acidosis metabólica y enfermedad renal

1. MR 1 EDWIN RIVERA
ACIDOSIS
METABOLICA

2. BIBLIOGRAFÍA

3. OBJETIVOS
•CONOCER LOS CONCEPTOS BASICOS DE LA
INTERPRETACION DEL AGA Y ELECTROLITOS.
•CONOCER EL CONCEPTO Y FISIOPATOLOGIA DE LA
ACIDOSIS METABOLICA.
•IDENTIFICAR LOS TIPOS DE ACIDOSIS METABOLICA.
•CONOCER EL CUADRO CLINICO Y TRATAMIENTO DE LOS
TIPOS MAS COMUNES DE ACIDOSIS METABOLICA.

4. INTERPRETACION DE AGA Y
ELECTROLITOS

5. INTERPRETACION DE AGA Y
ELECTROLITOS

6. INTERPRETACION DE AGA Y
ELECTROLITOS

7. INTERPRETACION DE AGA Y
ELECTROLITOS

8. INTERPRETACION DE AGA Y ELECTROLITOS

9. DEFINICION DE
ACIDOSIS METABOLICA

10. DEFINICION DE
ACIDOSIS METABOLICA
La acidosis metabólica es el trastorno
acido-base que se produce en
situaciones de ganancia neta de ácidos
o pérdida de HCO 3

11. FISIOPATOLOGIA

12. FISIOPATOLOGIA

13. FISIOPATOLOGIA

15. FISIOPATOLOGIA

16. FISIOPATOLOGIA

17. CAUSAS DE ACIDOSIS
METABOLICA

18. CAUSAS DE ACIDOSIS METABOLICA

19. CAUSAS DE ACIDOSIS METABOLICA

21. CLINICA DE ACIDOSIS METABOLICA
– Efecto sobre el metabolismo del K+:
• Hiperpotasemia por alteración en la excreción urinaria asociada
• Depleción de K por pérdida urinaria
– Aumento del metabolismo proteico
– Efectos sobre el metabolismo del calcio, fósforo y magnesio:
• Aumento de la reabsorción ósea
• Hipercalciuria
• Osteoporosis
– Efectos sobre glándulas:
• Diaforesis
• Hipersecreción péptica con náuseas, vómitos, gastroduodenitis
– Efectos sobre el sistema nervioso central: vasodilatación
• Estupor
• Coma

22. CLINICA DE ACIDOSIS METABOLICA
– Efectos sobre la ventilación:
• Taquipnea
• Hiperpnea
• Respiración de Kussmaul
– Efectos sobre el riñón:
• Reducción del filtrado glomerular
• Activación del sistema renina-
angiotensina-aldosterona

23. ACIDOSIS METABOLICAS
ANION GAP ELEVADO
El acido láctico proviene del metabolismo del Ac. Pirúvico.
Se produce 15 -20 mmol/kg x día
VN: 0,5 – 1,5 meq/L
Lactato sérico > 2 mmol/l + pH < 7,35 + pCO2 <= 42 mm Hg.
ACIDOSIS LACTICA

24. ACIDOSIS LACTICA

25. ACIDOSIS LACTICA
Tipo A o acidosis
anaerobia: debida a hipoxia y
exceso de formación de ácido
láctico
Tipo B o acidosis aerobia: debida a
la disminución del metabolismo
hepático del ácido láctico en
ausencia de hipoxia.

26. ACIDOSIS LACTICA
TRATAMIENTO
El objetivo primario es la corrección de la
causa inicial.
El uso de bicarbonato debe ser cauteloso
(hiperpotasemia extrema o descenso
extremo del pH)

29. No se ha demostrado de forma
consistente ningún beneficio del
tratamiento con bicarbonato en la
cetoacidosis diabética, en la acidosis
láctica, en el shock séptico, en la
acidosis metabólica intraoperatoria, ni
en el paro cardiaco.

30. CETOACIDOSIS DIABETICA
Es una de las complicaciones más frecuentes de la diabetes mellitus tipo 1
Se produce por un déficit de insulina que produce un trastorno metabólico
en el que concurren tres alteraciones: hiperglucemia, hipercetonemia y
acidosis metabólica.

31. CETOACIDOSIS DIABETICA
El plan general de tratamiento debe incluir, por lo tanto:
- Insulina para frenar la producción de H+.
- Reexpansión del volumen extracelular.
- Corrección del posible déficit de potasio.

32. Intoxicación por alcoholes (metanol,
etilenglicol, propilenglicol, isopropanol,
dietilenglicol)
Son acidosis graves que se caracterizan por hiperosmolalidad
y acidosis metabólica con hiato aniónico aumentado.
Cálculo del hiato osmolal: la diferencia entre la osmolalidad
medida por el osmómetro y la calculada por la ecuación
hiato osmolal > 20 mOsm/l

34. ACIDOSIS METABOLICAS
ANION GAP NORMAL
El mecanismo primario es el descenso de la concentración plasmática de
bicarbonato que se acompaña de una elevación proporcional de las cifras de cloro
plasmático.
Acidosis metabólica por pérdidas gastrointestinales
Acidosis por pérdidas renales de bicarbonato
Acidosis tubular renal proximal y distal (tipos II y I)
Acidosis tubular tipo IV
Acidosis en la enfermedad renal crónica

35. TRATAMIENTO
El tratamiento de la acidosis metabólica por pérdidas
gastrointestinales consiste en la administración de
suero salino fisiológico y potasio, añadiendo
bicarbonato 1/6 M intravenoso en las acidosis agudas y
pH < 7,2 o, en caso de acidosis crónica, bicarbonato
oral si el bicarbonato plasmático es inferior a 22
mmol/l.
El tratamiento de las acidosis tubulares renales consiste
en la administración de bicarbonato en forma de
bicarbonato sódico o citrato potásico; la diferencia
principal es que en la acidosis proximal (tipo II), la dosis
debe ser más alta (aproximadamente 3 mEq/kg/día),
mientras que en la acidosis distal (tipo I) la dosis es
menor (aproximadamente 1 mEq/kg/día).
En ERC es conveniente tratar la acidosis renal, que
conduciría a la larga a la desmineralización ósea. El
tratamiento debe iniciarse cuando las cifras de
bicarbonato plasmático desciendan por debajo de 20
mEq/l. Se utiliza bicarbonato sódico en dosis bajas (1
mEq/kg/día, o incluso menos). En los niños la acidosis
debe corregirse agresivamente para facilitar el crecimiento
óseo normal

36. GRACIAS

53. ANATOMIA

54. ANATOMIA

56. CIRUGIAS PERINEALES
CIRUGIAS OBTETRICAS
CIRUGIAS EN ANO Y RECTO
INSUFICIENCIA VASCULAR AGUDA

57. HERNIORRAFIAS
DOLOR AGUDO POSOPERATORIO
MANEJO DEL DOLOR CRONICO
MANEJO DEL DOLOR POR CANCER

58. A PICTURE IS WORTH
A THOUSAND WORDS

59. ANESTESICOS USADOS

60. A PICTURE IS WORTH
A THOUSAND WORDS

61. DOSIS = 01ML /SEGMENTO
/AÑO DE EDAD
En lidocaína 1% o bupivacaina
0,25%

62. POSICION DEL PACIENTE

63. GESTANTES
NIÑOS GRANDES Y ADULTOS
RECIEN NACIDOS E INFANTES

64. PROCEDIMIENTO

65. A PICTURE IS WORTH
A THOUSAND WORDS

66. A PICTURE IS WORTH
A THOUSAND WORDS

68. A PICTURE IS WORTH
A THOUSAND WORDS

69. A PICTURE IS WORTH
A THOUSAND WORDS

70. A PICTURE IS WORTH
A THOUSAND WORDS

71. A PICTURE IS WORTH
A THOUSAND WORDS

72. A PICTURE IS WORTH
A THOUSAND WORDS

73. A PICTURE IS WORTH
A THOUSAND WORDS

74. A PICTURE IS WORTH
A THOUSAND WORDS

75. A PICTURE IS WORTH
A THOUSAND WORDS

76. A PICTURE IS WORTH
A THOUSAND WORDS

77. A PICTURE IS WORTH
A THOUSAND WORDS

78. A PICTURE IS WORTH
A THOUSAND WORDS

79. A PICTURE IS WORTH
A THOUSAND WORDS

80. A PICTURE IS WORTH
A THOUSAND WORDS

81. A PICTURE IS WORTH
A THOUSAND WORDS

82. A PICTURE IS WORTH
A THOUSAND WORDS

83. A PICTURE IS WORTH
A THOUSAND WORDS

84. A PICTURE IS WORTH
A THOUSAND WORDS

85. A PICTURE IS WORTH
A THOUSAND WORDS

86. A PICTURE IS WORTH
A THOUSAND WORDS

87. A PICTURE IS WORTH
A THOUSAND WORDS

88. A PICTURE IS WORTH
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89. A PICTURE IS WORTH
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90. RECOMENDACIONES FINALES

91. A PICTURE IS WORTH
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92. A PICTURE IS WORTH
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93. A PICTURE IS WORTH
A THOUSAND WORDS

94. A PICTURE IS WORTH
A THOUSAND WORDS

95. A PICTURE IS WORTH
A THOUSAND WORDS

96. A PICTURE IS WORTH
A THOUSAND WORDS

97. A PICTURE IS WORTH
A THOUSAND WORDS

98. A PICTURE IS WORTH
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99. A PICTURE IS WORTH
A THOUSAND WORDS

100. TABLE OF CONTENTS
Section A
01 Here you could
describe the topic of
the section
02 Section B
Here you could
describe the topic of
the section
03 Section C
Here you could
describe the topic of
the section
04 Section D
Here you could
describe the topic of
the section

101. INTRODUCTION
Do you know what helps you make your point
clear? Lists like this one:
● They’re simple
● You can organize your ideas clearly
● You’ll never forget to buy milk!

102. IDENTIFYING THE INFORMATION
Mercury is the closest
planet to the Sun
Mercury
Venus has a beautiful
name, but it’s hot
Venus
Despite being red, Mars
is actually cold
Mars

103. PATIENT MEDICAL HISTORY
Age
35 years
Allergies
No
Gender
Male
2020
Earth is the planet
where we all live on
2010
Despite being red, Mars
is actually a cold place
Location
Barcelona, Spain
2015
Mercury is the closest
planet to the Sun

104. REVIEW OF SYSTEMS
Neptune is the farthest
planet from the Sun
Neptune
Venus has a beautiful
name, but it’s hot
Venus
Despite being red, Mars
is actually a cold place
Mars
Mercury is the closest
planet to the Sun
Mercury

105. PHYSICAL EXAMINATION
Despite being red, Mars is a cold
place full of iron oxide dust
Mars
Venus is a terribly hot place. It is the
second planet from the Sun
Venus

106. Normal Range Optimal Range Patient’s Range
Mercury 0.35 to 5.0 1.8 to 3.0 1.2
Mars 6-12 ug/d 5.4-11.5 ug/d 7 ug/d
Jupiter <15 <15 <12
FINDINGS

107. MORE FINDINGS
Mercury
Mercury is the closest
planet to the Sun
Venus has a beautiful
name, but it’s hot
Venus
Despite being red, Mars
is actually a cold place
Mars
15K 30M 50%

108. EXPANSION
First Stage
Mercury is the closest
planet to the Sun
Second Stage
Despite being red, Mars is
actually cold
Third Stage
Neptune is the farthest
planet from the Sun

109. “Mercury is the closest
planet to the Sun and
the smallest”
DISCUSSION
—Dr. Doe
“Despite being red, Mars
is actually a cold place
full of iron oxide dust”
—Dr. Smith
“Venus has a beautiful
name and is the second
planet from the Sun”
—Dr. Jones

110. DISCUSSION SUMMARY
Venus has a beautiful name and is the
second planet from the Sun. It’s terribly
hot—even hotter than Mercury

111. Jupiter Venus Mars
No Yes Yes
Yes No No
No No Yes
COMPARISON

112. DIAGNOSIS
Earth is the beautiful
planet we all live on
Jupiter is the biggest
planet of them all
Neptune is the farthest
planet from the Sun
Mercury is the closest
planet to the Sun
Venus has a beautiful
name, but it’s hot
Despite being red, Mars
is actually a cold place

113. TREATMENT
Despite being red, Mars
is actually a cold place
Mars
Neptune is the farthest
planet from the Sun
Neptune
Mercury is the closest
planet to the Sun
Mercury

114. PATIENT MONITORING
Week 1
Mercury is the closest planet to the Sun
Week 2
Despite being red, Mars is actually cold
Week 3
It is the farthest planet from the Sun
To modify this graph, follow the link,
change the data and paste the new graph
here
Week 1
Week 2
Week 3

115. AWESOME
WORDS

116. ● Here you can describe a reason
to start the treatment
● Here you can describe a reason
to start the treatment
● Here you can describe a reason
to start the treatment
● Here you can describe a reason
to start the treatment
CONTRAINDICATIONS & INDICATIONS
● Here you can describe a reason
to stop the treatment
● Here you can describe a reason
to stop the treatment
● Here you can describe a reason
to stop the treatment
● Here you can describe a reason
to stop the treatment

117. PROTOTYPE
You can replace the image on the
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118. POST-PREVENTION
Despite being red, Mars is actually a cold place
Mars
Mercury is the closest planet to the Sun
Mercury
Neptune is the farthest planet from the Sun
Neptune

119. CASE TIMELINE
Week 1
Mercury is the closest
planet to the Sun
Week 2
Neptune is the farthest
planet from the Sun
Week 3
Despite being red,
Mars is actually cold
Week 4
Jupiter is the biggest
planet of them all

120. CONCLUSIONS
● Here you can describe what each of your conclusions are
● Here you can describe what each of your conclusions are
● Here you can describe what each of your conclusions are
● Here you can describe what each of your conclusions are
● Here you can describe what each of your conclusions are
Venus has a beautiful name and is the
second planet from the Sun. It’s terribly
hot—even hotter than Mercury

121. REFERENCES
● AUTHOR (YEAR). Title of the publication. Publisher
● AUTHOR (YEAR). Title of the publication. Publisher
● AUTHOR (YEAR). Title of the publication. Publisher
● AUTHOR (YEAR). Title of the publication. Publisher
● AUTHOR (YEAR). Title of the publication. Publisher
● AUTHOR (YEAR). Title of the publication. Publisher

122. —SOMEONE FAMOUS
“Venus has a beautiful name and is the
second planet from the Sun. It’s terribly
hot—even hotter than Mercury”

123. OUR TEAM
Here you could describe
your team member
Jane Doe
Here you could describe
your team member
Nick Smith

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