acid—base balance 1
TRANSCRIPT
In The name of God
Create PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
AcidAcid--Base Balance Base Balance
Physiology- The pH of ECF is tightly regulated- Normal: 7: 35 – 7: 45 - Daily production of acid :12000meq- Removal lung (most)- kidney (small ,50-100meq/day)but
restore buffer capacity (HCO3)¯¯¯- Respiratory or renal disfunctionbreakdown in
processacid-base disorders
Create PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
--addition of acid addition of acid [[HH++ ]] &pH&pH--PH<PH<77..3535= [= [HH++ ]]=blood is acidotic or acidemic=blood is acidotic or acidemic--PH>PH>77..4545=[H=[H++]]=blood is alkalemic or alkalotic=blood is alkalemic or alkalotic
Create PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
Effect of PH imbalanceEffect of PH imbalance
Majority of body functions optimally at or near pH of 7.40
AcidosisCNS depression,lethargy,disorientation,comaAlkalosisover exitability of CNSperipheral
nerves,tetany, muscular spasms of extremities,face body,respiratory failure
Significant pH alteration Heart contractility
Create PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
PaCOPaCO22
Normal :35-45mmHg paco2 is respiratory componet of acid base status regulation: 1) co2 production rate 2) Alveolar ventilation fever or exercise co2 productionVAnormal
paco2 Paco2 is the most reliable index of VE(minute volume) PaCO2 [H+ ]Respiratory Acidosis Paco2 [H+ ] = Respiratory Alkalosis
Create PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
Arterial HcoArterial Hco33¯̄ Normal = 22—26 mEq/ L Metabolic component of Acid –Base status Regulation by renal system Hco3¯PH=Metabolic Alkalosis Hco3¯PH =Metabolic Acidosis Hco3¯ may change in response to primary change
of paco2 (12—24 hr ) Co2 + H2O H2co3 H+ + Hco3¯ Paco2 Hco3¯ Paco2Hco3¯
Create PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
Base Excess & Base deficitBase Excess & Base deficitBBEE++ BEBE¯̄
Normal : 2mEq/L
Be indicate pure metabolic component
Create PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
AcidAcid——Base disordersBase disorders
1 )Simple disorder: Respiratory AcidosisRespiratory AlkalosisMetabolic AcidosisMetabolic Alkalosis
2 ) Mixed disorders
Create PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
Respiratory AcidosisRespiratory Acidosis -Alveolar Ventilation relative to co2 production Paco2 (paco2 > 45 mmhg ) or higher than expected level of
compensation Ethiology :1) Respiratory :
*Acute upper Airway obstruction*sever diffuse airway obstruction (Acute or
chronic) * Massive pulmonary edema
2) Nonrespiratory: * Drug overdose*Spinal cord trauma*Neuromuscular disease*Head trauma*trauma to thoracic cage
Create PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
Compensation of Respiratory Compensation of Respiratory AcidosisAcidosis
Acute :pH paco2 Hco3¯ BE Partial compensation : PH paco2 Hco3¯ BE completely compensated :pH normal up to 7.39
paco2 HCO3¯ BE Acute Respiratory Acidosis:10—15mmHg
paco21mEq/L Hco3¯ Chronic Respiratory Acidosis:10mmhg
paco24mEq/L Hco3¯
Create PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
Clinical Effect of Respiratory Clinical Effect of Respiratory AcidosisAcidosis
Acute:CNS:Headache,sleepy,lethargy,confusion, semiconciousness,coma(paco2>70 mmhg)
But chronic :higher level of paco2 may be well tolerated
Hypoxemia may presented CVS : 1)paco2 vasodilution+COwarm flushed
skin +bounding pulse 2) Arrhytmias 3)Cerebral vasodilation ICP,Retinal
venous distention , pupilledema & headache Hco3¯(in compensation of Respiratory
Acidosis)Cl level
Create PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
Respiratory AlkalosisRespiratory Alkalosis
Paco2 <35mmHg Alveolar Ventilation Relation to co2 Production Ethiology :Pain, Hypoxemia(pao2<55-60mmHg),
Acidosis , Anexity, Mechanical ventilation pH , paco2 and normal Hco3¯ &
BE=uncompensated R Alkalosis pH7.45 , paco2 , Hco3¯ , BE =partial
compensation R Alkalosis pH in normal range , paco2 , Hco3¯ , BE=Full
compensated R Alkalosis
Create PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
Metabolic AcidosisMetabolic Acidosis Hco3¯ BE Buffers : production or loss H+Acid) : load H+ or Excretion Loss of Hco3¯ : diarrhea , renal disease Metabolic Acid production: Keto acidosis , lactic
acidosis,certain toxins(Metanol) Post hypocapnia disorder ANION GAP:Na–(Cl¯+Hco3¯) Normal=8-16mEq/L . With K =1220mEq/L Normal Anion gap : HCL , diarrhea , RTA , (type 2 ,
proximal) High Anion gap :Renal Failure , lactic acidosis , keto
acidosisCreate PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
Metabolic AlkalosisMetabolic Alkalosis
-Hco3¯> Normal -Accumolation of Hco3¯or H loss Ethiology: Hypokalemia or hypochloremi *Nasogastric suction
*persistent vomiting*post hypercapnia Disorder*Diuretic therapy*Steroid therapy*Excessive Adminstration of sodium bicarbonat
Create PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
Compensation of M AlkalosidCompensation of M Alkalosid
Hypoventilation paco2(Not in awake paients) Uncompensated M Alkalosis :Hco3¯ BE
PH & Normal paco2 Partial compensated: ph is not yet normal ,
Hco3¯ BE Paco2>45mmHg Complet compensation : paco2 enough to
PHNormal
Create PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
Create PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
Create PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
Mixed Acid Mixed Acid ––Base disorderBase disorder When two of the symple are Acid –Base are present
simultaneosly Respiratory & metabolic Acidosis: cardiopulmonary
arrest , COPD , Hypoxia , poisoning & Drug overdosage (Barbiturate)
Metabolic & Respiratory Alkalosis :Critical care unit:MV , anxeity , pain , Nasogastric suctioning , vomiting , transfusion, antiacid
Metabolic Acidosis & Respiratory Alkalosis:lactic acidosis(Hypoxia)+MV(Hyper ventilation)
Metabolic Alkalosis & Respiratory Acidosis:COPD+Diuretic therapy
Create PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
یون ھیدروژن یون ھیدروژن باز در رابطھ با غلظتباز در رابطھ با غلظت- - پارامتر ھاي اسیدپارامتر ھاي اسیداجزاياجزاي
باز-پارامترھاي اسیدتنفسي و اجزاي متابولیكتنفسي و اجزاي متابولیك اجزا PH غلظت یون ھیدروژن
Paco2 Pao2o2sat
تنفسي , اجزا
Hco3BEBEecfBB
متابولیك , اجزا
Create PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
Interpretation and discussionInterpretation and discussion
PH Acidosis PH Alkalosis
PaCo2 Acidosis Paco2 Alkalosis
BE Alkalosis BE Acidosis
Pao2<60mmHg Hypoxia Sao2<%90 Hypoxia
Create PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
MIXED VENOUS BLOOD
pH 7.36PCO2 46 mmHgPO2 40 mmHgSO2 75%
pH 7.40PCO2 40 mmHgPO2 95 mmHgSO2 95%
ARTERIAL BLOOD
External Respiration
Internal Respiration
Create PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
در شرایط طبیعي و بحرانيدر شرایط طبیعي و بحراني PHPHغلظت یون ھیدروژن و غلظت یون ھیدروژن و
تشنج طبیعي كوما
پارامتر
١٦ ١٢٥ ٤٠ [ H ]
٧/٨ ٦/٩ ٧/٤ PH
Create PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
Create PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
Interpretation and discussion Interpretation and discussion
PH=7/16 7.35-7.45 Paco2=40mmHg 35-45mmHg Pao2=60mmHg 80-100mmHg Sao2=85% >90% Cao2=11vol% 16-20 vol% BE= 14 ±2 Hco3¯ = 14mEq/L 22-26mEq/L
Create PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
Interpretation and discussionInterpretation and discussion
PH = 7.49 Paco2 = 32mmHg Pao2 = 68 mmHg Sao2=91.5% Cao2 = 16 vol% Hco3¯ = 22mEq/L BE = 1
Create PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
Interpretation and discussionInterpretation and discussion
Ph = 7.41 Paco2 = 61mmHg Pao2 = 66 mmHg Sao2=91. 4% Cao2 = 12.2 vol% Hco3¯ = 37mEq/L BE =+11
Create PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
Interpretation and discussionInterpretation and discussion
PH = 6.96 Paco2 = 17mmHg Pao2 = 110mmHg Sao2=99. 9% Cao2 = 19 vol% Hco3¯ = 3.5mEq/L BE = 24
Create PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
Interpretation and discussionInterpretation and discussion
PH = 7.53 Paco2 = 31mmHg Pao2 = 90mmHg Hco3¯ =25mEq/L BE = +5mEqL
Create PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
Interpretation and discussionInterpretation and discussion
PH = 7.25 Paco2 = 32mmHg Hco3¯ =16mEq/L BE = - 10 mEqL
Create PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
Interpretation and discussionInterpretation and discussion
PH = 7.21 Paco2 = 67mmHg Pao2 = 49 mmHg Sao2=76% Cao2 = 10.4 vol% Hco3¯ = 26 mEq/L BE = 2 Hb = 10
Create PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
Interpretation and discussionInterpretation and discussion
PH = 7/409 Paco2 = 27/2 BE = -5/2 Hco3¯ = 16/7 Pao2 = 53 O2sat = 86
Create PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
Create PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
Create PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
Create PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)
Create PDF files without this message by purchasing novaPDF printer (http://www.novapdf.com)