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PATOLOGIA CLÍNICA ______________________________________

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HEMOGASOMETRIA ______________________________________
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Ana Laura D´Amico Fam ______________________________________
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INTRODUÇÃO
»Importância da manutenção do pH –
equilíbrio!!!
»Até mesmo processos fisiológicos
desviam o pH sanguineo.
»Mecanismos de defesa contra essa
variação.
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SISTEMAS TAMPÃO
»Independentes entre si, mas cooperativos.
»São eles:
» Proteínas plasmáticas
» Hemoglobina
» Fosfato-ácido fosfórico
» Bicarbonato-ácido carbônico
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PROTEÍNAS PLASMÁTICA ______________________________________
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HEMOGLOBINA ______________________________________
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ANIDRASE CARBÔNICA ______________________________________
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CO2 + H20 H2CO3
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BICARBONATO-ÁCIDO
CARBÔNICO
» O bicarbonato de Sódio pega um H+ e leva ao rim
» O rim excreta o H+ e reabsorve um Na+
» Urina torna-se muito ácida
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FOSFATO DE SÓDIO - ______________________________________
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ÁCIDO FOSFÓRICO ______________________________________
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»Representa apenas 1% do sistema ______________________________________
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SISTEMAS TAMPÃO ______________________________________
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»Assim: ______________________________________
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» Os pulmões atuam ______________________________________
realizando trocas ______________________________________
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gasosas (CO2) ______________________________________
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» Os Rins promovem ______________________________________
trocas metabólicas ______________________________________
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******VIDEO
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COLETA DA ______________________________________
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HEMOGASOMETRIA ______________________________________
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DISTURBIOS ÁCIDO-BASE ______________________________________
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COMPENSAÇÃO ______________________________________
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pH pCO2 HCO3 ______________________________________
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Alcalose Metabólica ______________________________________
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Acidose Metabólica ______________________________________
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Alcalose Respiratória ______________________________________
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Acidose Respiratória ______________________________________
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ACIDOSE RESPIRATÓRIA ______________________________________
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CO2 CO2 + H20 H2CO3 ______________________________________
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ACIDOSE RESPIRATÓRIA
»Determinada por doenças que
impedem a eliminação de CO2.
»Depressão dos centros respiratórios
»Afecções respiratórias
»Obstrução de vias aéreas
»Movimento do tórax reduzido
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ACIDOSE RESPIRATÓRIA
»Neste caso, nunca usar bicarbonato
»Deve-se hiperventilar o paciente!
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ACIDOSE RESPIRATÓRIA ______________________________________
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Mesmo? ______________________________________
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» Sim, pois HCO2 em solução ácida associa um H+. ______________________________________
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ACIDOSE METABÓLICA
»Cetoacidose diabética
»insuficiência renal
»Acidose láctica - choque
»Toxinas exógenas – (etileno glicol)
»Acidificantes urinários
»Diarréia
»Inibidores da anidrase carbônica
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ACIDOSE METABÓLICA
»Se a causa da acidose metabólica
for Insuficiência Renal NÃO
haverá possibilidade de
compensação!!!!
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ACIDOSE METABÓLICA ______________________________________
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¡ Repor bicarbonato! ______________________________________
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EB x 0,3 x peso corporal = mEq “perdidos” ______________________________________
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ALCALOSE METABÓLICA
»Perda de ácido ou excesso de base!
»Vômito gástrico puro
»Sobredose de bicarbonato de sódio
(NaHCO3)2
»Diminuição do FEC –
»Diminuição do potássio
»Hipoalbuminemia
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ALCALOSE METABÓLICA ______________________________________
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»Sistemas-tampão pouco ______________________________________
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eficientes! ______________________________________
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»Tratamento: fluidoterapia ______________________________________
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ALCALOSE RESPIRATÓRIA ______________________________________
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» HIPERVENTILAÇÃO!!! ______________________________________
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ALCALOSE RESPIRATÓRIA ______________________________________
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»Calor ______________________________________
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»Ansiedade ______________________________________
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»Medo ______________________________________
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»Dor ______________________________________
»Lesões do SNC ______________________________________
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»Anemia pronunciada ______________________________________
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»Ventilação mecânica aumentada ______________________________________
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ALCALOSE RESPIRATÓRIA ______________________________________
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»Tratamento: ______________________________________
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»TRATAR A CAUSA!!!! ______________________________________

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DISTÚRBIOS MISTOS ______________________________________
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» Doenças concomitantes desviam o pH. ______________________________________
» Por exemplo: ______________________________________
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» Vômito e Diarréia ______________________________________
» Insuficiência Renal e Vômito. ______________________________________
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» Como estará o pH???? ______________________________________
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O PROCESSO PRIMÁRIO DETERMINA O pH ______________________________________
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EXEMPLO ______________________________________
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n HCO3 10 mEq/L ______________________________________
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n pCO2 33,3 mmHg ______________________________________
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n EB -15 ______________________________________
n Prop. 10:1 ______________________________________
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Parâmetro Arterial ______________________________________
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pH 7,35- 7,45 ______________________________________
PCO2(mmHg) 31 - 43 ______________________________________
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HCO3 19- 22 ______________________________________
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