Ebook Marinos the little ICU book (2/E): Part 2
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Ebook Marinos the little ICU book (2/E): Part 2
Acid-Base AnalysisThis chapter describes how to identify acid-base disorders using the pH, PCO2 and bicarbonate (HCO3) concentration in blood. Include Ebook Marinos the little ICU book (2/E): Part 2ed are: (a) simple rules for the identification of primary, secondary, and mixed acid-base disorders, (b) formulas for determining the expected acid-base changes for each of the primary acid-base disorders, and (c) a description of the “anion gap” and how it is used.I.ACID-BASE BALANCEAccording to t Ebook Marinos the little ICU book (2/E): Part 2raditional concepts of acid-base physiology, die hydrogen ion (H*) concentration in extracellular fluid is determined by die balance between the partiEbook Marinos the little ICU book (2/E): Part 2
al pressure of carbon dioxide (PCO2) and the bicarbonate (HCO3) concentration (1):[H+] = k X (PCO2 HC03)(23.1)(k is a proportionality constant). This Acid-Base AnalysisThis chapter describes how to identify acid-base disorders using the pH, PCO2 and bicarbonate (HCO3) concentration in blood. Include Ebook Marinos the little ICU book (2/E): Part 2tory acid-base disorder is a change in [H*] dial is a direct result of a change in PCO2. According to Equation 23.1, an increase in PCO2 will increase die [H+] and produce a respiratory acidosis, while a decrease in PCO2 will decrease the [H+] and produce a respiratory alkalosis.2.A metabolic acid-b Ebook Marinos the little ICU book (2/E): Part 2ase disorder is a change in [H+] that is a direct result of a change in HCO3. Equation 23.1 predicts that an increase in HCO3 will decrease die [H+] aEbook Marinos the little ICU book (2/E): Part 2
nd produce a metabolic alkalosis, while a decrease in HCO3 will increase the [H+] and produce a metabolic acidosis.3.Acid base disorders can be primarAcid-Base AnalysisThis chapter describes how to identify acid-base disorders using the pH, PCO2 and bicarbonate (HCO3) concentration in blood. Include Ebook Marinos the little ICU book (2/E): Part 2ase DisorderPrimary ChangeCompensatory ResponseRespiratory Acidosis(tPC02)(t HCO3)Respiratory Alkalosis(IPCOj)(IHCOj)Metabolic Acidosis(*hco3)(IPCOj)Metabolic Alkalosis(t HCO3)(tPCO2)B. Compensatory Responses1.2.3.Compensatory responses are designed to limit the change in H* concentration produced b Ebook Marinos the little ICU book (2/E): Part 2y the primary acid-base disorder. This is accomplished by changing the secondary variable in the same direction as the primary variable (e.g., a primaEbook Marinos the little ICU book (2/E): Part 2
ry increase in PCO2 is accompanied by a compensatory increase in HC03), as shown in Table 23.1.Compensatory responses do not completely correct the chAcid-Base AnalysisThis chapter describes how to identify acid-base disorders using the pH, PCO2 and bicarbonate (HCO3) concentration in blood. Include Ebook Marinos the little ICU book (2/E): Part 2cribe these responses are shown in Table 23.2.c. Responses to Primary Metabolic DisordersThe response to a metabolic acid-base disorder involves a change in minute ventilation that is mediated by peripheral chemoreceptors in the carotid body, located at the carotid bifurcation in the neck.1.Response Ebook Marinos the little ICU book (2/E): Part 2 to Metabolic AcidosisThe compensatory response to metabolic acidosis is an increase in minute ventilation (tidal volume and respirator}' rate) and aEbook Marinos the little ICU book (2/E): Part 2
subsequent decrease in arterial PCO2 (PaCO2). This response appears in 30-120 minutes, and can take 12 to 24 hours to complete (2). The magnitude of tAcid-Base AnalysisThis chapter describes how to identify acid-base disorders using the pH, PCO2 and bicarbonate (HCO3) concentration in blood. Include Ebook Marinos the little ICU book (2/E): Part 2 equation can be rewritten as follows:Expected PaCO2 = 40 - [1.2 X (24 - HCO3)] a.EXAMPLE: For a primary metabolic acidosis with a plasma HCO3 of 14 mEq/L, the AHCO3 is 24 - 14 = 10 mEq/L, the APaCO2 is 1.2 X 10 = 12 mm I Ig, and the expected PaCO2 is 40 -12 = 28 mm Ilg. If die measured PaCO2 is >28 Ebook Marinos the little ICU book (2/E): Part 2 mm Hg. there is a secondary respiratory acidosis, and if the measured PaCO2 is <28 mm Hg, there is a secondary respiratory alkalosis.2.Response to MeEbook Marinos the little ICU book (2/E): Part 2
tabolic AlkalosisThe compensatory response to metabolic alkalosis is a decrease in minute ventilation and a subsequent increase in PaCO2. ibis responsAcid-Base AnalysisThis chapter describes how to identify acid-base disorders using the pH, PCO2 and bicarbonate (HCO3) concentration in blood. Include Ebook Marinos the little ICU book (2/E): Part 2timulate than inhibit). The magnitude of die response is defined by die equation below (2).A PaCO2 = 0.7 X A HCO3(23.4)Using a normal PaCO2 of 40 mm Hg and a normal HCO3 of 24 mF.q/L, the above equation can be rewritten as follows: Ebook Marinos the little ICU book (2/E): Part 2Acid-Base AnalysisThis chapter describes how to identify acid-base disorders using the pH, PCO2 and bicarbonate (HCO3) concentration in blood. IncludeGọi ngay
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