Clinical aspect of Acid-base disturbance 27-9-2016 (1).pdf

Clinical aspect of Acid-base disturbance  Acid-base disturbance * - [ H] = 24* Pco2/ [Hco3] Acidemia : pH < 7.35, H, Pco2, Hco3 blood is alkaline Alkalemia: pH > 7.45, H, Pco2, Hco3...

Clinical aspect of Acid-base disturbance  Acid-base disturbance * - [ H] = 24* Pco2/ [Hco3] Acidemia : pH < 7.35, H, Pco2, Hco3 blood is alkaline Alkalemia: pH > 7.45, H, Pco2, Hco3 Acidemia Alkalemia 1 35 PH lower than. than 7 45. PH higher - = - high hydrogen partial pressure low hydrogen pressure - low oxygen -high oxygen bicarbonate - low bicarbonate -high  Acid-base disturbance Two types respiratory metabolic PO2 Loading… 103 Acidosis ( Pco2 Acidosis Hco ) Pco2 3 alkalosis ) alkalosis Hco 3  Acid-base disturbance / compensation Compensatory response is a defense mechanism that function to reduce the effect of a particular disorders on the PH Either by renal or respiratory to alter Pco2 /Hco3 ratio z & alter carbon dioxide alter bicarbonate  Acid-base disturbance / compensation Metabolic disorder respiratory compensation compensation Loading… Respiratory disorder metabolic  Acid-base disturbance / compensation Metabolic acidosis ( low Hco3) compensated by (low Pco2) bicarbonate This is done by hperventitlation (increase RR) KUSSMAL BREATHING - breath faster to compensate (O2 Metabolic alkalosis (high Hco3) by increase Pco2 (hypoventialtion) - alm is to lower co2 fast - bicarbonate is high -breath Slower Chypoventilation) bring co2 lower acidosis alkalosis · hyperventilation - hypoventilation  Acid-base disturbance / compensation Respiratory acidosis (high Pco2) by increase (Hco3) nemoglobin Through either buffering system (H2Co3 Hb HHb and Hco3 Or through renal excretion of H hydrogen acidosis alkalosis compensation of respiratory compensation of respiratory extracellular from intracellular to buffering system : Hlons by hemoglobin O-10 min more - lowers Hexcretion - venal excretion of hydrogen 2 - 6 hr : Kidney then metabolization respiratory first ,  Acid-base disturbance / compensation Compensation of respiratory alkalosis by: 0-10 minutes: H ion moves from intracellular to extracellular for the following reaction H+ HCO3 H2CO3 2-6 HRs: kidney will compensate by lowering H secretion  Diagnosis A History 2 Physical examination 3 Arterial blood gas stake blood Normal values of arterial blood gas pH 7.35 – 7.45 Hco3 bicarbonate 20 – 28 mEq/L Pco2 Carbon dioxide 35 -45 mmHg  Steps for interpretation of ABG 1. look at pH Inspect serum bicarbonate and carbon dioxide > see - b bicarbonate carbon aloxide If theyre within the range Determine whether the patient’s compensation is appropriate See IfIt's alkalosis or acidosis then compensate It Clinical aspect of Acid-base disturbance 3 days newborn, had respiratory distress, connected to mechanical ventilator atLoading… Jihaz fanafos PIO 60% rate 60/min, 2 PEEP 4. nigh His follow-up blood gas as shown:  Clinical aspect of Acid-base disturbance PH 7.5 highecosis low PCO 20 mmHg 2 PO 85 mmHg 2 IOW HCo 18 mEq/L 3 Respiratory alkalos'srememberthatthebodaa Clinical aspect of Acid-base disturbance Interpretation Non-compensated respiratory alkalosis  Respiratory alkalosis Causes: of respiratory alkalosis Hyperventilation of psychogenic origin Overventilation mechanically as doctors , they put the ventilation too much for that Fatient Early stage of acidic overdose  Respiratory alakalosis Clinical picture: tingling feeling due to low calcium Paresthesia of the extremities due to reduction of ionized calcium Clinical aspect of Acid-base disturbance One year old child, was admitted for repeated vomiting. His examination showed dry mucous membrane. moderate denydration His blood gas results as shown:  Clinical aspect of Acid-base disturbance PH 7.49 high PCo 45 mmHg high 2 35 mEq/L high Hco 3 - metabolic alralosis - partial compensation (PH not brought to normal) Clinical aspect of Acid-base disturbance Interpretation Partial compensation metabolic alkalosis  Metabolic alkalosis Causes: Loss of hydrogen as in vomiting or gastric aspiration Increased renal reabsorption of bicarbonate (hyperaldosteronism) too much aldosterone  Metabolic alkalosis Clinically: effects of no snowing symptoms Mostly asymptomatic +/_ weakness and muscle cramps Clinical aspect of Acid-base disturbance respiratory 65 years old man with bronchial asthma, was admitted to the hospital for respiratory distress. His blood gas as shown:  Clinical aspect of Acid-base disturbance 7.35 normal PH 65 mmHg PCo nigh 2 40 mmHg low Po 2 hypoxic 28 mEq/L normal HCo 3 acidosis respiratory first see PH - If low sacidosis If salkalosis high - Clinical aspect of Acid-base disturbance Interpretation Fully compensated respiratory acidosis  Respiratory acidosis Causes: Neuromuscular disorders Air-way obstruction overdose drug Sedative overdose scollosis abnormal spine-affect long - area kyphoscoliosis  Respiratory acidosis Clinically: Increase cerebral blood flow Headaches Increase intracranial pressure Clinical aspect of Acid-base disturbance One week old newborn was admitted for poor feeding and lethargy. His blood gas as shown:  Clinical aspect of Acid-base disturbance 7.2 low PH 20 mmHg low PCo 2 88 mmHg PO 2 15 mEq/L low HCo 3 metabolic acidosis - partial compensation Clinical aspect of Acid-base disturbance Interpretation Partial compensation metabolic Acidosis  Metabolic acidosis Causes: Renal tubular acidosis Diabetic ketoacidosis Diarrhea Poisoning Loading… Lactic acidosis Inborn errors of metabolism what this had Patient  Metabolic acidosis Clinically: Deep, rapid respiration (kussmaul breathing) Decrease in cardiac function resulting in hypotension and pulmonary edema  Clinical aspect of Acid-base disturbance/ Anion gap Anion gap is the quantity of anion not balanced by cations It is usually 12+/_ 4 It is normal in the body because of unmeasured protein anion Its clinical significance is related to mainly situation of metabolic acidosis Calculated by : Na – (Hco3+cl) bicarbonate + choride-sodium Clinical aspect of Acid-base disturbance Serum electrolytes of this patient as shown: Na 145 mom/l (136-146) K 5.4 mmol/l (3.5-5.2) - Cl 97 mmol/l (98-108) - HCo 3 15 mmol/l (23-27) 15 + 97 = 112 143 33 - = - or Calculate anion gap? 30  Increased anion gap A. Anion gap = 30 Causes: Anion gap Renal failure Diabetic ketoacidosis Lactic acidosis Organic acidemia