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Acid Base Disorders

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by

YK Chung

on 30 September 2013

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Transcript of Acid Base Disorders

Acid Base
Disorders

Check Arterial pH
pH<7.4
Acidemia
pH>7.4
Alkalemia
pCO2>40 mmHg
pCO2<40 mmHg
pCO2>40 mmHg
pCO2<40 mmHg
Respiratory
Acidosis
Metabolic
Acidosis
w/Compensation
(Hyperventilation)

Respiratory
Alkalosis


Metabolic
Alkalosis
w/Compensation
(Hypoventilation)


Check Anion Gap
= Na - (Cl + HCO3)

Hypoventilation

-Airway obstruction
- Acute lung dx
- Chronic lung dx (COPD)
- Opioids, narcotics,
sedatives > Hypoventilation
- Weakening of Respiratory muscles
- Alveolar Hyperventilation
- Anxiety
- Pulmonary Embolism, pneumonia, asthma
- Sepsis
- Hypoxia
- Mechanical Ventilation
- Pregnancy
- Liver disease
- Salicylate toxicity
-Diuretic use
- Vomiting
- Antacid use
- Hyperaldosteronism
Increased Anion Gap


Normal Anion Gap (8-12 mEq/L)

MUDPILES:

Methanol (formic acid)
Uremia
Diabetic ketoacidosis/starvation
Paraldehyde or Phenytoin
Intoxication, Iron tablets, Isoniazid
Lactic acidosis
Ethylene glycol
- Diarrhea
- Glue sniffing
- Renal tubular acidosis
- Hyperchloremia
Is it Acidosis? Metabolic? Anion Gap? Compensated? Corrected?
What are the normal values?
pH = 7.40

pCO2 = 40

HCO3 = 24

pO2 = 100-.25(age)

What are the clinical effects?
Acidosis
Alkalosis
- Right shift in oxygen-hemoglobin dissociation curve diminishes the affinity of hemoglobin for oxygen. (Increased oxygen delivery to tissues)
- Depresses CNS
- Decreases pulmonary blood flow
- Arrhythmias
- Impairs myocardial function
- Hyperkalemia
- Decreases cerebral blood flow
- Left shift in oxygen-hemoglobin dissociation curve increases the affinity of hemoglobin for oxygen (so decreases oxygen delivery to tissues)
-Arrhythmias
- Tetany, seizures
YoungKey Chung, MSIII
Wayne State University School of Medicine
Acute or Chronic Respiratory Acidosis?
Acute
Chronic
Immediate compensation elevation of HCO3-

Increase of 1 mmol/L for every 10 mmHg increase in PaCO2

Kidneys will slowly adapt

HCO3- increase of 4 mmol/L for every 10 mmHg increase in PaCO2

Acute or Chronic Respiratory Alkalosis?
Acute
Chronic
For every 10 mm Hg decrease in PaCO2, plasma HCO3 decreases by 2 mEq/L

pH increases by 0.08 mEq/L

For each 10 mmHg decrease in paCo2, plasma HCO3- decreases by 5-6 mEq/L

Blood pH decreases by 0.02 mEq/L

WHAT DOES THIS MEAN?
1. Lactate is added

2. H+ from acid is buffered by the bicarbonate system

3. Co2 is formed and removed by the lungs
H+ + HCO3- <-> H2CO3- <-> H2O + CO2

4 .HCO3- levels decrease in the ECF

5. Kidneys reabsorb more HCO3- to maintain pH


DIFFERENT VARIATIONS CAN ARISE:
1. Change in anion gap = Change in HCO3-

1. You add acid, then anion gap increases proportionately!

2. Change in AG is less than HCO3- change
"Normal AG Acidosis + High AG Acidosis"

2. You started with low HCO3-. That is why when you added acid, the HCO3- is lower than the predicted value.

3. Change in AG is greater than HCO3- change
"Metabolic alkalosis + High AG Acidosis"

3. When you have a high AG, the acid is buffered by HCO3-. So, HCO3- decreases. If it doesn't, then you had a lot of HCO3- to start with.
ANION GAP = Na - (Cl + HCO3)
Normal AG = 12 +/- 4
Homeless Man with Altered Mental Status, with a positive UDS:


Lab Values:
Na: 158 mEq/L
K:4.0 mEq/L
Cl:110 mEq/L
HCO3:16 mEq/L
BUN:14 mg/dL
Cre:1.5 mg/dL
Glucose:108 mg/dL
PT:16.0 seconds
INR:1.5
Ethanol level:0 mg/dL
ABG Results:
pH:7.28
pCO2: 30 mmHg
pO2: 95 mmHg


% O2 sat: 98%
Full transcript