Актуальная Медицина - Acidosis

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Acidosis is a condition in which there is either a production in the body of two abnormal acids-beta-hydroxybutyric andcetoacetic acids, or a diminution in the alkali reserve of the blood.

Causes. The condition is usually due to faulty metabolism of fat which results in the production of beta-hydroxybutyric and acetoacetic acids. It occurs in diabetes mellitus when this is either untreated or inadequately treated, starvation, persisting vomiting and delayed anaesthetic vomiting. It also occurs in the terminal stages of glomerulonephritis when it is due to failure of the kidneys. A milder form of it may occur in  sever fevers, particularly in children.

Symptoms. General lassitude, vomiting, thirst, restlessness , and the presence of acetone in the urine form the earliest manifestations of the condition. In diabetes a state of coma may ensu\e and the disease end fatally.

Treatment The underlying condition must always be treated: e.g. if the acidosis is due to diabetes mellitus insulin must be given. Sodium bicarbonate is rarely necessary for diabetic ketoacidosus; if it used, it is invariable now given intravenously. Acidosis might be treated with oral sodium bicarbonate in cases of chronic renal failure. Anaesthetists dislike the administration of bicarbonate to acidotic patients, since there is some evidence that it can make intracellular acidosis worse. They almost always use hyperventilation of the artificially ventilated patient to correct acidosis.

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