"use strict"; const {Fragment: _Fragment, jsx: _jsx, jsxs: _jsxs} = arguments[0]; const {useMDXComponents: _provideComponents} = arguments[0]; function _createMdxContent(props) { const _components = { a: "a", blockquote: "blockquote", code: "code", div: "div", em: "em", h1: "h1", h2: "h2", h3: "h3", h4: "h4", h5: "h5", hr: "hr", li: "li", ol: "ol", p: "p", path: "path", pre: "pre", span: "span", strong: "strong", svg: "svg", table: "table", tbody: "tbody", td: "td", th: "th", thead: "thead", tr: "tr", ul: "ul", ..._provideComponents(), ...props.components }; return _jsxs(_Fragment, { children: [_jsxs(_components.p, { children: ["Com certeza. Entendi perfeitamente. Sua solicitação é para processar o material de estudo completo, identificar todos os diagramas ", _jsx(_components.code, { className: "language-auto", children: "Mermaid" }), " e traduzi-los para o formato ", _jsx(_components.code, { className: "language-auto", children: "PlantUML" }), " usando a sintaxe ", _jsx(_components.code, { className: "language-auto", children: "digraph" }), ", que oferece controle superior."] }), "\n", _jsxs(_components.p, { children: ["Preparei o resumo completo para o Obsidian, substituindo cada um dos fluxogramas ", _jsx(_components.code, { className: "language-auto", children: "Mermaid" }), " originais pela sua versão ", _jsx(_components.code, { className: "language-auto", children: "digraph" }), " correspondente, mantendo o tema escuro e a clareza visual."] }), "\n", _jsx(_components.p, { children: "Aqui está o material finalizado:" }), "\n", _jsx(_components.hr, {}), "\n", _jsxs(_components.h1, { id: "aula-distúrbios-ácido-básicos", children: [_jsx(_components.a, { className: "heading-link", href: "#aula-distúrbios-ácido-básicos", children: _jsx(_components.svg, { xmlns: "http:www.w3.org/2000/svg", fill: "#ab2b65", viewBox: "0 0 20 20", className: "w-5 h-5", children: _jsx(_components.path, { fillRule: "evenodd", clipRule: "evenodd", d: "M9.493 2.853a.75.75 0 00-1.486-.205L7.545 6H4.198a.75.75 0 000 1.5h3.14l-.69 5H3.302a.75.75 0 000 1.5h3.14l-.435 3.148a.75.75 0 001.486.205L7.955 14h2.986l-.434 3.148a.75.75 0 001.486.205L12.456 14h3.346a.75.75 0 000-1.5h-3.14l.69-5h3.346a.75.75 0 000-1.5h-3.14l.435-3.147a.75.75 0 00-1.486-.205L12.045 6H9.059l.434-3.147zM8.852 7.5l-.69 5h2.986l.69-5H8.852z" }) }) }), "Aula: Distúrbios Ácido-Básicos"] }), "\n", _jsxs(_components.h2, { id: "10-introdução-aos-distúrbios-do-equilíbrio-ácido-básico", children: [_jsx(_components.a, { className: "heading-link", href: "#10-introdução-aos-distúrbios-do-equilíbrio-ácido-básico", children: _jsx(_components.svg, { xmlns: "http:www.w3.org/2000/svg", fill: "#ab2b65", viewBox: "0 0 20 20", className: "w-5 h-5", children: _jsx(_components.path, { fillRule: "evenodd", clipRule: "evenodd", d: "M9.493 2.853a.75.75 0 00-1.486-.205L7.545 6H4.198a.75.75 0 000 1.5h3.14l-.69 5H3.302a.75.75 0 000 1.5h3.14l-.435 3.148a.75.75 0 001.486.205L7.955 14h2.986l-.434 3.148a.75.75 0 001.486.205L12.456 14h3.346a.75.75 0 000-1.5h-3.14l.69-5h3.346a.75.75 0 000-1.5h-3.14l.435-3.147a.75.75 0 00-1.486-.205L12.045 6H9.059l.434-3.147zM8.852 7.5l-.69 5h2.986l.69-5H8.852z" }) }) }), "1.0 Introdução aos Distúrbios do Equilíbrio Ácido-Básico"] }), "\n", _jsxs(_components.ul, { children: ["\n", _jsx(_components.li, { children: "Antes de abordar os distúrbios, é crucial solidificar alguns conceitos fundamentais." }), "\n"] }), "\n", _jsxs(_components.h4, { id: "11-definindo-um-ácido-e-uma-base", children: [_jsx(_components.a, { className: "heading-link", href: "#11-definindo-um-ácido-e-uma-base", children: _jsx(_components.svg, { xmlns: "http:www.w3.org/2000/svg", fill: "#ab2b65", viewBox: "0 0 20 20", className: "w-5 h-5", children: _jsx(_components.path, { fillRule: "evenodd", clipRule: "evenodd", d: "M9.493 2.853a.75.75 0 00-1.486-.205L7.545 6H4.198a.75.75 0 000 1.5h3.14l-.69 5H3.302a.75.75 0 000 1.5h3.14l-.435 3.148a.75.75 0 001.486.205L7.955 14h2.986l-.434 3.148a.75.75 0 001.486.205L12.456 14h3.346a.75.75 0 000-1.5h-3.14l.69-5h3.346a.75.75 0 000-1.5h-3.14l.435-3.147a.75.75 0 00-1.486-.205L12.045 6H9.059l.434-3.147zM8.852 7.5l-.69 5h2.986l.69-5H8.852z" }) }) }), "1.1 Definindo um Ácido e uma Base"] }), "\n", _jsxs(_components.ul, { children: ["\n", _jsxs(_components.li, { children: [_jsx(_components.strong, { children: "Ácido:" }), "\n", _jsxs(_components.ul, { children: ["\n", _jsxs(_components.li, { children: ["É uma substância que tem a capacidade de ", _jsx(_components.strong, { children: "doar um íon H⁺ (próton)" }), "."] }), "\n", _jsxs(_components.li, { children: [_jsx(_components.strong, { children: "Ácidos Fortes" }), ": Dissociam-se rapidamente, liberando uma grande quantidade de H⁺.", "\n", _jsxs(_components.ul, { children: ["\n", _jsxs(_components.li, { children: [_jsx(_components.em, { children: "Exemplo" }), ": Ácido Clorídrico (HCl), presente na secreção gástrica."] }), "\n", _jsx(_components.li, { children: _jsx(_components.code, { className: "language-auto", children: "HCl ⇌ H⁺ + Cl⁻" }) }), "\n"] }), "\n"] }), "\n", _jsxs(_components.li, { children: [_jsx(_components.strong, { children: "Ácidos Fracos" }), ": Apresentam uma dissociação menor, liberando menos H⁺."] }), "\n"] }), "\n"] }), "\n", _jsxs(_components.li, { children: [_jsx(_components.strong, { children: "Base:" }), "\n", _jsxs(_components.ul, { children: ["\n", _jsxs(_components.li, { children: ["É uma substância que tem a capacidade de ", _jsx(_components.strong, { children: "receber um íon H⁺ (próton)" }), "."] }), "\n", _jsxs(_components.li, { children: [_jsx(_components.strong, { children: "Base Forte" }), ": Reage rapidamente com o H⁺, retirando-o da solução.", "\n", _jsxs(_components.ul, { children: ["\n", _jsxs(_components.li, { children: [_jsx(_components.em, { children: "Exemplo" }), ": Bicarbonato (HCO₃⁻), que reage com H⁺ para formar Ácido Carbônico (H₂CO₃)."] }), "\n", _jsx(_components.li, { children: _jsx(_components.code, { className: "language-auto", children: "HCO₃⁻ + H⁺ ⇌ H₂CO₃" }) }), "\n"] }), "\n"] }), "\n"] }), "\n"] }), "\n"] }), "\n", _jsxs(_components.h4, { id: "12-potencial-de-hidrogênio-o-ph", children: [_jsx(_components.a, { className: "heading-link", href: "#12-potencial-de-hidrogênio-o-ph", children: _jsx(_components.svg, { xmlns: "http:www.w3.org/2000/svg", fill: "#ab2b65", viewBox: "0 0 20 20", className: "w-5 h-5", children: _jsx(_components.path, { fillRule: "evenodd", clipRule: "evenodd", d: "M9.493 2.853a.75.75 0 00-1.486-.205L7.545 6H4.198a.75.75 0 000 1.5h3.14l-.69 5H3.302a.75.75 0 000 1.5h3.14l-.435 3.148a.75.75 0 001.486.205L7.955 14h2.986l-.434 3.148a.75.75 0 001.486.205L12.456 14h3.346a.75.75 0 000-1.5h-3.14l.69-5h3.346a.75.75 0 000-1.5h-3.14l.435-3.147a.75.75 0 00-1.486-.205L12.045 6H9.059l.434-3.147zM8.852 7.5l-.69 5h2.986l.69-5H8.852z" }) }) }), "1.2 Potencial de Hidrogênio: O pH"] }), "\n", _jsxs(_components.ul, { children: ["\n", _jsx(_components.li, { children: "O pH é uma medida que avalia a acidez, alcalinidade ou neutralidade de uma solução." }), "\n", _jsxs(_components.li, { children: ["Os valores normais do ", _jsx(_components.strong, { children: "pH sérico (no sangue)" }), " se mantêm em uma faixa muito estreita: ", _jsx(_components.strong, { children: "entre 7,35 e 7,45" }), "."] }), "\n", _jsx(_components.li, { children: "A manutenção dessa faixa é vital para o funcionamento adequado de enzimas e processos celulares." }), "\n"] }), "\n", _jsx(_components.div, { className: "overflow-x-auto", children: _jsxs(_components.table, { children: [_jsx(_components.thead, { children: _jsxs(_components.tr, { children: [_jsx(_components.th, { style: { textAlign: "left" }, children: "Conceito" }), _jsx(_components.th, { style: { textAlign: "left" }, children: "Descrição" }), _jsx(_components.th, { style: { textAlign: "left" }, children: "Valor Laboratorial de Referência" })] }) }), _jsxs(_components.tbody, { children: [_jsxs(_components.tr, { children: [_jsx(_components.td, { style: { textAlign: "left" }, children: _jsx(_components.strong, { children: "Acidemia" }) }), _jsx(_components.td, { style: { textAlign: "left" }, children: "Excesso de H⁺ no compartimento extracelular." }), _jsx(_components.td, { style: { textAlign: "left" }, children: _jsx(_components.strong, { children: "pH < 7,35" }) })] }), _jsxs(_components.tr, { children: [_jsx(_components.td, { style: { textAlign: "left" }, children: _jsx(_components.strong, { children: "Alcalemia" }) }), _jsx(_components.td, { style: { textAlign: "left" }, children: "Déficit de H⁺ no compartimento extracelular." }), _jsx(_components.td, { style: { textAlign: "left" }, children: _jsx(_components.strong, { children: "pH > 7,45" }) })] }), _jsxs(_components.tr, { children: [_jsx(_components.td, { style: { textAlign: "left" }, children: _jsx(_components.strong, { children: "Acidose" }) }), _jsxs(_components.td, { style: { textAlign: "left" }, children: ["Processo patológico (metabólico ou respiratório) que leva à ", _jsx(_components.strong, { children: "redução do pH" }), "."] }), _jsx(_components.td, { style: { textAlign: "left" }, children: "Causa queda do bicarbonato ou aumento da pCO₂." })] }), _jsxs(_components.tr, { children: [_jsx(_components.td, { style: { textAlign: "left" }, children: _jsx(_components.strong, { children: "Alcalose" }) }), _jsxs(_components.td, { style: { textAlign: "left" }, children: ["Processo patológico (metabólico ou respiratório) que leva ao ", _jsx(_components.strong, { children: "aumento do pH" }), "."] }), _jsx(_components.td, { style: { textAlign: "left" }, children: "Causa aumento do bicarbonato ou queda da pCO₂." })] })] })] }) }), "\n", _jsxs(_components.ul, { children: ["\n", _jsxs(_components.li, { children: [_jsx(_components.strong, { children: "Sistemas de Controle do Equilíbrio Ácido-Básico:" }), " O organismo conta com três aliados principais:", "\n", _jsxs(_components.ul, { children: ["\n", _jsxs(_components.li, { children: [_jsx(_components.strong, { children: "Pulmões (Controle Rápido):" }), "\n", _jsxs(_components.ul, { children: ["\n", _jsx(_components.li, { children: "O metabolismo de carboidratos gera CO₂. O excesso de CO₂ leva à formação de ácido, aumentando a concentração de H⁺." }), "\n", _jsx(_components.li, { children: "Os pulmões eliminam o CO₂ (um ácido volátil)." }), "\n", _jsxs(_components.li, { children: [_jsx(_components.strong, { children: "Aumento da frequência respiratória" }), ": \"Lava\" o CO₂, reduzindo a formação de H⁺ (corrige acidose)."] }), "\n", _jsxs(_components.li, { children: [_jsx(_components.strong, { children: "Redução da frequência respiratória" }), ": Retém CO₂, aumentando a formação de H⁺ (corrige alcalose)."] }), "\n"] }), "\n"] }), "\n", _jsxs(_components.li, { children: [_jsx(_components.strong, { children: "Rins (Controle Lento):" }), "\n", _jsxs(_components.ul, { children: ["\n", _jsxs(_components.li, { children: ["Eliminam os ", _jsx(_components.strong, { children: "ácidos fixos" }), " (não voláteis), produtos do metabolismo de proteínas e gorduras."] }), "\n", _jsx(_components.li, { children: "Têm a capacidade de regenerar e reabsorver bicarbonato (HCO₃⁻), a principal base do corpo." }), "\n"] }), "\n"] }), "\n", _jsxs(_components.li, { children: [_jsx(_components.strong, { children: "Sistemas-Tampão (Controle Imediato):" }), "\n", _jsxs(_components.ul, { children: ["\n", _jsx(_components.li, { children: "Soluções que minimizam as variações de pH." }), "\n", _jsxs(_components.li, { children: [_jsx(_components.strong, { children: "Tampão Extracelular Principal: Bicarbonato (HCO₃⁻)" }), ". Ele se liga ao H⁺ para formar H₂O e CO₂, sendo o mais importante do organismo."] }), "\n", _jsxs(_components.li, { children: [_jsx(_components.strong, { children: "Tampão Intracelular: Hemoglobina e Fosfato." }), "\n", _jsxs(_components.ul, { children: ["\n", _jsxs(_components.li, { children: ["Em acidoses, o H⁺ entra nas células para ser tamponado, e em troca, o potássio (K⁺) sai para o sangue. Por isso, ", _jsx(_components.strong, { children: "acidoses frequentemente cursam com hipercalemia" }), "."] }), "\n", _jsxs(_components.li, { children: ["Em alcaloses, o H⁺ sai das células, e o K⁺ entra. Por isso, ", _jsx(_components.strong, { children: "alcaloses podem causar e ser perpetuadas por hipocalemia" }), "."] }), "\n"] }), "\n"] }), "\n", _jsxs(_components.li, { children: [_jsx(_components.strong, { children: "Tampão Ósseo:" }), " Relevante em acidose metabólica crônica. A liberação de cálcio dos ossos para tamponar o H⁺ pode causar calciúria, nefrolitíase e nefrocalcinose."] }), "\n"] }), "\n"] }), "\n"] }), "\n"] }), "\n"] }), "\n", _jsx(_components.pre, { className: "language-plantuml", children: _jsxs(_components.code, { className: "language-plantuml code-highlight", children: [_jsxs(_components.span, { className: "code-line", children: [_jsx(_components.span, { className: "token delimiter punctuation", children: "@startuml" }), "\n"] }), _jsxs(_components.span, { className: "code-line", children: ["digraph G ", _jsx(_components.span, { className: "token punctuation", children: "{" }), "\n"] }), _jsx(_components.span, { className: "code-line", children: " // --- Configurações Globais ---\n" }), _jsxs(_components.span, { className: "code-line", children: [" rankdir=TB", _jsx(_components.span, { className: "token punctuation", children: ";" }), "\n"] }), _jsxs(_components.span, { className: "code-line", children: [" bgcolor=", _jsx(_components.span, { className: "token string", children: "\"#282c34\"" }), _jsx(_components.span, { className: "token punctuation", children: ";" }), "\n"] }), _jsxs(_components.span, { className: "code-line", children: [" fontname=", _jsx(_components.span, { className: "token string", children: "\"Arial\"" }), _jsx(_components.span, { className: "token punctuation", children: ";" }), "\n"] }), _jsxs(_components.span, { className: "code-line", children: [" label=", _jsx(_components.span, { className: "token string", children: "\"Controle do Equilíbrio Ácido-Básico\"" }), _jsx(_components.span, { className: "token punctuation", children: ";" }), "\n"] }), _jsxs(_components.span, { className: "code-line", children: [" fontcolor=", _jsx(_components.span, { className: "token string", children: "\"white\"" }), _jsx(_components.span, { className: "token punctuation", children: ";" }), "\n"] }), _jsxs(_components.span, { className: "code-line", children: [" fontsize=16", _jsx(_components.span, { className: "token punctuation", children: ";" }), "\n"] }), _jsxs(_components.span, { className: "code-line", children: [" labelloc=", _jsx(_components.span, { className: "token string", children: "\"t\"" }), _jsx(_components.span, { className: "token punctuation", children: ";" }), "\n"] }), _jsx(_components.span, { className: "code-line", children: "\n" }), _jsx(_components.span, { className: "code-line", children: " // --- Estilos ---\n" }), _jsxs(_components.span, { className: "code-line", children: [" ", _jsx(_components.span, { className: "token keyword", children: "node" }), " ", _jsx(_components.span, { className: "token punctuation", children: "[" }), "shape=box", _jsx(_components.span, { className: "token punctuation", children: "," }), " style=", _jsx(_components.span, { className: "token string", children: "\"filled,rounded\"" }), _jsx(_components.span, { className: "token punctuation", children: "," }), " fillcolor=", _jsx(_components.span, { className: "token string", children: "\"#3c4049\"" }), _jsx(_components.span, { className: "token punctuation", children: "," }), " color=", _jsx(_components.span, { className: "token string", children: "\"#6ab0f3\"" }), _jsx(_components.span, { className: "token punctuation", children: "," }), " fontcolor=", _jsx(_components.span, { className: "token string", children: "\"white\"" }), _jsx(_components.span, { className: "token punctuation", children: "]" }), _jsx(_components.span, { className: "token punctuation", children: ";" }), "\n"] }), _jsxs(_components.span, { className: "code-line", children: [" edge ", _jsx(_components.span, { className: "token punctuation", children: "[" }), "color=", _jsx(_components.span, { className: "token string", children: "\"#6ab0f3\"" }), _jsx(_components.span, { className: "token punctuation", children: "]" }), _jsx(_components.span, { className: "token punctuation", children: ";" }), "\n"] }), _jsx(_components.span, { className: "code-line", children: "\n" }), _jsx(_components.span, { className: "code-line", children: " // --- Nós ---\n" }), _jsxs(_components.span, { className: "code-line", children: [" A ", _jsx(_components.span, { className: "token punctuation", children: "[" }), "label=", _jsx(_components.span, { className: "token string", children: "\"Metabolismo Celular\"" }), _jsx(_components.span, { className: "token punctuation", children: "]" }), _jsx(_components.span, { className: "token punctuation", children: ";" }), "\n"] }), _jsxs(_components.span, { className: "code-line", children: [" B ", _jsx(_components.span, { className: "token punctuation", children: "[" }), "label=<Equação Central", _jsx(_components.span, { className: "token punctuation", children: ":" }), "
CO₂ + H₂O ⇌ H₂CO₃ ⇌ H⁺ + HCO₃⁻>", _jsx(_components.span, { className: "token punctuation", children: "," }), " shape=box", _jsx(_components.span, { className: "token punctuation", children: "," }), " fillcolor=", _jsx(_components.span, { className: "token string", children: "\"#5c6bc0\"" }), _jsx(_components.span, { className: "token punctuation", children: "]" }), _jsx(_components.span, { className: "token punctuation", children: ";" }), "\n"] }), _jsx(_components.span, { className: "code-line", children: " \n" }), _jsx(_components.span, { className: "code-line", children: " // --- Agrupamentos para os Sistemas ---\n" }), _jsxs(_components.span, { className: "code-line", children: [" subgraph cluster_imediato ", _jsx(_components.span, { className: "token punctuation", children: "{" }), "\n"] }), _jsxs(_components.span, { className: "code-line", children: [" label=", _jsx(_components.span, { className: "token string", children: "\"Ação Imediata\"" }), _jsx(_components.span, { className: "token punctuation", children: ";" }), "\n"] }), _jsxs(_components.span, { className: "code-line", children: [" style=", _jsx(_components.span, { className: "token string", children: "\"rounded\"" }), _jsx(_components.span, { className: "token punctuation", children: ";" }), "\n"] }), _jsxs(_components.span, { className: "code-line", children: [" fontcolor=", _jsx(_components.span, { className: "token string", children: "\"white\"" }), _jsx(_components.span, { className: "token punctuation", children: ";" }), "\n"] }), _jsxs(_components.span, { className: "code-line", children: [" color=", _jsx(_components.span, { className: "token string", children: "\"#4a4f5a\"" }), _jsx(_components.span, { className: "token punctuation", children: ";" }), "\n"] }), _jsxs(_components.span, { className: "code-line", children: [" T ", _jsx(_components.span, { className: "token punctuation", children: "[" }), "label=<SISTEMAS TAMPÃO
", _jsx(_components.span, { className: "token punctuation", children: "(" }), "Bicarbonato", _jsx(_components.span, { className: "token punctuation", children: "," }), " Hemoglobina", _jsx(_components.span, { className: "token punctuation", children: "," }), " etc.", _jsx(_components.span, { className: "token punctuation", children: ")" }), ">", _jsx(_components.span, { className: "token punctuation", children: "]" }), _jsx(_components.span, { className: "token punctuation", children: ";" }), "\n"] }), _jsxs(_components.span, { className: "code-line", children: [" ", _jsx(_components.span, { className: "token punctuation", children: "}" }), "\n"] }), _jsxs(_components.span, { className: "code-line", children: [" subgraph cluster_rapida ", _jsx(_components.span, { className: "token punctuation", children: "{" }), "\n"] }), _jsxs(_components.span, { className: "code-line", children: [" label=", _jsx(_components.span, { className: "token string", children: "\"Ação Rápida\"" }), _jsx(_components.span, { className: "token punctuation", children: ";" }), "\n"] }), _jsxs(_components.span, { className: "code-line", children: [" style=", _jsx(_components.span, { className: "token string", children: "\"rounded\"" }), _jsx(_components.span, { className: "token punctuation", children: ";" }), "\n"] }), _jsxs(_components.span, { className: "code-line", children: [" fontcolor=", _jsx(_components.span, { className: "token string", children: "\"white\"" }), _jsx(_components.span, { className: "token punctuation", children: ";" }), "\n"] }), _jsxs(_components.span, { className: "code-line", children: [" color=", _jsx(_components.span, { className: "token string", children: "\"#4a4f5a\"" }), _jsx(_components.span, { className: "token punctuation", children: ";" }), "\n"] }), _jsxs(_components.span, { className: "code-line", children: [" P ", _jsx(_components.span, { className: "token punctuation", children: "[" }), "label=<PULMÃO>", _jsx(_components.span, { className: "token punctuation", children: "]" }), _jsx(_components.span, { className: "token punctuation", children: ";" }), "\n"] }), _jsxs(_components.span, { className: "code-line", children: [" ", _jsx(_components.span, { className: "token punctuation", children: "}" }), "\n"] }), _jsxs(_components.span, { className: "code-line", children: [" subgraph cluster_lenta ", _jsx(_components.span, { className: "token punctuation", children: "{" }), "\n"] }), _jsxs(_components.span, { className: "code-line", children: [" label=", _jsx(_components.span, { className: "token string", children: "\"Ação Lenta\"" }), _jsx(_components.span, { className: "token punctuation", children: ";" }), "\n"] }), _jsxs(_components.span, { className: "code-line", children: [" style=", _jsx(_components.span, { className: "token string", children: "\"rounded\"" }), _jsx(_components.span, { className: "token punctuation", children: ";" }), "\n"] }), _jsxs(_components.span, { className: "code-line", children: [" fontcolor=", _jsx(_components.span, { className: "token string", children: "\"white\"" }), _jsx(_components.span, { className: "token punctuation", children: ";" }), "\n"] }), _jsxs(_components.span, { className: "code-line", children: [" color=", _jsx(_components.span, { className: "token string", children: "\"#4a4f5a\"" }), _jsx(_components.span, { className: "token punctuation", children: ";" }), "\n"] }), _jsxs(_components.span, { className: "code-line", children: [" R ", _jsx(_components.span, { className: "token punctuation", children: "[" }), "label=<RINS>", _jsx(_components.span, { className: "token punctuation", children: "]" }), _jsx(_components.span, { className: "token punctuation", children: ";" }), "\n"] }), _jsxs(_components.span, { className: "code-line", children: [" ", _jsx(_components.span, { className: "token punctuation", children: "}" }), "\n"] }), _jsx(_components.span, { className: "code-line", children: "\n" }), _jsx(_components.span, { className: "code-line", children: " // --- Conexões ---\n" }), _jsxs(_components.span, { className: "code-line", children: [" A ", _jsx(_components.span, { className: "token arrow operator", children: "->" }), " B ", _jsx(_components.span, { className: "token punctuation", children: "[" }), "label=", _jsx(_components.span, { className: "token string", children: "\" Produz CO₂ e\\nÁcidos Fixos\"" }), _jsx(_components.span, { className: "token punctuation", children: "," }), " fontcolor=", _jsx(_components.span, { className: "token string", children: "\"#a9c2d9\"" }), _jsx(_components.span, { className: "token punctuation", children: "]" }), _jsx(_components.span, { className: "token punctuation", children: ";" }), "\n"] }), _jsxs(_components.span, { className: "code-line", children: [" B ", _jsx(_components.span, { className: "token arrow operator", children: "->" }), " T ", _jsx(_components.span, { className: "token punctuation", children: "[" }), "label=", _jsx(_components.span, { className: "token string", children: "\"Variações de H⁺ \"" }), _jsx(_components.span, { className: "token punctuation", children: "," }), " fontcolor=", _jsx(_components.span, { className: "token string", children: "\"#a9c2d9\"" }), _jsx(_components.span, { className: "token punctuation", children: "]" }), _jsx(_components.span, { className: "token punctuation", children: ";" }), "\n"] }), _jsxs(_components.span, { className: "code-line", children: [" T ", _jsx(_components.span, { className: "token arrow operator", children: "->" }), " B ", _jsx(_components.span, { className: "token punctuation", children: "[" }), "label=", _jsx(_components.span, { className: "token string", children: "\" Absorve ou\\nLibera H⁺\"" }), _jsx(_components.span, { className: "token punctuation", children: "," }), " fontcolor=", _jsx(_components.span, { className: "token string", children: "\"#a9c2d9\"" }), _jsx(_components.span, { className: "token punctuation", children: "]" }), _jsx(_components.span, { className: "token punctuation", children: ";" }), "\n"] }), _jsxs(_components.span, { className: "code-line", children: [" B ", _jsx(_components.span, { className: "token arrow operator", children: "->" }), " P ", _jsx(_components.span, { className: "token punctuation", children: "[" }), "label=", _jsx(_components.span, { className: "token string", children: "\" Aumento de H⁺ (Acidose)\\n \"" }), _jsx(_components.span, { className: "token punctuation", children: "," }), " fontcolor=", _jsx(_components.span, { className: "token string", children: "\"#a9c2d9\"" }), _jsx(_components.span, { className: "token punctuation", children: "]" }), _jsx(_components.span, { className: "token punctuation", children: ";" }), "\n"] }), _jsxs(_components.span, { className: "code-line", children: [" P ", _jsx(_components.span, { className: "token arrow operator", children: "->" }), " B ", _jsx(_components.span, { className: "token punctuation", children: "[" }), "label=", _jsx(_components.span, { className: "token string", children: "\" Aumenta Frequência Respiratória\\n(Elimina CO₂) \"" }), _jsx(_components.span, { className: "token punctuation", children: "," }), " fontcolor=", _jsx(_components.span, { className: "token string", children: "\"#a9c2d9\"" }), _jsx(_components.span, { className: "token punctuation", children: "]" }), _jsx(_components.span, { className: "token punctuation", children: ";" }), "\n"] }), _jsxs(_components.span, { className: "code-line", children: [" B ", _jsx(_components.span, { className: "token arrow operator", children: "->" }), " R ", _jsx(_components.span, { className: "token punctuation", children: "[" }), "label=", _jsx(_components.span, { className: "token string", children: "\" Aumento de H⁺ (Acidose)\"" }), _jsx(_components.span, { className: "token punctuation", children: "," }), " fontcolor=", _jsx(_components.span, { className: "token string", children: "\"#a9c2d9\"" }), _jsx(_components.span, { className: "token punctuation", children: "]" }), _jsx(_components.span, { className: "token punctuation", children: ";" }), "\n"] }), _jsxs(_components.span, { className: "code-line", children: [" R ", _jsx(_components.span, { className: "token arrow operator", children: "->" }), " B ", _jsx(_components.span, { className: "token punctuation", children: "[" }), "label=", _jsx(_components.span, { className: "token string", children: "\" Excreta H⁺\\nRegenera HCO₃⁻\"" }), _jsx(_components.span, { className: "token punctuation", children: "," }), " fontcolor=", _jsx(_components.span, { className: "token string", children: "\"#a9c2d9\"" }), _jsx(_components.span, { className: "token punctuation", children: "]" }), _jsx(_components.span, { className: "token punctuation", children: ";" }), "\n"] }), _jsxs(_components.span, { className: "code-line", children: [_jsx(_components.span, { className: "token punctuation", children: "}" }), "\n"] }), _jsxs(_components.span, { className: "code-line", children: [_jsx(_components.span, { className: "token delimiter punctuation", children: "@enduml" }), "\n"] })] }) }), "\n", _jsxs(_components.h4, { id: "13-a-equação-de-henderson-hasselbalch", children: [_jsx(_components.a, { className: "heading-link", href: "#13-a-equação-de-henderson-hasselbalch", children: _jsx(_components.svg, { xmlns: "http:www.w3.org/2000/svg", fill: "#ab2b65", viewBox: "0 0 20 20", className: "w-5 h-5", children: _jsx(_components.path, { fillRule: "evenodd", clipRule: "evenodd", d: "M9.493 2.853a.75.75 0 00-1.486-.205L7.545 6H4.198a.75.75 0 000 1.5h3.14l-.69 5H3.302a.75.75 0 000 1.5h3.14l-.435 3.148a.75.75 0 001.486.205L7.955 14h2.986l-.434 3.148a.75.75 0 001.486.205L12.456 14h3.346a.75.75 0 000-1.5h-3.14l.69-5h3.346a.75.75 0 000-1.5h-3.14l.435-3.147a.75.75 0 00-1.486-.205L12.045 6H9.059l.434-3.147zM8.852 7.5l-.69 5h2.986l.69-5H8.852z" }) }) }), "1.3 A Equação de Henderson-Hasselbalch"] }), "\n", _jsxs(_components.ul, { children: ["\n", _jsx(_components.li, { children: "É a fórmula matemática que descreve a relação entre pH, bicarbonato (componente metabólico) e pCO₂ (componente respiratório)." }), "\n", _jsxs(_components.li, { children: [_jsx(_components.strong, { children: "Associação Clínica Chave:" }), "\n", _jsxs(_components.ul, { children: ["\n", _jsx(_components.li, { children: _jsx(_components.code, { className: "language-auto", children: "pH ∝ HCO₃⁻ / pCO₂" }) }), "\n", _jsxs(_components.li, { children: ["Para o ", _jsx(_components.strong, { children: "pH subir (Alcalemia)" }), ", é necessário um processo de ", _jsx(_components.strong, { children: "alcalose" }), ": um ", _jsx(_components.strong, { children: "aumento de HCO₃⁻" }), " ou uma ", _jsx(_components.strong, { children: "queda de pCO₂" }), "."] }), "\n", _jsxs(_components.li, { children: ["Para o ", _jsx(_components.strong, { children: "pH cair (Acidemia)" }), ", é necessário um processo de ", _jsx(_components.strong, { children: "acidose" }), ": uma ", _jsx(_components.strong, { children: "queda de HCO₃⁻" }), " ou um ", _jsx(_components.strong, { children: "aumento de pCO₂" }), "."] }), "\n"] }), "\n"] }), "\n"] }), "\n", _jsxs(_components.h4, { id: "14-distúrbios-primários-do-equilíbrio-ácido-básico", children: [_jsx(_components.a, { className: "heading-link", href: "#14-distúrbios-primários-do-equilíbrio-ácido-básico", children: _jsx(_components.svg, { xmlns: "http:www.w3.org/2000/svg", fill: "#ab2b65", viewBox: "0 0 20 20", className: "w-5 h-5", children: _jsx(_components.path, { fillRule: "evenodd", clipRule: "evenodd", d: "M9.493 2.853a.75.75 0 00-1.486-.205L7.545 6H4.198a.75.75 0 000 1.5h3.14l-.69 5H3.302a.75.75 0 000 1.5h3.14l-.435 3.148a.75.75 0 001.486.205L7.955 14h2.986l-.434 3.148a.75.75 0 001.486.205L12.456 14h3.346a.75.75 0 000-1.5h-3.14l.69-5h3.346a.75.75 0 000-1.5h-3.14l.435-3.147a.75.75 0 00-1.486-.205L12.045 6H9.059l.434-3.147zM8.852 7.5l-.69 5h2.986l.69-5H8.852z" }) }) }), "1.4 Distúrbios Primários do Equilíbrio Ácido-Básico"] }), "\n", _jsx(_components.div, { className: "overflow-x-auto", children: _jsxs(_components.table, { children: [_jsx(_components.thead, { children: _jsxs(_components.tr, { children: [_jsx(_components.th, { style: { textAlign: "left" }, children: "Distúrbio Primário" }), _jsx(_components.th, { style: { textAlign: "left" }, children: "Alteração Principal" })] }) }), _jsxs(_components.tbody, { children: [_jsxs(_components.tr, { children: [_jsx(_components.td, { style: { textAlign: "left" }, children: _jsx(_components.strong, { children: "Acidose Metabólica" }) }), _jsxs(_components.td, { style: { textAlign: "left" }, children: [_jsx(_components.strong, { children: "Queda" }), " nos níveis de bicarbonato (HCO₃⁻)"] })] }), _jsxs(_components.tr, { children: [_jsx(_components.td, { style: { textAlign: "left" }, children: _jsx(_components.strong, { children: "Alcalose Metabólica" }) }), _jsxs(_components.td, { style: { textAlign: "left" }, children: [_jsx(_components.strong, { children: "Aumento" }), " nos níveis de bicarbonato (HCO₃⁻)"] })] }), _jsxs(_components.tr, { children: [_jsx(_components.td, { style: { textAlign: "left" }, children: _jsx(_components.strong, { children: "Acidose Respiratória" }) }), _jsxs(_components.td, { style: { textAlign: "left" }, children: [_jsx(_components.strong, { children: "Aumento" }), " do pCO₂"] })] }), _jsxs(_components.tr, { children: [_jsx(_components.td, { style: { textAlign: "left" }, children: _jsx(_components.strong, { children: "Alcalose Respiratória" }) }), _jsxs(_components.td, { style: { textAlign: "left" }, children: [_jsx(_components.strong, { children: "Queda" }), " do pCO₂"] })] })] })] }) }), "\n", _jsxs(_components.ul, { children: ["\n", _jsxs(_components.li, { children: [_jsx(_components.strong, { children: "Distúrbios Mistos:" }), " Ocorrem quando há alterações simultâneas, tanto metabólicas quanto respiratórias. O diagnóstico preciso requer a ", _jsx(_components.strong, { children: "análise da gasometria arterial" }), "."] }), "\n"] }), "\n", _jsx(_components.hr, {}), "\n", _jsxs(_components.h2, { id: "20-acidose-metabólica", children: [_jsx(_components.a, { className: "heading-link", href: "#20-acidose-metabólica", children: _jsx(_components.svg, { xmlns: "http:www.w3.org/2000/svg", fill: "#ab2b65", viewBox: "0 0 20 20", className: "w-5 h-5", children: _jsx(_components.path, { fillRule: "evenodd", clipRule: "evenodd", d: "M9.493 2.853a.75.75 0 00-1.486-.205L7.545 6H4.198a.75.75 0 000 1.5h3.14l-.69 5H3.302a.75.75 0 000 1.5h3.14l-.435 3.148a.75.75 0 001.486.205L7.955 14h2.986l-.434 3.148a.75.75 0 001.486.205L12.456 14h3.346a.75.75 0 000-1.5h-3.14l.69-5h3.346a.75.75 0 000-1.5h-3.14l.435-3.147a.75.75 0 00-1.486-.205L12.045 6H9.059l.434-3.147zM8.852 7.5l-.69 5h2.986l.69-5H8.852z" }) }) }), "2.0 Acidose Metabólica"] }), "\n", _jsxs(_components.h4, { id: "21-definição", children: [_jsx(_components.a, { className: "heading-link", href: "#21-definição", children: _jsx(_components.svg, { xmlns: "http:www.w3.org/2000/svg", fill: "#ab2b65", viewBox: "0 0 20 20", className: "w-5 h-5", children: _jsx(_components.path, { fillRule: "evenodd", clipRule: "evenodd", d: "M9.493 2.853a.75.75 0 00-1.486-.205L7.545 6H4.198a.75.75 0 000 1.5h3.14l-.69 5H3.302a.75.75 0 000 1.5h3.14l-.435 3.148a.75.75 0 001.486.205L7.955 14h2.986l-.434 3.148a.75.75 0 001.486.205L12.456 14h3.346a.75.75 0 000-1.5h-3.14l.69-5h3.346a.75.75 0 000-1.5h-3.14l.435-3.147a.75.75 0 00-1.486-.205L12.045 6H9.059l.434-3.147zM8.852 7.5l-.69 5h2.986l.69-5H8.852z" }) }) }), "2.1 Definição"] }), "\n", _jsxs(_components.ul, { children: ["\n", _jsxs(_components.li, { children: ["É um processo patológico definido pela ", _jsx(_components.strong, { children: "redução dos níveis séricos de bicarbonato" }), " (abaixo de 22 mEq/L)."] }), "\n", _jsxs(_components.li, { children: ["Pode ser causada por um ", _jsx(_components.strong, { children: "ganho de ácidos" }), " ou por uma ", _jsx(_components.strong, { children: "perda de bases" }), "."] }), "\n", _jsx(_components.li, { children: "Leva a uma tendência de queda do pH para < 7,35 (acidemia)." }), "\n"] }), "\n", _jsxs(_components.h4, { id: "22-classificação-e-ânion-gap", children: [_jsx(_components.a, { className: "heading-link", href: "#22-classificação-e-ânion-gap", children: _jsx(_components.svg, { xmlns: "http:www.w3.org/2000/svg", fill: "#ab2b65", viewBox: "0 0 20 20", className: "w-5 h-5", children: _jsx(_components.path, { fillRule: "evenodd", clipRule: "evenodd", d: "M9.493 2.853a.75.75 0 00-1.486-.205L7.545 6H4.198a.75.75 0 000 1.5h3.14l-.69 5H3.302a.75.75 0 000 1.5h3.14l-.435 3.148a.75.75 0 001.486.205L7.955 14h2.986l-.434 3.148a.75.75 0 001.486.205L12.456 14h3.346a.75.75 0 000-1.5h-3.14l.69-5h3.346a.75.75 0 000-1.5h-3.14l.435-3.147a.75.75 0 00-1.486-.205L12.045 6H9.059l.434-3.147zM8.852 7.5l-.69 5h2.986l.69-5H8.852z" }) }) }), "2.2 Classificação e Ânion Gap"] }), "\n", _jsxs(_components.ul, { children: ["\n", _jsxs(_components.li, { children: ["\n", _jsxs(_components.p, { children: ["A acidose metabólica é classificada em dois grandes grupos com base no ", _jsx(_components.strong, { children: "Ânion Gap (AG)" }), " ou ", _jsx(_components.strong, { children: "Hiato Aniônico" }), "."] }), "\n", _jsxs(_components.ol, { children: ["\n", _jsx(_components.li, { children: _jsx(_components.strong, { children: "Acidose metabólica com ânion gap aumentado." }) }), "\n", _jsx(_components.li, { children: _jsx(_components.strong, { children: "Acidose metabólica com ânion gap normal (ou hiperclorêmica)." }) }), "\n"] }), "\n"] }), "\n", _jsxs(_components.li, { children: ["\n", _jsx(_components.p, { children: _jsx(_components.strong, { children: "O que é o Ânion Gap?" }) }), "\n", _jsxs(_components.ul, { children: ["\n", _jsxs(_components.li, { children: ["Baseia-se no princípio da ", _jsx(_components.strong, { children: "eletroneutralidade do plasma" }), ": a soma das cargas positivas (cátions) deve ser igual à soma das cargas negativas (ânions)."] }), "\n", _jsx(_components.li, { children: "O AG representa os ânions não medidos rotineiramente no sangue (proteínas como a albumina, sulfato, fosfato)." }), "\n", _jsxs(_components.li, { children: [_jsx(_components.strong, { children: "Fórmula:" }), "\n", _jsxs(_components.ul, { children: ["\n", _jsx(_components.li, { children: _jsx(_components.code, { className: "language-auto", children: "Ânion Gap = Na⁺ – (Cl⁻ + HCO₃⁻)" }) }), "\n"] }), "\n"] }), "\n", _jsxs(_components.li, { children: [_jsx(_components.strong, { children: "Valor Normal:" }), " 8 a 12 mEq/L."] }), "\n", _jsxs(_components.li, { children: [_jsx(_components.strong, { children: "Utilidade Clínica:" }), "\n", _jsxs(_components.ul, { children: ["\n", _jsxs(_components.li, { children: [_jsx(_components.strong, { children: "AG Aumentado" }), ": Geralmente indica uma acidose causada pelo ", _jsx(_components.strong, { children: "acúmulo de um ácido" }), ". O ânion desse ácido \"ocupa\" o espaço do bicarbonato, que foi consumido para tamponar o H⁺."] }), "\n", _jsxs(_components.li, { children: [_jsx(_components.strong, { children: "AG Normal (Hiperclorêmica)" }), ": Geralmente indica uma acidose causada pela ", _jsx(_components.strong, { children: "perda de bicarbonato" }), ". Para manter a eletroneutralidade, o corpo retém cloreto (Cl⁻), resultando em hipercloremia."] }), "\n"] }), "\n"] }), "\n"] }), "\n"] }), "\n"] }), "\n", _jsxs(_components.h4, { id: "23-causas-de-acidose-metabólica", children: [_jsx(_components.a, { className: "heading-link", href: "#23-causas-de-acidose-metabólica", children: _jsx(_components.svg, { xmlns: "http:www.w3.org/2000/svg", fill: "#ab2b65", viewBox: "0 0 20 20", className: "w-5 h-5", children: _jsx(_components.path, { fillRule: "evenodd", clipRule: "evenodd", d: "M9.493 2.853a.75.75 0 00-1.486-.205L7.545 6H4.198a.75.75 0 000 1.5h3.14l-.69 5H3.302a.75.75 0 000 1.5h3.14l-.435 3.148a.75.75 0 001.486.205L7.955 14h2.986l-.434 3.148a.75.75 0 001.486.205L12.456 14h3.346a.75.75 0 000-1.5h-3.14l.69-5h3.346a.75.75 0 000-1.5h-3.14l.435-3.147a.75.75 0 00-1.486-.205L12.045 6H9.059l.434-3.147zM8.852 7.5l-.69 5h2.986l.69-5H8.852z" }) }) }), "2.3 Causas de Acidose Metabólica"] }), "\n", _jsxs(_components.h5, { id: "231-acidose-metabólica-com-ânion-gap-elevado", children: [_jsx(_components.a, { className: "heading-link", href: "#231-acidose-metabólica-com-ânion-gap-elevado", children: _jsx(_components.svg, { xmlns: "http:www.w3.org/2000/svg", fill: "#ab2b65", viewBox: "0 0 20 20", className: "w-5 h-5", children: _jsx(_components.path, { fillRule: "evenodd", clipRule: "evenodd", d: "M9.493 2.853a.75.75 0 00-1.486-.205L7.545 6H4.198a.75.75 0 000 1.5h3.14l-.69 5H3.302a.75.75 0 000 1.5h3.14l-.435 3.148a.75.75 0 001.486.205L7.955 14h2.986l-.434 3.148a.75.75 0 001.486.205L12.456 14h3.346a.75.75 0 000-1.5h-3.14l.69-5h3.346a.75.75 0 000-1.5h-3.14l.435-3.147a.75.75 0 00-1.486-.205L12.045 6H9.059l.434-3.147zM8.852 7.5l-.69 5h2.986l.69-5H8.852z" }) }) }), "2.3.1 Acidose Metabólica com Ânion Gap Elevado"] }), "\n", _jsxs(_components.ul, { children: ["\n", _jsxs(_components.li, { children: [_jsx(_components.strong, { children: "Acidose Lática" }), ": Principal causa de acidose metabólica com AG elevado.", "\n", _jsxs(_components.ul, { children: ["\n", _jsxs(_components.li, { children: [_jsx(_components.strong, { children: "Tipo A (mais comum)" }), ": Associada à ", _jsx(_components.strong, { children: "má perfusão tecidual" }), " (choque hemodinâmico), levando ao metabolismo anaeróbio e acúmulo de lactato."] }), "\n", _jsxs(_components.li, { children: [_jsx(_components.strong, { children: "Tipo B" }), ": Causada por defeitos na metabolização do lactato, sem má perfusão.", "\n", _jsxs(_components.ul, { children: ["\n", _jsxs(_components.li, { children: [_jsx(_components.em, { children: "Drogas" }), ": ", _jsx(_components.strong, { children: "Metformina" }), ", Linezolida, Inibidores de transcriptase reversa."] }), "\n"] }), "\n"] }), "\n"] }), "\n"] }), "\n", _jsxs(_components.li, { children: [_jsx(_components.strong, { children: "Cetoacidoses" }), ": Acúmulo de cetoácidos.", "\n", _jsxs(_components.ul, { children: ["\n", _jsxs(_components.li, { children: [_jsx(_components.strong, { children: "Cetoacidose Diabética" }), ": Deficiência de insulina impede o uso de glicose, levando à queima de gordura e produção de cetoácidos."] }), "\n", _jsxs(_components.li, { children: [_jsx(_components.strong, { children: "Cetoacidose Alcoólica" }), ": Baixo aporte calórico e estímulo do álcool à lipólise."] }), "\n", _jsxs(_components.li, { children: [_jsx(_components.strong, { children: "Jejum Prolongado" }), ": Produção de cetoácidos para energia."] }), "\n"] }), "\n"] }), "\n", _jsxs(_components.li, { children: [_jsx(_components.strong, { children: "Insuficiência Renal (Aguda ou Crônica Avançada)" }), ": Acúmulo de ácidos fixos (sulfato, fosfato) que o rim doente não consegue eliminar."] }), "\n", _jsxs(_components.li, { children: [_jsx(_components.strong, { children: "Intoxicações Exógenas" }), ":", "\n", _jsxs(_components.ul, { children: ["\n", _jsxs(_components.li, { children: [_jsx(_components.strong, { children: "Metanol" }), " (presente em solventes e bebidas adulteradas): Metabolizado em ácido fórmico, tóxico para o nervo óptico, causando ", _jsx(_components.strong, { children: "alterações visuais" }), "."] }), "\n", _jsxs(_components.li, { children: [_jsx(_components.strong, { children: "Etilenoglicol" }), " (presente em anticongelantes): Metabolizado em ácido glicólico e ácido oxálico. Causa lesão renal aguda e ", _jsx(_components.strong, { children: "presença de cristais de oxalato de cálcio na urina" }), "."] }), "\n", _jsxs(_components.li, { children: [_jsx(_components.strong, { children: "Salicilatos" }), " (AAS): Inicialmente causa alcalose respiratória (estímulo direto do centro respiratório), mas depois evolui para acidose metabólica com AG elevado."] }), "\n", _jsxs(_components.li, { children: [_jsx(_components.strong, { children: "Paracetamol" }), ": Em intoxicações, pode levar ao acúmulo de ácido piroglutâmico (oxoprolina)."] }), "\n"] }), "\n"] }), "\n", _jsxs(_components.li, { children: ["\n", _jsxs(_components.blockquote, { children: ["\n", _jsxs(_components.p, { children: [_jsx(_components.strong, { children: "Gap Osmolar" }), ": Em suspeita de intoxicação por álcoois tóxicos, calcula-se o gap osmolar. Se a osmolalidade medida for >10 unidades acima da calculada, fortalece o diagnóstico."] }), "\n"] }), "\n"] }), "\n"] }), "\n", _jsxs(_components.h5, { id: "232-acidose-metabólica-com-ânion-gap-normal-hiperclorêmica", children: [_jsx(_components.a, { className: "heading-link", href: "#232-acidose-metabólica-com-ânion-gap-normal-hiperclorêmica", children: _jsx(_components.svg, { xmlns: "http:www.w3.org/2000/svg", fill: "#ab2b65", viewBox: "0 0 20 20", className: "w-5 h-5", children: _jsx(_components.path, { fillRule: "evenodd", clipRule: "evenodd", d: "M9.493 2.853a.75.75 0 00-1.486-.205L7.545 6H4.198a.75.75 0 000 1.5h3.14l-.69 5H3.302a.75.75 0 000 1.5h3.14l-.435 3.148a.75.75 0 001.486.205L7.955 14h2.986l-.434 3.148a.75.75 0 001.486.205L12.456 14h3.346a.75.75 0 000-1.5h-3.14l.69-5h3.346a.75.75 0 000-1.5h-3.14l.435-3.147a.75.75 0 00-1.486-.205L12.045 6H9.059l.434-3.147zM8.852 7.5l-.69 5h2.986l.69-5H8.852z" }) }) }), "2.3.2 Acidose Metabólica com Ânion Gap Normal (Hiperclorêmica)"] }), "\n", _jsxs(_components.ul, { children: ["\n", _jsxs(_components.li, { children: [_jsx(_components.strong, { children: "Perdas Intestinais" }), ": Principal causa.", "\n", _jsxs(_components.ul, { children: ["\n", _jsxs(_components.li, { children: [_jsx(_components.strong, { children: "Diarreia" }), ": As secreções intestinais (pós-ângulo de Treitz) são ricas em bicarbonato. A perda na diarreia causa acidose."] }), "\n"] }), "\n"] }), "\n", _jsxs(_components.li, { children: [_jsx(_components.strong, { children: "Perdas Renais: Acidoses Tubulares Renais (ATR)" }), ": Defeitos na acidificação da urina ou na reabsorção de bicarbonato.", "\n", _jsxs(_components.ul, { children: ["\n", _jsxs(_components.li, { children: [_jsx(_components.strong, { children: "ATR tipo II (Proximal)" }), ": Defeito na reabsorção de HCO₃⁻ no túbulo proximal. Causas: ", _jsx(_components.strong, { children: "mieloma múltiplo" }), ", aminoglicosídeos, ", _jsx(_components.strong, { children: "acetazolamida" }), "."] }), "\n", _jsxs(_components.li, { children: [_jsx(_components.strong, { children: "ATR tipo I (Distal)" }), ": Incapacidade de secretar H⁺ no túbulo distal. Cursa classicamente com ", _jsx(_components.strong, { children: "pH urinário alcalino e hipocalemia" }), ". Associada a doenças autoimunes (Sjögren) e anfotericina B. Causa nefrolitíase e nefrocalcinose."] }), "\n", _jsxs(_components.li, { children: [_jsx(_components.strong, { children: "ATR tipo IV" }), ": Associada ao hipoaldosteronismo. A falta de aldosterona impede a secreção de K⁺ e H⁺. É a única que cursa com ", _jsx(_components.strong, { children: "HIPERCALEMIA" }), ". Causas: diabetes, IECA/BRA, espironolactona."] }), "\n"] }), "\n"] }), "\n", _jsxs(_components.li, { children: ["\n", _jsxs(_components.blockquote, { children: ["\n", _jsxs(_components.p, { children: [_jsx(_components.strong, { children: "Ânion Gap Urinário (AGu):" }), " Usado para diferenciar a causa da acidose com AG normal."] }), "\n", _jsxs(_components.ul, { children: ["\n", _jsxs(_components.li, { children: [_jsx(_components.strong, { children: "Fórmula:" }), " ", _jsx(_components.code, { className: "language-auto", children: "AGu = Na⁺ (urinário) + K⁺ (urinário) – Cl⁻ (urinário)" })] }), "\n", _jsxs(_components.li, { children: [_jsx(_components.strong, { children: "Interpretação:" }), "\n", _jsxs(_components.ul, { children: ["\n", _jsxs(_components.li, { children: [_jsx(_components.strong, { children: "AGu Negativo" }), ": Rim funcionando normalmente, eliminando ácido (na forma de NH₄Cl). A causa é ", _jsx(_components.strong, { children: "extrarrenal (diarreia)" }), "."] }), "\n", _jsxs(_components.li, { children: [_jsx(_components.strong, { children: "AGu Positivo ou Zero" }), ": Rim não consegue eliminar ácido. A causa é ", _jsx(_components.strong, { children: "renal (ATR)" }), "."] }), "\n"] }), "\n"] }), "\n"] }), "\n"] }), "\n"] }), "\n", _jsxs(_components.li, { children: [_jsx(_components.strong, { children: "Ureterossigmoidostomia" }), ": Anastomose do ureter no sigmoide. A urina (rica em cloreto) em contato com a mucosa intestinal leva à reabsorção de Cl⁻ em troca da secreção de HCO₃⁻."] }), "\n", _jsxs(_components.li, { children: [_jsx(_components.strong, { children: "Administração Excessiva de Solução Fisiológica (SF 0,9%)" }), ": A infusão de grandes volumes de uma solução rica em cloreto causa hipercloremia, forçando o rim a excretar bicarbonato para manter a eletroneutralidade."] }), "\n"] }), "\n", _jsx(_components.hr, {}), "\n", _jsxs(_components.h3, { id: "fluxograma-diagnóstico-da-acidose-metabólica", children: [_jsx(_components.a, { className: "heading-link", href: "#fluxograma-diagnóstico-da-acidose-metabólica", children: _jsx(_components.svg, { xmlns: "http:www.w3.org/2000/svg", fill: "#ab2b65", viewBox: "0 0 20 20", className: "w-5 h-5", children: _jsx(_components.path, { fillRule: "evenodd", clipRule: "evenodd", d: "M9.493 2.853a.75.75 0 00-1.486-.205L7.545 6H4.198a.75.75 0 000 1.5h3.14l-.69 5H3.302a.75.75 0 000 1.5h3.14l-.435 3.148a.75.75 0 001.486.205L7.955 14h2.986l-.434 3.148a.75.75 0 001.486.205L12.456 14h3.346a.75.75 0 000-1.5h-3.14l.69-5h3.346a.75.75 0 000-1.5h-3.14l.435-3.147a.75.75 0 00-1.486-.205L12.045 6H9.059l.434-3.147zM8.852 7.5l-.69 5h2.986l.69-5H8.852z" }) }) }), "Fluxograma Diagnóstico da Acidose Metabólica"] }), "\n", _jsx(_components.pre, { className: "language-plantuml", children: _jsxs(_components.code, { className: "language-plantuml code-highlight", children: [_jsxs(_components.span, { className: "code-line", children: [_jsx(_components.span, { className: "token delimiter punctuation", children: "@startuml" }), "\n"] }), _jsxs(_components.span, { className: "code-line", children: ["digraph G ", _jsx(_components.span, { className: "token punctuation", children: "{" }), "\n"] }), _jsx(_components.span, { className: "code-line", children: " // --- Configurações Globais ---\n" }), _jsxs(_components.span, { className: "code-line", children: [" rankdir=TB", _jsx(_components.span, { className: "token punctuation", children: ";" }), "\n"] }), _jsxs(_components.span, { className: "code-line", children: [" bgcolor=", _jsx(_components.span, { className: "token string", children: "\"#282c34\"" }), _jsx(_components.span, { className: "token punctuation", children: ";" }), "\n"] }), _jsxs(_components.span, { className: "code-line", children: [" fontname=", _jsx(_components.span, { className: "token string", children: "\"Arial\"" }), _jsx(_components.span, { className: "token punctuation", children: ";" }), "\n"] }), _jsx(_components.span, { className: "code-line", children: "\n" }), _jsx(_components.span, { className: "code-line", children: " // --- Estilos ---\n" }), _jsxs(_components.span, { className: "code-line", children: [" ", _jsx(_components.span, { className: "token keyword", children: "node" }), " ", _jsx(_components.span, { className: "token punctuation", children: "[" }), "shape=box", _jsx(_components.span, { className: "token punctuation", children: "," }), " style=", _jsx(_components.span, { className: "token string", children: "\"filled,rounded\"" }), _jsx(_components.span, { className: "token punctuation", children: "," }), " fillcolor=", _jsx(_components.span, { className: "token string", children: "\"#3c4049\"" }), _jsx(_components.span, { className: "token punctuation", children: "," }), " color=", _jsx(_components.span, { className: "token string", children: "\"#6ab0f3\"" }), _jsx(_components.span, { className: "token punctuation", children: "," }), " fontcolor=", _jsx(_components.span, { className: "token string", children: "\"white\"" }), _jsx(_components.span, { className: "token punctuation", children: "]" }), _jsx(_components.span, { className: "token punctuation", children: ";" }), "\n"] }), _jsxs(_components.span, { className: "code-line", children: [" edge ", _jsx(_components.span, { className: "token punctuation", children: "[" }), "color=", _jsx(_components.span, { className: "token string", children: "\"#6ab0f3\"" }), _jsx(_components.span, { className: "token punctuation", children: "," }), " fontcolor=", _jsx(_components.span, { className: "token string", children: "\"#a9c2d9\"" }), _jsx(_components.span, { className: "token punctuation", children: "]" }), _jsx(_components.span, { className: "token punctuation", children: ";" }), "\n"] }), _jsx(_components.span, { className: "code-line", children: "\n" }), _jsx(_components.span, { className: "code-line", children: " // --- Nós ---\n" }), _jsxs(_components.span, { className: "code-line", children: [" A ", _jsx(_components.span, { className: "token punctuation", children: "[" }), "label=", _jsx(_components.span, { className: "token string", children: "\"Suspeita Clínica de Acidose\"" }), _jsx(_components.span, { className: "token punctuation", children: "]" }), _jsx(_components.span, { className: "token punctuation", children: ";" }), "\n"] }), _jsxs(_components.span, { className: "code-line", children: [" B ", _jsx(_components.span, { className: "token punctuation", children: "[" }), "label=Bicarbonato <", _jsx(_components.span, { className: "token punctuation", children: ";" }), " 22 mEq/L>", _jsx(_components.span, { className: "token punctuation", children: "," }), " shape=diamond", _jsx(_components.span, { className: "token punctuation", children: "," }), " fillcolor=", _jsx(_components.span, { className: "token string", children: "\"#5c6bc0\"" }), _jsx(_components.span, { className: "token punctuation", children: "]" }), _jsx(_components.span, { className: "token punctuation", children: ";" }), "\n"] }), _jsxs(_components.span, { className: "code-line", children: [" C ", _jsx(_components.span, { className: "token punctuation", children: "[" }), "label=AG = Na - ", _jsx(_components.span, { className: "token punctuation", children: "(" }), "Cl + HCO₃", _jsx(_components.span, { className: "token punctuation", children: ")" }), ">", _jsx(_components.span, { className: "token punctuation", children: "," }), " shape=diamond", _jsx(_components.span, { className: "token punctuation", children: "," }), " fillcolor=", _jsx(_components.span, { className: "token string", children: "\"#5c6bc0\"" }), _jsx(_components.span, { className: "token punctuation", children: "]" }), _jsx(_components.span, { className: "token punctuation", children: ";" }), "\n"] }), _jsxs(_components.span, { className: "code-line", children: [" F ", _jsx(_components.span, { className: "token punctuation", children: "[" }), "label=AGu = Na + K - Cl>", _jsx(_components.span, { className: "token punctuation", children: "," }), " shape=diamond", _jsx(_components.span, { className: "token punctuation", children: "," }), " fillcolor=", _jsx(_components.span, { className: "token string", children: "\"#5c6bc0\"" }), _jsx(_components.span, { className: "token punctuation", children: "]" }), _jsx(_components.span, { className: "token punctuation", children: ";" }), "\n"] }), _jsx(_components.span, { className: "code-line", children: " \n" }), _jsxs(_components.span, { className: "code-line", children: [" G ", _jsx(_components.span, { className: "token punctuation", children: "[" }), "label=<Causa Extrarrenal
", _jsx(_components.span, { className: "token punctuation", children: "(" }), "AGu Negativo", _jsx(_components.span, { className: "token punctuation", children: ")" }), ">", _jsx(_components.span, { className: "token punctuation", children: "]" }), _jsx(_components.span, { className: "token punctuation", children: ";" }), "\n"] }), _jsxs(_components.span, { className: "code-line", children: [" H ", _jsx(_components.span, { className: "token punctuation", children: "[" }), "label=<Causa Renal
", _jsx(_components.span, { className: "token punctuation", children: "(" }), "AGu Positivo", _jsx(_components.span, { className: "token punctuation", children: ")" }), ">", _jsx(_components.span, { className: "token punctuation", children: "]" }), _jsx(_components.span, { className: "token punctuation", children: ";" }), "\n"] }), _jsxs(_components.span, { className: "code-line", children: [" G1 ", _jsx(_components.span, { className: "token punctuation", children: "[" }), "label=", _jsx(_components.span, { className: "token arrow operator", children: "<-" }), " Diarreia
- Fístulas pancreáticas/biliares>", _jsx(_components.span, { className: "token punctuation", children: "]" }), _jsx(_components.span, { className: "token punctuation", children: ";" }), "\n"] }), _jsxs(_components.span, { className: "code-line", children: [" H1 ", _jsx(_components.span, { className: "token punctuation", children: "[" }), "label=", _jsx(_components.span, { className: "token string", children: "\"- Acidose Tubular Renal (ATR)\"" }), _jsx(_components.span, { className: "token punctuation", children: "]" }), _jsx(_components.span, { className: "token punctuation", children: ";" }), "\n"] }), _jsx(_components.span, { className: "code-line", children: "\n" }), _jsxs(_components.span, { className: "code-line", children: [" I ", _jsx(_components.span, { className: "token punctuation", children: "[" }), "label=", _jsx(_components.span, { className: "token string", children: "\"Causas: Acúmulo de Ácidos\"" }), _jsx(_components.span, { className: "token punctuation", children: "]" }), _jsx(_components.span, { className: "token punctuation", children: ";" }), "\n"] }), _jsxs(_components.span, { className: "code-line", children: [" J ", _jsx(_components.span, { className: "token punctuation", children: "[" }), "label=", _jsx(_components.span, { className: "token arrow operator", children: "<-" }), " Acidose Lática
- Cetoacidoses ", _jsx(_components.span, { className: "token punctuation", children: "(" }), "diabética", _jsx(_components.span, { className: "token punctuation", children: "," }), " alcoólica", _jsx(_components.span, { className: "token punctuation", children: ")" }), "
- Insuficiência Renal
- Intoxicações ", _jsx(_components.span, { className: "token punctuation", children: "(" }), "Metanol", _jsx(_components.span, { className: "token punctuation", children: "," }), " Etilenoglicol", _jsx(_components.span, { className: "token punctuation", children: "," }), " Salicilatos", _jsx(_components.span, { className: "token punctuation", children: ")" }), ">", _jsx(_components.span, { className: "token punctuation", children: "]" }), _jsx(_components.span, { className: "token punctuation", children: ";" }), "\n"] }), _jsx(_components.span, { className: "code-line", children: "\n" }), _jsx(_components.span, { className: "code-line", children: " // --- Conexões ---\n" }), _jsxs(_components.span, { className: "code-line", children: [" A ", _jsx(_components.span, { className: "token arrow operator", children: "->" }), " B", _jsx(_components.span, { className: "token punctuation", children: ";" }), "\n"] }), _jsxs(_components.span, { className: "code-line", children: [" B ", _jsx(_components.span, { className: "token arrow operator", children: "->" }), " C", _jsx(_components.span, { className: "token punctuation", children: ";" }), "\n"] }), _jsxs(_components.span, { className: "code-line", children: [" C ", _jsx(_components.span, { className: "token arrow operator", children: "->" }), " F ", _jsx(_components.span, { className: "token punctuation", children: "[" }), "label=", _jsx(_components.span, { className: "token string", children: "\" AG Normal (8-12)\"" }), _jsx(_components.span, { className: "token punctuation", children: "]" }), _jsx(_components.span, { className: "token punctuation", children: ";" }), "\n"] }), _jsxs(_components.span, { className: "code-line", children: [" C ", _jsx(_components.span, { className: "token arrow operator", children: "->" }), " I ", _jsx(_components.span, { className: "token punctuation", children: "[" }), "label=", _jsx(_components.span, { className: "token string", children: "\" AG Aumentado (> 12)\"" }), _jsx(_components.span, { className: "token punctuation", children: "]" }), _jsx(_components.span, { className: "token punctuation", children: ";" }), "\n"] }), _jsxs(_components.span, { className: "code-line", children: [" F ", _jsx(_components.span, { className: "token arrow operator", children: "->" }), " G", _jsx(_components.span, { className: "token punctuation", children: ";" }), "\n"] }), _jsxs(_components.span, { className: "code-line", children: [" F ", _jsx(_components.span, { className: "token arrow operator", children: "->" }), " H", _jsx(_components.span, { className: "token punctuation", children: ";" }), "\n"] }), _jsxs(_components.span, { className: "code-line", children: [" G ", _jsx(_components.span, { className: "token arrow operator", children: "->" }), " G1", _jsx(_components.span, { className: "token punctuation", children: ";" }), "\n"] }), _jsxs(_components.span, { className: "code-line", children: [" H ", _jsx(_components.span, { className: "token arrow operator", children: "->" }), " H1", _jsx(_components.span, { className: "token punctuation", children: ";" }), "\n"] }), _jsxs(_components.span, { className: "code-line", children: [" I ", _jsx(_components.span, { className: "token arrow operator", children: "->" }), " J", _jsx(_components.span, { className: "token punctuation", children: ";" }), "\n"] }), _jsxs(_components.span, { className: "code-line", children: [_jsx(_components.span, { className: "token punctuation", children: "}" }), "\n"] }), _jsxs(_components.span, { className: "code-line", children: [_jsx(_components.span, { className: "token delimiter punctuation", children: "@enduml" }), "\n"] })] }) }), "\n", _jsx(_components.hr, {}), "\n", _jsxs(_components.h4, { id: "24-consequências-clínicas-e-fisiológicas-da-acidose-metabólica", children: [_jsx(_components.a, { className: "heading-link", href: "#24-consequências-clínicas-e-fisiológicas-da-acidose-metabólica", children: _jsx(_components.svg, { xmlns: "http:www.w3.org/2000/svg", fill: "#ab2b65", viewBox: "0 0 20 20", className: "w-5 h-5", children: _jsx(_components.path, { fillRule: "evenodd", clipRule: "evenodd", d: "M9.493 2.853a.75.75 0 00-1.486-.205L7.545 6H4.198a.75.75 0 000 1.5h3.14l-.69 5H3.302a.75.75 0 000 1.5h3.14l-.435 3.148a.75.75 0 001.486.205L7.955 14h2.986l-.434 3.148a.75.75 0 001.486.205L12.456 14h3.346a.75.75 0 000-1.5h-3.14l.69-5h3.346a.75.75 0 000-1.5h-3.14l.435-3.147a.75.75 0 00-1.486-.205L12.045 6H9.059l.434-3.147zM8.852 7.5l-.69 5h2.986l.69-5H8.852z" }) }) }), "2.4 Consequências Clínicas e Fisiológicas da Acidose Metabólica"] }), "\n", _jsxs(_components.ul, { children: ["\n", _jsxs(_components.li, { children: [_jsx(_components.strong, { children: "Respiração de Kussmaul" }), ": Padrão respiratório com inspirações profundas e rápidas, sem pausas, numa tentativa de compensar a acidose eliminando mais CO₂."] }), "\n", _jsxs(_components.li, { children: [_jsx(_components.strong, { children: "Desvio da Curva de Dissociação da Hemoglobina para a Direita" }), ":", "\n", _jsxs(_components.ul, { children: ["\n", _jsx(_components.li, { children: "Em ambiente ácido (pH baixo), a afinidade da hemoglobina pelo oxigênio diminui." }), "\n", _jsxs(_components.li, { children: ["Isso facilita a ", _jsx(_components.strong, { children: "liberação de oxigênio para os tecidos" }), ", um mecanismo adaptativo em situações de hipóxia."] }), "\n"] }), "\n"] }), "\n", _jsxs(_components.li, { children: [_jsx(_components.strong, { children: "Efeitos Cardiovasculares" }), ": Em acidemia grave (pH < 7,1), há interferência na resposta aos receptores adrenérgicos, causando ", _jsx(_components.strong, { children: "disfunção miocárdica, vasodilatação (vasoplegia) e hipotensão arterial" }), ". É uma causa de parada cardiorrespiratória."] }), "\n"] }), "\n", _jsx(_components.div, { className: "overflow-x-auto", children: _jsxs(_components.table, { children: [_jsx(_components.thead, { children: _jsxs(_components.tr, { children: [_jsx(_components.th, { style: { textAlign: "left" }, children: "Sistema" }), _jsx(_components.th, { style: { textAlign: "left" }, children: "Consequências da Acidemia Grave" })] }) }), _jsxs(_components.tbody, { children: [_jsxs(_components.tr, { children: [_jsx(_components.td, { style: { textAlign: "left" }, children: _jsx(_components.strong, { children: "Cardiovasculares" }) }), _jsx(_components.td, { style: { textAlign: "left" }, children: "Hipotensão, Vasoplegia, Inotropismo negativo" })] }), _jsxs(_components.tr, { children: [_jsx(_components.td, { style: { textAlign: "left" }, children: _jsx(_components.strong, { children: "Metabólicas" }) }), _jsx(_components.td, { style: { textAlign: "left" }, children: "Hipercalemia, Resistência à insulina, Aumento do catabolismo" })] }), _jsxs(_components.tr, { children: [_jsx(_components.td, { style: { textAlign: "left" }, children: _jsx(_components.strong, { children: "Cerebrais" }) }), _jsx(_components.td, { style: { textAlign: "left" }, children: "Rebaixamento do nível de consciência, Redução do metabolismo cerebral" })] }), _jsxs(_components.tr, { children: [_jsx(_components.td, { style: { textAlign: "left" }, children: _jsx(_components.strong, { children: "Respiratórias" }) }), _jsx(_components.td, { style: { textAlign: "left" }, children: "Hiperventilação (Kussmaul), Fadiga respiratória" })] })] })] }) }), "\n", _jsxs(_components.h4, { id: "25-tratamento-da-acidose-metabólica", children: [_jsx(_components.a, { className: "heading-link", href: "#25-tratamento-da-acidose-metabólica", children: _jsx(_components.svg, { xmlns: "http:www.w3.org/2000/svg", fill: "#ab2b65", viewBox: "0 0 20 20", className: "w-5 h-5", children: _jsx(_components.path, { fillRule: "evenodd", clipRule: "evenodd", d: "M9.493 2.853a.75.75 0 00-1.486-.205L7.545 6H4.198a.75.75 0 000 1.5h3.14l-.69 5H3.302a.75.75 0 000 1.5h3.14l-.435 3.148a.75.75 0 001.486.205L7.955 14h2.986l-.434 3.148a.75.75 0 001.486.205L12.456 14h3.346a.75.75 0 000-1.5h-3.14l.69-5h3.346a.75.75 0 000-1.5h-3.14l.435-3.147a.75.75 0 00-1.486-.205L12.045 6H9.059l.434-3.147zM8.852 7.5l-.69 5h2.986l.69-5H8.852z" }) }) }), "2.5 Tratamento da Acidose Metabólica"] }), "\n", _jsxs(_components.ul, { children: ["\n", _jsxs(_components.li, { children: [_jsx(_components.strong, { children: "Acidose Aguda" }), ":", "\n", _jsxs(_components.ul, { children: ["\n", _jsxs(_components.li, { children: ["O foco principal é ", _jsx(_components.strong, { children: "tratar a causa de base" }), " (ex: tratar o choque na acidose lática, dar insulina na cetoacidose diabética)."] }), "\n", _jsxs(_components.li, { children: ["A ", _jsx(_components.strong, { children: "reposição de bicarbonato NÃO é rotineira" }), "."] }), "\n", _jsxs(_components.li, { children: [_jsx(_components.strong, { children: "Riscos da reposição de bicarbonato" }), ": hipernatremia, hipocalemia (o K⁺ volta para a célula), hipocalcemia (aumento da ligação do cálcio à albumina, diminuindo o cálcio iônico ativo) e piora da acidose intracelular."] }), "\n", _jsxs(_components.li, { children: [_jsx(_components.strong, { children: "Indicação de Bicarbonato" }), ": Considerado em casos de acidemia grave (", _jsx(_components.strong, { children: "pH < 7,2" }), ") associada a lesão renal aguda, com o objetivo de reduzir a mortalidade e a necessidade de diálise."] }), "\n"] }), "\n"] }), "\n", _jsxs(_components.li, { children: [_jsx(_components.strong, { children: "Acidose Crônica" }), ":", "\n", _jsxs(_components.ul, { children: ["\n", _jsxs(_components.li, { children: ["O tratamento envolve a ", _jsx(_components.strong, { children: "reposição de bases" }), " (ex: bicarbonato de sódio oral)."] }), "\n", _jsx(_components.li, { children: "A correção melhora a força muscular e a doença óssea associada." }), "\n"] }), "\n"] }), "\n"] }), "\n", _jsx(_components.hr, {}), "\n", _jsxs(_components.h2, { id: "30-alcalose-metabólica", children: [_jsx(_components.a, { className: "heading-link", href: "#30-alcalose-metabólica", children: _jsx(_components.svg, { xmlns: "http:www.w3.org/2000/svg", fill: "#ab2b65", viewBox: "0 0 20 20", className: "w-5 h-5", children: _jsx(_components.path, { fillRule: "evenodd", clipRule: "evenodd", d: "M9.493 2.853a.75.75 0 00-1.486-.205L7.545 6H4.198a.75.75 0 000 1.5h3.14l-.69 5H3.302a.75.75 0 000 1.5h3.14l-.435 3.148a.75.75 0 001.486.205L7.955 14h2.986l-.434 3.148a.75.75 0 001.486.205L12.456 14h3.346a.75.75 0 000-1.5h-3.14l.69-5h3.346a.75.75 0 000-1.5h-3.14l.435-3.147a.75.75 0 00-1.486-.205L12.045 6H9.059l.434-3.147zM8.852 7.5l-.69 5h2.986l.69-5H8.852z" }) }) }), "3.0 Alcalose Metabólica"] }), "\n", _jsxs(_components.h4, { id: "31-definição", children: [_jsx(_components.a, { className: "heading-link", href: "#31-definição", children: _jsx(_components.svg, { xmlns: "http:www.w3.org/2000/svg", fill: "#ab2b65", viewBox: "0 0 20 20", className: "w-5 h-5", children: _jsx(_components.path, { fillRule: "evenodd", clipRule: "evenodd", d: "M9.493 2.853a.75.75 0 00-1.486-.205L7.545 6H4.198a.75.75 0 000 1.5h3.14l-.69 5H3.302a.75.75 0 000 1.5h3.14l-.435 3.148a.75.75 0 001.486.205L7.955 14h2.986l-.434 3.148a.75.75 0 001.486.205L12.456 14h3.346a.75.75 0 000-1.5h-3.14l.69-5h3.346a.75.75 0 000-1.5h-3.14l.435-3.147a.75.75 0 00-1.486-.205L12.045 6H9.059l.434-3.147zM8.852 7.5l-.69 5h2.986l.69-5H8.852z" }) }) }), "3.1 Definição"] }), "\n", _jsxs(_components.ul, { children: ["\n", _jsxs(_components.li, { children: ["É um processo patológico definido pelo ", _jsx(_components.strong, { children: "aumento primário do bicarbonato sérico" }), " (acima de 26 mEq/L)."] }), "\n", _jsxs(_components.li, { children: ["Ocorre por um ", _jsx(_components.strong, { children: "ganho de bases" }), " ou por uma ", _jsx(_components.strong, { children: "perda de ácidos (H⁺)" }), "."] }), "\n", _jsx(_components.li, { children: "Leva a uma tendência de aumento do pH para > 7,45 (alcalemia)." }), "\n"] }), "\n", _jsxs(_components.h4, { id: "32-aspectos-fisiológicos", children: [_jsx(_components.a, { className: "heading-link", href: "#32-aspectos-fisiológicos", children: _jsx(_components.svg, { xmlns: "http:www.w3.org/2000/svg", fill: "#ab2b65", viewBox: "0 0 20 20", className: "w-5 h-5", children: _jsx(_components.path, { fillRule: "evenodd", clipRule: "evenodd", d: "M9.493 2.853a.75.75 0 00-1.486-.205L7.545 6H4.198a.75.75 0 000 1.5h3.14l-.69 5H3.302a.75.75 0 000 1.5h3.14l-.435 3.148a.75.75 0 001.486.205L7.955 14h2.986l-.434 3.148a.75.75 0 001.486.205L12.456 14h3.346a.75.75 0 000-1.5h-3.14l.69-5h3.346a.75.75 0 000-1.5h-3.14l.435-3.147a.75.75 0 00-1.486-.205L12.045 6H9.059l.434-3.147zM8.852 7.5l-.69 5h2.986l.69-5H8.852z" }) }) }), "3.2 Aspectos Fisiológicos"] }), "\n", _jsxs(_components.ul, { children: ["\n", _jsx(_components.li, { children: "O rim é muito eficiente em excretar bicarbonato. Para que a alcalose metabólica se instale e se mantenha, algo precisa impedir essa excreção." }), "\n", _jsxs(_components.li, { children: [_jsx(_components.strong, { children: "Fases da Alcalose Metabólica:" }), "\n", _jsxs(_components.ol, { children: ["\n", _jsxs(_components.li, { children: [_jsx(_components.strong, { children: "Fase de Geração" }), ": O evento inicial que causa o ganho de base ou perda de ácido."] }), "\n", _jsxs(_components.li, { children: [_jsx(_components.strong, { children: "Fase de Manutenção" }), ": Fatores que ", _jsx(_components.strong, { children: "perpetuam" }), " a alcalose, impedindo a correção renal."] }), "\n"] }), "\n"] }), "\n", _jsxs(_components.li, { children: [_jsx(_components.strong, { children: "Três Fatores de Manutenção (Perpetuadores):" }), "\n", _jsxs(_components.ol, { children: ["\n", _jsxs(_components.li, { children: [_jsx(_components.strong, { children: "Hipovolemia" }), ": A contração de volume estimula a reabsorção de sódio no túbulo proximal. Como a reabsorção de sódio está acoplada à de bicarbonato, o HCO₃⁻ também é reabsorvido, impedindo sua excreção."] }), "\n", _jsxs(_components.li, { children: [_jsx(_components.strong, { children: "Hipocloremia" }), ": A falta de cloreto força o rim a reabsorver sódio junto com bicarbonato, perpetuando a alcalose."] }), "\n", _jsxs(_components.li, { children: [_jsx(_components.strong, { children: "Hipocalemia" }), ": Na tentativa de poupar potássio, o rim aumenta a secreção de H⁺ em troca da reabsorção de sódio no túbulo coletor, piorando a alcalose."] }), "\n"] }), "\n"] }), "\n"] }), "\n", _jsxs(_components.h4, { id: "33-classificação", children: [_jsx(_components.a, { className: "heading-link", href: "#33-classificação", children: _jsx(_components.svg, { xmlns: "http:www.w3.org/2000/svg", fill: "#ab2b65", viewBox: "0 0 20 20", className: "w-5 h-5", children: _jsx(_components.path, { fillRule: "evenodd", clipRule: "evenodd", d: "M9.493 2.853a.75.75 0 00-1.486-.205L7.545 6H4.198a.75.75 0 000 1.5h3.14l-.69 5H3.302a.75.75 0 000 1.5h3.14l-.435 3.148a.75.75 0 001.486.205L7.955 14h2.986l-.434 3.148a.75.75 0 001.486.205L12.456 14h3.346a.75.75 0 000-1.5h-3.14l.69-5h3.346a.75.75 0 000-1.5h-3.14l.435-3.147a.75.75 0 00-1.486-.205L12.045 6H9.059l.434-3.147zM8.852 7.5l-.69 5h2.986l.69-5H8.852z" }) }) }), "3.3 Classificação"] }), "\n", _jsxs(_components.ul, { children: ["\n", _jsx(_components.li, { children: "A classificação é baseada na resposta à administração de cloreto (solução salina) e no estado volêmico." }), "\n"] }), "\n", _jsxs(_components.h5, { id: "331-alcaloses-hipovolêmicas-cloreto-sensíveis", children: [_jsx(_components.a, { className: "heading-link", href: "#331-alcaloses-hipovolêmicas-cloreto-sensíveis", children: _jsx(_components.svg, { xmlns: "http:www.w3.org/2000/svg", fill: "#ab2b65", viewBox: "0 0 20 20", className: "w-5 h-5", children: _jsx(_components.path, { fillRule: "evenodd", clipRule: "evenodd", d: "M9.493 2.853a.75.75 0 00-1.486-.205L7.545 6H4.198a.75.75 0 000 1.5h3.14l-.69 5H3.302a.75.75 0 000 1.5h3.14l-.435 3.148a.75.75 0 001.486.205L7.955 14h2.986l-.434 3.148a.75.75 0 001.486.205L12.456 14h3.346a.75.75 0 000-1.5h-3.14l.69-5h3.346a.75.75 0 000-1.5h-3.14l.435-3.147a.75.75 0 00-1.486-.205L12.045 6H9.059l.434-3.147zM8.852 7.5l-.69 5h2.986l.69-5H8.852z" }) }) }), "3.3.1 Alcaloses Hipovolêmicas (Cloreto-Sensíveis)"] }), "\n", _jsxs(_components.ul, { children: ["\n", _jsxs(_components.li, { children: ["Cursam com ", _jsx(_components.strong, { children: "cloreto urinário baixo (< 20 mEq/L)" }), "."] }), "\n", _jsx(_components.li, { children: "Melhoram com a reposição de volume e cloreto (SF 0,9%)." }), "\n", _jsxs(_components.li, { children: [_jsx(_components.strong, { children: "Causas Renais (Cloro urinário > 20):" }), "\n", _jsxs(_components.ul, { children: ["\n", _jsxs(_components.li, { children: [_jsx(_components.strong, { children: "Uso de Diuréticos" }), ": Tanto os de alça (furosemida) quanto os tiazídicos (hidroclorotiazida) causam perda de volume, cloro e potássio, levando à alcalose."] }), "\n"] }), "\n"] }), "\n", _jsxs(_components.li, { children: [_jsx(_components.strong, { children: "Causas Extrarrenais (Cloro urinário < 20):" }), "\n", _jsxs(_components.ul, { children: ["\n", _jsxs(_components.li, { children: [_jsx(_components.strong, { children: "Vômitos ou Drenagem Gástrica" }), ": É a principal causa. Há perda direta de ácido clorídrico (H⁺ e Cl⁻), gerando hipovolemia, hipocloremia e hipocalemia (perda urinária de potássio), que perpetuam a alcalose."] }), "\n", _jsxs(_components.li, { children: ["\n", _jsxs(_components.blockquote, { children: ["\n", _jsxs(_components.p, { children: [_jsx(_components.strong, { children: "Acidúria Paradoxal" }), ": Em pacientes com alcalose metabólica por vômitos, a urina pode estar paradoxalmente ácida. Isso ocorre porque, devido à hipovolemia severa, o rim prioriza reabsorver sódio e bicarbonato, secretando H⁺, o que acidifica a urina apesar da alcalemia sistêmica."] }), "\n"] }), "\n"] }), "\n"] }), "\n"] }), "\n"] }), "\n", _jsxs(_components.h5, { id: "332-alcaloses-normohipervolêmicas-cloreto-resistentes", children: [_jsx(_components.a, { className: "heading-link", href: "#332-alcaloses-normohipervolêmicas-cloreto-resistentes", children: _jsx(_components.svg, { xmlns: "http:www.w3.org/2000/svg", fill: "#ab2b65", viewBox: "0 0 20 20", className: "w-5 h-5", children: _jsx(_components.path, { fillRule: "evenodd", clipRule: "evenodd", d: "M9.493 2.853a.75.75 0 00-1.486-.205L7.545 6H4.198a.75.75 0 000 1.5h3.14l-.69 5H3.302a.75.75 0 000 1.5h3.14l-.435 3.148a.75.75 0 001.486.205L7.955 14h2.986l-.434 3.148a.75.75 0 001.486.205L12.456 14h3.346a.75.75 0 000-1.5h-3.14l.69-5h3.346a.75.75 0 000-1.5h-3.14l.435-3.147a.75.75 0 00-1.486-.205L12.045 6H9.059l.434-3.147zM8.852 7.5l-.69 5h2.986l.69-5H8.852z" }) }) }), "3.3.2 Alcaloses Normo/Hipervolêmicas (Cloreto-Resistentes)"] }), "\n", _jsxs(_components.ul, { children: ["\n", _jsxs(_components.li, { children: ["Cursam com ", _jsx(_components.strong, { children: "cloreto urinário alto (> 20 mEq/L)" }), "."] }), "\n", _jsxs(_components.li, { children: [_jsx(_components.strong, { children: "Não" }), " respondem à reposição de solução salina."] }), "\n", _jsxs(_components.li, { children: ["O principal mecanismo perpetuador é a ", _jsx(_components.strong, { children: "hipocalemia" }), "."] }), "\n", _jsxs(_components.li, { children: [_jsx(_components.strong, { children: "Causas Renais" }), ":", "\n", _jsxs(_components.ul, { children: ["\n", _jsxs(_components.li, { children: [_jsx(_components.strong, { children: "Hiperaldosteronismo" }), ": Excesso de aldosterona aumenta a reabsorção de sódio e a excreção de potássio e H⁺, causando hipertensão, hipocalemia e alcalose metabólica."] }), "\n", _jsxs(_components.li, { children: [_jsx(_components.strong, { children: "Síndrome de Liddle" }), ": Causa genética de hiperfunção do canal de sódio (ENaC) no túbulo coletor, mimetizando o hiperaldosteronismo."] }), "\n", _jsxs(_components.li, { children: [_jsx(_components.strong, { children: "Síndrome de Cushing" }), ": O excesso de cortisol tem efeito mineralocorticoide, agindo como a aldosterona."] }), "\n"] }), "\n"] }), "\n", _jsxs(_components.li, { children: [_jsx(_components.strong, { children: "Causas Extrarrenais" }), ":", "\n", _jsxs(_components.ul, { children: ["\n", _jsxs(_components.li, { children: [_jsx(_components.strong, { children: "Infusão de Bicarbonato" }), ": Administração excessiva de bicarbonato de sódio."] }), "\n", _jsxs(_components.li, { children: [_jsx(_components.strong, { children: "Hemotransfusão Maciça" }), ": O citrato, anticoagulante das bolsas de sangue, é metabolizado no fígado em bicarbonato."] }), "\n"] }), "\n"] }), "\n"] }), "\n", _jsx(_components.hr, {}), "\n", _jsxs(_components.h3, { id: "fluxograma-diagnóstico-da-alcalose-metabólica", children: [_jsx(_components.a, { className: "heading-link", href: "#fluxograma-diagnóstico-da-alcalose-metabólica", children: _jsx(_components.svg, { xmlns: "http:www.w3.org/2000/svg", fill: "#ab2b65", viewBox: "0 0 20 20", className: "w-5 h-5", children: _jsx(_components.path, { fillRule: "evenodd", clipRule: "evenodd", d: "M9.493 2.853a.75.75 0 00-1.486-.205L7.545 6H4.198a.75.75 0 000 1.5h3.14l-.69 5H3.302a.75.75 0 000 1.5h3.14l-.435 3.148a.75.75 0 001.486.205L7.955 14h2.986l-.434 3.148a.75.75 0 001.486.205L12.456 14h3.346a.75.75 0 000-1.5h-3.14l.69-5h3.346a.75.75 0 000-1.5h-3.14l.435-3.147a.75.75 0 00-1.486-.205L12.045 6H9.059l.434-3.147zM8.852 7.5l-.69 5h2.986l.69-5H8.852z" }) }) }), "Fluxograma Diagnóstico da Alcalose Metabólica"] }), "\n", _jsx(_components.pre, { className: "language-plantuml", children: _jsxs(_components.code, { className: "language-plantuml code-highlight", children: [_jsxs(_components.span, { className: "code-line", children: [_jsx(_components.span, { className: "token delimiter punctuation", children: "@startuml" }), "\n"] }), _jsxs(_components.span, { className: "code-line", children: ["digraph G ", _jsx(_components.span, { className: "token punctuation", children: "{" }), "\n"] }), _jsx(_components.span, { className: "code-line", children: " // --- Configurações Globais ---\n" }), _jsxs(_components.span, { className: "code-line", children: [" rankdir=TB", _jsx(_components.span, { className: "token punctuation", children: ";" }), "\n"] }), _jsxs(_components.span, { className: "code-line", children: [" bgcolor=", _jsx(_components.span, { className: "token string", children: "\"#282c34\"" }), _jsx(_components.span, { className: "token punctuation", children: ";" }), "\n"] }), _jsxs(_components.span, { className: "code-line", children: [" fontname=", _jsx(_components.span, { className: "token string", children: "\"Arial\"" }), 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"code-line", children: [" // --- Nós ", _jsx(_components.span, { className: "token punctuation", children: "(" }), "com labels simplificados para compatibilidade", _jsx(_components.span, { className: "token punctuation", children: ")" }), " ---\n"] }), _jsxs(_components.span, { className: "code-line", children: [" A ", _jsx(_components.span, { className: "token punctuation", children: "[" }), "label=", _jsx(_components.span, { className: "token string", children: "\"Alcalose Metabólica\\n(pH > 7,45 e HCO3 > 26)\"" }), _jsx(_components.span, { className: "token punctuation", children: "]" }), _jsx(_components.span, { className: "token punctuation", children: ";" }), "\n"] }), _jsxs(_components.span, { className: "code-line", children: [" B ", _jsx(_components.span, { className: "token punctuation", children: "[" }), "label=", _jsx(_components.span, { className: "token string", children: "\"Avaliar Volemia e\\nCloreto Urinário\"" }), _jsx(_components.span, { className: "token punctuation", children: "," }), " shape=diamond", _jsx(_components.span, { className: "token punctuation", children: "," }), " fillcolor=", _jsx(_components.span, { className: "token string", children: "\"#5c6bc0\"" }), _jsx(_components.span, { className: "token punctuation", children: "]" }), _jsx(_components.span, { className: "token punctuation", children: ";" }), "\n"] }), _jsx(_components.span, { className: "code-line", children: " \n" }), _jsxs(_components.span, { className: "code-line", children: [" C ", _jsx(_components.span, { className: "token punctuation", children: "[" }), "label=", _jsx(_components.span, { className: "token string", children: "\"Hipovolêmica (Cloreto-Sensível)\\nCloreto Urinário < 20 mEq/L\"" }), _jsx(_components.span, { className: "token punctuation", children: "]" }), _jsx(_components.span, { className: "token punctuation", children: ";" }), "\n"] }), _jsxs(_components.span, { className: "code-line", children: [" D ", _jsx(_components.span, { className: "token punctuation", children: "[" }), "label=", _jsx(_components.span, { className: "token string", children: "\"Normo/Hipervolêmica (Cloreto-Resistente)\\nCloreto Urinário > 20 mEq/L\"" }), _jsx(_components.span, { className: "token punctuation", children: "]" }), _jsx(_components.span, { className: "token punctuation", children: ";" }), "\n"] }), _jsx(_components.span, { className: "code-line", children: " \n" }), _jsxs(_components.span, { className: "code-line", children: [" E ", _jsx(_components.span, { className: "token punctuation", children: "[" }), "label=", _jsx(_components.span, { className: "token string", children: "\"Causas Extrarrenais\"" }), _jsx(_components.span, { className: "token punctuation", children: "]" }), _jsx(_components.span, { className: "token punctuation", children: ";" }), "\n"] }), _jsxs(_components.span, { className: "code-line", children: [" E1 ", _jsx(_components.span, { className: "token punctuation", children: "[" }), "label=", _jsx(_components.span, { className: "token string", children: "\"- Vômitos\\n- Drenagem Nasogástrica\"" }), _jsx(_components.span, { className: "token punctuation", children: "]" }), _jsx(_components.span, { className: "token punctuation", children: ";" }), "\n"] }), _jsx(_components.span, { className: "code-line", children: " \n" }), _jsxs(_components.span, { className: "code-line", children: [" F ", _jsx(_components.span, { className: "token punctuation", children: "[" }), "label=", _jsx(_components.span, { className: "token string", children: "\"Causas Renais*\"" }), _jsx(_components.span, { className: "token punctuation", children: "]" }), _jsx(_components.span, { className: "token punctuation", children: ";" }), "\n"] }), _jsxs(_components.span, { className: "code-line", children: [" F1 ", _jsx(_components.span, { className: "token punctuation", children: "[" }), "label=", _jsx(_components.span, { className: "token string", children: "\"Uso de Diuréticos (Alça, Tiazídicos)\\nPós-Hipercapnia\\n*Nota: Cloro urinário pode estar > 20\"" }), _jsx(_components.span, { className: "token punctuation", children: "]" }), _jsx(_components.span, { className: "token punctuation", children: ";" }), "\n"] }), _jsx(_components.span, { className: "code-line", children: " \n" }), _jsxs(_components.span, { className: "code-line", children: [" G ", _jsx(_components.span, { className: "token punctuation", children: "[" }), "label=", _jsx(_components.span, { className: "token string", children: "\"Causas Renais\"" }), _jsx(_components.span, { className: "token punctuation", children: "]" }), _jsx(_components.span, { className: "token punctuation", children: ";" }), "\n"] }), _jsxs(_components.span, { className: "code-line", children: [" G1 ", _jsx(_components.span, { className: "token punctuation", children: "[" }), "label=", _jsx(_components.span, { className: "token string", children: "\"- Hiperaldosteronismo\\n- Síndrome de Cushing\\n- Síndrome de Liddle\"" }), _jsx(_components.span, { className: "token punctuation", children: "]" }), _jsx(_components.span, { className: "token punctuation", children: ";" }), "\n"] }), _jsx(_components.span, { className: "code-line", children: " \n" }), _jsxs(_components.span, { className: "code-line", children: [" H ", _jsx(_components.span, { className: "token punctuation", children: "[" }), "label=", _jsx(_components.span, { className: "token string", children: "\"Causas Extrarrenais\"" }), _jsx(_components.span, { className: "token punctuation", children: "]" }), _jsx(_components.span, { className: "token punctuation", children: ";" }), "\n"] }), _jsxs(_components.span, { className: "code-line", children: [" H1 ", _jsx(_components.span, { className: "token punctuation", children: "[" }), "label=", _jsx(_components.span, { className: "token string", children: "\"- Infusão de Bicarbonato\\n- Hemotransfusão Maciça (citrato)\"" }), _jsx(_components.span, { className: "token punctuation", children: "]" }), 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--- Layout ---\n" }), _jsxs(_components.span, { className: "code-line", children: [" ", _jsx(_components.span, { className: "token punctuation", children: "{" }), "rank=same", _jsx(_components.span, { className: "token punctuation", children: ";" }), " C", _jsx(_components.span, { className: "token punctuation", children: ";" }), " D", _jsx(_components.span, { className: "token punctuation", children: ";" }), _jsx(_components.span, { className: "token punctuation", children: "}" }), "\n"] }), _jsxs(_components.span, { className: "code-line", children: [" ", _jsx(_components.span, { className: "token punctuation", children: "{" }), "rank=same", _jsx(_components.span, { className: "token punctuation", children: ";" }), " E", _jsx(_components.span, { className: "token punctuation", children: ";" }), " F", _jsx(_components.span, { className: "token punctuation", children: ";" }), " G", _jsx(_components.span, { className: "token punctuation", children: ";" }), " H", _jsx(_components.span, { 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14h2.986l-.434 3.148a.75.75 0 001.486.205L12.456 14h3.346a.75.75 0 000-1.5h-3.14l.69-5h3.346a.75.75 0 000-1.5h-3.14l.435-3.147a.75.75 0 00-1.486-.205L12.045 6H9.059l.434-3.147zM8.852 7.5l-.69 5h2.986l.69-5H8.852z" }) }) }), "3.4 Repercussões Clínicas"] }), "\n", _jsx(_components.div, { className: "overflow-x-auto", children: _jsxs(_components.table, { children: [_jsx(_components.thead, { children: _jsxs(_components.tr, { children: [_jsx(_components.th, { style: { textAlign: "left" }, children: "Sistema" }), _jsx(_components.th, { style: { textAlign: "left" }, children: "Consequências da Alcalemia Grave" })] }) }), _jsxs(_components.tbody, { children: [_jsxs(_components.tr, { children: [_jsx(_components.td, { style: { textAlign: "left" }, children: _jsx(_components.strong, { children: "Cardiovasculares" }) }), _jsx(_components.td, { style: { textAlign: "left" }, children: "Constrição arteriolar, Predisposição a arritmias, Angina" })] }), _jsxs(_components.tr, { children: [_jsx(_components.td, { style: { textAlign: "left" }, children: _jsx(_components.strong, { children: "Metabólicas" }) }), _jsx(_components.td, { style: { textAlign: "left" }, children: "Hipocalemia, Hipocalcemia (sintomática: tetania, cãibras)" })] }), _jsxs(_components.tr, { children: [_jsx(_components.td, { style: { textAlign: "left" }, children: _jsx(_components.strong, { children: "Cerebrais" }) }), _jsx(_components.td, { style: { textAlign: "left" }, children: "Rebaixamento do nível de consciência, Redução do fluxo cerebral, Convulsões" })] }), _jsxs(_components.tr, { children: [_jsx(_components.td, { style: { textAlign: "left" }, children: _jsx(_components.strong, { children: "Respiratórias" }) }), _jsx(_components.td, { style: { textAlign: "left" }, children: "Hipoventilação (compensatória), Hipercapnia, Hipóxia" })] }), _jsxs(_components.tr, { children: [_jsx(_components.td, { style: { textAlign: "left" } }), _jsx(_components.td, { style: { textAlign: "left" } })] })] })] }) }), "\n", _jsxs(_components.h4, { id: "35-tratamento", children: [_jsx(_components.a, { className: "heading-link", href: "#35-tratamento", children: _jsx(_components.svg, { xmlns: "http:www.w3.org/2000/svg", fill: "#ab2b65", viewBox: "0 0 20 20", className: "w-5 h-5", children: _jsx(_components.path, { fillRule: "evenodd", clipRule: "evenodd", d: "M9.493 2.853a.75.75 0 00-1.486-.205L7.545 6H4.198a.75.75 0 000 1.5h3.14l-.69 5H3.302a.75.75 0 000 1.5h3.14l-.435 3.148a.75.75 0 001.486.205L7.955 14h2.986l-.434 3.148a.75.75 0 001.486.205L12.456 14h3.346a.75.75 0 000-1.5h-3.14l.69-5h3.346a.75.75 0 000-1.5h-3.14l.435-3.147a.75.75 0 00-1.486-.205L12.045 6H9.059l.434-3.147zM8.852 7.5l-.69 5h2.986l.69-5H8.852z" }) }) }), "3.5 Tratamento"] }), "\n", _jsxs(_components.ul, { children: ["\n", _jsxs(_components.li, { children: ["O tratamento foca em ", _jsx(_components.strong, { children: "corrigir os fatores de manutenção" }), "."] }), "\n", _jsxs(_components.li, { children: [_jsx(_components.strong, { children: "Alcalose Cloreto-Sensível" }), ":", "\n", _jsxs(_components.ul, { children: ["\n", _jsxs(_components.li, { children: [_jsx(_components.strong, { children: "Reposição de volume com solução salina isotônica (SF 0,9%)" }), ". Isso fornece volume e cloreto."] }), "\n", _jsx(_components.li, { children: "Reposição de potássio (KCl), se houver hipocalemia." }), "\n"] }), "\n"] }), "\n", _jsxs(_components.li, { children: [_jsx(_components.strong, { children: "Alcalose Cloreto-Resistente" }), ":", "\n", _jsxs(_components.ul, { children: ["\n", _jsx(_components.li, { children: "Tratar a causa de base (ex: espironolactona para hiperaldosteronismo)." }), "\n", _jsxs(_components.li, { children: ["A correção da ", _jsx(_components.strong, { children: "hipocalemia" }), " é fundamental."] }), "\n"] }), "\n"] }), "\n"] }), "\n", _jsx(_components.hr, {}), "\n", _jsxs(_components.h2, { id: "40-acidose-respiratória", children: [_jsx(_components.a, { className: "heading-link", href: "#40-acidose-respiratória", children: _jsx(_components.svg, { xmlns: "http:www.w3.org/2000/svg", fill: "#ab2b65", viewBox: "0 0 20 20", className: "w-5 h-5", children: _jsx(_components.path, { fillRule: "evenodd", clipRule: "evenodd", d: "M9.493 2.853a.75.75 0 00-1.486-.205L7.545 6H4.198a.75.75 0 000 1.5h3.14l-.69 5H3.302a.75.75 0 000 1.5h3.14l-.435 3.148a.75.75 0 001.486.205L7.955 14h2.986l-.434 3.148a.75.75 0 001.486.205L12.456 14h3.346a.75.75 0 000-1.5h-3.14l.69-5h3.346a.75.75 0 000-1.5h-3.14l.435-3.147a.75.75 0 00-1.486-.205L12.045 6H9.059l.434-3.147zM8.852 7.5l-.69 5h2.986l.69-5H8.852z" }) }) }), "4.0 Acidose Respiratória"] }), "\n", _jsxs(_components.h4, { id: "41-definição", children: [_jsx(_components.a, { className: "heading-link", href: "#41-definição", children: _jsx(_components.svg, { xmlns: "http:www.w3.org/2000/svg", fill: "#ab2b65", viewBox: "0 0 20 20", className: "w-5 h-5", children: _jsx(_components.path, { fillRule: "evenodd", clipRule: "evenodd", d: "M9.493 2.853a.75.75 0 00-1.486-.205L7.545 6H4.198a.75.75 0 000 1.5h3.14l-.69 5H3.302a.75.75 0 000 1.5h3.14l-.435 3.148a.75.75 0 001.486.205L7.955 14h2.986l-.434 3.148a.75.75 0 001.486.205L12.456 14h3.346a.75.75 0 000-1.5h-3.14l.69-5h3.346a.75.75 0 000-1.5h-3.14l.435-3.147a.75.75 0 00-1.486-.205L12.045 6H9.059l.434-3.147zM8.852 7.5l-.69 5h2.986l.69-5H8.852z" }) }) }), "4.1 Definição"] }), "\n", _jsxs(_components.ul, { children: ["\n", _jsxs(_components.li, { children: ["Caracterizada por um ", _jsx(_components.strong, { children: "aumento primário da pCO₂" }), " (pressão parcial de CO₂)."] }), "\n", _jsxs(_components.li, { children: ["A causa é a ", _jsx(_components.strong, { children: "hipoventilação alveolar" }), ", ou seja, a incapacidade dos pulmões de eliminar o CO₂ produzido pelo corpo."] }), "\n", _jsx(_components.li, { children: "Resulta em tendência à queda do pH (< 7,35)." }), "\n", _jsx(_components.li, { children: "Pode ser aguda ou crônica." }), "\n"] }), "\n", _jsxs(_components.h4, { id: "42-causas", children: [_jsx(_components.a, { className: "heading-link", href: "#42-causas", children: _jsx(_components.svg, { xmlns: "http:www.w3.org/2000/svg", fill: "#ab2b65", viewBox: "0 0 20 20", className: "w-5 h-5", children: _jsx(_components.path, { fillRule: "evenodd", clipRule: "evenodd", d: "M9.493 2.853a.75.75 0 00-1.486-.205L7.545 6H4.198a.75.75 0 000 1.5h3.14l-.69 5H3.302a.75.75 0 000 1.5h3.14l-.435 3.148a.75.75 0 001.486.205L7.955 14h2.986l-.434 3.148a.75.75 0 001.486.205L12.456 14h3.346a.75.75 0 000-1.5h-3.14l.69-5h3.346a.75.75 0 000-1.5h-3.14l.435-3.147a.75.75 0 00-1.486-.205L12.045 6H9.059l.434-3.147zM8.852 7.5l-.69 5h2.986l.69-5H8.852z" }) }) }), "4.2 Causas"] }), "\n", _jsx(_components.div, { className: "overflow-x-auto", children: _jsxs(_components.table, { children: [_jsx(_components.thead, { children: _jsxs(_components.tr, { children: [_jsx(_components.th, { style: { textAlign: "left" }, children: "Mecanismo" }), _jsx(_components.th, { style: { textAlign: "left" }, children: "Causas de Acidose Respiratória Aguda" })] }) }), _jsxs(_components.tbody, { children: [_jsxs(_components.tr, { children: [_jsx(_components.td, { style: { textAlign: "left" }, children: _jsx(_components.strong, { children: "Alterações Neuromusculares" }) }), _jsxs(_components.td, { style: { textAlign: "left" }, children: ["Lesão de tronco/medula, Síndrome de Guillain-Barré, ", _jsx(_components.strong, { children: "Miastenia gravis" }), ", Drogas (opióides, benzodiazepínicos)"] })] }), _jsxs(_components.tr, { children: [_jsx(_components.td, { style: { textAlign: "left" }, children: _jsx(_components.strong, { children: "Obstrução de Vias Aéreas" }) }), _jsxs(_components.td, { style: { textAlign: "left" }, children: ["Corpo estranho, Edema de laringe, ", _jsx(_components.strong, { children: "Broncoespasmo grave (asma)" })] })] }), _jsxs(_components.tr, { children: [_jsx(_components.td, { style: { textAlign: "left" }, children: _jsx(_components.strong, { children: "Desordens Toracopulmonares" }) }), _jsx(_components.td, { style: { textAlign: "left" }, children: "Tórax instável, Pneumotórax" })] })] })] }) }), "\n", _jsx(_components.div, { className: "overflow-x-auto", children: _jsxs(_components.table, { children: [_jsx(_components.thead, { children: _jsxs(_components.tr, { children: [_jsx(_components.th, { style: { textAlign: "left" }, children: "Mecanismo" }), _jsx(_components.th, { style: { textAlign: "left" }, children: "Causas de Acidose Respiratória Crônica" })] }) }), _jsxs(_components.tbody, { children: [_jsxs(_components.tr, { children: [_jsx(_components.td, { style: { textAlign: "left" }, children: _jsx(_components.strong, { children: "Anormalidades Neuromusculares" }) }), _jsx(_components.td, { style: { textAlign: "left" }, children: "Paralisia diafragmática, Síndrome de Pickwick (hipoventilação da obesidade)" })] }), _jsxs(_components.tr, { children: [_jsx(_components.td, { style: { textAlign: "left" }, children: _jsx(_components.strong, { children: "Desordens Toracopulmonares" }) }), _jsxs(_components.td, { style: { textAlign: "left" }, children: [_jsx(_components.strong, { children: "Doença Pulmonar Obstrutiva Crônica (DPOC)" }), ", Cifoescoliose, Doença pulmonar intersticial terminal"] })] })] })] }) }), "\n", _jsxs(_components.h4, { id: "43-quadro-clínico", children: [_jsx(_components.a, { className: "heading-link", href: "#43-quadro-clínico", children: _jsx(_components.svg, { xmlns: "http:www.w3.org/2000/svg", fill: "#ab2b65", viewBox: "0 0 20 20", className: "w-5 h-5", children: _jsx(_components.path, { fillRule: "evenodd", clipRule: "evenodd", d: "M9.493 2.853a.75.75 0 00-1.486-.205L7.545 6H4.198a.75.75 0 000 1.5h3.14l-.69 5H3.302a.75.75 0 000 1.5h3.14l-.435 3.148a.75.75 0 001.486.205L7.955 14h2.986l-.434 3.148a.75.75 0 001.486.205L12.456 14h3.346a.75.75 0 000-1.5h-3.14l.69-5h3.346a.75.75 0 000-1.5h-3.14l.435-3.147a.75.75 0 00-1.486-.205L12.045 6H9.059l.434-3.147zM8.852 7.5l-.69 5h2.986l.69-5H8.852z" }) }) }), "4.3 Quadro Clínico"] }), "\n", _jsxs(_components.ul, { children: ["\n", _jsx(_components.li, { children: "Inespecífico. O aumento da pCO₂ causa vasodilatação cerebral." }), "\n", _jsxs(_components.li, { children: [_jsx(_components.strong, { children: "Sintomas Neurológicos" }), ": Confusão mental, tremores, ", _jsx(_components.strong, { children: "flapping (asterixis)" }), " e coma."] }), "\n", _jsx(_components.li, { children: "Em casos crônicos, os pacientes são mais adaptados. Sintomas agudos surgem durante exacerbações." }), "\n", _jsx(_components.li, { children: "Acidemia grave pode levar a arritmias e óbito." }), "\n"] }), "\n", _jsxs(_components.h4, { id: "44-tratamento", children: [_jsx(_components.a, { className: "heading-link", href: "#44-tratamento", children: _jsx(_components.svg, { xmlns: "http:www.w3.org/2000/svg", fill: "#ab2b65", viewBox: "0 0 20 20", className: "w-5 h-5", children: _jsx(_components.path, { fillRule: "evenodd", clipRule: "evenodd", d: "M9.493 2.853a.75.75 0 00-1.486-.205L7.545 6H4.198a.75.75 0 000 1.5h3.14l-.69 5H3.302a.75.75 0 000 1.5h3.14l-.435 3.148a.75.75 0 001.486.205L7.955 14h2.986l-.434 3.148a.75.75 0 001.486.205L12.456 14h3.346a.75.75 0 000-1.5h-3.14l.69-5h3.346a.75.75 0 000-1.5h-3.14l.435-3.147a.75.75 0 00-1.486-.205L12.045 6H9.059l.434-3.147zM8.852 7.5l-.69 5h2.986l.69-5H8.852z" }) }) }), "4.4 Tratamento"] }), "\n", _jsxs(_components.ul, { children: ["\n", _jsxs(_components.li, { children: ["Não há terapia específica. O tratamento é direcionado para a ", _jsx(_components.strong, { children: "correção da doença de base" }), "."] }), "\n", _jsxs(_components.li, { children: ["O objetivo é ", _jsx(_components.strong, { children: "melhorar a ventilação alveolar" }), " (ex: broncodilatadores, ventilação não invasiva ou invasiva)."] }), "\n"] }), "\n", _jsx(_components.hr, {}), "\n", _jsxs(_components.h2, { id: "50-alcalose-respiratória", children: [_jsx(_components.a, { className: "heading-link", href: "#50-alcalose-respiratória", children: _jsx(_components.svg, { xmlns: "http:www.w3.org/2000/svg", fill: "#ab2b65", viewBox: "0 0 20 20", className: "w-5 h-5", children: _jsx(_components.path, { fillRule: "evenodd", clipRule: "evenodd", d: "M9.493 2.853a.75.75 0 00-1.486-.205L7.545 6H4.198a.75.75 0 000 1.5h3.14l-.69 5H3.302a.75.75 0 000 1.5h3.14l-.435 3.148a.75.75 0 001.486.205L7.955 14h2.986l-.434 3.148a.75.75 0 001.486.205L12.456 14h3.346a.75.75 0 000-1.5h-3.14l.69-5h3.346a.75.75 0 000-1.5h-3.14l.435-3.147a.75.75 0 00-1.486-.205L12.045 6H9.059l.434-3.147zM8.852 7.5l-.69 5h2.986l.69-5H8.852z" }) }) }), "5.0 Alcalose Respiratória"] }), "\n", _jsxs(_components.h4, { id: "51-definição", children: [_jsx(_components.a, { className: "heading-link", href: "#51-definição", children: _jsx(_components.svg, { xmlns: "http:www.w3.org/2000/svg", fill: "#ab2b65", viewBox: "0 0 20 20", className: "w-5 h-5", children: _jsx(_components.path, { fillRule: "evenodd", clipRule: "evenodd", d: "M9.493 2.853a.75.75 0 00-1.486-.205L7.545 6H4.198a.75.75 0 000 1.5h3.14l-.69 5H3.302a.75.75 0 000 1.5h3.14l-.435 3.148a.75.75 0 001.486.205L7.955 14h2.986l-.434 3.148a.75.75 0 001.486.205L12.456 14h3.346a.75.75 0 000-1.5h-3.14l.69-5h3.346a.75.75 0 000-1.5h-3.14l.435-3.147a.75.75 0 00-1.486-.205L12.045 6H9.059l.434-3.147zM8.852 7.5l-.69 5h2.986l.69-5H8.852z" }) }) }), "5.1 Definição"] }), "\n", _jsxs(_components.ul, { children: ["\n", _jsxs(_components.li, { children: ["Definida por uma ", _jsx(_components.strong, { children: "queda primária da pCO₂" }), "."] }), "\n", _jsxs(_components.li, { children: ["A causa é a ", _jsx(_components.strong, { children: "hiperventilação alveolar" }), "."] }), "\n", _jsx(_components.li, { children: "Gera uma tendência de aumento do pH (> 7,45)." }), "\n"] }), "\n", _jsxs(_components.h4, { id: "52-causas", children: [_jsx(_components.a, { className: "heading-link", href: "#52-causas", children: _jsx(_components.svg, { xmlns: "http:www.w3.org/2000/svg", fill: "#ab2b65", viewBox: "0 0 20 20", className: "w-5 h-5", children: _jsx(_components.path, { fillRule: "evenodd", clipRule: "evenodd", d: "M9.493 2.853a.75.75 0 00-1.486-.205L7.545 6H4.198a.75.75 0 000 1.5h3.14l-.69 5H3.302a.75.75 0 000 1.5h3.14l-.435 3.148a.75.75 0 001.486.205L7.955 14h2.986l-.434 3.148a.75.75 0 001.486.205L12.456 14h3.346a.75.75 0 000-1.5h-3.14l.69-5h3.346a.75.75 0 000-1.5h-3.14l.435-3.147a.75.75 0 00-1.486-.205L12.045 6H9.059l.434-3.147zM8.852 7.5l-.69 5h2.986l.69-5H8.852z" }) }) }), "5.2 Causas"] }), "\n", _jsxs(_components.ul, { children: ["\n", _jsxs(_components.li, { children: ["A hiperventilação ocorre por dois mecanismos principais: ", _jsx(_components.strong, { children: "hipóxia" }), " (que estimula o centro respiratório) ou um ", _jsx(_components.strong, { children: "estímulo direto ao centro respiratório" }), "."] }), "\n"] }), "\n", _jsx(_components.div, { className: "overflow-x-auto", children: _jsxs(_components.table, { children: [_jsx(_components.thead, { children: _jsxs(_components.tr, { children: [_jsx(_components.th, { style: { textAlign: "left" }, children: "Mecanismo" }), _jsx(_components.th, { style: { textAlign: "left" }, children: "Causas" })] }) }), _jsxs(_components.tbody, { children: [_jsxs(_components.tr, { children: [_jsx(_components.td, { style: { textAlign: "left" }, children: _jsx(_components.strong, { children: "Hipóxia" }) }), _jsx(_components.td, { style: { textAlign: "left" }, children: "Pneumonia, Tromboembolismo pulmonar, Insuficiência cardíaca, Edema pulmonar" })] }), _jsxs(_components.tr, { children: [_jsx(_components.td, { style: { textAlign: "left" }, children: _jsx(_components.strong, { children: "Estímulo Direto do Centro Respiratório" }) }), _jsxs(_components.td, { style: { textAlign: "left" }, children: [_jsx(_components.strong, { children: "Ansiedade (crise de pânico)" }), ", Intoxicação por salicilato (fase inicial), Acidente vascular cerebral (AVC)"] })] })] })] }) }), "\n", _jsxs(_components.h4, { id: "53-quadro-clínico", children: [_jsx(_components.a, { className: "heading-link", href: "#53-quadro-clínico", children: _jsx(_components.svg, { xmlns: "http:www.w3.org/2000/svg", fill: "#ab2b65", viewBox: "0 0 20 20", className: "w-5 h-5", children: _jsx(_components.path, { fillRule: "evenodd", clipRule: "evenodd", d: "M9.493 2.853a.75.75 0 00-1.486-.205L7.545 6H4.198a.75.75 0 000 1.5h3.14l-.69 5H3.302a.75.75 0 000 1.5h3.14l-.435 3.148a.75.75 0 001.486.205L7.955 14h2.986l-.434 3.148a.75.75 0 001.486.205L12.456 14h3.346a.75.75 0 000-1.5h-3.14l.69-5h3.346a.75.75 0 000-1.5h-3.14l.435-3.147a.75.75 0 00-1.486-.205L12.045 6H9.059l.434-3.147zM8.852 7.5l-.69 5h2.986l.69-5H8.852z" }) }) }), "5.3 Quadro Clínico"] }), "\n", _jsxs(_components.ul, { children: ["\n", _jsx(_components.li, { children: "Os sintomas são mais proeminentes na forma aguda." }), "\n", _jsx(_components.li, { children: "Relacionam-se com hiperexcitabilidade neurológica e redução do fluxo sanguíneo cerebral." }), "\n", _jsxs(_components.li, { children: ["O aumento do pH favorece a ligação do cálcio à albumina, reduzindo o cálcio iônico livre e causando uma ", _jsx(_components.strong, { children: "hipocalcemia transitória funcional" }), "."] }), "\n", _jsxs(_components.li, { children: [_jsx(_components.strong, { children: "Sintomas" }), ": Parestesias (formigamento) periorais e em extremidades, cãibras, tontura, confusão mental. O quadro pode ser indistinguível de uma hipocalcemia aguda."] }), "\n"] }), "\n", _jsxs(_components.h4, { id: "54-tratamento", children: [_jsx(_components.a, { className: "heading-link", href: "#54-tratamento", children: _jsx(_components.svg, { xmlns: "http:www.w3.org/2000/svg", fill: "#ab2b65", viewBox: "0 0 20 20", className: "w-5 h-5", children: _jsx(_components.path, { fillRule: "evenodd", clipRule: "evenodd", d: "M9.493 2.853a.75.75 0 00-1.486-.205L7.545 6H4.198a.75.75 0 000 1.5h3.14l-.69 5H3.302a.75.75 0 000 1.5h3.14l-.435 3.148a.75.75 0 001.486.205L7.955 14h2.986l-.434 3.148a.75.75 0 001.486.205L12.456 14h3.346a.75.75 0 000-1.5h-3.14l.69-5h3.346a.75.75 0 000-1.5h-3.14l.435-3.147a.75.75 0 00-1.486-.205L12.045 6H9.059l.434-3.147zM8.852 7.5l-.69 5h2.986l.69-5H8.852z" }) }) }), "5.4 Tratamento"] }), "\n", _jsxs(_components.ul, { children: ["\n", _jsxs(_components.li, { children: ["Não há tratamento específico. A conduta é voltada para a ", _jsx(_components.strong, { children: "doença de base" }), "."] }), "\n", _jsx(_components.li, { children: "No caso de ansiedade, orientar o paciente a respirar mais lentamente ou usar um saco de papel para reinspirar o CO₂ pode ajudar." }), "\n"] })] }); } function MDXContent(props = {}) { const {wrapper: MDXLayout} = { ..._provideComponents(), ...props.components }; return MDXLayout ? _jsx(MDXLayout, { ...props, children: _jsx(_createMdxContent, { ...props }) }) : _createMdxContent(props); } return { default: MDXContent };