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Metabolic Acidosis And Alkalosis

Acid-base Imbalances: Metabolic Acidosis And Alkalosis

Acid-base Imbalances: Metabolic Acidosis And Alkalosis

Acid-Base Imbalances: Metabolic Acidosis and Alkalosis; Respiratory Acidosis and Alkalosis The hydrogen ion concentration ([H+]) of the body, described as the pH or negative log of the [H+], is maintained in a narrow range to promote health and homeostasis. The body has many regulatory mechanisms that counteract even a slight deviation from normal pH. An acid-base imbalance can alter many physiological processes and lead to serious problems or, if left untreated, to coma and death. A pH below 7.35 is considered acidosis and above 7.45 is alkalosis. Alterations in hydrogen ion concentration can be metabolic or respiratory in origin or they may have a mixed origin. Metabolic acidosis, a pH below 7.35, results from any nonpulmonary condition that leads to an excess of acids over bases. Renal patients with chronic acidemia may show signs of skeletal problems as calcium and phosphate are released from bone to help with the buffering of acids. Children with chronic acidosis may show signs of impaired growth. Metabolic alkalosis, a pH above 7.45, results from any nonpulmonary condition that leads to an excess of bases over acids. Metabolic alkalosis results from one of two mechanisms: an excess of bases or a loss of acids. Patients with a history of congestive heart failure and hypertension who are on sodium-restricted diets and diuretics are at greatest risk for metabolic alkalosis. Metabolic alkalosis can also be caused by prolonged vomiting, hyperaldosteronism, and diuretic therapy. Respiratory acidosis is a pH imbalance that results from alveolar hypoventilation and an accumulation of carbon dioxide. It can be classified as either acute or chronic. Acute respiratory acidosis is associated with a sudden failure in ventilation. Chronic respiratory acidosis is seen in patient Continue reading >>

Types Of Disturbances

Types Of Disturbances

The different types of acid-base disturbances are differentiated based on: Origin: Respiratory or metabolic Primary or secondary (compensatory) Uncomplicated or mixed: A simple or uncomplicated disturbance is a single or primary acid-base disturbance with or without compensation. A mixed disturbance is more than one primary disturbance (not a primary with an expected compensatory response). Acid-base disturbances have profound effects on the body. Acidemia results in arrythmias, decreased cardiac output, depression, and bone demineralization. Alkalemia results in tetany and convulsions, weakness, polydipsia and polyuria. Thus, the body will immediately respond to changes in pH or H+, which must be kept within strict defined limits. As soon as there is a metabolic or respiratory acid-base disturbance, body buffers immediately soak up the proton (in acidosis) or release protons (alkalosis) to offset the changes in H+ (i.e. the body compensates for the changes in H+). This is very effective so minimal changes in pH occur if the body is keeping up or the acid-base abnormality is mild. However, once buffers are overwhelmed, the pH will change and kick in stronger responses. Remember that the goal of the body is to keep hydrogen (which dictates pH) within strict defined limits. The kidney and lungs are the main organs responsible for maintaining normal acid-base balance. The lungs compensate for a primary metabolic condition and will correct for a primary respiratory disturbance if the disease or condition causing the disturbance is resolved. The kidney is responsible for compensating for a primary respiratory disturbance or correcting for a primary metabolic disturbance. Thus, normal renal function is essential for the body to be able to adequately neutralize acid-base abnor Continue reading >>

Acid-base Disorders

Acid-base Disorders

Acid-base disorders are pathologic changes in arterial pH and carbon dioxide partial pressure (Pco2), and in serum bicarbonate (HCO3−). Acidosis refers to physiologic processes that cause acid accumulation or alkali loss. Alkalosis refers to physiologic processes that cause alkali accumulation or acid loss. Actual changes in pH depend on the degree of physiologic compensation and whether multiple processes are present. Primary acid-base disturbances are defined as metabolic or respiratory based on clinical context and whether the primary change in pH is due to an alteration in serum HCO3− or in Pco2. Whenever an acid-base disorder is present, compensatory mechanisms begin to correct the pH (see Table: Primary Changes and Compensations in Simple Acid-Base Disorders). Compensation cannot return pH completely to normal and never overshoots. A simple acid-base disorder is a single acid-base disturbance with its accompanying compensatory response. Mixed acid-base disorders comprise ≥ 2 primary disturbances. Compensated or mild acid-base disorders cause few symptoms or signs. Severe, uncompensated disorders have multiple cardiovascular, respiratory, neurologic, and metabolic consequences (see Table: Clinical Consequences of Acid-Base Disorders and see Figure: Oxyhemoglobin dissociation curve.). Evaluation is with ABG and serum electrolytes. The ABG directly measures arterial pH and Pco2. HCO3− levels on ABG are calculated using the Henderson-Hasselbalch equation; HCO3− levels on serum chemistry panels are directly measured and are considered more accurate in cases of discrepancy. Acid-base balance is most accurately assessed with measurement of pH and Pco2 on arterial blood. In cases of circulatory failure or during cardiopulmonary resuscitation, measurements on ven Continue reading >>

Acidosis Vs. Alkalosis

Acidosis Vs. Alkalosis

In this lesson, we're going to learn about acidosis and alkalosis. We'll take a look at the causes, signs, and symptoms that are associated with each condition. Balanced Blood We are constantly having to find balance in our lives. From balancing work and play time to saving and spending money, sleep and awake time. Well, ideally at least. We do this because we know that we function best when we're balanced. There are many similar balances that are going on inside of our bodies. An important balance that must be maintained to allow us to function properly is the balance between acids and bases in our bodies. When these are balanced, the acids pair up with the bases, and our blood is close to neutral. If too much acid is in the blood, then we experience acidosis. If too much base is in the blood, we experience alkalosis. Acidosis and alkalosis are caused by different conditions in our bodies, and they can cause different problems to occur. Acidosis Acidosis results from the build-up of acids in the blood or from the loss of base in the blood. Acids are put into our bloodstream through two systems in the body: the digestive system and the respiratory system. Acidosis that occurs from the digestive system is referred to as metabolic acidosis. In this instance, acids accumulate in the blood due to consumption of acidic foods or foods that are broken down into acids, excess acids being produced during metabolism, kidneys not properly removing acid from the bloodstream during filtration, or production of acid by the body due to other medical conditions, such as diabetes. The other possible way to develop acidosis is by the malfunctioning of the respiratory system, which we refer to as respiratory acidosis. This can happen if breathing is extremely slow or shallow, the lungs do Continue reading >>

Disorders Of Acid-base Balance

Disorders Of Acid-base Balance

Learning Objectives By the end of this section, you will be able to: Identify the three blood variables considered when making a diagnosis of acidosis or alkalosis Identify the source of compensation for blood pH problems of a respiratory origin Identify the source of compensation for blood pH problems of a metabolic/renal origin Normal arterial blood pH is restricted to a very narrow range of 7.35 to 7.45. A person who has a blood pH below 7.35 is considered to be in acidosis (actually, “physiological acidosis,” because blood is not truly acidic until its pH drops below 7), and a continuous blood pH below 7.0 can be fatal. Acidosis has several symptoms, including headache and confusion, and the individual can become lethargic and easily fatigued. A person who has a blood pH above 7.45 is considered to be in alkalosis, and a pH above 7.8 is fatal. Some symptoms of alkalosis include cognitive impairment (which can progress to unconsciousness), tingling or numbness in the extremities, muscle twitching and spasm, and nausea and vomiting. Both acidosis and alkalosis can be caused by either metabolic or respiratory disorders. As discussed earlier in this chapter, the concentration of carbonic acid in the blood is dependent on the level of CO2 in the body and the amount of CO2 gas exhaled through the lungs. Thus, the respiratory contribution to acid-base balance is usually discussed in terms of CO2 (rather than of carbonic acid). Remember that a molecule of carbonic acid is lost for every molecule of CO2 exhaled, and a molecule of carbonic acid is formed for every molecule of CO2 retained. Metabolic Acidosis: Primary Bicarbonate Deficiency Metabolic acidosis occurs when the blood is too acidic (pH below 7.35) due to too little bicarbonate, a condition called primary bicar Continue reading >>

Metabolic Acidosis

Metabolic Acidosis

Metabolic acidosis is primary reduction in bicarbonate (HCO3−), typically with compensatory reduction in carbon dioxide partial pressure (Pco2); pH may be markedly low or slightly subnormal. Metabolic acidoses are categorized as high or normal anion gap based on the presence or absence of unmeasured anions in serum. Causes include accumulation of ketones and lactic acid, renal failure, and drug or toxin ingestion (high anion gap) and GI or renal HCO3− loss (normal anion gap). Symptoms and signs in severe cases include nausea and vomiting, lethargy, and hyperpnea. Diagnosis is clinical and with ABG and serum electrolyte measurement. The cause is treated; IV sodium bicarbonate may be indicated when pH is very low. Acidemia (arterial pH < 7.35) results when acid load overwhelms respiratory compensation. Causes are classified by their effect on the anion gap (see The Anion Gap and see Table: Causes of Metabolic Acidosis). High anion gap acidosis Ketoacidosis is a common complication of type 1 diabetes mellitus (see diabetic ketoacidosis), but it also occurs with chronic alcoholism (see alcoholic ketoacidosis), undernutrition, and, to a lesser degree, fasting. In these conditions, the body converts from glucose to free fatty acid (FFA) metabolism; FFAs are converted by the liver into ketoacids, acetoacetic acid, and beta-hydroxybutyrate (all unmeasured anions). Ketoacidosis is also a rare manifestation of congenital isovaleric and methylmalonic acidemia. Lactic acidosis is the most common cause of metabolic acidosis in hospitalized patients. Lactate accumulation results from a combination of excess formation and decreased utilization of lactate. Excess lactate production occurs during states of anaerobic metabolism. The most serious form occurs during the various types o Continue reading >>

The Effect Of Metabolic Acidosis And Alkalosis On The Blood Flow Through The Cerebral Cortex

The Effect Of Metabolic Acidosis And Alkalosis On The Blood Flow Through The Cerebral Cortex

Full text Full text is available as a scanned copy of the original print version. Get a printable copy (PDF file) of the complete article (403K), or click on a page image below to browse page by page. Links to PubMed are also available for Selected References. These references are in PubMed. This may not be the complete list of references from this article. Articles from Journal of Neurology, Neurosurgery, and Psychiatry are provided here courtesy of BMJ Publishing Group Continue reading >>

Acidosis/alkalosis

Acidosis/alkalosis

This article waslast modified on 31 January 2019. Acidosis and alkalosis are terms used to describe abnormal conditions when a patients blood pH may not fall within the healthy range. Measuring the hydrogen ion concentration, and calculating the pH , of blood is a way of finding out how acidic or alkaline the blood is. Normal blood pH must be within a narrow range of 7.35-7.45 so that the bodys metabolic processes can work properly and can deliver the right amount of oxygen to tissues. Many diseases and other conditions can cause a patients blood pH to fall outside of these healthy limits. In the human body, normal metabolism generates large quantities of acids (effectively compounds that produce a free hydrogen ion) that must be removed to keep a normal pH balance. Disruption of this balance can be caused by a build-up of acid or alkali (base) or by an increased loss of acid or alkali (see the diagram of taps and drains below). Alkalis, or bases, are compounds that remove a free hydrogen ion. Acidosis occurs when blood pH falls below 7.35, indicating an increase in hydrogen ion concentration. Alkalosis occurs when blood pH rises above 7.45, indicating a reduction in hydrogen ion concentration. Both of these conditions act as an alarm to the body; they trigger actions intended to restore the balance and to return the blood pH to its normal range. The major organs involved in regulating blood pH are the lungs and the kidneys. The lungs flush acid out of the body by exhaling carbon dioxide (CO2), which forms an acid when in solution (dissolved in the blood). Within physical limits, the body can raise and lower the rate of breathing to alter the amount of carbon dioxide that is breathed out. This can affect blood pH within seconds to minutes. The kidneys remove some acids Continue reading >>

Acid Base Statuses

Acid Base Statuses

A B Metabolic Acidosis (1) results from cold stress Respiratory Alkalosis (1) results from excessive CO2 blown off Body decr carbonic acid (1) results in slow respirations so that CO2 is retained Acidosis (1) symptoms (a) CNS depression (b) errors in judgment (c) disorientation (d) drowsiness (e) stupor (f) coma Hydrogen Ions excess (1) results in acidosis as pH falls below 7.35 (2) hydrogen ions are forced into the cells causing K+ to move into the cells Diabetic Ketoacidosis metabolic acidosis Metabolic Acidosis dehydration after an extended bout of diarrhea COPD respiratory acidosis Diarrhea (1) respirtory acidosis Anxiety (1)results in respiratory alkalosis (2) associated w/hyperventilation (2) during hyperventilation CO2 is blown off which lowers the amount of acid in the system Severe Asthma Respiratory Alkalosis Acute Renal Failure (1) metabolic acidosis (2) hypermagnesemia (3) hyperkalemia (4) hypocalcemia Diarrhea (1) metabolic acidosis (2) leads to meta acid because there is an over-elimination of bicarbonate Alkalosis (1) signs (a) tingling fingers, toes & face (b) estreme nervousness (c) twitching of muscles (d) tetany Severe Asthma respiratory acidosis Vomiting (1) metabolic alkalosis (2) leads to metabolic alkalosis as hydrochloric acid is lost from the stomach Aspirin metabolic acidosis Overdose of Morphine respiratory acisosis Vigorous Diuresis metabolic alkalosis End Stage Muscular Distrophy respiratory acidosis Severe Hypokalemia metabolic alkalosis Renal Failure (1) results in metabolic acisosis as fluid build up turns acidic Shock (1) metabolic acidosis (2) meta acid because acid is added to the system (3) anaerobic metabolic pathways result in lactate and hydrogen irons (forming lactic acid) Hyperventilation (1) respiratory alkalosis (2) leads to re Continue reading >>

Metabolic Alkalosis And Metabolic Acidosis Nclex Quiz | Acid-base Imbalances Quiz

Metabolic Alkalosis And Metabolic Acidosis Nclex Quiz | Acid-base Imbalances Quiz

This NCLEX quiz will test your ability to differentiate between metabolic acidosis vs metabolic alkalosis. You will be required to know the causes, signs and symptoms, and how to interpret blood gas values in this quiz. As a nursing student, it is crucial you know the basics about acid-base imbalances. Below are common test questions you may encounter on your nursing lecture exam or NCLEX licensing exam. Also, don’t forget to take our free Arterial Blood Gas (ABGs) Quiz. After you are done taking the quiz and click submit, the page will refresh and you will need to scroll down to see what you got right and wrong. In addition, below this quiz is a layout of the quiz with an answer key (if you wanted to print off the quiz..just copy and paste it). Don’t forget to share this quiz with your friends! Please do not re-post on other websites, however. Metabolic Acidosis and Metabolic Alkalosis Quiz NCLEX Diabetic ketoacidosis, aspirin toxicity, and renal failure are examples of the causes of ___________________. A. High anion gap metabolic acidosis B. Normal anion gap metabolic acidosis C. Low anion gap metabolic acidosis D. Normal anion gap respiratory acidosis A patient has the following arterial blood gases: PaCO2 33, HCO3 15, pH 7.23. Which of the following conditions are presenting? A. Metabolic alkalosis partially compensated B. Metabolic acidosis partially compensated C. Respiratory alkalosis not compensated D. Metabolic acidosis fully compensated A patient is in high anion gap metabolic acidosis due to diabetic ketoacidosis. Which of the following signs and symptoms would you expect to see in this patient? A. Kussmaul’s respirations B. Glucose 110 C. Hypoventilation D. Neuro-excitability A patient reports taking Diamox and has been reporting confusion, fatigue, a Continue reading >>

Metabolic Acidosis And Alkalosis

Metabolic Acidosis And Alkalosis

Page Index Metabolic Acidosis. Metabolic Alkalosis Emergency Therapy Treating Metabolic Acidosis Calculating the Dose Use Half the Calculated Dose Reasons to Limit the Bicarbonate Dose: Injected into Plasma Volume Fizzes with Acid Causes Respiratory Acidosis Raises Intracellular PCO2 Subsequent Residual Changes Metabolic Acidosis. The following is a brief summary. For additional information visit: E-Medicine (Christie Thomas) or Wikepedia Etiology: There are many causes of primary metabolic acidosis and they are commonly classified by the anion gap: Metabolic Acidosis with a Normal Anion Gap: Longstanding diarrhea (bicarbonate loss) Uretero-sigmoidostomy Pancreatic fistula Renal Tubular Acidosis Intoxication, e.g., ammonium chloride, acetazolamide, bile acid sequestrants Renal failure Metabolic Acidosis with an Elevated Anion Gap: lactic acidosis ketoacidosis chronic renal failure (accumulation of sulfates, phosphates, uric acid) intoxication, e.g., salicylates, ethanol, methanol, formaldehyde, ethylene glycol, paraldehyde, INH, toluene, sulfates, metformin. rhabdomyolysis For further details visit: E-Medicine (Christie Thomas). Treating Severe Metabolic Acidosis. The ideal treatment for metabolic acidosis is correction of the underlying cause. When urgency dictates more rapid correction, treatment is based on clinical considerations, supported by laboratory evidence. The best measure of the level of metabolic acidosis is the Standard Base Excess (SBE) because it is independent of PCO2. If it is decided to administer bicarbonate, the SBE and the size of the treatable space are used to calculate the dose required: Metabolic Alkalosis Etiology: Primary Metabolic alkalosis may occur from various causes including: Loss of acid via the urine, stools, or vomiting Transfer of Continue reading >>

Metabolic Acidosis And Alkalosis -

Metabolic Acidosis And Alkalosis -

1. ‫الرحيم‬ ‫الرحمن‬ ‫هللا‬ ‫بسم‬ Ahmad A. Al-Qudah Supervision : Dr. Saleem Bani Hani Metabolic Acidosis & Alkalosis 2. Metabolic Acidosis & Alkalosis • Terms And Definitions • Acid – Base Balance ( Regulation ) • Acid – Base Disorders ( Acidosis & Alkalosis ) • Metabolic Acidosis • Metabolic Alkalosis • Measurements • References 3. Terms And Definitions • Acid : substance that can yield Hydrogen ion Strong Acid pH < 3.0 • Base : substance that can yield Hydroxyl ion Strong Base pH > 9.0 • pH : terms that we use to describe the level of Acidity and Basicity of Aq. Solution . 4. Acid – Base Balance • Maintenance of Hydrogen ion concentration in the ECF ( Extracellular Fluid ) within the Normal Range . - Normal Range : 36 – 44 nmol/L - pH : 7.35 – 7.45 ( Slightly Alkaline ) ACID BASE 5. Acid – Base Balance ( Regulation ) How the Body maintain the Hydrogen ion concentration • Lung • Buffer System ( Carbonic Acid , Bicarbonate ) - Henderson Equation 6. Acid – Base Balance ( Regulation ) How the Body maintain the Hydrogen ion concentration • Kidney - Regulate by excreting Acid (Hydrogen ion) and reclaiming Bicarbonate . - Reclaiming Bicarbonate from glomerular filtrate . - Hydrogen ion combined with ammonia and excreting as Ammonium . 7. Acid – Base Disorders ( Acidosis & Alkalosis ) • Acidosis : Increase in Acids [ Hydrogen ion ] --> Decrease in pH • Alkalosis : Decrease in Acids [ Hydrogen ion ] -- > Increase in pH ACID BASE BASEACID 8. Metabolic Acidosis • is a metabolic condition that occurs when the body produces too much acid or when the kidneys are not removing enough acid from the body . Because of the decrease in Bicarbonate level . Shift to Right Bicarbonate Hydrogen ion 9. Metabo Continue reading >>

Blood Gas Analysis, Pt 5: Metabolic Acidosis And Alkalosis

Blood Gas Analysis, Pt 5: Metabolic Acidosis And Alkalosis

Base excess (BE) and bicarbonate (HCO3-) represent the metabolic components of the acid base equation. In general, both components will change in the same direction. Decreased HCO3– and BE indicate either a primary metabolic acidosis or a metabolic compensation for a chronic respiratory alkalosis. Elevated HCO3– and BE indicate either a primary metabolic alkalosis or a metabolic compensation for a chronic respiratory acidosis. The exception to this rule arises when a patient hypoventilates or hyperventilates. Carbonic acid equation CO2 + H2O ↔ H2CO3 ↔ HCO3– + H+ When a patient hypoventilates, CO2 will increase as a result of reduced expiration, so a shift to the right of the equilibrium will occur. The shift to the right will increase the bicarbonate levels proportional to the increase in CO2. The opposite occurs when a patient hyperventilates; the equilibrium shifts to the left, so a decrease in HCO3– is present. Since HCO3– is not independent to the patient’s respiratory status, it is an inaccurate way of measuring the metabolic component in patients with respiratory changes. For this reason, the BE value is the preferred. The BE represents the amount of acid, or base, needed to titrate 1L of the blood sample until the pH reaches exactly 7.4, with the assumption the blood sample is equilibrated to a partial pressure of CO2 of 40mmHg (the middle of the reference range) and the patient’s body temperature is normal. Possible causes The possible causes of the primary disease are: Metabolic acidosis lactic acidosis – shock and poor perfusion renal failure – reduced hydrogen ion (H+) excretion and increased loss of HCO3– diabetic ketoacidosis – ketone acids gastrointestinal (GI) losses – loss of HCO3– through vomiting and diarrhoea Metabolic al Continue reading >>

Metabolic Acidosis

Metabolic Acidosis

Metabolic acidosis is a condition that occurs when the body produces excessive quantities of acid or when the kidneys are not removing enough acid from the body. If unchecked, metabolic acidosis leads to acidemia, i.e., blood pH is low (less than 7.35) due to increased production of hydrogen ions by the body or the inability of the body to form bicarbonate (HCO3−) in the kidney. Its causes are diverse, and its consequences can be serious, including coma and death. Together with respiratory acidosis, it is one of the two general causes of acidemia. Terminology : Acidosis refers to a process that causes a low pH in blood and tissues. Acidemia refers specifically to a low pH in the blood. In most cases, acidosis occurs first for reasons explained below. Free hydrogen ions then diffuse into the blood, lowering the pH. Arterial blood gas analysis detects acidemia (pH lower than 7.35). When acidemia is present, acidosis is presumed. Signs and symptoms[edit] Symptoms are not specific, and diagnosis can be difficult unless the patient presents with clear indications for arterial blood gas sampling. Symptoms may include chest pain, palpitations, headache, altered mental status such as severe anxiety due to hypoxia, decreased visual acuity, nausea, vomiting, abdominal pain, altered appetite and weight gain, muscle weakness, bone pain, and joint pain. Those in metabolic acidosis may exhibit deep, rapid breathing called Kussmaul respirations which is classically associated with diabetic ketoacidosis. Rapid deep breaths increase the amount of carbon dioxide exhaled, thus lowering the serum carbon dioxide levels, resulting in some degree of compensation. Overcompensation via respiratory alkalosis to form an alkalemia does not occur. Extreme acidemia leads to neurological and cardia Continue reading >>

Metabolic And Respiratory Acidosis And Alkalosis

Metabolic And Respiratory Acidosis And Alkalosis

There are two main types of pH imbalances in the body: acidosis and alkalosis. An increase in H+ ion levels in the blood causes pH levels to fall resulting in acidosis. A decrease in H+ levels causes pH levels to rise, making the blood more basic, or alkaline. These conditions can be caused by two kinds of disturbances to the buffers that control the body’s pH levels, which alter the acid-base balance. Metabolic and respiratory acidosis and alkalosis are the results of disruptions to the bicarbonate and carbonic acid components of the chemical buffers. Metabolic and respiratory acidosis result when pH levels fall due to an increase in H+ ions or a loss of bases causing the bodily fluids to become slightly acidic. Insufficient bicarbonate levels lower the pH levels of fluids in the digestive tract, resulting in metabolic acidosis. Respiratory acidosis is caused by excessive carbonic acid in the respiratory system, which lowers pH levels through the retention of CO2. Alkalosis is the result of opposite changes to the acid-base balance: excessive bicarbonate levels in the digestive system increases pH as H+ ion concentrations decrease, which causes fluids to become more basic. Insufficient carbonic acid levels are caused by excessive exhalation of CO2, resulting in respiratory alkalosis. Treatment for metabolic and respiratory acidosis and alkalosis varies depending on the underlying cause of the imbalance. Respiratory acidosis caused by hypoventilation can be treated with oxygen therapy and the help of breathing machines to help restore normal oxygen/carbon dioxide exchange, allowing the kidneys time to increase production of bicarbonate and reestablish the acid-base balance of the blood. Respiratory alkalosis caused by hyperventilation can be treated with inhalation of Continue reading >>

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