This document discusses acid-base balance and disorders. It provides normal ranges for blood pH, PCO2, HCO3, and other markers. It describes different types of acidosis and alkalosis, including respiratory and metabolic varieties. Compensatory mechanisms that regulate blood pH are explained. Causes, signs, and treatments of acid-base imbalances are summarized. Caution is advised in correcting severe acidosis with bicarbonate.
Metabolic acidosis is a significant electrolyte disease defined by an acid-base imbalance in the body. Metabolic acidosis is caused by three major factors: increased acid production, bicarbonate loss, and a decreased ability of the kidneys to eliminate excess acids.
Metabolic acidosis is a significant electrolyte disease defined by an acid-base imbalance in the body. Metabolic acidosis is caused by three major factors: increased acid production, bicarbonate loss, and a decreased ability of the kidneys to eliminate excess acids.
Short Review regarding Metabolic Acidosis
The Causes, anion gap,urine osmolal gap, Renal Tubular Acidosis, approach to Metabolic Acidosis in Final Slide
Short Review regarding Metabolic Acidosis
The Causes, anion gap,urine osmolal gap, Renal Tubular Acidosis, approach to Metabolic Acidosis in Final Slide
Arterial blood gas test Diagnostic testjagan _jaggi
Arterial blood gas test
Diagnostic test
Description , 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.
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
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
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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.
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.
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
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.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
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
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.
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!
1. Dr. Hamed Ezzat El-Eraky
Nephrology Specialist
Mansoura International Hospital
2. PHPH
Is the –ve Log of H+ Concentration
Normal Plasma H+ Concentration is 40 nanomoles/litre
Thus, doubling or Halving H+ concentration Increases
or Decreases PH by Approximately 0.3
AcidAcid An H+ Donor
BaseBase An H+ Acceptor
3. Blood PH > 7.45AlkalaemiaAlkalaemia
Blood PH < 7.35AcidaemiaAcidaemia
AcidosisAcidosis
Is the Abnormal Process that Tends to
Lower the Blood PH
AlkalosisAlkalosis
Is the Abnormal Process that Tends to
Raise the Blood PH
4. PaO2PaO2
Is the Partial Pressure of O2 in arterial Blood Normal Value when Breathing Air: (Age Dependent(
95-100mmHg or 12.5-13 Kpa at Age of 20 Years - 80 mmHg or 10.8 Kpa at Age of 65 Years
A Substance that Counteracts the Effect of Acid or Base on Blood PHBufferBuffer
HCO3-HCO3- Is the Blood Bicarbonate Concentration Normal Value is : 22-26 mmol/l
PaCO2PaCO2 Is the Partial Pressure of CO2 in Arterial Blood Normal Value: 35-45 mmHg or 4.7-6 Kpa
Mixed DisorderMixed Disorder Two or More Primary Acid-Base Disorder Coexist
CompensationCompensation The Normal Body Processes that Returns Blood PH Towards Normal
6. Acid-base balance is assessed in terms of CO2-HCO3
buffer system. It is expressed in pH:
pH = 6.10 + log ([HCO3-] ÷ [0.03 x PCO2])
Large number of metabolic events are sensitive to pH
mainly brain and heart
That is why a number of mechanisms are present in acid
base regulation holding blood pH in narrow limits
7.38-7.42
7. An acidemia (low pH( can result from either a
low HCO3 or a high CO2 .
An alkalemia (high pH( can result from either
a
high HCO3 or a low CO2
8.
9. Continuous production of H+ from normal metabolism
Metabolic event Acid produced
Aerobic glycolysis CO2 (15,000 mmol/d)
Krebs Lactic acid
lipolysis Free FA
Hepatic metabolism ketones
Dietary protein amino acids
10. Immediately buffers in blood (NaHCO3)
change strong acid to weak acid
after several minutes this weak acid
decomposes to CO2 carried by Hb to be
expired by lungs
After several hours the kidney smoothly
reabsorbs the HCO3 wasted
11. Acidosis:
• hyperventilation to wash excess CO2 produced
• acidification of urine to remove H+
Alkalosis
• only alkalization of urine
• respiration cannot stop!!!
250 cases of acidosis for one case of alkalosis
12. Respiratory Acidosis
• CO2 retention due to hypoventilation: type II respiratory failure e.g.COPD
• there is conservation of HCO3 by the kidney
• new steady state of CO2 and HCO3 occurs
Metabolic Acidosis
• H+
buffered H2CO3 CO2 + H2O
• CO2 washed by hyperventilation CO2 falls
• HCO3 continuously consumed by H+ cannot raise and remains low HCO3
These compensatory mechanisms keep pH constant
When H+ production or CO2 retention > compensatory mechanisms fall in pH
acidosis
13. Fixed acids: which produces H+ cannot be excreted except
by kidneys e.g. lactic
Volatile acids can be changed into CO2 e.g. H2CO3 and
aerobic glycolysis
fixed : volatile = 100 : 15000 meq/day!!
Severe acidosis develops rapidly in respiratory
embarrassment
Acidosis develops slower in renal failure
14. HCl + NaHCO3 H2CO3 + Na Cl
Non volatile acids
Volatile acids
CO2H2O
HCO3
Kidney's
CO2 + H2O H2CO3
H+ Na+
CA
15. Normally blood is neutral
• amount of anions = amount of cations
Most abundant cations are
• Na+ 140 meq/L (135-145)
• K+ 4 meq/L (3.5-5.0)
Most abundant anions are
• HCO3 25 meq/L (22-26)
• Cl 104 meq/L (100-108)
16. If you measure all the anions they should be
equal to all the cations
• cations - anions = zero
it is difficult to measure them all.
An easy way is measure the most abundant
[Na + K] - [HCO3 + Cl] = [144] - [129] = 16
Why is this difference? Are the cations more?
Of course not
17. It is due to presence of unmeasured anions (and cations)
and if you measure them all definitely your sum will be zero
[Na + K + UC] - [HCO3 + Cl + UA] = 0
Unmeasured anions are mainly albumin and proteins
Unmeasured cations are mainly Ca and Mg
under normal conditions:
[Na + K] - [HCO3 + Cl] = 15 +/- 2
This is called normal anion gap
18. High Anion Gap Acidosis
Normal Anion Gap Acidosis
19. • There is a load of non chloride containing acid e.g. lactic
acid
• lactic acid + NaHCO3 Na lactate + H2CO3
• There is a fall in HCO3 conc and rise in lactate
• calc: [Na + K] - [HCO3 + Cl] = > 17
• The fall in HCO3 is compensated by the unmeasured
lactate
20. There is addition of a Cl acid e.g. HCl or Loss of
HCO3 (with renal absorption of chloride)
• HCl + NaHCO3 NaCl + H2CO3
• There is fall in HCO3 concentration and rise in chloride
• calc: [Na + K] - [HCO3 + Cl] = 15 +/- 2
since chloride is increased it is easier to name it
hyperchloremic acidosis
21. Three main causes (DAD)
1. Diversion of ureters (uretero-colic)
2. Diarrhea
3. Aldosterone deficiency (1ry or 2ry)
– Other less common causes (mainly drugs)
• RTA
• Diamox - ammonium chloride -arginine -Lysine
23. Sometimes you can get a mixed type
• renal failure due to obstructive uropathy
• Addison with pre-renal failure
• In such cases chloride is not that high and AG is just above
normal
If there is hypoalbuminemia
• less unmeasured negative charges available
• body has to get rid of Na to reach isoelectric
• anion gap will seem less than it should be
24. Kusmull’s respiration
• deep and rapid , shallow and rapid
Heart
• -ve inotrope , low AF threshold
Mental confusion
extracellular K shift
• Hyperkalemia
Effect on ODC
• Shift of ODC to the
right opposing 2-DPG
25. urine for ketones
+VE -VE
RBS
LOW OR N
STARVATION
high
DIABETES
Anion gap
high
renal failure
lactic acidosis
toxins
hyperchloremic
hypoaldosteronism
for workup
if renal function
and lactate
do not explain
send to toxicology
28. Hazards of giving
• hypertonic solution
volume overload (ESP IN RENAL FAILURE)
• Overshoot alkalosis :ketones and lactate could further be metabolized to
bicarbonates
• Rapid correction of acidosis may shift ODC to left and 2DPG will dominate
to cause hypoxia
• Bicarb will decompose to CO2 which passes easily to BBB and cause CSF
paradoxical acidification (the use of carbicarb)
29. Hazards of not giving
• effects on heart brain and muscle
At a certain stage with acidosis (pH7.15) all the
compensatory mechanisms are at their maximum
power
• No more compensatory mechanisms available:
• any mild change in concentrations of CO2 or HCO3 will
greatly affect the pH
30. Judge your decision by the pH and never by the HCO3
or CO2 levels
Do not give HCO3 unless pH is lower than 7.2 (7.1 by
some authors)
Calculate the deficit by the formula
[24-HCO3] x 50% of body weight
Correction should be slowly over 3 hours guided by
hourly blood gases and HCO3