Acid Base Balance Dr.

Ahmad Mowafy

nephrology

Acid base balance

Acid base balance acid base balance source Post graduates source arrhythmias in capsule series Acid base balance Two organs PH PH PH Organs pre graduates

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Acid Base Balance Dr. Ahmad Mowafy

... Lung .... Organ

PH PH

...
PH two organs control Kidney Kidney

PH

lung kidney

respiratory alkalosis

respiratory acidosis

Lung Metabolic acidosis

Lung kidney

metabolic alkalosis

PH Acidosis PH CO2

CO2 CO2 wash Acidosis respiration CO2 Acidosis CO2 wash of CO2 respiration Acidosis

Alkalosis

CO2 stimulation of respiratory centre Acidosis CO2 wash deep and rapid
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Acid Base Balance Dr. Ahmad Mowafy

Alkalosis

alkalosis Inhibition respiratory centers CO2 retention of CO2 respiration Lung Acid base balance kidney Acid base balance kidney acid base balance Acid base balance

Acid base balance

hydrogen ions HCO3 Acid base balance H ions HCO3

secretion

re absorption

tubules urine tubules

lumen Lumen lumen urine

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Acid Base Balance Dr. Ahmad Mowafy

Urine Urine

re absorption bicarbonate alkaline Kidney reserve

kidney Hypokalemia arrhythmias H ions

Hypo kalemia

Alkalosis alkalosis

hypo kalemia

hypo kalemia hydrogen ions H ions

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Acid Base Balance Dr. Ahmad Mowafy

H ions Hyper kalemia acidosis H ions Hyper kalemia H ions

alkalosis hypo kalemia Acidosis Hyper kalemia

H ions tubules toxic H ions H ions H ions tubules tubules tubules H ions tubules toxic

NH4

NH3 tubules Toxic tubules NH3

NH3 NH4

hypo kalemia

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Acid Base Balance Dr. Ahmad Mowafy

HCO3

alkalosis alkalosis alkalosis kidney kidney kidney kidney kidney

kidney

kidney Metabolic alkalosis kidney

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Acid Base Balance Dr. Ahmad Mowafy

saline

Acid base balance respiratory respiratory acidosis Metabolic alkalosis Metabolic acidosis alkalosis

respiration

kidney

Metabolic Acidosis metabolic acidosis metabolic acidosis etiology Metabolic acidosis

Chronic renal failure H ions retention acidosis acidosis acidosis acidosis diabetic keto acidosis keton bodies acteo acetic acid heart failure acidosis Heart failure Low cardic out put heart failure Low cardic out put Heart failure ischaemia Low cardic out put Hypoxia ischaemia hypoxia
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shock

Anemia

Acid Base Balance Dr. Ahmad Mowafy

an aerobic pathway Metabolism lactic acid an aerobic pathway acid acidosis Heart failure Hypoxia Ischaemia lactic acidosis aerobic pathway tissue hypoxia diarrhea diarrhea acute tubular acidosis

an

an aerobic pathway Lactic acidosis diabetes

Hypoxia

lactic acidosis

alkali renal tubular acidosis Isolated defect kidney Isolated defect

kidney

Kidney defect

H ions acidosis

acidosis

Hyper kalemia hyper kalemia etiology clinical picture investigation treatment

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Acid Base Balance Dr. Ahmad Mowafy

clinical picture

clinical picture clinical picture of the cause clinical picture of the cause Metabolic acidosis nephrology endocrine cardiology chronic renal failure Diabetic keto acidosis Heart failure GIT Diarrhea Isolated tubular acidosis

clinical picture of the cause differential diagnosis clinical pictures PH hyper ventilation Hyper ventilation acidosis hyper ventilation rapid deep respiration Hyper ventilation Wash of CO2 CO2

Investigations

Acid base balance

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Acid Base Balance Dr. Ahmad Mowafy

PH acidosis PH respiratory Metabolic PH alkalosis

HCO3

CO2

CO2 CO2 HCO3 PH Normal HCO3 Lung 100% kidney normal CO2 Lung CO2

HCO3

CO2 normal

PH Metabolic acidosis HCO3 Metabolic HCO3 HCO3 acidosis Metabolic CO2 Normal CO2 compensation

CO2 compensation

CO2

CO2 Kidney HCO3 PH Normal CO2 compensation HCO3 PH Metabolic acidosis

CO2 Metabolic

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Acid Base Balance Dr. Ahmad Mowafy

Metabolic alkalosis metabolic acidosis Normal compensation wash of CO2 CO2 kidney

CO2

compensation

CO2

CO2

compensation compensation HCO3

CO2 HCO3 H

HCO3 PH HCO3 PH CO2 C

PH

HCO3

Hypo kalemia

hyper kalemia alkalosis alkalosis

acidosis hypo kalemia hyper kalemia

Hyper kalemia

acidosis acidosis acidosis

acidosis H acidosis

H H ions Parallel to each other

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Acid Base Balance Dr. Ahmad Mowafy

H ions H ions

acidosis

Hyper kalemia

Hyper kalemia

acidosis hyper kalemia acidosis acidosis hyper kalemia Hypo kalemia alkalosis alkalosis Hypo kalemia

Investigations investigations for the cause Diabetic keto chronic renal failure heart failure acidosis

differential diagnosis

treatment treatment N.B. treatment treatment of metabolic acidosis N.B. N.B.

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treatment

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Acid Base Balance Dr. Ahmad Mowafy

treatment of the cause chronic renal failure Diabetic keto acidosis acidosis NaHCO3 NaHCO3 N.B. chronic renal failure acidosis tetany acidosis

N.B.
Metabolic acidosis

NaHCO3 acidosis

chronic renal failure

Hypo calcemia chronic renal failure acidosis hypo calcemia tetany Ionized calcium non ionized calcium acidosis NaHCO3 chronic renal failure

tetany

hypo calcemia Calcium

DKA

DKA

metabolic acidosis saline not essential

N.B.
endocrine

precipitating factors

DKA Logic bicarbonate essential

acidosis

diabetic keto acidosis

acidosis
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Acid Base Balance Dr. Ahmad Mowafy

diabetic keto acidosis acidosis sever alkalosis alkalosis alkalosis alkalosis alkalosis diabetic keto acidosis essential sever diabetic keto acidosis metabolic acidosis

bicarbonates are not essential

metabolic alkalosis
Metabolic acidosis source metabolic alkalosis etiology metabolic alkalosis Metabolic alkalosis

gastroectomy Metabolic alkalosis hypo kalemia alkalosis

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Acid Base Balance Dr. Ahmad Mowafy

endocrine

Metabolic alkalosis hypo kalemia Hypo kalemia vomiting , gastroectomy aspiration diuretics conn's cushing Hypo kalemia etiology

clinical pictures
clinical pictures conn's tetany cushing pictures of the cause

Metabolic alkalosis ca hypo para thyroidism

tetany tetany

metabolic alkalosis tetany metabolic alkalosis normo calcemic tetany tetany tetany Normo calcemic alkalosis Mg tetany see endocrine tetany tetany metabolic alkalosis Metabolic alkalosis

Investigations

PH HCO3 CO2 alkalosis metabolic alkalosis

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PH HCO3

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Acid Base Balance Dr. Ahmad Mowafy

CO2

alkalosis alkalosis

normal

CO2

hypo kalemia hyper kalemia alkalosis Investigations for the cause

alkalosis acidosis

treatment

kidney

kidney

wash

hypo ventilation

type 2

Blue bloter

Respiratory acidosis respiratory acidosis chest respiratory acidosis acidosis respiratory acidosis CO2 CO2 retention CO2 retention alkalosis CO2 CO2 respiratory acidosis Hypo ventilation chest type 2 COPD chest hypo ventilation COPD type 2 investigations COPD COPD respiratory acidosis respiratory alkalosis

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Acid Base Balance Dr. Ahmad Mowafy

dyspnea dyspnea dyspnea dyspnea respiratory alkalosis respiratory alkalosis Hyper ventilation dyspnea hyper ventilation dyspnea left sided heart failure dyspnea ascites respiratory alkalosis clinical picture clinical picture of the cause and tetany

CO2

wash

CO2 wash

CO2

cardiology pregenant female

dyspnea chest Pulmonary congestion

dyspnea tetany

Acid base balance

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Acid Base Balance Dr. Ahmad Mowafy

http://www.facebook.com/dr.tafreegh

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