Medmastery: bicarbonate loss and acid overload
Franz Wiesbauer explains how to differentiate between metabolic acidaemia caused by a loss of bicarbonate and that caused by the addition of acid.
Franz Wiesbauer explains how to differentiate between metabolic acidaemia caused by a loss of bicarbonate and that caused by the addition of acid.
Franz Wiesbauer explains the relationship between pH, HCO3 and pCO2 and a simple rule which will help you decide whether the primary problem is respiratory or metabolic in nature.
Metabolic acidosis DDx
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'.
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
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.
Fulminant hepatic failure is defined as the appearance of hepatic encephalopathy in a patient with acute deterioration of liver function with no previous history of liver disease.
the case. a 43 year old male presents to your ED with a three day history of severe epigastric pain and recurrent vomiting. He has now become increasingly breathless and is complaining of severe retrosternal chest pain.
the case. a 29-year old female with a past history of anorexia nervosa, polycystic ovarian syndrome, chronic back pain and analgesic abuse presents to the Emergency Department. She describes 3 days of bilateral ankle and facial swelling. She tells you…