Acid and Base Balace and Imbalance酸碱平衡与不平衡.pptVIP

* A patient presents with diabetic ketoacidosis: pH 6.95, PCOZ 28, [HC03-] 6, AG 32. * A patient with recurrent episodes of small bowel obstruction presents with severe abdominal pain and vomiting: pH 7.33, PCO3~5 , [HC03-] 18, AG 33. Urine dipstick negative for ketones. The blood pressure is 82154 and the heart rate 116. * A 21-year-old diabetic patient presents with vomiting and pH 7.75, PCO2~4 , [HC03-] 32, AG 30. The urine is strongly positive for ketones and serum ketones are strongly positive. * A 50-year-old 70 kg alcoholic man presents with 4 days of nausea, vomiting, and mild abdominal pain following a week-long drinking binge. He is unable to take anything by mouth. His mucous membranes are dry, and his vital signs reveal an orthostatic blood pressure drop with a rise in pulse. The following laboratory data are obtained: Na 134 mEqn, K 3.1 mEq/L, [HC03-] 20 mEq/L, C1 80 mEq/L, glucose 86 mg/dl, BUN 52 mg/dl, Cr 1.4 mg/dl, amylase pending, serum ketones: high positive reading. ABG: pH 7.32, PCO4~0 mm Hg, [HC03-] 20 mEq/L. Urine sodium 7 mEqL (low). Urine ketones: high reading. What is your diagnosis, and what do you do? * Symptoms of Metabolic Acidosis Headache, lethargy Nausea, vomiting, diarrhea Coma Death * Compensation for Metabolic Acidosis Increased ventilation Renal excretion of hydrogen ions if possible K+ exchanges with excess H+ in ECF ( H+ into cells, K+ out of cells) * Treatment of Metabolic Acidosis IV lactate solution * Metabolic Alkalosis Bicarbonate excess - concentration in blood is greater than 26 mEq/L Causes: Excess vomiting = loss of stomach acid Excessive use of alkaline drugs Certain diuretics Endocrine disorders Heavy ingestion of antacids Severe dehydration * Compensation for Metabolic Alkalosis Alkalosis most commonly occurs with renal dysfunction, so can’t count on kidneys Respiratory compensation difficult – hypoventilation limited by hypoxia * Symptoms of Metabolic Alkalosis Respiration slow and shallow Hyperactive reflex