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Acid—base balance 1

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Acid—base balance 1

  1. 1. In The name of GodCreate PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
  2. 2. Acid- Acid-Base Balance Physiology - The pH of ECF is tightly regulated - Normal: 7: 35 – 7: 45 - Daily production of acid :12000meq - Removal lung (most) - kidney (small ,50-100meq/day)but restore buffer capacity (HCO3)¯¯¯ - Respiratory or renal disfunctionbreakdown in processacid-base disordersCreate PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
  3. 3. -addition of acid [H+ ] &pH &pH -PH<7.35= [H+ ]=blood is acidotic or acidemic PH<7 35= [H -PH>7.45=[H+]=blood is alkalemic or alkalotic PH>7 45=[HCreate PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
  4. 4. Effect of PH imbalance Majority of body functions optimally at or near pH of 7.40 AcidosisCNS depression,lethargy,disorientation, coma Alkalosisover exitability of CNSperipheral nerves,tetany, muscular spasms of extremities,face body,respiratory failure Significant pH alteration Heart contractilityCreate PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
  5. 5. PaCO2 PaCO2  Normal :35-45mmHg  paco2 is respiratory componet of acid base status  regulation: 1) co2 production rate  2) Alveolar ventilation  fever or exercise co2 productionVAnormal paco2  Paco2 is the most reliable index of VE(minute volume)  PaCO2 [H+ ]Respiratory Acidosis  Paco2 [H+ ] = Respiratory AlkalosisCreate PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
  6. 6. Arterial Hco3¯ Hco3  Normal = 22—26 mEq/ L  Metabolic component of Acid –Base status  Regulation by renal system  Hco3¯PH=Metabolic Alkalosis  Hco3¯PH =Metabolic Acidosis  Hco3¯ may change in response to primary change of paco2 (12—24 hr )  Co2 + H2O  H2co3  H+ + Hco3¯  Paco2 Hco3¯  Paco2Hco3¯Create PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
  7. 7. Base Excess & Base deficit BE+ BE¯ BE¯  Normal : 2mEq/L  Be indicate pure metabolic componentCreate PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
  8. 8. Acid— Acid—Base disorders  1 )Simple disorder: Respiratory Acidosis Respiratory Alkalosis Metabolic Acidosis Metabolic Alkalosis  2 ) Mixed disordersCreate PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
  9. 9. Respiratory Acidosis  -Alveolar Ventilation relative to co2 production  Paco2 (paco2 > 45 mmhg ) or higher than expected level of compensation  Ethiology :1) Respiratory : *Acute upper Airway obstruction *sever diffuse airway obstruction (Acute or chronic) * Massive pulmonary edema 2) Nonrespiratory: * Drug overdose *Spinal cord trauma *Neuromuscular disease *Head trauma *trauma to thoracic cageCreate PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
  10. 10. Compensation of Respiratory Acidosis  Acute :pH paco2 Hco3¯ BE  Partial compensation : PH paco2 Hco3¯ BE  completely compensated :pH normal up to 7.39 paco2 HCO3¯ BE  Acute Respiratory Acidosis:10—15mmHg paco21mEq/L Hco3¯  Chronic Respiratory Acidosis:10mmhg paco24mEq/L Hco3¯Create PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
  11. 11. Clinical Effect of Respiratory Acidosis  Acute:CNS:Headache,sleepy,lethargy,confusion, semiconciousness,coma(paco2>70 mmhg)  But chronic :higher level of paco2 may be well tolerated  Hypoxemia may presented  CVS : 1)paco2 vasodilution+COwarm flushed skin +bounding pulse  2) Arrhytmias  3)Cerebral vasodilation ICP,Retinal venous distention , pupilledema & headache  Hco3¯(in compensation of Respiratory Acidosis)Cl levelCreate PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
  12. 12. Respiratory Alkalosis  Paco2 <35mmHg  Alveolar Ventilation Relation to co2 Production  Ethiology :Pain, Hypoxemia(pao2<55-60mmHg), Acidosis , Anexity, Mechanical ventilation  pH , paco2 and normal Hco3¯ & BE=uncompensated R Alkalosis  pH7.45 , paco2 , Hco3¯ , BE =partial compensation R Alkalosis  pH in normal range , paco2 , Hco3¯ , BE=Full compensated R AlkalosisCreate PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
  13. 13. Metabolic Acidosis  Hco3¯ BE  Buffers : production or loss  H+Acid) : load H+ or Excretion  Loss of Hco3¯ : diarrhea , renal disease  Metabolic Acid production: Keto acidosis , lactic acidosis,certain toxins(Metanol)  Post hypocapnia disorder  ANION GAP:Na–(Cl¯+Hco3¯)  Normal=8-16mEq/L . With K =1220mEq/L  Normal Anion gap : HCL , diarrhea , RTA , (type 2 , proximal)  High Anion gap :Renal Failure , lactic acidosis , keto acidosisCreate PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
  14. 14. Metabolic Alkalosis  -Hco3¯> Normal  -Accumolation of Hco3¯or H loss  Ethiology: Hypokalemia or hypochloremi *Nasogastric suction *persistent vomiting *post hypercapnia Disorder *Diuretic therapy *Steroid therapy *Excessive Adminstration of sodium bicarbonatCreate PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
  15. 15. Compensation of M Alkalosid  Hypoventilation paco2(Not in awake paients)  Uncompensated M Alkalosis :Hco3¯ BE PH & Normal paco2  Partial compensated: ph is not yet normal , Hco3¯ BE Paco2>45mmHg  Complet compensation : paco2 enough to PHNormalCreate PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
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  18. 18. Mixed Acid –Base disorder  When two of the symple are Acid –Base are present simultaneosly  Respiratory & metabolic Acidosis: cardiopulmonary arrest , COPD , Hypoxia , poisoning & Drug overdosage (Barbiturate)  Metabolic & Respiratory Alkalosis :Critical care unit:MV , anxeity , pain , Nasogastric suctioning , vomiting , transfusion, antiacid  Metabolic Acidosis & Respiratory Alkalosis:lactic acidosis(Hypoxia)+MV(Hyper ventilation)  Metabolic Alkalosis & Respiratory Acidosis:COPD+Diuretic therapyCreate PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
  19. 19. ‫ﭘﺎراﻣﺘﺮ ھﺎي اﺳﯿﺪ-ﺑﺎز در راﺑﻄﮫ ﺑﺎ ﻏﻠﻈﺖ ﯾﻮن ھﯿﺪروژن‬ ‫اﺟﺰاي‬ ‫ﺗﻨﻔﺴﻲ و اﺟﺰاي ﻣﺘﺎﺑﻮﻟﯿﻚ‬ ‫ﭘﺎراﻣﺘﺮھﺎي اﺳﯿﺪ-ﺑﺎز‬ ‫اﺟﺰا‬ ‫‪PH‬‬ ‫ﻏﻠﻈﺖ ﯾﻮن ھﯿﺪروژن‬ ‫2‪Paco‬‬ ‫اﺟﺰا, ﺗﻨﻔﺴﻲ‬ ‫2‪Pao‬‬ ‫‪o2sat‬‬ ‫3‪Hco‬‬ ‫اﺟﺰا, ﻣﺘﺎﺑﻮﻟﯿﻚ‬ ‫‪BE‬‬ ‫‪BEecf‬‬ ‫‪BB‬‬‫)‪Create PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com‬‬
  20. 20. Interpretation and discussion  PH Acidosis PH Alkalosis  PaCo2 Acidosis Paco2 Alkalosis  BE Alkalosis BE Acidosis  Pao2<60mmHg Hypoxia  Sao2<%90 HypoxiaCreate PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
  21. 21. External Respiration MIXED VENOUS BLOOD ARTERIAL BLOOD pH 7.36 pH 7.40 PCO2 46 mmHg PCO2 40 mmHg PO2 40 mmHg PO2 95 mmHg SO2 75% SO2 95% Internal RespirationCreate PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
  22. 22. ‫ در ﺷﺮاﯾﻂ ﻃﺒﯿﻌﻲ و ﺑﺤﺮاﻧﻲ‬PH ‫ﻏﻠﻈﺖ ﯾﻮن ھﯿﺪروژن و‬ ‫ﺗﺸﻨﺞ‬ ‫ﻃﺒﯿﻌﻲ ﻛﻮﻣﺎ‬ ‫ﭘﺎراﻣﺘﺮ‬ ١٦ ١٢٥ ٤٠ [H] ٧/٨ ٦/٩ ٧/٤ PHCreate PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
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  24. 24. Interpretation and discussion  PH=7/16 7.35-7.45  Paco2=40mmHg 35-45mmHg  Pao2=60mmHg 80-100mmHg  Sao2=85% >90%  Cao2=11vol% 16-20 vol%  BE= 14 ±2  Hco3¯ = 14mEq/L 22-26mEq/LCreate PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
  25. 25. Interpretation and discussion  PH = 7.49  Paco2 = 32mmHg  Pao2 = 68 mmHg  Sao2=91.5%  Cao2 = 16 vol%  Hco3¯ = 22mEq/L  BE = 1Create PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
  26. 26. Interpretation and discussion  Ph = 7.41  Paco2 = 61mmHg  Pao2 = 66 mmHg  Sao2=91. 4%  Cao2 = 12.2 vol%  Hco3¯ = 37mEq/L  BE =+11Create PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
  27. 27. Interpretation and discussion  PH = 6.96  Paco2 = 17mmHg  Pao2 = 110mmHg  Sao2=99. 9%  Cao2 = 19 vol%  Hco3¯ = 3.5mEq/L  BE = 24Create PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
  28. 28. Interpretation and discussion  PH = 7.53  Paco2 = 31mmHg  Pao2 = 90mmHg  Hco3¯ =25mEq/L  BE = +5mEqLCreate PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
  29. 29. Interpretation and discussion  PH = 7.25  Paco2 = 32mmHg  Hco3¯ =16mEq/L  BE = - 10 mEqLCreate PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
  30. 30. Interpretation and discussion  PH = 7.21  Paco2 = 67mmHg  Pao2 = 49 mmHg  Sao2=76%  Cao2 = 10.4 vol%  Hco3¯ = 26 mEq/L  BE = 2  Hb = 10Create PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
  31. 31. Interpretation and discussion  PH = 7/409  Paco2 = 27/2  BE = -5/2  Hco3¯ = 16/7  Pao2 = 53  O2sat = 86Create PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
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