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1、會(huì)計(jì)學(xué)12021-12-162第1頁(yè)/共45頁(yè)2021-12-163第2頁(yè)/共45頁(yè)2021-12-164第3頁(yè)/共45頁(yè)2021-12-165第4頁(yè)/共45頁(yè)2021-12-166第5頁(yè)/共45頁(yè)2021-12-167第6頁(yè)/共45頁(yè)2021-12-168蛋白血癥、貧血等，糾正這種堿儲(chǔ)不足，補(bǔ)充HCO3-是不適宜的。第7頁(yè)/共45頁(yè)2021-12-169第8頁(yè)/共45頁(yè)2021-12-1610第9頁(yè)/共45頁(yè)2021-12-1611第10頁(yè)/共45頁(yè)2021-12-1612第11頁(yè)/共45頁(yè)2021-12-1613第12頁(yè)/共45頁(yè)2021-12-1614第13頁(yè)/共45頁(yè)2021-12-1

2、615第14頁(yè)/共45頁(yè)2021-12-1616第15頁(yè)/共45頁(yè)2021-12-1617第16頁(yè)/共45頁(yè)2021-12-1618第17頁(yè)/共45頁(yè)2021-12-1619第18頁(yè)/共45頁(yè)2021-12-1620第19頁(yè)/共45頁(yè)2021-12-1621pH7.34PaCO260PaO256HCO3-32.1Base excess+8Saturation86%Click to continueClick to continue第20頁(yè)/共45頁(yè)2021-12-1622pH7.34PaCO28.0PaO27.5HCO3-32.1Base excess+8Saturation86%1. Is

3、he hypoxic?Is he hypoxic?YES.YES.The (A-a) PO2 = 2.4 kPa The (A-a) gradient is increased, and home oxygen might be appropriateClick to continue第21頁(yè)/共45頁(yè)2021-12-1623pH7.34PaCO28.0PaO27.5HCO3-32.1Base excess+8Saturation86%2. .Is there an acid base or ventilation problem?YES.YES.Click to continue第22頁(yè)/共

4、45頁(yè)2021-12-1624pH7.34PaCO28.0PaO27.5HCO3-32.1Base excess+8Saturation86%Diagnose disturbance Click to continue第23頁(yè)/共45頁(yè)2021-12-1625pH7.34PaCO28.0PaO27.5HCO3-32.1Base excess+8Saturation86%Click to continue第24頁(yè)/共45頁(yè)2021-12-1626pH7.34PaCO28.0PaO27.5HCO3-32.1Base excess+8Saturation86%Return to examples第2

5、5頁(yè)/共45頁(yè)2021-12-1627pH7.54PaCO222.5PaO291HCO3-22Base excess+2Saturation100%Click to continue第26頁(yè)/共45頁(yè)2021-12-1628pH7.54PaCO22.9PaO212.1HCO3-22Base excess+2Saturation100%Click to continue第27頁(yè)/共45頁(yè)2021-12-1629pH7.54PaCO22.9PaO212.1HCO3-22Base excess+2Saturation100%Click to continue第28頁(yè)/共45頁(yè)2021-12-1630

6、pH7.54PaCO22.9PaO212.1HCO3-22Base excess+2Saturation100%Diagnose disturbance Click to continue第29頁(yè)/共45頁(yè)2021-12-1631pH7.54PaCO22.9PaO212.1HCO3-20Base excess+2Saturation100%Click to continue第30頁(yè)/共45頁(yè)2021-12-1632pH7.54PaCO22.9PaO212.1HCO3-22Base excess+2Saturation100%Return to examples第31頁(yè)/共45頁(yè)2021-12-

7、1633pH7.23PaCO225PaO2225HCO3-12Base excess-10Saturation100%A 42 year old diabetic woman present with UTI symptoms; she has deep sighing respiration. This is the ABG on FiO2 1.Is she hypoxic?Is she hypoxic?Click to continue第32頁(yè)/共45頁(yè)2021-12-1634pH7.23PaCO23.3PaO229.9HCO3-12Base excess-10Saturation100%

8、NO. NO. This PaO2 is adequate for an FiO22. Is there an acid base or ventilation problem?Click to continue第33頁(yè)/共45頁(yè)2021-12-1635pH7.23PaCO23.3PaO229.9HCO3-12Base excess-10Saturation100%2. Is there an acid base or ventilation problem?YES.YES.Click to continue第34頁(yè)/共45頁(yè)2021-12-1636pH7.23PaCO23.3PaO229.9

9、HCO3-12Base excess-10Saturation100%There is:AcidosisPaCO2 is decreased NOT respiratory acidosisLook at HCO3-HCO3- is reducedBase excess is negative METABOLIC ACIDOSISClick to continue第35頁(yè)/共45頁(yè)2021-12-1637pH7.23PaCO23.3PaO229.9HCO3-12Base excess-10Saturation100%Using Winters formula:Expected PaCO2 =

10、3.2 3.7 kPaThe PaCO2 falls within this range SIMPLE METABOLIC ACIDOSISWhat is the anion gap?What is the anion gap?Click to continue第36頁(yè)/共45頁(yè)2021-12-1638pH7.23PaCO23.3PaO229.9HCO3-12Base excess-10Na+135Cl-99 What is the anion gap?What is the anion gap?= Na+ ( Cl= Na+ ( Cl- - + HCO + HCO3 3- - ) )= 13

11、5 ( 99 + 12 ) = 135 ( 99 + 12 ) NaNa= 24 mmol/l= 24 mmol/lThere is an anion gap acidosis due to accumulation of organic acids caused by diabetic ketoacidosisClick to continue第37頁(yè)/共45頁(yè)2021-12-1639pH7.23PaCO23.3PaO229.9HCO3-12Base excess-10Na+135Cl-99 Corrected bicarbonate = 24 mmol/lThe PaCO2 falls w

12、ithin the expected rangeSIMPLE METABOLIC ACIDOSIS; NO OTHER DISTURBANCEReturn to examples第38頁(yè)/共45頁(yè)2021-12-1640pH7.5PaCO26.2PaO210.6HCO3-38Base excess+8Saturation96%Click to continue第39頁(yè)/共45頁(yè)2021-12-1641problem?pH7.5PaCO246.5PaO280HCO3-38Base excess+8Saturation96%Click to continue第40頁(yè)/共45頁(yè)2021-12-1642pH7.5PaCO26.2PaO210.6HCO3-38Base excess+8Saturation96%Click to continue第41頁(yè)/共45頁(yè)2021-12-1643

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