内分泌
词汇介绍
拓展阅读
解析
metabolic 英 /ˌmetəˈbɒlɪk/ 美 /ˌmetəˈbɑːlɪk/
释 义 adj. 变化的;新陈代谢的
同根词 metabolism n. 新陈代谢
metabolize vi. 新陈代谢
metabolize vt. 使新陈代谢;使变形
例 句 Building of energy and cellular metabolic substances that are needed for the body. 能量和细胞新陈代谢的皮质的建立那是身体所需要的。
acidosis 英 /,æsɪ'dəʊsɪs/ 美 /,æsɪ'dosɪs/
释 义 n. [内科] 酸中毒,酸毒症;酸液过多症
同根词 acidotic adj. 酸中毒的;定酸量的
acidity n. 酸度;酸性;酸过多;胃酸过多
例 句 In addition, some people think that these children snoring at night acidosis phenomenon, would lead to stagnation in the growth of children. 此外,有人认为这些睡眠打鼾小儿在夜间有酸中毒现象,会导致孩子生长停滞。
概述
概述
代谢性酸中毒是当人体产生过量的酸(例如酮酸或乳酸)时发生的疾病,肾脏无法除去正常代谢产生了的酸,或人体失去太多的碳酸氢根离子。如果不加以控制,则代谢性酸中毒可导致酸血症,从而使得动脉血的pH值低于7.37 ,其原因多种多样,后果可能很严重,包括昏迷和死亡。与呼吸性酸中毒一起,它是酸血症的两个普遍原因之一。
临床表现
症状不是特异的,除非患者有明确的动脉血气采样指征,否则诊断可能会很困难。症状包括心悸,头痛,精神状态改变,如严重的焦虑因缺氧,视力异常,恶心,呕吐,腹痛,食欲改变及体重增加,肌肉无力,骨骼疼痛和关节痛。那些患有代谢性酸中毒的人可能会出现深呼吸,这通常与糖尿病性酮症酸中毒有关。快速的深呼吸增加了呼出的二氧化碳量,从而降低了血清中的二氧化碳水平,导致了一定程度的补偿,不会发生通过呼吸性碱中毒而形成碱血症的过度补偿。
治疗
治疗的目标是治疗潜在疾病,改善肾脏灌注并增加酸排泄。由于心律异常的风险,pH低于7.1是紧急情况,可能需要静脉注射碳酸氢盐治疗。应在严格监测动脉血气读数的同时给予碳酸氢盐。然而,这种干预在乳酸性酸中毒中有一些严重的并发症,在这种情况下,应格外小心,产生碳酸氢盐的潜在风险可能包括钾和钙移位,乳酸产量增加和二氧化碳生成。如果酸中毒特别严重和/或可能存在中毒,可以考虑请肾脏病专家会诊。
Metabolic Acidosis and Subclinical Metabolic Acidosis in CKD复制标题
CKD的代谢性酸中毒和亚临床代谢性酸中毒
发表时间:2018-12-01
影响指数:8.5
作者: Kalani L Raphael
期刊:J Am Soc Nephro
Metabolic acidosis was one of the first recognized complications of kidney failure. Landmark studies identified the importance of reduced renal ammonia production in the pathogenesis of acidosis and effects of acidosis on bone demineralization and protein catabolism. These consequences informed the clinical practice guideline recommendation to treat metabolic acidosis with alkali in CKD. Results from single-center studies suggest that correcting acidosis may also preserve kidney function in CKD. Although these potential benefits require confirmation in a definitive clinical trial, there is accumulating evidence that alkali might preserve kidney function in patients with CKD with normal serum total CO2 (tCO2) as well. If true, this would lead to a significant paradigm shift in how alkali is utilized in CKD. However, it is unclear which patients with normal tCO2 are most likely to benefit from alkali or the dose to prescribe in this setting. The prevalence and risk factors of metabolic acidosis, mechanisms of acid-mediated organ injury, results from interventional studies, and potential harms of alkali therapy are reviewed.Most nondialysis-requiring patients with CKD do not have metabolic acidosis, largely because of compensatory renal ammonia production and bone buffering. When defined as a serum tCO2 ,22 mEq/L, the prevalence of metabolic acidosis is 15%. However, its prevalence increases with worsening kidney function. For example, the prevalence of acidosis was 7% in stage 2, 13% in stage 3, and 37% in stage 4 CKD Chronic Renal Insufficiency Cohort Study (CRIC) participants, and similar trends were observed in the NephroTest Cohort.
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