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Related Concept Videos

Diagnosing Acidosis and Alkalosis01:24

Diagnosing Acidosis and Alkalosis

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Diagnosing acid-base imbalances involves systematically analyzing arterial blood samples, focusing on three key measurements: pH, bicarbonate (HCO3−) concentration, and carbon dioxide partial pressure (PCO2). This analysis follows a four-step process that helps identify the imbalance's underlying cause and nature.
First, the pH level is assessed to determine whether the blood pH is normal (7.35–7.45), low (acidosis), or high (alkalosis).
Next, the PCO2  and...
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Bronsted-Lowry Acids and Bases02:58

Bronsted-Lowry Acids and Bases

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The acid-base reaction class has been studied for quite some time. In 1680, Robert Boyle reported traits of acid solutions that included their ability to dissolve many substances, to change the colors of certain natural dyes, and to lose these traits after coming in contact with alkali (base) solutions. In the eighteenth century, it was recognized that acids have a sour taste, react with limestone to liberate a gaseous substance (now known to be CO2), and interact with alkalis to form neutral...
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Disorders of Acid-Base Balance01:29

Disorders of Acid-Base Balance

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The human body maintains a precise pH range of arterial blood between 7.35 and 7.45. Deviations result in either acidosis (pH < 7.35) or alkalosis (pH > 7.45). These conditions are further classified as respiratory or metabolic disorders based on their underlying cause.
Respiratory Acidosis and Alkalosis
Respiratory acidosis occurs due to an increase in the partial pressure of carbon dioxide PCO2 in the blood. It often arises from shallow breathing or impaired gas exchange caused by...
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Acid-Base Balance01:25

Acid-Base Balance

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The human body maintains a narrow pH range regulated through acid-base balance. This balance is crucial as changes in the hydrogen ion concentration can disrupt cell membrane stability, alter protein structures, and change enzyme activities. The normal pH of arterial blood is 7.4, venous blood and interstitial fluid is 7.35, and intracellular fluid averages 7.0.
When the pH of arterial blood rises above 7.45, it results in a condition called alkalosis. Conversely, a drop below 7.35 leads to...
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Renal Regulation of Acid-Base Balance01:29

Renal Regulation of Acid-Base Balance

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Metabolic reactions in the body produce nonvolatile acids, such as sulfuric acid, which generate an acid load of approximately 1 mEq of H+ per kilogram of body weight daily. Excreting H+ in the urine is essential to balance this acid load.
In the kidneys, cells within the proximal convoluted tubules (PCT) and the collecting ducts secrete hydrogen ions (H+) into the tubular fluid. Specifically, in the PCT, Na+/H+ antiporters secrete H+ while reabsorbing Na+.
However, the intercalated cells in...
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Bicarbonate-Carbonic Acid Buffer01:22

Bicarbonate-Carbonic Acid Buffer

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The carbonic acid-bicarbonate buffer system is critical for maintaining the body's pH balance. It operates on the equilibrium:
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Measurement and Analysis of Extracellular Acid Production to Determine Glycolytic Rate
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Anion-gap metabolic acidemia: case-based analyses.

Julian L Seifter1

  • 1Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. jseifter@bwh.harvard.edu.

European Journal of Clinical Nutrition
|September 3, 2020
PubMed
Summary
This summary is machine-generated.

Anion gap metabolic acidosis occurs when non-chloride acids increase blood acidity. Calculating the serum anion gap helps diagnose complex acid-base disorders and differentiate causes like toxic alcohol ingestions.

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Area of Science:

  • Nephrology
  • Internal Medicine
  • Clinical Chemistry

Background:

  • Metabolic acidosis is not always characterized by elevated chloride levels.
  • Anion gap metabolic acidosis arises from the accumulation of non-chloride organic acids.
  • The serum anion gap calculation is crucial for understanding acid-base balance.

Purpose of the Study:

  • To review the generation of anion-gap metabolic acidosis.
  • To illustrate diagnostic approaches using case discussions.
  • To differentiate between simple and complex acid-base disorders.

Main Methods:

  • Calculation of the serum anion gap: [Na+] - ([Cl-] + [HCO3-]).
  • Analysis of the delta anion gap/delta bicarbonate ratio (ΔAG/ΔHCO3-) to identify superimposed conditions.
  • Comparison of anion gap with osmolar gap to narrow differential diagnoses.

Main Results:

  • A normal anion gap (8-12 mEq/L) is primarily attributed to albumin.
  • A ΔAG/ΔHCO3- ratio of 1 indicates simple anion gap acidosis.
  • Ratios <1 or >1 suggest superimposed non-gap acidosis or metabolic alkalosis, respectively.
  • Anion gap and osmolar gap comparison aids in identifying toxic alcohol ingestions (e.g., methanol, ethylene glycol).

Conclusions:

  • The serum anion gap is a vital tool for diagnosing metabolic acidosis and its underlying causes.
  • Understanding the anion gap aids in managing complex acid-base disturbances.
  • This review emphasizes the clinical utility of the anion gap in patient diagnosis.