Professional Documents
Culture Documents
LILIK SUKESI
INTERNAL MEDICINE DEPARTMENT/PADJADJARAN UNIVERSITY
HASAN SADIKIN HOSPITAL - BANDUNG
DEFINITION :
acid
any molecule that dissociates in solution to release a
hydrogen ion (H+) or proton
base
any molecule capable of accepting a hydrogen ion
(H+) or proton
buffer
any substance that can reversibly bind hydrogen ion
(H+) or proton
Buffer + H+
HBuffer
HCO3- + H+
H2CO3
(20)
CO2 + H2O
(1)
H+ + HCO3- H2CO3 CO2 + H2O
excess CO2 will stimulate respiration
elimination of CO2
= K x
CO2
HCO3-
(0.03 ) x PCO2
= K x
HCO3-
HCO3pH = pK + log
(0.03 )x PCO2
respiratory factor
pH
increase in Pco2
pH
hemoglobin
H+ + Hb HHb
Pco2
alkalosis
(1) decreased tubular secretion of H+
(2) increased excretion of HCO3-
RESPIRATORY /
EXCRETORY RESPONSE
CO2 + H2O
yperventilation removes
H+ ion concentrations
ypoventilation increases
H+ ion concentrations
H2CO3
H+ + H
Distribution
and extraCellular
buffering
Cell
buffering
Respiratory
compensation
Renal H+
secretion
50
12
Hours
24
72
SIMPLE ACID-BASE
DISORDERS
Simple acid-base disorders have one
primary abnormality.
The four primary disorders are respiratory
acidosis, respiratory alkalosis, metabolic
acidosis and metabolic alkalosis.
Mixed acid-base disorders have more than
one abnormality
HCO3-
PCO2
Respiratory acidosis
Respiratory alkalosis
Acid-base Disturbance
Metabolic acidosis
Metabolic alkalosis
pH, PCO2 in
opposite
directions;
HCO3- will
follow PCO2
pH, HCO3in same
direction;
PCO2
will follow
HCO3-
Interpreting ABGs
1. Look at the pH
Compensation
1. respiratory acidosis
due to:
causes:
[pH, Pco2]
compensatory mechanism :
(1) body fluid buffers
(2) kidneys
2. respiratory alkalosis
due to:
causes:
[pH, Pco2]
compensatory mechanism:
(1) body fluid buffers
(2) kidneys
3. metabolic acidosis
[pH, HCO3-]
due to:
causes:
3. metabolic acidosis
causes:
[pH, HCO3-]
compensatory mechanism :
(1) lungs
(2) kidneys
4. metabolic alkalosis
due to: (1) excess loss of acid
[pH, HCO3-]
compensatory mechanism:
(1) lungs
(2) kidneys
alkalosis
over-excitability of central and peripheral
nervous system
1) muscle tetany
2) convulsion
3) respiratory arrest death
Anion-Gap
total concentration of anions and cations in
plasma must be equal to maintain electrical
neutrality
but, only certain cation (Na+) and anions (Cl-,
HCO3-) are routinely measured in clinical
laboratory
Anion-Gap
anion gap : difference between unmeasured
anions and unmeasured cations
Na+
unmeasured
cations
Cl-
HCO3-
unmeasured
anions
Anion-Gap
Na+
unmeasured
cations
Cl-
HCO3-
unmeasured
anions
= 144 - { 26
= 10 mEq/L
+ 108}
Anion-Gap
Na+
unmeasured
cations
Cl-
HCO3-
unmeasured
anions
anion gap
calcium,
if unmeasured
relative amount of Na+
magnesium,cation
potassium
Hx & Px
Check pH
Check pCO2
High pCO2
Low HCO3
and HCO3
Metabolic Acidosis Respiratory Acidosis
Expected
compensation
ACUTE
CHRONIC
Check
Anion Gap
Na-(Cl+HCO3)
Possible
Diagnoses
1 HCO3: 1 pCO2
1 HCO3: 1 pCO2
=12-16
>16
10 Pco2 :1 HCO3
10 Pco2 :3 HCO3
Low pCO2
Respiratory Alkalosis
10 Pco2 :2 HCO3
10 Pco2 :5 HCO3
COPD
Drugs-CNS/Resp
Depressants
Drugs
Normotensive
Hypertensive
Ketoacidosis
High Altitude
HCO3 Loss
Lactic
Acidosis
ASA
R.T.A.
Renal
Failure
Pregnancy
Diarrhea
Urine Cl
Intoxications
Sepsis
ASA
Methanol
> 10
Conns
Ethylene Glycol < 10
Diuretics
Cushings
Vomiting
Renal Artery Stenosis
Post-hypercapneia
ACIDIFICATION
OF URINE BY
EXCRETION OF
AMMONIA
Anion gap
examine pH
Step 2:
check
Pco2 HCO3-
respiratory acidosis
()
metabolic acidosis
()
respiratory alkalosis
()
metabolic alkalosis
()