酸碱平衡紊乱19046幻灯片.pptVIP

Blood pH =pKa + log [HCO3-/ HCO3] = pKa + log [HCO3-] [0.03xPCO2] [HCO3-/ H2CO3]=20/1 pH=7.4 Partial pressure of carbon dioxide in arterial blood (PaCO2)  Concept:pressure generated by carbon dioxide physically dissolved in arterial blood Normal Values: 4.39～6.25kPa (33～46mmHg, mean:40mmHg) Respiratory acidosis: an increase in the PaCO2 CO2 retention, hypercapnia, alveolar hypoventilation Respiratory alkalosis: a decrease in the PaCO2 excess CO2 elimination, hyperventilation, hypocapnia Standard bicarbonate , SB Actual bicarbonate , AB SB: standard condition, plasma HCO3- concentration Values: 22～27mmol/L（24mmol/L） Represent metabolic changes AB:Actual condition, plasma HCO3- concentration Represent metabolic and respiratory changes buffer base ,BB Standard condition, sum of total buffer bases Normal value: 45～55mmol/L Metabolic changes base excess ,BE strong acid or base which has to be added to a litre of fully saturated blood at 37°C to bring its pH to 7.4 Normal value:+3~-3 Metabolic change anion gap , AG the difference between the sum of the undetermined anions and the undetermined cations. AG=UA-UC Normal values：10～14 mmol/L Metabolic acidosis Anions：Na++{K++Ca2++Mg2+….} UC Cations：HCO3-+ CL-+[Pr-+HPO42- + + organic acid …] UA Diagram of plasma Anion Gap (mmol/L) Classification of an acid-base defect The primary defect in an acid-base disorder is defined by its initiating process, which can be metabolic (changes in HCO3-) or respiratory (changes in PaCO2). A compensatory response describes the secondary physiological response to the primary disturbance. 代谢性酸中毒Metabolic Acidosis 原因Common Causes of Metabolic AcidosisAG增高 Increased Anion Gap 固定酸增高Excess H+ Production 糖尿病酮症酸中毒Diabetic ketoacidosis* 乳酸性酸中毒L-lactic acidosis* Aspirin Common Causes of Metabolic AcidosisAG正常 Normal anion gap Excessive Loss of Bicarbonate Mild to moderate renal failure* Gastrointe