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Clinical manifestations
1. Acidosis in the cardiovascular system itself, the impact on heart rate was biphasic. When the blood pH value decreased from 7.40 to 7.0, the general performance of the heart rate too fast, which is mainly due to the secretion of acid poisoning caused more adrenaline. When the pH value continues to decline, heart rate gradually slowed down, mainly at this time may be inhibited acetylcholinesterase, leading to excessive accumulation of acetylcholine, which is the role of the heart over the role of epinephrine. If you use
Metabolic acidosis
Respiratory acidosis metabolic acidosis is common in what the patient?
Shock the patient's metabolic acidosis, lactic acidosis, which can produce serious consequences? Urine of patients with calcium renal stones, metabolic abnormalities, distal renal tubular acidosis and significance of the detection
Clinical diabetic ketoacidosis. Presentation
Misdiagnosis of diabetic ketoacidosis, alcoholic ketoacidosis clinical analysis of two cases
The names of diseases (English) metabolic acidosis of non-phonetic DAIXIEXINGSUANZHONGDU alias respiratory acidosis, metabolic and Western diseases, nutritional diseases classification codes TCM Classification of Diseases code for Western disease name defined metabolic acidosis (metabolic acidosis), also known as non-respiratory acidosis. Is due to intestinal disorders, loss of a large number of HCO3-, or a malfunction or break down due to renal metabolis


m, caused by excessive formation of acid metabolites, plasma HCO3-concentration caused the decline in a series of pathophysiological processes. May be due to excess acid enters the body, but also because of HCO3-from the extracellular fluid loss caused. Often by the clinical anion gap (AG) were divided into normal and excessive AG AG type two groups. Western medicine causes a release name. Normal AG metabolic acidosis type
(1) HCO3-losing too much:
proximal renal tubular acidosis: HCO3-due to proximal renal tubular reabsorption capacity is too low, a large number of HCO3-transport to the distal tubule, when more than its re-absorption capacity, a large number of HCO3-could be lost from the urine.
HCO3-loss from the gastrointestinal tract: the stomach below the digestive juice, including juice, bile fluid, relative to alkaline. Therefore, severe diarrhea, intestinal malabsorption, intestinal atrophy, biliary atrophy, pancreatic atrophy, intestinal decompression may be missing a lot of alkaline solution. Ureter sigmoid anastomosis, due to increased intestinal absorption of Cl-and HCO3-absorption decrease, causing high chloride acidosis. Carbonic anhydrase inhibitor used to HCO3-increased from urine or intestinal tract, leading to acidosis.
high potassium diet, urinary potassium increased discharge, inhibition of renal tubular exchange of H and Na, H retention in the body.
(2) HCO3 re-synthesis of obstacles:
distal renal tubular acidosis: decreased ability of distal renal tubular secretion of H, making the total reduction of H secretion, decreased renal HCO3-reabsorption.
low renin type of low aldosterone disease: the role of aldosterone on the renal tubular weakened, reduced secretion of H, and the hyperkalemia to reduced renal synthesis of NH3. Common in renal tubular interstitial disease, diabetes and so on.
Enter the excess acid or acid precursor: ammonium chloride, lysine hydrochloride, arginine hydrochloride and a lot of normal saline can lead to high chloride acidosis.
2. High AG metabolic acidosis type
(1) uremia: effective renal unit decrease in total acid excretion decreased, in addition to metabolic disorders caused by excessive acid production in vivo.
(2) Lactic acidosis: high fever, severe infection, trauma, burns and other catabolic hyperthyroidism caused by excessive lactic acid. Shock, circulatory failure or respiratory failure due to lack of oxygen, can generate too much lactic acid oxidation no time, and often accompanied by reduced capacity of liver using lactic acid. Another type of glycogen PAP 5, fructose 1,6 diphosphatase defects, pyruvate dehydrogenase, carboxylase enzyme deficiency and oxidative phosphorylation defects can lead to.
(3) Ketoacidosis: seen in diabetes, starvation, acute and chronic alcoholism, etc. ketosis occurred.
(4) poisoning: a major acid, methanol, ethylene glycol and so on. TCM etiology 1. Dietary factors: diet, stomach injury, loss of operation of the Division, leading to imbalance.
2. Physical factors: Congenital deficiency, acquired in conditioning failure, kidney deficiency, kidney failure sealed reservoir, leading to imbalance of yin and yang.
3. Chronic illness dystrophy, drug toxicity symptoms such as loss of Diabetes injury stronger governance governance, medicine yin and yang Poison and blood, resulting in dysfunctional organs. Intensity and spof seasonal population with the incidence of TCM pathogenesis pathology pathophysiology 1. Buffer bicarbonate buffer system blood, intracellular protein and phosphate buffer systems, first with the acidic substances and produce H2CO3, after the decomposition of discharge of pulmonary CO2, acid phosphate excretion from the kidney.
2. Compensatory respiratory acidosis high, H can stimulate the carotid sinus and the medullary respiratory center, increasing the depth and frequency of breathing, so that PCO2 decreased, the ratio remained relatively constant to HCO3/HCO3-.
3. Increase in renal acid excretion in urine row start of acid by the increase in the renal synthesis of NH3 few days more, so that the body too much acid in the form of NH4 discharge. Traditional Chinese medicine diagnosis diagnostic criteria 1. Lung-kidney:
Syndrome: shortness of breath, fatigue, weakness, palpitations, dry mouth, want to drink, the two zygomatic red red, red tongue or less thin coating, rapid pulse.Syndrome: recurrent vomiting, or for retching, dry mouth and throat, nausea, poor appetite, red tongue Shaojin moss or less, rapid pulse. Western medicine diagnosis is based on Western diagnostic criteria for metabolic acidosis, a few non-specific symptoms and signs, clinical diagnosis only on the reference value, must rely on laboratory tests. The characteristic changes in laboratory tests were: blood
HCO3-reduced the real bicarbonate (AB), standard bicarbonate (SB) reduced buffer base (BB) decrease in base excess (BE) negative increase, CO2 decreased binding; compensation in the normal range of pH , decompensated pH decreased. If these indicators do not change the obvious parallel, it may be associated with other types of acid-base balance disorders. History of disease symptoms and signs were mild metabolic acidosis as well compensated, mild symptoms are often masked by the primary disease, even if there is fatigue, weakness, dizziness, stretching, anorexia, fatigue, thirst, scanty urine, etc. is still difficult to identification. Often develop to moderately severe, plasma CO2 combining power in the 18-14mmol / L (40-30vol%) less obvious symptoms only group. At this point breathing increases, breathing muscles to assist breathing as sigh-like breath deepens. Ketoacidosis have rotten apple flavor; uremic acidosis has Niaowei; alcohol poisoning alcohol from time to time with acidosis, Where this feature quite helpful in the diagnosis. When the progression to severe stages, in addition to the above symptoms, often are in a trance, drowsiness fatigue, blurred consciousness, perception dull, and sometimes restless, sometimes presented stupor-like, and finally faint state. Signs, the skin and mucous membranes often dry; diabetes flushing cheeks, tongue, lips cherry red; uremia were pale and swollen; with shock who, heart, weak rapid pulse rate often thin, blood pressure, limb Jueleng, (toe ) end stasis purple, sticky skin (sweat); tune with high fever were often sweating, dehydration, loss of elasticity of dry skin and mucous membranes, with toxemia. Many signs will vary with the primary disease. Medical diagnostic imaging diagnostic laboratory diagnosis of electrical bonding often lower than normal CO2 to 25-18mmol / L (55-40vol%) were mild ,18-14mmol / L (40-30vol%) as moderate, 14mmol / L (30vol%) less severe. However, binding CO2 reduction is also found in respiratory alkalosis, differential expression analysis must be combined with clinical judgments. Need to be measured in plasma pH, blood gas analysis to help diagnosis. pH value can be normal (compensatory stage, can be 12mmol / L). Blood 1. blood gas analysis.
2. Blood lactate, blood ketone bodies, plasma renin activity and aldosterone were determined. Other diagnostic urinary CSF immunological fecal histological examination Western differential diagnosis 1. AG determination, can be broadly distinguished acidosis due to various reasons.
2. Lactic acidosis Lactic 3mmol / L (normal 1.2mmol / L).
3. Ketoacidosis blood ke 15mmol / L (normal 5 ~ 15mmol / L).
4. If urinary pH is alkaline, most consider renal tubular acidosis caused, if found in the urine amino acids, the most likely proximal renal tubular acidosis.
5. Aldosterone in low renin type of plasma renin activity was reduced viremia, aldosterone increased. Certificate in Traditional Chinese Medicine Identification prognostic evaluation standard Western treatment of complications 1. Primary disease under active treatment led to the basic cause of this disease and the specific circumstances.
(1) hypoxia, infection, toxic shock caused by oxygen as soon as possible, rehydration, given sufficient quantities of antibiotics, correction of electrolyte disorders.
(2) diabetic ketoacidosis, the insulin to be enough.
(3) proximal or distal renal tubular acidosis, add enough potassium.
(4) lactic acidosis by acute circulatory failure or respiratory failure caused by treatment of the primary disease can be rapidly improved. Due to other reasons should remove the cause, a rapid and massive supply of alkali salt, the amount of up to hundreds of mmol (usually with sodium bicarbonate, sodium lactate is not available.)
(5) alcoholic acidosis, quickly add saline and glucose.
(6), methanol, ethylene glycol poisoning, intravenous or oral administration of ethanol.
2. The use of basic drugs: mild to having to use basic drugs, or 1 ~ 2g of sodium bicarbonate given orally, 3 times a day. Intensive input from the veins. Renal tubular acidosis is often associated with high potassium prone to urinary tract stones, potassium citrate given orally appropriate.
(1) commonly used drugs: sodium bicarbonate for acidosis, the most commonly used drugs. Concentration of 1.5%, 4% and 5%. sodium lactate: less prone to alkalosis, and more for hyperkalemia, cardiac arrest, and procaine amide, such as the use of excessive Kuining Ding arrhythmia caused by poisoning while and sour. However, under aerobic conditions required by the liver into HCO3-in to correct acidosis, so the oxygen, kidney insufficiency and lactic acidosis, should not be used. 11.2% common solution, 1ml is equal to lmmol, may be required under the above formula ml. 11.2% when the solution with 5% glucose solution or water for injection, diluted 1/6M solution (isotonic solution) intravenously. THAM (Tris III): in body fluids with the H2C03, lactate, pyruvate and other metabolic acids in the H binding, increased HCO3 concentration, it can be used to treat metabolic acidosis, respiratory acidosis, mixed acidosis and sodium restriction are. If the rapid infusion can cause hypotension, hypocalcemia, respiratory depression, overdose can cause severe low blood sugar, such as the leakage of blood vessels during intravenous infusion can cause tissue necrosis. Commonly used are 3.63%, 7.26% two. The required amount of 3.63% THAM solution (ml)
(2) Note: severe acidosis is not appropriate to correct the pH to normal, the general first pH can be corrected to 7.2 rapid rise in PCO2 can correct the acidosis, because CO2 is very easy through the blood-brain barrier, cerebrospinal fluid pH to decrease, it can exacerbate symptoms of central nervous system, and make hemoglobin dissociation curve to the left, further aggravating the hypoxia. Metabolic acidosis cells prone to loss of potassium, so even if the serum potassium levels should pay attention to the normal potassium. Chinese medicine treatment 1. Lung-kidney:
Governing Law: clearing away heat.
Prescription: Radix Ophiopogon Decoction Zhibai Dihuang Wan addition and subtraction. Radix 10g, Radix 10g, Polygonatum 15g, Pollen 15g, heterophylla 30g, habitat 15g, paeonol 10g, Cork 10g, Anemarrhena 10g.Governing Law: nourishes stomach yin, Jiangni vomiting.
Recipe: Wheat Asp Decoction. Radix 18g, heterophylla 15g, rice 15g, law summer 9g, jujube 3, licorice 6g.
3. Coma, faint or troubled treasure may Angongniuhuang Dan served. Chinese Acupuncture and Integrative Medicine Massage preventive care and rehabilitation of historical research


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