Acid-Base Disturbances

Posted by e-Medical PPT
Renal Failure
Emergent indications for Hemodialysis
Uremic encephalopathy
Bleeding Diathesis
Severe hyperkalemia
Severe acidosis
Pulmonary edema refractory to diuretics

Non-emergent indications for Hemodialysis
 Accelerated hypertension poorly responsive to antihypertensive medications
 Persistent nausea and vomiting
 Plasma creatinine > 12 mg/dL, or (BUN) > 100 mg/dL.
 decreased cognitive tasking and depression,
 severe anemia unresponsive to erythropoietin,
 persistent pruritus

How to read an ABG
pH  acidemia / alkalemia
Major factor  metabolic / respiratory
Anion gap
Delta / delta

Case 1
A 55-year-old woman is admitted with a complaint of severe vomiting for 5 days. Physical examination reveals postural hypotension, tachycardia, and diminished skin turgor.
Case 2
A 58-year-old man with a history of chronic bronchitis developed severe diarrhea caused by pseudomembranous colitis.

Treatment of Metabolic Acidosis
The aim of therapy in metabolic acidosis is restoration of a normal extracellular pH.
The normal renal response in this setting is to markedly increase acid excretion, primarily as ammonium.
Thus, exogenous alkali may not be required if the acidemia is not severe (arterial pH >7.20), the patient is asymptomatic, and the underlying process, such as diarrhea, can be controlled

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