..............................................................

:




: : :
90: :
Acid base balance
nephrology

Acid base balance

acid base balance source
pre graduates Post graduates
source

arrhythamias
in capsule series
Acid base balance
Two organs PH
PH ....
Organs PH
Organ .... ... Lung
PH ....
.... PH ....

...
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..............................................................
two organs PH
control
lung Kidney
kidney .... Kidney
PH ..



Lung Lung
respiratory acidosis respiratory alkalosis
kidney Metabolic acidosis metabolic
alkalosis


PH

Acidosis
PH
... CO2




..... CO2
Acidosis
respiration wash CO2
CO2 ..... ... CO2
..
Acidosis stimulation of
..... respiratory centre ... wash of CO2
CO2 ... ..... Acidosis
Alkalosis


Acidosis respiration deep and rapid
2


..............................................................
wash CO2

alkalosis
respiratory centers Inhibition
.. retention of CO2 CO2 ....
.... Alkalosis
Lung respiration
Acid base balance
Acid base balance kidney

acid base balance
kidney


Acid base balance
Acid base balance



4
.... ...


.....

... hydrogen ions

... HCO3 ....

Acid base balance



3


..............................................................
H ions
HCO3



.... lumen tubules
Lumen urine
lumen .... tubules
re absorption secretion
urine... ...
...
.. Urine
Urine !!!!
!!!!


.... re absorption
...
...

..... bicarbonate

reserve alkaline

... Kidney



kidney

.....
4


..............................................................
........
..... ....
..
... ...
.... Hypokalemia ... ...
!!!

arrhythmias


H ions
....
...


hypo kalemia Alkalosis
Hypo kalemia
hypo kalemia alkalosis
hydrogen ions


H ions ...
..

H ions ... ...

: H ions ... Hyper kalemia


Hyper kalemia acidosis

hypo kalemia alkalosis H ions
5


..............................................................
Hyper kalemia Acidosis
) (

H ions

tubules .... H ions .... H ions
toxic ..... tubules tubules
... H ions H ions


toxic tubules tubules



...... NH3 NH3 ....
NH4
NH4 tubules

... NH3 Toxic
tubules



hypo kalemia

HCO3


6


..............................................................

alkalosis
alkalosis


alkalosis
kidney
kidney


kidney

kidney kidney

kidney





kidney


Metabolic alkalosis


kidney
...


7


..............................................................

...



saline

Acid base balance

Metabolic acidosis Metabolic alkalosis
respiratory acidosis respiratory alkalosis

Metabolic Acidosis
metabolic acidosis
kidney respiration

etiology metabolic acidosis
Metabolic acidosis
Chronic renal
failure
H ions retention
acidosis


..............................................................
... acidosis
acidosis acidosis
diabetic keto acidosis
keton bodies
acteo acetic acid
.... heart failure
Heart failure acidosis
heart failure Low cardic out put
Anemia shock
Heart failure Low cardic out put
Low cardic out put ischaemia
ischaemia Hypoxia
hypoxia

Metabolism an aerobic pathway
an aerobic pathway lactic acid
acid

Heart failure acidosis

Ischaemia Hypoxia Hypoxia
an aerobic pathway an aerobic pathway ....lactic acidosis
diabetes Lactic acidosis

tissue hypoxia lactic acidosis
...
diarrhea
diarrhea ... alkali
....
acute tubular acidosis renal tubular acidosis


... Isolated defect
Kidney .... kidney kidney

9


..............................................................


defect Isolated defect

H ions
acidosis



Hyper kalemia
hyper kalemia acidosis


etiology
clinical picture
investigation
treatment

clinical picture

clinical picture

clinical picture of the cause
clinical picture of the cause


Metabolic
acidosis

chronic renal failure nephrology
Diabetic keto acidosis endocrine
Heart failure cardiology
Diarrhea GIT
10


..............................................................
Isolated tubular acidosis

clinical picture of the cause
differential diagnosis

clinical pictures
PH

... hyper ventilation
acidosis Hyper ventilation
... hyper ventilation
Hyper ventilation rapid deep respiration
CO2 .... Wash of CO2

Investigations


...
Acid base balance

.... PH
PH .... acidosis
alkalosis ....
Metabolic respiratory PH
....
CO2 HCO3


) (
CO2
PH HCO3 CO2

HCO3 Normal
11


..............................................................
%100 Lung

CO2 normal kidney

...... Lung
CO2 ......... HCO3


Metabolic acidosis PH
.... HCO3 ... Metabolic HCO3
.... acidosis HCO3
CO2 ... Metabolic .... CO2 normal

CO2 .... Normal
compensation

CO2 .... CO2

.... Kidney CO2 compensation

PH .... HCO3
CO2 Normal
compensation CO2

PH .... HCO3 ....
Metabolic
Metabolic acidosis
Metabolic alkalosis
... CO2 metabolic acidosis
... kidney CO2 Normal

.......
.... compensation compensation
compensation CO2 ..... wash of CO2 CO2
.... compensation
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..............................................................
HCO3

PH HCO3
CO2

.... PH PH H
... .... HCO3
HCO3 .... C CO2 HCO3

..... ...

acidosis hyper kalemia
... hypo kalemia alkalosis alkalosis Hypo
kalemia
hyper kalemia acidosis acidosis Hyper kalemia
acidosis
acidosis

acidosis H ....
.....



H
....
... H ions

....
Parallel to each other

13


..............................................................

H ions
... H ions

....

acidosis Hyper kalemia Hyper
kalemia acidosis

acidosis hyper kalemia
hyper kalemia acidosis
alkalosis Hypo kalemia
Hypo kalemia alkalosis



Investigations
investigations for the cause
...
chronic renal failure Diabetic keto acidosis heart failure



differential diagnosis





treatment
treatment

14


..............................................................
treatment
.. ... treatment .N.B
treatment of metabolic
acidosis
.N.B

.N.B


treatment of the cause .....

chronic renal failure
Diabetic keto acidosis ....
.... acidosis
NaHCO3
NaHCO3
.N.B
.N.B .... chronic renal failure
... Metabolic acidosis
.... acidosis

tetany
acidosis chronic renal failure
NaHCO3

chronic renal failure Hypo calcemia
acidosis
tetany ..... hypo calcemia acidosis

non ionized calcium Ionized calcium

...
... ... acidosis
hypo calcemia tetany

15


..............................................................
chronic renal failure NaHCO3
Calcium

..... .N.B metabolic acidosis DKA

DKA endocrine
saline
precipitating factors
DKA not essential

Logic diabetic keto acidosis
acidosis bicarbonate
essential
acidosis

diabetic keto acidosis
... acidosis
sever alkalosis
alkalosis alkalosis alkalosis

diabetic keto acidosis alkalosis

essential
sever
diabetic keto acidosis bicarbonates
are not essential
metabolic acidosis

metabolic alkalosis
Metabolic acidosis


source
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..............................................................
metabolic alkalosis
etiology
metabolic alkalosis
....
Metabolic alkalosis ...
.....
...

......
..... gastroectomy
.... Metabolic alkalosis
hypo kalemia
.....
alkalosis
Metabolic alkalosis
vomiting , gastroectomy Hypo kalemia hypo
kalemia endocrine Hypo kalemia
cushing conn's diuretics aspiration
etiology

clinical pictures
clinical pictures

pictures of the cause cushing conn's

... Metabolic alkalosis
tetany ........
.... tetany ca hypo para
thyroidism
.... tetany ...


17


..............................................................
metabolic alkalosis
metabolic alkalosis tetany
tetany normo calcemic tetany
.... Normo calcemic tetany
tetany Mg alkalosis
see endocrine
tetany
metabolic alkalosis tetany
Metabolic alkalosis
Investigations

........ PH
..... HCO3
.... CO2
PH alkalosis
HCO3 metabolic alkalosis
CO2 normal alkalosis .... CO2

........ .... alkalosis....

alkalosis hypo kalemia
acidosis hyper kalemia
alkalosis
Investigations for the cause......

treatment

kidney

18


..............................................................
Respiratory acidosis
respiratory acidosis
respiratory acidosis chest kidney
... respiratory acidosis acidosis
CO2
CO2 retention
CO2 retention ...
.... hypo ventilation wash .... CO2 CO2
alkalosis
respiratory acidosis
Hypo ventilation
chest
chest COPD type 2 Blue bloter
type 2 COPD hypo
ventilation
type 2
investigations
...... COPD
....

... COPD
... respiratory acidosis

respiratory alkalosis
dyspnea
dyspnea dyspnea

dyspnea
respiratory alkalosis
respiratory alkalosis CO2 wash
CO2 wash CO2 Hyper ventilation
hyper ventilation dyspnea
dyspnea chest dyspnea
cardiology left sided heart
failure Pulmonary congestion pregenant
19


..............................................................
female ascites dyspnea
respiratory alkalosis

clinical picture
clinical picture of the cause and tetany

dyspnea
tetany

**** !!!!!
"..... ,
" *****

20