| ID | 167 |
|---|---|
| Name | METABOLIC ACIDOSIS |
| Cause | Causes: It occurs as a result of- A. Loss of bases as occurs in sustained diarrhoea, ulcerative colitis, gastrocolic fistula or prolonged intestinal aspiration etc. B. Increase in fixed acids due to formation of ketone bodies as in diabetes or starvation, retention of metabolites in renal insufficiency |
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| Introduction | Metabolic acidosis is characterized by a reduction in plasma bicarbonate and a consequent rise in [H+] with an access of any acid other than H2CO3 |
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| Etiology | |
| Clinical Features | Clinical features: In severe acidosis the leading sign is rapid, deep, noisy respiration. Except in renal acidosis, the pulse rate and B.P. are raised. The urine is strongly acidic. |
| Preventions | |
| Treatment | Treatment: Cases belonging to group- A: 1. Readily rectified by the administration of Ringers lactate solution or slow infusion of diluted sodium bicarbonate solution. 2. When dehydration is in evidence, rapid infusion of sufficient amount isotonic saline solution. Cases belonging to group- B: 1. Treatment of causes, as-Cardiac arrest. Diabetic ketoacidosis. Salicylate poisoing. Renal failure. 2. Bicarbonate deficit can be calculated but total correction’ is usually not necessary. Bicarbonate deficit = (standard serum bicarbonate minus pt. serum bicarbonate) x 30% body wt. in kg. Replace as 8.4%. sodium bicarbonate solution (contains 1 mmol or meq/ml) 3. Bicarbonate deficit should be corrected rapidly (give 50-100 mmol) following cardiac arrest as cardiac arrythmias are difficult to revert in the presence of acidosis. 4. There is little value in correcting acidosis in renal failure and value of correcting acidosis in diabetic ketoacidosis. 5. Correction of acidosis in salicylate poisoning remain doubtfull unless the PH is less than 7.1. |
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