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1. Acid Base ImbalanceBy: Dr. Ismah Haron

References: Oxford Handbook of Clinical Medicine & Wiki

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Interpretation

pH

<7.35:Acidosis

<PCO2: Metabolic

>PCO2: Respiratory

>7.45:Alkalosis

>HCO3-:

Metabolic

<HCO3-:

Respiratory 2

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Anion gap• To know the cause of acid base imbalance

• Anion gap = (Na+ + K+) – (Cl- + HCO3-)

• Normal level: 10 – 18 mmol/L

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Metabolic acidosis• Large anion gap (MUDPILES)- M-Methanol- U-Uremia; chronic renal failure- D-Diabetic ketoacidosis- P-Propylene glycol- I-Infection, Isoniazid, Inborn errors of metabolism- L-Lactic acidosis- E-Ethanol- S-Salicylates

• Normal anion gap- RTA, diarrhea/vomiting, Addison’s disease, pancreatic fistula,

acetazolamide

• Small anion gap- Hypoalbuminemia e.g. in CLD, nephrotic syndrome

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Metabolic alkalosis• Vomiting• Hypokalemia• Burns

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Respiratory acidosis• Type II respi failure - lung/neuromuscular cause

- E.g. in COPD, GBS, flail chest, pul fibrosis

- Exhaustion in asthma, pneumonia, pul edema respi arrest

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Respiratory alkalosis• HYPERVENTILATION

- Stroke, anxiety, pregnancy, subarachnoid bleed

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Compensated acid base imbalance

1. Evaluate pH—is it normal? Yes

2. Next evaluate pCO2 & HCO3

• pH normal + increased pCO2 + increased HCO3 = compensated respiratory acidosis

• pH normal + decreased HCO3 + decreased pCO2 = compensated metabolic acidosis

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2. Oxygen delivery methodDevice Oxygen flow rate Oxygen percentage

Nasal prong 1 – 4 L/min 24 – 35%

Simple face mask 5 – 10 L/min 40 – 60%

High flow mask 10 – 15 L/min Almost 100%

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3. Diabetes Mellitus Type 2Source: QR Management of Type 2 Diabetes Mellitus. Ministry of Health, Malaysia. 2009.

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HOW TO DIAGNOSE?

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THANK YOU 17