This presentation is about metabolic

1. ‫الرحيم‬ ‫الرحمن‬ ‫هللا‬ ‫بسم‬
Ahmad A. Al-Qudah
Supervision :
Dr. Saleem Bani Hani
Metabolic Acidosis & Alkalosis

2. Metabolic Acidosis & Alkalosis
• Terms And Definitions
• Acid – Base Balance ( Regulation )
• Acid – Base Disorders ( Acidosis & Alkalosis )
• Metabolic Acidosis
• Metabolic Alkalosis
• Measurements
• References

3. Terms And Definitions
• Acid : substance that can yield Hydrogen ion
Strong Acid pH < 3.0
• Base : substance that can yield Hydroxyl ion
Strong Base pH > 9.0
• pH : terms that we use to describe the level
of Acidity and Basicity of Aq. Solution .

4. Acid – Base Balance
• Maintenance of Hydrogen ion concentration in
the ECF ( Extracellular Fluid ) within the Normal
Range .
- Normal Range : 36 – 44 nmol/L
- pH : 7.35 – 7.45 ( Slightly Alkaline )
ACID BASE

5. Acid – Base Balance ( Regulation )
How the Body maintain the Hydrogen ion concentration
• Lung
• Buffer System ( Carbonic Acid , Bicarbonate )
- Henderson Equation

6. Acid – Base Balance ( Regulation )
How the Body maintain the Hydrogen ion concentration
• Kidney
- Regulate by excreting Acid (Hydrogen ion)
and reclaiming Bicarbonate .
- Reclaiming Bicarbonate from
glomerular filtrate .
- Hydrogen ion combined with ammonia
and excreting as Ammonium .

7. Acid – Base Disorders ( Acidosis & Alkalosis )
• Acidosis : Increase in Acids [ Hydrogen ion ] --> Decrease in pH
• Alkalosis : Decrease in Acids [ Hydrogen ion ] -- > Increase in pH
ACID BASE
BASE
ACID

8. Metabolic Acidosis
• is a metabolic condition that occurs when the body produces
too much acid or when the kidneys are not removing enough
acid from the body .
Because of the decrease in Bicarbonate level .
Shift to Right
Bicarbonate
Hydrogen ion

9. Metabolic Acidosis
Anion Gap
• Is the difference between plasma cations and anions .
• Help in diagnosis of Metabolic Acidosis . ( 10 – 18 mmol / L )
- Causes of Metabolic Acidosis with increased AG :
- Lactic Acid ( Hypoxia )
- Urate ( Renal Failure )
- Drugs / Toxins
- Ketones ( DM , Alcohol )
- Lactic Acid ( Hypoxia )
- Urate ( Renal Failure )
- Drugs / Toxins
- Ketones ( DM , Alcohol )
-Athletes , a lot of exercise , muscles
Lactic Acid builds up … mild , should rest.
- Lactic Acid ( Hypoxia )
- Urate ( Renal Failure )
- Drugs / Toxins
- Ketones ( DM , Alcohol )
• Is the difference between plasma cations and anions .
• Help in diagnosis of Metabolic Acidosis . ( 10 – 18 mmol / L )
- Causes of Metabolic Acidosis with increased AG :
- IDDM , Fatty acids break down ,
A CoA , Ketone bodies .

10. Metabolic Acidosis
- Causes of Metabolic Acidosis with Normal AG :
- Acids ingestion
- Drugs
- Renal tubular Acidosis
- Diarrhea
- Body start compensate to Metabolic Acidosis through Hyperventilation .
- Secondary Compensation , Kidney begins to correct the ratio by
reclaiming Bicarbonate .

11. Metabolic Alkalosis
• is a metabolic condition in which the pH is elevated beyond the
normal range as a result of increased bicarbonate concentration,
leading to decreased hydrogen ion concentration.
Shift to Left
Bicarbonate
Hydrogen ion

12. Metabolic Alkalosis
• Causes of Metabolic Alkalosis :
- Vomiting ( loss of Acids )
- Diuretics
- Ingestion of Base
- Massive Blood Transfusion ( Citrate )
- Body start compensate to Metabolic Alkalosis through
Hypoventilation .

13. Measurements
• The Calculation of Bicarbonate concentration is
based on the Henderson Equation , when pH and
pCO2 are known .
• Blood Gas Analyzer use electrodes
( electrochemical sensors) .

14. KAUH
• ABG Analyzer : Cobas b 221 .
• ABG + Electrolytes .
• Capillary , Syringe
• Whole Blood , Serum , Plasma
•Normal Ranges :
- pCO2 : 35 – 45 mmHg
- pH : 7.35 – 7.45
- Bicarbonate : 22 – 26 mmol/L

15. References
• Clinical Chemistry Techniques , Principles , Correlations 6th Edition .
• Color Atlas of Biochemistry Second edition.
• http://wiki.answers.com
• http://www.clevelandclinicmeded.com/medicalpubs/micu/metabolicaci
dosis.htm
• Lecture Notes in clinical chemistry-1 . ( Dr. Saleem Bani Hani )

16. Remember !
Behind every successful Doctor … there is a devoted M5BRJI
Behind every successful Doctor
There is a devoted M5BRJI
Be U ….. Be M5BRJI