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W S A V A W C P , 2005
Luis Núñez Ochoa
Facultad de Medicina Veterinaria y Zootecnia
Unam, Mexico
The body maintains a balance of acids and bases in order to constantly maintain
blood pH within a narrow range, despite the continuous generation of metabolic
products. In turn, this allows the body to maintain cell enzyme systems in good
operation conditions, together with the proper concentration of ionized (active)
forms of various electrolytes such as Ca++ and Mg++. This influences the speed of
metabolic reactions and trans-membrane transportation systems
(pharmacokinetics and pharmacodynamics).
In veterinary medicine, acid-base disorders are common, since they appear in
frequently found conditions such as diarrhea, vomiting, renal insufficiency,
dehydration, anesthesia, pneumonia, or diseases with restricted pulmonary
expansion (effusion, traumatisms, hernia, tumors, etc.). Disease typically results in
altered local/systemic pH, due to electrolyte/water/CO2 movements. In order to
establish the appropriate therapy, electrolyte variations should be interpreted
considering self physiologic basics in association with clinical findings.
Several mechanisms exist that maintain this equilibrium between acids and bases,
resulting in a pH level within the reference range:
1. Extracellular mechanism. This includes several buffers that either accept or
release protons (H+). Therefore, they minimize pH alterations such as
plasma protein, bicarbonate (HCO3-), phosphates, etc. Its operation is
immediate.
2. Intracellular mechanism. Represented by proteins, hemoglobin,
organic/inorganic phosphates. It is immediate.
3. Transcellular mechanism. It is mainly produced by K+/H+ ion exchange. It is
immediate.
4. Respiratory mechanism. Enhancing the retention or elimination of PCO2 (as
a representative of carbonic acid, in other words, "volatile acids". Its
activation is relatively immediate.
H++ HCO3-↔ H2CO3 ↔ H2O+ CO2 (elimination)
5. Renal mechanism (through the excretion or retention of H+ and HCO3-. In
other words, non-volatile acids. This is the longest-lasting mechanism,
since it starts in approximately 12-24 hours, and reaches its maximum
compensatory efficiency peaks in 2-5 days).
NaHCO3 + HCl (a non-volatile acid) ↔ NaCl + H2CO3 ↔ H2O+ CO2
DEFINITIONS
pH. Is the negative logarithm of H+ (ratio is inverse, i.e., the higher the H+ ion
concentration the lower the pH. The lower the H+ ion concentration the higher the
pH). pH is determined by the PCO2 : HCO3- ratio.
pH = 6.1+ log (HCO3-/ 0.03PCO2)
Where: 6.1 is the dissociation constant of carbonic acid in body fluids, 0.03 is the
CO2 solubility constant (as a conventional evaluation of H2CO3).
Acidemia. Decreased blood pH as compared to reference values.
Acidosis. A process that involves a gain of acids, a loss of bicarbonate, or
both.This results in decreased pH.
Metabolic acidosis. This is the most frequent process. It is characterized by a
non-volatile acid gain (mainly lactic acid) or a bicarbonate loss, or both, with an
incomplete physiological respiratory compensation (PCO2 or hypocapnia). This
results in decreased pH.
Respiratory acidosis. This process is characterized by alveolar hypoventilation
that results in increased PCO2 (hypercapnia) caused by obstruction of the airways,
depression of the breathing center (trauma, or drugs) breathing restrictive
processes (thoracic effusion, pneumothorax, diaphragmatic hernia, abdominal
distension and fractures or lesions of the thoracic walls), pulmonary disease, or a
mixture of two or more causes.
Alkalemia. Increased blood pH as compared to reference values.
Alkalosis. A process characterized by a chlorine loss or decreased PCO2. This
results in increased pH.
Metabolic alkalosis. A process that involves a chlorine loss or increased HCO3-
(due to excess therapy), with an incomplete physiologic respiratory compensation
(chemoreceptors of the breathing center detect the alkalosis and respond with
hypoventilation that results in increased PCO2 [0.7 mm Hg for each mmol/L] that
increases HCO3-). This results in increased pH. The most frequent causes are
vomit or sequestration of chlorine in the stomach in cases of torsion. Other
causes include the use of furosemide or mineralocorticoids.
Respiratory alkalosis. This is the least frequent pH disorder. It is characterized
by alveolar hyperventilation that results in decreased PCO2 levels (hypocapnia)
caused by hypoxemia, direct stimulation of the breathing center, stimulation of the
nociceptive (pain sensitive) receptors, as in pulmonary edema, pneumonia,
embolism, etc. It is accompanied by an incomplete physiological metabolic
compensation (HCO3- ).
Metabolic. A problem that results from a primary alteration in H+ or HCO3-.
Respiratory. A problem that results from a primary PCO2 change due to an
alteration in CO2 elimination.
Buffers. Substances that accept or release protons (H+). They minimize pH
changes such as plasma proteins, bicarbonate, phosphates, hemoglobin, etc.
PCO2 represents H2CO3 as a respiratory component of the acid-base balance.
TCO2 is the total amount ofCO2 that can be extracted from plasma. It includes
dissolved CO2 and HCO3-, where H2CO3 and CO2 represent 5% of the total, while
HCO3- is the remaining 95%. Therefore, TCO2 is considered as an acceptable mean
of HCO3- minus 1-2 mmol/L in normal individuals.
Base excess or deficit (BE+ or BE-). This represents only the metabolic
component of changes in non-volatile acids or bicarbonate, since it is estimated
under ideal conditions. In other words, with a PCO2 of 40 mm Hg, a temperature of
38°C, and the buffering capacity of hemoglobin is not considered.
Reference values are typically maintained at 0 ± 3.
Values >3 = metabolic alkalosis; <- 3 = metabolic acidosis
If this value is positive, the animal does not require a bicarbonate therapy, since an
excess exists. In animals with negative values, the need to correct the acid-base
imbalance can be calculated using the following equation:
HCO3- dose (mmol/L)= 0.3 (treatable space) X weight in kg X BE (mmol/L)
Treatable space = extracellular fluid. Some authors consider it to be 20%.
Example: a 20 kg dog with a BE of-27 (hence a base deficit), therefore:
HCO3- dose (mmol/L) = 0.3 X 20 kg X 27
HCO3- need (mmol/L) = 162 mmol
Expected physiologic compensation. It is important to determine if the
compensation is adequate or not. The following values are valid for dogs. (Cat
values need to be further verified.)
In metabolic acidosis, for each mmol/L that the HCO3- decreases, a PCO2
decrease of 0.7 mmHg is expected.
In metabolic alkalosis, for each mmol/L that HCO3- increases a PCO2
increase of 0.7 mmHg is expected.
In chronic respiratory acidosis, for each mmHg that the PCO2 increases, there
will be a HCO3- increase of 0.35.
In chronic respiratory alkalosis, for each mmHg that the PCO2 decreases, a
HCO3- decrease of 0.55 will occur.
Evaluation of blood pH/gases
The theory presented in the paragraphs above, will be explained using some
examples:
SIMPLE ACID-BASE DISORDERS
Example: diarrhea.
Example: vomiting.
Na+ : 151
mmol/L
K+ : 5 mmol/L
HCO3 20 mmol/L
-
Cl- 118
mmol/L
K+
HCO3-
Base excess or
deficit (BE)
pH
PCO2
(compensatory)
References
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electrolytes disorders. 1989, 19: 2, 307-326.
2. Autran de Morais, HS. Mixed acid-base disorders. In Fluid therapy in small animal practice. DiBartola
ed. W. B. Saunders, Phil. 1992: 276-296.
3. Bailey, JE; Pablo, LS. Practical aproach to acid-base disorders. Vet. Clin of North Am Small An.
Advances in fluids and electrolyte disorders. 1998, 28: 3, 645-662.
4. Carlson, GP. Fluid, Electrolyte and acid-base balance. In Clinical Biochemistry of Domestic Animals.
5th Ed. Kaneko, Harvey and Bruss ed. Academic Press, San Diego Cal. 1997: 485-516.
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Saunders, Phil. 1992: 216-243.
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Saunders, Phil. 1992: 244-257.
8. DiBartola, SP; Autran de Morais, HS. Respiratory acid-base disorders. In Fluid therapy in small
animal practice. DiBartola ed. W. B. Saunders, Phil. 1992: 258-275.
9. Orsini, JA. Pathophysiology, diagnosis, and treatment of clinical acid-base disorders. Comp Cont
Educ. Small An. 1989, 11: 5, 593-604.
10. Polzin, DJ; et al. Clinical application of the anion gap in evaluation of acid-base disorders. Comp
Cont Educ. Small An. 1982, 4: 12, 1021-1032.
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