Ebook Marinos the CIU book (4th edition): Part 2
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Ebook Marinos the CIU book (4th edition): Part 2
ACID-BASE DISORDERSLife is a struggle, not against sin, not against money power... but against hydrogen ions.H.L. MenckenACID-BASE ANALYSISSeek simpli Ebook Marinos the CIU book (4th edition): Part 2icity, and distrust it.Alfred North WhiteheadManaging ICU patients without a working knowledge of acid-base disorders is like trying to clap your hands when you have none; i.e., it simply can't be done. This chapter presents a structured approach to the identification of acid-base disorders based on Ebook Marinos the CIU book (4th edition): Part 2 the traditional relationships between the pH, PCO2, and bicarbonate (HCO3) concentration in plasma. Also included is a section on the evaluation of mEbook Marinos the CIU book (4th edition): Part 2
etabolic acidosis using the anion gap and a measurement known as the "gap-gap." Alternative approaches to acid-base analysis, such as the "Stewart metACID-BASE DISORDERSLife is a struggle, not against sin, not against money power... but against hydrogen ions.H.L. MenckenACID-BASE ANALYSISSeek simpli Ebook Marinos the CIU book (4th edition): Part 2s.BASIC CONCEPTSHydrogen Ion Concentration and pHThe hydrogen ion concentration [H+] in aqueous solutions is traditionally expressed by the pH, which apparently means the power of hydrogen, and is a logarithmic function of the [H+]; i.e.,pH—log(l/|H+|)“ log |H+|-31.1The physiological range of pH and Ebook Marinos the CIU book (4th edition): Part 2 corresponding [H+] is shown in Table 31.1. The normal pH of plasma is indicated as 7.40, which corresponds to a [H+] of 40 nEq/L.Features of the pHThEbook Marinos the CIU book (4th edition): Part 2
e relationships in Table 31.1 illustrate 3 unfortunate features of the pH: (a) it is a dimensionless number, which has no relevance in chemical or phyACID-BASE DISORDERSLife is a struggle, not against sin, not against money power... but against hydrogen ions.H.L. MenckenACID-BASE ANALYSISSeek simpli Ebook Marinos the CIU book (4th edition): Part 2 that as the pH decreases, the changes in [H+] become gradually larger with each change in pH. This means that changes in pH will have different implications for acid-base balance at different points along the pH spectrum. Although it is unlikely that the pH will be abandoned, it is not a representa Ebook Marinos the CIU book (4th edition): Part 2tive measure of the acid-base events in the body.Fable 31.1 pH and Hydrogen Ion ConcentrationpH[H*] (fiEq/L)pH[H1 (nEq/L)6.91.26I 74071037.5327.1807.6Ebook Marinos the CIU book (4th edition): Part 2
257.2647.7207.3507.81fiHydrogen Ions as a Trace ElementAlso evident in Table 31.1 is the fact that [H+] is expressed as nanoequivalents per liter (nEqACID-BASE DISORDERSLife is a struggle, not against sin, not against money power... but against hydrogen ions.H.L. MenckenACID-BASE ANALYSISSeek simpli Ebook Marinos the CIU book (4th edition): Part 2ncipal ions in extracellular fluid (sodium and chloride), whose concentration is expressed in mEq/L. This gives hydrogen ions the status of a trace element. How can such a small quantity of an ion have all the effects attributed to acidosis and alkalosis? Other trace elements certainly have importan Ebook Marinos the CIU book (4th edition): Part 2t biological effects, but it is also possible that changes in the [H+] are just one of several physicochemical changes that are taking place in the exEbook Marinos the CIU book (4th edition): Part 2
tracellular fluid. This would explain why the same degree of acidosis is more life-threatening in lactic acidosis than in ketoacidosis (as described iACID-BASE DISORDERSLife is a struggle, not against sin, not against money power... but against hydrogen ions.H.L. MenckenACID-BASE ANALYSISSeek simpli Ebook Marinos the CIU book (4th edition): Part 2ogy, the [h J .....V..V.determined by the balance between the partial pressure of carbon dioxide (PCO2) and the concentration of bicarbonate (HCO3) in the fluid. This relationship is expressed as follows (1):[H*l - 24 X (PCO2/HCQ3)(31,2)The PCO2/HCO3 ratio identifies the primary acid-base disorders Ebook Marinos the CIU book (4th edition): Part 2and secondary responses, which are shown in Table 31.2.Primary Acid-Base DisordersAccording to equation 31.2, a change in either the PCO2 or the HCO3Ebook Marinos the CIU book (4th edition): Part 2
will cause a change in the [H+] of extracellular fluid. When a change in PCO2 is responsible for a change in [H+], the condition is called a respiratoACID-BASE DISORDERSLife is a struggle, not against sin, not against money power... but against hydrogen ions.H.L. MenckenACID-BASE ANALYSISSeek simpli Ebook Marinos the CIU book (4th edition): Part 2onsible for a change in [H+], the condition is called a metabolic acid-base disorder: a decrease in HCO3 is a metabolic acidosis, and an increase in HCO3 is a metabolic alkalosis.Table 31.2 Primary Acid-Base Disorders and Secondary ResponsesA|H J = aPCOg/AHCOgPrimary DisorderPrimary ChangeSecondary Ebook Marinos the CIU book (4th edition): Part 2Response*Respiratory AddostsTpcOfeTHCO3Respiratory AlkalosisXPCOi1HCO9ACID-BASE DISORDERSLife is a struggle, not against sin, not against money power... but against hydrogen ions.H.L. MenckenACID-BASE ANALYSISSeek simpliACID-BASE DISORDERSLife is a struggle, not against sin, not against money power... but against hydrogen ions.H.L. MenckenACID-BASE ANALYSISSeek simpliGọi ngay
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