Disorders of Acid-Base Balance: New Perspectives

Abstract

Background: Disorders of acid-base involve the complex interplay of many organ systems including brain, lungs, kidney, and liver. Compensations for acid-base disturbances within the brain are more complete, while limitations of compensations are more apparent for most systemic disorders. However, some of the limitations on compensations are necessary to survival, in that preservation of oxygenation, energy balance, cognition, electrolyte, and fluid balance are connected mechanistically. Summary: This review aims to give new and comprehensive perspective on understanding acid-base balance and identifying associated disorders. All metabolic acid-base disorders can be approached in the context of the relative losses or gains of electrolytes or a change in the anion gap in body fluids. Acid-base and electrolyte balance are connected not only at the cellular level but also in daily clinical practice. Urine chemistry is essential to understanding electrolyte excretion and renal compensations. Key Messages: Many constructs are helpful to understand acid-base, but these models are not mutually exclusive. Electroneutrality and the close interconnection between electrolyte and acid-base balance are important concepts to apply in acid-base diagnoses. All models have complexity and shortcuts that can help in practice. There is no reason to dismiss any of the present constructs, and there is benefit in a combined approach.

Hypokalemia: a clinical update

“…External potassium balance is determined by the rate of potassium intake (normally 100 mEq/day) and rate of urinary (normally 90 mEq/day) and fecal excretion (normally 10 mEq/day). The distribution of potassium in muscles, bone, liver and red blood cells (RBC) and ECF has a direct effect on internal potassium balance ( 6 , 7 ) ( Fig. 1 ).…”

Effects and interaction of dietary electrolyte balance and citric acid on growth performance, intestinal histomorphology, digestive enzyme activity and nutrient transporters expression of weaned piglets

“…At weaning, young pigs are exposed to psychosocial and physical stressors accompanied by marked changes in gastrointestinal physiology, microbiology and immunology, which may result in poor growth performance and increased mortality (Hampson, 1986; Heo et al, 2012; Hu et al, 2013; Pluske et al, 1997). Dietary ion content is known to alter the acid–base balance, osmotic pressure and nutrient metabolism in animals (Dersjantli et al, 2002; Guzmán‐Pino et al, 2015; Seifter & Chang, 2017), which can influence growth performance (Jones et al, 2019). Calcium (from limestone), phosphorus (from calcium phosphate), and sodium and chloride (from salt and sodium bicarbonate) are often added to the diet to satisfy animal growth requirements (NRC, 2012).…”

Mechanism of Action of Non-Synonymous Single Nucleotide Variations Associated with α-Carbonic Anhydrase II Deficiency

“…CA-VIII, X and XI are regarded as the carbonic anhydrase related proteins (CARP) and do not possess CO2 hydration activity. From the α-CAs, CA-II has the highest rate of reaction and assists in the maintenance of homoeostasis within the body [12]. Reaction substrates and products (CO2, HCO3− and H+) are essential for the regulation of biological processes such as, but not limited to, respiration, cerebrospinal fluid (CSF) formation and bone resorption within cells [13,14].…”