Genetic Considerations

A number of inherited disorders can result in acid-base imbalances. Bartter's syndrome (a group of several disorders of impaired salt reabsorption in the thick ascending loop of Henle) results in metabolic alkalosis along with hypokalemia, and hyperaldosteronism. Bartter's syndrome is transmitted in an autosomal recessive pattern. Metabolic acidosis is often seen with inborn errors of metabolism such as Gaucher disease (autosomal recessive transmission).


Metabolic acidosis occurs primarily in patients with insulin-dependent diabetes mellitus (IDDM) and chronic renal failure, regardless of age. Metabolic acidosis from severe diarrhea can occur at any age, but children and the elderly are at greater risk because of associated fluid imbalances. Young women are at an increased risk of metabolic acidosis because of the popular fad diets of starvation. Ethnicity and race have no known effects on the risk for acid-base imbalance.

Metabolic alkalosis is a common disorder of adult hospitalized patients. Elderly patients are at risk for metabolic alkalosis because of their delicate fluid and electrolyte status. Young women who practice self-induced vomiting to lose weight are also at risk for developing metabolic alka-losis. Finally, middle-aged men and women with chronic hypercapnia respiratory failure are at risk for metabolic alkalosis if their PaCO2 levels are rapidly decreased with mechanical ventilation, corticosteroids, or antacids.

Patients of all ages are at risk for acute respiratory acidosis when an injury or illness results in alveolar hypoventilation. The elderly are at high risk for electrolyte and fluid imbalances, which can lead to respiratory depression. Patients with chronic obstructive pulmonary disease (COPD) are at highest risk for chronic respiratory acidosis. The typical COPD patient is a middle-aged man with a history of smoking. Older children and adults are at risk for respiratory alkalosis with large-dose salicylate ingestion. The elderly are at an increased risk for respiratory alkalosis because of the high incidence of pulmonary disorders, specifically pneumonia, in the elderly population. Identification of a respiratory alkalosis may be more difficult in the older patient because the early symptoms of increased respirations and altered neurological status may be attributed to other disease processes.

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