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      A Conceptual Approach to the Patient with Metabolic Acidosis

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          Abstract

          We shall illustrate that management of patients with an acid-base disorder could be improved if the acid-base analysis was based on a better understanding of basic concepts of physiology. Three concepts of acid-base physiology and their clinical implications are emphasized in a patient with diabetic ketoacidosis. First, when an acid is produced from neutral precursors in the body, there is a net increase in the number of hydrogen ions (H<sup>+</sup>) and new anions. The corollary is that H<sup>+</sup> will be removed when the accompanying anion is metabolized to a neutral end-product or is excreted in the urine with H<sup>+</sup> or ammonium (NH<sub>4</sub><sup>+</sup>). Second, buffering of H<sup>+</sup> is beneficial if H<sup>+</sup> are removed by bicarbonate rather than being able to bind to proteins. This latter function depends on having a low tissue PCO<sub>2</sub>, due to a combination of hyperventilation plus an adequate blood flow rate to vital organs. Third, the kidneys add new bicarbonate to the body when NH<sub>4</sub><sup>+</sup> is excreted with chloride ions.

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          Prolonged total fasting: A feast for the integrative physiologist

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            Citric acid ingestion: A life-threatening cause of metabolic acidosis

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              Author and article information

              Journal
              NEF
              Nephron
              10.1159/issn.1660-8151
              Nephron
              S. Karger AG
              978-3-8055-7488-4
              978-3-318-00906-4
              1660-8151
              2235-3186
              2002
              October 2002
              18 October 2002
              : 92
              : Suppl 1
              : 46-55
              Affiliations
              Renal Division, St. Michael’s Hospital, University of Toronto, Ont., Canada
              Article
              65377 Nephron 2002;92(suppl 1):46–55
              10.1159/000065377
              12401937
              © 2002 S. Karger AG, Basel

              Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

              Page count
              Figures: 6, Tables: 5, References: 37, Pages: 10
              Product
              Self URI (application/pdf): https://www.karger.com/Article/Pdf/65377
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