INTERPERTAION 1 MSc Exam Preparation Workshop What do you know about PH? What do you know about PH? How to maintain normal PH? How to maintain normal PH? What do you know about buffers? What do you know about buffers? What do you know about the anion gap ? What do you know about the anion gap ? What is the classification of ABD & Normal ABG ? What is the classification of ABD & Normal ABG ? MSc Exam Preparation Workshop Diet & CO2 Dissociation in water H+ Acid Base State Body enzymes (Need optimal PH for work) PH Optimal PH is maintained by chemical & systemic buffers MSc Exam Preparation Workshop e Phosphate& cytocolic proteins BODY CELL BODY CELL Hco3- Hco3- Extracellular environment BONE 1 2 3 MSc Exam Preparation Workshop ACIDOSISALKALOSIS HCO3 (Metabolic) CO2 (resp ) HCO3 (metabolic) PCO2 (Respiratory) Co2 wash (lung ) Hco3 (kid ) PCO2 (LUNG) HCO3 (Kid) Compensation Lesion MSc Exam Preparation Workshop + _ + _ Solution Plasma Anion gap Due to un measured anion in plasma Anion gap =( Na+K )-(HCO3+CL) Na & K Hco3 & cl MSc Exam Preparation Workshop PH : PaCO2: mmHg PaO2: mmHg Hco3 : meq\l 2 MSc Exam Preparation Workshop ACIDOSISALKALOSIS HCO3 (Metabolic) CO2 (resp ) HCO3 (metabolic) PCO2 (Respiratory) MSc Exam Preparation Workshop Primary Metabolic Acidosis Predicted CO2 = 1.5 Hco3 + 8 Primary Respiratory Acidosis (Acute) Every 10 mmHg rise of CO2 HCO3 by 1 meq\l Primary Respiratory Acidosis (Chronic ) Every 10 mmHg rise of CO2 HCO3 by 3.5meq\l Metabolic alkalosis Predicted CO2 = (HCO3m - HCO3n) MSc Exam Preparation Workshop Identify primary ABD Look to PH, HCO3 & PaCO2 Identify primary ABD Look to PH, HCO3 & PaCO2 Acidosis Alkalosis Metabolic respiratory 1.5 Hco3 +8 Pure or mixed 1.5 Hco3 +8 Pure or mixed ANION GAP NAG Diarrhea RTA NAG Diarrhea RTA WAG Exogenous (salicylate ) Endogenous ( lactic acidosis) DKA OA gram negative sepsis Defective renal excretion of acids WAG Exogenous (salicylate ) Endogenous ( lactic acidosis) DKA OA gram negative sepsis Defective renal excretion of acids Every 10mmhg of paco2 HCO3 1 (acute), 3.5 (chronic ) COMPENSATION Metabolic respiratory Chronic vomiting Diuretic therapy Bartter syndrome Mineralocorticoid excess Chronic vomiting Diuretic therapy Bartter syndrome Mineralocorticoid excess CNS depression Neuromuscular Upper & lower airway obstruction Exudate in alveoli (pneumonia) Surfactant deffeciency CNS depression Neuromuscular Upper & lower airway obstruction Exudate in alveoli (pneumonia) Surfactant deffeciency PH PH HCO3Paco2 HCO3PaCO MSc Exam Preparation Workshop A 10 months old baby admitted with sever diarrhea Ph : 7.12 Paco2 : 25 Hco3 : 12 s.Na : 142 s.k: 3.6 s.cl: 115 Ph : 7.12 Paco2 : 25 Hco3 : 12 s.Na : 142 s.k: 3.6 s.cl: 115 Comment on his ABG & Suggest the cause of the ABD MSc Exam Preparation Workshop A 13 years old girl known to be diabetic admitted with letheragy, vomting,acidotic breathing, & tachycardia bp 100/60, Ph : 7.28 Paco2 : 34 Hco3 : 18 s.Na : 140 s.k: 3.5 s.cl: 100 RBS: 385 Positive ketone bodies in urine Ph : 7.28 Paco2 : 34 Hco3 : 18 s.Na : 140 s.k: 3.5 s.cl: 100 RBS: 385 Positive ketone bodies in urine the girl was treated with 0.9 NS, insulin after 3 hours the child is still lethsrgic,patient devlop bilateral cerpitaion & bp measured and became 150\90. and Ph : 7.18 Paco2 : 26 Hco3 : 12 s.Na : 141 s.k: 4.5 s.cl: 100 RBS: 385 Negative ketone bodies Ph : 7.18 Paco2 : 26 Hco3 : 12 s.Na : 141 s.k: 4.5 s.cl: 100 RBS: 385 Negative ketone bodies What is the ABD & Possible cause? What is your next investigation do you want to do ? MSc Exam Preparation Workshop An 8 month old infant was noted to be failing to thrive, the baby admitted for clinical observation, urine was collected for 24 hrs and was 3.7ml/kg/h,the ABG data were. Ph : 7.21 Paco2 : 27 Hco3 : 13 s.Na : 140 s.k: 3.5 s.cl: 115 Ph : 7.21 Paco2 : 27 Hco3 : 13 s.Na : 140 s.k: 3.5 s.cl: 115 What is the ABD & Possible cause? MSc Exam Preparation Workshop 4 weeks old infant admitted with forceful vomiting from 15 th day of life with dehydration, the ABG data were as the following Ph : 7.55 Paco2 : 48 Hco3 : 40 s.Na : 135 s.k: 2.9 s.cl: 81 Ph : 7.55 Paco2 : 48 Hco3 : 40 s.Na : 135 s.k: 2.9 s.cl: 81 What is the ABD & Possible cause? What you well do to confirm your diagnosis? MSc Exam Preparation Workshop 7 years old asthmatic child, was admitted with exacerbation of wheezy chest, the ABG WAS Ph : 7.22 Paco2 : 80 Pao2: 75 Hco3 : 33 Ph : 7.22 Paco2 : 80 Pao2: 75 Hco3 : 33 What is the ABD & Possible cause? What is the proper action to correct the ABG?