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Acid/base
Respiratory
Acidosis
Metabolic
Alkalosis
Metabolic
Acidosis
Respiratory
Alkalosis
BE = 0
HCO3 = 24
7.4
ABG Rules
Rule 1: An increase or decrease in PaCO2 of
10 mm Hg, respectively, is associated with a
reciprocal decrease or increase of 0.08 pH
units.
Rule 2: An increase or decrease in [HCO3-]
or 10 mEq/L respectively is associated with
a directly related increase or decrease of
0.15 pH units.
Acidosis
pH < 7.2
decreased responsiveness to catecholamines
cardiac dysfunction
arrhythmias
increased potassium serum levels
RESPIRATORY ACIDOSIS
Increased pCO2 and pH below 7.35 due to
hypoventilation, emphysema etc.
Compensation occurs in the kidney through
increased H+ excretion and HCO3reabsorption. Bicarbonate/carbonic acid ratio
is 10-15:1.
RESPIRATORY ALKALOSIS
Hyperventilation due to O2 deficiency, CVA, or
anxiety are causes of respiratory
alkalosis. Renal compensation occurs by
decreasing H+ excretion and HCO3reabsorption.
H+ is reabsorbed. Bicarbonate/carbonic acid
ratio is 30-40:1.
METABOLIC ACIDOSIS
Due to loss of HCO3- by diarrhea,
ketoacidosis, keto acids from a high protein
diet,
high stomach acidity, anaerobic fermentation,
and renal disease. Compensation
occurs by an increase in respiration rate.
Bicarbonate/carbonic acid ratio is 10-15:1.
METABOLIC ALKALOSIS
Increased intake of antacids, low protein/high
vegetable diet, and vomiting/loss of
HCl are common causes. Compensation is by
hypoventilation. Bicarbonate/carbonic
acid ratio is 35:1.
Case Studies
KASUS
Anak 2 tahun, didiagnosis sebagai Meteorismus
akibat komplikasi dari Diare Akut dengan gangguan
elektrolit darah. Dasar diagnosis dari anamnesis
muntah, mencret dan kembung. Pada pemeriksaan
fisik tampak abdomen membuncit, tidak terdengar
bising usus. Gambaran soal berikut ini adalah hasil
laboratorium penunjang yang diambil dari darah
pasien. Yang mana hasil pemeriksaan dibawah ini
yang sesuai dengan kondisi diatas:
Hasil Laboratorium
pH
Serum
Na
K+
ClHCO3(meq/L) (meq/L) (meq/L) (meq/L)
(A) 7,25
(B) 7,35
(C) 7,50
(D) 7,45
(E) 7,32
128
130
130
140
140
5,8
2,8
3,6
4,0
3,0
88
90
88
100
112
16
21
34
22
18
Lanjutan kasus 1
Follow up 4 jam setelah di Rumah Sakit:
Pasien lelah (fatigue), sesak nafas (pernafasan
Kussmaull), Cuping Hidung, muntah.
Hasil AGD:
pH: 7,1 Asidosis, HCO3: - 25 Metabolik
Penanganan: Koreksi dg Bicnat
Alkalosis Metabolik
Overventilation pada kasus gagal nafas
Alkalosis
Klinis sama dg asidosis metabolik
Curah jantung menurun, depresi ventilasi
sentral
METABOLIC ALKALOSIS:
Metabolic alkalosis represents an increase in
[HCO3 -] with a compensatory rise in pCO2.
Differential Diagnosis
In two basic categories of diseases the kidneys
retain [HCO3 -]
They can be differentiated in terms of
response to treatment with sodium chloride
and also by the level of urinary [Cl-] as
determined by ordering a Spot,or random
urinalysis for chloride (UCl).
Differential Diagnosis
1. Neuromuscular Abnormalities with Ventilatory Failure
2. Central Nervous System Drugs, Sedative,,Central sleep apnea
3. Airway Obstruction
a. Chronic (COPD)
b. Acute (asthma)
c. Upper airway obstruction
d. Obstructive sleep apnea
4. Thoracic/Pulmonary Disorders
a. Bony thoracic cage: Flail chest, kyphoscoliosis
b. Parenchymal lesions: Pneumothorax, pulmonary edema,
c. Large pleural effusions
d. Scleroderma
e. Marked obesity (Pickwickian syndrome)
RESPIRATORY ALKALOSIS:
Respiratory alkalosis is a primary fall in pCO2
with a compensatory decrease in plasma
[HCO3 -].
Respiratory alkalosis occurs with increased
alveolar ventilation.
Differential Diagnosis
1. Central stimulation
a. Anxiety, hyperventilation syndrome, pain
b. Head trauma or CVA with central neurogenic hyperventilation
c. Tumors
d. Salicylate overdose
e. Fever, early sepsis
2. Peripheral stimulation
a. PE
b. CHF (mild)
c. Interstitial lung disease
d. Pneumonia
e. Altitude
f. Hypoxemia:
3. Miscellaneous
a. Hepatic insufficiency
b. Pregnancy
c. Progesterone
d. Hyperthyroidism
e. Iatrogenic mechanical overventilation
Anak 2 tahun, didiagnosis sebagai Meteorismus akibat komplikasi dari Diare Akut dengan gangguan elektrolit darah. Dasar diagnosis d
Respiratory
Acidosis
Respiratory
Alkalosis
Metabolic
Acidosis
Metabolic
Alkalosis
Plasma PH
Plasma PCO2
Plasma HCO3
Questions?