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Acid Base Disorders - Acidosis
Allan B. Schwartz, MD, is director of continuing medical education at Drexel University's College of Medicine, where he is also a professor in the College's Division of Nephrology and Hypertension. Here, he discusses the definition and recognition of metabolic acidosis, its differential diagnosis and treatment ... and the anion gap which separates metabolic acidosis into three sub categories. Dr. Schwartz discusses the three main causes of metabolic acidosis – excessive bicarbonate loss, excessive hydrogen ion load, and reduced hydrogen ion excretion. Using extensive graphic illustrations, he depicts the four major buffering mechanisms participating in metabolic acidosis, explains the Winters Rule relating to respiratory compensation in metabolic acidosis, and offers two case histories to demonstrate the Rule's value. The author details several mixed acid base disturbances, and provides "three easy steps" in the diagnosis of metabolic acidosis: Recognizing that it is a decrease in bicarbonate and in pH; evaluating respiratory adaptation, following Winters Rule; and calculating the anion gap which measures phosphate, sulfate, creatinate, and proteinate in metabolic acidosis. He concludes with a description of six main differential diagnoses which include ketoacidoses, poisonings, and alcohol abuse. |
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