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)

Coping with Asthma

Coping with Asthma

If you suffer with asthma, you will no doubt be familiar with the uncomfortable sensations as your bronchial tubes begin to narrow and your muscles around them start to tighten. A sticky mucus known as phlegm begins to produce and increase within your bronchial tubes and you begin to wheeze, cough and struggle to breathe.

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