Tài liệu Acid-Base Balance doc

Acid-Base Balance Ahmed Abughaban 2021040088 Acid-Base abnormalities  Metabolic Acidosis  Metabolic Alkalosis  Respiratory Acidosis  Respiratory Alkalosis Mechanisms of acid-base balance Respiratory system Kidneys Buffers HCO3 reabsorption Excretion of organic acids Titrable acids (HPO4) Ammonium (NH4) Ca, Hb, PP bones Metabolic Acidosis  Definition:  Primary decrease in serum HCO3  Decreased pH  Accumulation of acids Anion Gap Represents the unmeasured anions in plasma. AG=Na - (Cl + HCO3) Normal AG= 10-12 mEq/L Causes of ↑AG metabolic acidosis: “Accumulation of acids” 1. lactic acidosis 2. Ketoacidosis - diabetic, alcoholic, starvation 3. Toxins - ethylene glycol, methanol, salicylates 4. RF - acute & chronic Causes of normal AG metabolic acidosis: 1- Renal • RTA • Fanconi’s synd 2- GIT • Severe diarrhea • GIT fistula 3- Drugs (+ renal insuff.) • K sparing diuretics • Heavy metals • ACEIs • NSAIDs “Loss of alkali” POG unmeasured NON-IONIZED AG unmeasured IONIZED Plasma Osmolal Gap POG= measured - calculated plasma osm Steps in Acid-Base Diagnosis  Obtain ABG & electrolytes  Check pH & compare HCO3 on ABG & measured for accuracy  Calculate AG  Try to identify the cause according to the AG  Estimate compensatory response (PaCo2 ↓ 1.25 mmHg per mmol/L ↓ in HCO3) . Acid-Base Balance Ahmed Abughaban 2021040088 Acid-Base abnormalities  Metabolic Acidosis  Metabolic. Alkalosis  Respiratory Acidosis  Respiratory Alkalosis Mechanisms of acid-base balance Respiratory system Kidneys Buffers HCO3 reabsorption Excretion