Professional Documents
Culture Documents
Acid Base Discorders MIU BCPS 2015
Acid Base Discorders MIU BCPS 2015
What is acid?
What is base
What is pH?
pH = - log [H+]
Range is from 0 14
A change of 1 pH unit corresponds to a 10-fold
change in hydrogen ion concentration
Blood is:
A. Acidic
B. Basic
Acid excretion:
Lung (CO2)
Kidney (non volatile acids, as ammonium and phosphate)
10
Compensation:
pH is returned toward normal by altering the
component NOT primarily affected
Correction:
pH is returned toward normal by altering the
component PRIMARILY affected
11
12
PCO2 is pressure of
CO2 gas in the blood
13
14
15
16
17
18
19
Arterial
Mixed Venous
pH
7.4 (7.35-7.45)
7.38 (7.33-7.43)
PO2
80-100 mmHg
35-40 mmHg
SaO2
95%
70 75%
PCO2
35-45 mmHg
45-51 mmHg
HCO3
22-26 mEq/L
24-28 mEq/L
20
Primary
Disorder
Primary
problem
Effect
on pH
Compensatory
mechanism
Respiratory
acidosis
PCO2
HCO3
Respiratory
alkalosis
PCO2
HCO3
Metabolic
acidosis
HCO3
PCO2
Metabolic
alkalosis
HCO3
PCO2
21
Disorder
Rate of Compensation
Metabolic acidosis
Metabolic alkalosis
Respiratory Acidosis
(acute)
Respiratory Acidosis
(chronic)
Respiratory
Alkalosis (acute)
Respiratory
Alkalosis (chronic)
22
23
Normal value:
24
Lactic acid
Ketoacids
Phosphoric acid
Sulfuric acid
25
26
27
28
CO2
29
Causes
Neuromuscular disorders
Myopathies, neuropathies
Ventilator dysfunction
30
Chronic
SOB and fatigue with or without right-sided heart
failure (cor pulmonale)
31
Acute
Increased PCO2, moderately elevated HCO3 (25-30
mEq/L) and a dramatic decrease in pH
Also see decreased PO2 on room air
32
Chronic
Moderately decreased arterial pH (7.25-7.4),
elevated HCO3 and PCO2
In a patient with chronic bronchitis:
PCO2 50-60, PO2 45-60
33
Acute
Goal of therapy: normalize arterial blood pH within
8-24 hours
Administer oxygen; intubate and mechanically
ventilate if needed
34
Chronic
Goal of therapy: make patient comfortable and able
to continue with daily activities
Supportive care
Lung transplantation
35
36
ABG interpretation:
Step 1: assess pH
pH 7.25 (acidemia)
37
Assessment:
Acute respiratory acidosis secondary to narcotic
overdose resulting in hypoventilation
Initial management
Oxygen therapy
Naloxone
Intubate and mechanically ventilate, if necessary
38
39
Step 1: assess pH
pH 7.2 (acidemia)
40
Assessment:
Chronic respiratory acidosis secondary to severe
COPD
Initial management
Oxygen therapy
Optimize COPD medications
Lung transplant
41
42
43
CO2
44
Causes:
Anxiety
Hypoxia
Central nervous system disease
Drug-induced: Salicylates, catecholamines,
progesterone
Pregnancy
Sepsis
Mechanical ventilation
45
46
Acute:
pH > 7.45, PCO2 < 35 and a small compensatory
decrease in HCO3
For each 10 mm Hg decrease in PCO2, HCO3
decreases1-3 mEq/L
47
Chronic:
Normal-high pH with hypocapnea, mild
hypokalemia, hyperchloremia and metabolic
acidosis
Compensatory decrease in HCO3
48
No specific treatment
Treat cause or underlying condition
Stop hyperventilation, manage pain/anxiety
49
50
Step 1: assess pH
pH 7.5 (alkalemia)
51
Assessment:
Acute respiratory alkalosis secondary to
hyperventilation related to pre-procedure anxiety
Initial management
Calm and reassure the patient
Encourage slow, deep breathing
Have patient breathe into a paper bag or place an
oxygen mask with a CO2 reservoir on the patient
52
53
54
55
56
Renal failure
Ketoacidosis
Diabetic, alcoholic
Lactic acidosis
Rhabdomyolysis
Toxins
Methanol, ethylene glycol, paraldehyde, salicylates
57
GI bicarbonate loss
Hyperalimentation (TPN)
Diarrhea
Ureteral diversion
Small bowel, biliary, pancreatic or fistula drainage
58
Atrial tachycardia
Ventricular fibrillation
Arterial vasodilation and hypotension
Hyperkalemia
CNS depression
59
Increased AG is diagnostic
60
61
NaHCO3
Mainstay of therapy
Initial doses range from 100-150 mEq
Monitor ABG 30 minutes after each dose
Bolus then continuous NaHCO3 infusion
150 mEq NaHCO3 in 1 L D5W
62
NaHCO3
HCO3 deficit:
ADRs
THAM
63
64
Step 1: assess pH
pH 7.2 (acidemia)
Initial management
Treat DKA
Insulin, volume resuscitation, correct electrolyte
abnormalities (e.g., hypokalemia)
65
66
67
68
69
Severe:
Compromised cerebral and myocardial perfusion
Neurologic abnormalities
Headache, tetany, seizures, lethargy, delirium, stupor
Hypoventilation
SVT and ventricular arrhythmias
Hypokalemia (muscle weakness)
70
Diagnosis
Characterized by elevated arterial blood HCO3
and pH and hypokalemia
Compensatory increase in PCO2
For each 1 mEq/L increase in HCO3, PCO2 increases
0.5-2 mm Hg
71
72
73
74
75
Step 1: assess pH
pH 7.5 (alkalemia)
76
77
Diagnosis
Treatment
78
2.
3.
79
4.
4.
5.
80
81
82
83
84
85
Assessment:
Anion gap metabolic acidosis (from DKA?) + metabolic
alkalosis (vomiting?)
Initial management:
Treat DKA and volume resuscitate
86
87
88
89
Assessment:
Anion gap metabolic acidosis + respiratory acidosis +
non anion gap metabolic acidosis
Initial management:
Protect air (intubate) and determine underlying cause
of metabolic acidosis and treat accordingly
90
91
92
93
Assessment:
Respiratory alkalosis + metabolic acidosis
Initial management:
Treat salicylate toxicity
94
95