Acid-Base Disturbance

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??? ?????? Acid-Base Disturbance
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????(Fixed acid) ????????????????????
????????????????(??????)? Fixed
acidsVitrol? phosphor acid ?Organic acid.
2.???????(Origin of bases)
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???????
2. ????????????? (Respiratory regulation
of acid-base balance)
Controlling the elimination of CO2, thus
maintains an normal concentration of H2CO3,and a
relatively stable pH value in the blood.
PaCO20.03 H2CO3
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???????H?? ?????Na-H??
(Na-H exchange of proximal tubule)
?????????H ??NH3??NH4??
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???????
?????Na-H??(Na-H exchange of proximal tubule)
?????Na-H??????90NaHCO3???
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???????
??NH3??NH4?? (NH4 excretion)
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???????
????????H??????HCO3-???
(Regulation of distal tubule)
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???????
? ???????????NH3,???????????? ? ????????
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?????????
?Significance? pH gt 7.45
??????? pH lt 7.35 ????????

pH 7.357.45
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??????????????
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?SB?AB??? SB????????
AB???????????? AB SB ???????????
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??????????????
4.Buffer base(BB) ????????????(HCO3-?Hb-?
Pr- ?)???? ???4555mmol/L ??505mmol/L
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?????????
?If an acid must be added, the BE value is
position (). ?If an base must be added, the BE
value is negative (). ???? 03mmol/L?
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??????????????
The AG can be calculated by AG Na
-(Cl- HCO3-) 140 -(10424)
Normal value 122mmol/L.
AG
?Significance? ????????????
??????????????
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AG?????????HCO3-?, AG?gt16mmol/L, Cl???
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Metabolic acidosis
???????????(Excessive intake of exogenous
acids) ???(????)??????????????????
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Metabolic acidosis
AG??????????? HCO3-??AG???Cl? ?
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Metabolic acidosis
(2)HCO3-???
(4)???
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Metabolic acidosis
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Metabolic acidosis
1. ?????????????????? (Buffer regulation
of extracellular fluid )
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???????????(Decompensated metabolic
acidosis) HCO3-?/H2CO3??lt201,pHlt7.3,
?????AB?SB?BB?,ABlt () SB ,BE????
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Metabolic acidosis
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Metabolic acidosis
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Metabolic acidosis
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HCO3- / H2CO3?lt20/1ltpH7.35
HCO3-?/ H2CO3?20/1pH7.4
?Compensation? ??????????????????????
???????? ???????? paCO2?, pH?, ABgtSB,
BE?BB??? ???????? paCO2?, pH?Ok,ABgtSB,
SB?BE()?BB??
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Metabolic alkalosis
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?Causes and Mechanism
1.H??(Superabundance of H loss)
??HCO3-?????????H???
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2. HCO3-????(Excessive intake of alkaline
substances)
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?Mechanism of Compensation 1.??????????????????
? ??????OH-??????????,????????
??????(?????)pH?, AB?SB?BB?,BE()? ?
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Metabolic alkalosis
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Metabolic alkalosis
?Effects on body
2. ??????
4.????
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?Causes and Mechanism
?Mechanism of Compensation
?????pHok, paCO2?, AB?SB?BB??BE(-)?,ABltSB?
??????pH?, paCO2?, AB?SB?BB?BE??,ABltSB?
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??????????????
???????????????? ?????????????????????
1.????????? ?????(???)??????????
????(???????) ????(?????)?????
2.????????? ????????,?????AG???????
??????AG????????????? ??????AG??????????????

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????????????????
???????????????? 1.????????
???????????????,??NaHCO3?H2CO3
? ????????,?NaHCO3 / H2CO3??????20/1,??pH ????
????,?????????
2.????????? ?????????????????????,?
NaHCO3/ H2CO3??????????20/1,??pH????????,?? ?
????????
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???
1.?????????SB?AB?BE?AG????????? 2.????????????????
??????, ????????? 3.????????????????????
?????????????????? 4.??????????????????????? 5.???
?????????????????????
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RBC
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