Beruflich Dokumente
Kultur Dokumente
A Case-based Overview
Costanzo LS. BRS Physiology. 5th ed. Baltimore: Lippincott Williams & Wilkins; 2011:176.
Kamel KS, Halperin ML. Fluid, Electrolyte, and Acid-Base Physiology: A Problem-Based Approach, 5th Ed.
Philadelphia: Elsevier, 2017.
Note:
Anion gap calculation: Anion gap = Na+– (Cl-+ HCO-3)
Anion gap is normally 10–15 mEq/L and is increased if
unmeasured anion replaces HCO-3
Compensation calculation: (Winter’s formula): Decrease in
PCO2 = 1.5 (HCO-3) + 8 2
Marc Imhotep Cray, M.D. 27
Case 2
A 45-year-old man presents to the emergency department with
increased dizziness and weakness. After taking a history, you learn
that he has been accidentally taking twice the amount of a prescribed
diuretic. On physical examination, you notice that he has sunken
eyes, poor skin turgor, hyporeflexia in all reflexes, and orthostatic
hypotension. Laboratory studies show an arterial pH of 7.56 and an
arterial PCO2 of 45. Serum potassium and chloride are decreased.
No other abnormalities are noted. You immediately begin to
administer IV fluids and you suspect that this will reverse his
metabolic abnormality.
What is the Diagnosis?
Treatment
Saline-responsive: Fluid replacement
Saline-resistant: Treat underlying cause of mineralocorticoid excess;
replete potassium
Notes
Compensation: PCO2 increases 0.7 mm Hg for every 1 mEq/L HCO-3
increase
Pathophysiology
Primary disturbance: Increase in PCO2 (hypercapnia) owing to
decreased alveolar ventilation
Compensatory response: Increase in HCO-3 caused by increased
renal HCO-3 reabsorption as stimulated by low pH and high PCO2
Treatment
Treat underlying condition of acute respiratory acidosis
No treatment necessary for chronic respiratory acidosis
Notes
Acute compensation: 1 mEq/L HCO-3 increase for every 10 mm Hg
PCO2 increase
Chronic compensation: 3.5 mEq/L HCO-3 increase for every 10 mm
Hg PCO2 increase
Notes
Acute compensation: 2 mEq/L HCO-3 decrease for every 1 mm
Hg PCO2 decrease
Chronic compensation: 5 mEq/L HCO-3 decrease for every 10
mm Hg PCO2 decrease
Marc Imhotep Cray, M.D. 37
Step-By-Step Analysis of
Acid-Base Status
1. Is the patient acidemic or alkalemic?
2. Is the primary disturbance respiratory or metabolic?
3. For a respiratory disturbance, is it acute or chronic?
4. For metabolic acidosis, is an anion gap present?
5. If an anion gap is present, are there still other
coexistent metabolic disturbances?
6. What is the degree of compensation by respiratory
system for a metabolic disturbance?