Metabolic acidosis and alkalosis -

Metabolic acidosis and alkalosis

1. بسم الله الرحمن الرحيم Ahmad A. Al-Qudah Supervision : Dr. Saleem Bani Hani Metabolic Acidosis & Alkalosis

2. Metabolic Acidosis & Alkalosis Terms And Definitions Acid – Base Balance ( Regulation ) Acid – Base Disorders ( Acidosis & Alkalosis ) Metabolic Acidosis Metabolic Alkalosis Measurements References

3. Terms And Definitions Acid : substance that can yield Hydrogen ion Strong Acid pH < 3.0 Base : substance that can yield Hydroxyl ion Strong Base pH > 9.0 pH : terms that we use to describe the level of Acidity and Basicity of Aq. Solution .

4. Acid – Base Balance Maintenance of Hydrogen ion concentration in the ECF ( Extracellular Fluid ) within the Normal Range . - Normal Range : 36 – 44 nmol /L - pH : 7.35 – 7.45 ( Slightly Alkaline ) ACID BASE

5. Acid – Base Balance ( Regulation ) How the Body maintain the Hydrogen ion concentration Lung Buffer System ( Carbonic Acid , Bicarbonate ) - Henderson Equation

6. Acid – Base Balance ( Regulation ) How the Body maintain the Hydrogen ion concentration Kidney - Regulate by excreting Acid (Hydrogen ion) and reclaiming Bicarbonate . Reclaiming Bicarbonate from glomerular filtrate . Hydrogen ion combined with ammonia and excreting as Ammonium .

7. Acid – Base Disorders ( Acidosis & Alkalosis ) Acidosis : Increase in Acids [ Hydrogen ion ] --> Decrease in pH Alkalosis : Decrease in Acids [ Hydrogen ion ] -- > Increase in pH ACID BASE BASE ACID

8. Metabolic Acidosis is a metabolic condition that occurs when the body produces too much acid or when the kidneys are not removing enough acid from the body . Because of the decrease in Bicarbonate level . Shift to Right Bicarbonate Hydrogen ion

9. Metabolic Acidosis Anion Gap Is the difference between plasma cations and anions . Help in diagnosis of Metabolic Acidosis . ( 10 – 18 mmol / L ) - Causes of Metabolic Acidosis with increased AG : Lactic Acid ( Hypoxia ) Urate ( Renal Failure ) Drugs / Toxins Ketones ( DM , Alcohol ) Lactic Acid ( Hypoxia ) Urate ( Renal Failure ) Drugs / Toxins Ketones ( DM , Alcohol ) Athletes , a lot of exercise , muscles Lactic Acid builds up … mild , should rest. Lactic Acid ( Hypoxia ) Urate ( Renal Failure ) Drugs / Toxins Ketones ( DM , Alcohol ) Is the difference between plasma cations and anions . Help in diagnosis of Metabolic Acidosis . ( 10 – 18 mmol / L ) - Causes of Metabolic Acidosis with increased AG : - IDDM , Fatty acids break down , A CoA , Ketone bodies .

10. Metabolic Acidosis Causes of Metabolic Acidosis with Normal AG : - Acids ingestion - Drugs - Renal tubular Acidosis - Diarrhea Body start compensate to Metabolic Acidosis through Hyperventilation . Secondary Compensation , Kidney begins to correct the ratio by reclaiming Bicarbonate .

11. Metabolic Alkalosis is a metabolic condition in which the pH is elevated beyond the normal range as a result of increased bicarbonate concentration, leading to decreased hydrogen ion concentration. Shift to Left Bicarbonate Hydrogen ion

12. Metabolic Alkalosis Causes of Metabolic Alkalosis : - Vomiting ( loss of Acids ) - Diuretics - Ingestion of Base - Massive Blood Transfusion ( Citrate ) Body start compensate to Metabolic Alkalosis through Hypoventilation .

13. Measurements The Calculation of Bicarbonate concentration is based on the Henderson Equation , when pH and pCO 2 are known . Blood Gas Analyzer use electrodes ( electrochemical sensors) . Known Known

14. KAUH ABG Analyzer : Cobas b 221 . ABG + Electrolytes . Capillary , Syringe Whole Blood , Serum , Plasma Normal Ranges : pCO 2 : 35 – 45 mmHg pH : 7.35 – 7.45 Bicarbonate : 22 – 26 mmol /L

15. References Clinical Chemistry Techniques , Principles , Correlations 6 th Edition . Color Atlas of Biochemistry Second edition. http://wiki.answers.com http://www.clevelandclinicmeded.com/medicalpubs/micu/metabolicacidosis.htm Lecture Notes in clinical chemistry-1 . ( Dr. Saleem Bani Hani )

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