Metabolic Alkalosis Evaluation
Evaluation of causes of metabolic alkalosis requires a systematic approach involving history, examination and some specific investigations.
Category Acid-base
Metabolic Acidosis
a metabolic acidosis is an abnormal primary process or condition leading to an increase in fixed acids in the blood -> resulting in a fall in arterial plasma bicarbonate
Metabolic Acidosis Evaluation
A metabolic acidosis is a process which, if uncorrected, would lead to an acidaemia. It is usually associated with a low bicarbonate concentration (or total CO2), but an acidosis may be masked by a co-existing metabolic alkalosis.
Lactic Acidosis Evaluation
increased lactate production (including enhanced pyruvate production, reduced pyruvate conversion to CO2 & water or glucose, or preferential conversion of pyruvate to lactate)
Ketoacidosis
Ketoacidosis is a high anion gap metabolic acidosis due to an excessive blood concentration of ketone bodies (keto-anions).
Delta Ratio
Delta Ratio = the increase in Anion Gap / the decrease in HCO3-. if one molecule of metabolic acid (HA) is added to the ECF and dissociates, the one H+ released will react with one molecule of HCO3- to produce CO2 and H2O (buffering).
Base Excess vs Standard Base Excess
Base excess is dose of acid or alkali to return in vitro blood to normal pH (7.40) under standard conditions ( at 37C at a PCO2 of 40 mm Hg). Standard base excess is dose of acid or alkali to return the ECF to normal pH (7.40) under standard conditions ( at 37C at a PCO2 of 40 mm Hg)
Strong Ion Difference
Strong Ion Difference - The quantitative approach to acid-base chemistry is also known as the physicochemical method or the Stewart approach
Pyroglutamic Acidosis
Pyroglutamic acidosis is a rare cause of high anion gap metabolic acidosis (HAGMA). When glutathione levels are low, the activity of γ-glutamyl cyclotransferase is increased, resulting in pyroglutamic acid accumulation in glutathione-depleted states
D-Lactic acidosis
D-Lactic acidosis aka D-lactic encephalopathy. Rare cause of high anion gap metabolic acidosis (HAGMA), typically occurs in patients short bowel syndrome or following jejuno-ileal bypass surgery
ABG changes in Cardiac Arrest and CPR
The degree of acid-base abnormality during cardiac arrest and cardio-pulmonary resuscitation (CPR) is dependent on a number of variables
another bubble of trouble…
the case. 43 year old female is brought into your resuscitation bay by the paramedics. She has a 2 day history of vomiting and diarrhoea on the background of type 2 diabetes and alcohol abuse. Her son is concerned that…