A Practical Approach to Understanding Acid–Base Abnormalities in Critical Illness

Abstract

Acid-base disorders are common in the critically ill. Arterial blood gas (ABG) analysis is frequently used to identify and manage acid-base disturbances. Using a systematic problem-solving approach to acid-base disturbances will facilitate the identification and assess the progression and severity of the metabolic and respiratory abnormality. The intent of this review is to examine acid-base physiology and regulation, provide a method to evaluate a patient's acid-base disorder, and provide therapeutic interventions.

Acid–base equilibrium: The best clinical approach

“…This requires determining which is the predominant component (respiratory or metabolic), and analysing the consistency of the compensatory mechanism, always bearing in mind that there are physiological overcompensations that lead to mixed or combined acid-base disturbances 5,26,[43][44][45][46] .…”

“…respiratory acidosis with metabolic alkalosis); or if, on the contrary, it helps perpetuate the disorder (e.g. metabolic acidosis with respiratory acidosis) 5,6,26,29,32,[43][44][45][47][48][49][50] . (Fig.…”

Equilibrio ácido-base: el mejor enfoque clínico

“…Igualmente, durante el curso de una enfermedad con alteraciones del equilibrio ácido-base se pueden llegar a alterar otros sistemas, como el inmune, con alteraciones en los mediadores de inflamación o el óseo, con alteraciones en la resorción y la formación ósea; sin embargo, los mecanismos fisiopatológicos no están bien dilucidados 5 recibido transfusiones, o toma de fármacos) y el examen físico (signos de deshidratación o edema, polipnea, tetania, coma) del paciente con los parámetros de los gases arteriales. Para ello se debe determinar qué componente predomina (respiratorio o metabólico) y analizar la coherencia del mecanismo de compensación, teniendo siempre presente que hay compensaciones fisiológicas exageradas que llevan a trastornos mixtos o combinados del equilibrio acido-base 5,26,[43][44][45][46] .…”

Asit Baz Dengesi

“…Bu bilgi medulladaki solunum merkezine ulaşır ve VA artar ya da azalır. Bu feed-back kontrol mekanizması ekstraselüler pH değişikliklerine dakikalar içinde yanıta neden olur(13). Her feed-back mekanizması gibi problemin azalması gelen uyarıyı azaltır.…”

“…Birincisi HCO 3 reabsorpsiyonu, ikincisi yeni HCO 3 üretimi ve sonuncusu da asit sekresyonudur(11). Böbrekler asit-baz dengesini düzelterek vücut pH'ını normale getirebilirler, ancak bu proçes yavaştır ve günler içinde tamamlanır(13). : l5 gr/dl, pH: 7,40, PCO 2 : 4O mmHg iken BE değeri sıfırdır.…”