AcidBasePathoFall2012

1 metabolic acidosis compensated 2 metabolic acidosis

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1. Metabolic acidosis, compensated 2. Metabolic acidosis, not compensated 3. Respiratory acidosis, compensated 4. Respiratory acidosis, not compensated
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Compensation of Respiratory Acidosis Acute HCO3- should increase by 0.1 times the increase in PaCO2 + 3 Chronic HCO3- should increase by 0.35 times the increase in PaCO2 + 4
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Respiratory Acidosis Is pH high or low? Is the primary disturbance with HCO3- or PaCO2?
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Respiratory Acidosis Occurs when the lungs fail to excrete CO2 Acute respiratory acidosis is a medical emergency Patient isn’t getting enough O2 Usually requires mechanical ventilation Chronic respiratory acidosis is NOT a medical emergency Patients breathe comfortably with chronically low pH
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Respiratory Acidosis: Causes Acute Medications (anesthetics, opioids, sedatives) Stroke or head injury Asthma Pneumonia C h r o n i c C O P D T u m o r s
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Respiratory Acidosis Signs and Symptoms Chronic Asymptomatic Acute Confusion, seizures, stupor, coma
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Respiratory Acidosis Mechanism of Metabolic Compensation: Initially, chemical buffering of CO2 occurs Occurs over minutes If the respiratory acidosis lasts > 24 hours, metabolic compensation occurs Enhanced Bicarbonate reabsorption Ammoniagenesis Distal tubular hydrogen secretion Occurs over several days
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Questions?
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