Acid base lecture (1)
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![Page 1: Acid base lecture (1)](https://reader035.fdocuments.in/reader035/viewer/2022081421/5564841ed8b42a73418b47fc/html5/thumbnails/1.jpg)
Acid-Base Balance
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What
is an Acid-Base Status?
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It’s as simple as the Henderson-Hasselbalch Calculation…
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Let’s UNcomplicate the complicated
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Acid-Base is about 2 things:
The patient’s pH &
what is causing it
![Page 6: Acid base lecture (1)](https://reader035.fdocuments.in/reader035/viewer/2022081421/5564841ed8b42a73418b47fc/html5/thumbnails/6.jpg)
WHY DOES A PATIENT’S
Acid-Base Status MATTER?
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IT SHOULD
AFFECT YOUR
PATIENT CARE!
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So let’s learn how to do what we do BETTER.
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What is pH?
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pH is the potential for Hydrogen
pH = Hydrogen = H+
So, when you think pH, think H+
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What is normal?
pHpH
pH
pH
pH
pH
pH
pH pH
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pH < 7.35 = Acidosis
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pH > 7.45 = Alkalosis
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So, pH < 7.35 = acidosis pH > 7.45 = alkalosis
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Now the money question:
What is causing the imbalance?
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CAUSES OF DISTURBANCE:
Metabolicor
Respiratory
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Four Categories of Disturbance
Metabolic Respiratory
MetabolicAcidosis
RespiratoryAlkalosis
MetabolicAlkalosis
RespiratoryAcidosis
MetabolicAlkalosis
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MetabolicThe most basic way to determine metabolic disturbance is
to look at a patient’s bicarb level.
Metabolic = HCO3-
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Metabolic
Normal HCO3
- = 22-26
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Metabolic
HCO3- is a base.
So, if a patient’s HCO3- is
low, what is their acid-base disturbance?
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Metabolic AcidosisThe patient’s body has a deficit of bicarbonate.
HCO3- < 22
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Causes of Metabolic Acidosis
• Ketones (Diabetic, Alcoholic, Starving)
• Uremia• Lactic Acidosis• Glycols• Salicylates• Rhabdomyolysis• Various Toxins
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Metabolic AlkalosisThe patient’s body has an excess of bicarbonate.
HCO3- > 26
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Causes of Metabolic Alkalosis
• Renal Failure• Excessive Vomiting• GI Suctioning• Overuse of Antacids (Calcium
Carbonate)• Diuretics, Laxative Abuse• Hypo-kalemia, calcemia, chloremia• Hyperaldosteronism
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RespiratoryThe most basic way to determine respiratory
disturbance is to look at a patient’s PaCO2.
Respiratory = PaCO2
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Respiratory
Normal PaCO2
= 35-45
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Respiratory
CO2 is an acid.
So, if a patient’s PaCO2 is
high, what is their acid-base disturbance?
![Page 32: Acid base lecture (1)](https://reader035.fdocuments.in/reader035/viewer/2022081421/5564841ed8b42a73418b47fc/html5/thumbnails/32.jpg)
Respiratory Acidosis
Respiratory acidosis is an excess of carbon dioxide.
PaCO2 > 45
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Causes of Respiratory Acidosis
Anything that causes decreased ventilation.- COPD, Asthma, CHF, Pneumonia, Aspiration, Flail Chest, Pneumothorax, Pleural Effusion, etc…
Anything that causes decreased respiratory rate.
- Narcotics, Sedatives, Brainstem Injury, Cardiac Arrest, etc.
Practically every Respiratory Disorder known in Medicine
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Respiratory AlkalosisRespiratory alkalosis is a deficit of carbon dioxide.
PaCO2 < 35
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Causes of Respiratory Alkalosis
Pulmonary Embolism
Alcohol Fever Head Trauma CVA’s Pneumonia
Hyperthyroidism Exercise Anxiety Overaggressive
Mechanical Ventilation
Anything that can cause increased minute volume.
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Four Categories of Disturbance
Metabolic Acidosis
Respiratory Acidosis
MetabolicAlkalosis
Respiratory Alkalosis
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To Sum it Up:
HCO3- = Metabolic Acidosis
HCO3- = Metabolic Alkalosis
PaCO2 = Respiratory Acidosis
PaCO2 = Respiratory Alkalosis
![Page 40: Acid base lecture (1)](https://reader035.fdocuments.in/reader035/viewer/2022081421/5564841ed8b42a73418b47fc/html5/thumbnails/40.jpg)
Simple Disturbance
Cases
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Simple Disorders: Case 1
65 y/o Female
Carbon Monoxide Poisoning
pH: 7.20 torrHCO3: 12 mEq/LPaCO2: 38 torr
What is her acid-base status?
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Simple Disorders: Case 2
32 y/o Male
Acute Asthma
pH: 7.08 torrHCO3: 26 mEq/LPaCO2: 60 torr
What is his acid-base status?
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Simple Disorders: Case 3
21 y/o Male
Suspected Pulmonary Embolism
pH: 7.48 torrHCO3: 22 mEq/LPaCO2: 20 torr
What is his acid-base status?
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Simple Disorders: Case 4
28 y/o Pregnant Female
Excessive Vomiting X4 days
pH: 7.58 torrHCO3: 32 mEq/LPaCO2: 35 torr
What is her acid-base status?
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well, that was easy.
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we aren’t quite there yet…
Well,
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Keep Going
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Let’s talk about exceptions.
Sometimes a pH is normal, but there is still a disturbance.
Sometimes there is more than one disorder at play.
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Mixed Acid-Base Disorders
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The Body STRIVES for a pH of about
7.40
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THROUGH 3 SYSTEMS:
Blood
Lungs Kidneys
1st
2nd 3rd
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Buffer System
• Activates in Seconds• Fastest & First Line of
Defense• The MOST important
buffer system is the bicarbonate-carbonic acid system.
• Hemoglobin and Oxyhemoglobin, Protein, and Phosphate Buffer Pairs
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TENACITY
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RespiratorySystem
• Activates in Minutes to Hours
• Second Defense to Activate
• H+ concentration stimulates breathing center
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Renal System• Activates in Days
• Works by conserving or excreting H+ and HCO3-
• Strongest mechanism for control.
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When the body uses these systems to attempt to maintain a pH that is NORMAL,
this is called
COMPENSATION
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Example:
Pt has Respiratory Acidosis
Buffer System increases HCO3- in Blood
Increase in pH
![Page 59: Acid base lecture (1)](https://reader035.fdocuments.in/reader035/viewer/2022081421/5564841ed8b42a73418b47fc/html5/thumbnails/59.jpg)
Example:
Pt has Metabolic Acidosis
Increases Respiratory Rate
Decreases CO2
Increase in pH
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Compensation
If changes in pH don’t normalize, the disturbance is called
Partially Compensated
If changes in pH normalize, it is called Fully Compensated
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Compensation:
pH normal = Fully Compensated
pH abnormal = Partially Compensated
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Compensated Disorder
Cases
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Compensated Disorders: Case 1
65 y/o Female
COPD Exacerbation
pH: 7.35 torrHCO3: 18 mEq/LPaCO2: 60 torr
What is her acid-base status?
![Page 64: Acid base lecture (1)](https://reader035.fdocuments.in/reader035/viewer/2022081421/5564841ed8b42a73418b47fc/html5/thumbnails/64.jpg)
Compensated Disorders: Case 2
18 y/o Female
Type I Diabetic Patient
pH: 7.30 torrHCO3: 18 mEq/LPaCO2: 24 torr
What is her acid-base status?
![Page 65: Acid base lecture (1)](https://reader035.fdocuments.in/reader035/viewer/2022081421/5564841ed8b42a73418b47fc/html5/thumbnails/65.jpg)
Compensated Disorders: Case 3
18 y/o Male
Traumatic Brain Injury
pH: 7.45 torrHCO3: 18 mEq/LPaCO2: 22 torr
What is his acid-base status?
![Page 66: Acid base lecture (1)](https://reader035.fdocuments.in/reader035/viewer/2022081421/5564841ed8b42a73418b47fc/html5/thumbnails/66.jpg)
Extra Bad Mixed
Disorders
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Extra Bad Mixed Disorders
Sometimes you have two independent disorders that drive the pH in the same direction.
This is extra BAD.
Example: COPD patient in Shock (Respiratory and Metabolic Acidosis)
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One Disorder
is BAD.
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Two Disorders are
Extra Bad!
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Summary
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Summary• Determine the pH
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Summary• Determine the pH• Determine the category of disorder
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Summary• Determine the pH• Determine the category of disorder• Is it a mixed disorder?
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Summary• Determine the pH• Determine the category of disorder• Is it a mixed disorder?• Is it fully or partially compensated?
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Treat the patient you have, not the one you wish you had.