This document provides an overview of arterial blood gas (ABG) analysis. It defines ABG and its components, including pH, PaO2, PaCO2, HCO3, and SaO2. Normal values for each component are listed. Acid-base imbalances, including respiratory acidosis, respiratory alkalosis, metabolic acidosis, and metabolic alkalosis are described. Causes, signs, symptoms, and management are covered for each imbalance. The document also explains how to interpret an ABG strip and assess compensated vs non-compensated acid-base disorders.
this slide focuses on all the acid base disorder pertaining to the respiratory system. it focus on the compensatory mechanism, causes, clinical features and treatment.
Provides a simple organized way for ABG analysis with special emphasis on Acid-base balance interpretation & its crucial rule in clinical toxicology practice.
this slide focuses on all the acid base disorder pertaining to the respiratory system. it focus on the compensatory mechanism, causes, clinical features and treatment.
Provides a simple organized way for ABG analysis with special emphasis on Acid-base balance interpretation & its crucial rule in clinical toxicology practice.
Introduction to toxicology gases and metalsNITISH SHAH
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ECG is very important tool in diagnosis of various cardiovascular diseases ,it is important for every one dealing with cardiac patients to be aware about the basic information of electocardiogram, so my 1st lecture focused on conductiong system of the heart , the generation of deflection in ECG , and normal morphology of its waveform, and lastly focus oh method to determine heart rate and cadiac axis .
An arterial-blood gas test measures the amounts of arterial gases, such as oxygen and carbon dioxide. An ABG test requires that a small volume of blood be drawn from the radial artery with a syringe and a thin needle, but sometimes the femoral artery in the groin or another site is used.
The common indications for ABGs are:
Respiratory compromise, which leads to hypoxia or diminished ventilation.
Peri- or postcardiopulmonary arrest or collapse.
Medical conditions that cause significant metabolic derangement, such as sepsis, diabetic ketoacidosis, renal failure, heart failure, toxic substance ingestion, drug overdose, trauma, or burns.
Evaluating the effectiveness of therapies, monitoring the patient's clinical status, and determining treatment needs. For instance, clinicians often titrate oxygenation therapy, adjust the level of ventilator support, and make decisions about fluid and electrolyte therapy based on ABG results.
During the perioperative phase of major surgeries, which includes the preoperative, intraoperative, and postoperative care of the patient.
The components of an ABG analysis are PaO2, SaO2, hydrogen ion concentration (pH), PaCO2, HCO3-, base excess, and serum levels of hemoglobin, lactate, glucose, and electrolytes (sodium, potassium, calcium, and chloride).
First aid course focusing on management of burns, wounds of different types, disturbed conscious level and chemical intoxication whether by inhalation, ingestion or skin exposure.
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
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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.
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
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 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.
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.
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 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
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
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
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.
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.
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
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
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
2. Objectives
1)Define ABG & its indications.
2)Describe components of ABG & their normal
values.
3)Acid-Base imbalance.
4)Interpret ABG changes in clinical toxicology
practice.
3. What is the ABG?
Arterial blood gas analysis is an essential part for
diagnosing and managing the patient’s oxygenation
status, ventilation status and acid base balance.
Drawn from arteries( radial, brachial and femoral)
ABG
Oxygenation Ventilation Acid-Base
PaO2
SaO2
PCO2
PH
HCO3
4. ACID-BASE BALANCE
The primary aim of keeping this delicate balance is
to preserve the Homeostasis i.e. the highly complex
interactions that maintain all body systems to
functioning within a normal range.
Any extreme change in this balance (PH < 6.8 or >
7.8) may result in disastrous changes e.g.
denaturation of proteins & shut down of all
enzymatic and metabolic processes. Such disturbed
environment would be incompatible with life.
5.
6. Basic Biochemistry Facts
•Water (H2O) forms about 65 % of our total body weight.
•When acid e.g. HCL dissolves in a solution, it ionizes into H+
(Proton) and Cl-. So, The amount of H+ (Protons) in the solution
directly correlates with its acidity.
•When CO2 dissolves in a water solution, it combines with H2O to
form H2CO3. So, the amount of CO2 in the solution directly correlates
with its acidity.
•Most of our body metabolic processes make our media acidic e.g.
Metabolism of Fats and CHO generates CO2 (CO2+H2O=H2CO3)
Metabolism of Proteins generates many fixed acid e.g. Sulphuric,
Phosphoric and Uric acids.
•Bicarbonate is an amphoteric ion, meaning that it can behave as
either an acid or a base, depending on the surrounding media. Since
our internal body media is acidic so, It can be considered as a Base
(Alkali).
7. TO SUM UP…
•Increase in H+ or CO2 = Increase acidity
•Decrease in H+ or CO2 = Decrease acidity
•Increase in Bicarbonate = Increase alkalinity
•Decrease in Bicarbonate = Decrease alkalinity
Q: How to make the media more acidic?
1.Adding more acids e.g. H+ or CO2
2.Removing its alkaline part e.g. HCO3
Q: How to make the media more alkaline?
1.Adding more bases e.g. HCO3-
2.Removing its acidic part e.g. H+ or CO2
8. How can the body maintain that acid-base
balance?
•The 2 body systems that always try to achieve this balance are:
1)The Kidneys: through manipulating the amount of HCO3- and
H+ (By secretion, excretion or reabsorption)
2)The Lungs: through manipulating the amount of CO2 (Increase
or decrease the respiratory rate)
•If there is a defect in one system, the other one tries to buffer its
effects in order to reach the balance required for proper
homeostatic functioning (the principle of Compensation).
•The response of each system to make that balance varies e.g.
The Lungs: Respond in minutes.
The Kidneys: Respond in hours to days.
9. What are the components of ABG?
pH
Measurement of acidity or
alkalinity, based on the hydrogen
(H+)
7.35 – 7.45
PaO
2
The partial pressure oxygen that
is dissolved in arterial plasma.
80 - 100 mm Hg
PaCO2
The amount of carbon dioxide
dissolved in arterial blood.
35 – 45 mmHg
10. What are the components of ABG?
HCO
3
The calculated value of the serum
concentration of bicarbonate
22 – 26 mEq/L
SaO2
The arterial oxygen saturation.
>95 %
11. pH (Power of Hydrogen)
•pH is the negative logarithm of hydrogen ion concentration
in a water-based solution.
•Negative = Inversely related to the H+ ion concentration i.e.
Increase in H+ conc. In a solution decreases the PH.
•Why we use a logarithmic scale?
•H+ conc. Is expressed in nanoequivalents per liter. So, we use
the Log scale to shrink that large range into a simple scale (1-
14) making it easier to compare the magnitude of solution
acidity or alkalinity.
•For example, a pH of 3 is ten times more acidic than a pH of
4 and 100 times (10x10) more acidic than a pH value of 5.
13. ACID BASE DISORDERSACID BASE DISORDERS
BASIC CONCEPTS
•ABG shouldn’t be used alone in the diagnosis. Correlate the
clinical findings with the other lab and imaging studies to get a
panoramic assessment of the patient’s condition.
•ABG findings can assist not only in reaching a diagnosis, but
also in determining the prognosis of a patient.
14. (I) Respiratory Acidosis
It is defined as a pH less than 7.35 with a Paco2
greater than 45 mmHg.
Acidosis is the accumulation of co2 which
combines with water in the body to produce
carbonic acid, thus lowering the pH of the
blood.
15. Toxic Causes :
•Any condition that results in hypoventilation can cause
respiratory acidosis.
(a)
Central
(b)
Peripheral
CNS depression
opiates, sedatives,
anesthesia, methanol,
ethylene glycol...etc.
1-Respiratory muscle
paralysis
e.g. botulism
2- lung disease
e.g. pulmonary edema
3- respiratory passage
obstruction
e.g. organophosphorus
16. Signs & symptoms of Respiratory
Acidosis:
•Respiratory: Respiratory distress & shallow respiration.
•Nervous: (CO2 Narcosis) Headache, restlessness and
confusion. If co2 is extremely high, drowsiness and
unresponsiveness may be noted.
•CVS: Tachycardia and Dysrhythmias due to myocardial hypoxia.
Management:
•Oxygen & suctioning as needed.
•Pulse oximetry & ABG follow up.
•Treatment of the cause e.g. pneumothorax, severe pain (Rib
fracture) and CNS depressants toxicity.
•If the cause can not be readily resolved, mechanical ventilation.
17. (II) Respiratory Alkalosis
It is defined as a pH greater than 7.45 with a Paco2
lesser than 35 mmHg.
Alkalosis is due to excessive wash of co2
(hyperventilation), thus increasing the pH of the
blood.
18. Respiratory alkalosis…
Cont’dCauses : Excessive wash of co2 ( hyperventilation)
•Central stimulation: Psychological responses, Panic attack
(Cannabis), drugs as early theophylline & salicylates toxicity…etc.
•Withdrawal manifestations from depressant agents.
•Increased metabolic demands e.g. fever, sepsis, pregnancy or
thyrotoxicosis. (Body tries to get rid off the excess CO2 produced)
•Central nervous system lesions (CO2 is a potent cerebral V.D)
•MetHB, SulphHB. (compensation of Metabolic acidosis)
Signs &
symptoms:•CNS: Tachypnea, numbness, tingling, confusion, inability to
concentrate and blurred vision (Decrease cerebral Bl. Flow).
•CVS: Dysrhythmias and palpitations.
•Tetanic spasms of the arms and legs (Decrease ionized calcium).
19. Management of Respiratory
Alkalosis
• Oxygen for any patient with respiratory distress of any origin.
• Pulse oximetry and ABG monitoring.
• Treatment of the cause.
• If panic attack: calm the patient, oxygen +/- Benzodiazepines.
• If carpo-pedal spasms occur, don’t give calcium because it is
all a matter of distribution and not a decrease in total body
calcium.
20. (III) Metabolic Acidosis
It is defined as a pH less than 7.35 with a Hco3 less
than 22 mEq/L.
Toxic Causes : Any disorder that will lead to tissue
hypoperfusion whatever the cause will lead eventually to increase
in lactic acid production resulting in Metabolic Acidosis.
1) Late salicylate
2) Methanol
3) Ethylene glycol
4) Iron
21. Bicarbonate less than 22mEq/L with a pH of less than 7.35
Causes:
• Renal failure (Sulphuric, phosphoric, uric acids…etc.)
•Diabetic Ketoacidosis (Ketoacids)
•Anaerobic metabolism (Lactic acid)
•Starvation (Ketoacids)
•Convulsions (Lactic acid)
•Drugs: Salicylates, methanol, ethylene glycol, metformin intoxication.
•Diarrhea & ATN…normal anion gap metabolic acidosis.
Metabolic Acidosis…
Cont’d
Sign & symptoms
•CNS: Headache, confusion and restlessness progressing to lethargy,
then stupor or coma.
•Respiratory: Acidotic (Kussmaul) breathing: Rapid and shallow
•CVS: Tachycardia and Dysrhythmias
22. Management of Metabolic Acidosis
• Treatment of the cause should be our primary aim.
• Maintain adequate tissue oxygenation & Hemodynamic
stability.
• In severe cases, we can use Sodium Bicarbonate as a buffer
to maintain a pH value that is compatible with a proper
homeostatic functioning.
• N.B. Correction with NaHCO3 should proceed in a cautious
and non-aggressive way because pouring too much base
into the circulation would cause a left shift in the O2
dissociation curve (Less release of O2 from HB into the
tissues) causing more tissue hypoxia and may worsen the
patient’s condition.
• So, NaHCO3 correction should be guided by the
Hemodynamic status of the patient and ABG monitoring to
make a proper adjustment of the milliequivalents needed.
23. (IV) Metabolic Alkalosis
It is defined as a pH greater than 7.45 with Hco3 greater than
28 mEq/L
Causes
It is due to excessive acid loss (repeated vomiting and
nasogastric suction) OR bicarbonate retention e.g.
overuse of sodium bicarbonate .
24. Metabolic alkalosis…
Cont’dBicarbonate more than 26:28 mEq/L with a pH more than 7.45
Causes:
Excess of base OR loss of acid.
•Ingestion of excess antacids, excess use of bicarbonate, or use of
lactate in dialysis.
•Sever repeated vomiting, gastric suction, excess use of diuretics
(Furosemide & HCTZ), or high levels of aldosterone.
•Excess Corticosteroids use.
Signs/symptoms:
•CNS: Dizziness, lethargy disorientation, seizures & coma.
•M/S: weakness, muscle twitching, muscle cramps and tetanic spasms.
•GIT: Nausea, vomiting
•Respiratory depression (Compensation).
Treatment of the cause and stop the offending
agent.
26. Step 1: Assess the pH
•If below 7.35 = acidotic
•If above 7.45 = alkalotic
Step 2:
1- Assess the paCO2 level
•If below 35 = Respiratory alkalosis element
•If above 45 = Respiratory acidosis element
How can I interpret an ABG Strip?
2- Assess HCO3 value
•If below 22 = Metabolic acidosis element
•If above 26 = Metabolic alkalosis element
27. Step 3:
Determine if there is a compensatory mechanism
working to try to correct the pH (Full or partial).
Primary metabolic acidosis will have decreased
pH and decreased HCO3. Compensation occurs by
hyperventilation occur to decrease PaCO2
(Respiratory alkalosis).
Example:
Primary respiratory acidosis will have increased
PaCO2 and decreased pH. Compensation occurs when
the kidneys retain HCO3 (Metabolic alkalosis).
N.B. Over-compensation Never happen.
28.
29.
30. Case (1)
45 years old female patient admitted with a severe
attack of asthma. She has been experiencing increasing
shortness of breath since admission three hours ago.
Her arterial blood gas result is as follows:
pH: 7.22
PaCO2: 55 mmHg
HCO3: 25 mEq/L
Q1: What is the primary acid-base disorder in this patient?
Q2: Name 3 toxins that would give a similar ABG findings.
31. Comment:
•PH is low = Acidosis.
•PaCO2 is high = Respiratory acidosis element.
•Hco3 is Normal = Normal Metabolic element.
“Respiratory Acidosis, Not compensated”
Some toxins that would result in respiratory
acidosis:
1. Opiates & Opioids toxicity.
2. Methanol & Ethylene glycol toxicity.
3. Barbiturates & Clonidine Toxicity.
4. Botulinum toxin.
5. Paralytic snake venom.
32. Case ( 2)
55 years old male patient admitted with recurring
bowel obstruction. He has been experiencing
intractable vomiting for the last several hours.
His ABG findings are:
pH: 7.50
PaCO2: 42 mmHg
HCO3: 33 mEq/L
Q1: What is the primary acid-base disorder in this patient?
Q2: What do you expect serum level of K+ and CL- to be in this patient?
Q3: Name 3 toxins that would lead to intractable severe vomiting.
33. Comment:
PH: Increases = Alkalosis
PaCO2: Normal = Normal Respiratory element.
HCO3: Increased = Metabolic Alkalosis element.
“Metabolic alkalosis, Non Compensated”
Serum K+ & Cl- would decrease in the setting of repeated vomiting.
Some toxins that lead to severe intractable
vomiting:
1. Theophylline intoxication.
2. Organophosphorus intoxication.
3. Acetylcholinesterase inhibitors medications (TTT of
Myasthenia gravis) e.g. Neostigmine and Pyridostigmine.
4. Acute Digitalis toxicity.
34. Case (3)
A 65 year old kidney dialysis patient who has missed his
last 2 sessions at the dialysis center.
The ABG findings:
PH: 7.24
PaCO2: 31 mmHg
HCO3: 17 mEq/L
Q1: What is the primary acid-base disorder in this patient?
Q2: What do you expect regarding his breathing pattern?
Q3: Name 3 toxins that may lead to a similar ABG findings.
35. Comment:
PH: Decreased = Acidosis
PaCO2: Slightly decreases = Respiratory Alkalosis element
HCO3: Decreased = Metabolic acidosis element
“Metabolic Acidosis with mild compensatory
respiratory alkalosis”
Since the primary disorder is Metabolic acidosis, the respiratory system tries to
compensate by increasing the R.R. to get rid off CO2 (Acid) so, respiration will be
rapid and shallow acidotic (Kussmaul breathing).
Some toxins that may lead to Metabolic acidosis:
1. Metformin (Lactic acid).
2. Carbon Monoxide.
3. Iron & INH.
4. Any toxin that lead to tissue hypoperfusion & tissue hypoxia (Directly or indirectly)
36. Case (4)
23 year old female presents with dyspnea 2 hours after
ingestion of a preserved red meat. She has blue lips and
nails beds. She denies any drug intake for any reason.
Her ABG findings:
PH: 7.31
PaCO2: 24 mmHg
HCO3: 18 mEq/L
Q1: What is the primary acid-base disorder in this patient?
Q2: Name 2 differential diagnoses.
Q3: How to differentiate between these 2 differentials?
Q4: What do you expect the PaO2 and SaO2 to be if the condition was toxin-induced?
Q5: What is your management plan?
37. Comment:
PH: Decreased = Acidosis
PaCO2: Decreased = Respiratory alkalosis element
HCO3: Decreased = Metabolic acidosis element
“Metabolic acidosis partially compensated by
Respiratory alkalosis”
Differential diagnosis:
1.anxiety or panic attack
2.MetHB
How to Differentiate:
1.Presence or absence of metabolic acidosis.
2.MetHB level in the blood.
•In MetHB, SulphHB or CarboxyHB, the PaO2 & SaO2 are NORMAL.
Management:
1.Check vital signs.
2.Oxygen & Pulse oximeter.
3.Clinical, ABG and ECG monitoring
4.If no improvement, Methylene blue can be used to oxidize Fe+3 to normal ferrous HB.
Editor's Notes
Kidney impairment must be present to maintain the metabolic alkalosis.