Acid-Base Balance

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Acid-Base BalanceAc -Bas Balanc id e e Ahmed Abughaban 2021040088 Aci Base d abnor altes m ii Metabolic Acidosis Metabolic Alkalosis Respiratory Acidosis Respiratory Alkalosis M echani s d sm ofaci base bal anceRespiratory system Buffers Ca, Hb, PP Kidneys bonesHCO3 reabsorption Titrable acids (HPO4) Ammonium (NH4)Excretion of organic acidsM et abolc dosi i Aci s Definition:  Primary decrease in serum HCO3  Decreased pH  Accumulation of acidsAni G ap on Represents the unmeasured anions in plasma. AG=Na - (Cl + HCO3) Normal AG= 10-12 mEq/L es of↑A m abolc dos sC aus G et i aci i : “Accumulation of acids” 1. lactic acidosis 1. Ketoacidosis - diabetic, alcoholic, starvation 1. Toxins - ethylene glycol, methanol, salicylates 1. RF - acute & chronicC aus esofnorm alA G et m abolc dos s i aci i : “Loss of alkali” 1Renal 3Drugs(+renal •RTA insuff.) •Fanconi’s synd • K sparing diuretics • Heavy metals 2GIT • ACEIs •Severe diarrhea • NSAIDs •GIT fistulaPl asm a sm ol ap O alG AG POG unmeasured unmeasured IONIZED NON-IONIZED POG= measured - calculated plasma osmSt epsn d i Aci Base i D agnosi s 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)ABG i ngsn et fndi i m abolc i aci s dosi  pH < 7.35  HCO3 < 24 mEq/L  paCO2 < 35 mmHg (compensated)Tr m entofm et eat abolc dosi i aci s  TREAT THE CAUSE Hydrate the pt IV HCO3**HCO3 only when (1) pH < 7.1 (2)HCO3Thank You