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As kidney function declines, the tubules lose the ability to excrete excess acid, and this results in buffering of acid using serum bicarbonate, as well as bone and muscle stores. [ 12 ] There are many causes of acute metabolic acidosis, and thus it is helpful to group them by the presence or absence of a normal anion gap.
Metabolic alkalosis is an acid-base disorder in which the pH of tissue is elevated beyond the normal range (7.35–7.45). This is the result of decreased hydrogen ion concentration, leading to increased bicarbonate (HCO − 3), or alternatively a direct result of increased bicarbonate concentrations.
Diabetic ketoacidosis may be diagnosed when the combination of hyperglycemia (high blood sugars), ketones in the blood or on urinalysis and acidosis are demonstrated. [6] In about 10% of cases the blood sugar is not significantly elevated ("euglycemic diabetic ketoacidosis"). [3] A pH measurement is performed to detect acidosis.
Accordingly, measurement of base excess is defined, under a standardized pressure of carbon dioxide, by titrating back to a standardized blood pH of 7.40. The predominant base contributing to base excess is bicarbonate. Thus, a deviation of serum bicarbonate from the reference range is ordinarily mirrored by a deviation in base excess.
the 2001 observation, that non-diabetic offspring of type 2 diabetics had increased arterial stiffness and neuropathy despite normal blood glucose levels, [59] the 2008 observation, that non-diabetic first-degree relatives of diabetics had elevated enzyme levels associated with diabetic renal disease [60] and nephropathy. [61]
The magnitude of this difference (i.e., "gap") in the serum is calculated to identify metabolic acidosis. If the gap is greater than normal, then high anion gap metabolic acidosis is diagnosed. The term "anion gap" usually implies "serum anion gap", but the urine anion gap is also a clinically useful measure. [4] [5] [6] [7]
The version with seven tests is often referred to by medical professionals in the United States as the "CHEM-7", or "SMA-7" (Sequential Multiple Analysis-7). [1] The seven parts of a CHEM-7 are tests for: Four electrolytes: sodium (Na +) [2] potassium (K +) [3] chloride (Cl −) [4] bicarbonate (HCO 3 −) or CO 2 [5] blood urea (BU), blood ...
High anion gap metabolic acidosis is a form of metabolic acidosis characterized by a high anion gap (a medical value based on the concentrations of ions in a patient's serum). Metabolic acidosis occurs when the body produces too much acid , or when the kidneys are not removing enough acid from the body.