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disorder, more than one is occurring at the same time. Mixed disorders may feature an acidosis and alkosis at the same time that partially counteract each other, or there can be two different conditions affecting the pH in the same direction. The phrase "mixed acidosis", for example, refers to
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Symbol relating the hydrogen ion concentration or activity of a solution to that of a standard solution; approximately equal to the negative logarithm of the hydrogen ion concentration. pH is an indicator of the relative acidity or alkalinity of a
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or alkalemia. The process that causes the imbalance is classified based on the cause of the disturbance (respiratory or metabolic) and the direction of change in pH (acidosis or alkalosis). This yields the following four basic processes:
781:
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Yeomans, ER; Hauth, JC; Gilstrap, LC III; Strickland DM (1985). "Umbilical cord pH, PCO2, and bicarbonate following uncomplicated term vaginal deliveries (146 infants)".
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buffer. In responses to alkalosis, the kidney may excrete more bicarbonate by decreasing hydrogen ion secretion from the tubular epithelial cells, and lowering rates of
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There are numerous reasons that each of the four processes can occur (detailed in each article). Generally speaking, sources of acid gain include:
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Acid–base imbalances that overcome the buffer system can be compensated in the short term by changing the rate of
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has several powerful mechanisms to control pH by the excretion of excess acid or base. In responses to acidosis,
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pH is normally 7.18 to 7.38). It can exist in varying levels of severity, some life-threatening.
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657:. Any combination is possible, as metabolic acidosis and alkalosis can co exist together.
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1411:"Mixed Acid Base Disorders: Acid Base Tutorial, University of Connecticut Health Center"
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Stewart P (1978). "Independent and dependent variables of acid-base control".
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1315:, which in turn alters the pH. For instance, if the blood pH drops too low (
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The traditional approach to the study of acid–base physiology has been the
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1293:{\displaystyle {\ce {HCO_3^- + H+ <=> H2CO3 <=> CO2 + H2O}}}
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exist which reversibly bind hydrogen ions and impede any change in pH.
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192:, the normal range differs based on which umbilical vessel is sampled (
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Alveolar-arterial oxygen tension difference. The term formerly used (
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2002:
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1319:), the body will compensate by increasing breathing, expelling CO
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Abnormality of the human body's normal balance of acids and bases
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Use of hydrogen ions in the metabolism of various organic anions
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cells secrete more hydrogen and generate more bicarbonate, and
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The presence of only one of the above derangements is called a
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to deviate out of the normal range (7.35 to 7.45). In the
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cells reabsorb more bicarbonate from the tubular fluid,
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in the blood, shifting the above reaction according to
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Oxygen saturation of the hemoglobin of arterial blood
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Alveolar carbon dioxide tension, or partial pressure
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Arterial carbon dioxide tension, or partial pressure
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60:. Unsourced material may be challenged and removed.
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506:or acidemia, while an excess in bases is called
441:Oxygen saturation as measured by pulse oximetry
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177:is an abnormality of the human body's normal
8:
243:Alveolar oxygen tension, or partial pressure
226:Arterial oxygen tension, or partial pressure
209:Blood gas, acid-base, and gas exchange terms
208:
156:illustrates acid–base imbalance graphically.
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1977:
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707:from the metabolism of proteins and other
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120:Learn how and when to remove this message
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1579:Stewart's original text at acidbase.org
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1155:
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904:
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407:Arteriovenous oxygen content difference
1350:leads to increased formation of the NH
207:
7:
669:approach. The main variants are the
294:Oxygen tension of mixed venous blood
58:adding citations to reliable sources
1787:Mixed disorder of acid-base balance
1307:. This alters the concentration of
1547:On-line text at AnaesthesiaMCQ.com
1358:metabolism and ammonia excretion.
727:Intake of acids or acid precursors
25:
354:Alveolar-arterial tension ratio;
1604:Online acid–base physiology text
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458:Oxygen content of arterial blood
34:
45:needs additional citations for
2216:Fractional excretion of sodium
1614:Interpretation at nda.ox.ac.uk
1609:Diagnoses at lakesidepress.com
1558:Essentials of Human Physiology
1334:are slower to compensate, but
1248:
1223:
1182:
1157:
1052:is tightly regulated. Several
731:Sources of acid loss include:
1:
196:pH is normally 7.25 to 7.45;
1589:Overview at anaesthetist.com
1449:10.1016/0034-5687(78)90079-8
1389:10.1016/0002-9378(85)90523-x
1082:bicarbonate buffering system
760:Carbon dioxide loss through
502:An excess of acid is called
2194:Effective renal plasma flow
2038:Intracellular fluid/Cytosol
2407:
2143:Glomerular filtration rate
2135:Assessment and measurement
1998:Atrial natriuretic peptide
1554:"Section 7/7ch12/7ch12lin"
179:balance of acids and bases
2226:Tubuloglomerular feedback
2153:Augmented renal clearance
2110:Bicarbonate buffer system
1834:Physiology of the kidneys
1599:Tutorial at acid-base.com
1092:) can be shifted through
644:acid–base disorder. In a
471:
151:
142:
2307:Renin–angiotensin system
2115:Respiratory compensation
1872:Clearance of medications
1584:Overview at med.utah.edu
1313:Le Chatelier's principle
872:Self-ionization of water
857:Hammett acidity function
661:Calculation of imbalance
2221:BUN-to-creatinine ratio
1956:Countercurrent exchange
1327:, the opposite occurs.
1104:) to hydrogen ions and
681:approach introduced by
2381:Acid–base disturbances
1695:Alcoholic ketoacidosis
1594:Overview at anst.uu.se
1294:
1084:is especially key, as
2386:Equilibrium chemistry
2158:Renal clearance ratio
2077:Darrow Yannet diagram
1792:Acid–base homeostasis
1764:Contraction alkalosis
1690:Diabetic ketoacidosis
1574:Overview at mcgill.ca
1295:
887:Frustrated Lewis pair
847:Equilibrium chemistry
837:Dissociation constant
807:Acid–base homeostasis
611:respiratory alkalosis
382:describes this ratio.
379:oxygen exchange index
2376:Acid–base physiology
2183:Hemodialysis product
2163:Urea reduction ratio
2148:Creatinine clearance
1988:Antidiuretic hormone
1838:acid–base physiology
1569:Overview at kumc.edu
1119:
882:Lewis acid catalysis
738:Loss of acid in the
655:respiratory acidosis
653:in conjunction with
563:respiratory acidosis
69:"Acid–base disorder"
54:improve this article
2391:Respiratory therapy
2059:Transcellular fluid
2043:Extracellular fluid
1961:Filtration fraction
1655:Acid–base disorders
1377:Am J Obstet Gynecol
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1269:
1234:
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1203:
1168:
1137:
587:metabolic alkalosis
210:
175:Acid–base imbalance
138:Acid–base imbalance
18:Acid–base imbalance
2120:Renal compensation
2049:Interstitial fluid
1619:Acid Base Tutorial
1290:
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1253:
1204:
1191:
1187:
1123:
1112:) as shown below.
802:Acid–base reaction
749:Gastric aspiration
685:in 1978 is newer.
651:metabolic acidosis
539:metabolic acidosis
2371:Human homeostasis
2358:
2357:
2285:Blood composition
2278:Human homeostasis
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2178:Dialysis adequacy
2173:Standardized Kt/V
2129:
2128:
2087:Davenport diagram
2070:Acid–base balance
1969:
1968:
1946:Renal plasma flow
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1552:Nosek, Thomas M.
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1050:acid–base balance
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892:Chiral Lewis acid
709:organic molecules
705:nonvolatile acids
673:approach and the
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329:) is discouraged.
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167:Internal medicine
154:Davenport diagram
132:Medical condition
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16:(Redirected from
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2350:Thermoregulation
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2199:Extraction ratio
2102:Winters' formula
1978:
1941:Renal blood flow
1867:Pharmacokinetics
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1707:Normal anion gap
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1560:. Archived from
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1413:. Archived from
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1974:Other functions
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636:Mixed disorders
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1564:on 2016-03-24.
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1476:Classification
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1468:External links
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1437:Respir Physiol
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1383:(6): 798–800.
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2319:Fluid balance
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2305:
2304:
2303:
2300:
2298:
2295:
2293:
2290:
2289:
2287:
2283:
2279:
2272:
2267:
2265:
2260:
2258:
2253:
2252:
2249:
2237:
2234:
2232:
2229:
2227:
2224:
2222:
2219:
2217:
2214:
2213:
2211:
2207:
2200:
2197:
2195:
2191:
2190:PAH clearance
2188:
2184:
2181:
2180:
2179:
2176:
2174:
2171:
2169:
2166:
2164:
2161:
2159:
2156:
2154:
2151:
2149:
2146:
2144:
2141:
2140:
2138:
2136:
2132:
2121:
2118:
2116:
2113:
2111:
2108:
2107:
2105:
2103:
2100:
2097:
2093:
2090:
2088:
2085:
2083:
2080:
2078:
2075:
2073:
2071:
2067:
2060:
2057:
2055:
2052:
2050:
2046:
2044:
2041:
2040:
2039:
2035:
2031:
2029:
2028:Fluid balance
2025:
2019:
2016:
2014:
2011:
2009:
2006:
2004:
2001:
1999:
1996:
1994:
1991:
1989:
1986:
1985:
1983:
1979:
1976:
1972:
1962:
1959:
1957:
1954:
1952:
1949:
1947:
1944:
1942:
1939:
1938:
1936:
1934:
1930:
1924:
1921:
1919:
1918:Oligopeptides
1916:
1914:
1911:
1909:
1906:
1904:
1901:
1899:
1896:
1894:
1891:
1890:
1888:
1884:
1878:
1875:
1873:
1870:
1868:
1865:
1863:
1860:
1859:
1857:
1853:
1850:
1848:
1843:
1839:
1835:
1828:
1823:
1821:
1816:
1814:
1809:
1808:
1805:
1793:
1790:
1788:
1785:
1784:
1782:
1778:
1772:
1769:
1765:
1762:
1761:
1760:
1757:
1756:
1754:
1752:
1748:
1738:
1735:
1734:
1732:
1730:
1726:
1718:
1717:Renal tubular
1715:
1713:
1710:
1709:
1708:
1705:
1701:
1698:
1696:
1693:
1691:
1688:
1686:
1683:
1682:
1681:
1678:
1677:
1675:
1673:
1669:
1666:
1664:
1660:
1656:
1649:
1644:
1642:
1637:
1635:
1630:
1629:
1626:
1620:
1617:
1615:
1612:
1610:
1607:
1605:
1602:
1600:
1597:
1595:
1592:
1590:
1587:
1585:
1582:
1580:
1577:
1575:
1572:
1570:
1567:
1563:
1559:
1555:
1550:
1548:
1545:
1544:
1534:
1530:
1529:
1525:
1523:
1519:
1515:
1514:
1510:
1506:
1504:
1500:
1496:
1495:
1491:
1487:
1486:
1483:
1478:
1474:
1467:
1458:
1454:
1450:
1446:
1442:
1438:
1431:
1428:
1417:on 2009-04-26
1416:
1412:
1406:
1403:
1398:
1394:
1390:
1386:
1382:
1378:
1371:
1368:
1361:
1359:
1357:
1349:
1345:
1341:
1337:
1333:
1328:
1326:
1318:
1314:
1310:
1306:
1278:
1270:
1262:
1241:
1230:
1209:
1196:
1175:
1164:
1146:
1138:
1133:
1128:
1115:
1114:
1113:
1107:
1095:
1094:carbonic acid
1087:
1083:
1080:buffers. The
1079:
1078:intracellular
1075:
1071:
1067:
1063:
1059:
1058:Extracellular
1055:
1051:
1039:
1034:
1032:
1027:
1025:
1020:
1019:
1017:
1016:
1011:
1008:
1006:
1003:
1001:
998:
996:
993:
991:
988:
986:
983:
981:
978:
976:
973:
972:
971:
970:
966:
962:
957:
954:
952:
949:
947:
944:
942:
939:
937:
934:
932:
929:
927:
924:
922:
919:
917:
914:
913:
912:
911:
907:
903:
898:
895:
893:
890:
888:
885:
883:
880:
878:
875:
873:
870:
868:
865:
863:
860:
858:
855:
853:
850:
848:
845:
843:
840:
838:
835:
833:
830:
828:
825:
823:
820:
818:
815:
813:
812:Acid strength
810:
808:
805:
803:
800:
798:
795:
793:
790:
789:
788:
787:
783:
779:
778:
773:
767:
763:
759:
757:
753:
750:
747:
745:
741:
737:
734:
733:
732:
726:
724:
720:
716:
712:
710:
706:
702:
700:
697:Retention of
696:
695:
694:
688:
686:
684:
680:
676:
672:
668:
660:
658:
656:
652:
647:
643:
635:
628:
621:
614:
612:
609:
608:
604:
597:
590:
588:
585:
584:
580:
573:
566:
564:
561:
560:
556:
549:
542:
540:
537:
536:
533:compensation
532:
530:
524:
522:
519:
516:
515:
512:
509:
505:
493:
488:
486:
481:
479:
474:
473:
470:
465:
461:
457:
444:
440:
427:
423:
410:
406:
398:
394:
389:
385:
381:
380:
371:
360:
353:
345:
341:
336:
332:
318:
310:
306:
301:
297:
293:
280:
276:
263:
259:
246:
242:
229:
225:
212:
203:
201:
199:
195:
191:
187:
184:
180:
176:
168:
165:
163:
159:
155:
150:
146:
141:
136:
124:
121:
113:
110:December 2010
102:
99:
95:
92:
88:
85:
81:
78:
74:
71: –
70:
66:
65:Find sources:
59:
55:
49:
48:
43:This article
41:
37:
32:
31:
19:
2329:Proteostasis
1893:Solvent drag
1886:Reabsorption
1685:Ketoacidosis
1654:
1562:the original
1557:
1526:
1507:
1488:
1440:
1436:
1430:
1419:. Retrieved
1415:the original
1405:
1380:
1376:
1370:
1329:
1324:
1316:
1302:
1047:
842:Donor number
768:Compensation
730:
692:
679:quantitative
664:
645:
641:
639:
605:respiratory
557:respiratory
501:
396:
392:
387:
377:
366:
355:
343:
339:
334:
308:
304:
299:
174:
173:
116:
107:
97:
90:
83:
76:
64:
52:Please help
47:verification
44:
2292:Blood sugar
2231:Natriuresis
2096:Delta ratio
2082:Base excess
1993:Aldosterone
1771:Respiratory
1737:Respiratory
1729:Respiratory
1443:(1): 9–26.
1305:ventilation
1106:bicarbonate
1062:bicarbonate
1048:The body's
822:Amphoterism
751:in hospital
715:bicarbonate
675:bicarbonate
671:base excess
2365:Categories
2345:Predictive
2324:Hemostasis
2106:Buffering
2034:Body water
2013:Calcitriol
1933:Filtration
1421:2009-05-09
1362:References
1000:Superbases
946:Superacids
852:Extraction
80:newspapers
2314:Acid–base
2092:Anion gap
1862:Clearance
1855:Secretion
1845:Creating
1759:Metabolic
1751:Alkalosis
1672:Metabolic
1356:glutamine
1325:alkalemia
1249:⇀
1242:−
1231:−
1224:↽
1183:⇀
1176:−
1165:−
1158:↽
1134:−
1074:phosphate
897:ECW model
877:Titration
667:empirical
508:alkalosis
376:The term
162:Specialty
1981:Hormones
1903:Chloride
1663:Acidosis
1317:acidemia
1070:proteins
1068:, while
756:diarrhea
713:Loss of
504:acidosis
467:solution
1923:Protein
1913:Glucose
1533:D000137
1397:3919587
1340:tubular
1332:kidneys
1076:act as
1066:ammonia
985:Organic
931:Organic
926:Mineral
754:Severe
740:vomitus
517:process
94:scholar
2054:Plasma
1898:Sodium
1700:Lactic
1455:
1395:
995:Strong
941:Strong
689:Causes
642:simple
629:renal
581:renal
183:plasma
96:
89:
82:
75:
67:
2338:Other
2236:Urine
2209:Other
2003:Renin
1847:urine
1780:Other
1522:276.4
1518:276.2
1503:E87.4
1499:E87.2
1457:27857
990:Oxide
980:Lewis
967:types
956:Solid
936:Oxide
921:Lewis
908:types
744:urine
723:urine
719:feces
646:mixed
321:A-a D
190:fetus
101:JSTOR
87:books
2168:Kt/V
1908:Urea
1836:and
1528:MeSH
1513:9-CM
1453:PMID
1393:PMID
1330:The
1108:(HCO
1072:and
1064:and
1010:Weak
965:Base
951:Weak
906:Acid
827:Base
797:Acid
73:news
1509:ICD
1490:ICD
1445:doi
1385:doi
1381:151
1125:HCO
1088:(CO
742:or
721:or
717:in
56:by
2367::
2036::
1556:.
1531::
1516::
1497::
1494:10
1451:.
1441:33
1439:.
1391:.
1379:.
1259:CO
1206:CO
1100:CO
1096:(H
862:pH
526:CO
521:pH
463:pH
271:CO
254:CO
186:pH
152:A
2270:e
2263:t
2256:v
2201:)
2192:(
2098:)
2094:(
2061:)
2047:(
1826:e
1819:t
1812:v
1647:e
1640:t
1633:v
1520:-
1511:-
1501:-
1492:-
1482:D
1459:.
1447::
1424:.
1399:.
1387::
1352:3
1321:2
1287:O
1279:2
1275:H
1271:+
1263:2
1210:3
1197:2
1193:H
1147:+
1143:H
1139:+
1129:3
1110:3
1102:3
1098:2
1090:2
1037:e
1030:t
1023:v
528:2
491:e
484:t
477:v
454:2
452:O
449:a
447:C
437:2
435:O
432:p
430:S
420:2
418:O
415:a
413:S
403:2
401:O
399:)
397:v
395:-
393:a
391:(
388:C
374:2
372:O
369:A
367:P
365::
363:2
361:O
358:a
356:P
350:2
348:O
346:)
344:A
342:/
340:a
338:(
335:P
325:2
323:O
315:2
313:O
311:)
309:a
307:-
305:A
303:(
300:P
290:2
288:O
285:v
283:P
273:2
268:A
266:P
256:2
251:a
249:P
239:2
237:O
234:A
232:P
222:2
220:O
217:a
215:P
123:)
117:(
112:)
108:(
98:·
91:·
84:·
77:·
50:.
20:)
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