Metabolic acidoses

For disorders of carbohydrate metabolism and the primary lactic acidoses, see Chapter 34. 

During anaerobic glycolysis in the muscles and erythrocytes, glucose is converted into lactate, releasing protons in the process (see p. 338). The synthesis of the ketone bodies acetoacetic acid and 3-hydroxybutyric acid in the liver (see p. 312) also releases protons. Normally, the amounts formed are small and of little influence on the proton balance. If acids are formed in large amounts, however (e. g., during starvation or in diabetes mellitus see p. 160), they strain the buffer systems and can lead to a reduction in pH (metabolic acidoses lactacidosis or ketoacidosis). 

Fig. 3.15 Tabular survey of catabolites of 100 g protein and their hepatic and renal metabolic pathways including excretion in the urine under normal metabohc-acidosic and metabolic-alka-lotic conditions. (If no other units are specified, the data are in mmol)...

Hiemcke T. Metabole acidose door paraldehyde. [Metabolic acidosis due to paraldehyde.] Ned Tijdschr Geneeskd 1964 108 2165-7. 

AU anion gap metabolic acidoses can be explained by one (or a combination) of eight underlying mechanisms fisted... 

TABLE 46-4 Conditions of Metabolic Acidoses with High and Gaps... 

Narins RG, Krishna GG, Yee J, et al. The metabolic acidoses. In Narins RG, ed. Maxwell Kleeman s Clinical Disorders of Ruid and Electrolyte Metabolism, 5th ed. New York, McGraw-Hill, 1994 769-826. 

In metabolic acidoses, e.g. diabetic ketoacidosis and renal failure. 

There are a number of studies of other disease processes using NMR spectroscopy of urine. These include glomerularnephritis, kidney transplant patients over a period of 14 days post-operation to investigate the biochemical effects of rejection, phenol poisoning and metabolic acidoses caused by alcohol ingestion. 

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