Clinical Acid-Base Disorders

  • G. M. Woerlee
Part of the Developments in Critical Care Medicine and Anesthesiology book series (DCCA, volume 18)


This is chapter provides a detailed discussion of the clinical effects of common acid-base disorders encountered by the physician. It contains little discussion on the pathophysiology of these disorders as this is more than adequately covered in other texts. The physiological changes decribed are the unmodified changes produced by these disorders, and as such are not always observed. For this reason, the chapter on factors modifying the manifestations of acid-base disorders has preceded this chapter, and this chapter should be read in conjunction with the preceding chapter [chapter 13.2].


Systemic Vascular Resistance Renal Tubular Acidosis Metabolic Alkalosis Respiratory Acidosis Respiratory Alkalosis 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Diem, K., Lentner, C., (eds.), (1968), “Wissenschaftliche tabellen”, 7th edn., pub. CIBA-GEIGY AG, Basel.Google Scholar
  2. 2.
    Hill, G.L., et al., (1976), Decreased trypsin and bile acids in ileal fistula drainage during the administration of a chemically defined liquid elemental diet. BRITISH JOURNAL OF SURGERY, 63, 133–136.PubMedCrossRefGoogle Scholar
  3. 3.
    Hodgkin, J.E., et al., (1980), Incidence of metabolic alkalemia in hospitalized patients. CRITICAL CARE MEDICINE, 8, 725–728.PubMedCrossRefGoogle Scholar
  4. 4.
    Mithoefer, J.C., et al., (1968), Effect of intravenous NaHCO3 on ventilation and gas exchange in normal man. RESPIRATION PHYSIOLOGY, 4, 132–140.PubMedCrossRefGoogle Scholar
  5. 5.
    Grigor, K.C., et al., (1971), The effect of acetazolamide on postperfusion metabolic alkalosis. BRITISH JOURNAL OF ANAESTHESIA, 43, 352–361.PubMedCrossRefGoogle Scholar
  6. 6.
    Waddell, W.J., Bates, R.J., (1969), Intracellular pH. PHYSIOLOGICAL REVIEWS, 49, 285–329.PubMedGoogle Scholar
  7. 7.
    Poole-Wilson, P.A., Cameron, I.R., (1975), Intracellular pH and K+ of cardiac and skeletal muscle in acidosis and alkalosis. AMERICAN JOURNAL OF PHYSIOLOGY, 229, 1305–1310.PubMedGoogle Scholar
  8. 8.
    Khambatta, H.J., Sullivan, S.F., (1973), Effects of respiratory alkalosis on oxygen consumption and oxygenation. ANESTHESIOLOGY, 38, 53–58.PubMedCrossRefGoogle Scholar
  9. 9.
    Rastegar, H., et al., (1979), Respiratory alkalosis increases tissue oxygen demand. JOURNAL OF SURGICAL RESEARCH, 26, 687–692.8.PubMedCrossRefGoogle Scholar
  10. 10.
    Alexander, S.C., et al., (1965), Cerebral carbohydrate metabolism during hypocarbia in man. Studies during nitrous oxide anesthesia. ANESTHESIOLOGY, 26, 624–632.PubMedCrossRefGoogle Scholar
  11. 11.
    Alexander, S.C., et al., (1968), Cerebral carbohydrate metabolism in man during respiratory and metabolic alakalosis. JOURNAL OF APPLIED PHYSIOLOGY, 24, 66–72.PubMedGoogle Scholar
  12. 12.
    Relman, A.S., (1972), Metabolic consequences of acid-base disorders. KIDNEY INTERNATIONAL, 1, 347–359.PubMedCrossRefGoogle Scholar
  13. 13.
    Bradley, R.D., Semple, S.J.G., (1962), A comparison of certain acid-base characteristics of arterial blood, jugular venous blood and cerebrospinal fluid in man, and the effect on them of some acute and chronic acid-base disturbances. JOURNAL OF PHYSIOLOGY (LONDON), 160, 381–391.PubMedGoogle Scholar
  14. 14.
    Davies, D.G., Nolan, W.F., (1982), Cerebral interstitial fluid acid-base status follows arterial acid-base perturbations. JOURNAL OF APPLIED PHYSIOLOGY, 53, 1551–1555.PubMedGoogle Scholar
  15. 15.
    Euler, von U.S., Lishajko, F., (1963), Influence of pH on uptake and release of noradenaline in adrenergic nerve granules. JOURNAL OF NEUROCHEMISTRY, 10, 145–149.CrossRefGoogle Scholar
  16. 16.
    Nahas, G.G., et al., (1967), Acidemia and catecholamine output in the isolated canine adrenal gland. J AMERICAN JOURNAL OF PHYSIOLOGY, 213, 1186–1192.Google Scholar
  17. 17.
    Tenney, S.M., (1956), Sympatho-adrenal stimulation by carbon dioxide and the inhibitory effect of carbonic acid on epinephrine response. AMERICAN JOURNAL OF PHYSIOLOGY, 187, 341–346.PubMedGoogle Scholar
  18. 18.
    Darby, T.D., Watts, D.T., (1964), Acidosis and blood epinephrine levels in hemorrhagic hypotension. AMERICAN JOURNAL OF PHYSIOLOGY, 206, 1281–1284.PubMedGoogle Scholar
  19. 19.
    Fiorica, V., et al., (1969), Influence of blood pH on adrenomedullary response to hemorrhage. AMERICAN JOURNAL OF PHYSIOLOGY, 217, 1211–1215.PubMedGoogle Scholar
  20. 20.
    Bendixen, H.H., et al., (1963), Influence of respiratory acidosis on circulatory effect of epinephrine in dogs. CIRCULATION RESEARCH, 13, 64–70.PubMedGoogle Scholar
  21. 21.
    Schroeder, J.S., et al., (1970), Effects of respiratory acidosis on circulatory response to isoproterenol. AMERICAN JOURNAL OF PHYSIOLOGY, 218, 448–452.PubMedGoogle Scholar
  22. 22.
    Yakaitis, R.W., et al., (1978), Effects of catecholamines during respiratory alkalosis in dogs. JOURNAL OF APPLIED PHYSIOLOGY, 44, 581–584.PubMedGoogle Scholar
  23. 23.
    Hassan, H., et al., (1979), Hypercapnia and hyperkalemia. ANAESTHESIA, 34, 897–889.PubMedCrossRefGoogle Scholar
  24. 24.
    Edwards, R., et al., (1977), Acute hypocapneic hypokalemia: An iatrogenic anesthetic complication. ANESTHESIA AND ANALGESIA, 56, 786–792.PubMedCrossRefGoogle Scholar
  25. 25.
    Orringer, C.E., et al., (1977), Natural history of lactic acidosis after grand-mal seizures. A model for the srudyl of an anion-gap acidosis not associated with hyperkalemia. NEW ENGLAND JOURNAL OF MEDICINE, 297, 796–799.PubMedCrossRefGoogle Scholar
  26. 26.
    Fulop, M., (1979), Serum potassium in lactic acidosis and ketoacidosis. NEW ENGLAND JOURNAL OF MEDICINE, 300, 1087–1089.PubMedCrossRefGoogle Scholar
  27. 27.
    Wilson, R.F., et al., (1972), Severe alkalosis in critically ill surgical patients. ARCHIVES OF SURGERY, 105, 197–203.PubMedGoogle Scholar
  28. 28.
    Vaughan-Williams, E.M., Whyte, J.M., (1967), Chemosensitivity of cardiac muscle. JOURNAL OF PHYSIOLOGY (LONDON), 189, 119–137.Google Scholar
  29. 29.
    Campbell, G.S., (1955), Cardiac arrest: Further studies on the effect of pH changes on vagal inhibition of the heart. SURGERY, 38, 615–634.PubMedGoogle Scholar
  30. 30.
    Gerst, P.H., et al., (1966), A quantitative evaluation of the effects of acidosis and alkalosis upon the ventricular fibrillation threshold. SURGERY, 59, 1050–1060.PubMedGoogle Scholar
  31. 31.
    Katz, A.M., (1973), Effects of ischaemia on the contractile processes of heart muscle. AMERICAN JOURNAL OF CARDIOLOGY, 32, 456–460.PubMedCrossRefGoogle Scholar
  32. 32.
    Poole-Wilson, P.A., Langer, G.A., (1979), Effects of acidosis on mechan ical function and Ca2+ exchange in rabbit myocardium. AMERICAN JOURNAL OF PHYSIOLOGY, 236, H525–H533.PubMedGoogle Scholar
  33. 33.
    Nahas, G.G., Cavert, H.M., (1957), Cardiac depressant effect of CO2 and its reversal. AMERICAN JOURNAL OF PHYSIOLOGY, 190, 483–491.PubMedGoogle Scholar
  34. 34.
    Bos, van den, G.C., et al., (1979), Effect of carbon dioxide on myocardial contractile performance, blood flow and oxygen consumption. JOURNAL OF PHYSIOLOGY (LONDON), 287, 149–161.PubMedGoogle Scholar
  35. 35.
    Clancy, R.L., et al., (1967), Influence of sodium bicarbonate on myocardial performance. AMERICAN JOURNAL OF PHYSIOLOGY, 212, 917–923.PubMedGoogle Scholar
  36. 36.
    Wead, W.B., Little, R.C., (1967), Effect of hypocapnia and respiratory alkalosis on cardiac contractility. PROCEEDINGS OF THE SOCIETY FOR EXPERIMENTAL BIOLOGY & MEDICINE, 126, 606–609.Google Scholar
  37. 37.
    Poole-Wilson, P.A., (1982), Acidosis and contractility of heart muscle. CIBA FOUNDATION SYMPOSIUM, 87, 58–76.PubMedGoogle Scholar
  38. 38.
    Steinhart, C.R., et al., (1983), β-adenergic activity and cardiovascular response to severe respiratory acidosis. AMERICAN JOURNAL OF PHYSIOLOGY, 244, H46–H54.PubMedGoogle Scholar
  39. 39.
    Frumin, M J., et al., (1959), Apneic oxygenation in man. ANESTHESIOLOGY, 20, 789–798.PubMedCrossRefGoogle Scholar
  40. 40.
    Wollman, H., et al., (1968), Effects of extremes of respiratory and metabolic alkalosis on cerebral blood flow in man. JOURNAL OF APPLIED PHYSIOLOGY, 24, 60–65.PubMedGoogle Scholar
  41. 41.
    Cullen, D.J., Eger, E.I., (1974), Cardiovascular effects of carbon dioxide in man. ANESTHESIOLOGY, 41, 345–349.PubMedCrossRefGoogle Scholar
  42. 42.
    Kittle, C.F., et al., (1965), The role of pH and CO2 in the distribution of blood flow. SURGERY, 57, 139–153.PubMedGoogle Scholar
  43. 43.
    Richardson, D.W., et al., (1972), Systemic circulatory responses to hypocapnia in man. AMERICAN JOURNAL OF PHYSIOLOGY, 223, 1308–1312.PubMedGoogle Scholar
  44. 44.
    Ainslie, S.G., et al., (1979), Fentanyl concentrations in brain and serum during respiratory acid-base changes in the dog. ANESTHESIOLOGY, 51, 293–297.PubMedCrossRefGoogle Scholar
  45. 45.
    Schulman, D.S., et al., (1984), Blood pH and brain uptake of C14 morphine. ANESTHESIOLOGY, 61, 540–543.PubMedCrossRefGoogle Scholar
  46. 46.
    Tuller, M.A., Mehdi, F., (1971), Compensatory hypoventilation and hypercapnia in primary metabolic alkalosis. AMERICAN JOURNAL OF MEDICINE, 50, 281–290.PubMedCrossRefGoogle Scholar
  47. 47.
    Kety, S.S., Schmidt, C.F., (1946), The effects of acive and passive hyperventilation on cerebral blood flow, cerebral oxygen consumption, cardiac output, and blood pressure of normal young men. JOURNAL OF CLINICAL INVESTIGATION, 25, 107–119.CrossRefGoogle Scholar
  48. 48.
    Edmondson, J.W., et al., (1976), Tetany: Quantitative interrelationships between calcium and alkalosis. AMERICAN JOURNAL OF PHYSIOLOGY, 228, 1082–1086.Google Scholar
  49. 49.
    Rotheram, E.B., et al., (1964), CNS disorder during mechanical ventilation in chronic pulmonary disease. JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 189, 993–997.PubMedGoogle Scholar
  50. 50.
    Kilburn, K.H., (1966), Shock, seizures and coma with alkalosis during mechanical ventilation. ANNALS OF INTERNAL MEDICINE, 65, 977–984.PubMedGoogle Scholar
  51. 51.
    Mudge, G.H., (1966), Influence of plasma composition on sodium excretion and diuretic action. ANNALS OF THE NEW YORK ACADEMY OF SCIENCES, 139, 304–311.PubMedCrossRefGoogle Scholar
  52. 52.
    Williams, D.B., Lyons, J.H. (1980), Treatment of severe metabolic alkalosis with intravenous solution of hydrochloric acid. SURGERY, GYNECOLOGY & OBSTETRICS, 150, 315–321.Google Scholar
  53. 53.
    Harkeny, A.H., et al., (1975), Hydrochloric acid in the correction of metabolic alkalosis. ARCHIVES OF SURGERY, 110,819–821.Google Scholar
  54. 54.
    Berthelson, P., et al., (1986), Dissociation of renal and respiratory effects of acetazolamide in the critcally ill. BRITISH JOURNAL OF ANAESTHESIA, 58, 512–516.CrossRefGoogle Scholar

Copyright information

© Kluwer Academic Publishers 1988

Authors and Affiliations

  • G. M. Woerlee
    • 1
  1. 1.Department of AnaesthesiaUniversity Hospital of LeidenThe Netherlands

Personalised recommendations