Ph =7.4CO2 = 40HCO3- = 24Acute respiratory acidosisORMetabolic acidosis superimposed onchronic respiratory acidosis
↓↑↑
-hypercapnia
↑
[>24 & <30=24+6]Simply
Chronic respiratory acidosis
ORAcute respiratory acidosis WITHPartially compensated metabolic alkalosisORMetabolic alkalosis superimposed on acuterespiratory acidosis
↓ ↑↑↑↑
[>30=24+6]--- renal absorption of bicarbonate.Need 24-36hrs for maximum effect.Acute respiratory alkalosis
↑↓↓
--hypocapnia
↓
[<24&>18=24-6]Simply
Chronic respiratory alkalosis.
ORAcute respiratory alkalosis WITHPartially compensated metabolic acidosis
↑ ↓↓↓↓
[<18=24-6 ]--- renal loss of bicarbonateAcute metabolic acidosis
↓
No change
↓↓
Simply
Chronic metabolic acidosis
ORAcute metabolic acidosis WITH Partially compensated Resp. alkalosisORRespiratory compensated metabolicacidosis.
↓↓
- increases respiratoryrate.
↓↓
Acute metabolic alkalosis
↑
No change
↑↑
Simply
Chronic metabolic alkalosis
ORAcute metabolic alkalosis WITH Partially compensated Resp. acidosisORRespiratory compensated metabolicalkalosis
↑↑
- decreases respiratoryrate.
↑↑
Ph =7.4CO2 = 40HCO3- = 24Acute respiratoryacidosis
↓ ↑↑ ↑
Acute respiratoryalkalosis
↑ ↓↓ ↓
Acute metabolicacidosis
↓
No change
↓↓
Acute metabolicalkalosis
↑
No change
↑↑
1.Acute respiratory acidosis -------HCO3- >24 & <30 [24+6]2.Chronic respiratory acidosis-----HCO3- >30 [24+6]1.Acute respiratory alkalosis ----- HCO3- <24 & >18 [24-6]
2.
Chronic respiratory alkalosis ---HCO3- <18 [24-6]Combined Or Mixed Disorders :
alkalosis + acidosis
–if the PH isnormal[7.35 – 7.45] , it must be a mixed disorder sincethere isnofull compensation
2 acidosis (or) 2 alkalosis
a.
if PH isvery low, it must be 2 acidosis
b.
if PH isvery high, it must be 2 alkalosisSo there are
4
Mixed/Combined Disorders:1.Mixed Respiratory acidosis with Metabolic alkalosis. [PH=7.38 ]2.Mixed Respiratory alkalosis with Metabolic acidosis. [PH=7.42 ]3.Mixed Respiratory acidosis with Metabolic acidosis. [PH=7.2 ]4.Mixed Respiratory alkalosis with Metabolic alkalosis [PH=7.6 ]
1.
alkalosis + acidosis
a.
E.g:
Adult
salicylate intoxication in rheumatoid arthritis ---------Mixedrespiratory alkalosis and Metabolic acidosis
i.
Salicylate is uncoupler of ETS-----increased O2 consumption-----hypoxia------hyperventilation -------respiratory alkalosis -------as acompensation metabolic acidosis comes -----due to decreased ATPsynthesis due to uncoupling neural tissue dies ------respiratory centrewon’t works ------then respiratory acidosis comes -----so finally
bothrespiratory and metabolic acidosis
comes.
b.
E.g:
Child
salicylate intoxication ---------Mixed respiratory alkalosis andMetabolic acidosis ------but this respiratory alkalosis goes away rapidly and landup in profound metabolic acidosis.c.E.g: endotoxic shock ----------- Mixed respiratory alkalosis and Metabolicacidosisd.Problem - PH = 7.42 , PCO2 = 22 , HCO3- = 14 Ans: Mixed respiratory alkalosisand metabolic acidosis .
e.
Steps in sloving this problemi.PH = 7.42 ---inference is alkalosis[because >7.4]
ii.
PCO2 = 22 ---
↓
so this is respiratory alkalosis
iii.
HCO3- = 14 ---
↓↓
so this is Chronic respiratory alkalosis ---but this isNOT the answer
iv.
Observe here clearly that PH =7.42 which is 0.02 above than 7.4 & near normal to 7.4 ( 7.35 – 7.45 is normal range according to goljan )( see clearly in other problems that in a partially compensated , PH iseither < 7.35 or > 7.45 ---but never between 7.35 – 7.45 , if presentit is mixed disorder with acidosis + alkalosis ) -----so this is notChronic respiratory alkalosis because compensation ( chronic ) neverbrings the PH to normal & compensation is always outside the normalrange ( partially compensated)v.So this is mixed respiratory alkalosis and Metabolic acidosis becausePH is above 7.4 and come to 7.42 .
2.2 acidosis (or) 2 alkalosis
If the CO2 and HCO3-
change in opposite directions
, it is a combineddisturbance . It is either a combined respiratory and metabolic acidosis or acombined respiratory and metabolic alkalosisCombined Respiratory And Metabolic Alkalosis.----------if the CO2 is depressedand HCO3- elevatedCombined Respiratory And Metabolic Acidosis.------------if the CO2 is elevatedand HCO3- depressed
i.
E.g: PCO2=55mmHg , HCO3- =20 mEq/L Ans: Combined respiratoryand metabolic acidosis.—1.PH = these type of problems they don’t give PH2.PCO2=55mmHg ----inference is eithera.Acute respiratory acidosisb.Chronic respiratory acidosisc.Chronic metabolic alkalosis
3.
HCO3- =20 mEq/L ---
↓
---but in All Acute respiratory acidosisor Chronic respiratory acidosis or Chronic metabolic alkalosisthe HCO3 has to be
↑
------but here it is
↓
-----so this isCombined Respiratory And Metabolic Acidosis
ii.
E.g: Cardiorespiratory arrest with no breathing (acute respiratoryacidosis) and cardic standstill(metabolic acidosis from lactic acidosis )Note : arrows represent the degree of magnitudePHPCO2HCO3-Respiratory acidosis
(compensation)
↓↑↑
(primary)
↑
Chronic Metabolicacidosis
↓↓
(compensation)
↓↓
(primary)Final blood gas
↓↓
(extremeacademia)
↑ ↓
Steps to follow to solve the problem :1.first see PH
a.
PH low – it is acidosis [ E.g: 7.3 ,7.2 etc ------- PH is < 7.35]
b.
PH high – it is alkalosis [ E.g: 7.6 ,7.51 etc -------- PH is > 7.45]
c.
PH is
normal –
“mixed alkalosis + acidosis”
[ E.g:
between“7.35 – 7.45”
– “0.05 less or more than 7.4” … like 7.42 … it must be amixed disorder since there is NO full compensation
d.
PH is
very low
, it must be
“mixed 2 acidosis”
[ E.g: 7.08 & PCO2 =49 ,HCO3- = 14 –--- combined respiratory and metabolic acidosis---sometimes PH is NOT given in the problems. See the point 2. c.i above .
e.
PH is
very high
, it must be
“mixed 2 alkalosis”
---some times PH is NOTgiven in the problems. See the point 2. c.i above .
2.
next see CO2
[after coming to the conclusion that it is acidosis when PH is low ]
a.
If PCO2high (
↑↑
).----------------It is Respiratory acidosis
i.Then see HCO3-
1.
HCO3- is
↑
[>24 & <30=24+6 ] ---Acute Respiratoryacidosis
2.
HCO3- is
↑↑
[>30=24+6] ---Chronic Respiratory acidosis
3.
HCO3- is
↓
-------- It is Combined Respiratory AndMetabolic Acidosis OR Respiratory acidosis WITH Metabolicacidosis. E.g: PH =7.23 ; PCO2=54 ;
of 00
Acid Base Balance
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thanks for all the info do have practice test for prometric exam;nurse specialist?