10 Questions
What is the primary abnormality in non-respiratory acidosis?
Either increased production or decreased excretion of hydrogen ions
Which of the following is a cause of non-respiratory acidosis due to increased H+ formation?
Ketoacidosis
What is the term used to describe the clinical state of having a high hydrogen ion concentration in the blood?
Acidemia
Which of the following is NOT a cause of non-respiratory acidosis?
Respiratory alkalosis
What happens to bicarbonate concentration in non-respiratory acidosis?
It decreases
Which of the following is a cause of non-respiratory acidosis due to loss of bicarbonate?
Diarrhea
Which of the following is a cause of non-respiratory acidosis due to decreased H+ excretion?
Renal tubular acidosis
What is the term used to describe the clinical state of having a low hydrogen ion concentration in the blood?
Alkalemia
What is the primary disorder in non-respiratory acidosis?
Decreased bicarbonate concentration
Which of the following is NOT a cause of non-respiratory acidosis due to increased H+ formation?
Renal tubular acidosis
Study Notes
Non-Respiratory Acidosis
- Characterized by high [H+], low pH, low PCO2, and low [HCO3]
- Compensation occurs through hyperventilation, which increases removal of carbon dioxide and lowers PCO2
- Hyperventilation is a direct result of increased [H+] stimulating the respiratory center
- Respiratory compensation cannot completely normalize [H+] since it is the high concentration itself that stimulates compensatory hyperventilation
Clinical Effects of Acidosis
- Compensatory response is hyperventilation, leading to Kussmaul breathing
- Increased [H+] leads to increased neuromuscular irritability, risking arrhythmias and cardiac arrest, especially with hyperkalaemia
- Depression of consciousness can progress to coma and death
Metabolic Alkalosis (Non-Respiratory Alkalosis)
- Characterized by primary increase in ECF bicarbonate concentration and reduction in [H+]
- Normally, an increase in plasma bicarbonate concentration leads to incomplete renal tubular bicarbonate reabsorption and excretion of bicarbonate in the urine
- However, in non-respiratory alkalosis, high renal bicarbonate reabsorption occurs due to factors such as:
- Decrease in ECF volume
- Mineralocorticoid excess
- Potassium depletion
- Massive quantities of bicarbonate must be ingested to produce a sustained alkalosis
Causes of Metabolic Alkalosis
- Loss of hydrogen ion in gastric fluid during vomiting
- Ingestion of absorbable alkali as sodium bicarbonate
- Severe potassium depletion
- Consequences of diuretic therapy, leading to 'paradoxical' acid urine
Clinical Effects of Alkalosis
- Hypoventilation, confusion, and eventually coma
- Muscle cramps, tetany, and paraesthesia due to decrease in unbound plasma calcium concentration
Correction of Non-Respiratory Alkalosis
- Reversal of both primary cause and mechanism for its maintenance is required
Disorders of Hydrogen Ion Homeostasis
- Acidosis and alkalosis define primary acid-base disturbance, even when [H+] is within the normal range
- Definitions:
- Non-respiratory (Metabolic) acidosis: Decrease in bicarbonate concentration
- Non-respiratory (Metabolic) alkalosis: Increase in bicarbonate concentration
- Respiratory acidosis: Increase in PCO2
- Respiratory alkalosis: Decrease in PCO2
- Primary mixed acid-base disorders: Disorders of combined respiratory and non-respiratory origin
- 'Acidemia' and 'alkalaemia' refer to whether [H+] in blood is higher or lower than normal
This quiz covers the characteristics of non-respiratory acidosis, including biochemical changes and compensation mechanisms, as well as pancreatic, intestinal, and biliary fistulae and drainage.
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