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Metabolic acidosis

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acid base imbalance

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Metabolic acidosis

  1. 1. 1. Acid Base Imbalance By: Dr. Ismah Haron References: Oxford Handbook of Clinical Medicine & Wiki 06/08/2014 1
  2. 2. Interpretation pH <7.35: Acidosis <PCO2: Metabolic >PCO2: Respiratory >7.45: Alkalosis >HCO3 -: Metabolic <HCO3 -: Respiratory 06/08/2014 2
  3. 3. Anion gap • To know the cause of acid base imbalance • Anion gap = (Na+ + K+) – (Cl- + HCO3 -) • Normal level: 10 – 18 mmol/L 06/08/2014 3
  4. 4. Metabolic acidosis • Large anion gap (MUDPILES) - M-Methanol - U-Uremia; chronic renal failure - D-Diabetic ketoacidosis - P-Propylene glycol - I-Infection, Isoniazid, Inborn errors of metabolism - L-Lactic acidosis - E-Ethanol - S-Salicylates • Normal anion gap - RTA, diarrhea/vomiting, Addison’s disease, pancreatic fistula, acetazolamide • Small anion gap - Hypoalbuminemia e.g. in CLD, nephrotic syndrome 06/08/2014 4
  5. 5. Metabolic alkalosis • Vomiting • Hypokalemia • Burns 06/08/2014 5
  6. 6. Respiratory acidosis • Type II respi failure - lung/neuromuscular cause - E.g. in COPD, GBS, flail chest, pul fibrosis - Exhaustion in asthma, pneumonia, pul edema  respi arrest 06/08/2014 6
  7. 7. Respiratory alkalosis • HYPERVENTILATION - Stroke, anxiety, pregnancy, subarachnoid bleed 06/08/2014 7
  8. 8. Compensated acid base imbalance 1. Evaluate pH—is it normal? Yes 2. Next evaluate pCO2 & HCO3 • pH normal + increased pCO2 + increased HCO3 = compensated respiratory acidosis • pH normal + decreased HCO3 + decreased pCO2 = compensated metabolic acidosis
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  11. 11. 2. Oxygen delivery method Device Oxygen flow rate Oxygen percentage Nasal prong 1 – 4 L/min 24 – 35% Simple face mask 5 – 10 L/min 40 – 60% High flow mask 10 – 15 L/min Almost 100% 06/08/2014 11
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  13. 13. 3. Diabetes Mellitus Type 2 Source: QRManagementofType2DiabetesMellitus.MinistryofHealth,Malaysia.2009. 06/08/2014 13 HOW TO DIAGNOSE?
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  17. 17. THANK YOU  06/08/2014 17

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