Point and Pearls Excerpt
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The bicarbonate buffer system is the predominant buffer system maintained via actions of the kidneys and lungs: CO2 + H2O = H2CO3 = HCO3- + H+
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Ventilatory compensation begins within minutes, but takes up to 24 hours for maximal effect; the renal response occurs over hours to days.
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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.
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Mortality associated with hyperlactatemia occurs more often when buffer systems can no longer compensate and a lactic acidosis ensues.
Most Important References
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Kitabchi AE, Umpierrez GE, Miles JM, et al. Hyperglycemic crises in adult patients with diabetes. Diabetes Care. 2009;32(7):1335-1343. (Clinical practice guideline)
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Lee S-W, Hong Y-S, Park D-W, et al. Lactic acidosis not hyperlactatemia as a predictor of inhospital mortality in septic emergency patients. Emerg Med J. 2008;25(10):659-665. (Prospective observational; 126 patients)
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Schwartz WB, Relman AS. A critique of the parameters used in the evaluation of acid-base disorders. Whole-blood buffer base and standard bicarbonate compared with blood pH and plasma bicarbonate concentration. N Engl J Med. 1963;268:1382-1388. (Landmark review)
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Miller M, Eriksson L, Fleisher L, et al. Perioperative Acid- Base Balance. In: Miller’s Anesthesia, 8th Ed. Philadelphia, PA: Elsevier Saunders. 2015; pages 1811-1829. (Textbook chapter)
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Emmett M, Narins RG. Clinical use of the anion gap. Medicine (Baltimore). 1977;56(1):38-54. (Landmark review)
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Astrup P, Jorgensen K, Andersen OS, et al. The acid-base metabolism. A new approach. Lancet. 1960;1(7133):1035-1039. (Landmark review and original contribution)
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Stewart PA. Independent and dependent variables of acid-base control. Respir Physiol. 1978;33(1):9-26. (Landmark review and original contribution)
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