Acid Base Disorders.

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Presentation transcript:

Acid Base Disorders

Acid Base -Basic Concepts Hydrogen Ion [H+] is tightly controlled [H+] is determined by the balance between PaCO2 and serum HCO3 (bicarbonate) Henderson-Hasselbalch Equation [H+] = 24 (PaCO2 / HCO3-)

Normal Values [H+] = 40 nEq/L pH = 7.40 (7.35-7.45) PaCO2 = 40 mm Hg (35-45) HCO3 = 24 mEq/L (22-26)

Keep It Simple PaCO2 = Acid HCO3 = Base  PaCO2 =  pH (Acidemia)  PaCO2 =  pH (Alkalemia) HCO3 = Base  HCO3 =  pH (Alkalemia)  HCO3 =  pH (Acidemia)

In Numbers Acidosis: pH < 7.35 Alkalosis: pH > 7.45 Respiratory PaCO > 40 mmHg Metabolic HCO3 < 24 mEq/L Alkalosis: pH > 7.45 Respiratory PaCO2 < 40 mmHg Metabolic HCO3 >24 mEq/L

Simple Acid-Base Disorders

Acid-Base Analysis What do You Need? Arterial Blood gases (pH, CO2) Serum chemistry (Na, K, Cl, HCO3)

Simple Vs. Mixed Compensation Concept [H+] = 24 (PaCO2 / HCO3-) Is compensation appropriate? Must know “rules of thumb” of compensation

Respiratory Compensation Compensate for metabolic disorders Prompt response Metabolic acidosis Hyperventilation - ↓ PaCO2 Metabolic alkalosis Hypoventilation - ↑ PaCO2

Metabolic Compensation Compensation for respiratory disorders Slow response Starts in 6-12 hours Steady state in few days Respiratory acidosis Stimulates HCO3 reabsorption --↑ HCO3 Respiratory alkalosis Inhibits HCO3 reabsorption -- ↓ HCO3

Metabolic Acidosis Anion Gap Metabolic acidosis is grouped according to the anion gap Anion Gap (AG) The difference between measured cations and measured anions in the serum AG= Na+ - [Cl- + HCO3-] Normal (9 - 12 mEq/L)

Wide Anion Gap Acidosis Methanol Uremia Diabetic Ketoacidosis, Ketoacidosis Paraldehyde Iron, Isoniazid (INH) Lactic Acidosis Ethanol, Ethylene glycol Salicylates

Non (normal) Anion Gap Acidosis Hyperalimentation Acetazolamide, amphotericin RTA –Renal Tubular Acidosis Diarrhea Ureteral Diversions Pancreatic fistula Saline resuscitation

Metabolic Alkalosis Characterized by Primary  in HCO3 concentration Compensatory  in PaCO2 Classified according to urinary chloride Chloride responsive Chloride resistant

Metabolic Alkalosis Chloride Responsive Urine Cl- >20 mEq/L Volume Contraction: Nasogastric suctioning Vomiting Diuretics Post Hypercapnia Hypokalemia Hypomagnesemia Penicillin

Metabolic Alkalosis Chloride Unresponsive Urine Cl- < 20 mEq/L Mineralcorticoid excess Exogenous steroids Alkali Ingestion Licorice Too much wine Tobacco chewers Bartter’s Syndrome