metabolic acidosis and alkalosis -

الرحيم الرحمن الله بسم

Ahmad A. Al-Qudah

Supervision: Dr. Saleem Bani Hani

Metabolic Acidosis & Alkalosis

Metabolic Acidosis & Alkalosis

• Terms And Definitions

• Acid – Base Balance ( Regulation )

• Acid – Base Disorders ( Acidosis & Alkalosis )

• Metabolic Acidosis • Metabolic Alkalosis • Measurements

• References

Terms And Definitions

• Acid : substance that can yield Hydrogen ion Strong Acid pH < 3.0

• Base : substance that can yield Hydroxyl ion Strong Base pH > 9.0

• pH : terms that we use to describe the level of Acidity and Basicity of Aq. Solution .

Acid – Base Balance

• Maintenance of Hydrogen ion concentration in the ECF ( Extracellular Fluid ) within the Normal Range .

- Normal Range : 36 – 44 nmol/L - pH : 7.35 – 7.45 ( Slightly Alkaline )

ACID BASE

Acid – Base Balance ( Regulation )How the Body maintain the Hydrogen ion concentration

• Lung

• Buffer System ( Carbonic Acid , Bicarbonate )

- Henderson Equation

Acid – Base Balance ( Regulation )How the Body maintain the Hydrogen ion concentration

• Kidney - Regulate by excreting Acid (Hydrogen ion) and reclaiming Bicarbonate .

- Reclaiming Bicarbonate from glomerular filtrate .- Hydrogen ion combined with ammonia and excreting as Ammonium .

Acid – Base Disorders ( Acidosis & Alkalosis )

• Acidosis : Increase in Acids [ Hydrogen ion ] --> Decrease in pH

• Alkalosis : Decrease in Acids [ Hydrogen ion ] -- > Increase in pH

ACID BASE

BASEACID

Metabolic Acidosis

• is a metabolic condition that occurs when the body produces too much acid or when the kidneys are not removing enough acid from the body .

Because of the decrease in Bicarbonate level .

Shift to Right Bicarbonate

Hydrogen ion

Metabolic AcidosisAnion Gap

• Is the difference between plasma cations and anions .• Help in diagnosis of Metabolic Acidosis . ( 10 – 18 mmol / L )

- Causes of Metabolic Acidosis with increased AG :

- Lactic Acid ( Hypoxia )

- Urate ( Renal Failure )- Drugs / Toxins

- Ketones ( DM , Alcohol )




-Athletes , a lot of exercise , muscles Lactic Acid builds up … mild , should rest.




• Is the difference between plasma cations and anions .• Help in diagnosis of Metabolic Acidosis . ( 10 – 18 mmol / L )

- Causes of Metabolic Acidosis with increased AG :

- IDDM , Fatty acids break down , A CoA , Ketone bodies .

Metabolic Acidosis

- Causes of Metabolic Acidosis with Normal AG : - Acids ingestion - Drugs - Renal tubular Acidosis - Diarrhea

- Body start compensate to Metabolic Acidosis through Hyperventilation .

- Secondary Compensation , Kidney begins to correct the ratio by reclaiming Bicarbonate .

Metabolic Alkalosis

• is a metabolic condition in which the pH is elevated beyond the normal range as a result of increased bicarbonate concentration, leading to decreased hydrogen ion concentration.

Shift to Left Bicarbonate

Hydrogen ion

Metabolic Alkalosis

• Causes of Metabolic Alkalosis : - Vomiting ( loss of Acids ) - Diuretics - Ingestion of Base - Massive Blood Transfusion ( Citrate )

- Body start compensate to Metabolic Alkalosis through Hypoventilation .

Measurements

• The Calculation of Bicarbonate concentration is based on the Henderson Equation , when pH and pCO2 are known .

• Blood Gas Analyzer use electrodes ( electrochemical sensors) .

Known

Known

KAUH• ABG Analyzer : Cobas b 221 .• ABG + Electrolytes . • Capillary , Syringe • Whole Blood , Serum , Plasma •Normal Ranges :

- pCO2 : 35 – 45 mmHg

- pH : 7.35 – 7.45

- Bicarbonate : 22 – 26 mmol/L

References

• Clinical Chemistry Techniques , Principles , Correlations 6th Edition .

• Color Atlas of Biochemistry Second edition.

• http://wiki.answers.com

• http://www.clevelandclinicmeded.com/medicalpubs/micu/metabolicacidosis.htm

• Lecture Notes in clinical chemistry-1 . ( Dr. Saleem Bani Hani )

Remember!

Behind every successful Doctor … there is a devoted M5BRJI Behind every successful Doctor

There is a devoted M5BRJI

Be U..… Be M5BRJI

metabolic acidosis and alkalosis -

Health & Medicine