Journal of nephrology
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Journal of nephrology · Mar 2006
ReviewMetabolic acidosis: pathophysiology, diagnosis and management.
Derangements in the intermediate metabolism of nutrients can lead to organic acid acidoses, which in turn can have severe clinical consequences that include even the patient's death. Lactic acidosis and ketoacidosis represent the most relevant clinical forms of this type of metabolic acidosis. Assessment and proper management of the organic acid acidoses require the intervention of a skillful clinician that balances the potential benefits and risks of the prescribed measures to the specific needs of the individual patient. To this aim, knowledge of the pathophysiology, diagnosis, and therapy of the various forms of acidoses including alkali administration, represent essential requirements.
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Metabolic alkalosis is a primary pathophysiologic event characterized by the gain of bicarbonate or the loss of nonvolatile acid from extracellular fluid. The kidney preserves normal acid-base balance by two mechanisms: bicarbonate reclamation mainly in the proximal tubule and bicarbonate generation predominantly in the distal nephron. Bicarbonate reclamation is mediated mainly by a Na-H antiporter and to a smaller extent by the H-ATPase. ⋯ The effects of metabolic alkalosis on the body are varied and include effects on the central nervous system, myocardium, skeletal muscle, and the liver. Treatment of this disorder is simple, once the pathophysiology of the cause is delineated. Therapy consists of reversing the contributory factors promoting alkalosis and in severe cases, administration of carbonic anhydrase inhibitors, acid infusion, and low bicarbonate dialysis.