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Acid–Base Disturbance: Laboratory Characteristics of Primary or Single Acid–Base Disturbance

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Table 8–1. Acid–Base Disturbance: Laboratory Characteristics of Primary or Single Acid–Base Disturbance

Disturbance

Acute Primary Change

Partial Compensatory Response

Arterial pH

Serum [K+] (meq/L)

Unmeasured Anions (Anion Gap1)

Clinical Features

Normal

None

None

7.35–7.45

3.5–5.0

12–18

None

Respiratory acidosis

Pco2 ↑ (co2 retention)

↑ Hco3

N

Dyspnea, polypnea, respiratory outflow obstruction, ↑ anterior-posterior chest diameter, rales, wheezes. In severe cases, stupor, disorientation, coma.

Respiratory alkalosis

Pco2 ↓ (co2 depletion)

↓ Hco3

N or ↓

Anxiety, occasional complaint of breathlessness, frequent sighing, lungs usually clear to examination, positive Chvostek and Trousseau signs.

Metabolic acidosis

Hco3 depletion

↓ Pco2

↑ or ↓

N or ↑

Weakness, air hunger, Kussmaul respiration, dry skin and mucous membranes, poor skin turgor. In severe cases, coma, hypotension, death.

Metabolic alkalosis

Hco3

retention

↑ Pco2

N

Weakness, positive Chvostek and Trousseau signs, hyporeflexia.

1Anion gap = ([Na+] + [K+]) − (Hco3 + [CI]) = 12–18 meq/L normally.

Reproduced, with permission, from Stobo JD et al (editors). The Principles and Practice of Medicine, 23rd ed. Originally published by Appleton & Lange. Copyright © 1996 by Appleton & Lange.

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