????a a?t???a??? a?

1
????a a?t???a??? a?µat??

• ?a???? ????a??e??
• ?p??????? ?a????t??

2

• ? ??? st????eta? st?? ??a??t?ta t?? ???a??sµ?? ?a
  ???µ??e? t?? ??e?ßas??? ?s????p?a
• ???ad? ?a ap?ß??e? t?? pe??sse?a ????? p??
  pa?????ta? ap? t?? µetaß???sµ? ?a? ?a a?t????pe?
  t?? d?ata?a??? p?? ?fe????ta? se ??s? ? t?a?µa
  ß??ß?
• ? f?s???????? ??tta???? ?e?t?????a d??s?
  e???µ?? e?asfa???eta? ap? t?? d?at???s? e???
  f?s????????? e????? pH.
• ?a???????? pH ep??e????? t?? f?s????????
  ?e?t?????a t?? d?af???? e???µ??

3
?p?d?as? t?? pH st?? d?ast????t?ta t?? e???µ??
4

• F?s???????? pH e?a?t?ta? ap? t?? f?s????????
  ?e?t?????a t?? a?ap?e?st???? (p?e?µ??e?) ?a? t??
  µetaß?????? (?ef???) st???e??? p?? a?t????p???
  t?? µetaß???? t?? pH p??? t?? µ?a ? t?? ????
  ?ate????s?.
• ?? ?? p?e?µ??e? de? ?e?t??????? ?ata???t?s? CO2
  (???) ? pt?s? t?? pH (????s?) ? ?ef??? ap?ß???
  ????? (H) ??a d?????s? t?? pH
• ?? a?t????p?st???? µ??a??sµ?? e??a? pepe?asµ????
• ?a?? t?? d?????s? t?? pH µe t??? a?t????p?st?????
  µ??a??sµ???, ? ?p??e?µe?? p???s? µp??e? ?a
  ep?µ??e? ?a? µp??e? ?a apa?te? ?at???? pa??µßas?

5

• ? µ?t??s? t?? ae???? a?µat?? ?a? ? s?s??t?s? µe
  ??????? st???e?a t?? as?e???? µp????µe ?a
  e?t?µ?s??µe t?? ??a??p???t??? ?e?t?????a t??
  µ??a??sµ?? t?? ??e?ßas???? ?s????p?a?.

6

• ??e?µ??e?
• S?µµet????? st?? ??e?ßas??? ?s????p?a µe t?
  ???µ?st??? s?st?µa t?? d?tta???a?????
• (H2CO3-) ? (CO2) p?? ap?ß???eta? ap? t???
  p?e?µ??e?
• ???? ep?peda (H2CO3-) ?d????? se a???s? t??
  s????t?ta? ?a? t?? ß????? t?? a?ap???? ?ste ?a
  ap?ß???e? ? (CO2) ap? t??? p?e?µ??e?.

7
??ap?e?st??? S?st?µa

• ??a se µe???? ?ept?
• ? ??ap??? ? CO2 ? H
• ? ??ap??? ? CO2 ? H
• CO2 ? H

8

• ?ef???
• ?? ?ef??? s?µµet????? st?? ??e?ßas??? ?s????p?a
  ?ste ?a d?at????e? f?s????????? ? ????? carbonic
  acid/bicarbonate µe ap?ß??? ? epa?a???f?s?
  d?tta???a????? ? µe pa?a???? d?tta???a????? a?
  e??a? a?a??a??
• ?? ?ef??? ep?s?? ß?????? st?? ap?ß??? ????? p??
  de? µetat??p??ta? se a???a µ??f? ?ste ?a
  ap?ß?????? µe ?? a?ap???

9
?ef???

• ????? ap? ??e? se ?µ??e?
• ?pa?a??f?s? HCO3-
• ?p?????s? H
• ?p?????s? aµµ???a?

10
? e??s?s? Henderson-Hasselbalch (1916)
11
???s?s? Henderson-Hasselbalch

• pH pKa log ß?s? / ???
• pH pKa log HCO3- / CO2
• p?
• 6.1 log 24 / 1.2
• 6.1 1.3
• 7.40
• S?µa?t???? ? ????? HCO3- CO2 20 / 1

12
pH d?af???? ??s???

• 0 HCL
• 1 Gast???? ???
• 2 ??µ?? ?eµ?????
• 3 ??d?, µp??a
• 4 ?t?µ?te?
• 5 ?a???? ?af??
• 6 ???a
• 6.5 S????

• 7 ??µa
• 8 Ta?ass??? ?e??
• 9 ?a?e????? s?da
• 10 Great Salt Lake
• 11 ?µµ???a
• 12 ??tta???a????
• 13 ?a?a??st??? f??????
• 14 NaOH

13
F?s????????? t?µ?? ABGs
??t???a?? F?eß???
pH 7.40 (7.35-7.45) 7.36 (7.32-7.38)
H nEq/L 40 (35-45) 46 (42-48)
PCO2 mm Hg 40 (35-45) 46 (42-50)
HCO3 mEq/L 24 (22-26) 25 (23-27)
PO2 mm Hg 80-100 40
SO2 gt90 75
14
(No Transcript)
15
F?s????????? t?µ??

• pH 7.35-7.45
• pCO2 35-45 mm Hg
• HCO3 21-28 mEq/L
• pO2
• ??????e? 80-100 mm Hg
• ?e???? 60-70 mm Hg
• SaO2
• ??????e? gt 95
• ?e???? 40-90
• Base excess 2 mEq/L

16
??t???a?? a?µa

• pH 7.35-7.45
• pCO2 35-45 torr
• pO2 gt79 torr
• ?CO3 23-30 mmol/L
• Base Excess/Deficit 3 mEq/L
• SO2 gt94

17

• pH 7.35 - 7.45
• ??t?? t?? ??e?ßas???? ?s????p?a? (s?????t??s?
  ???t?? ?d???????)
• pO2 60-90
• ??t?? t?? µe????? p?es?? t?? ??????? st?
  a?t???a?? a?µa
• pCO2 35-45
• ??t?? t?? µe????? p?es?? t?? d???e?d??? st?
  p??sµa, µ?t?? t?? ?at? ?ept?? ae??sµ??,
  ???µ??eta? ap? t?? ae??sµ?, a?a??? t?? ?at?stas?
  t?? a?ap?e?st???? ??e?ßas???? ?s????p?a?
• HCO3 22-26
• ??t?? t?? e?e??e??? d?tta???a????? st? a?µa
  a?a??? t?? µetaß????? ??e?ßas??? ?s????p?a p??
  ???µ??eta? ap? t??? ?ef????
• BE (-2) - (2)
• ?e???e? t?? p?s?t?ta t?? ????? ? t?? ß?s?? p??
  apa?te?ta? ??a ?a ?µa??p????e? t? st? f?s????????
  pH ??t? ap? ???sµ??e? s?????e?
• O2Sat 96-100
• ?e???e? t? p?s?st? t?? a?µ?sfa?????? p?? e??a?
  desµe?µ??? µe t?? Hgb

18
???????µ??

• ???????µ?? a???????s?? a????s?? ae????
  a?t???a??? a?µat??.
• 1. pH ????s? ? a?????s?
• ????s? lt 7.35
• ??????s? gt 7.45

19
???????µ??

• 2. ?? t? pH e??a? pa????????, p??a e??a? ? a?t?a
  a?ap?e?st??? ? µetaß????? (?ef???)
• ?? ? paCO2 s?et??eta? µe t?? µetaß??? t?? pH,
  t?te t? p??ß??µa e??a? a?ap?e?st???
• ????s? ? ???? CO2
• ??????s? ? ?aµ??? CO2
• ?? ta HCO3- (ß?s? ? "alkali") s?et??eta? µe t?
  pa???????? pH, t?te t? p??ß??µa e??a? µetaß?????
• ??????s? ? ???? HCO3-
• ????s? ? ?aµ??? HCO3-

20
???????µ??

• 3. ???e? e??a? ?? t?µ?? t?? paCO2 ? HCO3- p?? ???
  s?et????ta? µe t? pH.
• ?? ?? t?µ?? e??a? f?s?????????, t?te de? ?p???e?
  a?t????p?st???? µ??a??sµ??
• ?? de? e??a? f?s????????? a??? t? pH pa?aµ??e?
  pa????????, t?te ?p???e? µe???? a?t????p?s?
• ?? e??a? f?s????????? ?a? t? pH f?s????????, t?te
  ?p???e? p????? a?t????p?s?

21

• ?a 6 ß?µata ??a t?? a????s? t?? ABG
• ???a? t? pH f?s?????????
• ???a? t? CO2 f?s?????????
• ???a? ta HCO3 f?s?????????
• ???a? t? CO2 ? ta HCO3 pa??????a µe t?? µetaß???
  t?? pH?
• ???a? t? CO2 ?a? ta HCO3 st?? a?t??et? ?ate????s?
  µe t?? µetaß??? t?? pH?
• ???a? t? pO2 ?a? t? SaO2 f?s?????????

22
????s?
23
??????s?
24
?a???e? p?? p??pe? ?a ??µ?µaste

• ? PaCO2 ?at? 10 mmHg ? ? 1 meq/L HCO3P
• ? PaCO2 ?at? 10 mmHg ? ? 2 meq/L HCO3P

25
(No Transcript)
26
???????µ?? ???
27
(No Transcript)
28
?a?ade??µata

• 28 et?? ???a??a, ?st????? d?ata?a??? pa?????
• ?a???s???eta? st? ??? ?a? pa?ap??e?ta? ??a
  d?sp???a
• ?????a ?pe?ae??sµ?? ?a? d?s???e?a?
• ABG
• pH 7.52
• paCO2 28 mmHg
• HCO3- 24 mEq/L
• pH gt 7.45 a?????s?
• paCO2 lt 35 ta??p???a, ap?ß??? d???e?d??? (???)
• HCO3- f?s????????.
• ??ap?e?st??? a?????s?

29
?a?ade??µata

• 80 et?? ??d?a?, ?st????? ???
• ??sp???a ?a? ???a???? ?????
• ABG
• pH 7.24paCO2 65 mmHgHCO3- 24mEq/L
• pH lt 7.35 ????s?
• paCO2 gt 45 a?epa???? ae??sµ?? (?p?ae??sµ??)
• HCO3- f?s???????? (de? ?p???e? a?t????p?s?)
• ??ap?e?st??? ????s?

30
?a?ade??µata

• ?f?ß?, µ???? ad??aµ?a t??
• ???ta se d?a?ta, ad??at?
• ABG
• pH 7.50paCO2 37HCO3- 30
• pH gt 7.45 a?????s?
• paCO2 e??a? f?s????????
• HCO3- lt 25 (?µet??, a???µ??? ???s? ?pa?t????)
• ?etaß????? a?????s?

31
?a?ade??µata

• 54 et?? ???a??a, ??s??????e?a?t?µe??? d?aß?t??
• ?d??aµ?a, ?a?t?a, ?µet??, d??a
• ABG
• pH 7.29
• paCO2 35 mmHg
• HCO3- 18 mEq/L
• pH lt 7.35 ????s?
• paCO2 f?s????????
• HCO3- lt 25
• ?etaß????? ????s?

32
??t???????t?s?
33
??t???????t?s?
34
??t???????t?s?
35
????µas?a Allen
36
??a??t?? ae???? a?µat??
37
(No Transcript)
38
??ap?e?st??? ????s?

• (?aµ??? pH, ???? pCO2)
• ??s?e?t?????a ???t??? a?ap????, ?p??e?d?,
  a?a?s??t???, ?atasta?t???, ?p?ae??sµ??
• ??ata?a??? pa??se?? a?ap?e?st???? µ??? ?
  ???a????? t????µat??, µ?as???e?a ??f?s?????s?,
  p?a??a µ?at??f??? s??????s? Gravis
• ??ata?a??? a?ta??a??? ae????, ???, asf???a, ???
  p?e?µ????? ??d?µa

39
??ap?e?st??? a?????s?

• (???? pH, ?aµ??? pCO2)
• ?pe?ae??sµ??, ate?e?tas?a, ßa??? a?a?µ?a, ?????,
  p?e?µ????? eµß???
• ?a??se?? ??S, ste??????, ?pa?a???e?d??
  a?µ???a??a, d???t???as? µe sa????????
• ?pe?µetaß?????? ?atast?se??, p??et??,
  ???e?t?????s?, s???
• ?pe?ae??sµ?? st?? d????e?a µ??a????? ae??sµ??

40
?etaß????? ????s?

• (?aµ??? pH, ?aµ??? HCO3)
• ??aß?t??? ?et????s?
• Ga?a?t??? ????s?
• ???s???? ?????, sa?????????, µe?a?????,
  pa?a?de?d??
• ?p??e?a d?tta???a????? (d??????a, f?st???e?,
  s??????a)
• ?ef???? a?ep???e?a

41
?etaß????? a?????s?

• (???? pH, ???? HCO3)
• ?p??e?a ?????,
• ?µet??,
• ??a???f?s? ?ast????? ?????,
• ??????t???,
• ?p??a??a?µ?a,
• ?pe?asßest?a?µ?a,
• ???s???? HCO3

42
?t?s? pH

•  (pe??ss?te?? ???, ?aµ??? pH)
• ??t??? f?s??? ?s??s?
• ?a??sa???a
• ?e??a
• ???????a
• ??ap?e?st??? a?ep???e?a
• ?a???? pa??se?? a?ap?e?st????
• ?a???? pa??se?? ?a?d?a??e?a???
• ??e?µ????? ??d?µa
• ?a?d?a?? a?a??p?
• ?ef???? a?ep???e?a
• Ga?a?t??? ????s?
• ?et????s?

43
????s? pH

• (pe??ss?te?e? ß?se??, ?aµ??? pH)
• ?pe?ae??sµ??
• ?????
• ????? ,
• ??a?µ?a
• S??
• ?p?e? pa??se?? a?ap?e?st????
• ?p?a S??
• ?µf?a?µa
• ?p??a??a?µ?a
• ??t?????a
• ?µet??
• ?sp?????

44
Sf??µata

• ???a? st?? s?????a
• ?aµ??? a?µ?sfa?????
• ??µ???s?

45
?etaf??? t?? de??µat??

• S?st? a??de?s?
• ???a??? µetaf???
• ??p???t?s? se p???

46
?etaß??? pH, pCO2 pO2 se s??s? µe t? ????? ?a?
t? ?e?µ???as?a
???????? Se 37? C / 10 min Se 4? C / 10 min a?? 1? C
PH 0.01 unit 0.001 unit 0.0146
PO2 0.1 mm Hg 0.01 mm Hg 7
PCO2 1 mm Hg 0.1 mm Hg C 4
47
Useful tip Suppose a driver buys their first car
between 22 26 y/o. Therefore, think of sodium
bicarbonate as sodium "buycarbonate"

• ??ap?e?st??? ????s?
• ?p??e?a HCO3 ap? t??? ?ef???? ??a ?a d??????e? t?
  pH
• ??ap?e?st??? a?????s?
• ?ata???t?s? HCO3 ap? t??? ?ef???? ??a ?a
  d??????e? t? pH

48
F?s????????? t?µ?? CO2 35-45. Useful tip ?d?e?
t?µ?? µe pH 7.35-7.45 Note Notice that both
CO2 and pH have 35 and 45 in them.

• ?etaß????? a?????s?
• ?ata???t?s? CO2 ap? t??? p?e?µ??e? ??a ?a
  d??????e? t? pH
• ?etaß????? ????s?
• ?p?ß??? CO2 ap? t??? p?e?µ??e? ??a ?a d??????e?
  t? pH

49
(No Transcript)
50

• http//www.templejc.edu/ems/resource.htm
• http//www.tmc.tulane.edu/departments/anesthesiolo
  gy/acid/acid.html
• http//www.templejc.edu/ems/resource.htm