Acid-base disorders treatment

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. 

Acid-base disturbances are always manifestations of underlying clinical disorders. It is useful to specifically define the primary acid-base abnormality, as each disorder is caused by a limited number of disease processes. Establishing the specific disease process responsible for the observed acid-base disorder is clinically important because treatment of a given acid-base disorder will only be accomplished by correcting the underlying disease process. 

Primary therapy of most acid-base disorders must include treatment or elimination of the underlying cause, not just correction of the pH and electrolyte disturbances. 

Acid-base disorders are common, and often serious, disturbances that may result in significant morbidity and mortality. This chapter reviews the mechanisms responsible for the maintenance of acid-base balance and the laboratory analyses that aid clinicians in their assessment of acid-base disorders. The pathophysiology of the four primary acid-base disturbances is presented, the therapeutic options are critiqued, and guidelines for the achievement of the desired therapeutic outcomes are presented. Because many drugs affect acid-base homeostasis and many acid-base abnormalities are potentially preventable, clinicians must anticipate drug-related problems in order to avoid or minimize the clinical consequences, and when necessary design appropriate treatment regimens. 

Fig. 5 The 95% confidence intervals for arterial blood gases in primary acid-base disorders. Arterial H i.s plotted against PCO. with lines oF equal HCO.V radiating from origin. Tlie hatched box shows normal values. Graphs such as these may be used to chart the progress of a patient under treatment to correct an acid-base disorder.

Disorders of acid base balance are usually a consequence of disease such as diabetes mellitus. The main thrust of treatment is reversing the primary disease process and then the regulatory mechanisms of the body automatically reverse the acid- base abnormalities. There are, however, conditions in which the acid-base disorder must be treated directly because otherwise the patient dies of the acid base upset before the primary illness can be treated. Acidaemia in particular needs treatment. In most pathological conditions involving metabolic disorders of acid-base physiology, the result is acidaemia, alkalaemia being much less common. 

Supplementation with appropriate vitamins and the addition of sufficient protein generally resolve nutritionally based disorders. Severe corneal disease caused by prolonged vitamin A deprivation is typically more resistant to treatment.Topical treatment with lubricants or retinoic acid may be helpful in combating vitamin A deficiency. 

In 18 children with nalidixic acid intoxication, most of whom were aged under 1 year, the clinical effects were neurological disorders of alertness, hjrpertensive cranial syndrome, and neuronal damage some had a metabolic acidosis (30). Treatment included gastric lavage, correction of acid-base balance, and control of convulsions. 

Power D A, Duggan J, Brady H R 1999 Renal-dose (low-dose) dopamine for the treatment of sepsis-related and other forms of acute renal failure ineffective and probably dangerous. Clinical and Experimental Pharmacology and Physiology 26(suppl) S23-S28 Rose B D 1989 In Rose B D (ed) Clinical physiology of acid-base and electrolyte disorders, 3rd edn. McGraw Hill, New York, pp. 389-415... 

Intoxication disorders include urea cycle disorders, organic acidurias, aminoacidopathies, fatty acid oxidation disorders, and carbohydrate disorders such as galactosemia or hereditary fructose intolerance. In these disorders, a partial or complete lack of enzymatic activity causes the accumulation of substances proximal to the metabolic block in tissues and body fluids, where they act as toxins (Fig. 5.1). Treatment is based on limiting the substances that are the source of the toxic metabolites and introducing alternatives (e.g., drugs, procedures) that speed the elimination of those toxic metabolites. 

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