TAILIEUCHUNG - Acid Base Balance In Critical Care Medicine

Two other sets of concepts that generate strong, and sometimes conflicting, reactions are the notion of what is 'public' (the public sector, the state, action that takes place in public) versus what is 'private' (of interest only to the individual/family, the private sector); and the meanings associated with money. We suggest that donation is a multi-layered process with each layer having its own public and private meanings. It may therefore be more helpful to think of public and private as being complementary and overlapping rather than in opposition (see Box ). Money, in turn, may be conceptualised in many. | Acid Base Balance in Critical Care Medicine Patrick J Neligan MA MB FCARCSI Clifford S Deutschman MS MD FCCM Copyright Patrick Neligan Department of Anesthesia University of Pennsylvania 2005. This Document is for education purposes only it cannot be distributed without permission. Learning Objectives after reading this issue the participant should be able to 1. To describe acid base chemistry in terms of the physical chemistry of water. 2. Compare and contrast different approaches to acid base data interpretation 3. Use the physical-chemical approach to interpret most acid base abnormalities encountered in the ICU. For the past 100 years acid base chemistry has occupied a special corner of clinical medicine. Physicians generally agree that acid base balance is important but struggle to understand the science pathology and application. Undoubtedly the body carefully controls the relative concentrations of hydrogen and hydroxyl ions in the extracellular and intracellular spaces. Alterations in this balance disrupts transcellular ion pumps leading to significant cardiovascular problems. Most acid-base abnormalities are easily explained but some remain problematic. Moreover traditional teaching emphasizes data interpretation rather than pathophysiology1. Consequently much confusion exists regarding cause effect and treatment of acid base abnormalities. The modern physical-chemical approach introduced by Peter Stewart 2 and subsequently refined 3-6 has significantly enhanced our understanding of these problems and simplified the clinical application 4 7. 1 Physical Chemistry of Water The human body is composed principally of water. Water is a simple triatomic molecule with an unequal charge distribution resulting in a H-O-H bond angle of 105 . This leads to polarity aggregation a high surface tension low vapor pressure high specific heat capacity high heat of vaporization and a high boiling point. Water is a highly ionizing. Water is itself slightly ionized into a .

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