ACID BASEACID BASE

K depletion is most often due to urinary K depletion is most often due to urinary or G I losses or G I losses

What test would you do to differentiate What test would you do to differentiate between these tow disordersbetween these tow disorders

Urinary K excretion will be less than 25 Urinary K excretion will be less than 25 meq/day in extrarenal lossesmeq/day in extrarenal losses

ACID BASEACID BASE Untreated patients with CHF or cirrhosis Untreated patients with CHF or cirrhosis

are generally normokalemic in spite of are generally normokalemic in spite of secondary hyperaldosteronism secondary hyperaldosteronism

Why is thatWhy is that

ACID BASEACID BASE

A patient with cirrhosis and ascites is A patient with cirrhosis and ascites is admitted to the hospital with acute G I admitted to the hospital with acute G I bleed . A portocaval shunt was done . He bleed . A portocaval shunt was done . He received 19 units of blood . Ascites was received 19 units of blood . Ascites was drained but reaccumulated .drained but reaccumulated .

pH 7.53 PCO2 50 HCO3 40pH 7.53 PCO2 50 HCO3 40

ACID BASEACID BASE

What is responsible for the metabolic What is responsible for the metabolic alkalosis alkalosis

What would expect the urine pH and N+ What would expect the urine pH and N+ to be to be

How would you correct the alkalosisHow would you correct the alkalosis

ACID BASEACID BASE

A 45 year old lady with peptic ulcer A 45 year old lady with peptic ulcer disease report 6 days of persistent disease report 6 days of persistent vomiting BP 100/60 and low JVP vomiting BP 100/60 and low JVP

Na+ 140 K+ 2.2 HCO3 42 pH 7.53 Na+ 140 K+ 2.2 HCO3 42 pH 7.53 PCO2 53 Cr 1.9 mg/dl PCO2 53 Cr 1.9 mg/dl Urine pH 5.0 Na+ 2 K+ 21 Cl- 3Urine pH 5.0 Na+ 2 K+ 21 Cl- 3 How would you treat this patientHow would you treat this patient

ACID BASEACID BASE

Twenty four hours after appropriate Twenty four hours after appropriate therapy HCO3 30therapy HCO3 30

Urine Na+ 100 K+ 20 Cl- 3Urine Na+ 100 K+ 20 Cl- 3 How would you account for the How would you account for the

discrepancy between high urine Na+ and discrepancy between high urine Na+ and low chloridelow chloride

A 22 year old woman complain of fatigue A 22 year old woman complain of fatigue and weakness for one year . Physical and weakness for one year . Physical exam was normal including normal BPexam was normal including normal BP

Na+ 141 K+ 2.1 HCO3 45Na+ 141 K+ 2.1 HCO3 45 Urine Na+80 K+ 170/dayUrine Na+80 K+ 170/day What is the differential diagnosis What is the differential diagnosis What would you order nextWhat would you order next

The following lab tests are The following lab tests are for tow patients would you for tow patients would you give Na HCO3 to either one give Na HCO3 to either one

Na 140Na 140 K 4.2K 4.2 Cl 114Cl 114 HCO 3 16HCO 3 16

Na 140Na 140 K 4.7K 4.7 Cl 122Cl 122 HCO3 7HCO3 7 pH 7.32pH 7.32 PCO2 14PCO2 14

ACID BASEACID BASE

A 31 year old man with epilepsy. Lab tests A 31 year old man with epilepsy. Lab tests immediately post seizure showed immediately post seizure showed

pH 7.14pH 7.14 PCO2 45PCO2 45 Na 140Na 140 K 4.0K 4.0 Cl 98Cl 98 HCO3 17HCO3 17 What is the acid base diturbanceWhat is the acid base diturbance

ACID BASEACID BASE

A 58 year old man with COPD develop sever A 58 year old man with COPD develop sever diarrhea lab resultsdiarrhea lab results

Na 138Na 138 K 3.8K 3.8 Cl 115Cl 115 HCO3 9HCO3 9 pH 6.9pH 6.9 PCO2 40PCO2 40 What is the acid bse diturbaneWhat is the acid bse diturbane

ACID BASEACID BASE

After NaHCO3 administration the patient After NaHCO3 administration the patient is still acidotic why ?is still acidotic why ?

ACID BASEACID BASE

pH PCO2 HCO3pH PCO2 HCO3a 7.37 65 37a 7.37 65 37b 7.22 60 26b 7.22 60 26c 7.35 60 32c 7.35 60 32

1 a markedly obese 24 year old man1 a markedly obese 24 year old man2 A 14 year old girl with acute asthma2 A 14 year old girl with acute asthma3 A 65 year old woman with chronic bronchitis on 3 A 65 year old woman with chronic bronchitis on

diureticsdiuretics

ACID BASEACID BASE

A 54 year old man with COPD has tow A 54 year old man with COPD has tow days history of sever dyspnea . CXR days history of sever dyspnea . CXR showed left lower lobe pneumonia showed left lower lobe pneumonia

pH 7.25pH 7.25 HCO3 30HCO3 30 PCO2 70PCO2 70 PO2 30PO2 30 Urine Na 4Urine Na 4

ACID BASEACID BASE

He was given oxygen He was given oxygen and intravenous and intravenous aminophylin and aminophylin and became became unresponsiveunresponsive

pH 7.18pH 7.18 PCO2 86PCO2 86 HCO3 31HCO3 31 PO2 62PO2 62

What s the acid base What s the acid base disturbancedisturbance

What is responsible What is responsible for the increase CO2 for the increase CO2 in the hospitalin the hospital

If the CO2 is rapidly If the CO2 is rapidly lowered to 40 what lowered to 40 what will happen to the pHwill happen to the pH

ACID BASEACID BASE

A 65 year old man has a history of smoking A 65 year old man has a history of smoking and hypertension which is treated with diuretic and hypertension which is treated with diuretic

pH 7.48pH 7.48 PCO2 51PCO2 51 HCO3 36HCO3 36 PO2 73PO2 73 What is the acid base disturbanceWhat is the acid base disturbance Does the patient has significant lung diseaseDoes the patient has significant lung disease