:
: : :
90: :
Acid base balance
nephrology
..............................................................
two organs PH
control
lung Kidney
kidney .... Kidney
PH ..
Lung Lung
respiratory acidosis respiratory alkalosis
kidney Metabolic acidosis metabolic
alkalosis
PH
Acidosis
PH
... CO2
..... CO2
Acidosis
respiration wash CO2
CO2 ..... ... CO2
..
Acidosis stimulation of
..... respiratory centre ... wash of CO2
CO2 ... ..... Acidosis
Alkalosis
Acidosis respiration deep and rapid
2
..............................................................
wash CO2
alkalosis
respiratory centers Inhibition
.. retention of CO2 CO2 ....
.... Alkalosis
Lung respiration
Acid base balance
Acid base balance kidney
acid base balance
kidney
Acid base balance
Acid base balance
4
.... ...
.....
..............................................................
H ions
HCO3
.... lumen tubules
Lumen urine
lumen .... tubules
re absorption secretion
urine... ...
...
.. Urine
Urine !!!!
!!!!
.... re absorption
...
...
..... bicarbonate
reserve alkaline
... Kidney
kidney
.....
4
..............................................................
........
..... ....
..
... ...
.... Hypokalemia ... ...
!!!
arrhythmias
H ions
....
...
hypo kalemia Alkalosis
Hypo kalemia
hypo kalemia alkalosis
hydrogen ions
H ions ...
..
H ions ... ...
: H ions ... Hyper kalemia
Hyper kalemia acidosis
hypo kalemia alkalosis H ions
5
..............................................................
Hyper kalemia Acidosis
) (
H ions
tubules .... H ions .... H ions
toxic ..... tubules tubules
... H ions H ions
toxic tubules tubules
...... NH3 NH3 ....
NH4
NH4 tubules
... NH3 Toxic
tubules
hypo kalemia
HCO3
6
..............................................................
alkalosis
alkalosis
alkalosis
kidney
kidney
kidney
kidney kidney
kidney
kidney
Metabolic alkalosis
kidney
...
7
..............................................................
...
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
.... 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
..............................................................
defect Isolated defect
H ions
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
10
..............................................................
Isolated tubular acidosis
clinical picture of the cause
differential diagnosis
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
11
..............................................................
%100 Lung
CO2 normal kidney
...... Lung
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
12
..............................................................
HCO3
PH HCO3
CO2
.... 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
13
..............................................................
H ions
... H ions
....
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
14
..............................................................
treatment
.. ... treatment .N.B
treatment of metabolic
acidosis
.N.B
.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
15
..............................................................
chronic renal failure NaHCO3
Calcium
metabolic alkalosis
Metabolic acidosis
source
16
..............................................................
metabolic alkalosis
etiology
metabolic alkalosis
....
Metabolic alkalosis ...
.....
...
......
..... 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 ...
17
..............................................................
metabolic alkalosis
metabolic alkalosis tetany
tetany normo calcemic tetany
.... Normo calcemic tetany
tetany Mg alkalosis
see endocrine
tetany
metabolic alkalosis tetany
Metabolic alkalosis
Investigations
........ PH
..... HCO3
.... CO2
PH alkalosis
HCO3 metabolic alkalosis
CO2 normal alkalosis .... CO2
treatment
kidney
18
..............................................................
Respiratory acidosis
respiratory acidosis
respiratory acidosis chest kidney
... respiratory acidosis acidosis
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
19
..............................................................
female ascites dyspnea
respiratory alkalosis
clinical picture
clinical picture of the cause and tetany
dyspnea
tetany
**** !!!!!
"..... ,
" *****
20