The relationship between H+,PaCO₂ and HCO₃ are expressed in the equation of:
|
|
- Jeremy Stafford
- 5 years ago
- Views:
Transcription
1 [Acid-Base Balance] [Dr. Bashir Khasawneh] [5 th February 2012] Acid-Base Basic Concepts: The relationship between H+,PaCO₂ and HCO₃ are expressed in the equation of: Which is modified from Henderson-Hasselbach equation: PaCO 2 and HCO 3 - are two titers that responsible to keep H+ in the system under control. H+ are referring to the intracellular hydrogen ions that leak a little bit to the blood. That is why people with crash injury will get acidosis as the hydrogen ions get out from intracellular, just like potassium. But they present in a small amount in the blood to keep an appropriate acidity. So from the equation, you can see that when PaCO₂ increase, HCO 3 - will increase too. Same thing happen if HCO 3 - decrease, PaCO₂ will have to decrease with it to keep the H+ in balance. Regarding [H+], the problem is that it presents in the body in a very minute amount (by neq or nmol/l), this problem has been overcome by using the concept of ph. So instead of saying: "the normal [H+] in blood is 40nEq", we can say: "the normal physiological blood ph is 7.40" Since ph is a logarithm, the relation will be in an opposite way. If H+ concentration is high, ph will drop and vice versa and they are not proportional.
2 Take a look at this table (slide 3) If we increase H+ from 40nEq (normal) 62nEq; the ph will decrease by while if we decrease H+ by same amount from 40nEq 18nEq, the ph will increase by And you can see that the ph is more sensitive towards the alkalosis side(high ph); small change of H+ concentration will cause a greater shift of the ph because alkalosis is more dangerous than acidosis. Normal values So here are few numbers that you have to remember: [H+] = 40 neq/l ph = 7.40 ( ) PaCO 2 = 40 mm Hg (35-45) HCO 3 = 24 meq/l (22-26) You have to know that the normal value of ph is 7.40 while are the acceptable physiological range which means any ph within this range is acceptable, but it is not normal. Some people say 7.42 is normal, it is not, it is acceptable. The normal one is Same thing for the PaCO 2, HCO 3, H+, you have the normal and acceptable physiological range. Now, simply: PaCO 2 = Acid PaCO 2 = ph (Acidemia) PaCO 2 = ph (Alkalemia) HCO 3 = Base HCO 3 = ph (Alkalemia) HCO 3 = ph (Acidemia)
3 While in numbers, if PaCO₂ is more than 40mmHg, it is acidosis and if it is less than that, it is alkalosis. And the opposite way to HCO 3, if it is more than 24mEq/L, it is alkalosis while less than that value will be acidosis. And for ph, just think the same. As simple as that Acid-Base Analysis Now, how do we do the acid-base analysis? It is by: 1. Arterial Blood Gases(ABG). We draw out a unit of arterial blood and from there we can get ph and PaCO₂. While for HCO₃, we calculate it using the Henderson-Hasselbach equation. Or, you can get it from 2. Serum chemistry where you can measure HCO 3 with Na, K, Cl. This way actually increases the costs while the value actually doesn t differ that much from the calculated one. So now, we usually depend on the calculated HCO from ABG. Since PaCO₂ is regulated by respiration, abnormalities that primarily alter the PaCO₂ are referred to as respiratory acidosis (high PaCO₂) and respiratory alkalosis (low PaCO₂). In contrast, [HCO3-] is regulated primarily by renal processes. Abnormalities that primarily alter the [HCO3-] are referred to as metabolic acidosis (low [HCO3-]) and metabolic alkalosis (high [HCO3-]). Simple acid base disorders -Disorders that is either metabolic or respiratory. Type of Disorder ph PaCO 2 [HCO 3 ] Metabolic Acidosis Metabolic Alkalosis Acute Respiratory Acidosis Chronic Respiratory Acidosis Acute Respiratory Alkalosis Chronic Respiratory Alkalosis Mixed acid base disorders -More than one acid base disturbance present. ph may be normal or abnormal. Let me give you an example of mixed acid base disorder.
4 A patient has COPD from a long time ago. Because of this, he always has high PaCO₂. So this is what we call chronic respiratory acidosis. And suddenly he has septic shock which caused him to have metabolic acidosis.*causes of disorders will be explained later* Now he has both respiratory and metabolic acidosis. So when he is admitted to the hospital, he is treated with steroids and diuretics which cause him to have metabolic alkalosis. So now, he has both respiratory acidosis and metabolic alkalosis. So the imbalances do exist in such order. Now, to solve this case, first we have to look for the primary disorder. The primary disorder for this patient is chronic respiratory acidosis (PaCO₂ high). What happen next is compensatory mechanism. We have two types of compensation. 1. Respiratory compensation which will compensate for metabolic disorder. 2. Metabolic compensation which will compensate for respiratory disorder. Compensation 1.RESPIRATORY COMPENSATION It is a prompt response towards metabolic acidosis or alkalosis. In case of metabolic acidosis, hyperventilation will occur in order to get rid of CO₂, compensating for the decreased HCO 3. While in metabolic alkalosis, the opposite happens. Metabolic acidosis Hyperventilation - PaCO 2 Metabolic alkalosis Hypoventilation - PaCO 2 For example in a DKA patient who develop sudden acidosis. The HCO 3 in this patient is decreased. So what is going to happen? The respiratory system will compensate this by having hyperventilation. But now, how do we know that this response is an appropriate one or not?by using these formulae: Metabolic Acidosis PaCO₂ = [1.5 x HCO 3 + 8] 2 Metabolic Alkalosis PaCO₂ = 0.9 HCO 3 For example in a patient with metabolic acidosis which means primarily his HCO 3 is low. So, after compensation, the expected PaCO₂ should be calculated using this formula. If his HCO 3 is for example 10, you are expecting his compensated PaCO₂ to be around 23 (21-25). If his PaCO₂ is below this range, we will say that this patient
5 is having another disorder which is respiratory acidosis. So now he has both metabolic and respiratory acidosis In metabolic alkalosis, similar concept is applied. For every HCO 3 increases, the PaCO₂ will increase. For example if the HCO 3 is increase to 30 (normal is 24), the HCO 3 is 6}. How much will the PaCO 2 increase? PaCO₂ = 5.4}, normal PaCO₂ is 40, so you will expect the PaCO₂ to be compensated to is still acceptable, but what happen if the value is 25? It means this patient has both metabolic alkalosis and respiratory alkalosis. So these are what we call the rule of compensation. 2.METABOLIC COMPENSATION The kidney will work on the HCO 3 to compensate for chronic respiratory disorder. That s why those with COPD, they have chronic CO₂ retention, and therefore they will have high HCO 3. Pregnant woman, liver cirrhosis patient who have chronic hyperventilation, their HCO 3 will chronically decreased. However, this compensation by the kidney is not prompt or immediate. So in a patient with acute respiratory acidosis like one given 10mg morphine because of certain procedure, don t expect the HCO 3 to follow straight away. But once they increase after a few days, they are very appropriate because kidney doesn t get tired as much as lung. From slide 13 Slow response -Starts in 6-12 hours -Steady state in few days Respiratory acidosis -Stimulates HCO 3 reabsorption - HCO 3 Respiratory alkalosis -Inhibits HCO 3 reabsorption - HCO 3 Metabolic Compensation (continuation): Now the compensation rules for that Chronic Respiratory Acidosis HCO 3 = 0.35 PaCO 2 So approximately HCO 3 changes by one third (1/3) of what PaCO 2 changes
6 Chronic Respiratory Alkalosis HCO 3 = 0.5 PaCO 2 Let s give you an example: A patient with COPD presented with PaCO 2 = 80 meq/l increased by 40 According to the equation the expected change in HCO 3 will be: HCO 3 = 0.35 x 40 = 14 meq/l so we expect from the kidney to retain HCO 3 and HCO 3 will elevate to be = = 38 (doctor said 40) So he came to the ER with PaCO 2 = 80 and HCO 3 = 40 it s a compensated respiratory acidosis The importance of this is that I know there is no acute problem. When I see such readings it means that the patients is having chronic compensated respiratory acidosis, it s true that the patient is chronically ill but at least he is stable, he doesn t need immediate intervention On the other hand if a patient came with PaCO 2 = 65 meq/l and HCO 3 =26 meq/l PaCO 2 = 25 HCO3= 0.35 x 25 8 expected HCO3 = = 32 meq/l In this case there is an acute problem and the patient needs more attention. The two serious problems in acid base imbalance are Metabolic acidosis and Respiratory acidosis Metabolic Acidosis: Metabolic acidosis is grouped according to the anion gap (AG). What is anion gap? It is the difference between the sum of the measured cations and measured anions in the plasma or serum calculated as follows: {[Na +] ([Cl-] + [HCO3-])}. The word 'gap' is misleading, because in our body anions must equal cations otherwise the body won't be neutral! So why is there a 'gap'? There are hidden anions like the negatively charged plasma proteins that are unmeasured; this anion gap estimates the unmeasured anions.
7 Normal AG= (9-12 meq/l), if AG is > 20, we call it wide AG Usually the normal value is around 10, any number above 15 or 20 means we have a fixed acid in the serum Wide Anion Gap Metabolic Acidosis: (Usually caused by serious problems). -Causes of wide anion gap metabolic acidosis are best remembered by the popular mnemonic MUDPILES or KULT: M = Methanol U = Uremia (renal failure). D = DKA and ketoacidosis P = Paraldehyde I = Iron & Isoniazid INH L = Lactic acidosis (usually due to sepsis). E = Ethanol and Ethylene Glycol S = Salycilate K = Ketoacidosis (DKA, alcoholic ketoacidosis, starvation) U = Uremia (Renal Failure) L =Lactic acidosis T = Toxins (Ethylene glycol, methanol, paraldehyde, salicylate) If you look at them they are all serious, but in our country you may see DKA, lactic acidosis, and Uremia (renal failure). The common cause of lactic acidosis is shock. Methanol is serious, it affects the eyes and cause blindness. Ethylene glycol causes renal failure, its crystals deposit in the glomeruli. Salicylate can be fatal also If I get a patient with HCO 3 =12 and low PaCO 2, this looks like a pure metabolic acidosis, it is important for this patient to be investigated further: lactic acid level, blood sugar, salicylate overdose, ethanol level, KFT This is different from normal anion gap, which is a more benign condition Non (normal) Anion Gap Metabolic Acidosis Hyperalimentation (over IV feeding). Acetazolamide (drug we use it to induce metabolic acidosis), amphotericin B (patients who have immunosuppression take it for fungal infections) RTA Renal Tubular Acidosis. Ureteral Diversions. Diarrhea- obvious cause, the patient loses HCO 3 with diarrhea Pancreatic fistula. Saline resuscitation.
8 So the causes of Normal anion gap metabolic acidosis are not serious and more easily managed Metabolic Alkalosis : Characterized by : - Primary in HCO 3 concentration - Compensatory in PaCO 2 Classified according to urinary chloride - Chloride responsive: when Cl is high in urine. Usually, the cause is vomiting in this group. - Chloride resistant. Metabolic Alkalosis -Chloride Responsive: Urine Cl - > 20 meq/l. Caused by: Volume Contraction: - Nasogastric suctioning - Vomiting - Diuretics Post Hypercapnia, when PaCO 2 is high HCO 3 increases to compensate, suddenly the hypercapnia is relieved by hyperventilation or HCO 3. What will remain? HCO 3 alone! Because it takes time to go back to normal. Hypokalemia. Hypomagnesemia. - these 2 disorders are missed in medicine. Penicillin. Diuresis.
9 Metabolic Alkalosis - Chloride Unresponsive: Urine Cl - < 20 meq/l. Caused by: Mineralcorticoid excess Exogenous steroids (most common cause) Alkali Ingestion Licorice Too much wine Tobacco chewers Bartter s Syndrome (they like to put questions about it in the exam) Cl - responsive if you give them normal saline infusion they will get benefit, whereas Cl - unresponsive they won't. Solving Acid Base Disorders :
10 This is a way to validate blood gases to know if its value is correct or not [H + ] = 24 PaCO 2 / [HCO 3 - ] For example the normal [H + ] = 24 40/ 24 = = 40 ph = 7.40 So if you looked at the blood gases and it says the ph= 7.57 this means the values are wrong because if the PaCO 2 is 40 and the HCO 3 is 24 then we expect the ph to be normal or around that like 7.39 or 7.38 but if it is 7.57 then I don t rely on this reading there must be something wrong with it. We look at the blood gases if the ph < 7.40 this means that the primary concern is Acidosis if the ph > 7.40 then the primary concern is Alkalosis Now if the primary concern is on the acidosis site and the PaCO 2 explains it (meaning it s high), then this is respiratory acidosis while if the HCO 3 is very low and explains it then it s metabolic acidosis, in this simple way. So if the ph= 7.30 and the HCO 3 = 15 metabolic Acidosis if the ph= 7.50 and the PaCO 2 = 20 respiratory alkalosis This is how you do it in a simple manner. Here we calculate the compensation rules that we talked about if it is outside the range then it s a mixed disorder, and there are some examples later on. If the patient s PaCO 2 = 80 then the HCO 3 should be 40, if the HCO 3 = 20 then this indicates Mixed metabolic acidosis, while if the HCO 3 = 50 then mixed metabolic alkalosis. Let s give you some case studies : Case Study - 1: A 39 year old woman was admitted with a history of generalized weakness, dyspnea, continuous nausea and diarrhea. Bowel motions were frequent and watery. ABG: ph 7.29, PaCO2 25.6, PaO2 98 Na+=125, K+=2.8, Cl-=101, HCO3=14
11 I know that diarrhea causes non anion gap metabolic acidosis Let s look at the ABG: the ph 7.29 acidosis, what explains it from these readings? the low HCO 3 this is metabolic acidosis Calculate the anion gap [Na +] ([Cl-] + [HCO3-]) 125 ( ) = 12 So this is a normal anion gap metabolic acidosis most likely caused by the diarrhea Case Study - 2: A 78 year old lady presented with at a 1 week history of abdominal pain and vomiting. ABG: ph 7.49, PaCO2 52, PaO2 78 Na 137, K 2.2, CL 91, HCO3 38 Urine CI 43 meq/l. Vomiting causes metabolic alkalosis because you lose H + in the vomitus ph = 7.49 explained by HCO 3 = 38 metabolic alkalosis We said in metabolic alkalosis for every HCO 3 by 1 then the PaCO 2 by 1 (give or take, it s not a strict rule) HCO 3 is increased by 14 and the PaCO 2 is increased by 12 it s compensated So this is a simple metabolic alkalosis secondary to vomiting Whatever the acid base disorder, if there is a wide anion gap this indicates presence of metabolic acidosis.
12 Case Study - 3: A 21 year old MS is brought to the ER at ~3 am, stuporous and tachypneic. History is remarkable for failing the respiratory module in 2nd year. An ABG and electrolytes have been drawn by the ER nurse. ABG: ph=7.43, PaCO2=18 Na + =143, K + =3.8, Cl - =106, HCO3=12 ph =7.43 slightly on the alkalosis side PaCO 2 = 18! Very low respiratory alkalosis. HCO 3 = 12. low; Compensatory? Mixed? compensation HCO3 = (0.5) PaCO 2 HCO3 = 11 so we expect the HCO 3 to decrease by = 13 Then this is a chronic respiratory alkalosis We have to calculate the anion gap. AG = 143 (106+12) = 25 wide AG metabolic acidosis; that s why the ph is like this What can cause such a condition? It s toxicity the ethanol and methanol depress the respiratory center, whereas aspirin stimulates the respiratory center so this is a classic aspirin overdose Primary Respiratory Disorders- Acute vs. Chronic: ACUTE PaCO2 = 10 ph=0.08 (~0.1) CHRONIC PaCO2 = 10 ph=0.03 In acute respiratory acidosis, ph = Δ PaCO2 In chronic respiratory acidosis, ph = Δ PaCO2. Acute usually is serious and needs intervention like bipap machine or whatever mechanical ventilation while Chronic needs only outpatient care
13 Another example PaCO 2 = 40 if it is acute ph = the ph expected to be 7.00 If it is chronic ph = = 0.12 the ph will be 7.28 if it is chronic The ph =7.33 because he has a chronic metabolic alkalosis, these patients are usually on steroids and diuretics Case Study - 4: A 55 year old woman presented to the ER with dyspnea and wheezes. She is heavy smoker. An ABG and electrolytes have been drawn by the ER nurse. ABG: ph=7.33, PaCO 2 =65 Na + =144, K + =4.2, Cl - =104, HCO 3 = 32 ph =7.33 acidosis. PaCO2 = 65! Respiratory acidosis. HCO3 high (compensatory). Compensation : Δ HCO3= 1/3 Δ PaCO2 Δ PaCO2 = = 25 Δ HCO3= 1/3 25 =~ = 32 AG = 144 (104+32) = 8 normal. Chronic compensated respiratory acidosis. What is the significance of knowing whether the case is acute or chronic? When a patient comes to the ER with respiratory acidosis we have to assess his case if it is acute or chronic, because if I know that his case is chronic I will be sure that nothing new has happened to him, I can give him nebulizers and steroids then send him home..the END. Done by, Siti Zulaikha Hairuddin (B1) Big thanks to those who help me for this lecture. May Allah bless you in everything you do enshallah
9/14/2017. Acid-Base Disturbances. Goal. Provide an approach to determine complex acid-base disorders
Acid-Base Disturbances NCNP October 10, 2017 Eric Magaña, M.D. Presbyterian Medical Center Department of Pulmonary and Critical Care Medicine Goal Provide an approach to determine complex acid-base disorders
More information3/17/2017. Acid-Base Disturbances. Goal. Eric Magaña, M.D. Presbyterian Medical Center Department of Pulmonary and Critical Care Medicine
Acid-Base Disturbances Eric Magaña, M.D. Presbyterian Medical Center Department of Pulmonary and Critical Care Medicine Goal Provide an approach to determine complex acid-base disorders Discuss the approach
More informationPedsCases Podcast Scripts
PedsCases Podcast Scripts This is a text version of a podcast from Pedscases.com on Approach to Acid-Base Disturbance. These podcasts are designed to give medical students an overview of key topics in
More informationAcid and Base Balance
Acid and Base Balance 1 2 The Body and ph Homeostasis of ph is tightly controlled Extracellular fluid = 7.4 Blood = 7.35 7.45 < 7.35: Acidosis (acidemia) > 7.45: Alkalosis (alkalemia) < 6.8 or > 8.0: death
More informationPhysiological Causes of Abnormal ABG s
Physiological Causes of Abnormal ABG s Major Student Performance Objective 1 1. The student will be able to discuss causes for various types of blood gas results. 2. They will also be required to discuss
More informationAcid/Base Disorders 2015
Objectives - 2 1. Identify acid/base disorders 2. Discuss etiologies for 1 0 acid/base disorders (will not include mixed disorders) 3. Interpret acid/base disorders by interpreting arterial blood gas &
More informationCarbon Dioxide Transport. Carbon Dioxide. Carbon Dioxide Transport. Carbon Dioxide Transport - Plasma. Hydrolysis of Water
Module H: Carbon Dioxide Transport Beachey Ch 9 & 10 Egan pp. 244-246, 281-284 Carbon Dioxide Transport At the end of today s session you will be able to : Describe the relationship free hydrogen ions
More informationAcids, Bases, and Salts
Acid / Base Balance Objectives Define an acid, a base, and the measure of ph. Discuss acid/base balance, the effects of acidosis or alkalosis on the body, and the mechanisms in place to maintain balance
More informationSlide 1. Slide 2. Slide 3. Learning Outcomes. Acid base terminology ARTERIAL BLOOD GAS INTERPRETATION
Slide 1 ARTERIAL BLOOD GAS INTERPRETATION David O Neill MSc BSc RN NMP FHEA Associate Lecturer (Non Medical Prescribing) Cardiff University Advanced Nurse Practitioner Respiratory Medicine Slide 2 Learning
More informationDr. Suzana Voiculescu
Dr. Suzana Voiculescu AB balance parameters Extracellular ph (plasmatic ph)= 7.35-7.45 < 7.35= acidosis >7.45= alkalosis Kassirer-Bleich equation [H+] = 24 PCO2/ [HCO3-] predicts that the ratio of dissolved
More informationInter Inter Pretation of Acid Base Disturbance in Critically ill Patients. By :-: Dr. Vinay Bhomia M.D.
Inter Inter Pretation of Acid Base Disturbance in Critically ill Patients. By :-: Dr. Vinay Bhomia M.D. Normal Blood PH 7.35 to 7.45 Crucial importance to maintain homeostatic function of Body. Any Significant
More informationDr. Suzana Voiculescu Discipline of Physiology and Fundamental Neurosciences Carol Davila Univ. of Medicine and Pharmacy
Dr. Suzana Voiculescu Discipline of Physiology and Fundamental Neurosciences Carol Davila Univ. of Medicine and Pharmacy AB balance parameters Extracellular ph (plasmatic ph)= 7.35-7.45 < 7.35= acidosis
More information1. What is the acid-base disturbance in this patient?
/ABG QUIZ QUIZ 1. What is the acid-base disturbance in this patient? Presenting complaint: pneumonia 1 point Uncompensated metabolic alkalosis Partially compensated respiratory alkalosis Mixed alkalosis
More informationAcid-Base Balance Workshop. Dr. Najla Al Kuwaiti Dr. Abdullah Al Ameri Dr. Amar Al Shibli
Acid-Base Balance Workshop Dr. Najla Al Kuwaiti Dr. Abdullah Al Ameri Dr. Amar Al Shibli Objectives Normal Acid-Base Physiology Simple Acid-Base Disorders Compensations and Disorders The Anion Gap Mixed
More informationAcid Base Balance. Professor Dr. Raid M. H. Al-Salih. Clinical Chemistry Professor Dr. Raid M. H. Al-Salih
Acid Base Balance 1 HYDROGEN ION CONCENTRATION and CONCEPT OF ph Blood hydrogen ion concentration (abbreviated [H + ]) is maintained within tight limits in health, with the normal concentration being between
More informationArterial Blood Gas Interpretation: The Basics
http://www.medicine-on-line.com ABG Basics: Page 1/10 Arterial Blood Gas Interpretation: The Basics Author: David C Chung MD, FRCPC Affiliation: The Chinese University of Hong Kong Sampling of arterial
More informationAcid Base Disorders: Key Core Concepts. Thomas DuBose M.D., MACP, FASN ASN Board Review Course Online Resource Material 2014
Acid Base Disorders: Key Core Concepts Thomas DuBose M.D., MACP, FASN ASN Board Review Course Online Resource Material 2014 Speaker Disclosure I, Thomas DuBose, M.D., have no financial relationships or
More informationCASE 27. What is the response of the kidney to metabolic acidosis? What is the response of the kidney to a respiratory alkalosis?
CASE 27 A 21-year-old man with insulin-dependent diabetes presents to the emergency center with mental status changes, nausea, vomiting, abdominal pain, and rapid respirations. On examination, the patient
More informationOutline. ABG Interpretation: A Respirologist s approach. Acid-Base Disturbances. What use is an ABG? Acid-Base Disturbances. Alveolar Ventilation
Outline ABG Interpretation: A Respirologist s approach Dr. Shane Shapera Division of Respirology University Health Network October 2014 A quick review of acidbase physiology The 8 steps to ABG interpretation
More informationUNIT VI: ACID BASE IMBALANCE
UNIT VI: ACID BASE IMBALANCE 1 Objectives: Review the physiological mechanism responsible to regulate acid base balance in the body i.e.: Buffers (phosphate, hemoglobin, carbonate) Renal mechanism Respiratory
More informationCarver College of Medicine University of Iowa
October 15, 2010 Deborah J. DeWaay MD Assistant Professor of Medicine Associate Vice Chair i of Education Department of Internal Medicine Medical University of South Carolina Joel A. Gordon, MD Professor
More informationThere are many buffers in the kidney, but the main one is the phosphate buffer.
9 Yanal Obada Zalat Renal Control of AcidBase Balance The kidneys play three major roles in the maintenance of normal acidbase balance: 1excretion of H+ (fixed _non volatile H+) 2Reabsorption of filtrated
More informationArterial Blood Gas Analysis
Arterial Blood Gas Analysis L Lester www.3bv.org Bones, Brains & Blood Vessels Drawn from radial or femoral arteries. Invasive procedure Caution must be taken with patient on anticoagulants ph: 7.35-7.45
More informationAcid-Base Imbalance-2 Lecture 9 (12/4/2015) Yanal A. Shafagoj MD. PhD
AcidBase Imbalance2 Lecture 9 (12/4/2015) Yanal A. Shafagoj MD. PhD Introduction Disturbance in acidbase balance are common clinical problem that range in severity from mild to life threatening, the acute
More informationBlood Gases 2: Acid-Base and Electrolytes Made Simple. Objectives. Important Fact #1
Blood Gases 2: Acid-Base and Electrolytes Made Simple Gary L. Horowitz, MD Beth Israel Deaconess Medical Center Boston, MA Objectives Identify the 4 major acid-base disturbances, giving typical values
More informationAcid-Base Tutorial 2/10/2014. Overview. Physiology (2) Physiology (1)
Overview Acid-Base Tutorial Nicola Barlow Physiology Buffering systems Control mechanisms Laboratory assessment of acid-base Disorders of H + ion homeostasis Respiratory acidosis Metabolic acidosis Respiratory
More informationACID-BASE BALANCE. It is important to remember that more than one of the above processes can be present in a patient at any given time.
ACID-BASE BALANCE Epidemiology/Pathophysiology Understanding the physiology of acid-base homeostasis is important to the surgeon. The two acid-base buffer systems in the human body are the metabolic system
More informationInterpretation of ABG. Chandra Shekhar Bala, FCPS( Medicine) Junior Consultant NINS and Hospital, Dhaka
Interpretation of ABG Chandra Shekhar Bala, FCPS( Medicine) Junior Consultant NINS and Hospital, Dhaka ABG analysis of Ms Rubi Ms. Rubi, 20 year-old lady PH 7.29 presented with breathlessness. She had
More informationAcid Base Balance by: Susan Mberenga RN, BSN, MSN
Acid Base Balance by: Susan Mberenga RN, BSN, MSN Acid Base Balance Refers to hydrogen ions as measured by ph Normal range: 7.35-7.45 Acidosis/acidemia: ph is less than 7.35 Alkalosis/alkalemia: ph is
More informationInterpretation of. No Da Vinci Code
Interpretation of Mixed Acid Base Disorders- No Da Vinci Code by Surg Capt Aamir Ijaz, Consultant Pathologist / Assoc Prof of Pathology, PNS SHIFA ARTERIAL BLOOD GASES Measured on a Blood Gas Analyser.
More informationBiochemistry of acid-base disorders. Alice Skoumalová
Biochemistry of acid-base disorders Alice Skoumalová Main topics of the lecture: Measurement of acid-base dysbalance Classification of the acid-base disorders 4 basic acid-base disorders and their compensaiton
More informationThere are number of parameters which are measured: ph Oxygen (O 2 ) Carbon Dioxide (CO 2 ) Bicarbonate (HCO 3 -) AaDO 2 O 2 Content O 2 Saturation
Arterial Blood Gases (ABG) A blood gas is exactly that...it measures the dissolved gases in your bloodstream. This provides one of the best measurements of what is known as the acid-base balance. The body
More informationAre you ready to have fun?
Arterial Blood Gas INTERPRETATION By Nena Bonuel, MSN, RN, CCRN, CNS, ACNS-BC Nurse Specialist, Center for Professional Excellence Are you ready to have fun? 1. Yes! 2. I rather go shopping 3. I still
More information/ABG. It covers acid-base disturbance, respiratory failure, and a small summary for some other derangements. Causes of disturbance
/ABG This page focuses on providing some possible causes for the various disturbances that may be seen on an ABG. Although not an exhaustive list, it attempts to outline the main headings for possible
More informationThe equilibrium between basis and acid can be calculated and termed as the equilibrium constant = Ka. (sometimes referred as the dissociation constant
Acid base balance Dobroslav Hájek dhajek@med.muni.cz May 2004 The equilibrium between basis and acid can be calculated and termed as the equilibrium constant = Ka. (sometimes referred as the dissociation
More informationSIMPLY Arterial Blood Gases Interpretation. Week 4 Dr William Dooley
SIMPLY Arterial Blood Gases Interpretation Week 4 Dr William Dooley Plan Structure for interpretation 5-step approach Works for majority of cases Case scenarios Some common concerns A-a gradient BE Anion
More informationARTERIAL BLOOD GASES PART 1 BACK TO BASICS SSR OLIVIA ELSWORTH SEPT 2017
ARTERIAL BLOOD GASES PART 1 BACK TO BASICS SSR OLIVIA ELSWORTH SEPT 2017 WHAT INFORMATION DOES AN ABG GIVE US? ph = measure of hydrogen ion concentration (acidity or alkalinity) PaCO2 = partial pressure
More informationArterial Blood Gases Interpretation Definition Values respiratory metabolic
Arterial Blood Gases Interpretation Definition A blood gas test measures the amount of oxygen and carbon dioxide in the blood. It is also useful in determining the ph level of the blood. The test is commonly
More informationAcid-Base Physiology. Dr. Tamás Bense Dr. Alexandra Turi
Acid-Base Physiology Dr. Tamás Bense Dr. Alexandra Turi What is a blood gas assessment? We get it from an arterial sample (a.radialis, a. brachialis, a. femoralis) Invasive technique If the patient is
More informationDisorders of Acid-Base
Disorders of Acid-Base Balance Bởi: OpenStaxCollege Normal arterial blood ph is restricted to a very narrow range of 7.35 to 7.45. A person who has a blood ph below 7.35 is considered to be in acidosis
More informationSteady a disturbed equilibrium
Steady a disturbed equilibrium Accurately interpret the acidbase balance of acutely ill patients. By Susan J. Appel, APRN,BC, CCRN, PhD, and Charles A. Downs, APRN,BC, CCRN, MSN DDerangements in acidbase
More informationACID-BASE DISORDERS. Assist.Prof.Dr. Filiz BAKAR ATEŞ
ACID-BASE DISORDERS Assist.Prof.Dr. Filiz BAKAR ATEŞ Acid-Base Regulation Metabolic processes continually produce acid and, to a lesser degree, base. Hydrogen ion (H+) is especially reactive; it can attach
More informationAcids and Bases their definitions and meanings
Acids and Bases their definitions and meanings Molecules containing hydrogen atoms that can release hydrogen ions in solutions are referred to as acids. (HCl H + Cl ) (H 2 CO 3 H + HCO 3 ) A base is an
More informationDespite the continuous production of acid in the body,
Review Article Diagnosing AcidBase Disorders AK Ghosh Abstract Diagnosis and management of acidbase disorders ranks high among the medical problems that intimidate many physicians. In practice, acid base
More informationBlood Gases, ph, Acid- Base Balance
Blood Gases, ph, Acid- Base Balance Blood Gases Acid-Base Physiology Clinical Acid-Base Disturbances Blood Gases Respiratory Gas Exchange Chemical Control of Respiration Dyshemoglobins Oxygen Transport
More informationPARAMEDIC RESOURCE MANUAL
ONTARIO BASE HOSPITAL GROUP PARAMEDIC RESOURCE MANUAL ACID-BASE BALANCE SECTION SIX Version 1.1 2010 Update PARAMEDIC RESOURCE MANUAL OBJECTIVES: ACID-BASE BALANCE The objectives indicate what you should
More informationUNIT 9 INVESTIGATION OF ACID-BASE DISTURBANCES
UNIT 9 INVESTIGATION OF ACIDBASE DISTURBANCES LEARNING OBJECTIVES At the end of this chapter, students must be able to: 1. Describe the main parametres that define the acidbase equilibrium 2. Identify
More informationAdvanced Pathophysiology Unit 8: Acid/Base/Lytes Page 1 of 31
Advanced Pathophysiology Unit 8: Acid/Base/Lytes Page 1 of 31 Learning Objectives for this File: 1. Review acids, bases and chemical relationship. 2. Understand acid dissociation, conjugate base 3. Review
More informationS.M. Gorbatkin MD, PhD Emory Board Review in Internal Medicine July Renal Division Department of Veterans Affairs Medical Center Atlanta
S.M. Gorbatkin MD, PhD Emory Board Review in Internal Medicine July 2016 External Industry Relationships * Equity, stock, or options in biomedical industry companies or publishers Board of Directors or
More informationRenal Physiology. April, J. Mohan, PhD. Lecturer, Physiology Unit, Faculty of Medical Sciences, U.W.I., St Augustine.
Renal Physiology April, 2011 J. Mohan, PhD. Lecturer, Physiology Unit, Faculty of Medical Sciences, U.W.I., St Augustine. Office : Room 105, Physiology Unit. References: Koeppen B.E. & Stanton B.A. (2010).
More informationWanchai Wongkornrat Cardiovascular Thoracic Surgery Siriraj Hospital Mahidol University
Wanchai Wongkornrat Cardiovascular Thoracic Surgery Siriraj Hospital Mahidol University Assess adequacy of ventilation and oxygenation Aids in establishing a diagnosis and severity of respiratory failure
More informationAcid-Base Balance 11/18/2011. Regulation of Potassium Balance. Regulation of Potassium Balance. Regulatory Site: Cortical Collecting Ducts.
Influence of Other Hormones on Sodium Balance Acid-Base Balance Estrogens: Enhance NaCl reabsorption by renal tubules May cause water retention during menstrual cycles Are responsible for edema during
More informationChapter 26 Fluid, Electrolyte, and Acid- Base Balance
Chapter 26 Fluid, Electrolyte, and Acid- Base Balance 1 Body Water Content Infants: 73% or more water (low body fat, low bone mass) Adult males: ~60% water Adult females: ~50% water (higher fat content,
More informationClinical Approach to the Patient with Potential Acid- Base Disturbances
Education Article Iran J Ped June 2007, Vol 17 (No 2), Pp:171-178 Clinical Approach to the Patient with Potential Acid- Base Disturbances Farahnak Assadi* 1, MD 1. Pediatric Nephrologist, Rush University
More informationDisorders of Acid-Base Balance
OpenStax-CNX module: m46413 1 Disorders of Acid-Base Balance OpenStax College This work is produced by OpenStax-CNX and licensed under the Creative Commons Attribution License 3.0 By the end of this section,
More informationPICU Resident Self-Study Tutorial Interpreting Blood Gases
Christopher Carroll, MD INTRODUCTION Blood gases give us a huge amount of information regarding the patient s physiologic condition and are the best method available to assess a patient s oxygenation and
More informationControl of Breathing
Physio # 11 Dr. Yanal Shafaqoj Done By: Lejan Al - Dof'at 13/12/13 Control of Breathing We talked previously about Oxygen extraction and CO 2 production, and how these are transfused through blood (in
More informationAcid Base Imbalance. 1. Prior to obtaining the ABG s an Allen s test should be performed. Explain the rationale for this.
Acid Base Imbalance Case 1. An 18-year-old male arrives via EMS to the emergency department. He is experiencing Tachypnea, dizziness, numbness and paraesthesia. He is anxious, respirations are 28 per minute
More informationInterpretation of Arterial Blood Gases. Prof. Dr. W. Vincken Head Respiratory Division Academisch Ziekenhuis Vrije Universiteit Brussel (AZ VUB)
Interpretation of Arterial Blood Gases Prof. Dr. W. Vincken Head Respiratory Division Academisch Ziekenhuis Vrije Universiteit Brussel (AZ VUB) Before interpretation of ABG Make/Take note of Correct puncture
More informationABG Interpretation Regulation of Acid Base Balance Regulation of Volatile Acids by the Lungs
11 ABG Interpretation Regulation of Acid Base Balance Normal serum ph is 7.35-7.45 Seriously bad things start happening when ph falls to 7.2 or rises to 7.55 Three physiologic systems act interdependently
More informationNote: During any ONE run the ph remains constant. It may be at any one of the above levels but it never change during a single run.
1 BGYC34 (2007) PhysioEx Lab 10 AcidBase Balance Marking Scheme Part 1 Complete PhysioEx lab #10. Handin all of the pages associated with the lab. Note that there are 9 activities to be completed. You
More informationPrinciples of Fluid Balance
Principles of Fluid Balance I. The Cellular Environment: Fluids and Electrolytes A. Water 1. Total body water (TBW) = 60% of total body weight 2. Fluid Compartments in the Body a. Intracellular Compartment
More informationABG Analysis in Clinical Setting
C H A P T E R 117 ABG Analysis in Clinical Setting Rajesh Mahajan, Suman Sethi INTRODUCTION Acid-Base balance is an intricate concept which requires an intimate and detailed knowledge of the body s metabolic
More informationCarbon Dioxide Transport and Acid-Base Balance
CHAPTER 7 Carbon Dioxide Transport and Acid-Base Balance Carbon Dioxide Transport Dioxide Transport In plasma: Carbamino compound (bound to protein) Bicarbonate Dissolved CO 2 CO 2 Is Converted to HCO
More informationBasic facts repetition Regulation of A-B balance. Pathophysiology of clinically important disorders
In The name of God Acid base balance Basic facts repetition Regulation of A-B balance Pathophysiology of clinically important disorders Acid-Base Balance Physiology - The ph of ECF is tightly regulated
More informationELECTROLYTES RENAL SHO TEACHING
ELECTROLYTES RENAL SHO TEACHING Metabolic Alkalosis 2 factors are responsible for generation and maintenance of metabolic alkalosis this includes a process that raises serum bicarbonate and a process that
More informationAcid-base balance is one of the most important of the body s homeostatic mechanisms Acid-base balance refers to regulation of hydrogen ion (H + )
Acid-base balance is one of the most important of the body s homeostatic mechanisms Acid-base balance refers to regulation of hydrogen ion (H + ) concentration in body fluids Precise regulation of ph at
More informationAcid base balance CHAPTER 3. Acid as a by-product of metabolism. By the end of this chapter you will be able to:
Cooper-03.qxd 4/19/06 5:04 PM Page 36 CHAPTER 3 Acid base balance By the end of this chapter you will be able to: Understand how the body maintains a narrow ph Know the meaning of common terms used in
More informationDisclaimer. Chapter 3 Disorder of Water, Electrolyte and Acid-base Professor A. S. Alhomida. Disorder of Water and Electrolyte
Disclaimer King Saud University College of Science Department of Biochemistry The texts, tables, figures and images contained in this course presentation (BCH 376) are not my own, they can be found on:
More informationAcid-base mysteries explained. Friedrich Luft Experimental and Clinical Research Center, Berlin-Buch
Acid-base mysteries explained Friedrich Luft Experimental and Clinical Research Center, Berlin-Buch Hydrogen ion concentration ph 7.4 In plasma 40 nmol/l (compared to mmol for other electrolytes M, mmol,
More informationDKA: Tripping on Acidosis
DKA: Tripping on Acidosis Grace Chan Oei, MD, MA Attending Physician, Division of Pediatric Critical Care, Loma Linda University Children s Hospital Assistant Professor of Pediatrics, Loma Linda University
More informationAcid-Base Balance Dr. Gary Mumaugh
Acid-Base Balance Dr. Gary Mumaugh Introduction Acid-base balance is one of the most important of the body s homeostatic mechanisms Acid-base balance refers to regulation of hydrogen ion (H + ) concentration
More informationFluid and Electrolytes P A R T 4
Fluid and Electrolytes P A R T 4 Mechanisms that control acid-base homeostasis Acids and bases continually enter and leave body Hydrogen ions also result from metabolic activity Acids Hydrogen ion donors
More informationPrimer on clinical acid-base problem solving
Primer on clinical acid-base problem solving William L. Whittier, MD and Gregory W. Rutecki, MD Acid-base problem solving has been an integral part of medical practice in recent generations. Diseases discovered
More informationACID/BASE. A. What is her acid-base disorder, what is her anion gap, and what is the likely cause?
These fluid and electrolyte problems are modified from those in a previous textbook for this sequence, Renal Pathophysiology edited by James A. Shayman M.D., Professor of Internal Medicine, University
More informationNeaam Al-Bahadili. Rana J. Rahhal. Mamoun Ahram
5 Neaam Al-Bahadili Rana J. Rahhal Mamoun Ahram In this sheet we will continue taking about Titration curve and Buffers in human body. Let s begin Titration curve of phosphate buffer: 1. There are 3 buffering
More informationAcid-Base Imbalance. Shu-Yi (Emily) Wang, PhD, RN, CNS Denver School of Nursing
Acid-Base Imbalance Shu-Yi (Emily) Wang, PhD, RN, CNS gpwsy@hotmail.com Denver School of Nursing ph Ranges Compatible With Life In blood, the ph represents the relationship between the respiratory and
More informationi-stat Alinity v Utilization Guide
istat Alinity v Utilization Guide The istat Alinity v delivers blood gas, acidbase, electrolyte, chemistry, and hematology measurements in a completely portable, handheld package. Accuracy is ensured by
More informationAnna Vinnikova, M.D. Division of Nephrology Virginia Commonwealth University
Metabolic Acidosis Anna Vinnikova, M.D. Division of Nephrology Virginia Commonwealth University Graphics by permission from The Fluid, Electrolyte and Acid-Base Companion, S. Faubel and J. Topf, http://www.pbfluids.com
More informationImages have been removed from the PowerPoint slides in this handout due to copyright restrictions.
Arterial Blood Gas Interpretation Routine Assessment Inspection Palpation Auscultation Labs Na 135-145 K 3.5-5.3 Chloride 95-105 CO2 22-31 BUN 10-26 Creat.5-1.2 Glu 80-120 Arterial Blood Gases WBC 5-10K
More informationANATOMY & PHYSIOLOGY - CLUTCH CH ACID-BASE BALANCE-- CONTROLLING BLOOD PH
!! www.clutchprep.com ANATOMY & PHYSIOLOGY - CLUTCH CONCEPT: INTRO. TO DISTURBING AND MAINTAINING BLOOD ph Physiological Sources of Acid (and Base): Acids are molecules/substances that H+ to a solution.
More information[Chapter 25] The Liver and the Gut. John A Kellum
[Chapter 25] The Liver and the Gut John A Kellum 25.1 Introduction Throughout this book we have seen that the Stewart formulation can be used to help understand the mechanisms of acid-base equilibrium
More informationChapter 20 8/23/2016. Fluids and Electrolytes. Fluid (Water) Fluid (Water) (Cont.) Functions
Chapter 20 Fluids and Electrolytes All items and derived items 2015, 2011, 2006 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. Fluid (Water) Functions Provides an extracellular transportation
More informationsounds are distant with inspiratory crackles. He sits on the edge of his chair, leaning forward, with both hands on his
I NTE R P R ETI N G A R T E R I A L B L O O D G A S E S : EASY AS A B C Take this step-by-step approach to demystify the parameters of oxygenation, ventilation, acid-base balance. BY WILLIAM C. PRUITT,
More informationArterial blood gas analysis
perioperativecpd.com continuing professional development Arterial blood gas analysis Article based on original by the Resuscitation Council U.K. Introduction Interpreting the analysis of an arterial blood
More informationOxygen and ABG. Dr Will Dooley
Oxygen and ABG G Dr Will Dooley Oxygen and ABGs Simply in 10 cases Recap of: ABG interpretation Oxygen management Some common concerns A-a gradient Base Excess Anion Gap COPD patients CPAP/BiPAP First
More informationMetabolic Alkalosis: Vomiting
RENAL ANL) ACID-BASE PHYSIOLOGY 213 Case 37 Metabolic Alkalosis: Vomiting Maria Cuervo is a 20-year-old philosophy major at a state university. When the "24-hour" stomach flu went around campus during
More informationNeaam Al-Bahadili. Rana J. Rahhal. Mamoun Ahram
5 Neaam Al-Bahadili Rana J. Rahhal Mamoun Ahram In this sheet we will continue taking about Titration curve and Buffers in human body. Let s begin Titration curve of phosphate buffer: 1. There are 3 buffering
More informationInterpretation of the Arterial Blood Gas
Interpretation of the Arterial Blood Gas Self-Learning Packet This self-learning packet is approved for 2 contact hours for the following professionals: 1. Registered Nurse 2. Licensed Practical Nurse
More informationZuur-Base Stoornissen INTRODUCTION AND DEFINITIONS. Acid-Base Disturbances. Acid - Base Balance. Topics
Acid Base Balance ZuurBase Stoornissen Dr. M. Verhaegen Maintenance of a physiologic ph ([H + ]) is important for Oxygen transport Enzyme activity Biochemical reactions Cellular function Organ function
More informationRESPIRATORY SYSTEM and ACID BASE
RESPIRATORY SYSTEM and ACID BASE Arif HM Marsaban Rudyanto Sedono Department of Anesthesiology and Intensive Therapy Faculty of medicine University of Indonesia Dr Cipto Mangunkusumo General Hospital Jakarta
More informationPrinciples of Anatomy and Physiology
Principles of Anatomy and Physiology 14 th Edition CHAPTER 27 Fluid, Electrolyte, and Acid Base Fluid Compartments and Fluid In adults, body fluids make up between 55% and 65% of total body mass. Body
More informationZuur-Base Stoornissen INTRODUCTION AND DEFINITIONS. Acid-Base Disturbances. Acid - Base Balance. Topics
2022018 Acid Base Balance ZuurBase Stoornissen Dr. M. Verhaegen Maintenance of a physiologic ph ([H + ]) is important for Oxygen transport Enzyme activity Biochemical reactions Cellular function Organ
More informationPhysiology week 16 Renal 2 (volume/buffers)
Physiology week 16 Renal 2 (volume/buffers) Defense of Tonicity and Volume Defense of tonicity Tonicity = osmolality of a solution relative to plasma Osmolality measures [ ] all particles in solution,
More informationAcid-Base disturbances Physiological approach
AcidBase disturbances Physiological approach Pieter Roel Tuinman, M.D., PhD, intensivist Department of Intensive Care, VU Medical Center, Amsterdam, The Netherlands p.tuinman@vumc.nl Content Introduction
More informationEmergency Medical Training Services Emergency Medical Technician Paramedic Program Outlines Outline Topic: Patho Instructor Notes Revised: 11/2013
Emergency Medical Training Services Emergency Medical Technician Paramedic Program Outlines Outline Topic: Patho Instructor Notes Revised: 11/2013 Cells form 4 basic tissue groups: 1. Epithelial 2. Connective
More informationWater, Electrolytes, and Acid-Base Balance
Chapter 27 Water, Electrolytes, and Acid-Base Balance 1 Body Fluids Intracellular fluid compartment All fluids inside cells of body About 40% of total body weight Extracellular fluid compartment All fluids
More informationAcid-Base Balance * OpenStax
OpenStax-CNX module: m46409 1 Acid-Base Balance * OpenStax This work is produced by OpenStax-CNX and licensed under the Creative Commons Attribution License 3.0 By the end of this section, you will be
More informationZuur-Base Stoornissen INTRODUCTION AND DEFINITIONS. Acid - Base Balance. Topics. Acid-Base Disturbances
1492017 Acid Base Balance ZuurBase Stoornissen Dr. M. Verhaegen Coassistenten 14 09 2017 Maintenance of a physiologic ph ([H + ]) is important for Oxygen transport Enzyme activity Biochemical reactions
More informationACID-BASE BALANCE URINE BLOOD AIR
ACIDBASE BALANCE URINE BLOOD AIR H 2 PO 4 NH 4 HCO 3 KIDNEY H H HCO 3 CELLS Hb H LUNG H 2 CO 3 HHb CO 2 H 2 O ph = 7.4 [HCO 3 ] = 24 meq/l PCO 2 = 40 mm Hg CO 2 PRIMARY RENAL MECHANISMS INVOLVED IN ACIDBASE
More information