Metabolic Acidosis/Alkalosis
peptic ulcers
excess of alkali in ECF occurs when a patient takes excessive amounts of acid neutralizers such as NaHCO3 to ease pain. What is this cause of metabolic acidosis?
can cause cellular catabolism and acid accumulation
how does excessive exercise, fever and severe infection cause metabolic acidosis?
can cause cellular breakdown due to sever increase in metabolism, which increases cellular needs.
how does hyperthyroidism cause metabolic acidosis?
kidney mechanisms for conserving sodium and water and for excreting H+ fail.
How does renal abnormalities (failure) cause metabolic acidosis?
diabetic ketoacidosis, lactic acidosis, poisoning and renal failure.
conditions associated with an anion gap that is greater than 16 mmHg.
metabolic acidosis with high ion gap
due to excess acid rather than a lack of bicarbonate. Possible causes are ketoacidosis, lactic acidosis, ingestion of toxins such as methanol ethylene glycol, or aspirin and uremic acidosis( renal failure)
diabetic ketoacidosis
failure to metabolize adequate quantities of glucose causes the liver to increase metabolism of fatty acids. Oxidation of fatty acids produces ketone bodies, which cause the ECF to become more acid. Ketones require base for excretion. What is this form of metabolic acidosis?
loss of bicarbonate ions in the small intestines is in excess. Also the loss of sodium ions exceeds Cl-. There for HCl of formed
how does chronic diarrhea cause metabolic acidosis?
loss of potassium from the body os accompanied by loss of chloride.
how does hypokalemia cause metabolic alkalosis?
lactic pyretic and other acids accumulate as the result of cellular breakdown.
how does starvation and malnutrition cause metabolic acidosis?
causes cellular breakdown and the release of acid
how does trauma and shock cause metabolic acidosis?
large amounts of chloride and hydrogen ions are lost. bicarbonate ions increase to compensate for chloride loss
how does vomiting and gastric suction cause metabolic alkalosis?
a decrease in bicarbonate concentration or acid excess.
how is metabolic acidosis characterized?
there is an increase in bicarbonate concentration or a loss of hydrogen ion in the ECF.
how is metabolic alkalosis characterized?
metabolic acidosis
pt presents with the following what does she have? CNS:restlessness, apathy, weakness, disorientation, stupor and coma resp: Kussmaul breathing, deep rapid, vigorous breath. Skin: flushing and warm skin Cardiac: cardiac dysrhythmia's, decreased HR and cardiac output. GI: nausea vomiting and abdominal pain Lab values: pH <7.35 HCO3 <24 BE <-2 serum CO2 <22
metabolic alkalosis
pt. presents with the following, what does she have? CNS: irritability, confusion, tetany-like symptoms, hyperactive reflexes resp: shallow breathing GI: vomiting with loss of chloride and potassium Labs: pH >7.45 HCO3 28 mEq/L BE: >+2 serum CO2 >32 mEq/L
anion gap
this is a useful indicator for determining the cause of metabolic acidosis. It can be normal (12-20 mEq/L) or high (>20 mEq/L
metabolic acidosis with normal ion gap
typically due to a loss of bicarbonate due to diarrhea or GI fistula or to renal causes such as carbonic anhydrase inhibitors or renal tubular acidosis. what is present?
over use of acid neutralizers
why would anion gap be less than 16 mmHg?
