Acid – Base Disorders Viyeka Sethi PGY 4 Med-Peds.

Slides:



Advertisements
Similar presentations
DEFINITIONS acidemia/alkalemia acidosis/alkalosis an abnormal pH
Advertisements

Acid Base Anthony R Mato, MD. Basics Normal pH is 7.38 to 7.42 Key players are CO2 and HCO3 – concentrations “emia” : refers to blood pH Acidemia : pH.
Acid-Base Disturbances
Biochemical basis of acidosis and alkalosis: evaluating acid base disorders Eric Niederhoffer, Ph.D. SIU-SOM.
Acid-Base Disorders Adapted from Haber, R.J.: “A practical Approach to Acid- Base Disorders.” West J. Med 1991 Aug; 155: Allison B. Ludwig, M.D.
See Marieb & Hoehn 9th ed., Chapter 26
A&E(VINAYAKA) Blood Gas Analysis Dr. Prakash Mohanasundaram Department of Emergency & Critical Care medicine Vinayaka Missions University.
Evaluation and Analysis of Acid-Base Disorders
The Simple Acid/Base Disorders Dr. Dave Johnson Associate Professor Dept. Physiology UNECOM.
Arterial Blood Gas Assessments
Deborah J. DeWaay MD Assistant Professor of Medicine Associate Vice-Chair of Education Department of Internal Medicine Medical University of South Carolina.
Waleed Talal Alotaibi MBBS. objectives Definitions How to approach? Differential diagnosis Anion gap VS. non-anion gap metabolic acidosis Treatment of.
Acid-base Disturbances Mohammed saeed abdullah al-mogobaa Mohammed saeed abdullah al-mogobaa
Ibrahim alzahrani R1 Quiz of the week. 18 years old male who presented with sever cough, greenish sputum and high grade fever (39.5). He developed sever.
ACID-BASE SITUATIONS.
Approach to Acid Base Disorder
 The Components  pH / PaCO 2 / PaO 2 / HCO 3 / O 2 sat / BE  Desired Ranges  pH  PaCO mmHg  PaO mmHg  HCO 3.
Understanding Acid/Base Balance Marilyn F. Brown Broad Concepts: Body pH tolerated in very narrow range 7.35 – 7.45 pH is defined as H+ ion concentration.
Acid Base Balance Cases Dr Svitlana Zhelezna Clinical Teaching Fellow UHCW NHS Trust 2013/2014 academic year.
Diabetes Clinical cases CID please… Chemical Pathology: Y5 Karim Meeran.
BY : MUHANNAD ALI ASIRI Acid base balance.
Acid-Base Imbalance NRS What is pH? pH is the concentration of hydrogen (H+) ions The pH of blood indicates the net result of normal acid-base.
Getting an arterial blood gas sample
Getting an arterial blood gas sample
با نام و یاد خدا.
Acid-Base Balance KNH 413. Acid-Base Balance Acids- rise in pH Donate or give up H+ ions Nonvolatile acids or fixed acids Inorganic acids that occur through.
Simple Rules for the Interpretation of Arterial Blood Gases Nicholas Sadovnikoff, MD, FCCM Assistant Professor, Harvard Medical School Co-Director, Surgical.
Acid-Base Balance Disturbances. Acids are produced continuously during normal metabolism. (provide H+ to blood) H + ion concentration of blood varies.
Introduction to Acid Base Disturbances
Arash Safaie, MD Emergency Physician.   pH  ↓7.36: Acidemia  ↑7.44: Alkalemia  Physiologic Buffers  Bicarbonate  Carbonic Acid Systems (RBCs) 
Nephrology Core Curriculum Simple Acid-Base Disorders.
Acid-Base Balance Disturbances
ARTERIAL BLOOD GASES for starters… Jean D. Alcover, M.D. 2nd year resident UP-PGH Department of Medicine.
Practice Problems Acid-Base Imbalances interpretation of Arterial Blood Gases (ABG) RESP.
ABG interpretation. Oxygenation Check the FiO2 Know your A-a gradient – A-a Gradient (at sea level) = PaO2 - FIO2 x ( ) - (PaCO2/0.8) – Can be.
Arterial Blood Gas Analysis
ABG INTERPRETATION. BE = from – 2.5 to mmol/L BE (base excess) is defined as the amount of acid that would be added to blood to titrate it to.
Acidemia: blood pH < 7.35 Acidosis: a primary physiologic process that, occurring alone, tends to cause acidemia. Examples: metabolic acidosis from decreased.
第 10 組:郭震亞 許瑜真 許程凱 梁華昌. CaseNa + Cl - CO 2 pHpCO 2 pO 2 Normal J Glucose normal Lactate (-) Ketones.
SAQ 25 Feedback Don Liew December Stem A previously well 55 year-old woman presents with … severe vomiting for 5 days. Observations: HR 110 BP100/60.
Acid Base Balance B260 Fundamentals of Nursing. What is pH? pH is the concentration of hydrogen (H+) ions The pH of blood indicates the net result of.
Arterial Blood Gas Interpretation Dr. Shinjan Patra. Post Graduate Trainee, General Medicine, Midnapore Medical College, West Bengal ,India
It aiN’T All that Simple Dr alex Hieatt Consultant ED
Acid-Base Imbalance.
Diabetes Clinical cases CID please… Chemical Pathology: Y5
Acid base principles and disorders
Acid-Base Imbalance.
ABG INTERPRETATION.
ACID BASE DISORDER DR UZMA MALIK
Jeff Kaufhold, MD FACP 2013 Source: The ICU Book Chapter 36-38
Acid-Base Imbalance.
Acid-Base Imbalance.
This lecture was conducted during the Nephrology Unit Grand Ground by Medical Student rotated under Nephrology Division under the supervision and administration.
ABG Analysis Dr. Katrina Romualdez ED Registrar
Approach to Acid Base Disorder Dr.Md.Nazrul Islam Associate Professor Department of Biochemistry Dinajpur Medical College Bangladesh.
Anion Gap (AG) It is a measure of anions other than HCO3 and Chloride Biochemical Basis: Always: CATIONS = ANIONS 11/18/2018 5:41 PM.
CLINICAL INTERPRETATION OF ABG
Blood gas and acid base evaluation
Acid-Base Balance KNH 413.
Acid-Base Balance KNH 413.
See Marieb & Hoehn 9th ed., Chapter 26
Acid Base Disorders.
Acid-Base Balance KNH 413.

Approach to Acid-Base Disorder
Arterial Blood Gas Analysis
Acid-Base Balance KNH 413.
Arterial blood gas Dr. Basu MD.
Acid-Base Balance KNH 413.
Arterial Blood Gas Analysis
Presentation transcript:

Acid – Base Disorders Viyeka Sethi PGY 4 Med-Peds

Four Main Acid-Base Disorders DisorderPrimary Alteration Secondary Response Mechanism of Response Metabolic Acidosis in plasma HCO3 in plasma pCO2 Hyperventilation Metabolic Alkalosis in plasma HCO3 increase in pCO2 Hypoventilation Respiratory Acidosis in plasma pCO2 in plasma HCO3 Increase in acid excretion; increase in reabsorption of HCO3 Respiratory Alkalosis in plasma pCO2 in plasma HCO3 Suppression of acid excretion; decrease in reabsorption of HCO3

Normal Values ArterialVenous pH7.40<7.35 HCO324 pCO240>40 pO2>70<60

Step by Step 1. Determine the primary disturbance:  Acidemia or Alkalemia: look at the pH < 7.40 = acidemia > 7.40 = alkalemia  Respiratory or Metabolic: look at HCO3 and CO2 HCO3 = primary metabolic acidosis pCO2 = primary respiratory acidosis and vice versa for alkalosis

2. Determine acute or chronic for Respiratory Disturbance: o Compensation attempts to normalize pH but can be present with an abnormal pH o Expected change in pCO2 best used for primary metabolic disturbance and expected change in HCO3 for primary respiratory disturbance

Respiratory Disturbance Compensation pCO2 in pH in HCO3 Acute Resp. Acidosis Chronic Resp. Acidosis pCO2 in pH in HCO3 Acute Resp. Alkalosis Chronic Resp. Alkalosis

3. Primary Metabolic Disturbance: o Calculate anion gap : Na – (Cl + HCO3) o Normal = 12 +/- 2 o If gap is >20 then there is primary metabolic acidosis regardless of pH or bicarb. o Helps narrow differential with a anion gap or non-anion gap metabolic acidosis

4. Assess appropriate respiratory compensation for metabolic disorder: o Respiratory compensation is fast o Winters formula: Expected pCO2 = (1.5 * HCO3) + 8 (+/-2) o If measured pCO2 is < expected then co-existing resp. alkalosis > expected then co-existing resp. acidosis

5. Determine if other metabolic disturbances co-exist with AG metabolic acidosis: o Delta gap – accounts for increase in anion gap and shows any variation in HCO3 o If no other disorder is present then the calculation should be 24

Delta Gap Corrected HCO3 = measured HCO3 + (AG - 12) o So if corrected HCO3 >24 then metabolic alkalosis co-exists <24 then non-anion gap metabolic acidosis co- exists

Hints Simple acid base – compensatory response always in direction of primary variable Compensation is more pronounced with chronic disorders Normal pH indicates two or more acid-base disorders If given electrolytes, use them!!!

Pneumonics for pnuemonic lovers Metabolic Acidosis Anion Gap “MUDPILERS” Metabolic Acidosis Non- Gap “HARDUPS” Acute Resp. Acidosis “anything causing hypoventilation” Metabolic Alkalosis “CLEVERPD” Respiratory Alkalosis “CHAMPS” Methanol Uremia DKA/Alcoholic ketoacidosis Paraldehyde Isoniazid Lactic acidosis Ethanol Renal failure/Rhabdo Salicylates Hyperalimentation Acetazolamide Renal Tubular Acidosis Diarrhea Uretero-Pelvic shunt Post-hypocapnia Spironolactone CNS depression Airway obstruction Pulmonary edema Pneumonia Hemo/Pneumo thorax Neuromuscular Contraction Licorice Endocrine (Conn/Cushing /Bartters) Vomiting Excess alkali Refeeding Post- hypercapnia Diuretics CNS disease Hypocapnia Anxiety Mech. Ventilation Progesterone Salicylates Sepsis

Case 1 3 yo boy with diarrhea is evaluated in the ER. Initial ABG shows: ph – 7.23 HCO3 – 10 pCO2 – 23 AG - 13 Alkalemia or acidemia? Low pH = acidemia Primary disturbance resp. or metabolic? Low HCO3 = metabolic acidosis Normal AG so no need for Delta gap equation BUT Is there adequate respiratory compensation? (Use Winter’s formula) Expected pCO2 = (1.5 * HCO3) + 8 +/-2 So, Expected pCO2 = (1.5 * 10) + 8 +/-2 =(15) + 8 +/-2 =23 +/- 2 So, we have a metabolic acidosis with respiratory compensation

Case 2 5 yo boy presents to ED with dyspnea for 3 days. ABG shows the following: pH – 7.35 paCO2 – 60 paO2 – 57 HCO Acidemia or alkalemia? Low pH = Acidemia Primary Resp. or Metabolic disturbance? Respiratory Check yourself….using rules for Primary Resp disturbance For every 10 increase in pCO2 - pH decreases by.08 acutely or.03 chronically HCO3 increases by 1 acutely or 3 chronically So, this is a chronic resp. acidosis

Case 3 15 yo with 4 days of vomiting and fever. pH- 7.50Na- 138 pCO2- 42Cl- 80 pO2- 80HCO3- 34 Acidemia or alkalemia? High ph = alkalemia Respiratory or Metabolic? High HCO3 = metabolic Is Resp. compensation appropriate? Exp. pCO2 = (1.5 * HCO3) + 8 +/-2 =(51) + 8 +/-2 =59 +/- 2 So, NO the CO2 is lower so we have a Co-existent resp.alkalosis Anion Gap? 138 – ( ) = 24 Checking the Delta gap only useful in a primary metabolic acidosis.

Case 4