Acidosis And Alkalosis .... SID

First of all
Strong Ion Difference SID means

SID = ([Na+] + [K+] + [Ca2+] + [Mg2+]) – ([Cl] + [other strong anions: A]) = 40–44 mEq

If all other factors (PCO2, albumin, and phosphate) are kept constant, an increase in SID will decrease hydrogen ion liberation from water (and increase hydroxyl ion liberation), causing alkalosis

Decrease in SID increases hydrogen ion liberation, to maintain electrical neutrality, causing acidosis

The chief determinant of SID is the relationship between the relative concentration of sodium, chloride and free water in ECF

The normal ratio of sodium to chloride is approximately 1.4:1. Any process that reduces that ratio reduces SID and leads to acidosis (sodium loss, chloride gain, or free water gain). Any process that increases that ratio increases SID and leads to alkalosis (sodium gain, chloride loss, or free water gain)

Second Acid–base disturbances are an importantnpart of clinical and laboratory investigation of perioperative and critically ill patients.

There are 6 primary acid–base abnormalities
(ATOT:weak acids)

1. Acidosis as a result of increased PaCO2

2. Acidosis as a result of decreased SID: increased chloride (hyperchloremic), reduced sodium (dilutional)/ increased free water

3. Acidosis as a result of increased ATOT(weak acids): hyperphosphatemia, hyperproteinemia

4. Alkalosis as a result of decreased PaCO2

5. Alkalosis as a result of increased SID: decreased chloride (hypochloremic), increased sodium/decreased free water (contractional)

6. Alkalosis as a result of decreased ATOT: hypophosphatemia, hypoalbuminemia

Comments

The pressure volume loop...

In the pressure-volume loop below, cardiac work is best represented by: the area of the curve the slope of the line from points C to D the distance of the line from points C to D the slope of a line from points A to D .. .. ... .... ... .... .... .... In the pressure-volume loop below, cardiac work is best represented by: the area of the curve Cardiac work is the product of pressure and volume and is linearly related to myocardial oxygen consumption. Cardiac work is best represented by the area of the curve of a pressure-volume loop.

Driving Pressure in ARDS: A new concept!

Driving Pressure and Survival in the Acute Respiratory Distress Syndrome Marcelo B.P. Amato, M.D., Maureen O. Meade, M.D., Arthur S. Slutsky, M.D., Laurent Brochard, M.D., Eduardo L.V. Costa, M.D., David A. Schoenfeld, Ph.D., Thomas E. Stewart, M.D., Matthias Briel, M.D., Daniel Talmor, M.D., M.P.H., Alain Mercat, M.D., Jean-Christophe M. Richard, M.D., Carlos R.R. Carvalho, M.D., and Roy G. Brower, M.D. N Engl J Med 2015; 372:747-755 February 19, 2015 DOI: 10.1056/NEJMsa1410639 BACKGROUND Mechanical-ventilation strategies that use lower end-inspiratory (plateau) airway pressures, lower tidal volumes (V T ), and higher positive end-expiratory pressures (PEEPs) can improve survival in patients with the acute respiratory distress syndrome (ARDS), but the relative importance of each of these components is uncertain. Because respiratory-system compliance (C RS ) is strongly related to the volume of aerated remaining functional lung during disease (termed functional lung size)...

Anaphylaxis updates part 2- Empty Ventricle Syndrome

Patients with anaphylaxis should not suddenly sit, stand, or be placed in the upright position. Instead, they should be placed on the back with their lower extremities elevated or, if they are experiencing respiratory distress or vomiting, they should be placed in a position of comfort with their lower extremities elevated. This accomplishes 2 therapeutic goals: 1) preservation of fluid in the circulation (the central vascular compartment), an important step in managing distributive shock; and 2) prevention of the empty vena cava/empty ventricle syndrome, which can occur within seconds when patients with anaphylaxis suddenly assume or are placed in an upright position. Patients with this syndrome are at high risk for sudden death. They are unlikely to respond to epinephrine regardless of route of administration, because it does not reach the heart and therefore cannot be circulated throughout the body

sedationstation

Search This Blog