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Pathophysiology of Acid Base Balance: the Theory Practice Relationship
Intensive and Critical Care Nursing (2008) 24, 28—40 ORIGINAL ARTICLE Pathophysiology of acid base balance: The theory practice relationship Sharon L. Edwards ∗ Buckinghamshire Chilterns University College, Chalfont Campus, Newland Park, Gorelands Lane, Chalfont St. Giles, Buckinghamshire HP8 4AD, United Kingdom Accepted 13 May 2007 KEYWORDS Summary There are many disorders/diseases that lead to changes in acid base Acid base balance; balance. These conditions are not rare or uncommon in clinical practice, but every- Arterial blood gases; day occurrences on the ward or in critical care. Conditions such as asthma, chronic Acidosis; obstructive pulmonary disease (bronchitis or emphasaemia), diabetic ketoacidosis, Alkalosis renal disease or failure, any type of shock (sepsis, anaphylaxsis, neurogenic, cardio- genic, hypovolaemia), stress or anxiety which can lead to hyperventilation, and some drugs (sedatives, opoids) leading to reduced ventilation. In addition, some symptoms of disease can cause vomiting and diarrhoea, which effects acid base balance. It is imperative that critical care nurses are aware of changes that occur in relation to altered physiology, leading to an understanding of the changes in patients’ condition that are observed, and why the administration of some immediate therapies such as oxygen is imperative. © 2007 Elsevier Ltd. All rights reserved. Introduction the essential concepts of acid base physiology is necessary so that quick and correct diagnosis can The implications for practice with regards to be determined and appropriate treatment imple- acid base physiology are separated into respi- mented. ratory acidosis and alkalosis, metabolic acidosis The homeostatic imbalances of acid base are and alkalosis, observed in patients with differing examined as the body attempts to maintain pH bal- aetiologies. -
Cyanide Remediation: Current and Past Technologies C.A
CYANIDE REMEDIATION: CURRENT AND PAST TECHNOLOGIES C.A. Young§ and T.S. Jordan, Department of Metallurgical Engineering, Montana Tech, Butte, MT 59701 ABSTRACT Cyanide (CN-) is a toxic species that is found predominantly in industrial effluents generated by metallurgical operations. Cyanide's strong affinity for metals makes it favorable as an agent for metal finishing and treatment and as a lixivant for metal leaching, particularly gold. These technologies are environmentally sound but require safeguards to prevent accidental spills from contaminating soils as well as surface and ground waters. Various methods of cyanide remediation by separation and oxidation are therefore reviewed. Reaction mechanisms are given throughout. The methods are compared in regard to their effectiveness in treating various cyanide species: free cyanide, thiocyanate, weak-acid dissociables and strong-acid dissociables. KEY WORDS cyanide, metal-cyanide complex, thiocyanate, oxidation, separation INTRODUCTION ent on the transport of these heavy metals through their tissues, cyanide is very toxic. Waste waters from industrial operations The mean lethal dose to the human adult is transport many chemicals that have ad- between 50 and 200 mg [2]. U.S. EPA verse effects on the environment. Various standards for drinking and aquatic-biota chemicals leach heavy metals which would waters regarding total cyanide are 200 and otherwise remain immobile. The chemicals 50 ppb, respectively, where total cyanide and heavy metals may be toxic and thus refers to free and metal-complexed cya- cause aquatic and land biota to sicken or nides [3]. According to RCRA, all cyanide species are considered to be acute haz- die. Most waste-water processing tech- ardous materials and have therefore been nologies that are currently available or are designated as P-Class hazardous wastes being developed emphasize the removal of when being disposed of. -
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BRITISH 511 Auc,.Auo. 25,25, 19621962 CARBON-MONOXIDE POISONIN6 MEDICAL JOURNAL Br Med J: first published as 10.1136/bmj.2.5303.511 on 25 August 1962. Downloaded from Case Reports HYPERVENTILATION IN Case 1.-A woman aged 61 was found with her head in CARBON-MONOXIDE POISONING a gas-oven. On admission to hospital she was deeply unconscious, with a generalized increase of muscle tone. BY pulse rate 140 a minute, and blood-pressure 110/70 mm. Hg. G. L. LEATHART, M.D., M.R.C.P. There was marked hyperventilation suggesting the possibility of coincident aspirin poisoning. A stomach wash-out, how- Nuflield Department of Industrial Health, the Medical ever, revealed no tablets, and a sample of urine collected School, King's College, Newcastle upon Tyne a few hours later contained no detectable salicylate. In 24 hours she had recovered fully and was transferred to a The recent revival of interest in the use of 5% or 7% mental hospital. carbogen in the treatment of carbon-monoxide poisoning Case 2.-An accountant aged 40 was working late in his has prompted the description of four unusual cases in office and was seen to be well at 9.15 p.m. At 8.45 a.m. which gross hyperventilation occurred. The investiga- the following morning he was found in the office with the tion of these cases was not very thorough, but such cases gas turned on but unlit. He was deeply unconscious with are seen so seldom that it is felt that even this incomplete strikingly deep and rapid respiration suggesting a condition report may be of value in stimulating further research. -
TITLE: Acid-Base Disorders PRESENTER: Brenda Suh-Lailam
TITLE: Acid-Base Disorders PRESENTER: Brenda Suh-Lailam Slide 1: Hello, my name is Brenda Suh-Lailam. I am an Assistant Director of Clinical Chemistry and Mass Spectrometry at Ann & Robert H. Lurie Children’s Hospital of Chicago, and an Assistant Professor of Pathology at Northwestern Feinberg School of Medicine. Welcome to this Pearl of Laboratory Medicine on “Acid-Base Disorders.” Slide 2: During metabolism, the body produces hydrogen ions which affect metabolic processes if concentration is not regulated. To maintain pH within physiologic limits, there are several buffer systems that help regulate hydrogen ion concentration. For example, bicarbonate, plasma proteins, and hemoglobin buffer systems. The bicarbonate buffer system is the major buffer system in the blood. Slide 3: In the bicarbonate buffer system, bicarbonate, which is the metabolic component, is controlled by the kidneys. Carbon dioxide is the respiratory component and is controlled by the lungs. Changes in the respiratory and metabolic components, as depicted here, can lead to a decrease in pH termed acidosis, or an increase in pH termed alkalosis. Slide 4: Because the bicarbonate buffer system is the major buffer system of blood, estimation of pH using the Henderson-Hasselbalch equation is usually performed, expressed as a ratio of bicarbonate and carbon dioxide. Where pKa is the pH at which the concentration of protonated and unprotonated species are equal, and 0.0307 is the solubility coefficient of carbon dioxide. Four variables are present in this equation; knowing three variables allows for calculation of the fourth. Since pKa is a constant, and pH and carbon dioxide are measured during blood gas analysis, bicarbonate can, therefore, be determined using this equation. -
Acids and Bases
Name Date Class CHAPTER 14 REVIEW Acids and Bases SECTION 1 SHORT ANSWER Answer the following questions in the space provided. 1. Name the following compounds as acids: sulfuric acid a. H2SO4 sulfurous acid b. H2SO3 hydrosulfuric acid c. H2S perchloric acid d. HClO4 hydrocyanic acid e. hydrogen cyanide 2. H2S Which (if any) of the acids mentioned in item 1 are binary acids? 3. Write formulas for the following acids: HNO2 a. nitrous acid HBr b. hydrobromic acid H3PO4 c. phosphoric acid CH3COOH d. acetic acid HClO e. hypochlorous acid 4. Calcium selenate has the formula CaSeO4. H2SeO4 a. What is the formula for selenic acid? H2SeO3 b. What is the formula for selenous acid? 5. Use an activity series to identify two metals that will not generate hydrogen gas when treated with an acid. Choose from Cu, Ag, Au, Pt, Pd, or Hg. 6. Write balanced chemical equations for the following reactions of acids and bases: a. aluminum metal with dilute nitric acid ϩ → ϩ 2Al(s) 6HNO3(aq) 2Al(NO3)3(aq) 3H2(g) b. calcium hydroxide solution with acetic acid ϩ → ϩ Ca(OH)2(aq) 2CH3COOH(aq) Ca(CH3COO)2(aq) 2H2O(l ) MODERN CHEMISTRY ACIDS AND BASES 117 Copyright © by Holt, Rinehart and Winston. All rights reserved. Name Date Class SECTION 1 continued 7. Write net ionic equations that represent the following reactions: a. the ionization of HClO3 in water ϩ → ϩ ϩ Ϫ HClO3(aq) H2O(l ) H3O (aq) ClO3 (aq) b. NH3 functioning as an Arrhenius base ϩ → ϩ ϩ Ϫ NH3(aq) H2O(l ) ← NH4 (aq) OH (aq) 8. -
Combining Sodium Bicarbonate and Lidocaine Injection
Combining Sodium Bicarbonate and Lidocaine injection Tom Simpleman Consultant Pharmacist the FAWKS company http://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=f9c826a7‐8f19‐4857‐b5be‐11dcafcfc7a9 Referenced information from National Institutes of Health DESCRIPTION: Sodium Bicarbonate Inj., 8.4% USP Neutralizing Additive Solution is a sterile, nonpyrogenic, solution of sodium bicarbonate (NaHCO3) in Water for Injection. It is added to an appropriate local anesthetic as a neutralizing agent immediately prior to administration. The solution contains no bacteriostat, antimicrobial agent or added buffer and is intended only for single-use. pH is adjusted with carbon dioxide. Per the USP monograph for Sodium Bicarbonate Inj., pH is between 7.0 and 8.5. Osmolar concentration is 2 mOsmol/mL (calc.). Sodium bicarbonate, 84 mg is equal to one milliequivalent each of Na+ and HCO3-. Sodium Bicarbonate, USP is chemically designated as NaHC03, a white crystalline powder soluble in water. Sodium bicarbonate in water dissociates to provide sodium (Na+) and bicarbonate (HCO3-) ions. Sodium (Na+) is the principal cation of the extracellular fluid and plays a large part in the therapy of fluid and electrolyte disturbances. Bicarbonate (HCO3-) is a normal constituent of body fluids and the normal plasma level ranges from 24 to 31 mEq/liter. Bicarbonate anion is considered “labile” since at a proper concentration of hydrogen ion (H+) it may be converted to carbonic acid (H2CO3) and thence to its volatile form, carbon dioxide (CO2) excreted by the lung. Normally a ratio of 1:20 (carbonic acid; bicarbonate) is present in the extracellular fluid. In a healthy adult with normal kidney function, practically all the glomerular filtered bicarbonate ion is reabsorbed; less than 1% is excreted in the urine. -
UNITED STATES PATENT OFFICE. ">Co
UNITED STATES PATENT OFFICE. LEONHARD LEDERER, OF MUNICH, GERMANY. PROCESS OF PRE PARNG HAO D DERVATIVES OF ACET ONE. SPECIFICATION forming part of Letters Patent No. 643,144, dated February 13, 1900. Application filed August 10, 1897, Serial No. 647,759. (No specimens.) To all livhon, it nay conce77: iodacetone. Also if not kept dry it some Beit known that I, LEONHARDLEDERER, a times undergoes decomposition at an ordi citizen of the Kingdom of Bavaria, residing nary temperature, thereby evolving so much SO at Munich, Bavaria, Germany, have invented heat that vapor of iodin is set free. Alco a new and useful Process of Preparing the hol, ether, and most of the organic solvents IIalogen Derivatives of Acetone, of which the set free iodin from per-iod-acetone. With following is a specification. dilute soda-lye it forms iodoform in the cold. 55 It is well known that the halogens act read The action of iodin on acetone-dicarbonic. ily upon acetonedicarbonic acid. For in acid can be so regulated by definite diminu stance, bromin added to an aqueous solution tions of the quantity of iodin added as to re of acetonedicarbonic acid is immediately sult in lower stages of iodin combination with taken up. An aqueous solution of acetonedi acetone. With regard to its behavior toward carbonic acid decomposed with an alcoholic alcohol and ether the penta-iod derivative is iodin solution takes up quickly the color of in close relation with the periodacetone. On the latter without visible reaction. If, how the addition of dilute soda-lye it is trans ever, this mixture be gently Warmed, reac formed into iodoform even in the cold, but tion takes place, evolving carbonic acid gas; not with the soda solution. -
Parenteral Nutrition Primer: Balance Acid-Base, Fluid and Electrolytes
Parenteral Nutrition Primer: Balancing Acid-Base, Fluids and Electrolytes Phil Ayers, PharmD, BCNSP, FASHP Todd W. Canada, PharmD, BCNSP, FASHP, FTSHP Michael Kraft, PharmD, BCNSP Gordon S. Sacks, Pharm.D., BCNSP, FCCP Disclosure . The program chair and presenters for this continuing education activity have reported no relevant financial relationships, except: . Phil Ayers - ASPEN: Board Member/Advisory Panel; B Braun: Consultant; Baxter: Consultant; Fresenius Kabi: Consultant; Janssen: Consultant; Mallinckrodt: Consultant . Todd Canada - Fresenius Kabi: Board Member/Advisory Panel, Consultant, Speaker's Bureau • Michael Kraft - Rockwell Medical: Consultant; Fresenius Kabi: Advisory Board; B. Braun: Advisory Board; Takeda Pharmaceuticals: Speaker’s Bureau (spouse) . Gordon Sacks - Grant Support: Fresenius Kabi Sodium Disorders and Fluid Balance Gordon S. Sacks, Pharm.D., BCNSP Professor and Department Head Department of Pharmacy Practice Harrison School of Pharmacy Auburn University Learning Objectives Upon completion of this session, the learner will be able to: 1. Differentiate between hypovolemic, euvolemic, and hypervolemic hyponatremia 2. Recommend appropriate changes in nutrition support formulations when hyponatremia occurs 3. Identify drug-induced causes of hypo- and hypernatremia No sodium for you! Presentation Outline . Overview of sodium and water . Dehydration vs. Volume Depletion . Water requirements & Equations . Hyponatremia • Hypotonic o Hypovolemic o Euvolemic o Hypervolemic . Hypernatremia • Hypovolemic • Euvolemic • Hypervolemic Sodium and Fluid Balance . Helpful hint: total body sodium determines volume status, not sodium status . Examples of this concept • Hypervolemic – too much volume • Hypovolemic – too little volume • Euvolemic – normal volume Water Distribution . Total body water content varies from 50-70% of body weight • Dependent on lean body mass: fat ratio o Fat water content is ~10% compared to ~75% for muscle mass . -
Rational Treatment of Acid-Base Disorders
Practical Therapeutics Drugs 39 (6): 841-855, 1990 0012-6667/90/0006-0841/$07.50/0 © ADlS Press Limited All rights reserved. DRUG03353 Rational Treatment of Acid-Base Disorders Margaret L. McLaughlin and Jerome P. Kassirer Nephrology Division, Department of Medicine, New England Medical Center, and Department of Med icine, Tufts Un iversity School of Medi cine, Boston , Massachusetts, USA Contents Summary , ,.., , ,.., ,.., ,..,.. 842 I. Metabolic Acidosis 843 1.1 Clinical Manifestations 843 1.2 Causes of Metabolic Acidosis 843 1.3 Treatment of Metabolic Acidosis 844 1.3.1 General Remarks 844 1.3.2 Loss of Alkaline Gastrointestinal Fluids 845 1.3.3 Carbonic Anhydrase Inhibitors 845 1.3.4 Urinary Diversion , 845 1.3.5 Lactic Acidosis 845 1.3.6 Diabetic Ketoacidosis 846 1.3.7 Alcoholic Ketoacidosis 846 1.3.8 Renal Tubular Acidosis ll47 1.3.9 Renal Acidosis (Uraemic Acidosis) 848 2. Metabolic Alkalosis , 848 2.1 Clinical Manifestations 848 2.2 Causes of Metabolic Alkalosis 848 2.3 Treatment of Metabolic Alkalosis 849 2.3.1 Milk-Alkali Syndrome 850 2.3.2 Combined Therapy with Nonabsorbabl e Alkali and Exchange Resins 850 2.3.3 Acute Alkali Loading 850 2.3.4 Gastric Fluid Losses 850 2.3.5 Diuretic Therapy , 851 2.3.6 Posthypercapnic Alkalosis 851 2.3.7 Primary Aldosteron ism 851 2.3.8 Bartter's Syndrom e 85I 2.3.9 Cushing's Syndrome 852 3. Respiratory Acidosis 852 3.1 Clinical Manifestations 852 3.2 Causes of Respiratory Acidosis , 852 3.3 Treatment of Respiratory Acidosis , 852 4. -
Tissue and Renal Response to Chronic Respiratory Acidosis
TISSUE AND RENAL RESPONSE TO CHRONIC RESPIRATORY ACIDOSIS Norman W. Carter, … , Donald W. Seldin, H. C. Teng J Clin Invest. 1959;38(6):949-960. https://doi.org/10.1172/JCI103878. Research Article Find the latest version: https://jci.me/103878/pdf TISSUE AND RENAL RESPONSE TO CHRONIC RESPIRATORY ACIDOSIS * By NORMAN W. CARTER,t DONALD W. SELDIN AND H. C. TENG (From the Department of Internal Medicine, The University of Texas Southwestern Medical School, Dallas, Texas) (Submitted for publication October 27, 1958; accepted February 26, 1959) The elevation of pCO2 which occurs during to enter during respiratory acidosis is the red cell respiratory acidosis is accompanied by a rise in (1, 3, 9). The role of renal losses in the produc- the concentration of bicarbonate and a fall in the tion of hypochloremia is less certain. In short concentration of chloride in serum (1). The term human experiments, chloruresis has not increased bicarbonate concentration results from been observed during respiratory acidosis (5, both cellular and renal responses. The cellular 10). However, in the rat, Epstein, Branscome response is characterized by the exchange of ex- and Levitin observed increased chloride excre- tracellular hydrogen ions for intracellular cations, tion during the first 24 hours of an imposed re- thereby contributing to the elevation of the ex- spiratory acidosis (11). tracellular concentration of bicarbonate (2, 3). The present study in the rat was undertaken in The renal factors responsible for the elevated an attempt to delineate the pattern of renal and bicarbonate concentration may be divided into extrarenal responses to respiratory acidosis. -
Structure and Functioning of the Acid–Base System in the Baltic Sea
Earth Syst. Dynam., 8, 1107–1120, 2017 https://doi.org/10.5194/esd-8-1107-2017 © Author(s) 2017. This work is distributed under the Creative Commons Attribution 3.0 License. Structure and functioning of the acid–base system in the Baltic Sea Karol Kulinski´ 1, Bernd Schneider2, Beata Szymczycha1, and Marcin Stokowski1 1Institute of Oceanology, Polish Academy of Sciences, IO PAN, ul. Powstanców´ Warszawy 55, 81-712 Sopot, Poland 2Leibniz Institute for Baltic Sea Research Warnemünde, IOW, Seestrasse 15, 18119 Rostock, Germany Correspondence: Karol Kulinski´ ([email protected]) Received: 6 April 2017 – Discussion started: 12 April 2017 Revised: 21 October 2017 – Accepted: 6 November 2017 – Published: 11 December 2017 Abstract. The marine acid–base system is relatively well understood for oceanic waters. Its structure and func- tioning is less obvious for the coastal and shelf seas due to a number of regionally specific anomalies. In this review article we collect and integrate existing knowledge of the acid–base system in the Baltic Sea. Hydro- graphical and biogeochemical characteristics of the Baltic Sea, as manifested in horizontal and vertical salinity gradients, permanent stratification of the water column, eutrophication, high organic-matter concentrations and high anthropogenic pressure, make the acid–base system complex. In this study, we summarize the general knowledge of the marine acid–base system as well as describe the peculiarities identified and reported for the Baltic Sea specifically. In this context we discuss issues such as dissociation constants in brackish water, differ- ent chemical alkalinity models including contributions by organic acid–base systems, long-term changes in total alkalinity, anomalies of borate alkalinity, and the acid–base effects of biomass production and mineralization. -
Alternative Solvents for Catalysis and Organic Reactions
ALTERNATIVE SOLVENTS FOR CATALYSIS AND ORGANIC REACTIONS A Thesis Presented to The Academic Faculty By Vittoria Madonna Blasucci In Partial Fulfillment of the Requirements for the Degree Doctor of Philosophy in Chemical & Biomolecular Engineering Georgia Institute of Technology December 2009 ALTERNATIVE SOLVENTS FOR CATALYSIS AND ORGANIC REACTIONS Dr. Charles A. Eckert, Advisor School of Chemical & Biomolecular Engineering Georgia Institute of Technology Dr. Charles L. Liotta, Co-Advisor School of Chemistry & Biochemistry Georgia Institute of Technology Dr. William Koros School of Chemical & Biomolecular Engineering Georgia Institute of Technology Dr. Christopher Jones School of Chemical & Biomolecular Engineering Georgia Institute of Technology Dr. Amyn Teja School of Chemical & Biomolecular Engineering Georgia Institute of Technology Date Approved: September 30th 2009 For my Mom and Dad- Without them I would have never made it through ACKNOWLEDGEMENTS First, I would like to acknowledge my advisor, Prof. Charles Eckert. Under his guidance, I was given the freedom to take my research into the areas that interest me the most. Not only is he a valuable information source, but he is also an excellent mentor. In addition, I thank my co-advisor, Prof. Charles Liotta. It has been my pleasure to work with someone who truly loves what they do and refreshing to see somebody who enjoys science so much. Due to these two professors, my time at Georgia Tech has been excellent. I greatly appreciate the time and advice of my committee members: Professors Amyn Teja, Bill Koros, and Chris Jones. Thank you for reading through and editing this document! I would also like to acknowledge Dr.