bone fracture healing을 공부하다가 공유합을 촉진하는 칼로리, 단백질 등이 생각보다 훨씬 중요한 문제라는 사실
더 중요한 것은 이 영양물질이 공급될 수 있는 blood supply이고,
산염기 평형이 맞아야 bone fracture healing이 제대로 된다고..
There are four cardinal acid-base disturbances:
1) respiratory acidosis,
2) respiratory alkalosis,
3) metabolic acidosis, and
4) metabolic alkalosis.
아이고 재미없어 못하겠네. 언젠가 필요할때 해야지
산염기 평형에 관한 논문.pdf
Maintenance of acid-base homeostasis is a vital function of the living organism. Deviations of systemic acidity in either direction can impose adverse consequences and when severe can threaten life itself. Acid-base disorders frequently are encountered in the outpatient and especially in the inpatient setting. Effective management of acid-base disturbances, commonly a challenging task, rests with accurate diagnosis, sound understanding of the underlying
pathophysiology and impact on organ function, and familiarity with treatment and attendant complications [1].
Clinical acid-base disorders are conventionally defined from the vantage point of their impact on the carbonic acid-bicarbonate buffer system. This approach is justified by the abundance of this buffer pair in body fluids; its physiologic preeminence; and the validity of the isohydric principle in the living organism, which specifies that all the other buffer systems are in equilibrium with the carbonic acid-bicarbonate buffer pair.
Thus, as indicated by the Henderson equation, [H+] = 24 PaCO2/[HCO-3] (the equilibrium relationship of the carbonic
acid-bicarbonate system), the hydrogen ion concentration of blood ([H+], expressed in nEq/L) at any moment is a function of the prevailing ratio of the arterial carbon dioxide tension (PaCO2, expressed in mm Hg) and the plasma bicarbonate concentration ([HCO-3], expressed in mEq/L). As a corollary, changes in systemic acidity can occur only through changes in the values of its two determinants, PaCO2 and the plasma bicarbonate concentration.
Those acid-base disorders initiated by a change in PaCO2 are referred to as respiratory disorders; those initiated by a change in plasma bicarbonate concentration are known as metabolic disorders.
There are four cardinal acid-base disturbances:
1) respiratory acidosis,
2) respiratory alkalosis,
3) metabolic acidosis, and
4) metabolic alkalosis.
Each can be encountered alone, as a simple disorder, or can be a part of a mixeddisorder, defined as the simultaneous presence of two or more simple acid-base disturbances. Mixed acid-base disorders are frequently observed in hospitalized patients, especially in the critically ill. The clinical aspects of the four cardinal acid-base disorders are depicted. For each disorder the following are illustrated: the underlying pathophysiology, secondary adjustments in acid-base equilibrium in response to the initiating disturbance, clinical manifestations, causes, and therapeutic principles.
1) respiratory acidosis,
SIGNS AND SYMPTOMS OF respiratory acidosis
Main components of the ventilatory system
Determinants and causes of carbon dioxide retention. When the respiratory pump is unable to balance the opposing load, respiratory acidosis develops. Decreases in respiratory pump strength, increases in load, or a combination of the two, can result in carbon dioxide retention. Respiratory pump failure can occur because of depressed central drive, abnormal neuromuscular transmission, or respiratory muscle dysfunction. A higher load can be caused by increased ventilatory
demand, augmented airway flow resistance, and stiffness of the lungs or chest wall. In most cases, causes of the various determinants of carbon dioxide retention, and thus respiratory acidosis, are categorized into acute and chronic subgroups, taking into consideration their usual mode of onset and duration [2].
Acute respiratory acidosis management.
Securing airway patency and delivering an oxygen-rich mixture are critical initial steps in management. Subsequent measures must be directed at identifying and correcting the underlying cause, whenever possible [1,9].
PaCO2—arterial carbon dioxide tension.
Chronic respiratory acidosis management.
Therapeutic measures are guided by the presence or absence of severe hypercapnic encephalopathy or hemodynamic instability. An aggressive approach that favors the early use of ventilator assistance is most appropriate for patients with acute respiratory acidosis. In contrast, a more conservative approach is advisable in patients with chronic hypercapnia because of the great difficulty often encountered in weaning these patients from ventilators. As a rule, the lowest possible inspired fraction of oxygen that achieves adequate oxygenation (PaO2 on the order of 60 mm Hg) is used. Contrary to acute respiratory acidosis, the underlying cause of chronic respiratory acidosis only rarely can be resolved [1,9].