ACIDBASE DISORDERS - rEMERGs：酸碱平衡障碍remergs.pptVIP

ACID/BASE DISORDERS Resident Rounds Rob Hall PGY3 April 24, 2003 Objectives Approach to A/B disorders Clinical examples of each disorder Differential dx of each disorder Combined disorders Should we even do ABGs? MANY studies showing that venous gases have similar pH and pC02 to ABGs MANY studies show that ABGs rarely change management How to interpret an ABG What is the pH? Is there an acidemia or alkalemia? Is it respiratory or metabolic? Is there any compensation? Is the compensation appropriate? What is the anion gap? Took some pills ABG pH 7.25 PC02 22 HC03 15 Interpretation? Is there a second acid base disorder? Metabolic acidosis + respiratory alkalosis Think ASA!! Compensation:the clue to mixed disorders ACIDOSIS Respiratory Acute 1:10 Chronic 1:3 Metabolic 1:1 ALKALOSIS Respiratory Acute 1:10 Chronic 1:2 Metabolic 0.6:1 80 female with suspected ischemic gut…… pH 6.9, PC02 35, HCO3 8 Why is the acidemia important? Consequences of SevereAcid Base Disorders Severe Acidemia Negative ionotropy Arrythmias Reduced response to catecholamines Hyperkalemia Muscle weakness Altered LOC and seizures Poor enzyme function Severe Alkalemia Reduced coronary blood flow Arrythmias Hypokalemia Altered LOC and seizures Poor enzyme function Case 75 yo female Altered LOC Fever Sinus tachycardia Tachypnea ABG: pH 7.50, pC02 30, HC03 23 Interpretation? Diagnosis? Differential dx of the acid/base disorder? Respiratory Alkalosis Pain Anxiety Pregnancy Pulmonary disease/hypoxia CNS disorder Thyrotoxicosis ASA Cases 70yo smoker since birth COPD exacerbation pH 7.15, pC02 60, HC03 26 Is he a chronic CO2 retainer? pH 7.35, pC02 60, HC03 32 Interpretation? pH 7.05, pC02 100, HC03 32 What is his “normal” pC02? Chronic Respiratory Acidosis You know that the HC03 increases in a 1:3 ratio to the increase in pC02 If the HC03 is up by 7, the pC02 is chronically up by about 20 What is the differential dx of respiratory acidosis? Respiratory Acidosis HYPOVENTILATION Brain stem Spinal C