1. This lecture was conducted during the Nephrology Unit Grand Ground by a Sub-intern under Nephrology Division, Department of Medicine in King Saud University.
Nephrology Division is NOT responsible for the content of the presentation for it is intended for learning and /or education purpose only.

2. HOW TO APPROACH PATIENTS WITH ACIDOSIS
Hadeel Salah Al Jamei

3. OUTLINE Definitions Brief Physiology Etiology
Presentation Of The Patient
How To Approach The Patient
Investigations
Treatment
OUTLINE

4. Acid, Acidosis, Acidemia?
pH?
Base, Alkalosis, Alkalemia?
DEFINITIONS

5. MEANS OF REGULATING H+ Buffer Systems (Buffer + H+  HBuffer)
Bicarbonate exatracellular
CO2 + H2O  H2CO3
H2CO3  H+ + HCO3-
Phospahte exatracellular
Protiens intracellualr
Respiratory Systems
Hypoventilation vs. hyperventilation
Renal System
MEANS OF REGULATING H+

6. CAUSES OF ACIDOSIS What is the anion gap?
Respiratory
Acute
Chronic
Metabolic
Normal Anion Gap
Increased Anion Gap
What is the anion gap?
How to calculate it? [Na+] – [HCO3-] – [Cl-]
CAUSES OF ACIDOSIS

8. Hx is V.IMP
SIGNS AND SYMPTOMS

9. Respiratory compensation Renal compensation Respiratory compensation
Arterial blood sample pH
pH < 7.35
pH > 7.45
Acidosis
Alkalosis
HCO3- < 22
PCO2 > 45
HCO3- > 26
PCO2 < 35
Metabolic
respiratory
Metabolic
respiratory
Respiratory compensation
Renal compensation
Respiratory compensation
Renal compensation
PCO2 < 35
HCO3- > 26
PCO2 > 45
HCO3- < 22

10. OTHER MODALITIES OF INVESTIGATIONS
Metabolic
Anion gap
serum chemistry
Urinalysis
Ketone levels
Lactate levels
Salicylate levels
ECG
Respiratory
Chest X-ray
Ct scan
Drug toxicology
CT scan
MRI
PFTs
EMG
NCV
OTHER MODALITIES OF INVESTIGATIONS

11. Treat the underlying cause
ABC and Vitals
Metabolic Acidosis
Treat the underlying cause
NaHCO3
Respiratory Acidosis
Pharmacological
Oxygen
Ventilatory support
TREATMENT

12. SUMMARY History Is Important Acidemia Or Alkalemia
Respiratory Or Metabolic
If respiratory: acute or chronic
If metabolic: normal or increased anion gap?
Is There A Compensation?
SUMMARY

13. Acidosis App

14. Qx Calculate App

16. Textbook of medical physiology by Guyton and Hall 11th edition
Pocket medicine by marc sabatine 4th edition.
Step up to medicine 2nd edition.
REFERENCES