Acidosis
(pH<7.

35)

 

Respiratory
acidosis
 Respiratory
physiology


PCO2

greater
than

40
 • Hypoventilation

mmHg,
HCO3greater
than
 • Decreased
gas

24
mM/L
 exchange


 • Airway
obstruction


 

Metabolic
acidosis
 Drug
history

• Salicylate

PCO2

less
than

40
mmHg,

intoxication

HCO3
less
than
24
mM/L

• Methanol
ingestion

Anion
gap
greater
than
12

• Ethylene
glycol

mM/L

Ketones
(present)



• Glucose
>
200


 mg/dl
>DKA


 • Glucose
<
200


 mg/dl>Starvation


 (absent)


 • Renal
failure


 • Lactic
acidosis

Metabolic
acidosis
 Urine
pH>5.5
renal
loss
of

HCO3

PCO2

less
than

40
mmHg,

• Carbonic
anhydrase

HCO3
less
than
24
mM/L

inhibitors

Anion
gap
less
than
12

• Renal
tubular

mM/L

acidosis

Hypercholremic
metabolic

• Hypoaldosteronism

aciddosis

Urine
pH<5.5
GI
loss
of



HCO3




 • Diarrhea


 Ileostomy

•




 

Alkalosis

(pH>7.45)



Respiratory
Alkalosis

PCO2


<35
mmHg,
HCO3
<

25
mM/L





Metabolic
Alkalosis

PCO2

less
than

40
mmHg,

HCO3
less
than
24
mM/L

Anion
gap
greater
than
12

mM/L



Metabolic
Alkalosis

PCO2

less
than

40
mmHg,

HCO3
less
than
24
mM/L

Anion
gap
less
than
12

mM/L

Potassium: causes of
potassium leaving cells
A$$E$
(postoperative).
Acidosis: H+ ions move
Exercise: catabolism of
cells.
Sodium chloride lost: K+
replaces it and is then
excreted.
Cerebellar damage
symptoms VANISHED:
Vertigo
Ataxia
Nystagmus
Intention tremor
Slurred (or Staccato)
speech
Exagerrated broad based
gait
Hypotonic reflexes
Dysdiadochokinesia.
Starvation: catabolism of
cells.
Stress: catabolism of cells




RNA viruses: negative
stranded "Always Bring
Polymerase Or Fail
Replication":
Arena
Bunya
Paramyxo
Orthomyxo
Filo
Rhabdo
· Note: Negative RNA
viruses need there own
polymerase.
Pyrogenic meningitis:
likeliest bug in age
group "Explaining Hot
Neck Stiffness":
· In order from birth to
death:
E. coli [infants]
Haemophilus influenzae
[older infants, kids]
Neisseria meningitis
[young adults]
Streptococcus
pneumoniae [old folks]
Cranial nerves: sensory, Deep tendon reflexes:
motor or both "Some root supply · God
Say Marry Money But designed body reflexes
My Brother Says Big according to a nursery
Brains Matter More": rhyme:
· From I to XII: One, two-- buckle my
Sensory shoe. Three, four-- kick
Sensory the door. Five, six-- pick
Motor up sticks. Seven, eight--
Motor shut the gate.
Both S1,2 = ankle jerk
Motor L3,4 = knee jerk
Both C5,6 = biceps and
Sensory brachioradialis
Both C7,8 = triceps
Both Acute Coronary
Motor Syndrome: initial
Motor treatment ABCD:
JVP: raised JVP Aspirin
differential PQRST Beta blocker
(EKG waves): Coagulation
Pericardial effusion (anticoagulation with
Quantity of fluid raised heparin/LMW Heparin)
(fluid over load) Double product control
Right heart failure (decrease heart rate and
Superior vena caval blood pressure)
obstruction
Tricuspid stenosis/
Tricuspid regurgitation/
Tamponade (cardiac)
 Hypoxia
Alkalosis
 • Altitude

sickness

(pH>7.45)
 Central stimulation

 • anxiety⇒hyper
Respiratory
Alkalosis
 ventilation

PCO2


<35
mmHg,
HCO3
<

25
mM/L

• salcylate


 intoxication


 • encephalitis




 GI loss of acid
Metabolic
Alkalosis
 • vomiting

PCO2

>

40
mmHg,
HCO3
 • nasograstic

>28
mM/L
 suction

Urine
CL
>10
mM/L


 High blood pressure
Metabolic
Alkalosis
 • hyperaldostero
PCO2

>

40
mmHg,
HCO3
>
 nism

28
mM/L
 • Cushing’s

Urine
CL
>15
mM/L

syndrome




 • Renal
artery

stenosis

Normal Bp
• Barber’s

syndrome

• Sever
K+
deficit

• diuretics

Hypovolemia prevents renal bicarbonate formation

Salicylate intoxication

Early: metabolic acidosis + respiratory alkalosis

Late: metabolic acidosis + respiratory acidosis

Alkalosis vs. acidosis: directions of pH and HCO3

ROME:
Respiratory ⇔Opposite:
(Alkalosis) pH is ⇑PCO2 is ⇓
(Acidosis) pH is ⇓, PCO2 is ⇑
Metabolic ⇒Equal:
(Alkalosis) pH is ⇑, HCO3 is ⇑
(Acidosis) pH is ⇓, HCO3 is