Download MBBS Biochemistry PPT 32 Acid_Base Lecture Notes

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