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Understand medical acid base problems with this clear explanation from Dr. Seheult of www.medcram.co...
This is video 2 of 8 on medical acid base.
Speaker: Roger Seheult, MD
Clinical and Exam Preparation Instructor
Board Certified in Internal Medicine, Pulmonary Disease, Critical Care, and Sleep Medicine.
Co-founder of www.medcram.co...
MedCram: Medical topics explained clearly including: Asthma, COPD, Acute Renal Failure, Mechanical Ventilation, Oxygen Hemoglobin Dissociation Curve, Hypertension, Shock, Diabetic Ketoacidosis (DKA), Medical Acid Base, VQ Mismatch, Hyponatremia, Liver Function Tests, Pulmonary Function Tests (PFTs), Adrenal Gland, Pneumonia Treatment, any many others. New topics are often added weekly- please subscribe to help support MedCram and become notified when new videos have been uploaded.
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Recommended Audience: Health care professionals and medical students: including physicians, nurse practitioners, physician assistants, nurses, respiratory therapists, EMT and paramedics, and many others. Review for USMLE, MCAT, PANCE, NCLEX, NAPLEX, NDBE, RN, RT, MD, DO, PA, NP school and board examinations.
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2 окт 2024

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Комментарии : 72

@medicinaP2010 11 лет назад

what he is trying to say is that if we think that in the body there is a net charge of 0, that means that there is one cation for every anion. the sum of the most important cations renders a number that must be equal to the sum of the most important anions. the difference between those sums is the anion gap which represents 12 anions that are not accounted in the chem7 that are mostly in the form of phosphate and albumin. hope it helps

@mariacuocci6033 11 месяцев назад

I really love the way you explain things! Thank you for your help!

@Medcram 8 лет назад

See the whole series at www.medcram.com along with other top quality videos including reviews in pulmonary, cardiology, infectious disease, and hematology!

@rdseheult 12 лет назад

The equation is Albumin X3 = predicted anion gap. Unfortunetly, the answer (12) was written underneath the underlined equation making it look like the "12" was part of the equation - which it was not.

@SaharAleeKoloukani 10 лет назад

that anion gap problem solved for good. courtesy of you! Great.

@danichols7 6 лет назад

Hey Doc, Nurse here applying to anesthesia school. Question for you. As I understand it, when carbonic acid dissociates into bicarb and a hydrogen proton, the bicarb exits the blood cell into the serum and the hydrogen binds with hemoglobin. (Correct??) Now, let's assume a patient is in respiratory distress. Since, the patient would not exchange gas as readily, wouldn't the bicarb still linger in the serum?? I'm just wondering where the bicarb goes in respiratory depression. It seems to me the bicarb wouldn't convert back into CO2 so it would linger and help to buffer against acidosis.

@christineolinghouse2038 11 лет назад

thank for making this information available. Clinically, how important is factoring albumin into your assessment of anion gap? Is pre-albumin more reflective ? We typicially treat DKA with IV insulin until the AG is less than 12, but if the albumin is low, should we take a different approach?

@Katiebangs 5 лет назад

Excellent video! I'm confused as to why the CO2 in the Chem 7 actually reflects the HCO3-, but it is not this way in the ABGs? Does it have to do with the arterial vs venous blood?

@Medcram 5 лет назад

+KO Katie no it’s the way they measure the samples. Co2=hco3 but not pco2

@dominicvaldes 11 лет назад

very nice explanation

@ibrahimstudy 12 лет назад

is the equation for predicted Anion Gap on on time: 15:26 correct? if your albumin is 2, then your expected Anion gap should be 6, not 6/12=0.5 ?

@joandawood6981 8 лет назад

thanks a lot !!

@hosam.eldin.bebars 9 лет назад

many many thanx for your great effort

@Medcram 9 лет назад

Hosam Eldin Bebars you are welcome. thank you for the comment

@rdseheult 11 лет назад

Happy Sabbath!

@krutika88 8 лет назад

wonderful lecture series Dr. Seheult. The beauty is in your simplicity.

@tamousha 10 лет назад

Im a swedish student of specialist nursing and I just want to express how great these videos are! I finally understood what I have been stuggling with for hours reading books.The video with its mind map layout was perfect for me and my learning though. I also posted the link to all of my classmates. Keep up the good work! :D

@lisatowe778 6 лет назад

I have wished someone could explain this to me for decades in a way I could process it, the WHY and HOW are necessary for me to really know something. Thank you!

@joaosoares3719 9 лет назад

When you lose HCO3- just by losing it the concentration of Cl- will rise (to maintain electrical neutrality). I presume that's the reason why you don't have a delta gap in these situations... Where does that Cl- come from? And why doesn't it rise when you lose HCO3- by combining it with a proton?

@gggggggggg-uc3ss 8 лет назад

Chloride shift

@neciromar2484 6 лет назад

what that means cl shift wher is come frome

@mohammedelfadil5859 8 лет назад

i get the concept of anion gap metabolic acidosis very clear now thanQ so much :)

@IsabelleJ84 8 лет назад

Another awesome lecture, is it possible to have transcription of the lectures to read for review?

@Medcram 8 лет назад

+Isabelle Joseph We are working on that. I'm thinking about a comprehensive review in each category - A printed syllabus perhaps. Look for it in the future.

@MrA91000-medical-etc 4 года назад

Excuse me, approximatelly at 10:55, Albumin is ~ 4 mg/dL or ~ 4 g/dL ??? Please reply! Thanks! Happy New Year 2020!

@kellyclinton1691 12 лет назад

Thanks for the great explanation of anion gap acid base problems..

@rdseheult 11 лет назад

The AG rises because the conjugate base rises and is not in the second column of the chem 7. H+ stealing the HCO3 BY ITSELF doesn't increase the AG its the negatively charged conjugate base that does this. If the H+ doesn't come from a conjugate base the AG won't increase - this is called a non anion GAP metabolic acidosis: most commonly loss of bicarb (HCO3).

@zeeshanmansuri3714 10 лет назад

Finally I understood anion gap! Thank you!

@mariselaporras712 7 лет назад

I love your lectures!!! I can hear your voice all day long, so soothing and relaxing

@marusyaivanova5336 3 года назад

Thank You!

@zandroredoble597 8 лет назад

Why does the K+ not included in the calculation of an ion gap? why Na? and why does in Chem 7 it only inlcudes. Na K Cl CHO3 BUN CR and Glucose? thanks more power

@darkdogisout 11 лет назад

Dear Dr. Rogers, I was hoping if you could help me with the following questions regarding this video. 1 Why is the typical anion gap 12 and not 16? 2. is the example where you explain that a surplus of acid and its conjugated base will raise the AG. This is because the H+ steals the HCO3- and thus the AG will rise. Then you tell that a loss of HCO3- will not result in a increased AG. That I do not understand. HCO3- will disappear and then the AG must increase too? What am I doing wrong here?

@sreejith.skumar9829 9 лет назад

thanks for the videos sir... you are great

@tahakhidr 6 лет назад

Awesome lecture. Thanks!

@MrAldosteron 11 лет назад

So if some body has got hypoalbuminemia due to any reason , the predicted anion gap will be less .. so the pt will suffer from metabolic acidosis >> is that true?

@mahmooddr 11 лет назад

more 12 negatively charged molecules? But anion gap of 12 is in favor of cations not the anions...

@noemiv866 11 лет назад

Thank you for taking your time with these videos! You're an awesome teacher!

@hotfoot214 11 лет назад

Dr S you are the absolute best.I have taught this subject for years...and know understand it better and will be able to pass this on to my students...thank you ...this is a mitzvah" in the Jewish religion....GOD bless you

@eslamelsherbeny6240 6 лет назад

why you sau that 12 formed by negative charges despite Na is 140 ...shouldn't it 12 positive charger or what!!!!

@Medcram 6 лет назад

+Eslam Elsherbeny there are 12 more positive charges with na k and co2. Therefore there are 12 negative charges out there not accounted for. That is the anion gap.

@duraivengatesan9674 9 лет назад

You got a great voice doc..I'm so confused with acid base balance.thank you fr ur videos...

@rdseheult 11 лет назад

no. hypoalbuminemia doesn't cause metacolic acidosis

@reahnonya8578 8 лет назад

I can't say THANK YOU loud enough. Going back to school for FNP and have one week to "review" acid base. I don't think I ever actually comprehended it before. I am not one to have anxiety or panic attacks, but I think I had one coming on last night before I discovered this series. Not out of the woods yet, but I think I am seeing the sunlight through the trees and I'm just on video 2.

@Medcram 8 лет назад

+'Reah Nonya Thanks for the comment and hope the rest of the series continued to clarify Acid Base for you.

@VM325Xi 9 лет назад

Great video, I just got a lil confused with this.. Bicarb up... met alkalosis..Bicarb.. down..metabolic acidosis.. why with the Pco2 is inverse... Pco2 up resp acidosis Pco2 down... respiratory alkalosis.?.. why is this inverse?. thx.

@elliebucher2307 9 лет назад

+Victor Moncada pCO2 is an acid, HCO- is a base.

@foreverrlive 9 лет назад

+Victor Moncada pco2 is same thing as H+, as they dissociate. so when u have high CO2, u have H+ (hydrogen atoms are acidic, low pH)

@DelenaLambert 9 лет назад

Thank you, sir for this amazing explanation. Yesterday I was losing hope of understanding that anion gap thing. I just have a question to make sure I understand this correctly: Is the reason the anion gap rises when negative conjugate bases are created is because the body seeks to be neutral so positive charges (e.g. Na+) are produced on the other side? And the reason it doesn't rise when bicarbonate is just lost because no negative charge is being produced so no extra positive charge is being produced??? Did I get this correctly?

@DelenaLambert 9 лет назад

I get it now. If in a metabolic acidosis lactate is produced it replaces a part of the bicarbonate. That means that the anion gap rises. If bicarbonate is lost through diarrhea for example the NaCl retention rises. That means that the amount of bicarbonate lost gets replaced by Cl-... which is why the anion gap doesn't really change much.

@AnotherBadyoga 6 лет назад

damn, these are great lectures

@stephaniefabara2520 11 лет назад

I really needed something or someone who explain this to me! I really love your work. Thanks!!

@Bahar1370 10 лет назад

what are the unit for the numbers you are using? THANKS

@pratiikkaushik8285 9 лет назад

He uses mg/dl.

@caseybrown3884 5 лет назад

Thank you for yet another great lecture! Thanks for teaching me about some of these former mysteries.

@rosseannecruz5201 4 года назад

You’re my best professor 👨‍🏫

@giovasags 11 лет назад

Many many thanks from Italy! I understood you much more that i did with my italian teachers. It was so simple!!

@Bahar1370 10 лет назад

thank you so so much for all these series.

@eileeny.137 11 лет назад

Nice, simple, easy to understand and straight forward.

@onlyfact7535 9 лет назад

but if the albumin is =2 shouldn't the anion gap =10? 11:14

@gggggggggg-uc3ss 8 лет назад

Normal albumin is 4, you take half of it = 2 ... Normal anion gap is 12, you take half of it, = 6

@onlyfact7535 8 лет назад

thank you

@joshuathompson9477 6 лет назад

No... He gets 6 by multiplying albumin (2) with 3 as expected anion gap=albumin * 3 In the given case albumin was 2 Thus 2*3= 6

@eknath9999 10 лет назад

Excellent ........ Thank u.....

@sfgox10 9 лет назад

This helped me so much.

@Medcram 9 лет назад

***** Good to hear- thank you for the feedback

@unrivaled37 8 лет назад

i love you

@lieseltower4913 9 лет назад

Why is the anion gap not 16?

@maureennkwadi 9 лет назад

liesel tower My prof too told me the nion gap is 16. So I don´t understand why it is 12 here. But his explanations are really good.

@Medcram 9 лет назад

liesel tower Thank you for the comment. We've corrected the example at about 7:00 in the video to show the Cl at 104 which would give an anion gap value of 12.

@AzureLance 9 лет назад

MEDCRAMvideos Not sure if there's a delay or in another video but heads up, It still says 100 (Cl)

@akshaymishra9160 8 лет назад

anion gap has a range of 8-16 mEq/L

@constantion305 11 лет назад

I wish you did a shorter video series for this because it too time consuming going through these video a few hours before an exam. However thank you very much and your work is always awesome.