Acid-base Disorders And Their Treatment

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ISBN: 9780824759155 | 082475915X
Cover: Hardcover
Copyright: 8/9/2005

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With detailed contributions and research from experts in the physiology of normal acid-base homeostasis and the management of acid-base disorders, this reference supplies an abundance of information on acid-base physiology, disorders of acid-base equilibrium, and the management and treatment of these disorders in clinical practice. A unique and timely source, this guide provides a large number of tables, references, and figures to illustrate the relationship between the underlying physiology and diagnosis of acid-base disorders.

Foreword

iii

Jordan J. Cohen

John T. Harrington

Jerome P. Kassirer

Preface

Contributors

xvii

SECTION I

Acid-Base Chemistry and Buffering

(24)

F. John Gennari

John H. Galla

Introduction

(5)

Buffering

(11)

The Role of Strong Ions

(3)

Conclusion

(1)

References

(4)

Intracellular Acid-Base Homeostasis

(22)

F. John Gennari

Introduction

(1)

Assessment of Intracellular pH

(2)

Nonequilibrium Distribution of H+

(1)

Regulation of Cell pH

(6)

Cell Buffer Properties

(1)

Effect of Changes in ECF pH on Cell pH

(1)

Cell PCO2 and [HCO3]

(1)

pH in Intracellular Organelles

(4)

Summary

(1)

References

(6)

Determinants of Carbon Dioxide Tension

(32)

Shahrokh Javaheri

Introduction

(1)

Why Is PaCO2 40 mmHg in Man?

(1)

The Imidazole α-Stat Hypothesis

(1)

Quantitative Components of Ventilation

(4)

Pathophysiology of Alterations in PaCO2

(1)

Normal Control of Breathing

(8)

Overview of Mechanisms Causing Changes in PaCO2

(2)

Changes in PaCO2 in Metabolic Acid--Base Disturbances

(3)

Changes in PaCO2 in Cardiopulmonary Disorders

(3)

Hypercapnia in Neuromuscular Disorders

(1)

Obesity--Hypoventilation Syndrome

(2)

Summary

(1)

References

(6)

Renal Regulation of Hydrogen Ion Balance

(40)

L. Lee Hamm

Introduction and Overview

(1)

Carbonic Anhydrase

(1)

Bicarbonate Reabsorption

(17)

Ammonium Excretion

(3)

References

101

(18)

Molecular Biology of Renal Acid-Base Transporters

119

(58)

Orson W. Moe

Michel Baum

Robert J. Alpern

Introduction

119

(1)

Acid-Base Transporters in Renal Epithelia: Overview

120

(29)

Other Acid-Base Transporters

149

(4)

Concluding Remarks

153

(1)

References

153

(24)

Regulation of Acid-Base Balance: Overview

177

(32)

F. John Gennari

Introduction

177

(1)

Body Buffers

178

(3)

Acid Balance

181

(5)

Renal HCO3 Reabsorption and Acid Excretion

186

(2)

Factors Influencing HCO3 Reabsorption and Acid Excretion

188

(13)

References

201

(8)

Gastrointestinal Influences on Hydrogen Ion Balance

209

(32)

Alan N. Charney

Mark Donowitz

Introduction

209

(1)

The Intestine Is Not a Kidney

210

(1)

Bioavailability of Oral Intake

211

(2)

Importance of Diet

213

(3)

Intestinal Transit Time

216

(2)

Cellular Transport Pathways of H+ and HCO-3

218

(6)

Gastrointestinal Causes of Acid/Base Disorders

224

(7)

Role in Therapeutics

231

(3)

Concluding Comments

234

(1)

References

234

(7)

An Evolutionary Perspective on the Acid-Base Effects of Diet

241

(52)

Anthony Sebastian

Lynda A. Frassetto

Renee L. Merriam

Deborah E. Sellmeyer

R. Curtis Morris, Jr.

Introduction

241

(2)

Definitions of Metabolic Acidosis and Alkalosis

243

(1)

Determinants of the Set-Point at which Blood Acidity and Plasma [HCO-3] Regulate in ``Normal'' Subjects

244

(7)

Acidosis vs. Acid Retention

251

(4)

Pathophysiological Consequences of Diet-Induced, Age-Amplified Metabolic Acidosis in Humans

255

(15)

Diet-Induced Potassium-Replete Chloride-Sufficient Chronic Low-Grade Metabolic Alkalosis as the Naturally Selected Optimal Systemic Acid-Base State of Humans

270

(8)

Summary and Implications for Further Research

278

(2)

References

280

(13)

SECTION II

Metabolic Acidosis: General Considerations

293

(20)

Michael Emmett

Introduction

293

(1)

Secondary Respiratory Response to Metabolic Acidosis

293

(3)

Plasma Electrolyte Profile and Differential Diagnosis

296

(1)

Use of Anion Gap in Metabolic Acidosis

296

(4)

Plasma Potassium Concentration in Metabolic Acidosis

300

(2)

Clinical Manifestations of Metabolic Acidosis

302

(4)

Effects of Metabolic Acidosis on the Kidney

306

(2)

Summary

308

(1)

References

309

(4)

Diabetic and Other Forms of Ketoacidosis

313

(38)

Horacio J. Adrogue

Nicolaos E. Madias

Introduction

313

(1)

Pathophysiology--General Considerations

313

(1)

Diabetic Ketoacidosis

314

(22)

Nonketotic Hyperglycemia

336

(5)

Starvation Ketosis

341

(1)

Alcoholic Ketoacidosis

342

(2)

References

344

(7)

Lactic Acidosis

351

(32)

Virginia L. Hood

Introduction

351

(1)

Physiology and Pathophysiology

351

(6)

Metabolic Consequences of Lactic Acid Accumulation

357

(1)

Clinical Manifestations

358

(1)

Diagnosis

359

(1)

Etiology

360

(9)

Clinical Course

369

(1)

Treatment

369

(6)

References

375

(8)

Toxin-Induced Metabolic Acidosis

383

(34)

Man S. Oh

Mitchell L. Halperin

Introduction

383

(1)

Major Toxins

384

(18)

Toxins Leading to the Production of Lactic Acid

402

(2)

Uncommon Toxins

404

(3)

References

407

(10)

Renal Tubular Acidosis

417

(52)

K. M. L. S. T. Moorthi

Daniel Batlle

Introduction

417

(1)

Proximal Renal Tubular Acidosis

418

(8)

Distal Renal Tubular Acidosis (Distal RTA)

426

(13)

Distal Renal Tubular Acidosis with Hyperkalemia

439

(8)

Diagnostic Evaluation of Distal RTA

447

(6)

Therapy of Distal RTA

453

(1)

References

454

(15)

Metabolic Acidosis in Chronic Renal Insufficiency

469

(18)

F. John Gennari

Introduction

469

(1)

Normal Regulation of Acid-Base Homeostasis

469

(2)

Pathophysiology of Metabolic Acidosis in Renal Insufficiency

471

(3)

Summary of Pathophysiology

474

(1)

Acid Balance in Chronic Renal Insufficiency

474

(3)

Clinical Characteristics of Renal Insufficiency--Associated Metabolic Acidosis

477

(2)

Deleterious Effects of Metabolic Acidosis

479

(1)

Diagnosis and Management

480

(2)

Summary

482

(1)

References

482

(5)

SECTION III

Hyperchloremic Metabolic Acidosis Due to Intestinal Losses and Other Nonrenal Causes

487

(14)

Donald E. Wesson

Melvin Laski

Introduction

487

(1)

Diagnosis

488

(1)

Pathophysiology of Metabolic Acidosis in Diarrhea

489

(4)

Management of HCMA Due to Diarrhea

493

(1)

Pancreatic and Biliary Losses

494

(1)

Villous Adenoma

495

(1)

Strong Acid Ingestion or Administration

495

(1)

Parenteral Nutrition

496

(1)

References

497

(4)

Metabolic Alkalosis: General Considerations

501

(18)

Robert G. Luke

Introduction

501

(1)

Definitions

501

(1)

Respiratory Adaptation

502

(1)

Classification

503

(1)

Pathophysiology

504

(3)

Clinical Features

507

(3)

Diagnosis

510

(4)

Prevalence and Outcome

514

(1)

References

514

(5)

Chloride-Depletion Alkalosis

519

(34)

John H. Galla

Definitions

519

(1)

Classification

519

(1)

Generation

520

(4)

Posthypercapnia

524

(2)

Maintenance

526

(11)

Management

537

(4)

References

541

(12)

Potassium-Depletion Metabolic Alkalosis

553

(32)

Manoocher Soleimani

Definition

553

(1)

Classification

553

(1)

Clinical Presentation

554

(1)

Pathophysiology

555

(5)

Effect of K+ Depletion and Hypokalemia on Bicarbonate Reabsorption in Nephron Segments

560

(7)

Specific Causes

567

(4)

Diagnosis

571

(1)

Management

572

(2)

References

574

(11)

Metabolic Alkalosis: Miscellaneous Causes

585

(12)

John H. Galla

Robert G. Luke

Introduction

585

(1)

Hypercalcemic Disorders

585

(3)

Milk-Alkali Syndrome

588

(3)

Other Disorders

591

(1)

References

592

(5)

SECTION IV

Respiratory Acidosis

597

(44)

Horacio J. Adrogue

Nicolaos E. Madias

Introduction and Definitions

597

(1)

Pathophysiology

597

(8)

Secondary Physiologic Adjustments

605

(10)

Clinical Manifestations of Respiratory Acidosis

615

(3)

Causes of Respiratory Acidosis

618

(2)

Diagnosis

620

(1)

Treatment

621

(8)

References

629

(12)

Respiratory Alkalosis

641

(40)

Reto Krapf

Henry N. Hulter

Introduction and Definitions

641

(1)

Pathophysiology of Respiratory Alkalosis

642

(8)

Effects of Hypocapnia on Extracellular Volume and Electrolyte Balance

650

(4)

Systemic and Clinical Consequences of Respiratory Alkalosis

654

(5)

Causes of Acute and Chronic Respiratory Alkalosis

659

(9)

Diagnosis

668

(1)

Treatment

669

(1)

References

669

(12)

Mixed Acid--Base Disorders

681

(16)

Asghar Rastegar

Introduction

681

(1)

Approach to the Patient with a Mixed Acid--Base Disorder

682

(1)

Tools for Diagnosing Mixed Acid-Base Disorders

683

(2)

Classification of Mixed Acid-Base Disorders

685

(2)

Examples of Mixed Disorders: Diagnosis and Management

687

(8)

References

695

(2)

SECTION V

Effect of Renal Replacement Therapy on Acid--Base Homeostasis

697

(20)

F. John Gennari

Introduction

697

(1)

Nature of the Acid-Base Equilibrium Engendered by Renal Replacement Therapy

698

(13)

Summary

711

(1)

References

712

(5)

Acid-Base Disorders in Dialysis Patients

717

(14)

F. John Gennari

Introduction

717

(1)

Identifying an Acid-Base Disorder

717

(2)

Diagnosis of Specific Disorders

719

(1)

Evaluation of the Secondary Response

720

(1)

Causes and Management

720

(7)

Mixed Acid-Base Disorders

727

(1)

Summary

728

(1)

References

729

(2)

SECTION VI

Acid-Base Considerations in Infants and Children

731

(44)

George J. Schwartz

Introduction

731

(1)

Maturation of Acid-Base Homeostasis

732

(1)

Overview of Acid-Base Handling by the Neonatal Kidney

733

(3)

Sites of Acid-Base Transport Along the Developing Nephron

736

(8)

Specific Acid-Base Problems of Infants and Children

744

(21)

References

765

(10)

SECTION VII

Measurement of Acid-Base Status

775

(14)

Horacio J. Adrogue

Nicolaos E. Madias

Introduction

775

(1)

Blood Gas Analyzers

775

(12)

References

787

(2)

Normal Acid-Base Values

789

(12)

Horacio J. Adrogue

Nicolaos E. Madias

Introduction

789

(1)

Scales of Acidity: pH vs. Hydrogen Ion Concentration

789

(3)

The Range of Normal Values

792

(6)

References

798

(3)

Tools for Clinical Assessment

801

(16)

Horacio J. Adrogue

Nicolaos E. Madias

Introduction

801

(1)

Definition of Terms

801

(1)

Simple Acid-Base Disorders

802

(1)

Secondary Responses

803

(1)

Mixed Acid-Base Disorders

803

(1)

Systematic Approach to Acid-Base Diagnosis

804

(1)

Assessment of the Accuracy of the Acid-Base Measurements and the Reliability of Blood Sampling

805

(1)

Role of Clinical Information to Identify the Acid-Base Disorder

806

(2)

Identification of the Primary or Dominant Acid-Base Disorder

808

(1)

Assess the Expected Secondary Response to Determine Whether a Simple or Mixed Acid--Base Disorder is Present

808

(1)

Establish the Cause of the Acid-Base Disorder by Evaluating Other Laboratory Parameters

809

(4)

Measurement of Urine Electrolytes, pH, and Calculation of Urine Anion Gap

813

(2)

References

815

(2)

Illustrative Cases

817

(32)

F. John Gennari

John H. Galla

Horacio J. Adrogue

Nicolaos E. Madias

Introduction

817

(1)

Case 1

817

(3)

Case 2

820

(1)

Case 3

821

(2)

Case 4

823

(3)

Case 5

826

(2)

Case 6

828

(2)

Case 7

830

(1)

Case 8

831

(2)

Case 9

833

(2)

Case 10

835

(2)

Case 11

837

(2)

Case 12

839

(1)

Case 13

840

(2)

Case 14

842

(1)

Case 15

843

(2)

Case 16

845

(2)

Case 17

847

(2)

Index

849

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Acid-base Disorders And Their Treatment

Summary

Table of Contents

Supplemental Materials