Acid-base Disorders And The Kidney.
In the normal human body, the extracellular fluid pH of 7.40 is closelyprotected. Any increase in acidity or alkalinity summons forth three lines ofdefense, starting immediately with the blood buffers, followed soon by therespiratory system's control of CO2, and finally purged by the renal excretion ofthe excess acid or base. The complex interrelated processes of the renalresponses require a few days to accomplish maximum compensation. We havepresented the fundamental principles governing maintenance of the acid-baseequilibrium to provide a conceptual framework for understanding the clinicaldisorders of hydrogen ion metabolism. The somewhat elusive concepts of endogenousacid production and net acid balance have also been reviewed to help reveal thepathophysiology of metabolic acidosis caused by renal tubular acidosis, chronicrenal failure, certain infant feedings, and total parenteral nutrition. Thedevelopment and perpetuation of metabolic alkalosis in relationship to chlorideand potassium deficiency have been examined. In the delineation of a clinicalacid-base disorder, the clinician must bear in mind the continual interactions ofelectrolytes and hormonal systems and should be pr Continue reading >>