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Published by Vjesh V Mohan

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Published by: Vjesh V Mohan on Feb 15, 2011
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COMPONENTS TO DETERMINE ACID BASE BALANCE pH ( Sorenson introduces ) paCO2 paO2 Oxygen Saturation Base Excess Bicarbonate   


CALCULATION OF FREE H+ IONS HendersonHenderson-Hasselbalch equation .

COMPENSATORY MECHANISM  Buffer System Respiratory Mechanism hyperventilation hypoventilation   Renal Mechanism kidney movement of bicarbonate formation of acids formation of ammonium .

with change in Na+ cl- .HOW TO DIAGNOSE ACID BASE DISORDER STEPS         Obtain ABG and Electrolyte simultaneously Compare HCO3 on ABG and electrolytes to verify accuracy Calculate Anion gap (AG) Know four causes of high AG acidosis( ketoacidosis. lactic acid acidosis. renal failure& toxins) Know two causes of hyperchloremic or non gap acidosis Estimate compensatory response Compare AG and HCO3 Compare change in cl.

Metabolic Acidosis Clinical Manifestations      Increased ventillation Peripheral arterial vasodilation Pulmonary Oedema CNS depression with headache.Lethargy.Stupor Glucose intolerance .

leukemia.cardiacfailure.drug or toxin ingestion     .cancer.shock.HIGH ANION GAP ACIDOSIS ASSESSMENT  History Collection and ABG analysis Check for Diabetes Mellitus Check for evidence of alcoholism Observation of clinical signs of uremia determination of BUN & Creatinine Check for hypotension.

Lactic Acidosis CAUSES        Circulatory insufficiency Severe anemia Malignancies Thiamine deficiency Infections Drugs or toxins Infarction .

Metabolic Alkalosis CAUSES  Exogenous HCO3. normotension.loads HCO3Effective ECFV contraction. K+ deficiency. hypertension. k+ deficiency. and secondary hyperrenimic hyperaldosternism Gastrointestinal Origin Renal origin   ECFV expansion. mineralocorticoid excess .

Metabolic Alkalosis CLINICAL MANIFESTATIONS  Mental confusion Seizures Paresthesia Muscular cramping Tetany Arrhythmias Hypoxemia Hypokalemia Hypophosphatemia         .

Myoclonic jerks)        .Respiratory Acidosis CLINICAL MANIFESTATIONS  Hypoxemia Dyspnoea Confusion Psychosis Hallucinations Loss of Memory Personality changes Motor disturbances( tremor.

Respiratory Alkalosis CLINICAL MANIFESTATIONS  Dizziness  Mental confusion  Seizures  Cardiac Arrhythmias  Hypokalemia  Paresthesia .

Laboratory Profile Imbalance pH HCO3 paCO K+ 2 Ca2+ ClCl- Metabolic Acidosis N or N Respiratory Acidosis Metabolic Alkalosis Respiratory Alkalosis N .

NURSING MANAGEMENT Assessment  Assess the neurological status Assess the cardiological status Assess the respiratory status Assess for any skin manifestations Check ABG values Assess for any behavioural changes Assess the musculoskeletal system       .

Nursing Diagnosis  Ineffective Breathing Pattern related to reduced gas exchange Decreased cardiac output related to poor cardiac contractility decreased vascular volume Deficient fluid volume related to dehydration Acute pain related to muscle spasm Risk for falls related to muscle weakness     .

18 pCO2=18 HCO3=9 k+ = 4.1 Ans: Increased AG metabolic acidosis .1 Cl.= 110 ClAG = 23.PROBLEMS       pH=7.

       pH = 7.1 pCO2 = 50 HCO3 = 15 Na = 140 K+ = 5 Cl.= 105 ClAG = 23 Ans: Increased AG Metabolic acidosis .

55 Pco2 = 66 pO2 = 68 HCO3 = 36 Ans: Metabolic alkalosis .    pH =7.

    pH = 7.25 pCO2 = 65 pO2 = 55 HCO3 = 28 Ans: Respiratory acidosis .


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