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American Journal of Kidney Diseases :... Sep 2023The respiratory system plays an integral part in maintaining acid-base homeostasis. Normal ventilation participates in the maintenance of an open buffer system, allowing... (Review)
Review
The respiratory system plays an integral part in maintaining acid-base homeostasis. Normal ventilation participates in the maintenance of an open buffer system, allowing for excretion of CO produced from the interaction of nonvolatile acids and bicarbonate. Quantitatively of much greater importance is the excretion of CO derived from volatile acids produced from the complete oxidation of fat and carbohydrate. A primary increase in CO tension of body fluids is the cause of respiratory acidosis and develops most commonly from one or more of the following: (1) disorders affecting gas exchange across the pulmonary capillary, (2) disorders of the chest wall and the respiratory muscles, and/or (3) inhibition of the medullary respiratory center. Respiratory alkalosis or primary hypocapnia is most commonly caused by disorders that increase alveolar ventilation and is defined by an arterial partial pressure of CO <35 mm Hg with subsequent alkalization of body fluids. Both disorders can lead to life-threatening complications, making it of paramount importance for the clinician to have a thorough understanding of the cause and treatment of these acid-base disturbances.
Topics: Humans; Acidosis, Respiratory; Alkalosis, Respiratory; Carbon Dioxide; Hypocapnia; Bicarbonates; Alkalosis; Hydrogen-Ion Concentration; Acid-Base Equilibrium
PubMed: 37341662
DOI: 10.1053/j.ajkd.2023.02.004 -
The Annals of Pharmacotherapy Jan 2024The objective of this review is to discuss acid-base physiology, describe the essential steps for interpreting an arterial blood gas and relevant laboratory tests, and... (Review)
Review
OBJECTIVE
The objective of this review is to discuss acid-base physiology, describe the essential steps for interpreting an arterial blood gas and relevant laboratory tests, and review the 4 distinct types of acid-base disorders.
DATA SOURCES
A comprehensive literature search and resultant bibliography review of PubMed from inception through March 7, 2023.
STUDY SELECTION AND DATA EXTRACTION
Relevant English-language articles were extracted and evaluated.
DATA SYNTHESIS
Critically ill patients are prone to significant acid-base disorders that can adversely affect clinical outcomes. Assessing these acid-base abnormalities can be complex because of dynamic aberrations in plasma proteins, electrolytes, extracellular volume, concomitant therapies, and use of mechanical ventilation. This article provides a systematic approach to acid-base abnormalities which is necessary to facilitate prompt identification of acid-base disturbances and prevent untoward morbidity and mortality.
RELEVANCE TO PATIENT CARE AND CLINICAL PRACTICE
Many acid-base disorders result from medication therapy or are treated with medications. Pharmacists are uniquely poised as the medication experts on the multidisciplinary team to assist with acid-base assessments in the context of pharmacotherapy.
CONCLUSION
The use of a systematic approach to address acid-base disorders can be performed by all pharmacists to improve pharmacotherapy and optimize patient outcomes.
Topics: Humans; Critical Illness; Respiration, Artificial; Critical Care; Pharmacists; Acid-Base Imbalance
PubMed: 37125739
DOI: 10.1177/10600280231165787