1004-1300_troll-acidbasedisorders - Acid Base Problems Greg Troll MD Objectives(slide 1 Upon completion of this section the student will be able to

1004-1300_troll-acidbasedisorders - Acid Base Problems Greg...

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1 Acid Base Problems Greg Troll, MD The cases in this will be the substance of the exercise. Answer initially to the best of your ability. Then discuss with you neighbor and I will ask again. If you get how to do and understand these cases you will have learned how to do moderately difficult acid base problems. My “lecture” will focus on how to solve these case by case. Be prepared! (is the boy scout’s marching song) Objectives (slide 1) Upon completion of this section, the student will be able to:Describe the following components of arterial acid-base balance:– 1. the respiratory component, in which pulmonary ventilation results in carbon dioxide elimination and controls the arterial pCO2,-2. the important buffers,– 3. the metabolic component, which is affected by tissue metabolism and the gastrointestinal system, and which is regulated by the kidneys.– 4. Describe the appropriate use of arterial blood gases (ABGs) and how the values are derived.Recognize the following conditions and list their common causes:– 1. metabolic acidosis, non-anion gap– 2. metabolic acidosis, anion gap– 3. metabolic alkalosis– 4. respiratory acidosis– 5. respiratory alkalosis– Recognize the importance of urine Cl-measurement and urine pH in the evaluation of metabolic alkalosis and metabolic acidosis, respectively.Recognize mixed acid-base conditions.– Recognize appropriate and inappropriate respiratory compensation for a given acute or chronic metabolic abnormality. Objectives (slide 2)
2 Terms 1 Acidemia — An arterial pH below the normal range (less than 7.36). Alkalemia — An arterial pH above the normal range (greater than 7.44). Acidosis — A process that tends to lower the extracellular fluid pH (hydrogen ion concentration increases). This can be caused by a fall in the serum bicarbonate (HCO3) concentration and/or an elevation in PCO2. Alkalosis — A process that tends to raise the extracellular fluid pH (hydrogen ion concentration decreases). This can be caused by an elevation in the serum HCO3 concentration and/or a fall in PCO2. Terms 2 Metabolic acidosis — A disorder that causes reductions in the serum HCO3 concentration and pH. Metabolic alkalosis — A disorder that causes elevations in the serum HCO3 concentration and pH Respiratory acidosis — A disorder that causes an elevation in arterial PCO2 and a reduction in pH. Respiratory alkalosis — A disorder that causes a reduction in arterial PCO2 and an increase in pH. Terms 3 Simple acid-base disorder — The presence of one of the above four disorders with the appropriate respiratory or renal compensation for that disorder. Mixed acid-base disorder — The simultaneous presence of more than one acid-base disorder. Mixed acid-base disorders can be suspected from the patient's history, from a lesser- or greater-than-expected compensatory respiratory or renal response, and from analysis of the serum electrolytes and anion gap. As an example, a patient with severe vomiting would be expected to develop a metabolic alkalosis due to the loss of acidic gastric fluid. If, however,

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