Download MBBS Biochemistry PPT 32 Acid_Base Lecture Notes

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to the concentration of dissolved CO2.
Simple depiction of normal gap, anion gap acidosis,

and nonanion gap acidosis.
Increase in anion gap

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Methanol

Uremia

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Diabetic ketoacidosis

Paraldehyde

Iron, Isoniazid, Ibuprofen

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Lactic acidosis

Ethylene glycol

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Salicylates, starvation ketoacidosos

Decrease in Anion Gap

Laboratory error

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1.Increase in unmeasured cations

2.Lithium intoxication

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3.Increased immunoglobulin

4.Monoclonal gammopathies

5.Nephrotic syndrome

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6.Hyperlipidemia
Normal Anion Gap

GI fluid loss

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Severe diarrhoea Hypokalemia

Pancreatitis K+ variable

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Renal tubular acidosis

Proximal (type II) RTA Urine pH <5.5 , K+ normal or low

Distal (typeI) RTA Urine pH >5.5 with hypokalemia

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Type IV RTA Urine pH < 5.5 with hyperkalemia

An alcoholic has been vomiting :

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pH= 7.55, Hco3- =40 mmol/L, Na+= 135, k+= 2.8, Cl-= 80

AG= 135- (40+80) = 15

Superimposed alcoholic ketoacidosis

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Beta hydroxy butyrate conc= 15 mM pH= 7.4, Hco3-= 25 mmol/L

AG= 135- (25+80)= 30

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Mixed Acidosis and Alkalosis
Alcohol

Serum Anion Serum

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Urine

osmol Gap

acetone oxalate

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gap

Ethanol

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+

----

-----

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-----

Methanol

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+

+

-----

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-----

Isopropanol +

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---

+

----

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Ethylene

+

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+

-----

+

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glycol

PREDICTlON OF COMPENSATORY RESPONSES ON SIMPLE ACI DBA5E

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DISTURBANCES AND PATTERN OF CHANGES

Disorder

Prediction of compensation

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pH

HCO3-

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PaCO2

Metabolic

Paco2 will 1.25 mm H g per Low

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Low

Low

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acidosis

mmol/l in [HC03-]

Metabolic

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Paco2 will 6 mmHg per 10 High

High

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High

alkalosis

mmol/l

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in [HC03-]

Respiratory

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[HCO3--] will 0.2

High

Low

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Low

alkalosis

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mmo1/L (Acute) and 0.4

mmol/l (chr) per mmH g in

PaCO2

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Respiratory

[HCO3--]will 0.1-0.4

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Low

High

High

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acidosis

mmo1/L per mm Hg in

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PaCO2
Conditions leading to Metabolic Alkalosis

Chloride responsive (Urine Cl- < 10 mmol/L)

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Contraction alkalosis (Hypovolemia)



Prolonged vomiting

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Upper duodenal obstruction

Dehydration

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Chloride resistant (Urine Cl- > 10 mmol/L)

Mineralocorticoid Excess

Primary hyperaldosteronism

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Bilateral adrenal hyperplasia

Secondary hyperaldosteronism

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Glucocorticoid excess

Primary adrenal adenoma

Pituitary adenoma secreting ACTH

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Exogenous cortisol therapy

Bartter syndrome (defective renal Cl- absorption )

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Exogenous base

Bicarbonate containing iv fluid therapy

Massive blood transfusion ( Sodium citrate overload)

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Milk Alkali syndrome

Conditions leading to Respiratory Acidosis

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Factors that directly depress the respiratory centre

Drugs such as narcotics

CNS trauma, tumor

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Infections of the CNS

Comatose states

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Conditions that affect the Respiratory apparatus

COPD (most common)

Severe pulmonary fibrosis

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Disease of the upper airway e,g laryngospasm, tumor

Impair lung motion due to pleural effusion

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ARDS



Others Abdominal distension as in peritonotitis and ascites

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Extreme obesity

Sleep disorder, sleep apnea
Factors causing respiratory Alkalosis

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Nonpulmonary stimulation of respiratory center

Anxiety, hysteria

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Febrile state

Metabolic encephalopathy

CNS infection

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Cerebrovascular accident

Hypoxia

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Drugs and agents such salicylates, cathecholamines

Pulmonary disorder

Pnemonia

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pulmonary emboli

Interstitial lung diasease

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CHF

Respiratory compensation after correction of metabolic acidosis

Others Ventilation induced hyperventilation

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