Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.
MPSS Diana América Chávez Cabrera
1. Saber las indicaciones de la gasometría.2. Conocer la técnica correcta de toma de muestra   arterial.3. Principios fisi...
 Es la medición de los gases disueltos en una muestra de  sangre (arterial o venosa) por medio de un gasómetro.A. Crespo ...
IndicacionesA. Crespo Giménez, F. J. Garcés Molina, “Indicaciones e interpretación de la gasometría” Servicio de Neumologí...
 Con el índice y medio, comprimir al mismo  tiempo las arterias radial y cubital. La palma empalidece al no tener flujo ...
http://www.youtube.com/watch?v=zFuGJHFlIN8
De la regulación ácido-base
pH• La medida logarítmica  del volumen requeridp  para contener 1 Eq de  ´H+ (hidrogenión)Porth Fisiopatología. Salud-enfe...
Porth Fisiopatología. Salud-enfermedad: un enfoque conceptual. Edición, 7ª 2006
pH bajo, Acidosis                                                            pH alto, Alcalosis                           ...
Sistemas BufferPorth Fisiopatología. Salud-enfermedad: un enfoque conceptual. Edición, 7ª 2006
pH                7.35-7.45* Algunos                  consideran de 7.4-7.45                  como valor normalpCO2       ...
 ¿Cuál es la diferencia entre dificultad e insuficiencia  respiratoria? ¿O es lo mismo?    Dificultad respiratoria: Diag...
Tipo 1:• Hipoxémica (PaO2 <60 mmHg)• Causas:  • FiO2 baja  • Alteraciones parénquima pulmonar (neumonía,    broncoaspiraci...
Productos                             Metabolismo                                                                         ...
“Línea de tiempo”Porth Fisiopatología. Salud-enfermedad: un enfoque conceptual. Edición, 7ª 2006
¿Es acidosis o alcalosis?                                             pH dentro de                                       ...
Alcalosis                                                          Acidosis             metabólica                        ...
• Alcalemia metabólica:                                               • Alcalemia respiratoria:      Aumenta HCO3-        ...
Brecha aniónica                                                                          Son aniones no                   ...
Cationes                              AnionesConceptualizando  la Anión GapWilliam L Whittier, Gregory W Rutecki "Primer o...
Por cada gramo de Albúmina por debajo de         4 mg/dL se le suma 2.5 mEq/L al Anión GapWilliam L Whittier, Gregory W Ru...
¿Cuál sería el Anión Gap real de un paciente   con 2.3 g/dL de albúmina y AGap aparente de                         13?  Al...
 M:          Metanol/Metformina U:          Urea D:          cetoacidosis Diabética P:          Paraaldehído I:      ...
 C:  Cationes elevados      Hipernatremia      Hipercalcemia      Hipermagnesemia H: Hipoproteinemia* (Hipoalbuminemi...
Acidosis Metabolica:            • PaCO2 disminuye1.3 mmHg              por cada1 mEq/L de              HCO3 que disminuye....
Acidosis respiratoria aguda:               • HCO3 aumenta 1 mEq/L por                 cada 10 mmHg de aumento             ...
Alcalosis respiratoria aguda:                                             • HCO3 disminuye 2 meq/L                        ...
William L Whittier, Gregory W Rutecki "Primer on clinical acid-base problem solving" Disease-a-Month - March 2004(Vol. 50,...
Los aniones y cationes guardan una relación 1:1                            • Regla de la “electroneutralidad”             ...
 Por lo tanto, cuando hay ACIDOSIS METABÓLICA DE  ANIÓN GAP NORMAL es IMPOSIBLE saber si coexiste  con ALCALOSIS METABÓLI...
Corregir el                       HCO32 métodos                     Buscando la                     relación 1:1    Se com...
 Regla 1: Acidemia (pH < 7.4)             pH       7.34                                            Regla 2: Metabólico (...
pH       7.34                      Regla 5…        pCO2          31 mmHg                            AGap medido – AGap id...
pH       7.34                      Regla 5…        pCO2          31 mmHg                            AGap medido – AGap id...
pH       7.34                 Regla 5…        pCO2          31 mmHg                                           Con la rel...
Falla en                     interpretación                     por el equipoExceso de                                    ...
Indicaciones y                       contraindicaciones                                                             Test d...
Interpretación de gasometrías
Interpretación de gasometrías
Interpretación de gasometrías
Interpretación de gasometrías
Upcoming SlideShare
Loading in …5
×

Interpretación de gasometrías

17,595 views

Published on

DIANA AMÉRICA CHÁVEZ CABRERA
UNIVERSIDAD VILLA RICA
CENTRO DE INVESTIGACIÓN Y SIMULACIÓN
INTERPRETACIÓN DE GASOMETRÍAS
PRINCIPIOS DIAGNÓSTICOS DE TRASTORNOS ÁCIDO BASE

Published in: Health & Medicine
  • DOWNLOAD THIS BOOKS INTO AVAILABLE FORMAT (2019 Update) ......................................................................................................................... ......................................................................................................................... Download Full PDF EBOOK here { https://soo.gd/irt2 } ......................................................................................................................... Download Full EPUB Ebook here { https://soo.gd/irt2 } ......................................................................................................................... Download Full doc Ebook here { https://soo.gd/irt2 } ......................................................................................................................... Download PDF EBOOK here { https://soo.gd/irt2 } ......................................................................................................................... Download EPUB Ebook here { https://soo.gd/irt2 } ......................................................................................................................... Download doc Ebook here { https://soo.gd/irt2 } ......................................................................................................................... ......................................................................................................................... ................................................................................................................................... eBook is an electronic version of a traditional print book THIS can be read by using a personal computer or by using an eBook reader. (An eBook reader can be a software application for use on a computer such as Microsoft's free Reader application, or a book-sized computer THIS is used solely as a reading device such as Nuvomedia's Rocket eBook.) Users can purchase an eBook on diskette or CD, but the most popular method of getting an eBook is to purchase a downloadable file of the eBook (or other reading material) from a Web site (such as Barnes and Noble) to be read from the user's computer or reading device. Generally, an eBook can be downloaded in five minutes or less ......................................................................................................................... .............. Browse by Genre Available eBooks .............................................................................................................................. Art, Biography, Business, Chick Lit, Children's, Christian, Classics, Comics, Contemporary, Cookbooks, Manga, Memoir, Music, Mystery, Non Fiction, Paranormal, Philosophy, Poetry, Psychology, Religion, Romance, Science, Science Fiction, Self Help, Suspense, Spirituality, Sports, Thriller, Travel, Young Adult, Crime, Ebooks, Fantasy, Fiction, Graphic Novels, Historical Fiction, History, Horror, Humor And Comedy, ......................................................................................................................... ......................................................................................................................... .....BEST SELLER FOR EBOOK RECOMMEND............................................................. ......................................................................................................................... Blowout: Corrupted Democracy, Rogue State Russia, and the Richest, Most Destructive Industry on Earth,-- The Ride of a Lifetime: Lessons Learned from 15 Years as CEO of the Walt Disney Company,-- Call Sign Chaos: Learning to Lead,-- StrengthsFinder 2.0,-- Stillness Is the Key,-- She Said: Breaking the Sexual Harassment Story THIS Helped Ignite a Movement,-- Atomic Habits: An Easy &amp; Proven Way to Build Good Habits &amp; Break Bad Ones,-- Everything Is Figureoutable,-- What It Takes: Lessons in the Pursuit of Excellence,-- Rich Dad Poor Dad: What the Rich Teach Their Kids About Money THIS the Poor and Middle Class Do Not!,-- The Total Money Makeover: Classic Edition: A Proven Plan for Financial Fitness,-- Shut Up and Listen!: Hard Business Truths THIS Will Help You Succeed, ......................................................................................................................... .........................................................................................................................
       Reply 
    Are you sure you want to  Yes  No
    Your message goes here
  • DOWNLOAD THIS BOOKS INTO AVAILABLE FORMAT (2019 Update) ......................................................................................................................... ......................................................................................................................... Download Full PDF EBOOK here { https://soo.gd/irt2 } ......................................................................................................................... Download Full EPUB Ebook here { https://soo.gd/irt2 } ......................................................................................................................... Download Full doc Ebook here { https://soo.gd/irt2 } ......................................................................................................................... Download PDF EBOOK here { https://soo.gd/irt2 } ......................................................................................................................... Download EPUB Ebook here { https://soo.gd/irt2 } ......................................................................................................................... Download doc Ebook here { https://soo.gd/irt2 } ......................................................................................................................... ......................................................................................................................... ................................................................................................................................... eBook is an electronic version of a traditional print book THIS can be read by using a personal computer or by using an eBook reader. (An eBook reader can be a software application for use on a computer such as Microsoft's free Reader application, or a book-sized computer THIS is used solely as a reading device such as Nuvomedia's Rocket eBook.) Users can purchase an eBook on diskette or CD, but the most popular method of getting an eBook is to purchase a downloadable file of the eBook (or other reading material) from a Web site (such as Barnes and Noble) to be read from the user's computer or reading device. Generally, an eBook can be downloaded in five minutes or less ......................................................................................................................... .............. Browse by Genre Available eBooks .............................................................................................................................. Art, Biography, Business, Chick Lit, Children's, Christian, Classics, Comics, Contemporary, Cookbooks, Manga, Memoir, Music, Mystery, Non Fiction, Paranormal, Philosophy, Poetry, Psychology, Religion, Romance, Science, Science Fiction, Self Help, Suspense, Spirituality, Sports, Thriller, Travel, Young Adult, Crime, Ebooks, Fantasy, Fiction, Graphic Novels, Historical Fiction, History, Horror, Humor And Comedy, ......................................................................................................................... ......................................................................................................................... .....BEST SELLER FOR EBOOK RECOMMEND............................................................. ......................................................................................................................... Blowout: Corrupted Democracy, Rogue State Russia, and the Richest, Most Destructive Industry on Earth,-- The Ride of a Lifetime: Lessons Learned from 15 Years as CEO of the Walt Disney Company,-- Call Sign Chaos: Learning to Lead,-- StrengthsFinder 2.0,-- Stillness Is the Key,-- She Said: Breaking the Sexual Harassment Story THIS Helped Ignite a Movement,-- Atomic Habits: An Easy &amp; Proven Way to Build Good Habits &amp; Break Bad Ones,-- Everything Is Figureoutable,-- What It Takes: Lessons in the Pursuit of Excellence,-- Rich Dad Poor Dad: What the Rich Teach Their Kids About Money THIS the Poor and Middle Class Do Not!,-- The Total Money Makeover: Classic Edition: A Proven Plan for Financial Fitness,-- Shut Up and Listen!: Hard Business Truths THIS Will Help You Succeed, ......................................................................................................................... .........................................................................................................................
       Reply 
    Are you sure you want to  Yes  No
    Your message goes here
  • DOWNLOAD THIS BOOKS INTO AVAILABLE FORMAT (2019 Update) ......................................................................................................................... ......................................................................................................................... Download Full PDF EBOOK here { https://soo.gd/irt2 } ......................................................................................................................... Download Full EPUB Ebook here { https://soo.gd/irt2 } ......................................................................................................................... Download Full doc Ebook here { https://soo.gd/irt2 } ......................................................................................................................... Download PDF EBOOK here { https://soo.gd/irt2 } ......................................................................................................................... Download EPUB Ebook here { https://soo.gd/irt2 } ......................................................................................................................... Download doc Ebook here { https://soo.gd/irt2 } ......................................................................................................................... ......................................................................................................................... ................................................................................................................................... eBook is an electronic version of a traditional print book THIS can be read by using a personal computer or by using an eBook reader. (An eBook reader can be a software application for use on a computer such as Microsoft's free Reader application, or a book-sized computer THIS is used solely as a reading device such as Nuvomedia's Rocket eBook.) Users can purchase an eBook on diskette or CD, but the most popular method of getting an eBook is to purchase a downloadable file of the eBook (or other reading material) from a Web site (such as Barnes and Noble) to be read from the user's computer or reading device. Generally, an eBook can be downloaded in five minutes or less ......................................................................................................................... .............. Browse by Genre Available eBooks .............................................................................................................................. Art, Biography, Business, Chick Lit, Children's, Christian, Classics, Comics, Contemporary, Cookbooks, Manga, Memoir, Music, Mystery, Non Fiction, Paranormal, Philosophy, Poetry, Psychology, Religion, Romance, Science, Science Fiction, Self Help, Suspense, Spirituality, Sports, Thriller, Travel, Young Adult, Crime, Ebooks, Fantasy, Fiction, Graphic Novels, Historical Fiction, History, Horror, Humor And Comedy, ......................................................................................................................... ......................................................................................................................... .....BEST SELLER FOR EBOOK RECOMMEND............................................................. ......................................................................................................................... Blowout: Corrupted Democracy, Rogue State Russia, and the Richest, Most Destructive Industry on Earth,-- The Ride of a Lifetime: Lessons Learned from 15 Years as CEO of the Walt Disney Company,-- Call Sign Chaos: Learning to Lead,-- StrengthsFinder 2.0,-- Stillness Is the Key,-- She Said: Breaking the Sexual Harassment Story THIS Helped Ignite a Movement,-- Atomic Habits: An Easy &amp; Proven Way to Build Good Habits &amp; Break Bad Ones,-- Everything Is Figureoutable,-- What It Takes: Lessons in the Pursuit of Excellence,-- Rich Dad Poor Dad: What the Rich Teach Their Kids About Money THIS the Poor and Middle Class Do Not!,-- The Total Money Makeover: Classic Edition: A Proven Plan for Financial Fitness,-- Shut Up and Listen!: Hard Business Truths THIS Will Help You Succeed, ......................................................................................................................... .........................................................................................................................
       Reply 
    Are you sure you want to  Yes  No
    Your message goes here
  • DOWNLOAD THIS BOOKS INTO AVAILABLE FORMAT (2019 Update) ......................................................................................................................... ......................................................................................................................... Download Full PDF EBOOK here { https://soo.gd/irt2 } ......................................................................................................................... Download Full EPUB Ebook here { https://soo.gd/irt2 } ......................................................................................................................... Download Full doc Ebook here { https://soo.gd/irt2 } ......................................................................................................................... Download PDF EBOOK here { https://soo.gd/irt2 } ......................................................................................................................... Download EPUB Ebook here { https://soo.gd/irt2 } ......................................................................................................................... Download doc Ebook here { https://soo.gd/irt2 } ......................................................................................................................... ......................................................................................................................... ................................................................................................................................... eBook is an electronic version of a traditional print book THIS can be read by using a personal computer or by using an eBook reader. (An eBook reader can be a software application for use on a computer such as Microsoft's free Reader application, or a book-sized computer THIS is used solely as a reading device such as Nuvomedia's Rocket eBook.) Users can purchase an eBook on diskette or CD, but the most popular method of getting an eBook is to purchase a downloadable file of the eBook (or other reading material) from a Web site (such as Barnes and Noble) to be read from the user's computer or reading device. Generally, an eBook can be downloaded in five minutes or less ......................................................................................................................... .............. Browse by Genre Available eBooks .............................................................................................................................. Art, Biography, Business, Chick Lit, Children's, Christian, Classics, Comics, Contemporary, Cookbooks, Manga, Memoir, Music, Mystery, Non Fiction, Paranormal, Philosophy, Poetry, Psychology, Religion, Romance, Science, Science Fiction, Self Help, Suspense, Spirituality, Sports, Thriller, Travel, Young Adult, Crime, Ebooks, Fantasy, Fiction, Graphic Novels, Historical Fiction, History, Horror, Humor And Comedy, ......................................................................................................................... ......................................................................................................................... .....BEST SELLER FOR EBOOK RECOMMEND............................................................. ......................................................................................................................... Blowout: Corrupted Democracy, Rogue State Russia, and the Richest, Most Destructive Industry on Earth,-- The Ride of a Lifetime: Lessons Learned from 15 Years as CEO of the Walt Disney Company,-- Call Sign Chaos: Learning to Lead,-- StrengthsFinder 2.0,-- Stillness Is the Key,-- She Said: Breaking the Sexual Harassment Story THIS Helped Ignite a Movement,-- Atomic Habits: An Easy &amp; Proven Way to Build Good Habits &amp; Break Bad Ones,-- Everything Is Figureoutable,-- What It Takes: Lessons in the Pursuit of Excellence,-- Rich Dad Poor Dad: What the Rich Teach Their Kids About Money THIS the Poor and Middle Class Do Not!,-- The Total Money Makeover: Classic Edition: A Proven Plan for Financial Fitness,-- Shut Up and Listen!: Hard Business Truths THIS Will Help You Succeed, ......................................................................................................................... .........................................................................................................................
       Reply 
    Are you sure you want to  Yes  No
    Your message goes here
  • DOWNLOAD THIS BOOKS INTO AVAILABLE FORMAT (Unlimited) ......................................................................................................................... ......................................................................................................................... Download Full PDF EBOOK here { https://soo.gd/qURD } ......................................................................................................................... Download Full EPUB Ebook here { https://soo.gd/qURD } ......................................................................................................................... Download Full doc Ebook here { https://soo.gd/qURD } ......................................................................................................................... Download PDF EBOOK here { https://soo.gd/qURD } ......................................................................................................................... Download EPUB Ebook here { https://soo.gd/qURD } ......................................................................................................................... Download doc Ebook here { https://soo.gd/qURD } ......................................................................................................................... ......................................................................................................................... ................................................................................................................................... eBook is an electronic version of a traditional print book THIS can be read by using a personal computer or by using an eBook reader. (An eBook reader can be a software application for use on a computer such as Microsoft's free Reader application, or a book-sized computer THIS is used solely as a reading device such as Nuvomedia's Rocket eBook.) Users can purchase an eBook on diskette or CD, but the most popular method of getting an eBook is to purchase a downloadable file of the eBook (or other reading material) from a Web site (such as Barnes and Noble) to be read from the user's computer or reading device. Generally, an eBook can be downloaded in five minutes or less ......................................................................................................................... .............. Browse by Genre Available eBooks .............................................................................................................................. Art, Biography, Business, Chick Lit, Children's, Christian, Classics, Comics, Contemporary, Cookbooks, Manga, Memoir, Music, Mystery, Non Fiction, Paranormal, Philosophy, Poetry, Psychology, Religion, Romance, Science, Science Fiction, Self Help, Suspense, Spirituality, Sports, Thriller, Travel, Young Adult, Crime, Ebooks, Fantasy, Fiction, Graphic Novels, Historical Fiction, History, Horror, Humor And Comedy, ......................................................................................................................... ......................................................................................................................... .....BEST SELLER FOR EBOOK RECOMMEND............................................................. ......................................................................................................................... Blowout: Corrupted Democracy, Rogue State Russia, and the Richest, Most Destructive Industry on Earth,-- The Ride of a Lifetime: Lessons Learned from 15 Years as CEO of the Walt Disney Company,-- Call Sign Chaos: Learning to Lead,-- StrengthsFinder 2.0,-- Stillness Is the Key,-- She Said: Breaking the Sexual Harassment Story THIS Helped Ignite a Movement,-- Atomic Habits: An Easy &amp; Proven Way to Build Good Habits &amp; Break Bad Ones,-- Everything Is Figureoutable,-- What It Takes: Lessons in the Pursuit of Excellence,-- Rich Dad Poor Dad: What the Rich Teach Their Kids About Money THIS the Poor and Middle Class Do Not!,-- The Total Money Makeover: Classic Edition: A Proven Plan for Financial Fitness,-- Shut Up and Listen!: Hard Business Truths THIS Will Help You Succeed, ......................................................................................................................... .........................................................................................................................
       Reply 
    Are you sure you want to  Yes  No
    Your message goes here

Interpretación de gasometrías

  1. 1. MPSS Diana América Chávez Cabrera
  2. 2. 1. Saber las indicaciones de la gasometría.2. Conocer la técnica correcta de toma de muestra arterial.3. Principios fisiológicos que rigen el equilibrio ácido-base4. Interpretación (no seas sólo un “toma-muestras”) a) Saber qué es la Insuficiencia respiratoria b) Diagnóstico básico de los trastornos ácido- base. c) ¿Qué puede alterar el resultado de la gasometría?5. Conclusiones
  3. 3.  Es la medición de los gases disueltos en una muestra de sangre (arterial o venosa) por medio de un gasómetro.A. Crespo Giménez, F. J. Garcés Molina, “Indicaciones e interpretación de la gasometría” Servicio de Neumología.Hospital Universitario La Paz. Universidad Autónoma de Madrid Medicine. 2010;10(63):4372-4
  4. 4. IndicacionesA. Crespo Giménez, F. J. Garcés Molina, “Indicaciones e interpretación de la gasometría” Servicio de Neumología.Hospital Universitario La Paz. Universidad Autónoma de Madrid Medicine. 2010;10(63):4372-4
  5. 5.  Con el índice y medio, comprimir al mismo tiempo las arterias radial y cubital. La palma empalidece al no tener flujo arterial. Liberar la presión de la arteria cubital, vigilar el tiempo que tarda en recuperar color:  Positivo: < 7 seg.  Dudoso: 8-14 seg.  Negativo: > 15 seg. Se repite liberando la arteria radial.
  6. 6. http://www.youtube.com/watch?v=zFuGJHFlIN8
  7. 7. De la regulación ácido-base
  8. 8. pH• La medida logarítmica del volumen requeridp para contener 1 Eq de ´H+ (hidrogenión)Porth Fisiopatología. Salud-enfermedad: un enfoque conceptual. Edición, 7ª 2006
  9. 9. Porth Fisiopatología. Salud-enfermedad: un enfoque conceptual. Edición, 7ª 2006
  10. 10. pH bajo, Acidosis pH alto, Alcalosis Función de la Anhidrasa Carbónica (CA)Porth Fisiopatología. Salud-enfermedad: un enfoque conceptual. Edición, 7ª 2006
  11. 11. Sistemas BufferPorth Fisiopatología. Salud-enfermedad: un enfoque conceptual. Edición, 7ª 2006
  12. 12. pH 7.35-7.45* Algunos consideran de 7.4-7.45 como valor normalpCO2 35-45 mmHg (nivel mar)pO2 80-100 mmHgHCO3 24 ±2 mEqSat.O2% 95-100% (normal)Lactato 1-1.5 mmol/LHb. >7 (Estado crítico) Si no los incluye, fíjate enNa 140-145 mEq/L los Labs de tu pacienteK 3.5-4.5 mEq/LCl- 99-105 mEq/LA. Gap. 3-10 mEq/L No lo incluye, tú debes calcularloAlbúmina 4g/dL Fíjate en los Labs de tu pacienteWilliam L Whittier, Gregory W Rutecki "Primer on clinical acid-base problem solving" Disease-a-Month - March 2004(Vol. 50, Issue 3, Pages 122-162, DOI: 10.1016/j.disamonth.2004.01.002)
  13. 13.  ¿Cuál es la diferencia entre dificultad e insuficiencia respiratoria? ¿O es lo mismo?  Dificultad respiratoria: Diagnóstico sindromático  Insuficiencia respiratoria: Diagnóstico gasométrico ¿Cuál es la definición de “insuficiencia respiratoria”?  Incapacidad del aparato respiratorio para mantener un intercambio gaseoso adecuado D. Barros, C. García Quero “Protocolo de interpretación clínica de la gasometría arterial en la insuficienciarespiratoria” Servicio de Neumología. Hospital Universitario La Paz. Medicine. 2010;10(63):4372-4
  14. 14. Tipo 1:• Hipoxémica (PaO2 <60 mmHg)• Causas: • FiO2 baja • Alteraciones parénquima pulmonar (neumonía, broncoaspiración, asma, neumopatías intersticiales, SIRA) gasto cardíaco bajo, anemia, sepsis, intoxicación por CO.Tipo 2:• Hipercápnica (PaCO2 >45 mmHg)• Causas: • EPOC, TEP,Tipo 3:• IR tipo 1 en el contexto postoperatorio• Causa más común: broncoaspiraciónTipo 4:• IR tipo 2 en el contexto de sepsis • Incremento demanda de O2 periférico +  CO2
  15. 15. Productos Metabolismo ácidos y celular básicos Sistemas bufferQuímicos Fisiológicos Amortiguadores • Sistema bicarbonato-ác.carbónico. • Regulación renal • Hemoglobina. • Regulación pulmonar • Proteínas. • Sistema fosfato disódico/monosódico. Porth Fisiopatología. Salud-enfermedad: un enfoque conceptual. Edición, 7ª 2006
  16. 16. “Línea de tiempo”Porth Fisiopatología. Salud-enfermedad: un enfoque conceptual. Edición, 7ª 2006
  17. 17. ¿Es acidosis o alcalosis? pH dentro de “rangos normales”William L Whittier, Gregory W Rutecki "Primer on clinical acid-base problem solving" Disease-a-Month - March 2004(Vol. 50, Issue 3, Pages 122-162, DOI: 10.1016/j.disamonth.2004.01.002)
  18. 18. Alcalosis Acidosis metabólica respiratoria Alcalosis Acidosis respiratoria metabólicaWilliam L Whittier, Gregory W Rutecki "Primer on clinical acid-base problem solving" Disease-a-Month - March 2004(Vol. 50, Issue 3, Pages 122-162, DOI: 10.1016/j.disamonth.2004.01.002)
  19. 19. • Alcalemia metabólica: • Alcalemia respiratoria: Aumenta HCO3- PCO2 disminuye• Acidemia metabólica: • Acidemia respiratoria:William L Whittier, Gregory W Rutecki "Primer on clinical acid-base problemPO2Disease-a-Month - March 2004 solving" aumenta Disminuye HCO3-(Vol. 50, Issue 3, Pages 122-162, DOI: 10.1016/j.disamonth.2004.01.002)
  20. 20. Brecha aniónica Son aniones no medidos en el plasma Valor alterado nos puede Valor normal sugerir el origen 3-10 mEq/L probable del desajuste en el estado ácido-baseWilliam L Whittier, Gregory W Rutecki "Primer on clinical acid-base problem solving" Disease-a-Month - March 2004(Vol. 50, Issue 3, Pages 122-162, DOI: 10.1016/j.disamonth.2004.01.002)
  21. 21. Cationes AnionesConceptualizando la Anión GapWilliam L Whittier, Gregory W Rutecki "Primer on clinical acid-base problem solving" Disease-a-Month - March 2004(Vol. 50, Issue 3, Pages 122-162, DOI: 10.1016/j.disamonth.2004.01.002)
  22. 22. Por cada gramo de Albúmina por debajo de 4 mg/dL se le suma 2.5 mEq/L al Anión GapWilliam L Whittier, Gregory W Rutecki "Primer on clinical acid-base problem solving" Disease-a-Month - March 2004(Vol. 50, Issue 3, Pages 122-162, DOI: 10.1016/j.disamonth.2004.01.002)
  23. 23. ¿Cuál sería el Anión Gap real de un paciente con 2.3 g/dL de albúmina y AGap aparente de 13? Albúmina normal Albúmina del paciente “déficit de albúmina” 4g - 2.3 g = 1.7 g/dL Constante “Déficit de albúmina” “déficit de AGap” 2.5 mEq/L x 1.7 mg/dL = 4.25 mEq/LAGap del paciente “Déficit de AGap” 13 mEq/L + 4.25 mEq = 17.25 mEq
  24. 24.  M: Metanol/Metformina U: Urea D: cetoacidosis Diabética P: Paraaldehído I: Isoniacida L: acidosis Láctica E: Etilenglicol S: SalicilatosWilliam L Whittier, Gregory W Rutecki "Primer on clinical acid-base problem solving" Disease-a-Month - March 2004(Vol. 50, Issue 3, Pages 122-162, DOI: 10.1016/j.disamonth.2004.01.002)
  25. 25.  C: Cationes elevados  Hipernatremia  Hipercalcemia  Hipermagnesemia H: Hipoproteinemia* (Hipoalbuminemia) I: Intoxicaciones (Incremento cationes)  Litio  Bromuro M: Mieloma Múltiple (Proteínas carga positiva) P: Policlonales, Gammapatías (Proteínas carga positiva)
  26. 26. Acidosis Metabolica: • PaCO2 disminuye1.3 mmHg por cada1 mEq/L de HCO3 que disminuye.Alcalosis Metabolica:• PaCO2 aumenta 0.6 mmHg por cada 10 mEq/L de HCO3 que aumenta.
  27. 27. Acidosis respiratoria aguda: • HCO3 aumenta 1 mEq/L por cada 10 mmHg de aumento en la PaCO2Acidosis respiratoria cónica:• HCO3 aumenta 4 mEq/L por cada 10 mmHg que la PaCO2 aumenta.
  28. 28. Alcalosis respiratoria aguda: • HCO3 disminuye 2 meq/L por cada 10 mmHg de PaCO2 que disminuye. Alcalosis respiratoria crónica: • HCO3 disminuye 5 mEq/L por cada 10 mmHg que disminuye PaCO2William L Whittier, Gregory W Rutecki "Primer on clinical acid-base problem solving" Disease-a-Month - March 2004(Vol. 50, Issue 3, Pages 122-162, DOI: 10.1016/j.disamonth.2004.01.002)
  29. 29. William L Whittier, Gregory W Rutecki "Primer on clinical acid-base problem solving" Disease-a-Month - March 2004(Vol. 50, Issue 3, Pages 122-162, DOI: 10.1016/j.disamonth.2004.01.002)
  30. 30. Los aniones y cationes guardan una relación 1:1 • Regla de la “electroneutralidad” • Por cada 1 mEq de incremento en la anion gap, debe acompañarse por del descenso de 1 mEq en el HCO3. Utilidad: En la acidosis metabólica de anión Gap elevado • Sirve para reconocer la coexistencia de acidosis con alcalosis.William L Whittier, Gregory W Rutecki "Primer on clinical acid-base problem solving" Disease-a-Month - March 2004(Vol. 50, Issue 3, Pages 122-162, DOI: 10.1016/j.disamonth.2004.01.002)
  31. 31.  Por lo tanto, cuando hay ACIDOSIS METABÓLICA DE ANIÓN GAP NORMAL es IMPOSIBLE saber si coexiste con ALCALOSIS METABÓLICAWilliam L Whittier, Gregory W Rutecki "Primer on clinical acid-base problem solving" Disease-a-Month - March 2004(Vol. 50, Issue 3, Pages 122-162, DOI: 10.1016/j.disamonth.2004.01.002)
  32. 32. Corregir el HCO32 métodos Buscando la relación 1:1 Se comprenderá mejor con un ejemplo
  33. 33.  Regla 1: Acidemia (pH < 7.4) pH 7.34  Regla 2: Metabólico (HCO3- : 16 mEQ) pCO2 31 mmHg  Regla 3: A. Gap elevado pO2 97 mmHg  (143 – [16 + 102])= 25 mEq AGap (recuérdalo) HCO3- 16 mEq  Un A.Gap >20 = ACIDOSIS Na 143 mEq/L  Regla 4: Compensación K 3.8 mEq/L  La acidosis metabólica se compensa con Cl 102 mEq/L disminución del CO2 BUN 18 mg/dL  PCO2 debe disminuir 1.3 por 1 mEq  HCO3- Cr 1.2 mg/dL  1.3 x (25-16) = 11 mEq debe disminuir el PCO2 Glucosa 72 mg/dL  La PCO2 ha disminuido 9 (31), aceptable. Albúmina 4.0 mg/dL  Acidosis metabólica compensada.  Regla 5… Nuevo reto.William L Whittier, Gregory W Rutecki "Primer on clinical acid-base problem solving" Disease-a-Month - March 2004(Vol. 50, Issue 3, Pages 122-162, DOI: 10.1016/j.disamonth.2004.01.002)
  34. 34. pH 7.34  Regla 5… pCO2 31 mmHg AGap medido – AGap ideal + HCO3 pO2 97 mmHg 25 - 10 + 16 HCO3- 16 mEq  HCO3 corregido= 31. Na 143 mEq/L  ¿Cómo se interpreta? Como una Acidosis K 3.8 mEq/L metabólica de Anión Gap coexistiendo con: Cl 102 mEq/L Acidosis metabólica AGap normal Valores < 22 BUN 18 mg/dL Alcalosis metabólica Valores > 28 Cr 1.2 mg/dL Glucosa 72 mg/dL  Cuando el resultado está entre 22 y 28, Albúmina 4.0 mg/dL decimos que es unaWilliam L Whittier, Gregory W Rutecki "Primer on clinical acid-base problem solving" Disease-a-Month - March 2004(Vol. 50, Issue 3, Pages 122-162, DOI: 10.1016/j.disamonth.2004.01.002)
  35. 35. pH 7.34  Regla 5… pCO2 31 mmHg AGap medido – AGap ideal + HCO3 pO2 97 mmHg 25 - 10 + 16 HCO3- 16 mEq Na 143 mEq/L HCO3 corregido= 31. K 3.8 mEq/L Es una Ac. Metabólica AGap elevado + Cl 102 mEq/L Alcalosis metabólica BUN 18 mg/dL Cr 1.2 mg/dL Glucosa 72 mg/dL Albúmina 4.0 mg/dLWilliam L Whittier, Gregory W Rutecki "Primer on clinical acid-base problem solving" Disease-a-Month - March 2004(Vol. 50, Issue 3, Pages 122-162, DOI: 10.1016/j.disamonth.2004.01.002)
  36. 36. pH 7.34  Regla 5… pCO2 31 mmHg  Con la relación 1:1, tomamos en cuenta que pO2 97 mmHg el AGap es de 25, (el valor normal del HCO3- 16 mEq AGap es de 10) por lo que está 15 mEq Na 143 mEq/L por encima de lo normal K 3.8 mEq/L  Lo esperado con la relación 1:1 es que el Cl 102 mEq/L HCO3 haya descendido al menos 15 mEq BUN 18 mg/dL (valor normal 25) y sólo disminuyó 9 mEq Cr 1.2 mg/dL (HCO3 = 16 mEq) Glucosa 72 mg/dL  Con ello decimos que hay una Albúmina 4.0 mg/dL también por no cumplirse la relación 1:1William L Whittier, Gregory W Rutecki "Primer on clinical acid-base problem solving" Disease-a-Month - March 2004(Vol. 50, Issue 3, Pages 122-162, DOI: 10.1016/j.disamonth.2004.01.002)
  37. 37. Falla en interpretación por el equipoExceso de Fiebre oheparina hipotermia Condiciones que pueden alterar el resultado: Burbujas de aire El hielo mantiene en la jeringa muestras por 1-2 hrs
  38. 38. Indicaciones y contraindicaciones Test de AllenLo que puede alterar Procedimiento de un resultado punción Bases fisiológicas equilibrio ácido base 5 pasos interpretación Insuficiencia respiratoria Tipo I Tipo III Tipo II Tipo IV

×