HCO3- due to the
increased
excretion of
ammonium.
↑[HCO3-] = 3.5
mEq/L for every
10 mm Hg ∆PCO2
Respiratory
Alkalosis
↓PCO2 ↓HCO3-
Acute
Intracellular
Buffering
↓[HCO3-] = 2
mEq/L for every
10 mm Hg ∆PCO2
Chronic
Decreased
reabsorption of
HCO3-, decreased
excretion of
↓[HCO3-] =4
mEq/L for every
10 mm Hg ∆PCO2
45. Steps cont’d
• 5. If metabolic acidosis, then look at the Anion Gap.(Normal
range is 12-16)
- If elevated (> than 16), then acidosis due to KULT.
(Ketoacidosis, Uremia, Lactic acidosis, Toxins).
- If anion gap is normal, then acidosis likely due to diarrhea,
RTA.
• 6. If metabolic process, is degree of compensation adequate?
- Calculate the estimated PCO2, this will help to
determine if a separate respiratory disorder is present.
46. Case 1
• A 44 year old moderately dehydrated man was
admitted with a two day history of acute severe diarrhea.
Electrolyte results: Na+ 134, K+ 2.9, Cl- 108, HCO3-
16, BUN 31, Cr 1.5.
ABG: pH 7.31 pCO2 33 mmHg
HCO3 16 pO2 93 mmHg
• What is the acid base disorder?
47. Case 2
A 22 year old female with type I DM, presents to the emergency
department with a 1 day history of nausea, vomiting, polyuria,
polydypsia and vague abdominal pain. O/E. noted for deep
sighing breathing, orthostatic hypotension, and dry mucous
membranes.
• Labs: Na 132 , K 6.0, Cl 93, HCO3- 10 glucose 720, BUN 38,
Cr 2.6.
ABG: pH 7.27 HCO3- 10 PCO2 23
• What is the acid base disorder?
48. Case 3
• A previously well 55 year old woman is admitted
with a complaint of severe vomiting for 5 days. Physical
examination reveals postural hypotension, tachycardia,
and diminished skin turgor. The laboratory finding
include the following:
• Electrolytes: Na 140 , K 3.4, Cl 77 HCO3 9,Cr 2.1
ABG: pH 7.23 , PCO2 22mmHg
• Interpret the ABGs
49. Case 4
• A 70 year old man with history of CHF
presents with increased shortness of breath and
leg swelling.
ABG: pH 7.24, PCO2 60 mmHg, PO2 52
HCO3- 27
• What is the acid base disorder?
50. Case 5
• A 72 year old man with history of COPD presents to the
hospital with alcoholic ketoacidosis.
• Serum chemistry: Na 136, K 5.1, Cl 85, HCO3- 25, BUN 28,
Cr 1.4,
ABG: pH 7.20, PCO2 60, HCO3- 25, PO2 75
Urine ketones 2+
• If the patient’s previous anion gap was 12, what was his
bicarbonate concentration prior to the onset of ketoacidosis?
51. Case 6
• A 50 year old insulin dependent diabetic woman was brought
to the ED by ambulance. She was semi-comatose and had been ill
for several days. Current medication was digoxin and a thiazide
diuretic for CHF.
Lab results
Serum chemistry: Na 132, K 2.7, Cl 79,
HCO3 19 Glu 815,
Lactate 0.9 urine ketones 3+
ABG: pH 7.41 PCO2 32 HCO3- 19 pO2 82
• What is the acid base disorder?
52. Case 7
A 60 year old homeless man presents with nausea, vomiting
and poor oral intake 2 days prior to admission. The patient
reports a 3 day history of binge drinking prior to symptoms.
Labs : Serum chemistry: Na 132, K 5.0, Cl 104, HCO3- 16 ,
BUN 25, Cr 1.3, Glu 75
ABG: pH 7.30, PCO2 29, HCO3- 16, PO2 92
Serum albumin 1.0
interpret the ABGs ?