Acid / Base Balance – Interpretation of Results comep oc 2010
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Acid / Base Balance – Interpretation of Results comep oc 2010
- 1. CoMEP TEACHING ACID / BASE BALANCE – INTERPRETATION OF RESULTS Dr. Alan S. Hutchison Clinical Biochemistry South Glasgow
- 8. Those of a nervous disposition, look away now……
- 10. Simple acid / base disorders [HCO 3 - ] P CO 2 Respiratory alkalosis [HCO 3 - ] P CO 2 Respiratory acidosis P CO 2 [HCO 3 - ] Metabolic alkalosis P CO 2 [HCO 3 - ] Metabolic acidosis Compensation Primary derangement [H + ] Disorder
- 13. METABOLIC ALKALOSIS Causes: vomiting, n/g suction, diarrhoea, villous adenoma of colon, diuretics, penicillin, Conn’s, Cushing’s & Bartter’s syndromes, liquorice ingestion, re-feeding, bicarbonate infusion 35 6.3 7.49 32 [HCO 3 - ] mmol/L (23-30) Pa CO 2 kPa (4.6-6.0) pH [H + ] nmol/L (36-43)
- 15. RESPIRATORY ALKALOSIS Causes: Any cause of hyperventilation, e.g. anxiety, CNS lesions, stimulants, fever, toxaemia, hyperthyroidism, pregnancy, hepatic disease, LVF, PTE, pneumonia [HCO 3 - ] mmol/L (23-30) Pa CO 2 kPa (4.6-6.0) pH [H + ] nmol/L (36-43) (chronic) 17 3.3 7.40 40 (acute) 22 3.3 7.47 34
- 22. 72-year-old man post cardiac arrest [HCO 3 - ] mmol/L (23-30) Pa CO 2 kPa (4.6-6.0) pH [H + ] nmol/L (36-43) 14 8.9 6.93 118
- 24. 72-year-old man post cardiac arrest Mixed metabolic acidosis and respiratory acidosis [HCO 3 - ] mmol/L (23-30) Pa CO 2 kPa (4.6-6.0) pH [H + ] nmol/L (36-43) 14 8.9 6.93 118
- 25. 62-year-old woman with congestive cardiac failure [HCO 3 - ] mmol/L (23-30) Pa CO 2 kPa (4.6-6.0) pH [H + ] nmol/L (36-43) 31 3.5 7.64 21
- 27. 62-year-old woman with congestive cardiac failure Mixed metabolic alkalosis and respiratory alkalosis [HCO 3 - ] mmol/L (23-30) Pa CO 2 kPa (4.6-6.0) pH [H + ] nmol/L (36-43) 31 3.5 7.64 21
- 28. 45-year-old woman with pulmonary thrombo-embolism [HCO 3 - ] mmol/L (23-30) Pa CO 2 kPa (4.6-6.0) pH [H + ] nmol/L (36-43) 14 2.7 7.45 35
- 30. 45-year-old woman with pulmonary thrombo-embolism Mixed metabolic acidosis and respiratory alkalosis [HCO 3 - ] mmol/L (23-30) Pa CO 2 kPa (4.6-6.0) pH [H + ] nmol/L (36-43) 14 2.7 7.45 35
- 31. 80-year-old man with cor pulmonale [HCO 3 - ] mmol/L (23-30) Pa CO 2 kPa (4.6-6.0) pH [H + ] nmol/L (36-43) 51 9.3 7.48 33
- 33. 80-year-old man with cor pulmonale Mixed metabolic alkalosis and respiratory acidosis [HCO 3 - ] mmol/L (23-30) Pa CO 2 kPa (4.6-6.0) pH [H + ] nmol/L (36-43) 51 9.3 7.48 33
- 34. 72-year-old man with l.v.f. treated with a diuretic Mixed metabolic alkalosis and respiratory alkalosis Add a lactic acidosis 12 94 140 34 4.0 7.67 21 Anion-cation gap (8-16) [Cl - ] mmol/L (97-107) [Na + ] mmol/L (135-145) [HCO 3 - ] mmol/L (23-30) Pa CO 2 kPa (4.6-6.0) pH [H + ] nmol/L (36-43) 18 94 140 28 4.0 7.58 26