Normal Anion Gap Metabolic Acidosis (NAGMA). HCO3 loss and replaced with Cl- -> anion gap normal. if hyponatraemia is present the plasma [Cl-] may be normal despite the presence of a normal anion gap acidosis -> this could be considered a 'relative hyperchloraemia'.
Metformin use is associated with lactic acidosis, but it remains controversial as a disease entity
Metabolic alkalosis is a a primary acid-base disorder that causes the plasma bicarbonate to rise to an abnormally high level. the severity of a metabolic alkalosis is determined by the difference between the actual [HCO3] and the expected [HCO3]
Evaluation of causes of metabolic alkalosis requires a systematic approach involving history, examination and some specific investigations.
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.
increased lactate production (including enhanced pyruvate production, reduced pyruvate conversion to CO2 & water or glucose, or preferential conversion of pyruvate to lactate)
Ketoacidosis is a high anion gap metabolic acidosis due to an excessive blood concentration of ketone bodies (keto-anions).
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 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 - The quantitative approach to acid-base chemistry is also known as the physicochemical method or the Stewart approach