Acid-Base

Acid-Base

1. Respiratory acidosis

   • Depression of respiration
     • CNs
     • Impaired movement
     • Airways disease
     • Hypoxia
       • Drowsy Cynosis
     • Hypercapnia
       • Neuro
         • Anxiety Coma Headache Myoclonus Extensor plantars
       • Cardiac
         • Systemic vasodilation
   • High pCO2
   • High H+
   • High Bic

2. Respiratory Alkalosis

   • Low H+
   • Low Bic
   • Low PCO2
   • Sepsis
   • Liver Failure
   • Aspirin OD
   • Hypoxaemia
     • lung disease R -> L shunts
   • Anxiety
   • CNS lesions
   • Leads to...
     • CV
       • Angina Increased HR
     • Hypocapnia
       • Cerebral vasoconstriction
         • Lightheadedness confusion syncope
     • Hypocalcaemia

3. Metabolic Alkalosis

   • Low H+
   • High Bic
   • High pCO2
   • Hypokalaemia
   • Barrets syndrome
   • Corticosteroids
     • Cushings
   • Duiretics
     • Nephrotic Syndrome
   • Vomiting/NG suction
   • Compensation...
     • Hypoventilation

4. Metabolic Acidosis

   • High H+
   • Low Bic
   • Low pCO2
   • No Anion Gap
     • Hypercholaemic acidosis
       • Interstital Nephritis
       • Early renal failure
       • GI Bic loss
         • Diarrhoea
       • UreteralDiversion
       • Renal Tubular acidosis
       • Hyperalimentation
       • Acids w/ Cl-
   • Compensation
     • Kassmaul Breathing
       • DKA pCO2 >1.6kPa
   • Increased Anion Gap
     • MEGS LARD
       • Methanol Ethyline Glycol Salicylate Lactic acidosis Alcoholic ketoacidosis Renal Failure Diabetic ketoacidosis
     • Bicarbonate loss
     • Increased Acid production
   • K+ homeostasis
     • Total decrease Plasma increase
   • Presentiaon
     • unconsciousness
     • _ve ionotropic
     • right O2 shift
       • Decreased 2,3 DPG
         • Left O2 shift
       • Increase Offloading

5. Alkalosis

   • Arterial pH > 7.44 H+ <36

6. Respiratory

   • Change in pCO2

7. Metabolic

   • Change in Bic

8. Acidaemia

   • pH <7.36 H+ >44
   • H+ ions
     • ATP generation ionise protein side groups  
     • Turnover
       • 2300-3000mmol/d 40-80mmol/d excreted
     • Production
       • Carbonic acid
         • 20,000mmol/d
       • Urea Synthesis
         • Renal excretion oxidation of AAs
       • Ketoacids
         • 40mmol/d Ketogenesis
       • Lactate
         • 1300mmol/d glycolysis