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Tài liệu dành cho sinh viên khối ngành Y học tập và tham khảo. Tài liệu tiếng anh trình bày về quá trình cân bẳng acid-base | Acid-Base Balance Ahmed Abughaban 2021040088 Acid-Base abnormalities Metabolic Acidosis Metabolic Alkalosis Respiratory Acidosis Respiratory Alkalosis Mechanisms of acid-base balance Respiratory system Kidneys Buffers HCO3 reabsorption Excretion of organic acids Titrable acids (HPO4) Ammonium (NH4) Ca, Hb, PP bones Metabolic Acidosis Definition: Primary decrease in serum HCO3 Decreased pH Accumulation of acids Anion Gap Represents the unmeasured anions in plasma. AG=Na - (Cl + HCO3) Normal AG= 10-12 mEq/L Causes of AG metabolic acidosis: “Accumulation of acids” lactic acidosis Ketoacidosis - diabetic, alcoholic, starvation Toxins - ethylene glycol, methanol, salicylates RF - acute & chronic Causes of normal AG metabolic acidosis: 1- Renal RTA Fanconi’s synd 2- GIT Severe diarrhea GIT fistula 3- Drugs (+ renal insuff.) K sparing diuretics Heavy metals ACEIs NSAIDs “Loss of alkali” POG unmeasured NON-IONIZED AG unmeasured IONIZED Plasma Osmolal Gap POG= measured - calculated plasma osm Steps in Acid-Base Diagnosis Obtain ABG & electrolytes Check pH & compare HCO3 on ABG & measured for accuracy Calculate AG Try to identify the cause according to the AG Estimate compensatory response (PaCo2 1.25 mmHg per mmol/L in HCO3) ABG findings in metabolic acidosis pH < 7.35 HCO3 < 24 mEq/L paCO2 < 35 mmHg (compensated) Treatment of metabolic acidosis TREAT THE CAUSE Hydrate the pt IV HCO3* *HCO3 only when (1) pH < 7.1 (2)HCO3<10mEq/L 1/2 dose IV bolus, then cont. IV infusion over 12-24h HCO3 deficit=0.6 x BW x (desired HCO3 - actual HCO3) Thank You | Acid-Base Balance Ahmed Abughaban 2021040088 Acid-Base abnormalities Metabolic Acidosis Metabolic Alkalosis Respiratory Acidosis Respiratory Alkalosis Mechanisms of acid-base balance Respiratory system Kidneys Buffers HCO3 reabsorption Excretion of organic acids Titrable acids (HPO4) Ammonium (NH4) Ca, Hb, PP bones Metabolic Acidosis Definition: Primary decrease in serum HCO3 Decreased pH Accumulation of acids Anion Gap Represents the unmeasured anions in plasma. AG=Na - (Cl + HCO3) Normal AG= 10-12 mEq/L Causes of AG metabolic acidosis: “Accumulation of acids” lactic acidosis Ketoacidosis - diabetic, alcoholic, starvation Toxins - ethylene glycol, methanol, salicylates RF - acute & chronic Causes of normal AG metabolic acidosis: 1- Renal RTA Fanconi’s synd 2- GIT Severe diarrhea GIT fistula 3- Drugs (+ renal insuff.) K sparing diuretics Heavy metals ACEIs NSAIDs “Loss of alkali” POG unmeasured NON-IONIZED AG unmeasured IONIZED Plasma Osmolal Gap POG= measured - calculated plasma osm Steps in Acid-Base Diagnosis Obtain ABG & electrolytes Check pH & compare HCO3 on ABG & measured for accuracy Calculate AG Try to identify the cause according to the AG Estimate compensatory response (PaCo2 1.25 mmHg per mmol/L in HCO3) ABG findings in metabolic acidosis pH < 7.35 HCO3 < 24 mEq/L paCO2 < 35 mmHg (compensated) Treatment of metabolic acidosis TREAT THE CAUSE Hydrate the pt IV HCO3* *HCO3 only when (1) pH < 7.1 (2)HCO3<10mEq/L 1/2 dose IV bolus, then cont. IV infusion over 12-24h HCO3 deficit=0.6 x BW x (desired HCO3 - actual HCO3) Thank You
