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Concept Map Essay

1755 words - 8 pages

ACID-BASE DISORDERS MADE SO EASY
EVEN A CAVEMAN CAN DO IT
Lorraine R Franzi, MS/HSM, RD, LDN, CNSD
Nutrition Support Specialist
University of Pittsburgh Medical Center
Pittsburgh, PA
I.
LEARNING OBJECTIVES
The clinician after participating in the roundtable will be able to:
1) Indicate whether the pH level indicates acidosis or alkalosis.
2) State whether the cause of the pH imbalance is respiratory or metabolic.
3) Identify if there is any compensation for the acid-base imbalance.
II. INTRODUCTION
Acid-Base balance is an intricate concept which requires an intimate and detailed knowledge of
the body’s metabolic pathways used to eliminate the H+ ion. Clinicians may find it ...view middle of the document...

Lorraine R Franzi, MS/HSM, RD, CNSD, LDN
University of Pittsburgh Medical Center
Page Two
TABLE 1. ACID-BASE DISORDER ETIOLOGIES
METABOLIC ACIDOSIS

METABOLIC ALKALOSIS

Excess Production of Organic Acids
1)
Ketoacidosis
a. Uncontrolled Diabetes Mellitus
b. Alcoholic
c. Starvation
d. Reduced CHO Intake
e. Violent Convulsions
f. Extreme and/or Prolonged Exercise
g. Prolonged Exposure to Severe Cold
2)
Lactic acidosis
a. Severe Hypoxemia
b. Underutilization of Lactic Acid
Excessive Ingestion of Exogenous Toxins
1)
Aspirin
2)
Methanol Alcohol
3)
Ethylene Glycol Antifreeze
4)
toluene
Excess Loss of HCO31)
Diarrhea
2)
Intestinal or Biliary Intubation
3)
Addison's Disease
4)
Pancreatic, Biliary or Intestinal Fistula
Retention of Organic Acis
Renal Insufficiency of Any Cause
Carbonic Anyhydrase Inhibitors
1)
Diuretics
2)
Azides, Sulfides, Cyanide Acetazolamide
Hyperchloremic Acidosis (Normal Anion Gap)
High Anion Gap Acidosis (Normal Cl- Level)

HCl Loss
1)
Stomach
a. Vomiting
b. Nasogastric Suctioning
2)
Intestinal Fistulae
Excessive Administration of HCO3(or Prescursors: Lactate, Acetate, Citrate)
1)
Oral
2)
PN with Excessive Acetate
3)
Bicarbonate Therapy in Metabolic Acidosis
4)
Ringer's Lactate or Citrated Blood
5)
Milk-Alkali Syndrome
Hypokalemia
Rapid Contraction of Extracellular Volume
(Hypovolemia)
1)
Loop Diuretics (Furosemide)
2)
Thiazide Diuretics (Hydrochlorothiazide)
3)
Dehydration
Increased Renal Excretion of Acid
1)
Diuretic Therapy
2)
Exogenous Mineralocorticoids
3)
Hyperaldosteronism
4)
K+ Depletion
5)
High pCO2
6)
Secondary Hypoparathyroidism

RESPIRATORY ACIDOSIS

RESPIRATORY ALKALOSIS

Airway Obstruction
1)
Emesis with Aspiration
2)
Bronchospasm
3)
Larygngospasm
4)
COPD
Respiratory Center Depression
1)
General Anesthesia
2)
Sedative or Narcotic Overdose
3)
head Injury
4)
Obesity (Pickwickian Syndrome)
5)
Brain Tumor
Circulatory Collapse
1)
Cardiac Arrest
2)
Pulmonary Edema
Neurogenic Causes
1)
Cervical Spine Injury
2)
Guillain-Barre Syndrome
3)
Myasthenic Crisis
4)
Drugs (Paralytic Agents, Organophosphates)
5)
Multiple Sclerosis
6)
Muscular Dystrophy
7)
Amyotrophic Lateral Scleosis
8)
Myxedema
9)
Post-traumatic Diaphragmatic Paralysis
10)
Phrenic Nerve Injury
Restrictive Effects
1)
Hemothroax/Pneumothorax
2)
ARDS
3)
Hydrothorax
4)
Ascites
5)
Obesity

Lack of O2/Hypoxia: Living at High Altitudes
Lung Disease
1)
Pneumonia
2)
Pulmonary Embolism
CNS - Respiratory Stimulation
1)
Cerebral Vascular Accident (Stroke)
2)
Fever
3)
Liver Disease
4)
Anxiety-Hyperventilation Syndrome
5)
Pregnancy
6)
Drugs and Toxins
a. Progesterone Derivatives
b. Salicylate Intoxication
7)
Hyperthyroidism
8)
Delerium Tremors
Congestive Heart Failure
Hepatic Insufficiency
Sepsis
Mechanical Ventilation
Peritonitis

Lorraine R Franzi, MS/HSM, RD, CNSD, LDN
University of...

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