by jrb06e


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Normal Blood Gas and Electolyte Levels
  • pH:     7.35 - 7.45
  • PCO2: 35 - 45
  • HCO3: 22 - 27
  • PO2: 80-100
  • Phosphorus: 2.7-4.5 mg/dL
  • Magnesium: 1.6 - 2.6 mg/dL
  • Calcium: 8.6 - 10.0 mg/dL
  • Potasium: 3.5 - 5.1 mg/dL
  • Sodium: 135 -145 mg/dL
Metabolic Alkalosis

  • Alkalemic pH (above 7.45)
  • HYPERbicarbonatemia
>27 mEQ/L
Disorders accociated with Metabolic Alkalosis
  • HYPOkalemia
  • HYPOcalcemia
  • Arrhythmias
  • Compensatory HYPOventilation
Effect on Oxy-Hemo Curve?
  • Reduce tissue oxygen levels
  • LEFT Shift
  • Decreases Cardiac Output
Pathophysiologic Changes in Metabolic Alkalosis
  • Irritability
  • HYPOkalemia causes cardiovascular disorders
  • Trousseau's Sign
Causes of Metabolic Alkalosis
  • Large infusions of NaHCO3
  • Milk Alkali Syndrom: large injestions of Calicum Carbonate
  • Defect in HCO3- excreation
  • Loss of Gastric Acid
  • Loss of Acid in Urine
  • Massive Transfusions of Blood:
Citrate anticoag. used in storage can be metabolized into Bicarbonate
Chloride Responsive Causes of M. Alkalosis
  • Vomiting/NG Tube Secreations
  • Lacative Abuse
  • Diuretic Use
Chloride Resistant Cause of M. Alkalosis
  • Mg or K deficiency
  • Thiazide or Loop Diuretic use
  • Hyperaldosteronism
Metabolic Acidosis
  • Acidemic pH (below 7.35)
  • HYPObicarbonatemia
<21 mEQ/L


Abnormal Loss of Bicarbonate or increased loads of organic acids
ANION GAP
  • Na- [Cl-HCO3]
  • Normal level is: 13 mEQ/L
  • 3/4 of Normal Anion Gap is Albumin
Pathophysiologic Changes in Metabolic Acidosis
  • Headache, Malaise
  • Kussmauls respirations
  • HYPOtension due to decreased C.O.
  • K+ is released from cells
High Anion Gap Acidosis
  • Production of Excess acids
  • Increased Retention of waste products
  • Ingestion of toxic substances
Types of High Anion Gap Acidosis
  • Ketoacidosis: Diabetic or Chronic Alcohol disease
  • Lacticacidosis: may be due to hypoperfusion of tissues
  • Renal Failure
  • Intoxication
Methanol, Ethylene Glycol, Aspirin
Types of Normal Anion Gap Acidosis
  • Renal Tubular Acidosis
I:Failure of acid secretion
II: Failure to reabsorb HCO3 at PCT
IV: Decrease in Urine Buffering Capacity

  • Diarrhea: HCO3 loss
  • Acetazolamide Therapy
  • Ammonium Chloride ingestion
Respiratory Acidosis
  1. HYPOventilation causes an INCREASE in PCO2
  2. Increased H+ con. leds to
  3. LOWER pH
  • HCO3 levels increase???
Causes of Respiratory Acidosis
  • Medications:
Narcotics, Anesthetics depress respiratory center
  • Emphysema
  • Asthma
  • Pulmonary Edema
  • Crush injury to thorax

Respiratory Alkalosis
  1. HYPERventilation causes a DECREASE in PCO2
  2. Decreased H+ con. leds to
  3. Increase in pH
  • HCO3- levels decrease???
Causes of Respiratory Alkalosis
  • Primary CNS Disorders
  • Hepatic Cirrhosis
  • Gram - Septicemia
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