acidosis
Introduction
Introduction to acidosis Acidosis refers to the accumulation of acidic substances in the blood and tissues of the body. The essence of this is that the concentration of hydrogen ions in the blood rises and the pH decreases. Under pathological conditions, when the body [BHCO3] decreases or [H2CO3] increases, the [BHCO3]/[H2CO3] ratio can be reduced, causing the blood pH to decrease, which is called acidosis. The accumulation of acidic substances in the blood and tissues of the body is characterized by an increase in the concentration of hydrogen ions in the blood and a decrease in the pH. basic knowledge The proportion of illness: 0.02% Susceptible people: no specific population Mode of infection: non-infectious Complications: mixed renal tubular acidosis, renal tubular acidosis, diabetic ketoacidosis
Cause
Cause of acidosis
Pay attention to various diseases that may induce acidosis such as shock, diabetes, uremia, certain tubular diseases, severe diarrhea, and medications that have caused acidosis, such as ammonium chloride and salicylic acid.
Prevention
Acidosis prevention
Mild acidosis can correct itself after correcting water shortage and electrolyte imbalance. It is not necessary to supplement sputum. Severe cases should correct acidosis in time. During the treatment of phlegm and blood stasis, attention should be paid to observe clinical manifestations and review blood biochemistry. When symptoms improve, The amount of urine is sufficient, CO 2 CP18mmol/L or more, no need to use alkaline drugs, when metabolic acidosis, serum K+ can be high, when correcting acidosis and lack of water, there may be hypokalemia K+, hand and foot convulsions, should Pay attention to K+.
Complication
Acidosis complications Complications, mixed renal tubular acidosis, renal tubular acidosis, diabetic ketoacidosis
1. Acidosis can reduce the binding of Ca2 to protein, thereby increasing the level of free Ca2. When correcting acidosis, sometimes the hand and foot spasm can be caused by the decrease of free Ca2. The decrease of blood pH can inhibit the 1 hydroxylase of kidney. Reduced production of active vitamin D3, chronic acidosis due to long-term bone calcium mobilization, can lead to metabolic bone disease, is quite common in patients with renal tubular acidosis.
2, acidosis can increase protein decomposition, chronic acidosis can cause malnutrition.
3, acidosis is often accompanied by hyperkalemia, when the alkali is corrected for acidosis, H+ is continuously buffered from the inside of the cell to the outside of the cell, and K+ is relocated from the outside of the cell to the cell, so that the blood potassium is lowered, but It should be noted that some patients with metabolic acidosis have potassium loss. Although there is acidosis but accompanied by hypokalemia, the serum potassium concentration will be further reduced when acidosis is corrected, causing severe or even fatal hypokalemia. The situation is found in diabetic patients with osmotic diuretic and potassium loss, diarrhea patients lose potassium, etc., to correct its acidosis, it is necessary to properly supplement potassium according to the degree of serum potassium reduction.
Symptom
Symptoms of acidosis Common symptoms Diarrhea, nausea, low metabolism, tachycardia
Shock, diabetes, uremia, diarrhea.
Examine
Acidosis check
1. Immediately after admission, blood routine, hematocrit, blood gas analysis, carbon dioxide binding, blood sodium, potassium, chlorine, calcium, phosphorus, urea nitrogen, blood potassium, sodium, chlorine, blood gas and carbon dioxide binding Once a day or every other day until normal. Urine routine, ketone body, sodium, potassium, chlorine, calcium, phosphorus and pH were measured immediately.
2, ECG examination, check each time before treatment and 4 to 6 hours after the start of treatment, review as appropriate. Blood lactic acid content is measured as necessary.
3. Record the type of liquid in and out within 24 hours, especially the amount of urine.
Diagnosis
Diagnosis and identification of acidosis
First, metabolic acidosis
Metabolic Acidosis is characterized by a decrease in plasma [HCO-] and a decrease in pH.
Metabolic acidosis can be divided into two categories according to whether AG increases: AG increases metabolic acidosis, and the patient's plasma [Cl-] level is normal, which is the normal blood chlorine metabolic acidosis often mentioned in the literature. AG normal metabolic acidosis, the patient's plasma [Cl-] level is elevated, that is, the literature often mentions high blood chlorine metabolic acidosis.
Second, respiratory acidosis
Respiratory Acidosis is characterized by an increase in plasma [H2CO3] concentration and a decrease in pH.
1. The respiratory center inhibits some central nervous system diseases such as cerebral neoplasms, cerebral poliomyelitis, encephalitis, meningitis, vertebral artery embolism or thrombosis, increased intracranial pressure, traumatic brain injury, etc. Activity can be suppressed, resulting in reduced ventilation and CO2 accumulation. In addition, some drugs such as anesthetics, sedatives, sedatives (morphine, sodium barbital, etc.) have the effect of inhibiting breathing, and too much dose can cause hypoventilation. Carbonic anhydrase inhibitors such as acetazolamide can cause metabolic acidosis as described previously. It also inhibits carbonic anhydrase in red blood cells and reduces the release of CO2 from red blood cells in the lungs, causing an increase in arterial blood Pco2. Patients with a tendency to acidosis should use this medicine with caution.
2, respiratory nerves, muscle dysfunction found in poliomyelitis, acute infectious polyneuritis (Guillain-barre syndrome) botulism, myasthenia gravis, hypokalemia or familial periodic paralysis, high spinal cord injury, etc. . In severe cases, the respiratory muscles can be paralyzed.
3, thoracic abnormal thoracic abnormalities affecting respiratory movements are common after the spine, scoliosis, flail chest (Flail Chest), relationship between ankylosing spondylitis (Ankylosing Spondylitis), cardiopulmonary obesity syndrome (Picwick syndrome).
4, airway obstruction is common with foreign body obstruction, laryngeal edema and inhalation of vomit.
5. Extensive lung disease is the most common cause of respiratory acidosis. It includes chronic obstructive pulmonary disease, bronchial asthma, severe interstitial lung disease, and the like. These lesions can seriously impede alveolar ventilation.
6. Insufficient CO2 inhalation means that the concentration of CO2 in the inhaled gas is too high, such as in a narrow space with poor ventilation and such as tunnels and tanks. At this time, the alveolar ventilation did not decrease.
