Download MBBS (Bachelor of Medicine, Bachelor of Surgery) 1st year (First Year) Biochemistry ppt lectures Topic 32 Acid_Base Notes. - biochemistry notes pdf, biochemistry mbbs 1st year notes pdf, biochemistry mbbs notes pdf, biochemistry lecture notes, paramedical biochemistry notes, medical biochemistry pdf, biochemistry lecture notes 2022 ppt, biochemistry pdf.
Relationship of pH to hydrogen ion concentration
Scheme demonstrating the relation between pH and the ratio of bicarbonate concentration
to the concentration of dissolved CO2.
Simple depiction of normal gap, anion gap acidosis,
and nonanion gap acidosis.
Increase in anion gap
Methanol
Uremia
Diabetic ketoacidosis
Paraldehyde
Iron, Isoniazid, Ibuprofen
Lactic acidosis
Ethylene glycol
Salicylates, starvation ketoacidosos
Decrease in Anion Gap
Laboratory error
1.Increase in unmeasured cations
2.Lithium intoxication
3.Increased immunoglobulin
4.Monoclonal gammopathies
5.Nephrotic syndrome
6.Hyperlipidemia
Normal Anion Gap
GI fluid loss
Severe diarrhoea Hypokalemia
Pancreatitis K+ variable
Renal tubular acidosis
Proximal (type II) RTA Urine pH <5.5 , K+ normal or low
Distal (typeI) RTA Urine pH >5.5 with hypokalemia
Type IV RTA Urine pH < 5.5 with hyperkalemia
An alcoholic has been vomiting :
pH= 7.55, Hco3- =40 mmol/L, Na+= 135, k+= 2.8, Cl-= 80
AG= 135- (40+80) = 15
Superimposed alcoholic ketoacidosis
Beta hydroxy butyrate conc= 15 mM pH= 7.4, Hco3-= 25 mmol/L
AG= 135- (25+80)= 30
Mixed Acidosis and Alkalosis
Alcohol
Serum Anion Serum
Urine
osmol Gap
acetone oxalate
gap
Ethanol
+
----
-----
-----
Methanol
+
+
-----
-----
Isopropanol +
---
+
----
Ethylene
+
+
-----
+
glycol
PREDICTlON OF COMPENSATORY RESPONSES ON SIMPLE ACI DBA5E
DISTURBANCES AND PATTERN OF CHANGES
Disorder
Prediction of compensation
pH
HCO3-
PaCO2
Metabolic
Paco2 will 1.25 mm H g per Low
Low
Low
acidosis
mmol/l in [HC03-]
Metabolic
Paco2 will 6 mmHg per 10 High
High
High
alkalosis
mmol/l
in [HC03-]
Respiratory
[HCO3--] will 0.2
High
Low
Low
alkalosis
mmo1/L (Acute) and 0.4
mmol/l (chr) per mmH g in
PaCO2
Respiratory
[HCO3--]will 0.1-0.4
Low
High
High
acidosis
mmo1/L per mm Hg in
PaCO2
Conditions leading to Metabolic Alkalosis
Chloride responsive (Urine Cl- < 10 mmol/L)
Contraction alkalosis (Hypovolemia)
Prolonged vomiting
Upper duodenal obstruction
Dehydration
Chloride resistant (Urine Cl- > 10 mmol/L)
Mineralocorticoid Excess
Primary hyperaldosteronism
Bilateral adrenal hyperplasia
Secondary hyperaldosteronism
Glucocorticoid excess
Primary adrenal adenoma
Pituitary adenoma secreting ACTH
Exogenous cortisol therapy
Bartter syndrome (defective renal Cl- absorption )
Exogenous base
Bicarbonate containing iv fluid therapy
Massive blood transfusion ( Sodium citrate overload)
Milk Alkali syndrome
Conditions leading to Respiratory Acidosis
Factors that directly depress the respiratory centre
Drugs such as narcotics
CNS trauma, tumor
Infections of the CNS
Comatose states
Conditions that affect the Respiratory apparatus
COPD (most common)
Severe pulmonary fibrosis
Disease of the upper airway e,g laryngospasm, tumor
Impair lung motion due to pleural effusion
ARDS
Others Abdominal distension as in peritonotitis and ascites
Extreme obesity
Sleep disorder, sleep apnea
Factors causing respiratory Alkalosis
Nonpulmonary stimulation of respiratory center
Anxiety, hysteria
Febrile state
Metabolic encephalopathy
CNS infection
Cerebrovascular accident
Hypoxia
Drugs and agents such salicylates, cathecholamines
Pulmonary disorder
Pnemonia
pulmonary emboli
Interstitial lung diasease
CHF
Respiratory compensation after correction of metabolic acidosis
Others Ventilation induced hyperventilation
This post was last modified on 05 April 2022