The metabolic alcalose is a disorder of the acido-basic balance defined by a rise of pH in the extracellular sector plasma tick.
Is the intracellular pH at the man of 7 (or 7.2?), extracellular pH of 7,4. These values are extremely closely controlled via several mechanisms based on the following equation: H+ + HCO3- <-> H2CO3 <-> H2O + CO2.
- the pulmonary plug makes it possible to eliminate an excess from Acide by hyperventilation (Dyspnée of Kussmaul: Breathing full, major, allowing to reject of CO2 and the steam and thus to make increase the pH.) On the contrary, one bradypnée (slow and surface breathing) involves an accumulation of CO2 and thus an acidification of blood.
- the Rein S have two essential functions:
The physiological standards at the human being are:
- pH : between 7,38 and 7,42.
- Bases : HCO3- = 26 mmol/L
- pCO2 (partial pressure in Carbon dioxide in the Blood) = 40 anion MmHg
- Hole (difference between the acids and the bases in plasma i.e. Na+ + K+ - + Cl-, normally located between 12 and 18.
During the metabolic alcalose, one a:
- a generally high pH (superior with 7,42), but sometimes normal by respiratory compensation (hypoventilation)
- of always high bicarbonates, higher than 26 mmol/L
- a pCO2 generally higher than 42 MmHg by compensation hypoventilation of the alcalose.
EtiologiesThe alcalose occurs consecutively with several anomalies, often associated between them:
- an increased contribution of bases, generally in the form of Bicarbonate of sodium or Bicarbonate of calcium,
- an Acid S, in general by the kidney,
- loss of Chlorine, digestive or renal loss of ,
- a extracellular Dehydration, which involves a concentration of bicarbonates,
- an increased reabsorption of bases by the Rein.
Excessive contribution of basesMaybe by contribution of bicarbonate of sodium (for example at the insufficient renal one), or of bicarbonate of calcium (Syndrome of the “milk drinkers”.
- digestive Losses (the saddles is very rich in chlorine. A Hypokaliémie is often associated): Vomiting S, digestive aspiration, digestive Tumor villous, etc
- renal Losses.
- Disease of Cushing
- Certain rare hereditary tubulopathies
DiagnosisThe clinical diagnosis is aspecific: it associates a muscular tetany, paraesthesias (abnormal feelings), to the maximum of the convulsions. Breathing is in general slow (bradypnée) by compensation. The diagnostic certainty is brought by gases of blood and the blood ionogramme (see higher). Other metabolic anomalies soivent being sought, because they are frequently associated: Hypokaliémie, hypocalcemy.
Treatment etiologicIt is always essential, and often sufficient with the corrections of the metabolic anomalies:
- Stop of an excessive bicarbonate catch,
- Stop or reduction in a treatment by diuretic
- Fight against the vomiting
Symptomatic treatmentIt rests not on an acidification of blood (except exceptional cases), but on the correction of the anomalies associated with the metabolic alcalose, and in particular the chlorinated deficit. This treatment is useful only for the deep alcaloses and/or source of a significant clinical repercussion.
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