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Decreased Anion Gap is Seen in Hypoalbuminemia Multiple myeloma (paraproteinemia) Bromide intoxication Hypercalcemia 4 blood pressure quick remedy order lozol 1.5 mg fast delivery. Osmolal Gap this is the difference between the measured plasma osmolality and the calculated osmolality blood pressure chart hypertension order lozol 2.5 mg visa, which may be calculated as 2 x [Na] + [glucose] + [urea] the normal osmolal gap is <10 mOsm pulmonary hypertension xray discount 2.5 mg lozol amex. A high osmolal gap (> 25) implies the presence of unmeasured osmoles such as alcohol blood pressure 12080 cheap 2.5mg lozol with visa, methanol, ethylene glycol, etc. Acute poisoning should be considered in patients with a raised anion gap metabolic acidosis and an increased plasma osmolal gap. Drugs Antacids containing magnesium, Chlorpropamide, Iodide (absorbed from dressings), Lithium, Polymixin B i. Hyperchloremic acidosis may occur in renal tubular acidosis, acetazolamide (carbonic anhydrase inhibitor) therapy, and ureteric transplantation into large gut (done for bladder carcinoma). Renal tubular acidosis may be due to failure to excrete acid or reabsorb bicarbonate. In ureteric transplantation, the chloride ions are reabsorbed in exchange for bicarbonate ions lost, leading to hyperchloremic acidosis. Increased reabsorption of Na with bicarbonate Loss of H+ and K+ Hypokalemia leads to alkalosis due to H+-K+ exchange. Cl is reabsorbed along with Na Hence urine chloride is low Alkalosis responds to administration of NaCl. Intravenous bicarbonate, Massive blood transfusion, Anatacids, Milk alkali syndrome Sodium citrate overload Exogenous base 5. Decrease in pH in metabolic acidosis stimulates the respiratory compensatory mechanism and produces hyperventilation- Kussmaul respiration to eliminate carbon dioxide leading to hypocapnia (Hypocarbia). Hence care should be taken while correcting acidosis which may lead to sudden hypokalemia. This is more likely to happen in treating diabetic ketoacidosis by giving glucose and insulin together. Clinical Features of Metabolic Acidosis the respiratory response to metabolic acidosis is to hyperventillate. So there is marked increase in respiratory rate and depth of respiration; this is called as Kussmaul respiration. In ketoacidosis, treatment is to give intravenous fluids, insulin and potassium replacement. In all cases, potassium abnormalities should be carefully looked into and treated. Bicarbonate Requirement: the amount of bicarbonate required to treat acidosis is calculated from the base deficit. Alkalosis occurs when a) excess base is added, b) base excretion is defective or c) acid is lost. All these will lead to an excess of bicarbonate, so that the ratio becomes more than 20. Loss of acid may result from severe vomiting or gastric aspiration leading to loss of chloride and acid. In alkalosis, there is an attempt to conserve hydrogen ions by kidney in exchange for K+. It is seen in prolonged vomiting, nasogastric aspiration or administration of diuretics. In Chloride resistant condition, urine chloride is greater than 10 mmol/L; it is seen in Box 29. Clinical Features of Metabolic Alkalosis the respiratory center is depressed by the high pH leading to hypoventilation. However, complete correction of alkalosis will be effective only if potassium is administered and the cause is removed (Table 29. Depending on whether the condition is of acute or chronic onset, the extent of compensation varies. Acute respiratory acidosis may result from bronchopneumonia or status asthmaticus.

The automated instruments are able to perform tests repetitively in short span of time with only minimal human involvement arrhythmia low blood pressure order lozol 1.5 mg fast delivery. Since these automated instruments analyses variety of constituents of biological samples like blood arrhythmia recognition posters lozol 1.5mg on line, urine arteria aorta definicion purchase lozol 2.5mg with mastercard, C 4 discount 2.5mg lozol otc. Further, use of automation minimizes error that occurs due to boredom when repetitive type of work is done by humans. However autoanalyzers are very costly equipments which can be afforded by only very large hospitals with sufficient financial backup. A sampler, proportionate pump, dialyzer, waterbath, colorimeter, spectrophotometer or spectrofluorimeter and recorder are main components of an autoanalyzer. Usually number of components and type of components of an autoanalyzer may vary according to the type of autoanalyzer. Further, method employed for estimation of an analyte in an autoanalyzer is largely choice of its maker or manufacturer. Various components of autoanalyzer are connected by plastic tubes which allows flow of solutions from one component to another. The proportionate pump aspirates small volume of sample from each of samples that are loaded. Then the aspirated samples are channeled to dialyzer where dialyzable and non dialyzable constituents of samples get separated. Appropriate reagents in specified amount are added by proportionate pump to these constituents for the color development. Now the intensity of color developed is read by colorimeter or any other measuring device and recorder does calculation and gives a printout containing values obtained for each analyte. They differ in manner in which they analyze various constituents of a sample or number of samples. This type of autoanalyzer is able to analyze samples in a sequence for more than one analyte. Further reagents and diluents are pumped continuously through tubings along with samples and every sample is subjected to same type of methods. For examples if blood glucose of one sample is analyzed with glucose oxidase method remaining samples glucose is also estimated by using same method. This type of autoanalyzer subjects samples to a set of tests (many tests) and results are given as printout. Using multichannel autoanalyzer more than 18 tests can be done on single sample simultaneously and 60-100 samples can be processed per hour. This type of autoanalyzer subjects each sample to only one test (single analyte) and results of many samples are given as printout. This type of autoanalyzer analyzes sample for an analyte by using more than one methods. In other words, in this type of autoanalyzer all samples are not processed in the same manner. This type of autoanalyzers are able to do only some steps of analysis and remaining steps are manually done. Introduction of desired volume of sample, mixing with reagents, color development etc. Channelling of colored solution to photometer, measurement of absorption, calculation and printout of results are done by auto analyzer. Some semi autoanalyzers are able to analyze only one analyte at a time (single channel analyzer) but continously it can analyze many samples in a sequence. Some semi auto analyzer are able to analyze more than one analyte (multichannel analyzer). Serum calcium estimation by titrametric method After 12hours fasting blood is collected. Ammonium oxalate is added to serum to precipitate calcium in serum as calcium oxalate. The excess ammonium oxalate is removed by washing precipitate with dilute ammonium hydroxide. A balnk containing only sulphuricacid is also titrated and titre value (B) is obtained. They produce urine from the blood to maintain water, electrolyte, acid-base balance of the body and normal composition of extracellular, intracellular fluids.

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