Acid-Base Disorders 2

Metabolic alkalosis; you are alkalotic, you have a high CO2 with retained bicarbonate. The compensation is low ventilation. You decrease your ventilation and you drive up your PCO2. The respiratory alkalosis, the PCO2 is low as you are blowing PCO2 off. The pH is high, the bicarbonate excretion is your compensation, so your CO2 will be low. When you are studying, make sure you have a clear view of this before you go to this. So make sure you understand clearly what the primary problem is, and then look at the compensation and that will help you with your study. Do it in a stepwise fashion. Don’t even bother with the compensations until you are clear what the primary problem is. See the primary problem then look to the compensation.

Okay, now, the next thing you do if you have an acidosis, and in particular is to determine the anion gap. The anion gap is the sodium minus the bicarbonate and chloride. Normally it’s 9-12. An increase in the anion gap over normal represents unmeasured anions and those are usually things like lactate, beta-hydroxybutyrate, that’s the so-called gap acidosis. Where you are dumping acids into the blood. A gap acidosis, those include lactic acidosis, uremia, diabetic ketoacidosis or organic acidemias. Other exogenous acids like salicylate or ethanol. Non-gap acidoses; most are either loss of diarrhea or other base from the body, usually from the GI tract but it can be from other places, or renal tubular acidosis. So gap acidoses are when you are dumping acids into the blood, a pathologic process is dumping acids into the blood. A non-gap acidosis is when you are losing something from somewhere that is usually basic. And that something from somewhere is usually diarrhea and bicarbonate, bicarbonate in the diarrhea.

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