Acid–Base Balance Disorders

Abstract

Abnormalities in maintaining the pH of the blood in a range that is incompatible with sustaining metabolic processes are known as acid–base balance disorders. Here, we define normal acid–base balance and describe the four basic acid–base balance disorders including metabolic acidosis, metabolic alkalosis, respiratory acidosis and respiratory alkalosis that occur. We suggest a diagnostic approach in defining the disorders and a differential diagnosis to their causes. Routine management of these disorders is also discussed.

Key Concepts:

  • Normal Physiologic function depends on the maintenance of a systemic arterial pH between 7.35 and 7.45.

  • The coordination of renal and respiratory regulatory mechanisms is responsible for maintaining physiologic pH.

  • The use of simple equations can differentiate between different acid–base disorders.

  • The causes of metabolic acidosis can be divided among those that lead to a high anion gap and those that present with a normal anion gap.

  • An approach to differentiating the causes of metabolic alkalosis is based on assessing volume status.

  • Respiratory acidosis develops in the setting of hypoventilation.

  • Respiratory alkalosis occurs when carbon dioxide output in the lungs exceeds its metabolic production in the tissues.

  • The ultimate treatment of acid–base disorders is focused on identifying and managing their underlying cause.

Keywords: acidosis; alkalosis; metabolic disorders; respiratory disorders

References

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Further Reading

DuBose TD Jr (2008) Disorders of acid‐base balance. In: Brenner BM (ed.) The Kidney, 8th edn, pp. 505–546. Philadelphia: Saunders.

DuBose TD Jr (2009) Metabolic alkalosis. In: Greenberg A (ed.) Primer on Kidney Diseases, 5th edn, pp. 84–90. Philadelphia: Saunders.

DuBose TD Jr and Alpern RJ (2000) Renal tubular acidosis. In: Schriver CR, Beaudet AL, Sly WS et al. (eds) The Metabolic Basis of Inherited Disease, 8th edn, pp. 4983–5021. New York: McGraw‐Hill.

Kraut JA and Kurtz I (2008) Toxic alcohol ingestions: clinical features, diagnosis, and management. Clinical Journal of the American Society of Nephrology 3(1): 208–225.

Kurtz I, Kraut J, Ornekian V and Nguyen MK (2008) Acid‐base analysis: a critique of the Stewart and bicarbonate‐centered approaches. American Journal of Physiology. Renal Physiology 294: F1009–F1031.

Simon DB, Karet FE, Rodriguez‐Soriano J et al. (1996) Genetic heterogeneity of Bartter's syndrome revealed by mutations in the K+ channel, ROMK. Nature Genetics 14(2): 152–156.

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How to Cite close
Hawfield, Amret T, and DuBose, Thomas D(Sep 2010) Acid–Base Balance Disorders. In: eLS. John Wiley & Sons Ltd, Chichester. http://www.els.net [doi: 10.1002/9780470015902.a0002250.pub2]