acid base disturbance · a) metabolic acidosis b) metabolic alkalosis c) respiratory acidosis d)...
TRANSCRIPT
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DISTURBANCE ACID BASE
DR. AKIF AHSAN Assistant Professor
Dept. of Biochemistry JNMC, AMU, Aligarh
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A C I D O S I S
A L K A L O S I S
Accumulation of acids or loss of bases
The pH in the arterial blood is < 7.38
Accumulation of bases or loss of acids
The pH in the arterial blood is > 7.42
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H2CO3
NaHCO3
NaHCO3
NaHCO3
H2CO3
H2CO3
Metabolic Acidosis
Metabolic Alkalosis
Respiratory Alkalosis
Respiratory Acidosis
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OBJECTIVES By the end of this session you should be able to
mention the primary defect, mention the compensatory change and enumerate the
causes of:
Metabolic acidosis 1.
Metabolic alkalosis 2.
Respiratory acidosis 3.
Respiratory alkalosis 4.
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Metabolic Acidosis
H2CO3
NaHCO3
< 20
H2CO3
NaHCO3
Primary Defect
Compensation
Secondary Hyperventilation
pH
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Clinical Manifestations
Kussmaul Respiration (Deep & Labored breathing)
Lethargy, confusion, headache & weakness.
Nausea & Vomiting
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ANION GAP CATIONS ANIONS
ANION GAP (12-16 mEq/L)
ANION GAP = (Na+ + K+) – (HCO3- + Cl -)
Unmeasured Anions
Na+
K+
HCO3-
Cl-
135-145 mEq/L
3.5-5 mEq/L
22-28 mEq/L
96-106 mEq/L
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CATIONS ANIONS
Anion Gap (NORMAL)
Unmeasured Anions
Na+
K+
HCO3-
Cl-
NORMAL Anion Gap Metabolic Acidosis
Metabol ic A c ido s i s
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CATIONS ANIONS
Anion Gap (HIGH)
Unmeasured Anions
Na+
K+
HCO3-
HIGH Anion Gap Metabolic Acidosis
Metabol ic A c ido s i s
Cl-
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↑ Loss of HCO3-
↑ Acid Production
↓ HCO3- reabsorption / ↓ H+ excretion
Causes of Metabolic Acidosis
Diarrhea
Lactic acidosis Diabetic keto-acidosis
Starvation
Renal failure Renal tubular acidosis Acetazolamide therapy
NAGMA (in BLACK) / HAGMA (in RED)
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Respiratory Alkalosis
H2CO3
NaHCO3
> 20
H2CO3
NaHCO3
Primary Defect
Compensation
↑ HCO3- excretion
pH
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Causes of Respiratory Alkalosis (Hyper-ventilation)
CNS stimulation
Anxiety Psychosis
Fever
Tissue Hypoxia
High altitude Severe Anemia
Miscellaneous causes
Hemothorax (stimulation of J receptors) Mechanical ventilation
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Clinical Manifestations
Tachypnea
Chest pain
Light headedness, syncope, seizures
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Respiratory Acidosis
H2CO3
NaHCO3
< 20
H2CO3
NaHCO3
Primary Defect
Compensation
Retention of HCO3
- by kidneys
pH
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Causes of Respiratory Acidosis (Hypo-ventilation)
Depression of respiratory center
Sedatives Morphine
Obstruction of respiratory tract
COPD Foreign body in upper resp. tract
Miscellaneous causes
Acute asthmatic attack Neuromuscular disorder (Muscular dystrophy)
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Clinical Manifestations
Breathlessness & Restlessness
Excess CO2 causes Vasodilation (warm & flushed skin)
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Metabolic Alkalosis
H2CO3
NaHCO3
> 20
H2CO3
NaHCO3
Primary Defect
Compensation
Secondary Hypoventilation
pH
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↑ HCO3- reabsorption / ↑ H+ excretion
Diuretics Hyper-aldosteronism
↑ Acid loss Vomit ing
Addition of exogenous base
Causes of Metabolic Alkalosis
Antacid Overdose (Magnesium hydroxide)
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Electrolyte Shift (compensatory response)
ALKALOSIS
H+ H+
H+
H+
H+
H+ H+
H+ H+ H+
ACIDOSIS H+ is buffered intra-cellularly
Hyper-kalemia
Cells try to correct alkalosis
Hypo-kalemia
K+
K+
H+
H+
H+
H+
H+ K+
K+
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Normal ABG Values
PaO2 : 75 to 100 mm Hg
PaCO2 : 38 to 42 mm Hg
HCO3- : 22 to 28 mM/L
Arterial Blood pH : 7.38 to 7.42
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MCQ
a) Metabolic acidosis b) Metabolic alkalosis c) Respiratory acidosis d) Respiratory alkalosis
A person was admitted in a coma. Analysis of the arterial blood gave the following values: PCO2 16 mm
Hg; HCO3- 5 mM/L and pH 7.1. What is the
underlying acid-base disorder?
[KEY: a]
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MCQ
a) Metabolic acidosis b) Metabolic alkalosis c) Respiratory acidosis d) Respiratory alkalosis
In a man undergoing surgery, it was necessary to aspirate the contents of the upper GI tract. After surgery, the following values were obtained from an arterial blood sample: pH 7.55; PCO2 52 mm Hg and HCO3
- 40 mM/L. What is the underlying disorder?
[KEY: b]
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MCQ
a) Uncompensated metabolic acidosis b) Uncompensated respiratory acidosis c) Simultaneous respiratory and metabolic acidosis d) Respiratory acidosis with partial renal
compensation
A young woman is found comatose, having taken an unknown number of sleeping pills an unknown time before. Her ABG report is as follows: pH 6.90;
HCO3- 13 mM/L, PaCO2 68 mm Hg. Her acid-base status is most accurately described as:
[KEY: c]
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MCQ
a) ↓ pCO2, normal HCO3- & ↑ pH
b) ↓ pCO2, ↓ HCO3- & ↓ pH
c) ↑ pCO2, normal HCO3- & ↓ p H
d) ↑ pCO2, ↑ HCO3- & ↑ pH
Which of the following laboratory results below indicates compensated metabolic
alkalosis?
[KEY: d]
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MCQ
a) Diarrhea b) Vomiting c) Diabetic keto-acidosis d) Starvation
Normal anion gap metabolic acidosis can be seen in:
[KEY: a]
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MCQ
a) Mineralocorticoid excess b) Hyperkalemia c) Thiazide diuretic therapy d) Recurrent vomiting
Causes of metabolic alkalosis include all the following except:
[KEY: b]
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MCQ
a) Anxiety b) Severe Anemia c) Acute Asthmatic Attack d) Hemothorax
All the following may cause respiratory alkalosis, except:
[KEY: c]
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CAN YOU ??? By the end of this session you should be able to
mention the primary defect, mention the compensatory change and enumerate the
causes of:
Metabolic acidosis 1.
Metabolic alkalosis 2.
Respiratory acidosis 3.
Respiratory alkalosis 4.