Sodium, electrolyte/acid-base disturbances

There is no specific antidote. Supportive care should be instituted for all patients with history of serious boric acid exposure. Substantial recent ingestions may benefit from administration of activated charcoal. Fluid and electrolyte balance, correction of acid/base disturbance, and control of seizures are essential to therapy. Hemodialysis has been successfully used to treat acute boric acid poisoning. Sodium bicarbonate may be used for any metabolic acidosis. 

From the point of view of potassium balance, there is increased renal excretion of potassium, loss of potassium in the vomitus and no potassium being delivered for absorption in the alimentary tract. All these factors contribute to a severe depletion of the body s total potassium content. Yet another factor contributes to potassium loss. A drop in volume of the circulating blood leads to aldosterone secretion via the renin-angiotensin mechanism which, in turn, promotes sodium reabsorption in the renal tubule this contributes further to excessive renal loss of potassium and hydrogen ions. The acidity of the urine is inappropriate as a response to metabolic alkalosis, but the preservation of electrolyte and fluid volume takes precedence over the acid-base disturbance. These various efiects all combine to yield a positive feedback system driving the metabolic alkalosis which, if not treated, reaches lethal levels in a few days. 

Conclusion. The acidity of the urine is (appropriate, inappropriate) as a response to metabolic alkalosis. The preservation of electrolyte and fluid volume (takes precedence, is subservient) to the correction of the acid-base disturbance. Cautious intravenous infusion of isotonic sodium chloride solution is likely to (improve, have no effect on, adversely affect) the patient s condition. 

Diuretic therapy is a common iatrogenic origin of metabolic disturbances of acid-base physiology. Diuretics are administered for their naturetic properties particularly in patients with cardiac, hepatic, pulmonary and renal disease, to rid the body of excess extracellular fluid. When the loss of sodium is matched by losses of other extracellular electrolytes in proportion to their extracellular concentrations, no disturbance of acid-base balance occurs. In cases where there is a disproportionate loss of bicarbonate, the result is metabolic acidosis. Conversely when there is an exaggeration of loss of ammonium or chloride ions by comparison with sodium, this leads to metabolic alkalosis. 

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