CHN ON RI

LON TOAN KIM

Bi Xun Phc-Nguyn Thnh Tm

TRNG HP 1:
Bnh nhn nam 19 tui, nhp vin v mt
Tin cn: i tho ng tp 1
Vi ngy nay, bnh nhn t ngng mt s ln
tim insulin, sau c triu chng kht v
tiu nhiu.
Khm lm sng ghi nhn bnh nhn khng st,
tim u, phi trong.

Kt qu xt nghim:
in gii mu
Na+
K+
ClGlucose
BUN
Creatinin
pH
pCO2

136 mEq/l
4,8 mEq/l
99 mEq/l
19 mm/l
24 mg/dl
0,9 mg/dl
Kh mu ng mch
7,26
18 mmHg

pO2

128 mmHg

HCO3-

8,1 mmol/l
TPTNT

Glucose

Ketone

4+

c kt qu kh mu ng mch:
Bc 1: pH = 7,26 < 7,35 toan mu
Bc 2: HCO3- = 8,1 mm/l < 22 toan chuyn ha
Bc 3: tnh b ca h hp
PaCO2 d on = (1,5 x 8,1) + 8 = 20 PaCO2 thc
t bng PaCO2 d on.
Bc 4:
Anion gap mu (AG) = [Na+] + [HCO3-] [Cl-] = 136
8,1 99 = 28,9 > 12 tng anion gap.
AG/ HCO3- = (28,9 12)/(24 8,1) # 1,06 toan
chuyn ha tng AG n thun
KMM: Toan chuyn ha tng anion gap n thun.

CHN ON NGUYN NHN

Nguyn nhn ca toan chuyn ha tng anion gap:
Suy thn
Toan mu lactic
Nhim ceton acid (T, nghin ru)
Ng c: salicylates, ethylene glycol, methanol,
paraldehyde
i chiu lm sng: tin cn i tho ng tp 1
khng tun th iu tr, ng huyt tng cao,
nc tiu c ceton dng tnh 4+ gi toan
chuyn ha do nhim ceton acid.
Chn on: Toan chuyn ha do nhim ceton acid trn
bnh nhn T type 1

TRNG HP 2:
Bnh nhn nam 60 tui nhp vin v tiu phn
en.
Vi ngy nay bnh nhn tiu phn en v i
khong 500 ml mu vo ngy nhp vin.
Khm lm sng:
Bnh nhn rt , mch 120 ln/pht,
huyt p 80/50 mmHg, da lnh m.
Tin cn: x gan do ru Child C, dn tnh
mch thc qun

Kt qu xt nghim:
Na+

in gii mu
131 mEq/l

K+

4,2 mEq/l

ClGlucose
BUN

85 mEq/l

Creatinin

2,45 mg/dl

pH

5,2 mm/l
69 mg/dl
Kh mu ng mch
7,1

pCO2

13,8 mmHg

pO2

103 mmHg

HCO3-

4,1 mmol/l
TPTNT

Ketone
Hb mu
Lactate mu

Vt
6,2 g/dl
20,3 mmol/l

c kt qu kh mu ng mch:
Bc 1: pH = 7,1 < 7,35 toan mu
B c 2: HCO3- = 4,1 mmol/l < 22 toan chuy n ha
B c 3: tnh b c a h h p
PaCO2 d on = (1,5 x 4,1) + 8 = 14 PaCO2 th c
t bng PaCO2 d on.
B c 4: anion gap mu (AG) = 131 4,1 85 = 41,9 >
12 tng anion gap
AG/ HCO3 = (41,9 12)/(24 4,1) = 1,5 toan
chuy n ha tng AG n thu n

CHN ON NGUYN NHN

Nguyn nhn c a toan chuy n ha tng anion gap:
Suy thn
Toan mu lactic
Nhi m ceton acid (T, nghin r u)
Ng c: salicylates, ethylene glycol, methanol,
paraldehyde

Lm sng: xut huyt tiu ha cp mc

nng, gy tt huyt p, gi nhim acid
lactic do gim oxy m.

Nhn xt:
Bnh nhn c suy thn, tuy nhin creatinin
mu khng qu cao nn t c kh nng gy
tch t acid gy toan mu.
nh lng acid lactic mu bng 20,3 mmol/l
(bnh thng < 4 mmol/l) khng nh toan
mu do acid lactic.
Chn on: Toan chuyn ha do nhim acid
lactic trn bnh nhn XHTH nng- X gan

TRNG HP 3:
Bnh nhn nam 48 tui, nhp vin v ln ln,
hnh vi khng ging thng ngy.
Khm: bnh nhn tnh, mt , nhiu m
hi, ni chuyn hi ln ln
Mch 90 ln/pht, huyt p 106/65 mmHg,
khng st, nhp th 24 ln/pht, SpO2 98%.
Tim u, phi trong, bng mm, c mm, ng
t bnh thng, khng du thn kinh khu tr.
Tin cn: thng ung aspirin v nhc u.

Kt qu xt nghim:
in gii mu
Na+
K+
ClGlucose

142 mEq/l
3,7 mEq/l
100 mEq/l
98 mg/dl
Kh mu ng mch

pH
pCO2

7,3
19,7 mmHg

pO2

79,2 mmHg

HCO3Salicylat mu

12 mmol/l
107 mg/dl ( 2-20 mg/dl)

c kt qu kh mu ng mch:
B c 1: pH = 7,3 < 7,35 toan mu
B c 2: HCO3- = 12 mm/l < 22 toan chuy n ha
B c 3: tnh b c a h h p
PaCO2 d on = (1,5 x 12) + 8 = 26 PaCO2 th c
t th p hn PaCO2 d on c ki m h h p i
km.
B c 4: anion gap mu (AG) = 142 12 100 = 30 >
12 tng anion gap
AG/ HCO3 = (30 12)/(24 12) = 1,5 toan
chuy n ha tng AG n thu n (khng km r i
lon toan ki m do chuy n ha khc).

CHN ON NGUYN NHN

Nguyn nhn ca toan chuyn ha tng AG:
Suy thn
Toan mu lactic
Nhim ceton acid (T, nghin ru)
Ng c: salicylates, ethylene glycol, methanol,
paraldehyde
i chiu lm sng: nng salicylat mu tng cao
salicylat l nguyn nhn gy toan chuyn ha tng AG.
Salicylat kch thch trc tip trung tm h hp gy th
nhanh v kim h hp v gy ri lon chuyn ha
glucose v acid bo, a n toan chuyn ha.
Chn on: Toan chuyn ha tng anion gap mu +
kim h hp do ng c aspirin

TRNG HP 4:
Bnh nhn n 60 tui, nhp vin v mt.
Bnh nhn tiu chy nng 1tun.
Khm lm sng:
Bnh nhn tnh, rt .
Du mt nc r
Huyt p t th nm 100/60 mmHg, t th
ngi 70/40 mmHg.

Na+
K+
ClBUN
Creatinin

Kt qu xt nghim:
in gii mu
137 mEq/l
2,5 mEq/l
118 mEq/l
65 mg/dl
3,1 mg/dl

pH
pCO2

Kh mu ng mch
7,11
16 mmHg

pO2

90 mmHg

HCO3-

4,9 mmol/l

Na+
K+
Cl-

in gii niu
45 mEq/l
15 mEq/l
100 mEq/l

c kt qu kh mu ng mch:

B c 1: pH = 7,11 < 7,35 toan mu

B c 2: HCO3- = 4,9 mm/l < 22 toan chuy n
ha
B c 3: tnh b c a h h p
PaCO2 d on = (1,5 x 4,9) + 8 = 15,35 PaCO2
th c t bng PaCO2 d on.
B c 4: anion gap mu (AG) = 137 4,9 118 =
14 khng tng anion gap

KMM: Toan chuyn ha khng tng anion gap.

CHN ON NGUYN NHN

Lc u nghi ng nhim toan chuyn ha do mt HCO3- qua
tiu chy. C th km theo toan do acid lactic (v c tt
huyt p, gim ti mu m), hoc cc acid khc (v suy
thn).
KMM: toan chuyn ha khng tng anion gap mu t c
kh nng toan chuyn ha do nhim acid.
Chn on xc nh toan mu do tiu chy bng tnh anion
gap niu = [Na+] + [K+] [Cl-] = 45 + 15 100 = - 40.
Bnh thng, anion gap niu c gi tr trong khong [20;0]. Bnh nhn ny c AG niu < -20 y l toan
chuyn ha do mt HCO3- qua tiu chy hoc toan ha
ng thn gn (AG niu > 0 l toan ha ng thn xa).
Bnh s ph hp vi nguyn nhn tiu chy.
Chn on: Toan chuyn ha khng tng AG do tiu chy.

TRNG HP 5:
Bnh nhn n 31 tui, nhp vin v yu lit
tay chn tng dn.
Khm: bnh nhn tnh, mch 77 ln/pht,
huyt p 110/70 mmHg, nhit 36,5oC,
nhp th 26 ln/pht.
Tim u, phi trong, bng mm
Mt phn x gn xng t chi, trng lc c
t chi gn nh khng cn, khng ri lon
cm gic.
Trc bnh nhn khng c bnh g v cng
khng dng thuc g.

Na+
K+
ClCreatinin

Kt qu xt nghim:
in gii mu
135 mEq/l
2,1 mEq/l
110 mEq/l
0,7 mg/dl

pH
pCO2

Kh mu ng mch
7,21
38 mmHg

pO2

98 mmHg

HCO3-

14 mmol/l

Na+
K+
ClpH

in gii niu
165 mEq/l
54 mEq/l
162 mEq/l
8

c kt qu kh mu ng mch:
Bc 1: pH = 7,21 < 7,35 toan mu
Bc 2: HCO3- = 14 mm/l < 22 toan chuyn ha
Bc 3: tnh b ca h hp
PaCO2 d on = (1,5 x 14) + 8 = 29 PaCO2 thc
t cao hn PaCO2 d on c toan h hp km
theo.
Bc 4: anion gap (AG) = 135 14 110 = 11
khng tng anion gap
KMM: toan chuyn ha khng tng anion gap +
Toan h hp.

CHN ON NGUYN NHN

Toan h hp c th do yu c h hp do gim kali mu.

Anion gap niu = [Na+] + [K+] [Cl-] = 165 + 54 162 = 57 > 0
y l toan ha ng thn xa.
Toan ha ng thn xa l tnh trng ng thn xa khng bi tit
c H+, lm H+ li trong mu gy toan chuyn ha, cn
nc tiu khng c H+ nn b kim ha. Bnh nhn ny c pH
nc tiu = 8 trong tnh trng toan ha mu gi toan ha
ng thn xa (bnh thng, mu b toan th ng xa phi tng
thi NH4+, nc tiu phi toan).
Chn on xc nh toan ha ng thn xa bng test NH4Cl.
Bnh nhn ung NH4Cl (0,1 g/kg) lm toan ha mu nhng
nc tiu khng tng NH4+, v pH nc tiu vn trn 7.

Kt lun: Toan chuyn ha khng tng AG do toan ha ng

thn xa + Toan h hp do yu c h hp do gim kali mu.

TRNG HP 6:
Bnh nhn nam 32 tui, nhp vin v t ngt
yu c t chi.
Khm:
Bnh nhn tnh, yu c t chi, ngoi ra khng
c g c bit.
Tin cn b ong t cch y 8 thng.
Ngoi ra bnh nhn khng c bnh g v cng
khng dng thuc g

Na+
K+
ClCreatinin

Kt qu xt nghim:
in gii mu
134 mEq/l
2,8 mEq/l
108 mEq/l
1,3 mg/dl

pH
pCO2

Kh mu ng mch
7,27
39,8 mmHg

pO2

95,8 mmHg

HCO3-

16,2 mmol/l

Na+
K+
ClpH

in gii niu
100 mEq/l
30 mEq/l
155 mEq/l
6

c kt qu kh mu ng mch:
Bc 1: pH = 7,27 < 7,35 toan mu
Bc 2: HCO3- = 16,2 mm/l < 22 toan chuyn ha
Bc 3: tnh b ca h hp
PaCO2 d on = (1,5 x 16,2) + 8 = 32,3 PaCO2
thc t cao hn PaCO2 d on c toan h hp
nh km theo.
Bc 4: anion gap (AG) = 134 16,2 108 = 9,8
khng tng anion gap
KMM: toan chuyn ha khng tng anion gap +
Toan h hp.

CHN ON NGUYN NHN

Toan h hp c th do yu c h hp do gim
kali mu.
Anion gap niu = [Na+] + [K+] [Cl-] = 100 + 30
155 = - 25 < - 20 toan mu do tiu chy hoc
do toan ha ng thn gn.
Bnh nhn khng tiu chy nn ngh toan ha ng
thn gn.
Toan ha ng thn gn l tnh trng ng thn gn
khng ti hp thu c HCO3- nn c th mt
HCO3-, gy toan chuyn ha. ng thn xa thi
NH4+ bnh thng nn nc tiu vn toan.

CHN ON NGUYN NHN

Chn on xc nh toan ha ng thn gn bng cch
truyn NaHCO3 tc 0,5-1 mEq/kg/gi nng nng
HCO3- mu ln khong 18-20 mm/l. ng thn gn s
lm thot HCO3- vo nc tiu khin nc tiu ang
toan tr nn kim (pH > 7,5) v phn sut thi HCO3ln hn 15-20%.
Cng thc tnh phn sut thi HCO3-:
FEHC03 = [HC03 niu Creatinin mu] / [HC03 mu
Creatinin niu] 100
Kt lun: Toan chuyn ha khng tng anion gap mu
do toan ha ng thn gn + Toan h hp do yu c
h hp do gim kali mu.

TRNG HP 7:
Bnh nhn n 28 tui nhp vin v mt.
Bnh nhn t lm cho nn nhiu ln trong thi
gian gn y do v l do tm l.
Bnh nhn than d cm u chi, vp b, st
cn.
Khm:
Bnh nhn tnh
Huyt p 90/70 mmHg.

Kt qu xt nghim:
Na+

in gii mu
135 mEq/l

K+
Cl-

2,4 mEq/l

BUN

39 mg/dl
0,8 mg/dl

Creatinin
pH
pCO2
HCO3Na+
K+
ClpH

79 mEq/l

Kh mu ng mch
7,61
45 mmHg
44 mmol/l
in gii niu
44 mEq/l
55 mEq/l
3 mEq/l
8

c kt qu kh mu ng mch:
Bc 1: pH = 7,61 > 7,45 kim mu
Bc 2: HCO3- = 44 mm/l > 22 kim
chuyn ha
Bc 3: tnh b ca h hp
PaCO2 d on = (0,7 x 44) + 20 = 50,8
PaCO2 thc t thp hn PaCO2 d on
c kim h hp km theo.
KMM: kim chuyn ha + Kim h hp.

KIM H HP
Nguyn nhn
Tng thng kh ph nang do hysterie
au, lo u.
Ri lon thn kinh trong chn thng s no, vim
no, u no, tai bin mch mu no.
Bnh h hp: vim phi, thuyn tc phi, suy h
hp cp
Sc: sc tim, sc nhim trng, gim th tch tun
hon
Ng c aspirine
Hn m gan
Th my iu chnh sai
Thiu oxy mu gy tng thng kh ph nang b tr

KIM CHUYN HA
Nng Clo niu trong chn on kim chuyn
ha
< 20 mmol/L
> 20 mmol/L
ap ng Cl:
e khang Cl:
Non oi, hut dch
Cng Aldosterone
da day
HC Cushing
Dung li tieu gan
ang s dung li
ay
tieu
Sau tang C02
Giam kali mau
nang
Hoi chng Bartter
HC Gitelman

CHN ON NGUYN NHN

Kim h hp trng hp ny c th do yu t
tm l.
Chn on nguyn nhn kim chuyn ha:
nh gi Clo nc tiu: Cl- = 3 mEq/l < 20
mEq/l Clo niu khng tng mt Clo
ngoi thn, trong trng hp ny l do nn
nhiu.
Kt lun: Kim chuyn ha do nn nhiu +
Kim h hp do yu t tm l.

TRNG HP 8:
Bnh nhn nam 28 tui, nhp vin v cn au
qun thn.
Khm:
Mch 92 ln/p, huyt p 110/70 mmHg
Bnh nhn khng c tin cn tng huyt p.

Kt qu xt nghim:
Na+
K+
ClCa++
Mg++
P
Creatinin
pH

in gii mu
137 mEq/l
3 mEq/l
103 mEq/l
4,6 mEq/l
2,13 mg/dl (bnh thng 1,8 3)
3,8 mg/dl (bnh thng 2,4 4,1)
0,95 mg/dl
Kh mu ng mch
7,45

pCO2

42 mmHg

HCO3-

31 mmol/l

Kali
Clo
Canxi

Nc tiu 24 gi
84 mmol (bnh thng 25 - 125)
325 mmol (bnh thng 110 - 250)
427 mg (bnh thng 100 300)

c kt qu kh mu ng mch:
Bc 1: pH = 7,45 kim mu nh
Bc 2: HCO3- = 31 mm/l > 22 kim
chuyn ha
Bc 3: tnh b ca h hp
PaCO2 d on = (0,7 x 31) + 20 = 41,7
PaCO2 thc t xp x PaCO2 d on.
KMM: Kim chuyn ha.

KIM CHUYN HA
Nng Clo niu trong chn on kim chuyn
ha
< 20 mmol/L
> 20 mmol/L
ap ng Cl:
e khang Cl:
Non oi, hut dch
Cng Aldosterone
da day
HC Cushing
Dung li tieu gan
ang s dung li
ay
tieu
Sau tang C02
Giam kali mau
nang
Hoi chng Bartter
HC Gitelman

CHN ON NGUYN NHN

nh gi Clo nc tiu: Clo niu 24 gi tng cao
theo di hi chng Bartter hoc Gitelman (o Clo
niu 24 gi hoc mu nc tiu mt thi im;
Clo niu tng nu > 20 mEq/l).
Canxi nc tiu 24 gi tng cho thy tng bi tit
canxi qua nc tiu, nn y l hi chng Bartter.
Cc c im v in gii v toan kim ca HC
Bartter ging nh khi dng li tiu quai, do cn
loi tr bnh nhn dng li tiu quai trc .
Kt lun: Kim chuyn ha do hi chng Bartter.

TRNG HP 9:
Bnh nhn n 18 tui, nhp vin v yu c,
mt mi, vp b.
Khm lm sng khng ghi nhn g c bit.

Kt qu xt nghim:

pH
pCO2
pO2
HCO3-

in gii mu
135 mEq/l
1,8 mEq/l
0,5 mEq/l (bnh thng 1,12 1,23)
87 mEq/l
1,1 mEq/l (bnh thng 1,5 2,5)
Bnh thng
Bnh thng
Kh mu ng mch
7,49
44 mmHg
98 mmHg
32 mmol/l

Kali
Clo
Canxi
Mg

Nc tiu 24 gi
280 mmol (bnh thng 25 - 125)
620 mmol (bnh thng 110 - 250)
0,11 mmol (bnh thng 2,5 7,5)
26 mmol (bnh thng 2,5 8)

Na+
K+
Ca++ ion ha
ClMg++
BUN
Creatinin

c kt qu kh mu ng mch:
Bc 1: pH = 7,49 kim mu
Bc 2: HCO3- = 32 mm/l > 22 kim
chuyn ha
Bc 3: tnh b ca h hp
PaCO2 d on = (0,7 x 32) + 20 = 42,4
PaCO2 thc t gn bng PaCO2 d on.
KMM: Kim chuyn ha.

KIM CHUYN HA
Nng Clo niu trong chn on kim chuyn
ha
< 20 mmol/L
> 20 mmol/L
ap ng Cl:
e khang Cl:
Non oi, hut dch
Cng Aldosterone
da day
HC Cushing
Dung li tieu gan
ang s dung li
ay
tieu
Sau tang C02
Giam kali mau
nang
Hoi chng Bartter
HC Gitelman

CHN ON NGUYN NHN

nh gi Clo nc tiu: Clo niu 24 gi tng cao
theo di hi chng Bartter hoc Gitelman.
Canxi nc tiu 24 gi gim, magie nc tiu 24
gi tng, magie mu gim nn y l hi chng
Gitelman.
Cc c im v in gii v toan kim ca hi
chng Gitelman ging nh khi dng li tiu
thiazide, do cn loi tr bnh nhn dng li
tiu thiazide trc .
Kt lun: Kim chuyn ha do hi chng
Gitelman.

TRNG HP 10:
Bnh nhn n 21 tui, c pht hin hn m
nm ngoi ng.
Khm:
Bnh nhn m, tm nh, SpO2 82%
Th chm, yu, c lc ngng th ngn.
ng t 2 bn co nh.
Tin cn: khng r.

Kt qu xt nghim:
Kh mu ng mch (BN th kh phng)

pH

7,26

pCO2

58 mmHg

pO2

71 mmHg

HCO3-

25 mmol/l

c kt qu kh mu ng mch:
Bc 1: pH = 7,26 toan mu
Bc 2: pCO2 = 58 mmHg > 40 toan h hp
Bc 3: nh gi h hp cp hay mn
pH/PaCO2 = (7,4 7,26)/(58 40) # 0,008
toan h hp cp
KMM: Toan h hp cp + Gim oxy mu
mc nh.

CHN ON NGUYN NHN

nh gi P(A-a)O2 (chnh p oxy ph nang ng
mch).
PAO2 = FiO2 x 713 PaCO2 x 1,25 = 0,21 x 713 58
x 1,25 = 77 mmHg
P(A-a)O2 = PAO2 PaO2 = 77 71 = 6 mmHg < 20
mmHg (gi tr bnh thng khi th kh tri c
FiO2 21%) P(A-a)O2 thp chng t toan h
hp ch do gim thng kh ph nang. iu ny
c ch trong loi tr vim phi ht, vn thng
gp bnh nhn m.
Kt lun: Toan h hp cp do gim thng kh
ngh do qu liu thuc gy nghin.

TRNG HP 11:
Bnh nhn nam 69 tui, nhp vin v kh th.
3 ngy nay bnh nhn ho, khc m m, kh
th nhiu, ng g.
Tin cn:
Ht thuc l nhiu t tr.
c chn on bnh phi tc nghn mn
tnh 5 nm nay, ang iu tr th oxy ti
nh.

Kt qu xt nghim:
Kh mu ng mch (BN th kh phng)

7,2

pH
pCO2

78 mmHg

pO2

40 mmHg
29.7 mmol/l

HCO3SpO2

87%

c kt qu kh mu ng mch:
Bc 1: pH = 7,2 toan mu
Bc 2: pCO2 = 78 mmHg > 40 toan h
h p
Bc 3: nh gi h hp cp hay mn

pH/PaCO2 = (7,4 7,2)/(78 40) #

0,005 toan h hp cp trn nn
mn.
KMM: toan h hp cp trn nn mn

CHN ON NGUYN NHN

PaO2 = 40 gim oxy mu mc nng
Sp02= 87 Sa02 = ? PaO2 = ?
Nh vy khng ph hp gia Sa02 v PaO2
ly nhm mu tnh mch.
Kt lun: Toan h hp cp trn nn mn
do t cp COPD.

TRNG HP 12:
Bnh nhn 69 tui, t ngt ngng tim mt
thi gian ngn sau phu thut.
Kh mu ng mch c ly 5 pht sau
ngng tim

Kt qu xt nghim:
Kh mu ng mch
pH

6,85

pCO2

82 mmHg

pO2

214 mmHg

HCO3-

14 mmol/l
in gii mu

Na+

136 mEq/l

K+

3,8 mEq/l

Cl-

98 mEq/l

Lactate
1,5 mmol/l)

12 mmol/l (bt 0,4

c kt qu kh mu ng mch:
Bc 1: pH = 6,85 toan mu
Bc 2: pCO2 = 82 mmHg > 40 toan h hp
HC03 gim toan hn hp
Cch khc: nh gi toan h hp cp hay
mn, hay toan chuyn ha + h hp c b
hay khng.
Bc 4: nh gi AG = 136 98 14 = 24
toan chuyn ha tng anion gap.
AG/ HCO3- = (24 12)/(24 14) # 1,2
toan chuyn ha tng AG n thun

CHN ON NGUYN NHN

Toan h hp do ngng th.
Lactat mu tng cao nn ngh toan chuyn
ha ny l do acid lactic (sinh ra do ngng
tim ngng th).
Kt lun: Toan h hp cp phi hp toan
chuyn ha do acid lactic do ngng tim
ngng th.

TRNG HP 13:
Bnh nhn nam 45 tui, nhp vin v au
ngc.
au ngc cp tnh kiu mng phi, sau ho
ra mu.
Tin cn: vim mch mu ang iu tr bng
prednisone 30 mg/ngy.
Khm lm sng ghi nhn mch 110 ln/pht,
nhp th 25 ln/pht, c ting c mng
phi.
V sau bnh nhn c chn on xc nh l
thuyn tc phi

Kt qu xt nghim:
Kh mu ng mch (BN th kh phng)
pH

7,51

pCO2

27 mmHg

pO2

62 mmHg

HCO3-

21 mmol/l

c kt qu kh mu ng mch:
Bc 1: pH = 7,51 kim mu
Bc 2: pCO2 = 27 mmHg < 40 kim
h hp
Bc 3: nh gi h hp cp hay mn
pH/PaCO2 = (7,51 7,4)/(40 27) #
0,008 kim h hp cp

KIM H HP
(PH > 7,45 V PACO2 < 35 MMHG)
Nguyn nhn
Tng thng kh ph nang do hysterie
au, lo u.
Ri lon thn kinh trong chn thng s no, vim no, u
no, tai bin mch mu no.
Bnh h hp: vim phi, thuyn tc phi, suy h hp cp
Sc: sc tim, sc nhim trng, gim th tch tun hon
Ng c aspirine
Hn m gan
Th my iu chnh sai
Thiu oxy mu gy tng thng kh ph nang b tr

CHN ON NGUYN NHN

Kim h hp do:
Bnh l h hp (thuyn tc phi)
Gim oxy mu
au, lo u (?)
Kt lun: Kim h hp cp trn bnh
nhn thuyn tc phi.

TI LIU THAM KHO

1)

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Vn Phc, Chu Ngc Hoa, ch bin. iu tr hc ni khoa. TP H
Ch Minh: NXB Y Hc; 2009. tr. 38-47.

2)

Bi Xun Phc, ng Vn Phc. Kh mu ng mch. Trong: ng

Vn Phc, Chu Ngc Hoa, ch bin. iu tr hc ni khoa. TP H
Ch Minh: NXB Y Hc; 2009. tr. 48-56.

3)

http://www.anaesthesiamcq.com/AcidBaseBook/AB9_6Case2.php

4)

http://www.anaesthesiamcq.com/AcidBaseBook/AB9_6Case20.php

5)

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poisoning: case report of a record-high level and a review. J Emerg
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6)

www.mediplane.com/education/PDF/CS_Salicylate_Toxicity.pdf

7)

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presenting as hypokalemic paralysis. Ann Saudi Med 2007;27:125-7. [
PubMed]

TI LIU THAM KHO

8)

Ram R, Swarnalatha G, Ashok KK, Madhuri HR, Dakshinamurty KV. Fanconi

syndrome following honeybee stings. Int Urol Nephrol 2010. [Epub ahead of
print] [PubMed]

9)

Richardson RM, Forbath N, Karanicolas S. Hypokalemic metabolic alkalosis

caused by surreptitious vomiting: report of four cases. Can Med Assoc J
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10)

Colussi G, De Ferrari ME, Tedeschi S, Prandoni S, Syrn ML, Civati G. Bartter

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11)

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a case report. J Nephrol 2010 ;23(5):617-8. [PubMed]

12)

http://www.cmua.nl/content/SEHLiteratuur/SEH%20literatuurbestanden/
ABG%20-%20monograph%20J%20Holmes.pdf

13)

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14)

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15)

http://www.anaesthesiamcq.com/AcidBaseBook/AB9_6Case9.php

16)

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Y Hc; 1994.tr. 203-204.