11
Oct
Teacher Answer:1. Respiratory acid-base imbalance
PCO2 and pH were based primarily on judgments.
(1) pCO2: incre 45mmHg, prompted respiratory acidosis; reduction <35mmHg, prompted respiratory alkalosis.
(2) pH: synergy with the pCO2 to determine whether the acid-base disturbance of respiratory decompensation.
increased 45mmHg when:
7.35 pH 7.45 compensatory respiratory acidosis
pH <7.35 decompensated respiratory acidosis
pCO2 reduction <35mmHg when:
7.35 pH 7.45 compensatory respiratory alkalosis 7.45 decompensated respiratory alkalosis
2. Metabolic acid-base imbalance
Needs such as pH, HCO3std, HCO3act, BE (B), BE (ecf), ctCO2 indicators such as more collaborative judgments, of which the pH, HCO3act (the equivalent of the materials on the HCO3-), BE (ecf) (equivalent materials The BE) three indicators are most important.
(1) HCO3act and BE (ecf): mainly used for the diagnosis of metabolic acid-base imbalance. The acid-base balance to reduce or increase the extent of the magnitude of their closely related.
Reduce (HCO3act <22mmol / L, BE (ecf) <-3mmol / L) metabolic acidosis prompted.
Increased (HCO 27mmol / L, BE (ecf)> +3 mmol / L) prompted metabolic alkalosis.
(2) pH: in conjunction with other indicators to determine whether metabolic decompensation acid-base imbalance.
Metabolic acidosis
7.35 pH 7.45 compensatory metabolic acidosis
pH <7.35 decompensated metabolic acidosis
Metabolic alkalosis
7.35
pH 7.45 compensatory metabolic alkalosis 7.45 decompensated metabolic alkalosis
(3) HCO3act and HCO3std: the difference between the two, reflecting the impact of respiration on the degree of acid-base balance, acid-base imbalance in the type of help for diagnosis and differential diagnosis. BE (ecf) and BE (B) the difference between the meaning of similar.
When HCO HCO3std time, CO2 retention, suggesting that compensatory or compensatory metabolic alkalosis respiratory acidosis.
When HCO3act
When HCO3act = HCO3std, but higher than normal value, suggesting decompensated metabolic alkalosis.
(4) ctCO2: HCO3act the same value and to help determine the metabolic acid-base imbalance.
Reduce (ctCO2 <24mmol / L), metabolic acidosis prompted.
Increased (c 32mmol / L), suggest metabolic alkalosis.
Under physiological conditions, blood gases including oxygen, nitrogen and carbon dioxide, also contain traces of argon, carbon monoxide, and rare gases. Via the respiratory and blood gas to maintain the capillaries outside the respiratory gas exchange with the org
Blood gas analysis of the major indicators include: (a) gas exchange indicator: partial pressure of oxygen (PaO2), carbon dioxide partial pressure (PaCO2), oxygen content; (b) acid-base balance indicators: pH (PH), base excess (BE ), bicarbonate (HCO3) and as respiratory carbon dioxide partial pressure and other factors.
of specimen
Peripheral arterial blood or directly from the femoral artery to analyze the gas content, directly or indirectly reflect the changes in alveolar gas, gas distribution, such as ventilation and diffusion functional status, blood is inserted into the body from the Swan-Ganz catheter balloon floating within the pulmonary artery to obtain mixed venous blood, the oxygen partial pressure and oxygen saturation (SO2) can be used as indicators of cardiac output, combined with arterial blood analysis values, but also speculated that oxygen consumption. Because clinical specimens are not ily available mixed venous blood, so do not do routine examination purposes.
1, arterial select
Can choose to take a superficial artery, easy to puncture the artery; stopped several times to retain an arterial blood sampling. Arterial blood sampling sites were selected: the radial artery, dorsal artery, brachial artery, femoral artery and so on.
2, punctures
(1) articles for: 2ml glass syringe 1, 5 or 7, a needle, rubber stopper, heparin 1 (1000 /ml), sterile (iodine, alcohol swabs), if necessary, prepare local anesthesia drugs.
(2) Operation:
0.2ml of heparin solution with a syringe pump, wet the wall, place the remaining liquid from the needle discharge as much as possible.
touch the arterial pulse at the most obvious location. Local routine disinfection, the use of intradermal injection of local anesthetic Picchu, without affecting the arterial pulse is appropriate.
patients who left food, the middle finger to touch the arterial pulse after disinfection at the right hand needle holder, needle bevel up, against the direction of blood flow in blood vessels penetrate into the 60 degree angle. Puncture without aspiration, as indeed into the artery, blood can enter the needle in their own. 0.5ml blood when the needle injection to be enough. Will pull out the needle piercing the rubber stopper, and air separation, arterial puncture site compression 5 to 10 minutes or so.
Application of disposable plastic syringes to prevent cross-infection between patients is very effective, but as arterial puncture with its blood samples with a syringe chance of success is relatively small. The reason:
A. Because syringes and needles bolt larger wall friction surface, so the needle even in the arteries, blood pressure often can not rely on access to syringes.
B. arterial blood in the syringe out of the darker, easily suspected to be blood and discarded.
C. prone to bubbles, and the discharge difficult.
D. blood for a little traction is required, the resulting negative pressure so that gas from the blood in the numerical error caused by precipitation.
The preservation and handling of specimens
After blood samples should be closed immediately with rubber stoppers to prevent the tip of the gas exchange, and we should try to avoid intraoperative blood bubbles into the syringe. Such as the memory bubbles syringe discharged as soon as possible, usually in PaO2 in 20.0kPa (150mmHg) below the tiny air bubbles on the measured PaO2 values did not impact on the PH, PaCO2 values without any intervention, blood samples at room temperature environment , due to the metabolism of white blood cells, can reduce PaO2, PaCO2 increased, especially in infection and leukemia cases, the increase in white blood cells, PaO2 decreased the rate of increase, blood samples should be stored in ice water or refrigerator, the temperature can inhibit leukocyte metabolic rate. However, if the occurrence of freezing blood samples may affect the determination of hemolysis caused by the results.
After taking blood samples, blood samples should be recorded time, body temperature, oxygen conditions, tidal volume and respiratory frequency, form, etc., as reference indicators for the correct clinical analysis. Do not take into account the conditions of inspired oxygen blood gas analysis and diagnosis made no sense.
In practice, patients sometimes expect to observe the dynamic changes of respiratory physiology and evolution will be continuous blood gas measurement, a more practical approach to training is the application of mass isolated from the blood gas, derived in vitro analysis.
Fluid acid-base balance of the related concepts
PH as the relative stability of body fluid acid-base balance, the balance is maintained by a variety of buffer systems and the regulation of activities in kidney and lung achieved. Imbalance can be caused by many factors, the disease became more serious, complex and even life-threatening.
PH: hydrogen ion concentration of the negative logarithm of the extracellular fluid of the normal is: 7.35 to 7.45, blood 0.03 to 0.05 lower than arterial blood. To indicate the pH of body fluids.
PH value of the change depends on the plasma in plasma bicarbonate (HCO3-) and carbonic acid (H2CO3) ratio, under normal circumstances, HCO3-/H2CO3 = 20 / 1. When the plasma H2CO3 primary rise, caused by decreased PH, PH <7.35, in order to decompensated respiratory acidosis. When HCO3-primary decreased, causing PH <7.35, in order to decompensated metabolic acidosis. When the primary decrease in plasma H2CO, causing increased PH, 7.45, in order to decompensated respiratory alkalosis. When HCO3-primary increased, 7.45 when decompensated metabolic poisoning. HCO3 and H2CO3 is to distinguish between primary change in metabolic or respiratory acid-base balance of the important criteria.
However, in PH normal body can not be excluded the existence of acid-base imbalance, because the acid-base balance, although the body and H2CO3 HCO3-buffer on the absolute value has changed, but by regulation of the body, can still be maintained The ratio of 20:1, so PH values remain within normal limits. This is called compensatory acid or alkali poisoning. In addition, some mixed acid-base imbalance in the normal PH range of values.
PaCO2 for the physical dissolution in plasma carbon dioxide partial pressure of carbon dioxide produced. It is to determine a major component of acid-base balance. Normal value: 4.40 to 6.27kPa (47mmHg), high arterial blood than 0.67 to 0.93kPa (5 to 7mmHg). PaCO2 also reflects the important status of the patient ventilation parameters. In the shallow breathing, decreased tidal volume, alveolar ventilation be reduced, so that PaCO2 increased, when PaCO26.27kPa (47mmHg) when the show hypoventilation, carbon dioxide retention, respiratory acidosis.
The impact of changes in PaCO2 on the body: elevated PaCO2 directly stimulate the central nervous system, so that sympathetic nerve activity, thereby strengthening myocardial contractility, arterial and venous blood vessels, so blood pressure. The circulatory system reaction that may be related to Ca2 related to PH due to changes in myocardial cells to free the increase in PaCO High carbon dioxide to the plasma HCO3-increased permeability of brain cells, in addition to cerebral vasodilation, increased capillary pressure, intracranial pressure was significantly increased. Such as patients with normal PaCO2, when its value quickly within 24 hours, more than 13.3kPa (100mmHg), can be caused by carbon dioxide anesthesia, the patient may be lethargy into a coma.
PaCO2 decreased hypocapnia caused the physiological activities of the body have a certain influence, its role is to reduce cardiac output, oxygen transport barriers, the oxygen away from the curve to the left cerebral blood flow reduction, convulsions, fall in intracranial pressure .
BE: PaCO2 was 25.33kPa (40mmHg) in the gas balance, the PH to 7.40 required to correct the amount of acid or alkali. That the plasma increase or decrease the alkali reserve of the situation. Normal value: 3 to-3mmol / L showed a base excess, mostly for primary metabolic alkalosis or respiratory acidosis compensation performance. BE was negative, the buffer base reduction, BESB, said there is accumulation of carbon dioxide, the respiratory acidosis; AB55mmol / L, show metabolic alkalosis.Primary plasma HCO3-decrease. Blood gas analysis: pH PaCO2 , SB .
The body from any cause the accumulation of non-volatile acid or alkaline substance is lost, can lead to metabolic acidosis. More common in shock, fever, fasting and peritonitis patients. As the body produces acid heap objects, break down fat, so that the ketone bodies accumulate, HCO3-is due to buffer excessive consumption of these substances. Large variety of digestive tract fistula to the loss, acute renal failure, acid or acidic drugs reported in excessive metabolic acidosis may be addressed. Clinically, some patients also see a lot of input for being saline, Ringer's solution, resulting in dilution of the body, and C1-HCO3-caused the high blood chloride increased metabolic acidosis.
(1) the impact on the body:
nervous system. Showed the inhibitory effect on the central nervous system, patients lethargy and even coma.
the cardiovascular system. Decrease of myocardial contractility, in addition to reduced capillary blood volume expansion leaving Huixin, decreased cardiac output, which in turn increase the microcirculation and acid poisoning. When associated with hyperkalemia, causing arrhythmia.
bone marrow system. Chronic metabolic acidosis, due to the constant release of calcium from the bones, and affect their development, children can see rickets, osteomalacia of adult patients seen.
other. In the acidic environment within the body by inhibiting the activity of many enzymes can be obvious and functional abnormalities in metabolic disorders.
(2) The principle of treatment: treatment of primary disease, correct acidosis, intravenous infusion of alkaline liquid, commonly used drugs are as follows:
NaHCO3: the role of rapid and effective. Into the body fluids from the solution of Na, HCO3-, and body fluids which combine to form H H2CO3, broken down into CO2 and H2O, excreted.
Common dose: 4% NaHCO3125-250ml intravenous drip.
Reference to the formula: NaHCO3 (mmol) = body weight (kg) base excess (mmol) 0.2
Enter the calculated value can be 50%, according to the results of blood biochemistry and blood gas analysis to consider to add. With excessive, can cause sodium overload, plasma osmolality increased, myocardial depression and other side effects, should be noted.
sodium lactate: enter body fluids separated into sodium hydroxide and lactic acid, the former with acid, converted to NaHCO3 and H2O, which has been oxidized in the liver and converted to CO2 and H2O, and release heat. Hypoxia or in other cases, liver damage, especially in a lactic acidosis is not easy to use.
Common dose: 1.9% sodium lactate solution.
11.2% sodium lactate, 20ml / expended diluted to 5% glucose 100ml, intravenous drip.
trimethylol aminomethane (THAM): enter the body fluids combined with CO2 and H2O, or the reaction H2CO3 HCO3-, in order to improve the PH value of body fluids. THAM is a powerful non-sodium buffer, stronger than NaHCO3, in the cell, the extracellular fluid also play a role, and to correct acidosis. THAM rapidly excreted in urine, remove acidic substances, and have a diuretic effect.
Common dose: 3.6% THAM isotonic solution intravenously. Limit sodium intake is best for patients.
Note: THAM is highly alkaline, pH = 10, stimulation of large organizations, it is leaking blood vessels, such as intravenous infusion, but can cause tissue and skin necrosis, muscle spasms. Rapid infusion can cause a large number of respiratory depression, hypotension, hypoglycemia and hypocalcemia.
2, metabolic alkalosis
Primary increase in plasma HCO3-caused. Blood gas analysis: pH , PaCO2 , SB .
Found with pyloric obstruction with persistent vomiting, long-term gastrointestinal decompression, a large loss of gastric juice after the increase in plasma HCO3-appropriate patients, it also found excessive intake of bicarbonate or a large number of input inventories blood, alkaline substances When the body heap.
(1) the impact on the body:
nervous system. Severe disease who can alkalosis irritability, delirium. At this time, oxygen from the curve to the left, the oxygenation of red protein can not release oxygen that may cause tissue hypoxia. In severe cases, coma can occur.
hypokalemia.
tetany and increased neuromuscular irritability. When accompanied with hypokalemia occurs when muscle weakness or paralysis.
(2) The principle of treatment: treatment of primary disease, to correct alkalosis, oral or infusion of acidic solutions. General treatment, to supplement normal saline and potassium chloride; critically ill patients may be given a certain amount of acidic drugs, such as 2% ammonium chloride.
3, respiratory acidosis
Due to increased plasma H2CO3 primary. Blood gas analysis: pH , PaCO2 , SB or unchanged.
Reduced ventilation due to various reasons can cause respiratory acidosis, such as respiratory obstruction, pulmonary disease itself.
(1) the impact on the body:
nervous system. Headache clinic can see patients, blurred vision, fatigue, weakness, delirium forgotten or drowsiness, severe cases can cause CO2 anesthesia and coma. High concentrations of CO2 can cerebral vasodilation, intracranial pressure and cerebrospinal fluid pressure is increased, and there is papilledema.
the cardiovascular system. Often accompanied by respiratory acidosis hypoxia, metabolic changes caused by the body. It may also occur in mixed acid-base disorders. At this point the patient decreased myocardial contractility, arrhythmia, cardiac output decreased.
(2) The principle of treatment: Treatment of primary disease, improve alveolar ventilation, if necessary, insert the endotracheal intubation and mechanical ventilation to discharge excess CO2. If serious condition, associated with central nervous system and cardiovascular system symptoms, but also NaHCO3 may be given intravenously. After the NaHCO3 input can further increase plasma PCO2, and worsening of the conditions, it must ensure that patients have enough courage to help CO2 emissions.
When artificial hyperventilation, PaCO2 fell too fast, the relative increase of HCO3-can lead to extracellular fluid poisoning. So, not only prone to hypokalemia, hypocalcemia, and CO2 by the blood-brain barrier can spout quickly from the brain, leading to central coma and even death. Thus treatment, pay attention to elevated PaCO2 decreased.
4, respiratory alkalosis
Primary decrease in plasma H2CO3. Blood gas analysis: PH , PaCO2 , SB .
Various causes hyperventilation may result in respiratory alkalosis, is common in shock, high fever, coma, respiratory center stimulation, metabolism, hyperthyroidism and inappropriate application of ventilator patients.
Also found in emotional, traumatic brain injury caused by hyperventilation early. [Medical education network collected more]
(1) the impact on the body: Chronic respiratory alkalosis are usually no symptoms of acute poisoning patients to be out of harm sense of nausea, shortness of breath, dizziness, altered consciousness and convulsions. Also available for the cell, outside the row of potassium ion exchange and increased occurrence of renal hypokalemia. Also be due to oxygen from the oxygen curve to the left occurred. Collected Medical Education Network
(2) The principle of treatment: the treatment of primary disease, symptomatic treatment. Given breathing mask to increase the absorption of CO2 in the back or mixed with 5% CO2 gas inhalation, can improve symptoms.
5, mixed acid-base disorders
Refers to two or more primary acid-base disorders co-exist.
(1) metabolic acidosis respiratory acidosis.
Blood gas analysis: pH , HCO3- , PaCO2 .
Found in cardiopulmonary arrest acute respiratory acidosis and chronic respiratory and lactic acidosis occurred in patients with toxic shock associated with lactic acidosis.
(2) respiratory acidosis with metabolic alkalosis:
Blood gas analysis: pH or or unchanged, HCO3- , PaCO2 .
Seen in chronic obstructive pulmonary disease caused by occurrence of hypercapnia respiratory acidosis patien
(3) respiratory alkalosis with metabolic acidosis:
Blood gas analysis: pH or or unchanged, HCO3- , PaCO2 .
Seen in bacterial sepsis due to acute renal necrosis, lactic acidosis can be combined and salicylic acid poisoning, caused by metabolic acidosis; directly increase the excitability of respiratory center caused by ventilation caused the respiratory alkalosis.
(4) respiratory alkalosis with metabolic alkalosis:
Blood gas analysis: pH PaCO2 , HCO3- .
Found in patients with liver cirrhosis due to respiratory alkalosis of hyperventilation such as receiving diuretic therapy or when vomiting occurs, you see also metabolic alkalosis.
(5) metabolic acidosis with metabolic alkalosis:
Blood gas analysis: According to the severity of both disorders, plasma pH, PaCO2, HCO3-can be normal or high, low. Found in renal failure patients receiving decompression time.
Line
2011/11/24 00:56
metabolic a. — acidosis resulting from accumulation in the blood of . arterial blood gas analysis and other tests are required to separate the main causes.
Ula
2011/11/25 12:32
acidosis: definition from answers.com
Sidney
2011/11/27 04:23
fyi: blood gas imbalances and the phases of acidosis and alkalosis . blood gas imbalances such as respiratory and metabolic acidosis and alkalosis can be fatal if unchecked.
Faithe
2011/12/06 03:55
metabolic acidosis - wikipedia, the free encyclopedia
Deborah
2011/12/11 12:14
metabolic acidosis occurs when the body produces too much acid, or . arterial blood gas analysis or a serum electrolytes test (such as a basic metabolic panel) .
Hyman
2011/12/12 18:16
metabolic acidosis - adventist healthcare
Sharon
2011/12/17 06:20
non-invasive blood gas interpretation - anion and bicarbonate gaps for diagnosing mixed acid-base disorders . clearly, the blood gases indicate a state of metabolic acidosis.
Deborah
2011/12/17 20:22
non-invasive blood gas interpretation, anion gap, delta gap .
Hellen
2011/12/17 22:04
metabolic acidosis is a disturbance in the body's acid-base balance that results in excessive acidity of the blood.
Afra
2011/12/19 21:38
floridahealthfinder.gov | health encyclopedia | metabolic .
Andy
2011/12/25 15:06
the answer is "metabolic" if bicarbonate has caused the observed . after giving bicarbonate, a repeat blood gas analysis should be performed (after a couple .
Rory
2011/12/31 03:12
blood gas text
Yetta
2012/01/01 10:53
an abnormal fall in hco3 (or base excess) decreases the ph (metabolic acidosis) . circumstances, the 'metabolic' component of the blood gas should be .
Marian
2012/01/02 04:27
blood gas interpretation
Samuel
2012/01/02 07:02
metabolic acidosis can indicate a more serious problem with a major organ like the liver, heart, or kidneys. arterial blood gas sampling is essential for the diagnosis.
Levi
2012/01/09 01:36
metabolic acidosis: information from answers.com
Allison
2012/01/16 01:50
metabolic acidosis is a disturbance of the body acid-base balance in which there is . an arterial blood gas to assess the severity of the metabolic acidosis .
Stacey
2012/01/16 10:45
acidosis - metabolic
Zoey
2012/02/03 09:50
the blood gas should be considered in conjunction with the patient's clinical condition. for example a metabolic acidosis will drop the ph to <7.4. if there is respiratory .
Susie
2012/02/21 11:01
acid base balance and interpretation of blood gas results
Terry
2012/02/25 01:58
metabolic acidosis is a condition in which there is too much acid in . arterial blood gas analysis or a serum electrolytes test (such as a basic metabolic panel) .
Frances
2012/02/25 12:02
metabolic acidosis - symptoms, diagnosis, treatment of .
Silvester
2012/02/25 14:01
find out all about metabolic acidosis, including the most common causes, symptoms and treatments. an arterial blood gas to assess the severity of the metabolic acidosis .
Emily
2012/03/23 07:19
metabolic acidosis - healthcentral
Denise
2012/04/13 22:27
if possible, treat underlying cause of metabolic acidosis & remeasure arterial blood gases; - continue steps until the pacoz and ph are within normal limits; .
Mariah
2012/04/15 02:28
arterial blood gas - wheeless' textbook of orthopaedics
Friends Links:Automation Control Blog
Automation Products Order Numbers
placental abruption complications
what is double crush syndrome