Basic Concepts of Fluid and Electrolyte Therapy
Basic Concepts of Fluid and Electrolyte Therapy
Basic Concepts of Fluid and Electrolyte Therapy
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change in Pco 2<br />
= respiratory process<br />
determine whether<br />
simple disorder i.e. either metabolic or respiratory process alone<br />
mixed disorder i.e. a combination <strong>of</strong> a metabolic <strong>and</strong> respiratory<br />
process occurring together. There will be evidence <strong>of</strong> compensatory<br />
changes in either bicarbonate or Pco 2<br />
calculate the anion gap<br />
determined primarily by negative charge on serum proteins,<br />
particularly albumin<br />
serum anion gap = unmeasured anions – unmeasured cations<br />
anion gap = [Na + ] – ([HCO – 3<br />
] + [Cl – ])<br />
normal anion gap = 5-11 mmol/l<br />
in hypoalbuminaemia the normal anion gap is adjusted downward<br />
by 2.5 mmol/l for every 10 g/l reduction in serum albumin<br />
concentration<br />
an increase in anion gap indicates a tendency towards acidosis<br />
<strong>and</strong> a decrease a tendency towards alkalosis.<br />
measure blood sugar, serum lactate <strong>and</strong>/or -hydroxybutyrate<br />
concentrations to determine cause <strong>of</strong> metabolic acidosis<br />
identify <strong>and</strong> treat the underlying cause<br />
Simple acid-base disorders<br />
Table 13 demonstrates simple acid-base disorders in terms <strong>of</strong> the primary<br />
change in bicarbonate or carbon dioxide, the compensatory<br />
changes that occur <strong>and</strong> the effect on pH. By a simple rule <strong>of</strong> thumb in<br />
simple acid-base disorders the acid-base buffer pair change in the<br />
same direction. If they change in the opposite direction the disorder<br />
must be mixed.<br />
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