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Definitions concerning acid base
disorders.
Systematic approach to acid-base
interpretation.
How to diagnose simple acid base
disorders?
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Acid
BasepH
Buffer
Acidemia
AlkalemiaAcidosis
Alkalosis
Acid Base Terminology
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Acid:
Tends to donate a proton (H+)
HCl (Acid)H ++ Cl
Base:Tends to accept a proton (H +)
NH3 (Base) + H+NH4+
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pH:
pH devised to facilitate working with small [H
+
]
pH = -log [H
+
]
Lower the pH more acidic
Higher the pH more alkaline
Acid BaseTerminology
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Balance done by buffer
system
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Bicarbonate buffer system
CO2 + H2O H2CO3 HCO3- + H+
By carbonic anhydrase enzymeImmediately act within sec
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Respiratory CO2 elimination
-Fast onset (min)
-Alveolar ventilation responds to PCO2
changes
CO
2CO2 CO
2
CO
2
CO
2CO
2
Cell
Metabolism
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Respiratory regulation
When breathing is increased, the blood
carbon dioxide level decreases and theblood becomes moreBasic.
When breathing is decreased, the bloodcarbon dioxide level increases and the
blood becomes moreAcidic.
It works within minutes.
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Kidney regulation
This work within hours or days.
The kidney generate& reabsorb Hco3 from tubularlumen and excrete hydrogen ion in the tubularlumen
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1. Extracellular buffering
Immediately acts
The first-responder
2.
Respiratory regulation of CO2 elimination
Fast onset (minutes)
Alveolar ventilation responds to PCO2
3. Renal regulation of H+/HCO3- excretion
Slower onset (
48 hr)
Kidney excretes excess [H+]
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pH 7.35-7.45
pCO2 35-45mmHgpO2 80-100mmHg
O2 Sat. 95-100%
HCO3 22-26mEq/L
Acid base balance
Blood tests Reference range
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Arterial blood gas (ABG) test
measures: Blood (pH)
The oxygen tension(PaO2)and saturation
(SaO2).
The Carbon dioxidetension (PaCO2)
TheHCO3level
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value
This test is used to:
Diagnosis of pH disturbance by
check the (PaCO2 and HCO3).Check the degree of body
compensation
Check the degree of blood oxygen
(tension and saturation) diagnosis
of hypoxia
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How It Is Done
Sample of arterial blood :
From the wrist OR From the groin
(radial artery) (femoral artery)
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(?Why)
Because you may give local anesthetic as
collection of blood from an artery is more
painful than vein as arteries are deeperand protected by nerves.
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"emia" - alterations in blood pH
pH < 7.35acidemia
pH > 7.45
alkalemia
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"os is" - pathologic process that may results in
alterations in blood pH primary process.
Acidosis (H)
By
PCO2 (> 45) or HCO3 (
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AlalKemia
AciDemia
w v
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How to solve problem?
Acid Base interpretation
1- look to ph
Ph 7.45 alkaemia
2-Change in HCO3 : metabolic disorder
3-Change in PCO2 : respiratory disorder
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Problem (1)
Ph : 7.30
PCO2 : 58
HCO3 : 25
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RESPIRATIOY ACIDOSIS
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Problem (2)
Ph : 7.55
PCO2 : 20
HCO3 : 26
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RESPIRATORY ALKALOSIS
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Problem (3)
Ph : 7.31
PCO2 : 34
HCO3 : 19
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Metabolic acidosis
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Problem (4)
Ph : 7.55
PCO2 : 37
HCO3 : 35
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METABOLIC ALKALOSIS
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Understand ?
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pH 7.48
pCO2 29mmHgHCO3 24mEq/L
Step 1. The pH is ----------Step 2. The PCO2 is ---------Step 3. The HCO3 is ---------The full diagnosis for this ABG is: -
Respiratory alkalosis
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pH 7.32
pCO2 48mmHgHCO3 25mEq/L
Step 1. The pH is ----------Step 2. The CO2 is ---------Step 3. The HCO3 is ---------
The full diagnosis for this ABG is: -----------------------
Respiratory acidosis
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pH 7.31
pCO2 38mmHgHCO3 15mEq/L
Metabolic acidosis
Step 1. The pH is ----------Step 2. The CO2 is ---------Step 3. The HCO3 is ---------
The full diagnosis for this ABG is: -----------------------
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pH 7.50
pCO2 34mmHgHCO3 32mEq/L
Step 1. The pH is ----------Step 2. The CO2 is ---------Step 3. The HCO3 is ---------
The full diagnosis for this ABG is: -----------------------
Metabolic alkalosis
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