this lecture was conducted during the nephrology unit grand ground by a sub- intern under nephrology...
TRANSCRIPT
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This lecture was conducted during the Nephrology Unit Grand Ground by a
Sub-intern under Nephrology Division, Department of Medicine in King Saud
University. Nephrology Division is NOT responsible for the content of the presentation for
it is intended for learning and /or education purpose only.
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HOW TO APPROACH PATIENTS WITH ACIDOSIS
Hadeel Salah Al Jamei
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• Definitions• Brief Physiology• Etiology• Presentation Of The Patient• How To Approach The Patient• Investigations
• Treatment
OUTLINE
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• Acid, Acidosis, Acidemia?• pH?
• Base, Alkalosis, Alkalemia?• pH?
DEFINITIONS
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• Buffer Systems (Buffer + H+ HBuffer)• Bicarbonate exatracellular
• CO2 + H2O H2CO3
• H2CO3 H+ + HCO3-
• Phospahte exatracellular
• Protiens intracellualr
• Respiratory Systems• Hypoventilation vs. hyperventilation
• Renal System
MEANS OF REGULATING H+
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CAUSES OF ACIDOSIS
Causes Of Acidosis
Respiratory
Acute
Chronic
Metabolic
Normal Anion Gap
Increased Anion Gap
What is the anion gap?How to calculate it? [Na+] – [HCO3
-] – [Cl-]
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SIGNS AND SYMPTOMS
Hx is V.IMP
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Renal compensation
Respiratory compensation
respiratoryMetabolic
AlkalosisAcidosis
pH
Arterial blood sample
Metabolicrespiratory
Respiratory compensation
Renal compensation
pH < 7.35 pH > 7.45
HCO3- < 22
HCO3- < 22
HCO3- > 26 PCO2 > 45
PCO2 > 45 HCO3- > 26
PCO2 < 35
PCO2 < 35
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OTHER MODALITIES OF INVESTIGATIONS
Metabolic
Anion gap
serum chemistry
Urinalysis
Ketone levels
Lactate levels
Salicylate levels
ECG
Respiratory
Chest X-ray
Ct scan
Drug toxicology
CT scan
MRI
PFTs
EMG
NCV
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TREATMENT
Metabolic Acidosis
Treat the underlying cause
NaHCO3
Respiratory Acidosis
Treat the underlying cause
Pharmacological
Oxygen
Ventilatory support
ABC and Vitals
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• History Is Important• Acidemia Or Alkalemia• Respiratory Or Metabolic• If respiratory: acute or chronic• If metabolic: normal or increased anion gap?
• Is There A Compensation?
SUMMARY
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Acidosis App
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Qx Calculate App
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• Textbook of medical physiology by Guyton and Hall 11th edition
• Pocket medicine by marc sabatine 4th edition.• Step up to medicine 2nd edition.• http://emedicine.medscape.com/article/768268-
overview#a0104• http://emedicine.medscape.com/article/301574-overview• http://cmbi.bjmu.edu.cn/uptodate/critical%20care/
Intoxications/Approach%20to%20the%20patient%20with%20metabolic%20acidosis.htm
• http://fitsweb.uchc.edu/student/selectives/TimurGraham/Welcome.html
REFERENCES