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    Moderator: Dr. R. K. Yadav (MD) Presented By: Ashish Jaisawal

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    The document discusses acid-base balance and its three main mechanisms of regulation: chemical buffers, respiratory regulation, and renal regulation. It focuses on the key ions involved in acid-base balance, hydrogen (H+) and bicarbonate (HCO3-), and how the lungs, kidneys, and chemical buffers work to maintain pH levels in the blood and extracellular fluids.

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    Moderator: Dr. R. K. Yadav (MD) Presented By: Ashish Jaisawal

    Uploaded by

    imranqazi11
    48 views47 pages
    The document discusses acid-base balance and its three main mechanisms of regulation: chemical buffers, respiratory regulation, and renal regulation. It focuses on the key ions involved in acid-base balance, hydrogen (H+) and bicarbonate (HCO3-), and how the lungs, kidneys, and chemical buffers work to maintain pH levels in the blood and extracellular fluids.

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    The document discusses acid-base balance and its three main mechanisms of regulation: chemical buffers, respiratory regulation, and renal regulation. It focuses on the key ions involved in acid-base balance, hydrogen (H+) and bicarbonate (HCO3-), and how the lungs, kidneys, and chemical buffers work to maintain pH levels in the blood and extracellular fluids.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    48 views47 pages

    Moderator: Dr. R. K. Yadav (MD) Presented By: Ashish Jaisawal

    Uploaded by

    imranqazi11
    The document discusses acid-base balance and its three main mechanisms of regulation: chemical buffers, respiratory regulation, and renal regulation. It focuses on the key ions involved in acid-base balance, hydrogen (H+) and bicarbonate (HCO3-), and how the lungs, kidneys, and chemical buffers work to maintain pH levels in the blood and extracellular fluids.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 47

    Moderator:

    DR. R. K. YADAV (MD)

    Presented by : Ashish
    jaisawal
    2
     Acid - Base balance is primarily
    concerned with two ions:
     Hydrogen (H+)
     Bicarbonate (HCO3- )

    H + HCO3 -
    3
    4
     Maintenance of an acceptable pH range in the
    extracellular fluids is accomplished by three
    mechanisms:
     1) Chemical Buffers
     React very rapidly
    (less than a second)
     2) Respiratory Regulation
     Reacts rapidly (seconds to minutes)
     3) Renal Regulation
     Reacts slowly (minutes to hours)
    5
     Chemical Buffers
     The body uses pH buffers in the blood to guard against
    sudden changes in acidity
     A pH buffer works chemically to minimize changes in the
    pH of a solution

    Buffer
    6
     Respiratory Regulation
     When breathing is increased,
    the blood carbon dioxide level
    decreases and the blood
    becomes more Base
     When breathing is decreased,
    the blood carbon dioxide level
    increases and the blood becomes more Acidic
     By adjusting the speed and depth of breathing, the
    respiratory control centers and lungs are able to regulate
    the blood pH minute by minute

    7
     Kidney Regulation
     Excess acid is excreted by the
    kidneys, largely in the form of
    ammonia
     The kidneys have some ability to
    alter the amount of acid or base
    that is excreted, but this generally
    takes several days

    8
    HOW TO BEGIN
     What tests do we use?
     ABG and Electrolytes
     What is normal pH
     7.4 +/- 0.5
     What is normal PCO2?
     40 +/- 5
     What is normal HCO3?
     24 +/- 4
     What is an anion gap?
     The unmeasured anions- albumin, phosphate, sulfate,
    lactate.
     What is the normal anion gap?
     12 +/- 2
     How do you calculate the anion gap?
     Na+ - (Cl + HCO3)
    ABG analysis

    Look at the pH.


     pH < 7.35, acidosis
     pH > 7.45, alkalosis

    Respiratory or Metabolic
    Look at PCO2, HCO3-

    If the change in PCO2 correlates with the pH Main pathology is metabolic

    • If low pH ----- pCO2 low ----- metabolic ( acidosis)


    • If high pH ----- pCO2 high ----- metabolic (alkalosis)

    If the change in PCO2 NOT correlates with the pH Main pathology is


    respiratory

    • If low pH ----- pCO2 high ----- respiratory ( acidosis)


    • If high pH ----- pCO2 low ----- respiratory ( alkalosis)
     Simple or mixed disorder
     Calculates expected compensation
     Determine anion gap (AG)

    Calculates expected compensation


     Metabolic acidosis
    PaCO2= (1.5 x HCO3-) + 8 ± 2
    or PaCO2 = [HCO3-] + 15

    Metabolic alkalosis
    PaCO2= (0.7 x HCO3-) + 21 ± 2

    or PaCO2= [HCO3-] + 15

    Acid - Base
     For primary metabolic acidosis or alkelosis

    if PCO2 > expected --- respiratory acidosis

    if PCO2 < expected --- respiratory alkalosis

    Acid - Base
     Respiratory alkalosis
    Acute pH= 7.4 + 0.008 ( 40 - pCO2)

    Chronic pH= 7.4 + 0.003( 40 - pCO2)

     Respiratory acidosis
    Acute pH= 7.4 - 0.008 ( pCO2 - 40)

    Chronic pH= 7.4 - 0.003 ( pCO2 - 40)

    Acid - Base
     Respiratory alkalosis
    Acute- [HCO3-] will 0.2 mmol/L per mmHg change
    in PaCO2
    Chronic- [HCO3-] will 0.4 mmol/L per mmHg
    change in PaCO2
    Respiratory acidosis
    Acute -[HCO3-] will 0.1 mmol/L per mmHg change
    in PaCO2
    Chronic -[HCO3-] will 0.4 mmol/L per mmHg change
    in PaCO2

    Acid - Base 6/9/99


     Primary Respiratory alkalosis
    Acute pH > expected ----- metabolic alkalosis

    Chronic Ph< expected ----- metabolic acidosis

     Primary Respiratory acidosis


    Acute pH < expected ----- metabolic acidosis

    Chronic pH > expected ----- metabolic alkalosis

    Acid - Base
    Determine anion gap (AG) – AG = NA – (HCO3+ CL)
     High AG metabolic acidosis
     Non AG acidosis – determined by delta gap

     Delta gap
     Delta HCO3 = HCO3 (electrolytes) + change in AG
     Delta gap < 24 = non AG acidosis
     Delta gap > 24 = metabolic alkalosis

     Note: The key to ABG interpretation is following the


    above steps in order.
    Serum Electrolytes Arterial Blood Studies
    Sodium 134 mEq/L PO2 89 mm Hg
    Potassium 3.8 mEq/L PCO2 32 mm Hg
    Chloride 83 mEq/L pH 7.48
    HCO3 24 mEq/L HCO3 24 mEq/L
    Which of the following is the most likely
    explanation of these laboratory findings?
    (A) Respiratory alkalosis
    (B) Respiratory alkalosis and metabolic acidosis
    (C) Metabolic acidosis
    (D) Respiratory alkalosis, metabolic acidosis, and
    metabolic alkalosis
    (E) Metabolic alkalosis, respiratory alkalosis, and
    respiratory acidosis
    pH = 7.48 implies primary respiratory alkalosis

    Anion gap: 134 – 107 = 27


    Metabolic acidosis
    Excess Anion gap 27 – 12 = 15
    15 + 24 exceeds 30

    Metabolic alkalosis
    Which of the following is the most likely
    explanation of these laboratory findings?
    (A) Respiratory alkalosis
    (B) Respiratory alkalosis and metabolic acidosis
    (C) Metabolic acidosis
    (D) Respiratory alkalosis, metabolic acidosis, and
    metabolic alkalosis
    (E) Metabolic alkalosis, respiratory alkalosis, and
    respiratory acidosis
     M ethanol
     U remia
     D iabetic Ketoacidosis, Ketoacidosis
     P araldehyde
     I ron, Isoniazid (INH)
     L actic Acidosis
     E thanol, Ethylene glycol
     S alicylates

    Acid - Base
     Drunk
     Hx of drug use
     Fruity breath
     Kussmaul’s breathin
     hypotension

    Acid - Base
     Chemistries
     BUN, Cr, glucose
     Lactate level
     Ketones
     Ethanol level
     Salicylate level
     UA

    Acid - Base
     Treat underlying condition

     Remember:
     Methanol
     Ethanol
     Ethylene Glycol
     Salicylates
     Can Be Removed via Dialysis

    Acid - Base
     When to administer??
    pH < 7.2
    HCO3 < 15 meq/L

    (Deleterious – hypokalemia, hypocalcimia,


    hypernatraemia, paradoxical acidosis)

     How to administer –
    (desired HCO3 – actual HCO3) x 0.5 x weight

    Acid - Base
     H yperalimentation
     A cetazolamide, amphotericin
     R TA
     D iarrhea
     U reteral Diversions
     P ancreatic fistula
     S aline resucitation

    Acid - Base
    IF YES THINK About
     Ileostomy
     Diarrhea
     Enteric Fistula

    Acid - Base
    IF NO: What is the urine pH?
     if > 5.5
     Type I RTA
     if < 5.5, then CHECK Potassium
     if K is low = RTA type II
     if K is High = RTA type IV

    Acid - Base
     P araproteinemias, Multiple myeloma
     L ithium intoxication
     E xcessive Calcium and Magnesium
     A lbumin is low (hypoalbuminemia)
     B romism

    Acid - Base
     Volume Contraction:
     NG suction
     Vomitting
     Diuretics
     Post Hypercapnia
     Hypokalemia
     Hypomagnesemia
     Carbenicillin, Penicillin

    Acid - Base
     Adrenal Disorders
     Glucocorticoid Excess
     Mineralcorticoid Excess
     Exogenous Steroids
     Alkali Ingestion
     Bartter’s Syndrome

    Acid - Base
     Muscle cramps
     Weakness
     Hypoxia
     Arrhythmias

    Acid - Base
     Volume repletion
     Correct Electrolytes
     Spironolactone (hyperaldo)
     Treat Underlying process

    Acid - Base
     Pulmonary Disease
     Pneumothorax
     Effusion
     COPD
     ARDS
     PE
     Inappropriate Vent setting

    Acid - Base
     Musculoskeletal Disease
     Guillain Barre
     Myasthenia gravis
     CNS
     Sedatives
     Trauma
     Infxn
     Neoplasm

    Acid - Base
     ADEQUATE VENTILATION

    Acid - Base
     Pulmonary Disease
     Pulmonary Edema
     Pneumonia
     PE
     Inappropriate Vent settings

    Acid - Base
     CNS
     Increased Respiratory drive
     Infection
     CVA
     Trauma
     Anxiety
     Drugs
     Salicylates
     Catecholamines

    Acid - Base
     Sepsis
     Fever
     Pregnancy
     Liver Disease
     Anemia
     Carbon monoxide poisoning

    Acid - Base
     TREAT UNDERLYING CAUSE

    Acid - Base
    47

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