quantitative acid base analysis fencl stewart approach
TRANSCRIPT
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Fencl–Stewart approach: Quantitative Acid-Base Analysis(Strong Ion Difference Changes)
Kiki MK Samsi, dr.,Sp.A, M.Kes
Pediatric Critical Care UnitSumber Waras Hospital
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There are three general mechanisms by which SID changes:
changing the water content of plasma (contraction alkalosis and dilutional acidosis)
changing the Cl- (hyperchloremic acidosis and hypochloremic alkalosis),
increasing the concentration of unidentified anions (organic acidosis).
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Dilutional Acidosis
2 liter
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WATER
Changing The Water Content Of Plasma
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Changing The Water Content Of Plasma
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Hyperchloremic acidosis resulting from NS
Changing The Water Content Of Plasma
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Changing The Water Content Of Plasma
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Normal acid-base following LR
Changing The Water Content Of Plasma
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Contraction Alkalosis
Changing The Water Content Of Plasma
DIURETIKx
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Changing the Cl-
Seorang anak 2 thn, BB 10 kg: Ileus obstruktif Muntah-muntah Dehidrasi berat pH 7.6, Kalium 2 meq/L, Cl 82 meq/L
Tatalaksana Pasang NGT untuk DEKOMPRESI Resusitasi cairan dengan RL Beri KCl untuk hipokalemia
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Changing the Cl-
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Na+ = 140 mEq/LCl- = 82 mEq/L
SID = 58 mEq/LOH- = 58 mEq/L
Hypocloremic Alkalosis
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The adverse effects of a severe alkalosis
Decreased myocardial contractility Arrhythmias Decreased cerebral blood flow Confusion Mental obtundation Neuromuscular excitability Impaired peripheral oxygen
unloading (due shift of oxygen dissociation curve to left).
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The adverse effects of a severe alkalosis
Hypoventilation (due respiratory response to metabolic alkalosis)
Pulmonary microatelectasis (consequent on hypoventilation)
Increased ventilation-perfusion mismatch (as alkalosis inhibits hypoxic pulmonary vasoconstriction).
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Na+ = 140 mEq/LCl- = 82 mEq/L
SID = 58 mEq/LOH- = 58 mEq/L
+
Hypocloremic Acidosis
Na+ = 137 mEq/LCl- = 109 mEq/LLactat = 28 mEq/L
SID = 0 mEq/LOH- = 0 mEq/L
Ringer Lactat
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Na+ = (140 + 137 mEq/L) : 2 = 138,5 mEq/L Cl- = ( 82 + 109 mEq/L) : 2 = 95,5 mEq/L
SID = 43 mEq/LOH- = 43 mEq/L
5843
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Na+ = 140 mEq/LCl- = 95 mEq/L
SID = 45 mEq/LOH- = 45 mEq/L
+
Hypocloremic Acidosis
Na+ = 154 mEq/LCl- = 154 mEq/L
SID = 0 mEq/LOH- = 0 mEq/L
NaCl 0,9%
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Na+ = (140 + 154 mEq/L) : 2 = 147 mEq/L Cl- = ( 82 + 154 mEq/L) : 2 = 118 mEq/L
SID = 29 mEq/LOH- = 29 mEq/L
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Treatment of the elevated Cl- and decreased SID would be done by increasing the SID. This could be accomplished through sodium bicarbonate administration. Other ways of administering Na+ with a metabolizable anion are through the use of the sodium salts of lactate, gluconate, acetate or citrate.
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