The Painless Guide to Mastering Clinical Acid-Base by Benjamin Abelow

Author:Benjamin Abelow [Abelow, Benjamin]
Language: eng
Format: epub
Publisher: Benjamin Abelow
Published: 2017-03-18T17:00:00+00:00

Generation + Maintenance = Metabolic Alkalosis

To better understand these concepts, study this figure, then refer back to it as you continue to read:

Bucket A represents a normal individual. There is no abnormal bicarbonate generation and the renal threshold is normal. Bucket B represents generation without maintenance. Excess bicarbonate is produced and enters the ECF, but the threshold is normal, so the bicarbonate spills into the urine without a marked increase in plasma [HCO3–] occurring. Bucket C represents generation plus maintenance. Excess bicarbonate is produced and retained, thus increasing plasma [HCO3–]. No bicarbonate spills unless [HCO3–] reaches the new threshold level. This patient has metabolic alkalosis. Note that if [HCO3–] does reach the new threshold level, bicarbonate starts to spill and [HCO3–] is maintained at the new (higher) level. Bucket D shows what happens to Bucket C if generation stops but the factors maintaining the abnormal threshold remain. Plasma [HCO3–] stays high. That is, metabolic alkalosis persists. Only after the factors that maintain the alkalosis are removed does the threshold fall. At that point, the kidney can excrete excess bicarbonate, correcting the metabolic alkalosis, as shown in Bucket E.

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