Introduction to Acid Base Disorders（酸碱平衡调节的重要性）.ppt

Case 6 Which of the following arterial blood values is most likely to be found in this patient? pH PCO2 PO2 7.50 28 90 7.50 52 72 7.38 38 88 7.25 65 42 Case 6 Step 1- Figure anion gap (15) Step 2. Determine the primary acid base abnormality Step 3- Solve for the predicted HCO3 from the ABG HCO3 = 24 X pCO2 80- last 2 digits of pH = 24 X 52 80-50 = 42 Case 6 Which of the following arterial blood values is most likely to be found in this patient? pH PCO2 PO2 7.50 28 90 7.50 52 72 7.38 38 88 7.25 65 42 Case 7 A 45 year old man is brought to the ER 12 hours after a drug overdose. Sodium 140 Potassium 4.0 Chloride 105 Bicarbonate 10 ABG 7.18/ pCO2 29/ pO2 98 Which medications did the patient likely ingest? Tricyclic antidepressants Aspirin and codeine Acetominophen Acetominophen and codeine Isopropyl alcohol Case 7 Step 1. Determine anion gap (15) Step 2. Determine primary acid base abnormality Step 3. Determine if HCO3/pCO2 is appropriate. Winter Equation pCO2= (HCO3 x 1.5) + 8 29= 15+8 ? Tells you that the pCO2 is too high=hypoventilation Case 7 A 45 year old man is brought to the ER 12 hours after a drug overdose. Sodium 140 Potassium 4.0 Chloride 105 Bicarbonate 10 ABG 7.18/ pCO2 29/ pO2 98 Which medications did the patient likely ingest? Tricyclic antidepressants Aspirin and codeine Acetominophen Acetominophen and codeine Isopropyl alcohol Importance of Acid-Base Regulation About 70 mmol/day acid production on normal western diet Plasma [H+]=40 nmol/l Stable [H+] required for protein function Buffers minimize the change in pH when an acid or base is added Buffer Systems H+ + HCO3- H2O + CO2 H2CO3 H+ + HPO42- H2PO4- H+ + His-Protein H-His-Protein DCT CNT PCT PST TAL CCD NH3 Acid-Base Physiology in the Nephron HCO3- NH4+ H+ NH4+ NH3 Arterial blood gas Arterial blood obtained in heparinized syringe. Perform Allen test to check collateral circulation. Transport sample to lab immediately on ice. pH, pCO2