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pCO2 35 - 45 30- 50
(On ventilator) 60 - 90
HCO3 24 - 28
Definition of terms
maintained
between 35 to 40 nmols
pH of ECF = 7.38
H+ Balance maintained
Mainly by
Excretion of H+ in urine
If PCo2 is expressed in
KPa s = 0.23
mmHg s = 0.03
Hydrogen Homeostasis
H+ concentration in body maintained tightly by
following mechanisms
mechanism of body
Plasma proteins
hemoglobin
Respiratory
Metabolic
Respiratory
Metabolic Acidosis
before &
after compensation
Normal anion gap acidosis
Occurs in
Addison’s disease
Diarrhea
Uretero sigmoidostomy
Hyperkalemic acidosis
Common finding in metabolic acidosis
Hypokalemic acidosis seen in
Renal tubular acidosis
Carbonic anhydrase inhibitor therapy
Hyperchloremic acidosis
Uretero sigmoidostomy
Biochemical finding in metabolic acidosis
compensated)
or normal (fully compensated
Treatment:
Volume correction
K+ correction
Treatment of cause
Respiratory Alkalosis
normal
Causes
Hysterical over breathing
Raised intracranial pressure
Hypoxia
Excessive artificial ventilation
Hyperthyroidism
Pregnancy
Fever
Compensatory change is a fall in plasma
HCO3
Acisosis
Depressed senosrium
Depressed myocardial squeeze
Hypercapnia
Headaches
Papilloedema
Asterixis
Alkalemia
Seizures
Ventricular arrhythmias
Muscle weakness
Tetany
Hypocapnia
ST elevation
Coronary spasm
Laboratory markers of acid base disorders
Serum Potassium
Hyperkalemia distal RTA
Metabolic alkalosis, RTA
Metabolic acidosis
Respiratory acidosis
Metabolic alkalosis
Respiratory alkalosis
APPROACH TO EVALUATION OF ACID BASE PROBLEM
pH 7.5
paCO2 25
HCO3 20
ABG Status ?
APPROACH TO EVALUATION OF ACID BASE PROBLEM
pH 7.3
paCO2 80
HCO3 40
ABG status ?
3) 30yrs Old lady admittedto ICU with post op fever
pH 7.10
paCO2 30
HCO3 9
Diagnosis?
4) Chronic CCF on diuretics worsening dyspnoea
pH 7.5
paCO2 45
HCO3 36
Diagnosis ?
5) 20 yrs old man profuse diarrhoea
pH 7.15
paCO2 12
HCO3 12
ABG ?
40yrs old vomiting following ingestion of unknown poison
pH 7.4
paCO2 20
HCO3 12
Diagnosis ?
CASE-1
36\F Underwent laprotomy
3rd pod pt develops breathlessness, oliguria
WBC count and blood urea nitrogen
Chest x ray – clear
Urine analysis – plenty of pus cells
Wound clear.
Diagnosis …… ??
Treatment ….. ??
6) 40yrs old vomiting following ingestion of unknown
poison
pH 7.4
paCO2 20
HCO3 12
Diagnosis ?
CASE-4
Altered sensorium
Urine – ketones +
Treatment …… ??
CASE-5
50/f hypertensive with pedal edema
Facial puffiness, oliguria, breathlessness
Altered sensorium
Blood urea nitrogen - raised
K+ ……..??
Hco3 ….. ??
Treatment …… ??
B1) Mr. A 53yrs old presented to casualty with the
following ABG
Treatment:
Supplemental O2 and diuretics
3 days later, ABG
b) pH 7.35, paCO2 60, HCO3 41, paCO2 70 (on 24% O2)
B2) Mr. B 65yrs old
Diagnosis ?
B3) Ms. C 18yrs old
Diagnosis ?
B4) Mr. D 72yrs odl COPD / CCF
Sys BP 70mmHg
initial ABG (on 40% O2)
a) pH - 7.1, paCO2 - 70, HCO3 - 21, paCO2 35
intubated & ventilated
subsequent ABG’s (on 40% O2)