F ARIS A LI N ASSER

I NVESTIGATION : The primary tests used to identify, evaluate, and monitor acid-base imbalances are: 1- Blood gases (ABG) 2- Electrolytes

B LOOD GASES : ABG usually on an arterial blood sample (blood obtained from an artery instead of a vein). They are a snapshot of the blood's pH,pH pO 2 (the amount of oxygen in the blood), and pCO 2 (the amount of carbon dioxide the blood). From these results, bicarbonate (HCO 3 - ) can be calculated.

E LECTROLYTES refers to a group of four tests: Na + (sodium), K + (potassium), Cl - (chloride), and bicarbonate (usually measured as total CO 2 content).

Based on these results, other tests may be ordered to diagnose the disease … Some examples include: GlucoseGlucose—to detect and/or monitor diabetesdiabetes LactateLactate—a high level indicates lactic acidosis KetonesKetones—a high level indicates ketoacidosis Emergency overdose and drug testingEmergency overdose and drug testing may detect one of several drugs or toxins Complete blood count (CBC)Complete blood count (CBC)—this is a group of general tests, but a high white blood cell (WBC) count may indicate sepsissepsis UrinalysisUrinalysis a low or high urine pH may provide clues to the cause of acidosis or alkalosis

TREATMENT

P RINCIPLE OF TREATMENT For metabolic acidosis” 1) Treat the primary diseases which cause metabolic acidosis. 2) Replenish alkaline (HCO3¯ ) to the patients with normal respiratory function. 3) In acidosis, [Ca 2+ ] increases, [Ca 2+ ] reduces during the correcting of acidosis.

4) Prevent the hypokalemia during treatment. (reason?) After the correction of acidosis, the [K + ] will fall down rapidly by moving into the cells. The hypokalemia can cause life-threatening cardiac arrhthmias.

Treatment of metabolic alkalosis 1- Re-expand volume with Normal Saline ( Primary Therapy) 2- Supplement with Potassium to treat hypokalemia (alkalosis associated with severe hypokalemia will be resistant to volume resuscitation until K is repleted) 3- H+ blockers or PPIs if vomiting/NG suction to prevent further losses in H+ ions 4- Discontinue diuretics

Treatment of Respiratory Acidosis Treatment is aimed at the underlying disease, and may include: 1- Bronchodilator drugs to reverse some types of airway obstruction 2- Noninvasive positive-pressure ventilation (sometimes called CPAP or BiPAP) or a breathing machine, if needed 3- Oxygen if the blood oxygen level is low 4- Treatment to stop smoking

Treatment of Respiratory alkalosis Treatment focuses on correcting the underlying condition that caused the alkalosis. Hyperventilation syndrome due to anxiety may be relieved by having the patient breath into a paper bag. By rebreathing the air that was exhaled, the patient will inhale a higher amount of carbon dioxide than he or she would normally.

C ONT … Antibiotics may be used to treat pneumonia or other infections. Other medications may be required to treat fever, seizures, or irregular heart beats

C ONT …. If the alkalosis is related to a drug overdose, the patient may require treatment for poisoning. Use of mechanical ventilation like a respirator may be necessary. If the respiratory alkalosis has triggered the body to compensate by developing metabolic acidosis, symptoms of that condition may need to be treated, as well.

R EFERNCES

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