Metabolic Acidosis Due to accumulation of any acid other than carbonic acids with a primary decrease in plasma HCO3Several

ral disorders can lead to metabolic acidosis: administration of acid, acid generation, impaired excretion of acid at the kidney or bicarbonate loss at the kidney or GI tract Calculating the anion gap can help with diagnosis

Anion gap Normal cations: Na+, K+, Ca2+ & Mg2+ Normal anions: Cl-, HCO3-, there are negative charges on albumin, phosphate, sulphate and organic acids Anion gap = (Na+ + K+) (HCO3- -Cl-)....because there are more unmeasured anions than cations the usual anion gap is 10-80mmol/L Metabolic acidosis and normal anion gap= HCl is being retained or HCO3- is being lost o Diarrhoea o Decreased renal secretion of H+ o Increased renal HCO3- loss o Increased HCl production Metabolic acidosis with high anion gap: o Lactic acidosis o Ketoacidosis o Uraemic acidosis

Lactic Acidosis When cellular respiration is abnormal either due to lack of oxygen or cellular abnormality. The most common is lack of oxygen occurring in septic or cardiogenic shock. Acidosis worsens cardiac function and increases vasoconstriction further

Kidney disease Can cause acidosis in several ways: o Low number of nephrons decreases ability to excrete ammonia and H+, tubular disease can cause excessive HCO3- loss o Chronic acidosis is commonly caused by kidney failure-where there is failure to excrete fixed acids. Calcium carbonate improves acidosis, acts as a phosphate binder and calcium supplement

Mixed metabolic acidosis For example gastroenteritis causing normal gap acidosis due to diarrhoea but anion gap is often increased by renal failure and lactic acidosis caused by hypovolaemia

Metabolic Alkalosis

Common. of acid-base disorders in patients Causes: o Chloride depletion: gastric losses, chlorvetic diuretics, diarrohea & CF o Potassium depletion: primary aldosteronism, mineralcorticoid excess, laxative abuse o Hypercalaemic states Most commonly chloride depletion, chloride can be lost from the gut, kidneys and skin

Respiratory Acidosis Retention of CO2. PaCO2 and [H+] are raised. A chronically raised PaCO2 is accompanied by renal retention of HCO3-. A primary respiratory acidosis with metabolic compensationventilator failure (COPD)

Respiratory Alkalosis Fall in PaCO2 and [H+]- often produced when patients are mechanically ventilated, spontaneous hyperventilation or patients living at altitude

Check pH Acidosis <7.35 pH Alkalosis 7.45pH

Check CO2

Check CO2

Normal
Acute metabolic acidosis

Increased Respiratory acidosis: hypoventilation

Increased Metabolic alkalosis: HCO3- elevated Vomiting/ loss of gastric juice

Decreased Resp alkalosis: hyperventilatio n

Check anion gap (10-18mmol/L)

Check HCO3(22-26)

Normal Loss of HCO3-or generation of HCL Diarrhoea

Increased Generation or retention of organic acids Lactic acidosis Metabolic acidosis & normal anion gap: Ketoacidosis Chronic renal failure

Normal Acute respiratory alkalosis: Fever or panic attack

Decreased Chronic resp alkalosis: Anaemia or CNS damage

Renal tubular necrosis Addisons disease Diarrhoea Pancreatic fistula

Metabolic acidosis & high anion gap Lactic acid: shock, infection & hypoxia Ketones Renal failure

Metabolic Alkalosis Vomiting Diuretics Burns Base ingestion

Respiratory acidosis Any lung, neurovascular or physical cause of respiratory failure

Respiratory Alkalosis Hyperventilation: ventilated patients, fever and panic attacks