This document discusses acid-base homeostasis and disorders. It begins by outlining the physiology of acid-base balance, noting the roles of the respiratory, renal, and buffering systems in maintaining homeostasis. It then covers the four primary acid-base disorders: respiratory acidosis, metabolic acidosis, metabolic alkalosis, and respiratory alkalosis. The document provides frameworks for evaluating acid-base status using an arterial blood gas and for interpreting compensatory responses. Sample cases are presented and analyzed to demonstrate applying these evaluation frameworks in clinical scenarios.
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
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
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.
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
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
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.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
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micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
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
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Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
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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
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Title: Sense of Smell
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 primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
1. Practical Acid Base
Hugo Carmona, MD
Division of Pulmonary, Critical Care and Sleep Medicine
University of Washington
2. Learning Objectives
• To discuss the physiology of acid-base homeostasis
• To explain the pathogenesis, risk factors, and clinical
manifestations of acid-base imbalances
• To build a framework for solving acid-base problems based on
history and lab data
There are many acid base disorders. This talk will not cover the underlying diseases
themselves in any great detail. We will instead build a framework for approaching
the problems.
3. Main principles of Acid-Base Homeostasis
• Cellular metabolism creates volatile and nonvolatile acids
• Volatile acid (Carbonic acid) is excreted by the lungs
• Nonvolatile acid (metabolic) is excreted by the kidneys: lactic acids
• Acids must be excreted to maintain homeostasis
• Buffers are the primary mechanism for maintaining pH balance
• Compensations in each system cause abnormalities in order to
maintain pH balance
4. Why does it matter to maintain homeostasis?
• Proper cell function, metabolism, protein function, salts,
• Cardiac, and brain activities
5. 3 Main Systems for Dealing with Acid/Base
Imbalance
• Buffers – immediate control
• Respiratory system – “delayed”
• Not as fast as buffer
• Renal system – delayed
• Can take days to compensate
Buffer
Renal
Respiratory
7. 4 major primary disorders
• Respiratory acidosis
• Metabolic acidosis
• Metabolic alkalosis
• The above 3 co-exists
• Respiratory alkalosis
• You can not have resp alkalosis with resp acidosis
8. Introduction to buffering system
• Each buffer is a weak acid and a base
• Donates H+ when too alkalotic
• Receives H+ when too acidic
• Primary buffer – carbonic acid-bicarbonate (extracellular)
• Bicarbonate HCO3
- is weak alkalotic, CO2 is the acid
• Bicarbonate made in RBC (Carbonic Anhydrase), gastric parietal cells and
kidney
• Other buffers: Phosphate (intracellular, renal tubules), hemoglobin (RBC),
protein (intracellular, blood)
10. Respiratory System
• Respiratory system: eliminates volatile acid (H2CO3)
• Eliminate carbonic acid via CO2
• System adjusts ventilation (rate, depth = minute ventilation) to amount of
carbonic acid remaining
• Thus, if PaCO2 building up, carbonic acid is building up
Lungs
11.
12. Renal System
• All other acids are nonvolatile = metabolic acids: lactic, keto,
phosphorus,
• Kidneys can excrete all metabolic acids (and cannot excrete volatile
acids)
• During normal excretion
• 1. distal tube secretes H+ -> acidify urine.
• 2. Phosphate and ammonia buffer to prevent over acidification
• Lots of acid? -> Lots of ammonia production
• 3. HCO3- (bicarbonate ion) reabsorbed to allow more blood buffering
16. Three Methods for Evaluating Acid Base
Disorders
• Base excess – using algorithms and charts (nomograms) to determine
amount of acid or base required to restore pH
• Often lab will calculate this for you
• Doesn’t identify co-existing metabolic disorders
• Physiochemical – Using PaCO2, SID, total nonvolatile weak acids
• Physiologic – Using HCO3 and anion gap
• Identifies four major disorders
17. Physiologic Method of Evaluating Acid Base
Disorder
• Henderson-Hasselbach Equation
• Isohydric principle = Acid is a H+ donor and base is a H+ acceptor
• Requires serum lab values and blood gas analysis
• Use this balance as a principle
18. How do you evaluate your patient’s acid base
status?
• Build a framework
• General appearance
• VS/RR
• Hx gathering
• CMP
• UA
• ABG
• pH
• Hco3-
• Co2
• Resp
• Kidney?
• GI?
19. Analyzing Acid-Base Status: A framework
• ABG: pH/PaCO2/PaO2/HCO3- (SEQUENCE!)
• Examine the pH and comparing it to the normal range
• Identify the primary process that led to the change in pH
• Calculate the serum anion gap
• Identify the compensatory process (if one is present)
• Identify if any other disorders are present or there is a mixed acid-
base process. (delta delta)
From A Luks. “A Primer on ABG Analysis”
22. Some cases
• 7.26/58/60/25
• Respiratory acidosis; uncompensated
• 7.55/30/60/24
• Respiratory alkalosis; uncompensated
• 7.14/27/100/14
• Metabolic Acidosis, compensated
• 7.52/35/100/38
• Metabolic Alkalosis, trying compensated
From A Luks. “A Primer on ABG Analysis”
23. Reading an ABG
• pH/PaCO2/PaO2/HCO3-
• Examine the pH and comparing it to the normal range
• Identify the primary process that led to the change in pH
• Calculate the serum anion gap
• Identify the compensatory process (if one is present)
• Identify if any other disorders are present or there is a mixed acid-
base process. (delta delta)
From A Luks. “A Primer on ABG Analysis”
24. Serum Anion Gap
The serum AG
attempts to
capture
“unmeasured”
metabolic acids:
other acids that
was not
measured
Ajkdblog.org
25. Serum Anion Gap
• Anion gap = [Na+] – ([Cl-] + [HCO3])
• Adjust for serum albumin
• For every 1 pt drop in albumin, anion gap is likely about 3 pts larger
• In other words, a normal serum anion gap = serum albumin * 2.5
• Normal anion gap is usually about 10 +/- 2
Na
K
Cl
HCO3
BUN
Cr
Gluc
26. Calculate the anion gap
• AG: 140 – (100+28) = 12
• Normal AG = 5
• AG: 130 – (110+16) = 4
• Normal AG = 10
140
3.5
100
28
20
2.5
110
Albumin 2
130
3.5
110
16
20
1
110
Albumin 4
30. Reading an ABG
• pH/PaCO2/PaO2/HCO3-
• Examine the pH and comparing it to the normal range
• Identify the primary process that led to the change in pH
• Calculate the serum anion gap
• Identify the compensatory process (if one is present)
• Identify if any other disorders are present or there is a mixed acid-
base process. (delta delta and serum osm gap)
From A Luks. “A Primer on ABG Analysis”
31. Break then Cases!
• What is/are the acid/base process(es) present? What is primary
process? If any, what are the compensatory processes?
• What is the differential diagnosis for this kind of disease?
32. Case 1
• 18 yo presents with abdominal pain, nausea, and confusion.
• Siblings were sick with a “stomach bug” for a few days beforehand
• Hasn’t been able to take any medication or eat due to nausea
132
5.5
80
14
45
1.5
425 ABG: 7.18/26/90/15
Albumin 4
Anion gap: 132 – (80+14) = 38
37. Case -1 Revisited. Is compensation
appropriate?
• Winter’s Formula: is the resp compensation in metabolic appropriate?
• PCO2=1.5 X[HCO3-]+8+/-2
• Even if the CO2 is low, the pt still has respiratory acidosis because the value is
over than what is expected
41. Case 2
• 70yo is found in their acute care room obtunded, with pinpoint pupils
and cyanosis
• They are POD1 s/p cholecystectomy
• They have no other medical problems
140
3.5
109
24
20
2
110 ABG: 7.15/90/53/24
Albumin 3
Anion gap: 140 – (109+24) = 7
Normal anion gap = 7.5
44. Respiratory Acidosis Compensation
• “Metabolic” compensation: Renal excretion of metabolic acids
• Requires days
• Loss of metabolic acids means more HCO3- around, restores pH
balance
46. Case 3
• 19 yo presents presents with severe depression. They are admitted
for “medical clearance”
• In the morning, they have a rapid response for tachypnea with RR in
the 30s after the phlebotomist came in to take bloodwork
• They deny taking any medications
140
4
110
22
15
0.6
100
ABG: 7.49/26/110/23
Albumin 4
Anion gap: 140-(110+22)=8
50. Case 4
• That same patient is readmitted with a suspected suicide attempt.
• They were found outside, delirious, and tachpneic
• They have evidence of emesis on them
142
3.6
85
28
30
1
120
ABG: 7.46/55/105/28
Albumin 4
Anion gap: 142-(85+28) = 29
52. Metabolic Alkalosis
• Excessive base or loss of metabolic acid
• Stomach is a large reservoir of gastric acid
• S/sx: muscle weakness, hypokalemia, hypovolemia, parasthesia,
seizure
In the body tolerates acidemia better than alkalotic; pt with alkalemia has more symptoms
Example: COPD, dump more H+ and keep more HCO3-, elevated HCO3-
Benefit that allows for both understanding of all disorders and causes
Often, it’s helpful to have a story and context
pH can be normal with mixed acid-base disorder
There’s a gap between
Serum Anion gap= Na+-
Adjust for serum albumin
AG can indicate there’s unmeasured metabolic acids causing acidemia
Lactic acidosis, renal failure and keto acidosis
What is/are the acid/base process(es) present? What is primary process? If any, what are the compensatory processes?
What is the differential diagnosis for this kind of disease?
Normal AG=10
Albumin: 4
Metabolic Acidosis, trying to compensated
AnionG= high
Ddx:
Lactic acidosis, renal failure and keto acidosis
Top part: most anion gap causes
Bottom part: most non-anion gap– loose a bunch of bicarbonate, acidosis that does not have an AG
Resp, Acidosis, uncompensated
Normal AG
Elevated R
Acute respiral failure ARDS; sepsis;
Opioid induced repiraotry hypotention;
Kideny will not act up quickly enough
Tx: reverse the sedation, Oxygenation, ventilation
What is/are the acid/base process(es) present? What is primary process? If any, what are the compensatory processes?
What is the differential diagnosis for this kind of disease?
Resp alkalosis, uncomnepsated,
Anion gap normal
Psychogenic tachypnea
Hypoxemia! lung
Pain
Anxiety
Metabolic Alkalosis, trying to compesnated almost normal
Elevated aniona gap,
Vomitng – taking some meds
Low intermittent NG suction can often cause in an acute setting