1. Nje qasje algoritmike
Hysni Dida

2. Marrja e
gjakut arterial

4. Radial Artery
Ulnar Artery

6. Hyrje
Astrupometri mat pH, pCO2 dhe pO2
[HCO3-] dhe diferenca bazike llogariten
duke perdorur ekuacionin Henderson-
Hasselbalch

7. Parametrat normale
Crregullimet acidobazike mund te verehen edhe nqs
kemi vetem 3 parametra pH, pCO2 dhe HCO3
Vlerat normale
• pH = 7.36 – 7.44
• PCO2 = 36-44 mmhg
• HCO3 = 22-26 mEq/L

9. Marredhenia midis [H+] & pH
pH [H+
] pH [H+
]
7.80
7.75
16
18
7.30
7.25
50
56
7.70
7.65
20
22
7.20
7.15
63
71
7.60
7.55
25
28
7.10
7.00
79
89
7.50
7.45
32
35
6.95
6.90
100
112
7.40
7.35
40
45
6.85
6.80
141
159

10. Baze deficiti dhe Baze eksesi
 Nje ndryshim me 0.15 ne pH eshte ekuivalent
me nje ndryshim ne baze me 10 mEq/L.
Nje renie ne baza psh HCO3 quhet
baze deficit dhe nje rritje ne baza
quhet baze ekses

11. Ndryshime Metabolike vs
Respiratore
 Kur ndryshimi primar eshte pCO2 atehere crregullimi
eshte respirator
 Kur ndryshimi primar eshte HCO3- => crregullim
metabolik

12. Acidemia vs Alkalemia
 Kur pH I gjakut eshte <7.35 kemi te bejme me
acidemi
Kur pH I gjakut eshte >7.45 kemi te
bejme me Alkalemi

13. Crregullimet primare dhe pergjigjet kompesatore
  


3
2
24
HCO
PaCO
H
Crregullimi Ndryshimi primar Ndryshimi kompesator
Respiratory acidosis PCO2 HCO3
Respiratory alkalosis PCO2 HCO3
Metabolic acidosis HCO3 PCO2
Metabolic alkalosis HCO3 PCO2
• Ndryshimet kompesatore ndodhin qe te mbajne te pandryshuar
raportin PCO2/HCO3
• Ndryshimet kompesatore jane ne te njejtin drejtim me ndryshimin
primar

16. Kompesimi
 Crregullimet respiratore kompesohen me ane te
veshkave
 Crregullimet metabolike kompesohen me ane te
veshkave (kur veshkat nuk jane shkaku) dhe me ane te
pulmoneve
 Crregullimi me I pa kompesuar eshte alkaloza
metabolike sepse kompesimi respirator eshte
hypoventilimi I cili nuk mund te zgjaze per nje kohe te
gjate sepse nxiten kemoreceptoret qendrore

17. Kompesimi respirator I acidozes metabolike
 Pergjigja ventilatore pas nje acidoze metabolike eshte te krijoje nje
alkaloze respiratore gje qe do te coje ne nje HIPERVENTILIM duke
ulur paCO2 I cili matet me formulen e Winter
 PaCO2 I pritur = (1.5×HCO3) + (8±2)
 Nese paCO2 I matur eshte ekuivalent me paCO2 e pritur atehere kompesimi
respirator eshte adekuat dhe kjo gjendje quhet Acidoze metabolike e kompesuar
 Nese paCO2 I matur eshte me I madh se paCO2 I pritur atehere pergjigja respiratore
nuk eshte adekuate dhe kemi nje acidoze respiratore shtese acidozes metabolike. Ky
crregullim quhet Acidoze metabolike primare me mbivendosje te nje acidoze
respiratore
 Nese paCO2 I matur eshte me I vogel se ai I pritur atehere eshte nje alkaloze
respiratore mbivendosur nje acidoze metabolike primare

18. Kompesimi I alkalozes metabolike
 Formula e meposhtme vlen ne rastet kur HCO3 >40
 PaCO2 I pritur = (0.7×HCO3) + (21±2)
 Nese paCO2 I matur eshte I barabarte me paCO2 e pritur atehere kemi
te bejme me kompesim adekuat respirator= Alkaloze metabolkie e
kompesuar
 Nese paCO2 I matur eshte me I madh se ai I pritur kompesimi
respirator nuk eshte adekuat dhe kemi nje acidoze respiratore
mbivendosur alkalozes metabolike primare
 Nese paCO2 I matur eshte me I ulet se ai I pritur atehere kemi nje
alkaloze respiratore te mbivendosur =Alkaloze metabolike primare
me mbivendosje nje alkaloze respiratore

19. Kompesimi metabolik
 Ndodh ne veshka
 Ndryshimi I perqendrimit te CO2 con ne ndryshim te perthithjes se HCO3- ne
tubulat renale
 Ne acidoze respiratore kemi rritje te paCO2 dhe rritje te perthithjes se HCO3-
ne veshka
 Ne alkaloze respiratore kemi ulje te paCO2 dhe ulje te perthithjes se HCO3-
 Eshte me I ngadalte , fillon 6-12 ore pasi eshte vendosur crregullimi primar ndaj
nje crregullim quhet akut para fillimit te kompesimt renal dhe kronik pas
fillimit te kompesimit renal

20. Kompesimi metabolik
 Alkaloza respiratore
 Ulet paCO2  ulet HCO3-
 Acidoza respiratore
 Rritet pa CO2  rritet HCO3-

21. Crregullimet Akute respiratore
 Perpara se te filloje kompesimi renal nje ndryshim I
paCO2 me 1mmHg do te sjelle nje ndryshim me 0.008
ne pH  ∆pH = 0.008 × ∆PaCO2
 Nga ky ekuacion del pH I pritur per nje acidoze respiratore akute
pH I pritur = 7.40 – [0.008 × (PaCO2 – 40)]
Ndersa pH I pritur per nje alkaloze respiratore
akute llogaritet
pH I pritur= 7.40 + [0.008 × (40 - PaCO2)]

22. Kompesimi renal ne crregullime kronike respiratore
 Kur vendoset kompesimi renal I plote cdo ndryshim
me 1mmHg paCO2 e ndryshon pH me vetem O.OO3
njesi ∆pH = 0.003 × ∆PaCO2
pH I pritur per nje acidoze respiratore te kompesuar
pH pritur= 7.40 – [0.003 × (PaCO2 – 40)]
 Ndersa per alkalozen respiratore te kompesuar
(kronike)
 pH pritur = 7.40 + [0.003 × (40 - PaCO2)]

24. Crregullimet dhe kompesimi
Type of Disorder pH PaCO2 [HCO3]
Metabolic Acidosis   
Metabolic Alkalosis   
Acute Respiratory Acidosis   
Chronic Respiratory Acidosis   
Acute Respiratory Alkalosis   
Chronic Respiratory Alkalosis   

25. Algoritmi I interpretimit te
crregullimeve AB
 Stadi O  percakto nese te dhenat jane te vlefshme
duke perdorur ek Haselbach
 Stadi 1  percakto ndryshimin primar
 Stadi 2  shiko pergjigjet kompesatore
 Stadi 3  perdor Gap per te percaktuar ac.metabolike

26. Stadi 1
 Rregulla 1  mund te kemi nje crregullim acidobazik
dhe kur vlera e pH ose paCO2 eshte normale
 Rregulla 2  nese pH dhe paCO2 jane te dy jonormal
shiko kahet
 ++=> nese jane me te njejtin kah =crreg.metabolik
++=> nese jane me kahe te kunderta = crreg.respirator
psh nese pH=7.23 dhe paCO2=23mmHg
Acidoze metabolike

27. Stadi 1
 Rregulla 3  nese pH ose paCO2 jane normal kemi nje
crregullim miks respirator dhe metabolik
 Nese pH eshte normal kahu I paCO2 tregon
crregullimin respirator
 Nese paCO2 eshte normal kahu I pH tregon
crregullimin metabolik
 Psh: pH=7.37 paCO2=55mmHg
 acidoze respiratore me alkaloze metabolike
 Ska crregullim primar sepse pH eshte normal

28. Stadi 2
 I vlefshem kur nga stadi 1 del nje crregullim primar
 Qellimi I ketij stadi eshte te percaktojme nese
kompesimi eshte adekuat ose jo.
 Rregulla 4 nese ka nje crregullim primar metabolik
perdor HCO3 e matur dhe gjej paCO2 e pritur
 Nese paCO2 pritur =paCO2 matur kompesim I plote
 Nese paCO2 pritur >paCO2 matur mbivendosje e alkalozes respiratore
 Nese paCO2 pritur <paCO2 matur mbivendosje e acidozes respiratore

29. Stadi 2
 Shembull : paCO2=23mmHg pH=7.32 HCO3=15 mEq/L
 Zbatojme rregullin 2  kemi ACIDOZE Metabolike primare
 paCO2 pritur=(1.5*15) +8± 2= 30.5±2 mmHg
 paCO2 pritur >paCO2 matur  acidoze metabolike primare me
mbivendosje alkaloze respiratore

30. Stadi 2
 Rregulla 5 nese ka crregullim respirator=perdor
paCO2 per te llogaritur pH pritur
 pH matur >pH pritur ne acidoz/alkaloz resp akute
kemi mbivendosje ACIDOZE metabolike
 pH matur <pH pritur ne acidoz/alkaloz resp.kronike
kemi mbivendosje ALKALOZ metabolike

31. Stadi 2
 Shembull : paCO2=23mmHg pH=7.54
 alkaloz respiratore
 pH pritur akute=7.4 +[0.008*(40-23)]=7.54
 pHpritur akut=pHmatur gjendje akute pa
kompesuar
 pra kemi alkaloz respiratore akute

32. Stadi 3
 Perdorim Gap per te llogaritur /percaktuar acidozen
metabolike
 Anion gap=diferenca midis anioneve te pamatshme
me kationet e pamatshme
 AG=Na -(HCO3 +Cl)=12

33. Stadi 3
 Acidoze metabolike me GA te rritur normokloremike
 Ketoacidoza
 Acidoza laktike
 Acidoza uremike
 Acidoza metabolike me GA normal hiperkloremike
 Acidoza renale tubulare
 Acidoza uremike e hershme
 Acidoza posthypokapnike
 Acidoza e diluimit’
 Diarrea

34. Stadi 3
 Influenca e albumines

35. Stadi 3
Urinary anion gap perdoret per te kuptuar shkaqet
renale/jorenale te Acidozes metabolike me AG normal
E pavlefshme ne Hypovolemi, oliguri, hyponatriuri,
acidoze me AG
UAG=(uNa+uK)-uCl =±10
Kur UAG <-10 shkaku eshte jorenal
Kur UAG >+10 shkaku eshte renal psh

36. Metabolic
Acidosis
Anion Gap
“MUDPILERS
”
Metabolic Acidosis
Non-Gap
“HARDUPS”
Acute Resp.
Acidosis
“anything
causing
hypoventilation”
Metabolic
Alkalosis
“CLEVERPD”
Respiratory
Alkalosis
“CHAMPS”
•Methanol
•Uremia
•DKA/Alcoho
lic ketoacidosis
•Paraldehyde
•Isoniazid
•Lactic acidosis
•Ethylene
Glycol
•Renal
failure(End-
Stage)/Rhabd
o
•Salicylates
•Hyperalimentation
•Acetazolamide
•Renal Tubular
Acidosis
•Diarrhea
•Ureterosigmoidosto
my
•Post-hypocapnia
•Spironolactone
•Early Renal Failure
Negative AG
•Multiple Myeloma
•CNS
depression
•Airway
obstruction
•Pulmonary
edema
•Pneumonia
•Hemo/Pneumo
thorax
•Neuromuscular
•Contraction
•Licorice
•Endocrine
(Conn/Cushing
/Bartters)
•Vomiting
•Excess alkali
•Refeeding
•Post-
hypercapnia
•Diuretics
•CNS disease
•Hypocapnia
•Anxiety
•Mech.
Ventilation
•Progesteron
e
•Salicylates
•Sepsis

46. Mixed Acid-Base Disorders
Mixed respiratory alkalosis & metabolic
acidosis
ASA overdose
Sepsis
Liver failure
Mixed respiratory acidosis & metabolic
alkalosis
COPD with excessive use of diuretics

47. Mixed Acid-Base Disorders
Mixed respiratory acidosis &
metabolic acidosis
Cardiopulmonary arrest
Severe pulmonary edema
Mixed high gap metabolic acidosis
& metabolic alkalosis
Renal failure with vomiting
DKA with severe vomiting

48. Mixed Acid-Base Disorders
Normal pH + ↓PCO2 + ↓HCO3 - Respiraory Alkalosis +
Metabolic Acidosis
Normal pH + ↑PCO2 + ↑ HCO3 - Respiratory Acidosis
+ Metabolic Alkalosis
Normal pH + Normal PCO2 + Normal HCO3 -
Metabolic Acidosis + Metabolic Alkalosis

56. Some Aids to Interpretation of Acid-Base Disorders
"Clue" Significance
High anion gap Always strongly suggests a metabolic
acidosis.
Hyperglycaemia If ketones present also diabetic
ketoacidosis
Hypokalemia and/or hypochloremia Suggests metabolic alkalosis
Hyperchloremia Common with normal anion gap acidosis
Elevated creatinine and urea Suggests uremic acidosis or hypovolemia
(prerenal renal failure)
Elevated creatinine Consider ketoacidosis: ketones interfere
in the laboratory method (Jaffe reaction)
used for creatinine measurement & give
a falsely elevated result; typically urea
will be normal.
Elevated glucose Consider ketoacidosis or hyperosmolar
non-ketotic syndrome
Urine dipstick tests for glucose and ketones Glucose detected if hyperglycaemia;
ketones detected if ketoacidosis
http://www.anaesthesiamcq.com/AcidBaseBook/ab9_2.php

58. Formulas
Metabolic Acidosis: (Winter’s formula)
 Expected PaCO2 = (1.5×HCO3) + (8±2)
 Metabolic Alkalosis:
 Expected PaCO2 = (0.7×HCO3) + (21±2)
 Acute Respiratory Acidosis:
 Expected pH = 7.40 – [0.008 × (PaCO2 – 40)]
 10mmhg ↑ in PaCO2 will ↑ HCO3 by 1mmol/L
 Acute Respiratory Alkalosis:
 Expected pH = 7.40 + [0.008 × (40 - PaCO2)]
 10mmhg ↓in PaCO2 will ↑ HCO3 by 2mmol/L
 Chronic Respiratory Acidosis:
 Expected pH = 7.40 – [0.003 × (PaCO2 – 40)]
 10mmhg ↑ in PaCO2 will ↑ HCO3 by 4mmol/L
 Chronic Respiratory Alkalosis:
 Expected pH = 7.40 + [0.003 × (40 - PaCO2)]
 10mmhg ↓ in PaCO2 will ↑ HCO3 by 4mmol/L
  


3
2
24
HCO
PaCO
H

59. Formulas ..Cont’d AG = Na - (CL + HCO3)
 AG Correction for Albumin
 Expected AG(mEq/L)=[2×Albumin(g/dL)]+[0.5×PO4(mg/dL)
 Adjusted AG = Obserbed AG + 2.5 × [4.5 - Measured Albumin (g/dL)]
 Urinary AG = (UNa + UK)-UCl
 Plasma Osmolality = 2×Na + Glucose/18 + BUN/2.8
 Na/Cl > 1.4 = metabolic alkalosis (hypochloremia)
 Na/Cl < 1.27 = non anion gap acidosis (hyperchloremia)
 AG Excess/HCO3 Deficit = (Measured AG - 12) /(24- Measured
HCO3)
 HCO3 deficit(mEq)=0.6×Wt(kg) (15-Measured HCO3)
 mEq of NaHCO3 = Apparent Volume of distribution × Target change in
HCO3
 TBW(kg) × [0.4 +(2.4/HCO3)] = Apparent Volume of distribution
 Cl Deficit (mEq) = 0.2 × Wt(kg) × (Normal Cl- Actual Cl)
 volume of isotonic saline needed to correct the deficit is the ratio: Cl
deficit/154

60. http://www.medcalc.com/acidbase.html