ACID BASE

DISORDERS
Bhargavi R Budihal
BGS GIMS
 WHAT IS AN ABG?
The Components
pH / PaCO2 / PaO2 / HCO3 / O2sat / BE
Desired Ranges
pH - 7.35 - 7.45 (7.40)

PaCO2 – 36-44mmHg (40)

PaO2 – 10.5 – 13.5 kPa
HCO3 - 21-27 (24) mEq/L
O2sat - 95-100%
Base Excess - +/-2 mEq/L
 ACID BASE BALANCE

The lungs and kidneys Buffering also occurs

attempt to maintain in the liver through
balance ammonia metabolism
to urea / glutamate
 ACID BASE BALANCE

Assessment of status via bicarbonate-carbon dioxide

buffer system
Henderson-Hasselbalch equation
-

pH= pK + log ([HCO3 ] / [H2CO3 ])

CO2 + H2O <--> H2CO3 <--> HCO3 + H-

ph = 6.10 + log ([HCO3] / [0.03 x PCO2])
THE TERMS

ACIDS BASES
Acidemi
Alkalemia
a
Acidosis Alkalosis
Respirat Respiratory
ory ↓CO2
•
↑CO2
Metabolic
↑ HCO3
Metaboli •
c
↓HCO3
 RESPIRATORY ACIDOSIS
RESPIRATORY ACIDOSIS

Decreased pH, I↑CO2, Decreased Ventilation

Causes
CNS depression
Pleural disease
COPD/ARDS
Musculoskeletal disorders
Compensation for metabolic alkalosis
 RESPIRATORY ACIDOSIS
RESPIRATORY ACIDOSIS

Acute vs Chronic
Acute - little kidney involvement.
Buffering via lungs ~ Hyperventilating
For every 10 mmg Hg increase in PCO2 ~ HCO3 decreases by 1 unit
Chronic - Renal compensation via synthesis and retention of HCO 3
For every 10 mmg Hg increase in PCO2 ~ HCO3 decreases by 3.5 units
RESPIRATORY
ALKALOSIS
Increased pH, Decreased CO2, Decreased Ventilation
Causes CHAMPS
C – CNS Disease e.g. Intracerebral
hemorrhage/ Cirrhosis
H – Hypoxia
A – Anxiety
M – Over ventilation
P – Progesterone
S – Salicylate/Sepsis
 RESPIRATORY ALKALOSIS

Acute vs. Chronic

Acute - For every 10mmg↓HCO3 ~ 2↓ in PCO2

Chronic - For every 10mmg↓HCO3 ~ 5 ↓ in PCO2

Decreased renal bicarb reabsorption and decreased
ammonium excretion to normalize pH
 METABOLIC ACIDOSIS
Decreased pH, Decreased HCO3
12-24 hours for complete activation of respiratory compensation  decreased
pCo2
The degree of compensation is assessed via the Winter’s Formula
PCO2 = {1.5(HCO3) +8 +/- 2 }
METABOLIC ALKALOSIS

Increased pH, Increased HCO3, Increased pCo2

Expected PCO2 = {0.9 x HCO3 + 16}
Causes – CLEVER PD
C- Contraction
L - Liquorice
E - Endocrine: Conn’s / Cushing’s / Bartter’s
V - Vomiting / NG Suction
E - Excess Alkali
R - Refeeding Alkalosis
P - Post Hyper-capnoea
D - Diuretics and Chronic diarrhoea
ANION GAP

Cation Na+ Unmeasured cation

Anion Cl + HCO3 + Unmeasured anion
AG =Unmeasured anion - Unmeasured cation
AG= [ Na] - [ Cl + HCO3 ]
Normal value = 8-12 (10)
 THE CAUSES
Metabolic Gap
Acidosis Non Gap Metabolic
M - Methanol
Acidosis
U - Uremia
D – DKA - AKA H - Hyperalimentation
P - Paraldehyde A – Acetazolamide
I – Isoniazid / Iron
L - Lactic Acidosis R – RTA
E - Ethylene Glycol D – Diarrhoea
R- Rhabdomyolysis
S - Salicylate U - Uretero-pelvic shunt
P - Pancreatic Fistula
S – Spironolactone
 BASE DEFICIT

BASS DEFICIT = -2 to +2
MIXED ACID-BASE
DISORDERS
Patients may have two or more acid-base disorders at one time
Corrected Bicarbonate = AG – 12 + Serum HCO3-
If > 30 then there is also underlying metabolic alkalosis
If < 23 then there is an underlying non-AG metabolic acidocis
 THE STEPS

Start with the pH – acidaemia or alkalaemia Note the PCO 2

Look at HCO3
Look for disorders revealed by failure of compensation Calculate anion gap
Calculate Corrected Bicarbonate
PROCEDURE
CONTRAINDICATIONS
Overlying infection or burn at the insertion site
Absent collateral circulation
AV fistula
Severe peripheral vascular disease
SITES
ALLEN’S TEST
EXAMPLE
Respiratory alkalosis with
metabolic compensation
EXAMPLE
Respiratory acidosis with
metabolic compensation
EXAMPLE
Respiratory alkalosis with
metabolic compensation
MCQ
MCQ
MCQ
Thank you