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Diagnosing Acidosis and Alkalosis01:24

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Diagnosing acid-base imbalances involves systematically analyzing arterial blood samples, focusing on three key measurements: pH, bicarbonate (HCO3−) concentration, and carbon dioxide partial pressure (PCO2). This analysis follows a four-step process that helps identify the imbalance's underlying cause and nature.
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The human body maintains a precise pH range of arterial blood between 7.35 and 7.45. Deviations result in either acidosis (pH < 7.35) or alkalosis (pH > 7.45). These conditions are further classified as respiratory or metabolic disorders based on their underlying cause.
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The human body maintains a narrow pH range regulated through acid-base balance. This balance is crucial as changes in the hydrogen ion concentration can disrupt cell membrane stability, alter protein structures, and change enzyme activities. The normal pH of arterial blood is 7.4, venous blood and interstitial fluid is 7.35, and intracellular fluid averages 7.0.
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Hypercapnic respiratory failure, also known as Type 2 or ventilatory respiratory failure, is a severe condition characterized by the body's inability to effectively remove carbon dioxide (CO2) from the bloodstream. It leads to an arterial CO2 pressure (PaCO2) exceeding 45 mmHg and a blood pH above 7.35. This situation indicates that the body's ventilatory demand, or the ventilation needed to maintain normal PaCO2 levels, surpasses its supply or the maximum gas flow achievable without...
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Acute respiratory failure is a condition characterized by the inability of the lungs to perform their primary function: gas exchange. This failure leads to insufficient oxygen levels (hypoxemia) in the blood, elevated carbon dioxide levels (hypercapnia), or both, causing critical impairment in organ function.
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The acid-base reaction class has been studied for quite some time. In 1680, Robert Boyle reported traits of acid solutions that included their ability to dissolve many substances, to change the colors of certain natural dyes, and to lose these traits after coming in contact with alkali (base) solutions. In the eighteenth century, it was recognized that acids have a sour taste, react with limestone to liberate a gaseous substance (now known to be CO2), and interact with alkalis to form neutral...
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Systemic acidemia impairs cardiac function in critically Ill patients.

S Rodríguez-Villar1, J A Kraut2, J Arévalo-Serrano3

  • 1Critical Care Department, King´s College Hospital NHS Trust Foundation. London, United Kingdom.

Eclinicalmedicine
|July 14, 2021
PubMed
Summary

Acidemia, or low blood pH, impairs cardiac function in critically ill patients. Early detection and pH management may improve outcomes for these patients.

Keywords:
ABG-aAcidemiaAcidosisCFICICOCPICardiac contractilityCardiac functionCritical careGEFPiCCOPoint-of-Care arterial blood gasSVITranspulmonary thermodilutiondPmxpH

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Area of Science:

  • Critical Care Medicine
  • Cardiology
  • Physiology

Background:

  • Acidemia is known to reduce cardiac function in animals.
  • No prior studies have investigated the impact of acidemia on human cardiac function.
  • This study addresses this gap by examining critically ill patients.

Purpose of the Study:

  • To investigate the association between acidemia and cardiac function in critically ill patients.
  • To assess cardiac function using advanced monitoring techniques.

Main Methods:

  • A prospective, multicenter, observational, cross-sectional study.
  • Involved 297 critically ill patients across 6 London ICUs.
  • Cardiac function was assessed using transpulmonary thermodilution with Pulse Contour Cardiac Output (PiCCO™) and correlated with lowest plasma pH.

Main Results:

  • Acidemia (pH ≤ 7.28) was significantly associated with impaired cardiac function, including reduced stroke volume index (SVI), global ejection fraction (GEF), and maximal pressure increase rate (dPmax).
  • A significant relationship was observed between quantitative pH levels and multiple cardiac function variables (SVI, GEF, dPmax, CFI, CPI, and CI).
  • While cardiac index (CI) showed no significant difference between pH categories, quantitative analysis revealed its association with pH.

Conclusions:

  • Acidemia is linked to impaired cardiac function in critically ill patients.
  • Findings support the potential benefit of early diagnosis and arterial pH management in this population.