METABOLIC ACIDOSIS(electrolyte imbalance)

METABOLIC ACIDOSIS

  • It is a serious electrolyte disorder characterized by an imbalance in the body's acid - base balance


CAUSES:(Mnemonic - KULT)

  • Ketoacidosis: DM/Starvation/alcoholic
  • Uremia : AKI/CKD/RAS(renal artery stenosis)/ATN(acute tubular necrosis)
  • Lactic acidosis :
Type A: shock , CO poisoning
Type B: DM/drugs- eg- phenformin,vancomycin
Type D: short bowel syndrome,jejunoileal bypass surgery(carbohydrates fermentation:bacterial flora ferment and form D-lactate
  • Toxins :
Methyl alcohol :
decrease alcohol dehydrogenase(antidote - fomepizole)
↓
formaldehyde formation occurs→retinal damage - blindness
↓
formic acid and H+ causes damage to BBB causing the encephalopathy





Ethylene glycol (antifreeze agent) :

consumption can cause precipitation of ca+ oxalate crystals and cause ATN


TREATMENT:
  1. Fluid of choice: Ringer lactate
  2. sodium bicarbonate - if PH < 7.2,inspite of fluid resuscitation - give soda bicarbonates
  3. Total correction - 0.5 x weight x(24 - actual value) - 1/2 bolus, 1/2 with IV fluid infusion
  4. Initial correction - 0.5 x weight x (15 - actual value)

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