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present for prolonged periods) is an increase in serum 1 ?• .

Û Respiratory alkalosis is caused by hyperventilation resulting in a decreased arterial CO2 concentration. The compensation for respiratory alkalosis (if present for prolonged periods) is a decrease in serum 1 ?• . Metabolic acidosis and alkalosis result from primary disturbances in the serum

concentration. Respiratory compensation of metabolic disturbances begins within minutes and is complete within 12 hours.

Metabolic acidosis is characterized by a decrease in serum I ICO \ j^g anion gap is used to narrow the differential diagnosis, as metabolic acidosis may be caused by addition of acids (increased anion gap) or loss of 1 3 (normal anion gap). The compensation for metabolic acidosis is an increase in ventilation with a decrease in arterial CO2.

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Metabolic alkalosis is characterized by an increase in serum 1 |V-A-J 3 . This disorder requires loss of fluid that is low in 1 1 ?• from the body or addition of

- "■ .' to the body. The compensation for metabolic alkalosis is a decrease in ventilation with an increase in arterial CO2.

Arterial blood gases, serum electrolytes, physical examination findings, the clinical history, and the patient's recent medications must be reviewed in order to establish the etiology of a given acid-base disturbance.

It is critical to treat the underlying causative process to effectively resolve most observed acid-base disorders. However, supportive treatment of the pH and electrolytes is often needed until the underlying disease state is improved.

Given its reputation for complexity and the need to memorize innumerable formulas, acid-base analysis intimidates many health care providers. In reality, acid-base disorders always obey well-defined biochemical and physiologic principles. The pH deI ICO"

termines a patient's acid-base status and an assessment of the bicarbonate (1 3 ) and arterial carbon dioxide (PaCO2) values identifies the underlying process. Rigorous use of a systematic approach to arterial blood gases increases the likelihood that derangements in acid-base physiology are recognized and correctly interpreted. This chapter will outline a clinically useful approach to acid-base abnormalities and then apply this approach in a series of increasingly complex clinical scenarios.

Disturbances of acid-base equilibrium occur in a wide variety of illnesses and are among the most frequently encountered disorders in critical care medicine. The importance of a thorough command of this content cannot be overstated given that acid-base disorders are remarkably common and may result in significant morbidity and mortality. Although severe derangements may affect virtually any organ system, the most serious clinical effects are cardiovascular (arrhythmias and impaired contractility), neurologic (coma and seizures), pulmonary (dyspnea, impaired oxygen delivery, respiratory fatigue, and respiratory failure), and/or renal (hypokalemia). Changes in acid-base status also affect multiple aspects of pharmacokinetics (clearance and protein binding) and pharmacodynamics.

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