Internal Medicine

0521779407-14 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:16

Metabolic Acidosis Metabolic Alkalosis 977

complications and prognosis

■complications of severe acidemia

➣decreased cardiac contractility

➣venoconstriction with centralization of blood

➣fatigue

➣dyspnea

■complications of long term acidemia

➣short stature in children

➣osteopenia

➣malnutrition, loss of muscle mass

■anion gap acidosis prognosis dependent upon outcome of underly-

ing condition

■normal gap acidosis prognosis generally good with proper correction

of electrolytes

METABOLIC ALKALOSIS

BIFF F. PALMER, MD

history & physical

■history and physical directed toward determining volume status of

patient

■normal or low blood pressure

➣light-headedness, loop and thiazide diuretics, vomiting/naso-

gastric suction

■hypertension

➣family history of hypertension

tests

■distinguish between primary metabolic alkalosis and compensated

respiratory acidosis

➣HCO3 concentration >24 mEq/L and blood pH >7.40 confirms

metabolic alkalosis

➣HCO3 concentration >24 mEq/L and blood pH <7.40 suggests

compensated respiratory acidosis

■Blood tests:

➣BUN, creatinine, Mg++

➣hemoconcentration of hematocrit and albumin suggest

decreased effective arterial volume (EABV)

➣if hypertensive, measure plasma renin and aldosterone