Day 2 :
Dr. Ashutosh has completed his Doctorate degree of Nephrology From Banaras Hindu University , which is a leading university of india . Presently he is working as Head of department ,Nephrology and Transplantation at Monilek Hospital in jaipur Rajasthan, india . He has deep interest in electrolyte disorders and acid base disturbances
This discussion of acid base disorders will be presented at RNT College Udaipur on 29th of March 2015. Acid base disturbances are common and some time they are confusing also. Because of its reputation for complexity , acid base analysis intimidates many physicians.
In this session I will present a practical step wise approach to interpretate disturbances in blood gas and electrolyte values. I will explain all acid base disorder with taking metabolic acidosis as an initial example. As we know that Acid base disorders are of two types, simple acid base disorder and mixed acid base disorders. We will learn to differentiate them by understanding law of compensation.
Assesing a patient's acid base status begins with the measurment of arterial pH, partial pressure of carbon dioxide and bicarbonate. We will also discuss the use of Anion gap and dalta ratio for diagnosis of mixed acid base disorders and will practice some examples of acid base disorder. We will also discuss acid base disorder with normal pH and pathology of normal gap acidosis.
if we have a patient of metabolic acidosis ,first we have to decide that wheather this acidosis is because of retention of CO2 or because of loss of bicarbonates? in other words respiratory or metabolic acidosis?
To answer this we should look towards the direction of change of CO2 with PH, If they are in same direction, it is metabolic disoder and when they are in opposite direction ,it is respiratory disorder.
second important thing to decide that there is only one disoder or more then one? If compensation is "as predicted "there is only one disorder if compensation is not "as predicted "there must be second or third disturbances.
Further calculation of Anion Gap in acidosis will provide us clue that loss of bicarbonates is due to consumed in neutralising pathological acids or they lost via kidney or GIT.