Building Schemata with ABG Slides PDF

 **AEROBIC RESPIRATION** Oxygen(gas) + Glucose = Adenosine Triphosphate (ATP)\[AKA: ENERGY\] + CO~2~ (gas)+ H~2~O (water) \[AKA: Carbonic acid\] **ANAEROBIC RESPIRATON** Glucose = ATP + Lactic Acid **PH BALANCE=Hydrogen (H+) [ions]** **Too much H+ is acid** **Too less H+...

 **AEROBIC RESPIRATION** Oxygen(gas) + Glucose = Adenosine Triphosphate (ATP)\[AKA: ENERGY\] + CO~2~ (gas)+ H~2~O (water) \[AKA: Carbonic acid\] **ANAEROBIC RESPIRATON** Glucose = ATP + Lactic Acid **PH BALANCE=Hydrogen (H+) [ions]** **Too much H+ is acid** **Too less H+ is alkaline** **Pa02** Partial pressure of 02. Pa02: 11Kpa on room air (21% 02 in air) is normal Pa02: less than 10Kpa on room air is hypoxaemia Pa02: less than 8Kpa on room air is severe hypoxaemia **But remember: main respiratory component is [PaC02]** If not removed it causes rise of H+ ions, so ***Respiratory Acidosis*** **[Respiratory Compensation]** Okay so if we have too much C02 in blood we try to blow of through exhalation (blow off) or we try to retain if we don't have enough (Basically, we can adjust ventilation settings if patient is ventilated) **[Metabolic Compensation]** This is a bit more complicated cos it takes the kidneys a few days to reduce the HC03 (bicarb) to decrease PH (make it more acidic)or increase HC03 to increase PH (to make it more alkalotic). **[HC03 (Bicarbonate)]** Okay so this buffers/mops up the H+ ions As it buffers the H+ ions it decreases It's the METABOLIC Component (Kidneys) **[Base Excess]** This is how much (plus or minus) HC03 is need to correct the PH. **[Respiratory or metabolic (some signs)]** **[Respiratory acidosis: ]** **[1.]**A sign is the RR (if high, patient might be hypo ventilating (cos not breathing deep enough), so this could cause build-up of C02 (C02+H20=carbonic acid) so decreased PH-acidic 2\. Breathing related conditions, which prevent C02 from being exhaled 3\. overdoses can cause respiratory acidosis too cos they alter breathing/unconsciousness **Treatment for respiratory acidosis:** 1. Bronchodilators 2. Mechanical ventilation **[Respiratory alkalosis]** Can happen from hyperventilation (breathing too much C02 out), so we need to slow the breathing down, cos Kidneys will not be able to adjust HC03 so quickly-Patient can show confusion-panic-numbness-tingling-palpitations. Now this one can happen following metabolic acidosis, so it is important to correct any metabolic changes, like hypokalaemia/hypocalcaemia. **[Metabolic Acidosis]** Decrease in bicarbonate and build-up of lactic acid 1. Increased acid production 2. Loss of bicarbonate (HC03) 3. Reduced ability of kidneys to excrete excess acid. For example; Diarrhoea & vomiting: loss of bicarbonate. Diabetic ketoacidosis: build-up of ketone (acidic) Chronic Renal failure: Alter how much acid can be excreted **Signs:** Confusion/coma/disorientation **Treatment**: Sodium bicarbonate/TREAT UNDERLYING CONDITION/Kayexalate (acidosis causes potassium to shift out of cells to extracelluar fluid and in alkalosis the reverse happens, so Kayexalate increase faecal potassium excretion by binding in the lumen of gut. **[Metabolic Alkalosis ]** Too much bicarbonate (HC03)- excess vomiting (loss of gastric secretions which have lots of hydrochloric acid) & nasogastric suction dehydration, endocrine disorders, Sodium bicarb overdose, hypokalaemia (When less potassium in cells, H+ shifts inside cell to maintain electrical neutrality) **Signs:** Numbness, swelling in lower legs, tingling, fatigue **Treatment**: Ammonium chloride (acidifying agent) **[YOU NEED TO KNOW THE NORMAL RANGES]** - PaO~2~ -- 11-13 kPa or 80 -- 100 mmHg for a fit and well person in **room air** (21% 02 in air) - pH -- 7.35 -- 7.45 - PaCO~2~ -- 4.7 -- 6.0 kPa or 35 -- 45 mmHg - HCO~3~ -- 22 -- 26 mmol/l - Base excess -- \< -2 mmol/l and \> +2 mmol/l (more negative than -2 mmol/l or greater than +2 mmol/l)