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General Reference ⬇

(Nejm 1998;338:107)

Pathophys and Cause ⬆ ⬇

Cause:Vomiting, diuretics (renal H+ loss to save K+ and Na+)

Pathophys:Sx and cmplc when pH >7.6, which causes decr ionized calcium levels

see Figure 17.1 for description of Metabolic and Respiratory Components of Acid-Base Balance

Signs and Symptoms ⬆ ⬇

Sx:Headache, tetany, seizures, delirium, stupor

Si:Depressed respirations

Complications ⬆ ⬇

Supraventricular and ventricular arrhythmias; angina induction

Lab and Xray ⬆ ⬇

Lab:

Alkalosis, hypo K+

Treatment ⬆

Rx:

KCl and NaCl repletion, not K-gluconate; NH4Cl 10 gm = 180 mEq iv as 1-2% soln, or arginine HCl in extreme or resistant cases

Acid-Base Nomogram Bands = Mean ±2 SD Response in Normals