1. Acid-base Disturbances Mohammed saeed abdullah al-mogobaa 432800224 Mohammed saeed abdullah al-mogobaa 432800224

2. How to Approach patient with Acid –Bases disorders

3. STEPS  History and physical examination  Identify the Acid-base abnormalities (pH, PCO 2, HCO 3 )  Define the acid-base disorders >  Calculate AG and  Is it acute or chronic  Simple or mixed  What is the underlying cause ?  Treat accordingly

4. STEPS  History and physical examination: Symptoms and signs : - deep rhythmic breathing ( kussmauls sign ), decrease cardiac out put and perforation, hypotension, vomiting, diarrhea, diuretic therapy, confusion, asterixis, headache, dizziness', anxiety,tetany, arrhythmias  Identify the Acid-base abnormalities (pH, PCO 2, HCO 3 )  Define the acid-base disorders  Calculate AG and  Is it acute or chronic  Simple or mixed  What is the underlying cause ?  Treat accordingly

6. STEPS  History and physical examination  Identify the Acid-base abnormalities (pH, PCO 2, HCO 3 ) Abnormal pH ( 7.35 - 7.45) Abnormal HCO 3 ( 22 - 24 mEq / L ) Abnormal Pco2 ( 35 - 45 mm Hg )  Define the acid-base disorders  Calculate AG  Simple or mixed  What is the underlying cause ?  Treat accordingly

8. STEPS  History and physical examination  Identify the Acid-base abnormalities (pH, PCO 2, HCO 3 )  identify the acid-base disorders  Calculate AG and  Simple or mixed  What is the underlying cause ?  Treat accordingly

9. PH Pco2HCO3 Metabolic acidosis Metabolic alkalosis Respiratory acidosis Respiratory alkalosis

10. STEPS  History and physical examination  Identify the Acid-base abnormalities (pH, PCO 2, HCO 3 )  Define the acid-base disorders >  Calculate AG and delta AG  Simple or mixed  What is the underlying cause ?  Treat accordingly

11. Anion Gap Na + Cl - HCO 3 - Protein, PO 4, SO 4, Organic acid K +, Ca +, Mg + Anion gap Anion gap = Na + - (Cl - + HCO 3 ) = 10 – 14 mEq/L If metabolic acidosis, then look at the Anion Gap. - If elevated (> than 14), then acidosis due to KULT. (Ketoacidosis, Uremia, Lactic acidosis, Toxins). - If anion gap is normal, then acidosis likely due to diarrhea, RTA.Anion Gap

12. STEPS  History and physical examination  Identify the Acid-base abnormalities (pH, PCO 2, HCO 3 )  Define the acid-base disorders >  Calculate AG and  Is it acute or chronic  Simple or mixed  What is the underlying cause ?  Treat accordingly

14. STEPS  History and physical examination  Identify the Acid-base abnormalities (pH, PCO 2, HCO 3 )  Define the acid-base disorders >  Calculate AG and  Simple or mixed  What is the underlying cause ?  Treat accordingly

15. Compensatory mechanism  Metabolic acidosis : Pco2 decrease by 1.2 mmHg for each 1 decrease in Hco3  Metabolic alkalosis : Pco2 increase by 0.6 mmHg for each 1 increase in Hco3

16. Compensatory mechanism  Respiratory acidosis : Acut / Hco3 increase by 1 in each 10 increase in Pco2 Chronic / Hco3 increase by 3.3 in each 10 increase in Pco2  Respiratory alkalosis : Acute / Hco3 decrease by 2.2 in each 10 decrease in Pco2 Chronic / Hco3 decrease by 4.4 in each 10 decrease in Pco2

17. Ph ( 7.35- 7.45) Pco2(35-40)Hco3(22-24)DignosisSimple or mixed 7.22612Metabolic acidosis Simple 7.494543Metabolic alkalosis Simle 7.255025Respiratory acidosis Simple 7.513020Respiratpry alkalosis Simple 7.14012 Metabolic acidosis + respiratory acidosis Mixed

18.  Case 1  A 44 year old moderately dehydrated man was admitted with a two day history of acute severe diarrhea.  Electrolyte results: Na+ 134, K+ 2.9, Cl- 108, HCO3- 16, BUN 31, Cr 1.5. ABG: pH 7.31 pCO2 33 mmHg HCO3 16 pO2 93 mmHg  What is the acid base disorder?

19. Massages to remember  Acid-base disturbance is not an isolated problem  Good HISTORY is VERY IMPORTANT  HCO3 level indicates METABOLIC problems  PCO2 level indicates RESPIRATORY problems  Anion gap and Delta AG for Metabolic acidosis  Relationship between HCO3 & PCO2  Look for the underlying CAUSE  Treat underlying cause

20. Refrence …

21.  Thank you …. Any qustion ??