血气分析——英文版VIP免费

APracticalApproachtoAcid-BaseDisordersBinDU,MDMedicalIntensiveCareUnitPekingUnionMedicalCollegeHospitalPrimaryAcid-BaseDisordersVariablePrimaryDisorderNormalRange,ArterialGasPrimaryDisorderpHAcidemia7.35–7.45AlkalemiaPCO2,mmHgRespiratoryalkalosis35–45RespiratoryacidosisHCO3,mmol/LMetabolicacidosis22–26MetabolicalkalosisRulesofThumbforRecognizingPrimaryAcid-BaseDisordersWithoutUsingaNomogramRule1LookatthepH.Whicheversideof7.40thepHison,theprocessthatcausedittoshifttothatsideistheprimaryabnormality.Principle:Thebodydoesnotfullycompensateforprimaryacid-basedisordersSimpleAcid-BaseDisordersAcuteRespiratoryAlkalosisArterialGasValueInterpretationpHPCO2*HCO37.5029mmHg22mmol/LAlkalemiaRespiratoryalkalosisNormalHCO3CausesAnxietyHypoxiaLungdiseasewithorwithouthypoxiaCentralnervoussystemdiseaseDruguse–salicylates,catecholamins,progesteronePregnancySepsisHepaticencephalopathyMechanicalventilation*ThisistheprimaryabnormalityAcuteRespiratoryAcidosisArterialGasValueInterpretationpHPCO2*HCO37.2560mmHg26mmol/LAcidemiaRespiratoryacidosisNormalHCO3CausesCentralnervoussystem(CNS)depression–drugs,CNSeventNeuromusculardisorders–myopathies,neuropathiesAcuteairwayobstruction–upperairway,laryngospasm,bronchospasmSeverepneumoniaorpulmonaryedemaImpairedlungmotion–hemothorax,pneumothoraxThoraciccageinjury–flailchestVentilatordysfunction*ThisistheprimaryabnormalityChronicRespiratoryAcidosisWithMetabolicCompensationArterialGasValueInterpretationpHPCO2*HCO37.3460mmHg31mmol/LRespiratoryacidosisMetaboliccompensationCausesChroniclungdisease–obstructiveorrestrictiveChronicneuromusculardisordersChronicrespiratorycenterdepression–centralhypoventilation*ThisistheprimaryabnormalityTheImportanceofDifferentiatingAcuteFromChronicRespiratoryAcidosis•Acuterespiratoryacidosis–Medicalemergencyrequiringemergentintubationandmechanicalventilation•Chronicrespiratoryacidosis–OftenaclinicallystableconditionMetabolicAcidosisWithRespiratoryCompensationArterialGasValueInterpretationpHPCO2HCO3*7.5048mmHg36mmol/LAlkalemiaRespiratorycompensationMetabolicalkalosisCausesUrinaryChlorideLevelLowUrinaryChlorideLevelNormalorHighVomiting,nasogastricsuctionDiureticuseinpastPosthypercapniaExcessmineralocorticoidactivity–Cushing’ssyndrome,Conn’ssyndrome,exogenoussteroids,licoriceingestion,increasedreninstates,Bartter’ssyndromeCurrentorrecentdiureticuseExcessalkaliadministrationRefeedingalkalosis*ThisistheprimaryabnormalityMetabolicAcidosisWithRespiratoryCompensationArterialGasValueInterpretationpHPCO2HCO3*7.2021mmHg8mmol/LAcidemiaRespiratorycompensationMetabolicacidosisAniongap=sodium–chloride－bicarbonateNormal=122(SD)mmol/LCausesNonanionGapAnionGapGIbicarbonateloss–Diarrhea–UreteraldiversionsHydrochloricadministrationPosthypocapniaGI=gastrointestinalRenalbicarbonateloss–Renaltubularacidosis–Earlyrenalfailure–Carbonicanhydraseinhibitors–AldosteroneinhibitorsKetoacidosis–Diabetic–AlcoholicRenalfailureLacticacidosisRhabdomyolysisToxins–Methanol–Ethyleneglycol–Paraldehyde–Salicylates*ThisistheprimaryabnormalityMixedAcid-BaseDisordersABGInterpretation•ABG–pH7.49,PCO247mmHg,HCO335mmol/L,Na139mmol/L,K3mmol/L,Cl89mmol/L•Interpretation–Simplemetabolicalkalosiswithcompensatoryrespiratoryacidosis?or–Mixedmetabolicalkalosisandrespiratoryacidosis?SummaryofExpectedCompensationforSimpleAcid-BaseDisordersPrimary...