Electrolyte and acid–base balance

image of Electrolyte and acid–base balance
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The evaluation of electrolytes and acid–base status in critically ill patients is an important tool, both for helping to achieve a rapid diagnosis and for refining patient management. This chapter reviews the relevant physiology and clinical significance of changes in the major electrolytes as well as providing an introduction to acid–base interpretation.

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Image of 5.13
5.13 Schematic representation of the use of anion gap for determining the cause of metabolic acidosis. As plasma electroneutrality must be maintained, the total number of cations must equal the total number of anions. (A) A normal dog, in which the anion gap (AG) represents the difference between the unmeasured cations (UC) and the unmeasured anions (UA). (B) A patient with a metabolic acidosis secondary to loss of bicarbonate. As no other anions have been added to the body, chloride is increased so electroneutrality is maintained and the patient has a normal anion gap (or hyperchloraemic) acidosis. (C) A patient in which the acidosis is caused by addition of an acid (i.e. anion) to the body (e.g. lactate or phosphate). This anion is buffered by bicarbonate which decreases, but as another anion is present chloride does not change. This represents a high anion gap (or normochloraemic) acidosis.
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