Pathological Analysis Theory PDF

‫ﻧﻈﺮﻳﺔ اﻟﺘﺤﻠﻴﻞ اﻟﻤﺮﺿﻲ‬ Pathological 3rd stage analysis 1st lecture theory ‫ اﻟﺴﻼﻣﺔ ﻣﻦ اﻟﻤﺨﺎﻃﺮ اﻟﺒﻴﻮﻟﻮﺟﻴﺔ‬ ‫داﺋﻤ...

‫ﻧﻈﺮﻳﺔ اﻟﺘﺤﻠﻴﻞ اﻟﻤﺮﺿﻲ‬ Pathological 3rd stage analysis 1st lecture theory ‫ اﻟﺴﻼﻣﺔ ﻣﻦ اﻟﻤﺨﺎﻃﺮ اﻟﺒﻴﻮﻟﻮﺟﻴﺔ‬ ‫داﺋﻤﺎ أن اﻟﺪم وﺳﻮاﺋﻞ اﻟﺠﺴﻢ اﻷﺧﺮى وأي ﻋﻴﻨﺎت أﻧﺴﺠﺔ ﻏﻴﺮ ﺛﺎﺑﺘﺔ ﻳﻤﻜﻦ‬ً ‫ ﻣﻦ اﻟﻤﻔﺘﺮض‬.‫أن ﺗﻜﻮن ﻣﻌﺪﻳﺔ ﻟﻤﺴﺒﺒﺎت اﻷﻣﺮاض اﻟﻤﺨﺘﻠﻔﺔ اﻟﺘﻲ ﺗﻨﺘﻘﻞ ﻋﻦ ﻃﺮﻳﻖ اﻟﺪم‬ SAFETY from biological hazards Blood, other body fluids, and any unfixed tissue samples are always assumed to be potentially infectious for various blood-borne pathogens.  ‫إدارة أﻧﻈﻤﺔ اﻟﺠﻮدة‬.‫ﻟﻀﻤﺎن ﺗﻘﺪﻳﻢ ﺧﺪﻣﺎت ﻣﺨﺒﺮﻳﺔ ﻋﺎﻟﻴﺔ اﻟﺠﻮدة‬ QUALITY SYSTEMS MANAGEMENT to ensure that quality laboratory services are provided. :‫ﻳﺠﺐ أن ﻳﺤﺘﻮي اﻟﻤﺨﺘﺒﺮ اﻟﺴﺮﻳﺮي ﻋﻠﻰ ﺟﻤﻴﻊ ﻣﺮاﺣﻞ ﻋﻤﻠﻴﺔ اﻻﺧﺘﺒﺎر‬ Modern equipment, The clinical laboratory must contain all phases of the testing process: hire well-trained staff, well-designed and safe By: physical environment, good management team. preanalysis: all the activities that take place before testing. :‫ﻣﻦ ﺧﻼل‬ Analysis: laboratory activities that ،‫ اﻟﻤﻌﺪات اﻟﺤﺪﻳﺜﺔ‬ produce a result. ،‫ ﺗﻮﻇﻴﻒ ﻣﻮﻇﻔﻴﻦ ﻣﺪرﺑﻴﻦ ﺟﻴﺪً ا‬ ،‫ ﺑﻴﺌﺔ ﻣﺎدﻳﺔ آﻣﻨﺔ وﻣﺼﻤﻤﺔ ﺟﻴﺪً ا‬ Postanalysis: patient reporting and.‫ ﻓﺮﻳﻖ إدارة ﺟﻴﺪ‬ result interpretation..‫ ﺟﻤﻴﻊ اﻷﻧﺸﻄﺔ اﻟﺘﻲ ﺗﺘﻢ ﻗﺒﻞ إﺟﺮاء اﻻﺧﺘﺒﺎر‬:‫اﻟﺘﺤﻠﻴﻞ اﻟﻤﺴﺒﻖ‬.‫ اﻷﻧﺸﻄﺔ اﻟﻤﻌﻤﻠﻴﺔ اﻟﺘﻲ ﺗﻨﺘﺞ ﻧﺘﻴﺠﺔ‬:‫اﻟﺘﺤﻠﻴﻞ‬.‫ ﺗﻘﺎرﻳﺮ اﻟﻤﺮﺿﻰ وﺗﻔﺴﻴﺮ اﻟﻨﺘﺎﺋﺞ‬:‫اﻟﺘﺤﻠﻴﻞ اﻟﻼﺣﻖ‬ ‫ ﻫﻮﻳﺔ ﻣﺮﻳﺾ ﻏﻴﺮ دﻗﻴﻘﺔ؛‬ ‫ ﻃﻠﺐ اﺧﺘﺒﺎر ﺧﺎﻃﺊ؛‬ :‫ﺗﺘﻀﻤﻦ اﻷﺧﻄﺎء اﻟﺘﺤﻠﻴﻠﻴﺔ اﻟﻤﺴﺒﻘﺔ اﻟﺸﺎﺋﻌﺔ ﻣﺎ ﻳﻠﻲ‬.‫ ﺟﻤﻊ اﻟﻌﻴﻨﺎت وﻧﻘﻠﻬﺎ واﺳﺘﻼﻣﻬﺎ ﺑﻄﺮﻳﻘﺔ ﻏﻴﺮ ﺻﺤﻴﺤﺔ‬.‫ اﻟﻮﺿﻊ ﻏﻴﺮ اﻟﺴﻠﻴﻢ ﻟﻠﻤﺮﻳﺾ أﺛﻨﺎء اﻟﺠﻤﻊ‬ Common inaccurate patient ID; ordering the wrong test; preanalytic errors improper specimen collection, transportation, and receipt. include: Improper status of patient during collection. inappropriate samples (such as incorrect blood tubes for particular analyses), ‫ ﻋﻴﻨﺎت ﻏﻴﺮ ﻣﻨﺎﺳﺒﺔ )ﻣﺜﻞ أﻧﺎﺑﻴﺐ اﻟﺪم ﻏﻴﺮ اﻟﺼﺤﻴﺤﺔ‬ calibration errors, ،(‫ﻟﺘﺤﻠﻴﻼت ﻣﻌﻴﻨﺔ‬ Analytic errors: instrument malfunctions, ،‫ أﺧﻄﺎء اﻟﻤﻌﺎﻳﺮة‬ :‫اﻷﺧﻄﺎء اﻟﺘﺤﻠﻴﻠﻴﺔ‬ interfering substances, ،‫ أﻋﻄﺎل اﻟﺠﻬﺎز‬ failure to verify results. ،‫ اﻟﻤﻮاد اﻟﻤﺘﺪاﺧﻠﺔ‬.‫ اﻟﻔﺸﻞ ﻓﻲ اﻟﺘﺤﻘﻖ ﻣﻦ اﻟﻨﺘﺎﺋﺞ‬ Tests Panels Postanalytic reports being sent to the wrong health care provider, errors: improper interpretation of test results by health care providers. :‫أﺧﻄﺎء ﻣﺎ ﺑﻌﺪ اﻟﺘﺤﻠﻴﻞ‬ ‫ ﻟﻮﺣﺎت اﻻﺧﺘﺒﺎرات‬ ،‫ إرﺳﺎل اﻟﺘﻘﺎرﻳﺮ اﻟﺨﻄﺄ إﻟﻰ ﻣﻘﺪم اﻟﺮﻋﺎﻳﺔ اﻟﺼﺤﻴﺔ‬.‫ اﻟﺘﻔﺴﻴﺮ ﻏﻴﺮ اﻟﺴﻠﻴﻢ ﻟﻨﺘﺎﺋﺞ اﻻﺧﺘﺒﺎرات ﻣﻦ ﻗﺒﻞ ﻣﻘﺪﻣﻲ اﻟﺮﻋﺎﻳﺔ اﻟﺼﺤﻴﺔ‬  ‫ ﻳﺴﺘﺨﺪم اﻟﺘﺨﻔﻴﻒ اﻟﺒﺴﻴﻂ‬ ‫ اﻟﺤﺠﻢ‬:‫ﻫﺬه اﻟﺼﻴﻐﺔ‬ ‫اﻹﺟﻤﺎﻟﻲ = ﺣﺠﻢ اﻟﻌﻴﻨﺔ‬ :‫اﻟﻌﻴﺎر‬ ‫ ﺣﺠﻢ اﻟﻤﺨﻔﻒ‬+ Titer: ‫ ﻗﻴﺎس اﻟﺘﺮﻛﻴﺰ‬ A simple dilution uses Measuring concentration this formula :‫ﻋﺎﻣﻞ اﻟﺘﺨﻔﻴﻒ‬ total volume = Sample volume DILUTION FACTOR: +diluent volume Dilution of sample to enable its testing ‫ﻟﺬا ﻓﺈن اﻟﺘﺨﻔﻴﻒ ﺑﻨﺴﺒﺔ‬ because of high concentration of tested So a 1:2 dilution has 1 part ‫ ﻳﺤﺘﻮي ﻋﻠﻰ ﺟﺰء‬1:2 material. ‫ﺗﺨﻔﻴﻒ اﻟﻌﻴﻨﺔ ﻟﺘﺴﻬﻴﻞ اﺧﺘﺒﺎرﻫﺎ ﺑﺴﺒﺐ‬ sample and 1 part diluent ‫واﺣﺪ ﻣﻦ اﻟﻌﻴﻨﺔ وﺟﺰء‬.‫اﻟﺘﺮﻛﻴﺰ اﻟﻌﺎﻟﻲ ﻟﻠﻤﺎدة اﻟﻤﺨﺘﺒﺮة‬ ‫واﺣﺪ ﻣﻦ اﻟﻤﺨﻔﻒ‬ Ratios A 1: 10 dilution has 1 part ratio, ex: 5 g of something dissolved in sample and 9 parts diluent 100 mL of something else can be ‫ أﺟﺰاء ﻣﻦ اﻟﻤﺨﻔﻒ‬9‫ ﻋﻠﻰ ﺟﺰء واﺣﺪ ﻣﻦ اﻟﻌﻴﻨﺔ و‬10 :1 ‫ﻳﺤﺘﻮي اﻟﺘﺨﻔﻴﻒ‬ expressed by the ratio 5:100 or by the decimal 0.05. ‫اﻟﻨﺴﺐ‬ ‫ ﻣﻞ ﻣﻦ‬100 ‫ ﺟﺮام ﻣﻦ ﺷﻲء ﻣﺎ ﻣﺬاﺑﺔ ﻓﻲ‬5 :‫ ﻋﻠﻰ ﺳﺒﻴﻞ اﻟﻤﺜﺎل‬،‫ اﻟﻨﺴﺒﺔ‬.0.05 ‫ أو ﺑﺎﻟﺮﻗﻢ اﻟﻌﺸﺮي‬5:100 ‫ﺷﻲء آﺧﺮ ﻳﻤﻜﻦ اﻟﺘﻌﺒﻴﺮ ﻋﻨﻬﺎ ﺑﻨﺴﺒﺔ‬.‫ أﺟﺰاء ﻣﻦ اﻟﻜﺎﺷﻒ أو اﻟﻌﻴﻨﺔ إﻟﻰ أﺟﺰاء ﻣﻦ اﻟﻤﺨﻔﻒ‬:‫اﻟﻨﺴﺒﺔ‬.‫ أﺟﺰاء ﻣﻦ اﻟﻜﺎﺷﻒ أو اﻟﻌﻴﻨﺔ إﻟﻰ اﻷﺟﺰاء اﻟﻜﻠﻴﺔ ﻣﻦ اﻟﻤﺤﻠﻮل‬:‫اﻟﺘﺨﻔﻴﻒ‬ Ratio: parts Dilution: parts of reagent reagent or or specimen to total specimen to parts of solution. parts diluent. Volume Reagent or Term Dilution Volume Diluent Specimen 1:9 1 part 8 parts Dilution 1:10 1 part 9 parts 1:9 1 part 9 parts Ratio 1:10 1 part 10 parts  ‫ ﻳﺘﻌﻴﻦ‬.‫دﻳﺴﻴﻠﺘﺮ‬/‫ ﻣﻠﻎ‬700< ‫ﻋﻴﻨﺔ ﺗﺤﺘﻮي ﻋﻠﻰ ﻧﺴﺒﺔ ﺟﻠﻮﻛﻮز‬ ‫ﻋﻠﻴﻨﺎ اﻟﺤﺼﻮل ﻋﻠﻰ ﺗﺮﻛﻴﺰ أﻗﻞ ﻣﻦ ذﻟﻚ ﺣﺘﻰ ﺗﺘﻤﻜﻦ اﻷداة‬.‫ﻣﻦ ﻗﺮاءﺗﻪ ﺑﺪﻗﺔ‬ a sample with a glucose of ‫ ﻣﻞ ﻣﺼﻞ ﻫﻮ اﻵن‬1 ‫ ﻣﻞ ﻣﺎء و‬1 ‫ﺟﺰءا واﺣﺪً ا ﻣﻦ اﻟﻤﺼﻞ‬ ً ‫ﺗﺄﺧﺬ‬ ‫إﺟﻤﺎﻟﻴﺎ‬ ً ‫ ﻣﻞ‬2 ‫اﻟﻌﻴﻨﺔ اﻟﺘﻲ ﺳﺘﺤﻠﻠﻬﺎ‬ ‫وﺟﺰءا واﺣﺪً ا ﻣﻦ اﻟﻤﺨﻔﻒ ﻓﻲ‬ ً >700 mg/dl. We have to get 1 ml water and 1 ml serum ‫أﻧﺒﻮب وﺗﺨﻠﻄﻬﻤﺎ‬ the concentration less than is now the specimen you You take 1 part will analyze 2 mls total that for the instrument to read serum and 1 part of diluent into a tube it accurately. and mix 1 ml serum 1 to 2 dilution – sometimes written 1:2 or say “1 part in a Run this on the total of 2 parts” analyzer 1 ml water ‫ﻗﻢ ﺑﺘﺸﻐﻴﻞ ﻫﺬا ﻋﻠﻰ اﻟﻤﺤﻠﻞ‬ The dilution factor in this case is Multiply the result of this by 2. the factor or 2 in this case "‫ أو ﻳﻘﻮل "ﺟﺰء واﺣﺪ ﻓﻲ إﺟﻤﺎﻟﻲ ﺟﺰأﻳﻦ‬1:2 ‫ ﻳُ ﻜﺘﺐ أﺣﻴﺎ ًﻧﺎ‬- 2 ‫ إﻟﻰ‬1 ‫ ﺗﺨﻔﻴﻒ‬ ‫ ﻓﻲ ﻫﺬه اﻟﺤﺎﻟﺔ‬2 ‫اﺿﺮب ﻧﺎﺗﺞ ﻫﺬا ﻓﻲ اﻟﻌﺎﻣﻞ أو‬.2 ‫ ﻋﺎﻣﻞ اﻟﺘﺨﻔﻴﻒ ﻓﻲ ﻫﺬه اﻟﺤﺎﻟﺔ ﻫﻮ‬ initial report unreadable final report 140 mg/dL Put 100 ul of serum and 900 ul of water into a tube and mix Run the dilution on the analyzer Take the result and multiply it by 10 Uric Acid reads 14 mg/dL x 10 = Final result 140 mg/dL Report the final result ‫دﻳﺴﻴﻠﺘﺮ‬/‫ ﻣﺠﻢ‬140 ‫اﻟﺘﻘﺮﻳﺮ اﻷوﻟﻲ ﻏﻴﺮ ﻣﻘﺮوء اﻟﺘﻘﺮﻳﺮ اﻟﻨﻬﺎﺋﻲ‬ ‫ ﻣﻴﻜﺮوﻟﺘﺮ ﻣﻦ اﻟﻤﺎء ﻓﻲ أﻧﺒﻮب واﺧﻠﻄﻬﻤﺎ‬900‫ ﻣﻴﻜﺮوﻟﺘﺮ ﻣﻦ اﻟﻤﺼﻞ و‬100 ‫ﺿﻊ‬ ‫ﺿﻊ اﻟﻤﺤﻠﻮل اﻟﻤﺨﻔﻒ ﻋﻠﻰ ﺟﻬﺎز اﻟﺘﺤﻠﻴﻞ‬ ‫ = اﻟﻨﺘﻴﺠﺔ‬10 × ‫دﻳﺴﻴﻠﺘﺮ‬/‫ ﻣﺠﻢ‬14 ‫ ﺣﻤﺾ اﻟﺒﻮﻟﻴﻚ ﻳﻘﺮأ‬10 ‫ﺧﺬ اﻟﻨﺘﻴﺠﺔ واﺿﺮﺑﻬﺎ ﻓﻲ‬ ‫دﻳﺴﻴﻠﺘﺮ‬/‫ ﻣﺠﻢ‬140 ‫اﻟﻨﻬﺎﺋﻴﺔ‬ ‫أﺑﻠﻎ ﻋﻦ اﻟﻨﺘﻴﺠﺔ اﻟﻨﻬﺎﺋﻴﺔ‬  ‫اﻟﺘﻨﻈﻴﻒ ﻓﻲ اﻷﺟﻬﺰة اﻟﻄﺒﻴﺔ‬.‫ﻹزاﻟﺔ اﻟﺪم وﺑﻘﺎﻳﺎ اﻟﺒﺮوﺗﻴﻦ واﻟﻤﻮاد اﻟﺨﻄﺮة اﻷﺧﺮى ﻣﻦ ﻣﻜﻮﻧﺎت اﻟﻤﺤﻠﻞ‬ Cleaning in medical devices to remove blood, protein residue, and other biohazardous substances from analyzer components. After using the instrument for a certain period, the sampling needle may become clogged due to protein condensation in the sample. This can cause failure to sample, resulting in zero results pipeline blockage issues. ،‫ﺑﻌﺪ اﺳﺘﺨﺪام اﻟﺠﻬﺎز ﻟﻔﺘﺮة ﻣﻌﻴﻨﺔ‬.‫ﻗﺪ ﺗﺼﺒﺢ إﺑﺮة أﺧﺬ اﻟﻌﻴﻨﺎت ﻣﺴﺪودة ﺑﺴﺒﺐ ﺗﻜﺎﺛﻒ اﻟﺒﺮوﺗﻴﻦ ﻓﻲ اﻟﻌﻴﻨﺔ‬ ‫ ﻣﻤﺎ ﻳﺆدي إﻟﻰ ﻧﺘﺎﺋﺞ ﺻﻔﺮﻳﺔ‬،‫ ﻗﺪ ﻳﺆدي ﻫﺬا إﻟﻰ ﻓﺸﻞ أﺧﺬ اﻟﻌﻴﻨﺎت‬ ‫ﻣﺸﺎﻛﻞ اﻧﺴﺪاد ﺧﻂ اﻷﻧﺎﺑﻴﺐ‬ :‫اﻟﻤﻌﺎﻳﺮة‬ ‫ ﻋﻤﻠﻴﺔ اﺧﺘﺒﺎر وﺿﺒﻂ أداة أو ﻧﻈﺎم اﺧﺘﺒﺎر ﻟﺘﺤﺪﻳﺪ اﻻرﺗﺒﺎط ﺑﻴﻦ اﺳﺘﺠﺎﺑﺔ‬.‫اﻟﻘﻴﺎس وﺗﺮﻛﻴﺰ أو ﻛﻤﻴﺔ اﻟﻤﺎدة اﻟﺘﻲ ﻳﺘﻢ ﻗﻴﺎﺳﻬﺎ ﺑﻮاﺳﻄﺔ إﺟﺮاء اﻻﺧﺘﺒﺎر‬ Calibration: a process of testing and adjusting an instrument or test system to establish a Calibration and correlation between the measurement Quality Control response and the concentration or amount of the substance that is being measured by the ‫اﻟﻤﻌﺎﻳﺮة وﻣﺮاﻗﺒﺔ اﻟﺠﻮدة‬ test procedure. Blank sample: A blank sample states to a reference sample that does not contain the substance of interest. It has zero concentration or activity of the target material. :‫اﻟﻌﻴﻨﺔ اﻟﻔﺎرﻏﺔ‬.‫ ﺗﺸﻴﺮ اﻟﻌﻴﻨﺔ اﻟﻔﺎرﻏﺔ إﻟﻰ ﻋﻴﻨﺔ ﻣﺮﺟﻌﻴﺔ ﻻ ﺗﺤﺘﻮي ﻋﻠﻰ اﻟﻤﺎدة اﻟﻤﻄﻠﻮﺑﺔ‬.‫ ﺗﺤﺘﻮي ﻋﻠﻰ ﺗﺮﻛﻴﺰ أو ﻧﺸﺎط ﺻﻔﺮي ﻟﻠﻤﺎدة اﻟﻤﺴﺘﻬﺪﻓﺔ‬  ‫ﺗﺤﻠﻴﻞ اﻟﻤﻮاد ذات اﻟﺘﺮﻛﻴﺰ اﻟﻤﻌﺮوف‬ ‫ﺑﻨﻔﺲ اﻟﻄﺮﻳﻘﺔ اﻟﻤﺴﺘﺨﺪﻣﺔ ﻓﻲ ﺗﺤﻠﻴﻞ‬ ‫ﻋﻴﻨﺎت اﻟﻤﺮﺿﻰ ﻟﺘﺤﺪﻳﺪ ﻣﻌﺎﻳﺮة اﻟﺠﻬﺎز أو‬ ‫ﻧﻈﺎم اﻻﺧﺘﺒﺎر ﻓﻲ اﻟﻨﻄﺎق اﻟﻘﺎﺑﻞ ﻟﻺﺑﻼغ‬ ‫ﻋﻨﻪ ﻟﻨﺘﺎﺋﺞ اﺧﺘﺒﺎر اﻟﻤﺮﻳﺾ‬ Quality control or Calibration verification: :‫ﻣﺮاﻗﺒﺔ اﻟﺠﻮدة أو اﻟﺘﺤﻘﻖ ﻣﻦ اﻟﻤﻌﺎﻳﺮة‬ the assaying of materials of known concentration in the same manner as patient serves the continuous samples to qualify the monitoring and documentation ‫ﻳﺨﺪم اﻟﻤﺮاﻗﺒﺔ اﻟﻤﺴﺘﻤﺮة وﺗﻮﺛﻴﻖ‬ instrument or test system’s of the quality of the analytical ‫ﺟﻮدة اﻟﻌﻤﻠﻴﺔ اﻟﺘﺤﻠﻴﻠﻴﺔ‬ calibration throughout the process reportable range for patient test results. Delta checks: comparing a current laboratory result with results obtained on a previous specimen from the same patient. ‫ ﻣﻘﺎرﻧﺔ ﻧﺘﻴﺠﺔ اﻟﻤﺨﺘﺒﺮ اﻟﺤﺎﻟﻴﺔ ﺑﺎﻟﻨﺘﺎﺋﺞ اﻟﺘﻲ‬:‫ﻓﺤﻮﺻﺎت دﻟﺘﺎ‬ ‫ﺗﻢ اﻟﺤﺼﻮل ﻋﻠﻴﻬﺎ ﻋﻠﻰ ﻋﻴﻨﺔ ﺳﺎﺑﻘﺔ ﻣﻦ ﻧﻔﺲ اﻟﻤﺮﻳﺾ‬ ‫أﻧﻮاع اﻟﻤﻴﺎه اﻟﻤﻘﻄﺮة‬ :(diH2O) ‫اﻟﻤﺎء ﻣﻨﺰوع اﻷﻳﻮﻧﺎت‬.‫ ﺗﺘﻢ إزاﻟﺔ اﻷﻳﻮﻧﺎت ﻋﻦ ﻃﺮﻳﻖ اﻟﺘﺮﺷﻴﺢ ﻣﻦ ﺧﻼل راﺗﻨﺠﺎت اﻟﺘﺒﺎدل اﻷﻳﻮﻧﻲ‬ ‫ ﻏﻴﺮ ﻣﻌﻘﻢ‬ ‫ ﻣﻮﺻﻠﻴﺔ ﻛﻬﺮﺑﺎﺋﻴﺔ ﻣﻨﺨﻔﻀﺔ‬ Types Of Distilled Water deionized water (diH2O): ions removed by filtration through an ion exchange resins. Non sterile low electrical conductivity distilled water (dH2O): Water Cost Time Sterility diH2O Low Minimal Low produced by boiling water then condensing water vapor in a clean dH O Moderate Extensive High 2 container. ddH O High Very Extensive High :(dH2O) ‫اﻟﻤﺎء اﻟﻤﻘﻄﺮ‬ 2 Sterilized ‫ ﻳﺘﻢ إﻧﺘﺎﺟﻪ ﻋﻦ ﻃﺮﻳﻖ ﻏﻠﻲ اﻟﻤﺎء ﺛﻢ‬ double-distilled water (ddH2O)..‫ﺗﻜﺜﻴﻒ ﺑﺨﺎر اﻟﻤﺎء ﻓﻲ وﻋﺎء ﻧﻈﻴﻒ‬ the ‘most pure’ type of laboratory-grade water. ‫ اﻟﻤﺎء اﻟﻤﻌﻘﻢ‬ combination of the two process RO water is pure water. water filtered through the membrane, remove more than 95% of ions.(ddH2O) ‫اﻟﻤﻘﻄﺮ ﻣﺮﺗﻴﻦ‬.‫ﻧﻘﺎء" ﻣﻦ ﻣﻴﺎه اﻟﻤﺨﺘﺒﺮ‬ ً ‫ "اﻟﻨﻮع اﻷﻛﺜﺮ‬ ‫ ﻣﺰﻳﺞ ﻣﻦ اﻟﻌﻤﻠﻴﺘﻴﻦ‬.‫ﻣﺎء اﻟﺘﻨﺎﺿﺢ اﻟﻌﻜﺴﻲ ﻫﻮ ﻣﺎء ﻧﻘﻲ‬ ،‫ اﻟﻤﺎء اﻟﻤﺼﻔﻰ ﻣﻦ ﺧﻼل اﻟﻐﺸﺎء‬ ‫ ﻣﻦ اﻷﻳﻮﻧﺎت‬%95 ‫ ﻳﺰﻳﻞ أﻛﺜﺮ ﻣﻦ‬  ‫اﺧﺘﺒﺎر اﻹﻋﺪاد اﻟﺴﺮﻳﺮي‬ ‫ﻧﻘﻄﺔ اﻟﺮﻋﺎﻳﺔ‬ Test Clinical Setting POINT OF CARE: Glucose. Laboratory testing that Blood gases: Critical care units, operating is performed out-side rooms. the central or core Cardiac markers: Emergency departments laboratory and generally DIPSTICK Urinalysis: Physicians’ offices at the site of clinical care Creatinine: Radiology suites prior to contrast or close to the patient. administration PT/INR Coagulation: clinics, cardiology simple tests (such as practices, home monitoring urine dipstick and whole Infectious diseases: Outpatient and blood glucose meters) emergency or emergency tests Drug screening: Emergency departments, (ABG). outpatient ‫اﻻﺧﺘﺒﺎرات اﻟﻤﻌﻤﻠﻴﺔ اﻟﺘﻲ ﻳﺘﻢ إﺟﺮاؤﻫﺎ ﺧﺎرج اﻟﻤﺨﺘﺒﺮ‬.‫ اﻟﺠﻠﻮﻛﻮز‬ ‫اﻟﻤﺮﻛﺰي أو اﻷﺳﺎﺳﻲ‬.‫ وﺣﺪات اﻟﻌﻨﺎﻳﺔ اﻟﻤﺮﻛﺰة وﻏﺮف اﻟﻌﻤﻠﻴﺎت‬:‫ ﻏﺎزات اﻟﺪم‬ ‫وﻓﻲ اﻟﻌﺎدة ﻓﻲ ﻣﻮﻗﻊ اﻟﺮﻋﺎﻳﺔ اﻟﺴﺮﻳﺮﻳﺔ أو ﺑﺎﻟﻘﺮب ﻣﻦ‬ ‫ أﻗﺴﺎم اﻟﻄﻮارئ ﺗﺤﻠﻴﻞ اﻟﺒﻮل‬:‫ ﻋﻼﻣﺎت اﻟﻘﻠﺐ‬.‫اﻟﻤﺮﻳﺾ‬ ‫ ﻋﻴﺎدات اﻷﻃﺒﺎء‬:‫ﺑﺎﺳﺘﺨﺪام ﺷﺮاﺋﻂ اﻻﺧﺘﺒﺎر‬ ‫ أﺟﻨﺤﺔ اﻷﺷﻌﺔ ﻗﺒﻞ إﻋﻄﺎء اﻟﺘﺒﺎﻳﻦ‬:‫ اﻟﻜﺮﻳﺎﺗﻴﻨﻴﻦ‬ ‫اﻻﺧﺘﺒﺎرات اﻟﺒﺴﻴﻄﺔ )ﻣﺜﻞ‬ :INR ‫ﻧﺴﺒﺔ‬/‫ ﺗﺨﺜﺮ اﻟﺪم ﺑﺎﺳﺘﺨﺪام ﺷﺮاﺋﻂ اﻻﺧﺘﺒﺎر‬ ‫ﺷﺮاﺋﻂ اﺧﺘﺒﺎر اﻟﺒﻮل وأﺟﻬﺰة ﻗﻴﺎس ﻧﺴﺒﺔ اﻟﺴﻜﺮ ﻓﻲ‬ ‫ واﻟﻤﺮاﻗﺒﺔ اﻟﻤﻨﺰﻟﻴﺔ‬،‫ وﻣﻤﺎرﺳﺎت أﻣﺮاض اﻟﻘﻠﺐ‬،‫اﻟﻌﻴﺎدات‬.(ABG) ‫اﻟﺪم اﻟﻜﺎﻣﻞ( أو اﻻﺧﺘﺒﺎرات اﻟﻄﺎرﺋﺔ‬ ‫ اﻟﻌﻴﺎدات اﻟﺨﺎرﺟﻴﺔ واﻟﻄﻮارئ‬:‫ اﻷﻣﺮاض اﻟﻤﻌﺪﻳﺔ‬ ‫ اﻟﻌﻴﺎدات اﻟﺨﺎرﺟﻴﺔ‬،‫ أﻗﺴﺎم اﻟﻄﻮارئ‬:‫ ﻓﺤﺺ اﻷدوﻳﺔ‬  :‫اﺧﺘﺒﺎرات ﻏﺎزات اﻟﺪم‬ ‫ﻣﻬﻤﺔ ﻓﻲ ﻗﺴﻢ اﻟﻄﻮارئ‬.‫ ودرﺟﺔ اﻟﺤﻤﻮﺿﺔ‬،‫ وﺛﺎﻧﻲ أﻛﺴﻴﺪ اﻟﻜﺮﺑﻮن‬،‫ﺗﺮﺗﺒﻂ اﻟﻌﺪﻳﺪ ﻣﻦ اﻻﺿﻄﺮاﺑﺎت ﺑﺎﺿﻄﺮاﺑﺎت ﻓﻲ ﺿﻐﻂ اﻟﺪم اﻟﺸﺮﻳﺎﻧﻲ‬ ‫ إﻻ أﻧﻬﺎ ذات ﻗﻴﻤﺔ ﻓﻲ ﺗﻘﻴﻴﻢ ﺷﺪة أﻣﺮاض اﻟﺠﻬﺎز‬،‫وﺑﻴﻨﻤﺎ ﻻ ﺗﻌﺘﺒﺮ ﻫﺬه اﻻﺧﺘﺒﺎرات ﺗﺸﺨﻴﺼﻴﺔ ﻓﻲ ﺣﺪ ذاﺗﻬﺎ‬.‫اﻟﺘﻨﻔﺴﻲ واﻟﻌﺪﻳﺪ ﻣﻦ اﻷﻣﺮاض اﻷﺧﺮى‬ BLOOD GASES tests: important in emergency department (ED) Many disorders are associated with abnormalities in arterial blood po2, pco2, and pH. While these tests are not themselves diagnostic, they are valuable in assessment of the severity of respiratory diseases and many other diseases. The blood gas test panel includes: :‫ﺗﺘﻀﻤﻦ ﻟﻮﺣﺔ اﺧﺘﺒﺎر ﻏﺎزات اﻟﺪم ﻣﺎ ﻳﻠﻲ‬ pco2 or ‫اﻟﺸﻮارد‬ po2 or sO2 partial electrolytes ‫ﻓﺠﻮة اﻷﻧﻴﻮن‬ partial oxygen pressure HCO3 PH (K , Na, Cl, Anion gap pressure saturation of carbon Ca) of oxygen dioxide ‫ ﺿﻐﻂ اﻷﻛﺴﺠﻴﻦ اﻟﺠﺰﺋﻲ أو‬sO2 ‫ﺗﺸﺒﻊ اﻷﻛﺴﺠﻴﻦ‬ ‫اﻟﻀﻐﻂ اﻟﺠﺰﺋﻲ ﻟﻸﻛﺴﺠﻴﻦ‬ pco2 ‫أو اﻟﻀﻐﻂ اﻟﺠﺰﺋﻲ‬ ‫ﻟﺜﺎﻧﻲ أﻛﺴﻴﺪ اﻟﻜﺮﺑﻮن‬.(HCO3‫ و‬Cl) ‫( واﻷﻧﻴﻮﻧﺎت اﻟﺤﺮة‬+K‫ و‬+Na) ‫ﺗﺸﻴﺮ ﻓﺠﻮة اﻷﻧﻴﻮن إﻟﻰ اﻟﻔﺮق ﺑﻴﻦ اﻟﻜﺎﺗﻴﻮﻧﺎت اﻟﺤﺮة اﻟﺮﺋﻴﺴﻴﺔ‬ The anion gap refers to the difference between the major free cations (Na+ and K+) and free anions (Cl and HCO3). ‫ﺗﺤﺪث ﻓﺠﻮة اﻷﻧﻴﻮن اﻟﻤﺮﺗﻔﻌﺔ ﻋﻨﺪﻣﺎ ﺗﻜﻮن‬ ‫ﻓﺠﻮة اﻷﻧﻴﻮن‬ Anion gap = (Na+ + K+ ) - (CI- +HCO - ) (‫اﻷﻧﻴﻮﻧﺎت اﻟﺤﻤﻀﻴﺔ )ﻣﺜﻞ اﻟﻼﻛﺘﺎت أو اﻟﻜﻴﺘﻮﻧﺎت‬.‫ﻣﻮﺟﻮدة وﺑﺎﻟﺘﺎﻟﻲ ُﺗﺴﺘﺨﺪم ﻓﻲ ﺣﺎﻟﺔ اﻟﺤﻤﺎض‬ An elevated anion gap occurs when acid anions (such as lactate or ketones) are present thus used for acidosis. ‫ ﻣﻠﻲ‬3 ‫ إﻟﻰ‬1 ،‫ﻟﺘﺮ‬/‫ﻣﻜﺎﻓﺊ‬ By presence of high levels of Basic protein contains 1 to 3 basic protein, often a ammonium ions, the Low mEq/L, monoclonal paraprotein. counterions are Cl and HCO3. Anion Gaps. “invisible” ion is ammonium vs measurable increase in Cl and a serious sign of possible malignancy—for ‫ﻓﺠﻮات اﻷﻧﻴﻮن اﻟﻤﻨﺨﻔﺾ‬ HCO3 ions. example, multiple myeloma. ‫ﺑﺴﺒﺐ وﺟﻮد ﻣﺴﺘﻮﻳﺎت ﻋﺎﻟﻴﺔ ﻣﻦ اﻟﺒﺮوﺗﻴﻦ‬ ،‫ﻳﺤﺘﻮي اﻟﺒﺮوﺗﻴﻦ اﻷﺳﺎﺳﻲ ﻋﻠﻰ أﻳﻮﻧﺎت اﻷﻣﻮﻧﻴﻮم‬ ‫ واﻟﺬي ﻏﺎﻟ ًﺒﺎ ﻣﺎ ﻳﻜﻮن ﻋﺒﺎرة ﻋﻦ ﺑﺮوﺗﻴﻦ‬،‫اﻷﺳﺎﺳﻲ‬ HCO3‫ و‬Cl ‫واﻷﻳﻮﻧﺎت اﻟﻤﻘﺎﺑﻠﺔ ﻫﻲ‬.‫أﺣﺎدي اﻟﻨﺴﻴﻠﺔ‬ - ‫ﻋﻼﻣﺔ ﺧﻄﻴﺮة ﻋﻠﻰ اﺣﺘﻤﺎل اﻹﺻﺎﺑﺔ ﺑﻤﺮض ﺧﺒﻴﺚ‬ ‫اﻷﻳﻮن "ﻏﻴﺮ اﻟﻤﺮﺋﻲ" ﻫﻮ اﻷﻣﻮﻧﻴﻮم ﻣﻘﺎﺑﻞ اﻟﺰﻳﺎدة‬.‫ اﻟﻮرم اﻟﻨﻘﻮي اﻟﻤﺘﻌﺪد‬،‫ﻋﻠﻰ ﺳﺒﻴﻞ اﻟﻤﺜﺎل‬.HCO3‫اﻟﻘﺎﺑﻠﺔ ﻟﻠﻘﻴﺎس ﻓﻲ أﻳﻮﻧﺎت اﻟﻜﻠﻮرﻳﺪ و‬  MOSM (‫)اﻟﺘﻨﺎﺿﺤﻴﺔ‬ MOSM (OSMOLARITY) :‫ ﻳﻤﻜﻦ ﻗﻴﺎس ﺗﺮﻛﻴﺰ اﻟﺪم أو اﻟﻤﺼﻞ أو اﻟﺒﻼزﻣﺎ ﻣﺒﺎﺷﺮة ﺑﺎﺳﺘﺨﺪام ﻣﻘﻴﺎس ﺗﺮﻛﻴﺰ أو ﺣﺴﺎﺑﻪ ﻣﻦ ﺧﻼل‬ Osmolality of blood, serum or plasma can be measured directly with an osmometer OR CALCULATED BY: NORMAL VALUE: 280–295 mOsm/kg In cases of swallowed a poison such as antifreeze or rubbing alcohol. Cases of an overdose of drugs such as salicylates, commonly found in aspirin. dehydration, overhydration. ‫ﻛﺠﻢ ﻓﻲ‬/‫ ﻣﻴﻠﻲ أﺳﻤﻮل‬295–280 :‫ اﻟﻘﻴﻤﺔ اﻟﻄﺒﻴﻌﻴﺔ‬ Help diagnose diabetes insipidus. ‫ﺣﺎﻻت اﺑﺘﻼع ﻣﺎدة ﺳﺎﻣﺔ ﻣﺜﻞ ﻣﻀﺎد اﻟﺘﺠﻤﺪ أو اﻟﻜﺤﻮل‬ ‫ ﺣﺎﻻت ﺗﻨﺎول ﺟﺮﻋﺔ زاﺋﺪة ﻣﻦ اﻷدوﻳﺔ ﻣﺜﻞ‬.‫اﻟﻤﺤﻤﺮ‬.‫ واﻟﺘﻲ ﺗﻮﺟﺪ ﻋﺎدة ﻓﻲ اﻷﺳﺒﺮﻳﻦ‬،‫اﻟﺴﺎﻟﻴﺴﻴﻼت‬ ‫ اﻟﻤﺴﺎﻋﺪة ﻓﻲ ﺗﺸﺨﻴﺺ ﻣﺮض‬.‫ ﻓﺮط اﻟﺘﺮﻃﻴﺐ‬،‫ اﻟﺠﻔﺎف‬.‫اﻟﺴﻜﺮي اﻟﻜﺎذب‬ ‫ﺗﺴﺘﺠﻴﺐ اﻟﺮﺋﺘﺎن ﺧﻼل دﻗﺎﺋﻖ‬ ‫)ﺳﺮﻳﻌً ﺎ( ﻷﺧﻄﺎء اﻟﺤﻤﺾ‬ :‫واﻟﻘﺎﻋﺪة ﻣﻦ ﺧﻼل‬ (‫ اﻟﺘﺨﻠﺺ ﻣﻦ ﺛﺎﻧﻲ أﻛﺴﻴﺪ اﻟﻜﺮﺑﻮن )ﻓﺮط اﻟﺘﻬﻮﻳﺔ‬ The lungs.(‫ أﺧﺬ ﺛﺎﻧﻲ أﻛﺴﻴﺪ اﻟﻜﺮﺑﻮن )ﻧﻘﺺ اﻟﺘﻬﻮﻳﺔ‬ respond eliminating CO2 within (hyperventilation) minutes (Rapid) to taking CO2 acid–base (hypoventilation). errors by: The kidney excrete H+ and (within take HCO3 hours, slow) has the take H+ and ability to: excrete HCO3 ،‫ﺗﺘﻤﺘﻊ اﻟﻜﻠﻴﺔ )ﺧﻼل ﺳﺎﻋﺎت‬ HCO3 ‫ وأﺧﺬ‬+H ‫ إﻓﺮاز‬ :‫ﺑﺒﻂء( ﺑﺎﻟﻘﺪرة ﻋﻠﻰ‬ HCO3 ‫ وإﺧﺮاج‬+H ‫ أﺧﺬ‬  :‫اﻟﺘﺸﻮﻫﺎت اﻟﻮﻇﻴﻔﻴﺔ ﻓﻲ ﻫﺬا اﻻﺧﺘﺒﺎر‬ The functional abnormalities in this test: Low po2 (hypoxemia or low O2 in blood or hypoxia in tissues) High pco2 (hypercapnia) Low arterial blood pH, High Low arterial blood pH, HCO3: respiratory acidosis HCO3 metabolic acidosis High arterial blood pH, High arterial blood pH, low HCO3 respiratory high HCO3 respiratory alkalosis alkalosis Arterial blood gas (ABG) is the gold standard for oxygenation, ventilation, and acid–base status Venous blood gas (VBG) is an simpler alternative to ABG. But VBG cannot be used to assess oxygenation and PCO2 Using heparin syringe, powder is best than liquid. ‫( ﻫﻮ اﻟﻤﻌﻴﺎر اﻟﺬﻫﺒﻲ ﻟﻸﻛﺴﺠﻴﻦ واﻟﺘﻬﻮﻳﺔ وﺣﺎﻟﺔ اﻟﺤﻤﺾ واﻟﻘﺎﻋﺪة‬ABG) ‫ ﻏﺎز اﻟﺪم اﻟﺸﺮﻳﺎﻧﻲ‬ ‫ وﻟﻜﻦ ﻻ ﻳﻤﻜﻦ اﺳﺘﺨﺪام ﻏﺎز اﻟﺪم‬.‫( ﻫﻮ ﺑﺪﻳﻞ أﺑﺴﻂ ﻟﻐﺎز اﻟﺪم اﻟﺸﺮﻳﺎﻧﻲ‬VBG) ‫ ﻏﺎز اﻟﺪم اﻟﻮرﻳﺪي‬ ‫اﻟﻮرﻳﺪي ﻟﺘﻘﻴﻴﻢ اﻷﻛﺴﺠﻴﻦ وﺛﺎﻧﻲ أﻛﺴﻴﺪ اﻟﻜﺮﺑﻮن‬.‫ ﻳﻜﻮن اﻟﻤﺴﺤﻮق أﻓﻀﻞ ﻣﻦ اﻟﺴﺎﺋﻞ‬،‫ ﺑﺎﺳﺘﺨﺪام ﺣﻘﻨﺔ اﻟﻬﻴﺒﺎرﻳﻦ‬  ‫ﺑﻌﺾ ﻗﻴﻢ ﻏﺎزات اﻟﺪم اﻟﺸﺮﻳﺎﻧﻲ‬ Some ABG values pH (7.35- 7.45) < 7.35 = acidaemia, > 7.45 = alkalaemia PO2 (> 10.6 kPa or > 80 mmHg in arterial blood on room air) PCO2 (4.7- 6.0 kPa or 35 45 mmHg in arterial blood) SO2 (> 96%on room air) HCO3st (22 -28 mmol/L) Lactate (0.4 -1.5 mmol/L) BE (-2 to +2) Na (135 - 145 mmol/L) K (3.5 - 5 mmol/L) Cl (95 -105 mmol/L) iCa (1.0 - 1.25 mmol/L) Modern blood gas analyzers have expanded test menus to include electrolytes, and other tests. Metabolic acidosis (low HCO3) With raised anion gap Lactic acidosis (e.g. hypoxaemia, sepsis) Ketoacidosis (diabetes, starvation) Renal failure Poisoning (aspirin, methanol, ethylene glycol) With normal anion gap Renal tubular acidosis ‫ ﻣﻊ وﺟﻮد ﻓﺠﻮة أﻧﻴﻮﻧﻴﺔ ﻣﺮﺗﻔﻌﺔ‬ Diarrhoea (‫ اﻹﻧﺘﺎن‬،‫ اﻟﺤﻤﺎض اﻟﻠﺒﻨﻲ )ﻣﺜﻞ ﻧﻘﺺ اﻷﻛﺴﺠﻴﻦ ﻓﻲ اﻟﺪم‬ Adrenal insufficiency (‫ اﻟﻤﺠﺎﻋﺔ‬،‫ اﻟﺤﻤﺎض اﻟﻜﻴﺘﻮﻧﻲ )ﻣﺮض اﻟﺴﻜﺮي‬ Drugs ‫ اﻟﻔﺸﻞ اﻟﻜﻠﻮي‬ (‫ اﻹﻳﺜﻴﻠﻴﻦ ﺟﻠﻴﻜﻮل‬،‫ اﻟﻤﻴﺜﺎﻧﻮل‬،‫ اﻟﺘﺴﻤﻢ )اﻷﺳﺒﺮﻳﻦ‬ ‫ ﻣﻊ وﺟﻮد ﻓﺠﻮة أﻧﻴﻮﻧﻴﺔ ﻃﺒﻴﻌﻴﺔ‬ ‫ اﻟﺤﻤﺎض اﻷﻧﺒﻮﺑﻲ اﻟﻜﻠﻮي‬ ‫ اﻹﺳﻬﺎل‬ ‫ ﻗﺼﻮر اﻟﻐﺪة اﻟﻜﻈﺮﻳﺔ‬  ‫ اﻟﺤﻤﺎض اﻟﻠﺒﻨﻲ‬ ‫ اﻟﺴﺒﺐ اﻷﻛﺜﺮ ﺷﻴﻮﻋً ﺎ ﻟﻠﺤﻤﺎض اﻷﻳﻀﻲ ﻟﺪى‬ ‫اﻟﻤﺮﺿﻰ اﻟﻤﻘﻴﻤﻴﻦ ﻓﻲ اﻟﻤﺴﺘﺸﻔﻴﺎت‪.‬‬ ‫ اﻧﺨﻔﺎض ‪ HCO3‬ﻣﻊ ارﺗﻔﺎع اﻟﻼﻛﺘﺎت‪.‬‬ ‫ اﻧﺨﻔﺎض اﻷﻛﺴﺠﻴﻦ ﻓﻲ اﻷﻧﺴﺠﺔ ﻳﺨﻔﺾ‬ ‫اﻟﺘﻤﺜﻴﻞ اﻟﻐﺬاﺋﻲ اﻟﻬﻮاﺋﻲ‪ ،‬وﺑﺎﻟﺘﺎﻟﻲ؛ ﺗﺼﺒﺢ اﻟﺨﻼﻳﺎ‬ ‫ﻣﻌﺘﻤﺪة ﻋﻠﻰ اﻟﺘﻤﺜﻴﻞ اﻟﻐﺬاﺋﻲ اﻟﻼﻫﻮاﺋﻲ‪.‬‬ ‫‪ LACTIC ACIDOSIS‬‬ ‫‪ the most common cause of‬‬ ‫‪metabolic acidosis in‬‬ ‫‪hospitalised patients.‬‬ ‫‪ low HCO3 with high‬‬ ‫‪lactate.‬‬ ‫‪ Low O2 in tissues lower‬‬ ‫‪aerobic metabolism,‬‬ ‫‪therefore; cells become‬‬ ‫‪dependent on anaerobic‬‬ ‫‪metabolism.‬‬ ‫اﻟﺤﻤﺎض اﻟﻜﻴﺘﻮﻧﻲ اﻟﺴﻜﺮي‬ ‫ ﻳﺤﺪث ﺑﺴﺒﺐ اﻧﺨﻔﺎض اﻷﻧﺴﻮﻟﻴﻦ ﻓﻲ ﻣﺮض اﻟﺴﻜﺮي ﻣﻦ اﻟﻨﻮع اﻷول‪.‬‬ ‫ ﻋﺪم اﻟﻘﺪرة ﻋﻠﻰ اﺳﺘﺨﺪام اﻟﺠﻠﻮﻛﻮز ﻳﺰﻳﺪ ﻣﻦ ﻋﻤﻠﻴﺔ اﻟﺘﻤﺜﻴﻞ اﻟﻐﺬاﺋﻲ‬ ‫ﻟﻠﺪﻫﻮن ﻣﻤﺎ ﻳﻨﺘﺞ اﻟﻜﻴﺘﻮﻧﺎت ﻣﻤﺎ ﻳﺆدي إﻟﻰ اﻟﺤﻤﺎض‪.‬‬ ‫ ﻳﺘﻤﻴﺰ اﻟﺤﻤﺎض اﻟﻜﻴﺘﻮﻧﻲ اﻟﺴﻜﺮي ﺑﺎﻟﺘﺎﻟﻲ‪:‬‬ ‫ ‪.1‬اﻟﺤﻤﺎض اﻷﻳﻀﻲ ذو اﻟﻔﺠﻮة اﻷﻧﻴﻮﻧﻴﺔ اﻟﻌﺎﻟﻴﺔ‬ ‫‪KETOACIDOSIS‬‬ ‫ ‪.2‬ارﺗﻔﺎع ﻧﺴﺒﺔ اﻟﺠﻠﻮﻛﻮز ﻓﻲ اﻟﺒﻼزﻣﺎ )ارﺗﻔﺎع ﺳﻜﺮ اﻟﺪم(‬ ‫‪ DIABETIC KETOACIDOSIS‬‬ ‫ ‪.3‬وﺟﻮد اﻟﻜﻴﺘﻮﻧﺎت )ﻳﻤﻜﻦ اﻛﺘﺸﺎﻓﻬﺎ ﻓﻲ اﻟﺪم أو اﻟﺒﻮل(‬ ‫‪ Caused by low insulin in type 1 diabetes.‬‬ ‫‪ Inability to use glucose increases metabolism of fats which produces‬‬ ‫‪ketones leading to acidosis.‬‬ ‫‪ DKA is therefore characterised by‬‬ ‫‪ 1. A high anion gap metabolic acidosis‬‬ ‫)‪ 2. An elevated plasma glucose (hyperglycaemia‬‬ ‫)‪ 3. The presence of ketones (detectable in blood or urine‬‬ ‫‪ other ketoacidosis‬‬ ‫‪ Increased production of ketones by starvation.‬‬ ‫ اﻟﺤﻤﺎض اﻟﻜﻴﺘﻮﻧﻲ اﻵﺧﺮ‬ ‫ زﻳﺎدة إﻧﺘﺎج اﻟﻜﻴﺘﻮﻧﺎت ﺑﺴﺒﺐ اﻟﺠﻮع‪.‬‬  ‫اﻟﻘﻼء اﻷﻳﻀﻲ‬ (Paco2↑) ‫ ارﺗﻔﺎع ﺗﺮﻛﻴﺰ ﺑﻴﺮوﻛﺴﻴﺪ اﻟﻬﻴﺪروﺟﻴﻦ ﺣﺪوث ﺗﻌﻮﻳﺾ ﺗﻨﻔﺴﻲ‬ ،‫ ﻳﺒﺪأ ﻓﻘﺪان أﻳﻮﻧﺎت اﻟﻬﻴﺪروﺟﻴﻦ ﻓﻲ ﻫﺬه اﻟﺤﺎﻟﺔ‬.‫ وﻟﻜﻦ اﻟﻜﻠﻰ ﺗﺼﺤﺢ ذﻟﻚ ﻋﻦ ﻃﺮﻳﻖ زﻳﺎدة إﻓﺮاز ﺑﻴﺮوﻛﺴﻴﺪ اﻟﻬﻴﺪروﺟﻴﻦ‬ (+K) ‫( واﻟﺒﻮﺗﺎﺳﻴﻮم‬−Cl) ‫ اﻟﺴﺒﺐ اﻟﻤﻌﺘﺎد ﻫﻮ اﻧﺨﻔﺎض أﻳﻮﻧﺎت اﻟﻜﻠﻮرﻳﺪ‬.‫( ﺑﺴﺒﺐ اﻟﻘﻲء أو اﻷدوﻳﺔ اﻟﻤﺪرة ﻟﻠﺒﻮل‬+Na) ‫واﻟﺼﻮدﻳﻮم‬ METABOLIC ALKALOSIS High HCO3 Respiratory compensation (↑Paco2) occurs Loss of H+ ions start the case, but the kidneys correct it by increasing HCO3 excretion. The usual cause are low chloride (Cl−), potassium (K+) and sodium (Na+) ions by vomiting or diuretic drugs. Effect of vomiting on acid–base balance. ‫ﺣﻤﻮﺿﺔ اﻟﺠﻬﺎز اﻟﺘﻨﻔﺴﻲ‬.Paco2 ‫ زﻳﺎدة ﻓﻲ‬.‫ ﻣﻤﺎ ﻳﺴﺒﺐ اﻧﺨﻔﺎض درﺟﺔ اﻟﺤﻤﻮﺿﺔ‬،‫ ﻳﺬوب ﺛﺎﻧﻲ أﻛﺴﻴﺪ اﻟﻜﺮﺑﻮن ﻓﻲ اﻟﺪم ﻟﺘﻜﻮﻳﻦ ﺣﻤﺾ اﻟﻜﺮﺑﻮﻧﻴﻚ‬.‫ ﻳﺤﺪث ﺑﺴﺒﺐ اﻧﺨﻔﺎض اﻟﺘﻬﻮﻳﺔ اﻟﺴﻨﺨﻴﺔ ﺑﺴﺒﺐ ﺿﻌﻒ اﻟﺠﻬﺎز اﻟﺘﻨﻔﺴﻲ‬ RESPIRATORY ACIDOSIS increase in Paco2. CO2 dissolves in blood to form carbonic acid, cause low pH. Caused by reduced alveolar ventilation by respiratory impairment. RESPIRATORY ALKALOSIS decrease in Paco2 caused by alveolar hyperventilation. Primary causes are pain, anxiety, fever, and hypoxaemia. ‫ﻗﻼء اﻟﺠﻬﺎز اﻟﺘﻨﻔﺴﻲ‬ ‫ اﻷﺳﺒﺎب اﻟﺮﺋﻴﺴﻴﺔ‬.‫ ﺑﺴﺒﺐ ﻓﺮط اﻟﺘﻬﻮﻳﺔ اﻟﺴﻨﺨﻴﺔ‬Paco2 ‫اﻧﺨﻔﺎض ﻓﻲ‬ ‫ﻫﻲ اﻷﻟﻢ واﻟﻘﻠﻖ واﻟﺤﻤﻰ وﻧﻘﺺ اﻷﻛﺴﺠﻴﻦ ﻓﻲ اﻟﺪم‬  ‫أﺳﺒﺎب اﻟﻘﻼء اﻟﺘﻨﻔﺴﻲ‬ Causes of Respiratory Alkalosis Diseases of the lung: any intrapulmonary pathology such as pneumonia, pulmonary fibrosis, pulmonary congestion, pulmonary embolism ،‫ أي ﻣﺮض داﺧﻞ اﻟﺮﺋﺔ ﻣﺜﻞ اﻻﻟﺘﻬﺎب اﻟﺮﺋﻮي‬:‫ أﻣﺮاض اﻟﺮﺋﺔ‬ Hypoxemia.‫ واﻻﻧﺴﺪاد اﻟﺮﺋﻮي‬،‫ واﺣﺘﻘﺎن اﻟﺮﺋﺔ‬،‫واﻟﺘﻠﻴﻒ اﻟﺮﺋﻮي‬ Central nervous system lesions ‫ ﻧﻘﺺ اﻷﻛﺴﺠﻴﻦ ﻓﻲ اﻟﺪم‬ Gram-negative sepsis ‫ آﻓﺎت اﻟﺠﻬﺎز اﻟﻌﺼﺒﻲ اﻟﻤﺮﻛﺰي‬ ‫ اﻹﻧﺘﺎن اﻟﺴﻠﺒﻲ اﻟﺠﺮام‬ Liver disease ‫ أﻣﺮاض اﻟﻜﺒﺪ‬ Drugs: salicylate, progesterone ‫ اﻟﺒﺮوﺟﺴﺘﺮون‬،‫ اﻟﺴﺎﻟﻴﺴﻴﻼت‬:‫ اﻷدوﻳﺔ‬ ‫أﺳﺒﺎب اﻟﺤﻤﺎض اﻟﺘﻨﻔﺴﻲ‬.‫ اﻟﺮﺑﻮ اﻟﺤﺎد‬،‫ ﻣﺮض اﻟﺮﺋﺔ اﻟﺨﻼﻟﻲ اﻟﻤﺘﻘﺪم‬،‫ ﻣﺮض اﻻﻧﺴﺪاد اﻟﺮﺋﻮي اﻟﻤﺰﻣﻦ‬:‫ أﻣﺮاض اﻟﺮﺋﺔ‬.‫ ﺗﺸﻮه اﻟﺼﺪر أو اﻧﺴﺪاد ﻣﺠﺮى اﻟﻬﻮاء‬.‫ ﻧﻘﺺ ﺑﻮﺗﺎﺳﻴﻮم اﻟﺪم‬،‫ اﻟﻮﻫﻦ اﻟﻌﻀﻠﻲ اﻟﺸﺪﻳﺪ‬:‫ أﻣﺮاض اﻟﻌﻀﻼت واﻷﻋﺼﺎب اﻟﺘﻨﻔﺴﻴﺔ‬.‫ اﻟﺘﺴﻤﻢ اﻟﻐﺬاﺋﻲ‬،‫ اﻟﺸﻠﻞ‬ Causes of Respiratory Acidosis Lung diseases: COPD, advanced interstitial lung disease, acute asthma Thoracic deformity or airway obstruction Diseases of respiratory muscle and nerve: myasthenia gravis, hypokalemia paralysis, botulism. Mixed Respiratory And Metabolic Acidosis the most dangerous pattern. Because no compensation. Caused by severe ventilatory failure, in which the rising Paco2 (respiratory acidosis) is accompanied by a low Pao2, resulting in tissue hypoxia and consequent lactic acidosis. ‫اﻟﺤﻤﺎض اﻟﺘﻨﻔﺴﻲ واﻷﻳﻀﻲ اﻟﻤﺨﺘﻠﻂ‬.‫ اﻟﻨﻤﻂ اﻷﻛﺜﺮ ﺧﻄﻮرة‬.‫ ﻷﻧﻪ ﻻ ﻳﻮﺟﺪ ﺗﻌﻮﻳﺾ‬ ،‫ ﻳﺤﺪث ﺑﺴﺒﺐ ﻓﺸﻞ ﺗﻨﻔﺴﻲ ﺷﺪﻳﺪ‬ ‫ ﻣﻤﺎ ﻳﺆدي إﻟﻰ‬،Pao2 ‫ )اﻟﺤﻤﺎض اﻟﺘﻨﻔﺴﻲ( اﻧﺨﻔﺎض‬Paco2 ‫ ﺣﻴﺚ ﻳﺼﺎﺣﺐ ارﺗﻔﺎع‬.‫ﻧﻘﺺ اﻷﻛﺴﺠﻴﻦ ﻓﻲ اﻷﻧﺴﺠﺔ واﻟﺤﻤﺎض اﻟﻠﺒﻨﻲ اﻟﻼﺣﻖ‬