Respiratory complaints in children

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Respiratory complaints in children
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Tachypnea

• An abnormally rapid rate of breathing.

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Bradyapnea
Rapid Range of normal breath/min Age
More than 60 30-50 Newborn
More than 50 20-30 Infancy
More than 40 20-30 Toddler
More than 30 15-20 Children

• An abnormally slow rate of breathing.

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Tachycardia

• An abnormal condition in which the myocardium
  contract regularly but at rate greater than
  normal.

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Bradycardia
Average Normal Range (beat/min) Age
125 70-190 0-1 months
120 80-160 1-11 months
110 80-130 2 years
100 80-120 4 years
100 75-115 6 years
90 70-110 6-12 years

• An abnormal circulatory condition in which the
  myocardium contract steadily but at a rate less
  than normal.

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Cyanosis

• Bluish discoloration of the skin mucous
  membrane caused by an excess of deoxygenated
  hemoglobin in the blood or a structure defect in
  the hemoglobin molecule.

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Grunting

• Abnormal short audible grant like breaks in
  exhalation that often accompany severe chest
  pain. The grant occurs because the glottis
  briefly stops the flow of air, halting the
  movement of the lungs their surrounding or
  supporting structures.

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Clubbing

• Increase in the soft tissue of the distal parts
  of a fingers or toes in which the extremities are
  broadened the nails are shiny abnormally
  curved.

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Nasal flaring

• A sign of respiratory distress, reduces the
  resistance to inspiratory airflow through the
  nose may improve ventilation.

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Hypoxia

• An inadequate reduce tension of cellular oxygen
  characterized by cyanosis, tachycardia,
  hypertension, peripheral vasoconstriction,
  dizziness mental confusion.

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Hypercarpia

• Greater than normal amount of carbon dioxide in
  the blood.

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Acid-base balance

• A condition existing when the net rate at which
  the body produces acid or bases equal the net
  rate at which acid or bases are excreted, the
  result is a stable concentration of hydrogen ion
  in body fluid.

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Wheeze

• A form of rhonchus common characterized by a high
  pitched musical quality. Its caused by a high
  velocity flow of air through a narrowed airway,
  Its heard both during inspiration expiration.

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Stridor

• An abnormal high pitched musical respiratory
  sound caused by an obstruction in the trachea or
  larynx.

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Cough

• A rapid expulsion of air from the lungs typically
  in order to clear the lung airways of fluids,
  mucus, or material.

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Differential diagnosis of acute stridor at
different ages

• Laryngotracheobronchitis commonly known as
  croup, is the most common cause of acute stridor
  in children, especially children aged 6 months to
  2 years.
• Aspiration of foreign body is common in children
  aged 1-2 years.
• Bacterial tracheitis is relatively uncommon and
  mainly affects children younger than 3 years.
• Retropharyngeal abscess is a complication of
  bacterial pharyngitis observed in children
  younger than 6 years .
• Peritonsillar abscess.
• Spasmodic croup, occurs most commonly in children
  aged 1-3 years.
• Allergic reaction.
• Epiglottitis is a medical emergency occurring
  most commonly in children aged 2-7 years.

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Differential diagnosis of chronic stridor at
different ages

• Laryngomalacia is the most common cause of
  inspiratory stridor in the neonatal period and
  early infancy.
• Patients with subglottic stenosis can present
  with inspiratory or biphasic stridor.
• Vocal cord dysfunction.
• Laryngeal dyskinesia, exercise-induced
  laryngomalacia, and paradoxical vocal fold motion
  are other neuromuscular disorders that may be
  considered.
• Laryngeal webs are caused by an incomplete
  recanalization of the laryngeal lumen during
  embryogenesis.
• Laryngeal cysts are a less frequent cause of
  stridor.
• Laryngeal hemangiomas (glottic or subglottic) are
  very rare.
• Laryngeal papillomas.
• Tracheomalacia.
• Tracheal stenosis.

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Croup

• Mucosal inflammation swelling by laryngeal
  tracheal infection.
• Can cause life-threatening airway obstruction in
  young children.

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Croup
Viral croup
Bacterial croup
Spasmodic or recurrent
haemophilus influenzae
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Viral croup

• 95.
• The commonest is Para-influenza v.
• RSV influenza.
• Affect.. 6 months_ 6 years (peak at 2 years).

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Pathogenesis..

• laryngeotrachiaitis

Mucosal inflammation increased Secretion.
Edema that cause narrowing of the trachea.
Obstruction of the airway.
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• Symptoms ( worse at night)
• Barking cough.
• Harsh stridor.
• Hoarseness.
• Fever coryza.

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Clinically assessment of sever upper airway
obstruction..

• Sternal subcostal recession.
• Respiratory rate.
• Heart rate.
• Increased agitation.
• Drawsiness ,tiredness , exhaustion.
• Central cyanosis.

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Management

• Basic manag.
• Dont examine the throat.
• Reduce the pt. anxiety.
• Observe the signs of hypoxia.
• Urgent tracheal intubation in case of
  obstruction.

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• Mild croup can managed at home.
• (mild obst. , stridor chest recession disappear
  at rest).
• Sever croup at hospital.
• (sever symptom , oxygen sat. less than 93 in
  air).
• Less than 2 require intubation.

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Cont. management..

• Inhalation of worm moist air.
• Oral dexamethazone nebulized steroids.
• Nebulized adrenaline
• (transient improvement in sever obst.)

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Spasmodic , recurrent croup

• Suddenly develop braking cough , stridor at night
  without preceding respiratory symptoms.
• Have hyper-reactive upper airway.
• Some will develop other or a topic illnesses hey
  fever, eczema.

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(Pseudomembranous croup) Bact. tracheitis.

• Rare but dangerous.
• Caused by staph aureus or h. influenza .
• Clinical pict. Similar to sever viral croup
  high fever ,appear toxic.
• Rapidly progressive airway obst.
• Copious thick secretion found with tracheal
  intubation.

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Acute Epiglottitis

• Definition
• Inflammation of supraglottic region of the
  oro-pharynx (epiglottis , vallecula, arytenoids,
  aryepiglottic folds).

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Causative organisms

• 1- Most commonly Hib
• 2- Hemophylus parainfluenzae
• 3- Strept. pneumoniae
• 4- Group A streptococcus
• 5- Staph. aureus

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• Frequency Generally uncommon .
• Increase incidence in areas that don't require
  mandatory Hib vaccine
• More common in children than in adults with a
  ratio of 2.61 respectively .
• But may occur at any age.
• Age In children 1 --gt 6 years
• adults gt45 with a male
  predominance.
• 31 MF ratio.
• However , with the introduction of Hib vaccine in
  infancy, there has been a 99 decrease in
  incidence of epiglottitis other Hib infections.

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• Morbidity Mortality
• 1- Airway obstruction by inflamed epiglottis
  that obstructs the airway also by impaired
  clearance of secretions.
• 2- difficulty intubating patients with extensive
  swelling.
• adult mortality rate 7.
• child mortality rate lt 1.

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Clinical picture

• is usually acute with rapidly progressive
  presentations.
• SYMPTOMS-
• 1- sore throat (95)
• 2- odynophagia / dysphagia (95)
• 3- muffled voice (54)
• 4- dyspnea
• 5- usually not preceded by prodromal
  symptoms or coryza . There may be mild or absent
  cough

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SIGNS

• Patient looks ill, toxic and irritable.
• fever gt 38.5 C.
• tachycardia and tachypnea.
• soft inspiratory stridor with rapidly progressing
  respiratory distress causing child to lean
  forward and hyperextend the neck to enhance air
  exchange.
• drooling and inability to handle secretions.
• cervical lymphadenopathy.
• on direct / indirect visualization of the
  larynx, a beefy, red, stiff and oedematous
  epiglottis can be seen.
• N.B. Attempts to lie the child down or examine
  the throat with spatula or obtain swabs must not
  be undertaken as they can precipitate total
  airway obstruction and death

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Diagnosis

• 1-Lab studies -
• a- Epiglottic swab samples for
  laboratory tests should not be drawn and
  epiglottic swab culture should not be obtained
  until the airway has been secured.
• b- Blood culture.

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• 2-Imaging studies -
• a- Lateral neck soft tissue x-ray
  is useful to confirm diagnosis (using a criteria
  of 7mm thickness as being 100 specific and
  sensitive as the normal thickness is 3mm).
• b- Chest x-ray for
  visualization of endotracheal tube. Radiographic
  evaluation is being replaced by direct
  visualization by pharyngoscopy
• c- Naso-pharygoscopsy (diagnostic
  method) should be done in patients who are not
  distressed and when DX of epiglottitis is
  suspected (avoid this method until airway has
  been secured).

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Treatment

• A- Securing the airway according to the degree
  of epiglottitis severity
• a-In patients with severe
  disease (i.e. presenting with respiratory
  distress ,stridor, inability to swallow, sitting
  erect and deterioration within 8-12 hours),
  securing the airway is the safest method
  
• 1- orotracheal intubaion is almost always
  required when there is acute airway obstruction.
• 2- if intubation can not be performed,
  cricothyroidotomy or needle-jet insufflation are
  the next lines of treatment.
• b- Patients without signs of
  airway compromise may be managed without
  immediate airway intervention by close monitoring
  in the ICU.

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Cont. treatment..

• B- Administer supplemental humidified Oxygen
• C- Antipyretics
• D- Antibiotic therapy after blood and epiglottic
  cultures have been obtained, emperic coverage for
  group A Streptococcus pneumoniae, S.pyogenes and
  H influenzae should be provided ( third degree
  cephalosporin or amoxicillin/clavulanic acid)
  e.g. Ceftriaxone, Ampicillin, Choloramphenicol
• N.B1 Racemic epinephrine, steroids, sedatives
  and Beta agonists should be avoided.
• N.B2 An anaesthesiologist and ENT specialist
  should be notified as soon as a possible case of
  emergency epiglottitis or if operative management
  is anticipated.

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Prevention

• 1- Hib vaccine.
• 2- close contacts of patients in whom Hib has
  been isolated should receive Rifampin prophylaxis.

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Complications

• 1- Pulmonary edema
• 2- Epiglottic abscess
• 3- Pneumonia
• 4- Meningitis
• 5- Cervical adenitis
• 6- Septic arthritis
• 7- Pericarditis
• 8- Cellulitis
• 9- Septic shock

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Difference between croup and epiglottitis
Croup Epiglottitis
Onset Over days Over hours
Preceding coryza Yes No
Cough Sever, barking Absent or slight
Able to drink Yes No
Drooling of saliva No Yes
Appearance Unwell Toxic, very ill
Fever lt38.5C gt38.5C
Stridor Harsh, rasping Soft, whispering
Voice, cry Hoarse Muffled, reluctant to speak
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Cough

• What is cough?
• A forceful expiration that removes excess
  secretions, foreign body and infected material
  from the airway.

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How does it happen?

• Cough may be voluntary or may be generated by
  reflux. Stimulation of irritant receptors in the
  airway mucosa
• nose,
• sinus,
• pharynx, IX
• larynx,
• trachea, X
  
• bronchi or bronchioles.
• Pleura
• Pericardium and diaphragm phrenic N.

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Mechanism of cough

• During cough, person inspires deeply to 60 to
  80of TLC.
• The glottis closes and respiratory muscles
  contract leading to compression which greatly
  increases intra-thoracic pressure.
• Explosive exhalation, the glottis open suddenly.
• The airways are cleared by compression and high
  velocity exhaled gas.

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• Loss of reflex can be due to
• unresponsive nerve endings,
• depression of cough center in brain stem,
• laryngeal disorders(paralysis of vocal cords),
• or extensive disease in peripheral airways and
  alveoli.)
• Complications
• leads to aspiration and
• pneaumonia.

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HISTORY

• 1) Onset
• 2) Duration
• 3) Productive
• 4) Time of day
• 5) Aggravating and alleviating factors
• 6) Associated wheeze or stridor
• 7) Associated symptoms
• 8) History of exposure to respiratory illness
• 9) Family Hx
• 10) Environmental history

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EXAMINATION

• General look
• Respiratory pattern and rate, work of breathing
• Inspection
• Palpation
• auscultation

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Caused of acute cough

• URTI
• Acute laryngitis, tracheobronchitis
• Acute broncheolitis
• Pneumonia
• Bronchial asthma
• Foreign body
• Measels, pertusis
• Chemical irritation

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Acute cough URT

• Common cold (coryza)
• Acute tonsillo-pharyngitis
• Acute sinusitis
• Acute laryngitis
• Chemical irritation
• Foreign body

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Common Cold

• What? Acute viral inflammation of mucous membrane
  of the nose and pharynx
• Cause? Rhinoviruses
• C/P? - Low grade fever
• -watery nasal discharge
• -sneezing
• -cough
• - signs of nasal congestion
• - unable to breast feed in infants

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Acute Tonsillo-Pharyngitis

• Cause? GAßS and adenoviruses
• C/P? Fever anorexia vomiting dysphagia
  thick voice cough

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BACTERIAL VIRAL
ONSET sudden gradual
COURSE sever mild
FEVER High grade Low grade
COUGH late Early
L.N. Not specific
WBCs gt10,000 lt10,000
DIARRHEA Not specific
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Acute Sinusitis

• Usually accompanies URTI
• Causes?
• - Hypertrophied adenoids
• Deformity of nasal septa
• Allergy
• Recurrent rhinitis
• C/P? - Fever -Headache
• - Mucopurulent nasal discharge
• - Post-nasal discharge
• - Facial tenderness

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Pneumonia

• Definition.
• Classification.
• Anatomical classification.
• Etiolological classification.
• Age classification.
• Differential diagnosis of recurrent pneumonia.

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Lobar Pneumonia

• Causes.
• Pathology.
• Clinical manifestation.
• Investigation.
• Complication.
• Treatment.

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Bronchopneumonia

• Causes.
• Pathology.
• Clinical manifestation.
• Investigation.
• Complication.
• Treatment.

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Viral Pneumonia

• Causes.
• Pathology.
• Clinical manifestation.
• Investigation.
• Treatment.

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Bronchiolitis

• Definition.
• Causes.
• Pathophysiology.
• Clinical manifestation.
• Investigation.
• Differential diagnosis.
• Complication cause of death
• Treatment.

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Cystic Fibrosis

• Epidemiology etiology
• Clinical manifestations
• Diagnostic studies
• Treatment
• Complications

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Epidemiology

• The commonest cause of chronic suppurative lung
  disease in caucasians, and the most common
  life-limiting recessive genetic disease in
  whites.
• (1 in 3200) in whites. (1 in 15,000) in African
  Americans. (1 in 31,000) in Asians.

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Etiology

• An autosomal recessive disorder.
• A gene mutation in chromosome 7, that codes for
  the protein called cystic fibrosis transmembrane
  regulator- (CFTR) which is defective in CF.
• (CFTR) is an AMP-dependent chloride channel
  blocker.
• In CF theres abnormal ion transport across the
  epithilial cells of the exocrine glands ( Resp.
  tract Pancrease ), -because CFTR is defective-
  resulting in increased viscosity of secretions
  and excessive conc. Of Na and Cl- in the sweat
  (up to 80-125 mmol/L).

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Clinical Manifestations

• Malabsorption
• Failure to thrive
• Recurrent or persistent (chronic) chest infection
  gtgt chronic reproductive cough, (purulent sputum)
• Organisms detected Staph. aureus, H. influenza,
  pseudomonas.
• Bronchiectasis, abscess formation.
• Hyperinflation of the chest due to air trapping,
  coarse crepitations or expiratory ronchi.
• Finger clubbing.
• In infants 10-20 gt meconium ileusgt signs of
  intestinal obstruction, failure to pass meconium.
  
• Steatorrhea lt pancreatic enzymes insufficiency
  (lipases, amylases, proteases)

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Diagnostic Studies

• Sweat Test
• Sweating is stimulated by pilocarpin
  iontophoresis, and sweat is collected.
• Two tests with an adequate volume of sweat should
  be performed by experienced staff to diagnose CF

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Treatment

• Carried out by a multidisciplinary team approach,
  including pediatricians, physiotherapists,
  nursing staff, dieticians, the primary care team,
  and teachers.
• The condition cannot be cured (so far).
• The aims of treatment are to prevent the
  progression of the lung disease and to maintain
  adequate nutrition and growth.

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• Causes of death in CF

Progressive bronchiectasis and respiratory
failure.
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Complications

• Respiratory.
• Gastro-intestinal.
• Others.

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Wheezing

• Definition and Physiology of wheezing
• A wheeze is a continuous musical sound heard
  during chest auscultation that lasts longer than
  250 msec.
• It is produced by the oscillation of opposing
  walls of a narrowed airway narrowed almost to the
  point of closure.
• It can be high-pitched or low-pitched, consist of
  single or multiple notes and occur during
  inspiration or expiration.
• Wheezing can originate from airways of any size,
  from the large extra-thoracic upper airway to the
  intra-thoracic small airways. In addition to
  narrowing or compression of the airway, wheezing
  requires sufficient airflow to generate airway
  oscillation and produce sound.

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Cont. physiology

• Wheezing caused by a large or central airway
  obstruction has a constant acoustical character
  throughout the lung, but varies in loudness
  depending upon the distance from the site of
  obstruction. It is referred to as monophonic (or
  homophonous) wheezing. In the setting of small
  airway obstruction, the degree of narrowing
  varies from place to place within the lung. As a
  result, the sounds generated also vary in quality
  and acoustical character and are described as
  polyphonic ( or heterophonous) wheezing.

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Clinical manifestations

• History
• Number and frequency of wheezing episodes.
• The relationship of the episodes to viral
  infection or aeroallergen exposure.
• The presence of allergic disease such as
  conjunctivitis, rhinitis or/and eczema.
• The parental Hx of asthma.

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• Physical examination
• The overall appearance of the child (respiratory
  distress and work of breathing).
• Whether theres wheezing, transmitted upper
  airway nasal congestion, stridor and wheezing, or
  wheezing and crackles.
• The location of wheezing ( unilateral, suggestive
  of a foreign body or bronchomalacia, or
  bilateral, suggestive of a more generalized
  process.
• The childs growth curve.
• Clinical features such as rhinitis and/or
  conjunctivitis and the presence of eczema.
• The presence of a central or midline structural
  or cutaneous lesion such as hemangioma (
  associated with an increased risk of an
  intrathoracic lesion).

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Differential diagnosis

• 1- Infection
• VIRAL RSV, para-influenza, Adenovirus,
  influenza and Rhinovirus.
• OTHERS Chlamydia trachomatis, Tuberculosis
  and Histoplasmosis.
• 2- Bronchitis.
• 3- Laryngeotracheobronchitis
• 4- Bacterial tracheitis
• 5- Asthma.
• 6- Anatomic abnormalities
• Central, extrinsic and intrinsic airway
  abnormaleties.
• Congenital heart disease with left-to-right
  shunt ( increased pulmonary edema).
• 7- Inherited.
• 8- Bronchopulmonary dysplasia.
• 9- Aspiration syndrome ( GERD).
• 10- Interstitial lung disease including
  bronchiolitis obliterans.
• 11- Foreign body.

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Recurrent Wheeze

• Age ? infant/ child
• Symptoms ? reversible/ not
• Hx of chest infection ? bronchiolitis,
  bronchectasis
• Associated symptom ? allergies, stridor, vomiting
  and choking,
• Hoarseness, growth failure.

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Differential Diagnosis of Recurrent Wheeze
Structural abnormalities
Tracheo-bronchomalacia
Vascular compression/ rings
Tracheal stenosis/webs
Cystic lesions/masses
Tumors/lymphadenopathy
Cardiomegaly
Functional abnormalities
Asthma
Gastro-esophageal reflux
Recurrent aspiration
Cystic fibrosis
Immunodeficiency
Primary ciliary dyskinesia
Bronchopulmonary dysplasia
Retained foreign body
Bronchiolitis obliterans
Pulmonary edema
Vocal cord dysfunction
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What is Asthma?

• Its paroxysmal attacks of cough, dyspnea and
  wheezes.
• Caused by? generalized obstruction of the airways
  due to bronchial hyper-reactivity.
• To a variety of stimuli.
• Associated w high degree of reversibility of the
  obstruction either spontaneously or with
  treatment.

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Precipitating Factors

• URTI? viral
• Allergens? house dust mite, pollens, mold, animal
  feathers
• Smoking? passive/ active.
• Changes in temperature.
• Exercise.
• Emotional changes.
• Chemicals? paints, aerosoles, fumes

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Diagnosis of Asthma

• Is established according to Hx and Ex
• Clinical Presentation
• Hx
• Age 50 lt 2 y / 80-90 lt 4 or 5 y.
• Symptoms? cough (non productive).
• ? wheeze.
• ?dyspnea/ chest tightening.
• ?associated symptom
  allergic rhinitis, conjunctivitis, eczema or
  food/drug allergy.
• Onset, progression, frequency, reversibility of
  symptom, condition of pt btw attacks.
• Precipitating aggravating factors.
• Past recurrent chest infection? pneumonia,
  bronchitis, bronchiolitis
• Family Hx? asthma or allergy.
• Social Hx? pets at home, smokers.

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• Examination
• General ?pt dyspnic, RR rapid prolonged
  expiration, alae nasi.
• Use of accessory muscles.
• Irritability, sweating or
  cyanosis.
• Inspection ?pallor.
• ? chest deformity.
• ?hyperinflation.
• Palpation.
• Percussion.
• Auscultation -decreased air entry.
• -vesicular breathing
  with prolonged expiration.
• -wheeze

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Severity of Asthma
Severe persistent Moderate persistent Mild persistent Intermittent
Daily Cont daily 2lt /w lt 2/ wk Frequency
lt60 60-80 lt80 Norm btw attacks PF FEV/PEF
Limits activity Affects activity 2/w days Affects activity Brief hrs-ds Attacks
Frequent daily 1lt/w 2lt/m lt2/ m Night cough
30lt 30lt 20-30 lt20 PEF var
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Classification of Acute Attacks of Asthma
According to Severity
Severe Moderate Mild
-severe at rest -sits upright -words -Moderate -Prefers sitting -No/mild -Can lie down -Speaks in sentences Dyspnea
Agitated, drowsy confused Usually agitated May be agitated Alertness
50lt 30-50lt Slight RR
Like mod nasal flaring chest hyperinflation moderate substenala, subcostal retraction No/mild Intercostal Retraction
May be cyanotic Pale Normal Color
Inaudible BS Insp exp wheeze End exp wheeze Ausclt
lt50 50-70 70-90 PEFR
lt90 90-95 gt95 O2 saturation
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In Status Asthmaticus, wheeze might be absent!
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Investigations

• Blood? leukocytosis, eosinophilia
• ABG? pO2 pCO2 pH
• Immunology evaluation? IgE Ab titers
• CXR? hyperinflation, cong heart ds.
• PFM? children 5lt y to ht/wt

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Management

• Short Acting Bronchodilators (relievers)
• Salbutamol, terbutaline inhalers.
• Prophylactic Therapy (preventers)
• Steroids.
• Na cromoglicate.
• Long acting B2 agonists.
• Slow release oral theophylline.
• Leukotrien modulators.
• Antihistamine.

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ARTERIAL BLOOD GASES

• An arterial blood gas test is a blood test to
  measure how well the body uses oxygen and gets
  rid of carbon dioxide. It also measures the
  acidity, or pH of the blood.
• The blood for this test is drawn from an artery.
  An artery is oxygen-rich blood from the heart and
  lungs to the rest of the body. Arteries run
  deeper under the skin than veins. For this
  reason, drawing blood from them is a little more
  difficult and uncomfortable. Even so, the entire
  procedure lasts only a few minutes.

89

• The artery most commonly used for this test is
  the radial artery in the wrist where your pulse
  is usually checked also we can take a sample from
  the brachial artery. Since blood pressure is
  stronger in arteries than in veins, the puncture
  may take longer to close. Firm pressure is
  applied to the site for 5 to 10 minutes following
  the test. A bandage is applied and you should
  rest quietly for an additional 15 minutes. The
  blood is evaluated in the laboratory immediately
  to get the most accurate results.
• An arterial blood gas may be requested to
  evaluate respiratory disease or conditions that
  affect the lungs. It is also used to check how
  well oxygen therapy or other breathing treatments
  are working. An abnormal result may mean that
  your body is not getting enough oxygen, not
  getting rid of enough carbon dioxide, OR that
  something is wrong with the way the kidneys are
  working.

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Precautions according blood sampling

• Anticoagulant heparin in the syringe.
• Make sure no air bubbles in the syringe.
• Transport it immediately to the lab.

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What does the Blood gas analyzer measure?

• It measures the PCO2, Po2 H directly, while
  HCO3- is calculated.

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Analyte Range Interperation
PH 7.35 7.45 The pH or H indicates if a patient is acidotic (pH lt 7.35 H gt45) or alkalotic (pH gt 7.45 H lt 35).
H 35 45 nmol/l
pO2 75 100 mmHg Values below 60 may require immediate action and possibly mechanical ventillation.
pCO2 35 45 mmHg (PCO2) indicates a respiratory problem for a constant metabolic rate, the PCO2 is determined entirely by ventilation.1 A high PCO2 (respiratory acidosis) indicates underventilation, a low PCO2 (respiratory alkalosis) hyper- or overventilation.
HCO3 - 22 30 mmol/l The HCO3- ion or base excess indicates whether a metabolic problem is present (such as ketoacidosis). A low HCO3- or negative base excess indicates metabolic acidosis, a high HCO3- or high positive base excess, metabolic alkalosis.
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Respiratory disorder

• In respiratory acid-base disorders ,the primary
  disturbance is caused by changes in the arterial
  blood PCO2.
• Even in ventilation or gas exchange.

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Respiratory acidosis

• High H
• Low PH
• High Pco2
• Slight high HCO3-

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Respiratory Acidosis

• Acute chronic.
• Acute
• is caused by alveolar hypoventilation by
  parially or compeletly reduced airflow thats
  leads to low PO2 high PCO2 (medical emergency).
• Causes choking , bronchopneumonia acute
  attacks of asthma.

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• In choric there is a renal compensation BY
  increasing the execrtion of hydrogen ion
  increase the bicarbonate level ( twice) in ECF
  giving a normal blood H level
• Causes chronic bronchitis, emphysema.

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Causes of respiratory acidosis

• Airway obstruction
• Chronic obstructive airway disease, e.g.
  bronchitis , emphysema.
• Brnochospasm, e.g. in asthma.
• Aspiration.
• Pulmonary disease
• Pulmonary fibrosis.
• Severe pneumonia.
• Respiratory distress syndrome.
• Depression of respiratory centre
• Anaesthetics.
• Sedative.
• Cerebral trauma.
• Tumors.

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Respiratory Alkalosis

• Less common than respiratory acidosis
• Low H
• High PH
• Low Pco2
• Slight low HCO3-

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Causes of respiratory alkalosis

• Hypoxia
• High altitude.
• Severe anemia.
• Pulmonary disease.
• Pulmonary disease
• Pulmonary edema.
• Pulmonary embolism.
• Increased respiratory drive
• Respiratory stimulant, e.g. salicylates.
• Hepatic failure.
• Primary hyperventilation syndrome.
• Mechanical overventilation.

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Diagnosis

• History.
• Arterial blood gases.
• Biochemical measures.

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Management of acid-base disorders

• According to the underline cause
• In diabetic ketoacidosis give fluids insulin.
• Artificial ventilation in status asthmaticus.
• Restoring the blood volume in cases of
  hemorrhage.

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Thank you
Group E1