acid base lecture 2012 (1)

7/29/2019 Acid Base Lecture 2012 (1)

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Fluid, Electrolyte and Acid-baseBalance Block

ACID-BASE BALANCE

By Harliansyah, PhD2012


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HYDROGEN IONS, ACIDS,

AND BASES HYDROGEN IONS (H+)

ACIDS

BASES

PHNormal arterial pH is 7.35 7.45


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ACID-BASE BALANCESAcidosis pH < 7.35

Alkalosis pH > 7.45

Buffers


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PRIMARY BUFFER SYSTEMS

IN EXTRACELLULAR FLUID


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REGULATION OF ACIDS AND

BASES THE BIG THREE ACID-BASE

REGULATORS

Chemical regulation

Biological regulation

Physiological regulation


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PHYSIOLOGICAL

REGULATION

Alkalosis

Acidosis


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ACID

BASE IMBALANCESRESPIRATORY ACIDOSIS

RESPIRATORY ALKALOSISMETABOLIC ACIDOSIS

METABOLIC ALKALOSIS


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ARTERIAL BLOOD GASES NORMAL BLOOD GASVALUES

pH 7.35-7.45 PCO2 35-45mmHg

HCO3 22-27mEq/L

PO2 80-100

mmHg


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ARTERIAL BLOOD GASES RESPIRATORY IMBALANCES

Respiratory function indicator is PCO2

Opposite response between the pHand PCO2

pH is down in an acidotic condition

and is elevated in an alkaloticcondition

pH and PCO determines if thecondition is a respiratory problem


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ARTERIAL BLOOD GASES METABOLIC IMBALANCES

HCO3 is indicator for metabolic

functionA corresponding response between

the pH and the HCO3

pH is down in an acidotic conditionand is elevated in an alkaloticcondition

The pH and the HCO3

determines ifthe condition is a metabolic problem


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ANALYZING ARTERIAL BLOOD

GAS RESULTS PYRAMID STEPS

Look at the blood gas report

PYRAMID STEP 1 Look at the pH. Is it up or down? If it is up, it

reflects alkalosis. If it is down, it reflects acidosis.

PYRAMID STEP 2

Look at the PCO2. Is it up or down? If it reflectsan opposite response as the pH then you knowthat the condition is a respiratory imbalance. If itdoes not reflect an opposite response as the pH,then move on to Pyramid Step 3.


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ANALYZING ARTERIAL BLOOD

GAS RESULTS PYRAMID STEP 3

Look at the HCO3. Does the HCO3 reflect a

corresponding response with the pH? If it does,then the condition is a metabolic imbalance.

PYRAMID STEP 4

Remember, compensation has occurred if the pH

is in a normal range of 7.35-7.45. If the pH is not within normal range, look at the

respiratory or metabolic function indicators.


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FLUID, ELECTROLYTE & ACID

-BASE REMEMBER~~~~

NORMAL CHEMISTRY LABORATORY VALUES

Serum electrolyte levels

CBC (changes in Hct related to FVD & FVE)

BUN & Blood Creatinine Levels (kidney functions)

Urine Specific gravity (normal 1.003 1.023)

ABGs


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LUID, ELECTROLYTE & ACID -

BASE OVERALL GOALS/EVALUATION

NORMAL FLUID, ELECTROLYTE AND ACID BASEBALANCE

CAUSES OF IMBALANCES IDENTIFIED ORCORRECTED

NO COMPLICATIONS FROM THERAPIES NEEDEDTO RESTORE BALANCE

INCLUDE FAMILY IN PROCESS


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acid base lecture 2012 (1)

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