Acid-base disturbances are physiological responses to a wide variety of underlying conditions and critical illnesses. Homeo-stasis of acid-base physiology is complex and interdependent with the function of the lungs, kidneys, and endogenous buffer systems.
Our June issue Acid-Base Disturbances: An Emergency Department Approach outlines several approaches to characterizing disturbances, with a case-based format and algorithms to aid in diagnostic testing and interpretation of arterial blood gases.
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Here are a few key points:
- Ventilatory compensation begins within minutes, but takes up to 24 hours for maximal effect; the renal response occurs over hours to days.
- Lactate accumulates due to tissue hypoxia and aerobic glycolysis. Type A lactic acidosis refers to that characterized by poor perfusion and acute hypoxia; type B lactic acidosis occurs in the absence of overt hypoperfusion or hypoxia.
- Mortality associated with hyperlactatemia occurs more often when buffer systems can no longer compensate and a lactic acidosis ensues.