Acidbase Disorder Common Causes

Metabolic acidosis Decreased acid excretion: chronic renal disease results in decreased acid excretion and is the most common cause of chronic metabolic acidosis Excessive acid production: oxygen tissue deprivation with shock and cardiopulmonary arrest, vigorous exercise (transient), prolonged periods of fever, ketoacidosis in insulin-dependent diabetics, alcoholic ketoacidosis, and ingestion of drugs and chemicals (methanol, ethylene glycol, aspirin)

Underproduction of bicarbonate: pancreatitis

Excessive loss of bicarbonate: severe diarrhea; intestinal obstruction; small bowel, pancreatic, ileostomy, or biliary fistula drainage Hyperchloremic acidosis, an increase in the extracellular concentration of chloride, also promotes bicarbonate loss

Metabolic alkalosis Most common: vomiting and nasogastric suctioning.

Other: ingestion of bicarbonates, carbonates, acetates, citrates, and lactates found in total parenteral nutrition solutions, Ringer's lactate, and sodium bicarbonate administration; rapid administration of stored blood and volume expanders with high citrate and acetate levels; excessive intake of antacids, which are composed of sodium bicarbonate or calcium carbonate; loss of acids (gastric fluid loss, diuretic therapy, excessive mineralocorticoid release); hypercalcemia; diuretic therapy; aldo-sterone excess.

Respiratory acidosis Depression of respiratory center in the medulla: head injury, drug ingestion

(anesthetics, opiates, barbiturates, ethanol) Decreased amount of functioning lung tissue: bronchial asthma, chronic bronchitis, emphysema, pneumonia, hemothorax, pneumothorax, pulmonary edema

Airway obstruction: foreign body aspiration, sleep apnea, bronchospasm, laryngospasm

Disorders of chest wall: flail chest, impaired diaphragm movement (pain, splinting, chest burns, tight chest or abdominal dressings) Abdominal distension: obesity, ascites, bowel obstruction Disorders of respiratory muscles: severe hypokalemia, Amyotrophic lateral sclerosis, Guillain-Barré syndrome, poliomyelitis, myasthenia gravis, drugs (curare, succinylcholine)

Respiratory alkalosis Hyperventilation due to hypoxemia (a decrease in the oxygen content of blood): anemia; hypotension; high altitudes; and pulmonary disease, such as pneumonia, interstitial lung disease, pulmonary vascular disease, and acute asthma Direct stimulation of the central respiratory center: anxiety, pain, fever, sepsis, salicylate ingestion, head trauma, central nervous system (CNS) disease (inflammation, lesions)

• TABLE 4 Common Causes of Acid-Base Disorders (continued)

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