..............................................................

:




: : :
90: :

Acid base balance nephrology

Acid base balance

acid base balance source
pre graduates Post graduates
source

arrhythamias
in capsule series

Acid base balance

PH Two organs
.... PH
PH Organs

Lung
.... Organ
...
.... PH
....
.... PH

1
 ..............................................................

...

PH two organs

control
Kidney lung
.... Kidney kidney
PH
..



Lung Lung
respiratory alkalosis respiratory acidosis
metabolic Metabolic acidosis kidney
alkalosis

PH

Acidosis

PH
... CO2





..... CO2
Acidosis

wash respiration
CO2
..... CO2

2
 ..............................................................

... CO2
..
stimulation of Acidosis
..... respiratory centre
... CO2 wash of CO2
... ..... Acidosis
Alkalosis


deep and rapid respiration Acidosis
CO2 wash

alkalosis
Inhibition respiratory centers
.. CO2 retention of CO2
.... ....
Alkalosis
respiration Lung
Acid base balance
kidney Acid base balance

acid base balance
kidney



Acid base balance

Acid base balance

4
....
...

3
 ..............................................................

.....


... hydrogen ions


... .... HCO3

Acid
base balance


H ions
HCO3

.... lumen
tubules
urine Lumen

.... lumen
secretion re absorption tubules

urine...
...
...
.. Urine

!!!! Urine

!!!!

4
 ..............................................................

re absorption ....

...
...



..... bicarbonate


alkaline reserve

... Kidney




kidney


.....

........
.....
....
..
...
.... ... Hypokalemia
... ...
!!!

arrhythmias


H ions
....

5
 ..............................................................

...


Alkalosis hypo kalemia
Hypo kalemia
alkalosis hypo kalemia
hydrogen ions


... H ions

..


... H ions
...


: ... H ions
Hyper kalemia

acidosis Hyper kalemia

H ions alkalosis hypo kalemia

Acidosis Hyper kalemia

) (

H ions

H ions .... tubules
toxic .... H ions
..... tubules tubules

6
 ..............................................................

H H ions
...
ions



tubules tubules toxic



...... NH3 NH3
.... NH4
tubules NH4

Toxic ... NH3
tubules

hypo kalemia

HCO3

7
 ..............................................................

alkalosis
alkalosis


alkalosis
kidney
kidney

kidney

kidney kidney

kidney





kidney


Metabolic alkalosis


kidney
...



...

8
 ..............................................................

saline

Acid base balance

Metabolic acidosis Metabolic alkalosis
respiratory acidosis respiratory alkalosis

Metabolic Acidosis
metabolic acidosis
kidney respiration

etiology metabolic acidosis

Metabolic acidosis
Chronic renal
failure
H ions retention
acidosis

... acidosis
acidosis acidosis
diabetic keto acidosis
keton bodies
acteo acetic acid

9
 ..............................................................

.... heart failure

Heart failure acidosis
heart failure Low cardic out put
Anemia shock
Heart failure Low cardic out put
Low cardic out put ischaemia
ischaemia Hypoxia
hypoxia

Metabolism an aerobic pathway
an aerobic pathway lactic acid
acid

Heart failure acidosis
Ischaemia Hypoxia Hypoxia
an aerobic pathway an aerobic pathway ....lactic acidosis
diabetes Lactic acidosis

tissue hypoxia lactic acidosis

...
diarrhea
diarrhea ... alkali

....
acute tubular acidosis renal tubular acidosis


... Isolated defect
Kidney .... kidney kidney



defect Isolated defect

H ions

10
 ..............................................................

acidosis

Hyper kalemia
hyper kalemia acidosis


etiology
clinical picture
investigation
treatment

clinical picture

clinical picture

clinical picture of the cause
clinical picture of the cause


Metabolic
acidosis

chronic renal failure nephrology
Diabetic keto acidosis endocrine
Heart failure cardiology
Diarrhea GIT
Isolated tubular acidosis

clinical picture of the cause
differential diagnosis

11
 ..............................................................

clinical pictures
PH

... hyper ventilation
acidosis Hyper ventilation
... hyper ventilation
Hyper ventilation rapid deep respiration
CO2 .... Wash of CO2

Investigations


...
Acid base balance

.... PH
PH .... acidosis
alkalosis ....
Metabolic respiratory PH

....
CO2 HCO3


) (
CO2
PH HCO3 CO2

HCO3 Normal
%100 Lung

CO2 normal kidney

...... Lung

12
 ..............................................................

CO2 ......... HCO3

Metabolic acidosis PH
.... HCO3 ... Metabolic HCO3
.... acidosis HCO3
CO2 ... Metabolic .... CO2 normal

CO2 .... Normal
compensation

CO2 .... CO2

.... Kidney CO2 compensation

PH .... HCO3
CO2 Normal
compensation CO2

PH .... HCO3 ....
Metabolic
Metabolic acidosis
Metabolic alkalosis

... CO2 metabolic acidosis

... kidney CO2 Normal

.......
.... compensation compensation
compensation CO2 ..... wash of CO2 CO2
.... compensation

HCO3

PH HCO3
CO2

13
 ..............................................................

.... PH PH H
... .... HCO3
HCO3 .... C CO2 HCO3

..... ...

acidosis hyper kalemia
... hypo kalemia alkalosis alkalosis Hypo
kalemia

hyper kalemia acidosis acidosis Hyper kalemia

acidosis

acidosis

acidosis H ....
.....

H
....
... H ions

....
Parallel to each other


H ions
... H ions

....

14
 ..............................................................

acidosis Hyper kalemia Hyper
kalemia acidosis

acidosis hyper kalemia
hyper kalemia acidosis

alkalosis Hypo kalemia

Hypo kalemia alkalosis

Investigations
investigations for the cause
...
chronic renal failure Diabetic keto acidosis heart failure



differential diagnosis

treatment
treatment


treatment
.. ... treatment .N.B
treatment of metabolic
acidosis
.N.B

15
 ..............................................................

.N.B

treatment of the cause .....

chronic renal failure
Diabetic keto acidosis ....

.... acidosis
NaHCO3
NaHCO3

.N.B
.N.B .... chronic renal failure
... Metabolic acidosis
.... acidosis

tetany
acidosis chronic renal failure
NaHCO3

chronic renal failure Hypo calcemia
acidosis
tetany ..... hypo calcemia acidosis

non ionized calcium Ionized calcium
...
... ... acidosis
hypo calcemia tetany

chronic renal failure NaHCO3

Calcium

..... .N.B metabolic acidosis DKA

16
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DKA endocrine
saline
precipitating factors

DKA not essential

Logic diabetic keto acidosis
acidosis bicarbonate
essential
acidosis

diabetic keto acidosis
... acidosis
sever alkalosis
alkalosis alkalosis alkalosis

diabetic keto acidosis alkalosis

essential
sever
diabetic keto acidosis bicarbonates
are not essential

metabolic acidosis

metabolic alkalosis
Metabolic acidosis


source
metabolic alkalosis
etiology
metabolic alkalosis
....
Metabolic alkalosis ...

17
 ..............................................................

.....
...

......
..... gastroectomy

.... Metabolic alkalosis

hypo kalemia

.....
alkalosis
Metabolic alkalosis
vomiting , gastroectomy Hypo kalemia hypo
kalemia endocrine Hypo kalemia
cushing conn's diuretics aspiration
etiology

clinical pictures
clinical pictures

pictures of the cause cushing conn's

... Metabolic alkalosis
tetany ........
.... tetany ca hypo para
thyroidism
.... tetany ...


metabolic alkalosis
metabolic alkalosis tetany
tetany normo calcemic tetany
.... Normo calcemic tetany
tetany Mg alkalosis

18
 ..............................................................

see endocrine
tetany
metabolic alkalosis tetany
Metabolic alkalosis

Investigations

........ PH

..... HCO3

.... CO2

PH alkalosis
HCO3 metabolic alkalosis
CO2 normal alkalosis .... CO2

........ .... alkalosis....

alkalosis hypo kalemia
acidosis hyper kalemia
alkalosis

Investigations for the cause......

treatment

kidney

Respiratory acidosis
respiratory acidosis
respiratory acidosis chest kidney
... respiratory acidosis acidosis

19
 ..............................................................

CO2
CO2 retention
CO2 retention ...
.... hypo ventilation wash .... CO2 CO2
alkalosis
respiratory acidosis
Hypo ventilation
chest
chest COPD type 2 Blue bloter
type 2 COPD hypo
ventilation
type 2

investigations
...... COPD
....

... COPD
... respiratory acidosis

respiratory alkalosis
dyspnea
dyspnea dyspnea

dyspnea
respiratory alkalosis
respiratory alkalosis CO2 wash
CO2 wash CO2 Hyper ventilation
hyper ventilation dyspnea
dyspnea chest dyspnea
cardiology left sided heart
failure Pulmonary congestion pregenant
female ascites dyspnea
respiratory alkalosis

clinical picture
clinical picture of the cause and tetany

20
 ..............................................................

dyspnea
tetany

**** !!!!!
"..... ,
" *****

21