Warmies

It's too damn hot outside. I'm wearing a sleeveless shirt right now. I have a sinus infection. The windows are open. And yet I have Christmas lights hanging in the windows and a Santa on the kitchen table. Where is my winter??

I'm not a big fan of the global warming theory, but today is one to test my beliefs. It's just too damn hot outside! 80 degrees? Are you kidding me?! Gah.

As for global warming; here's my take. Everything in this universe goes in cycles or circles. The moon around the earth, the earth around the sun, the menstrual cycle, life-death, seasons... I could go on and on. Why shouldn't the climate do the same? As much of a bleeding heart democrat as I can be, I just can't get on the bandwagon about this. It's a great cause but a lame battle cry. If we are going to change our polluting ways, we need to not only start at the bottom with grass roots efforts but start at the top with the big corporations (betcha thought I was going to say government). The change needs to happen, but it's not going to happen because the global warmies are pointing fingers. Everybody knows that scientific data can say anything you want it to say. In order for people to stop using such damaging products like petrol, plastics, et al and et cetera, you've got to give them alternatives. Give us more electric cars, cars that can run on air or water, better and cheaper solar power. Instead of whining Mr. and Mrs. Scientist of the world, give us an alternative. Rallies don't change the world. Inventions do.

Acid and Base

I have a test tomorrow on acid-base balance and renal function. I've been told that teaching something is the best way to learn it. You all get to be my students. Don't you feel lucky? Now pay attention, there will be a question at the end.

pH is determined by how many hydrogen atoms you have floating around in your plasma, which is the part of the blood that is not red and white blood cells. pH can also be measured in the urine, cerebro-spinal fluid, and GI tract for medical analysis.

We are going to focus on blood plasma pH, because that is what is measured in an ABG (aterial blood gas). If the hydrogen atoms are high, the pH is low. If there are not enough free hydrogen atoms, the pH reads high. The normal range for pH in the blood is between 7.35 and 7.45, with 7.4 (obviously, but importantly) being the dividing line.

Two compounds control pH through their respective body mechanisms. Let me explain. Carbon dioxide (CO2) is retained or 'blown off' by the lungs. The measure of CO2 in the ABG tells you if the lungs are functioning like they should, therefore it is the respiratory element of the puzzle. A change in CO2 reflects a problem with respiration; unless it is a compensatory mechanism, which I will discuss later. The normal range for CO2 is 35-45 (just like the decimal points in pH).

Bicarbonate (HCO3) is the other compound we look at in an ABG analysis. It is the metabolic element of an ABG analysis. It shows how well the kidneys are doing their job. It could also be out of normal range as a compensetory act for a respiratory problem. The normal range for HCO3 is 22-26.

These values can give you a plethora of information about a patient's state of health and possible causes for the medical problem.

pH: acid-7.35-normal-7.45-base
CO2- base-35-normal-45-acid
HCO3- acid-22-normal-26-base

Still with me? If so, you're a champ. Ok, onward we go.

If you will notice, there is a much wider range for CO2 than there is for HCO3. Respiratory compensation for acid-base imbalance is much quicker than metabolic and so less exact. It is also not quite as powerful as metabolic (think kidneys) compensation.

There are four main pH imbalances. They are:

1. Respiratory acidosis- pH will be <7.35, CO2 will be >45, and HCO3 will be WNL (within normal limits).
Here is an example.

pH- 7.20
CO2- 47
HCO3- 24

Respiratory acidosis is caused by a retention of CO2. This is an easy one to observe. The person will not be breathing. This can be caused by suffocation, barbituate overdose, trauma, pneumonia, sleep apnea, CHF (congestive heart failure), obesity, pulmonary embolism, and other problem that affect the lungs. You get the point. You don't breath, you get respiratory acidosis. To solve the problem, I suggest breathing again.

2. Respiratory alkalosis- pH will be >7.45, CO2 will be <35, and HCO3 will be WNL.

pH- 7.48
CO2- 31
HCO3- 25

Respiratory alkalosis is caused by hyperventilation. A person flips out over seeing a spider, starts breathing too fast, the lungs 'blow-off' too much CO2 and the blood becomes too alkaline. To solve this problem, kill the spider. Aspirin overdose can also cause respiratory alkalosis.

3. Metabolic acidosis- pH will be <7.35, CO2 will be WNL, and HCO3 will be <22.

The lab values could look like this:

pH- 7.33
CO2- 36
HCO3- 20

Metabolic acidosis (remember it's renal) can be caused by diabetic ketoacidosis (DKA), starvation, dehydration, diarrhea, end-stage renal disease (ESRD), hyperkalemia, or lactic acidosis.

4. Metabolic alkalosis- pH will be >7.45, CO2 will be WNL, and HCO3 will be >26.

pH- 7.48
CO2- 40
HCO3- 29

Metabolic alkalosis can be caused by persistant vomiting, gastric suction (getting your stomach pumped), kidney failure, use of a potassium-wasting duiretic, severe burns, or hypovolemia (blood loss, lack of fluids).

Is your head spinning yet? If not, stay with me and I'll tell you about all that compensation mess I mentioned earlier.

This is fairly simple to understand. If the lungs are causing too much acidity, the kidneys will respond with a more alkaline value. If the metabolic value is too acidic, the lungs will try to 'blow-off' more CO2, causing deep, rapid breathing known as Kussmaul's respirations.

If the lungs are causing the blood to be too alkaline, the bicarbonate value will become more acidic. If the kidneys aren't working right and the bicarbonate value becomes to alkaline, the lungs will compensate with a lower CO2 value.

Fascinating, isn't it?

Now for the question...

Do you like spiders?

The Religious Scientist

I will be a confirmed Episcopalian on March 4th. Today was the first day of my meetings with my priest, Mother Bear. I was glad to hear that the church will not consider me a heretic just because I don't believe God created the universe in seven earthly days.

Mother Bear did mention that the church is undergoing discussions of theology and doctrine at this time that will have a huge impact on the future Episcopal church. If that's the case, I hope that it will be in the direction of a blending of spirituality and science.

I was afraid to ask how 'the church' would respond to my belief that Jesus was not born of a virgin, but born of an immaculate love between Mary and Joseph. This, again, goes back to my belief that God cannot break his own laws. Some would say, "Well, God is omnipotent. He can do what he wants." I say, "Yes. He can do what he wants. But if he set up natural laws that 'make the world go round' then he must follow those laws. Otherwise he is not a part of nature and therefore does not exist."

My faith in God and his goodness lies within the proof that I see in the beauty of the human body and the world in which it resides. This trend that belief in the natural order must be suspended in order to be a true Christian doesn't sit well with me.

At the same time, sometimes I wonder: Am I a heretic? Will I be worthy when my Judgement comes? I don't think it is right to change a spiritual perspective simply because you are afraid of condemnation. I must be true to myself, as well as true to my faith and my God.

As my favorite quotable scientist once said, "Science without religion is lame. Religion without science is blind."



Of course, he didn't believe Jesus was born of a virgin birth either. So there you go! Ha!