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This lecture was conducted during the Nephrology Unit Grand Ground by a Sub- intern under Nephrology Division, Department of Medicine in King Saud University.

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Presentation on theme: "This lecture was conducted during the Nephrology Unit Grand Ground by a Sub- intern under Nephrology Division, Department of Medicine in King Saud University."— Presentation transcript:

1 This lecture was conducted during the Nephrology Unit Grand Ground by a Sub- intern under Nephrology Division, Department of Medicine in King Saud University. Nephrology Division is NOT responsible for the content of the presentation for it is intended for learning and /or education purpose only.

2 HOW TO APPROACH PATIENTS WITH ACIDOSIS Hadeel Salah Al Jamei

3 Definitions Brief Physiology Etiology Presentation Of The Patient How To Approach The Patient Investigations Treatment OUTLINE

4 Acid, Acidosis, Acidemia? pH? Base, Alkalosis, Alkalemia? pH? DEFINITIONS

5 Buffer Systems (Buffer + H +  HBuffer) Bicarbonate exatracellular CO 2 + H 2 O  H 2 CO 3 H 2 CO 3  H + + HCO 3 - Phospahte exatracellular Protiens intracellualr Respiratory Systems Hypoventilation vs. hyperventilation Renal System MEANS OF REGULATING H +

6 CAUSES OF ACIDOSIS Causes Of Acidosis RespiratoryAcuteChronicMetabolic Normal Anion Gap Increased Anion Gap What is the anion gap? How to calculate it? [Na + ] – [HCO 3 - ] – [Cl - ]

7

8 SIGNS AND SYMPTOMS Hx is V.IMP

9 Renal compensation Respiratory compensation respiratory Metabolic Alkalosis Acidosis pH Arterial blood sample Metabolic respiratory Respiratory compensation Renal compensation pH < 7.35 pH > 7.45 HCO 3 - < 22 HCO 3 - > 26 PCO 2 > 45 HCO 3 - > 26 PCO 2 < 35

10 OTHER MODALITIES OF INVESTIGATIONS Metabolic Anion gap serum chemistry Urinalysis Ketone levels Lactate levels Salicylate levels ECG Respiratory Chest X-ray Ct scan Drug toxicology CT scan MRI PFTs EMG NCV

11 TREATMENT Metabolic Acidosis Treat the underlying cause NaHCO3 Respiratory Acidosis Treat the underlying cause PharmacologicalOxygen Ventilatory support ABC and Vitals

12 History Is Important Acidemia Or Alkalemia Respiratory Or Metabolic If respiratory: acute or chronic If metabolic: normal or increased anion gap? Is There A Compensation? SUMMARY

13 Acidosis App

14 Qx Calculate App

15

16 Textbook of medical physiology by Guyton and Hall 11 th edition Pocket medicine by marc sabatine 4 th edition. Step up to medicine 2 nd edition. overview#a s/Approach%20to%20the%20patient%20with%20metabolic% 20acidosis.htm me.html REFERENCES


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