Treatment of acid-base disorders

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. 

Metabolic acidosis occurs as a consequence of many pathological conditions (Table 5.6). In addition to diabetes mellitus another example is cardiac failure, for instance following a severe coronary thrombosis. Here, tissue oxygenation 

Some causes of metabolic acidosis Diabetes mellitus 

Cardiac or ventilatory failure inadequate oxygenation of the tissues anaerobic metabolism release of lactic acid. 

Bicarbonate space is about 1/3 body weight. Total base excess of the whole body (mMol) 

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