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Approach to the patient presenting with metabolic acidosis

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The metabolism of fat and carbohydrates results in large amounts of CO2. Although CO2 is not an acid, it can combine with water to form H2CO3. The accumulation of volatile… Click to show full abstract

The metabolism of fat and carbohydrates results in large amounts of CO2. Although CO2 is not an acid, it can combine with water to form H2CO3. The accumulation of volatile or carbonic acids is prevented through removal of CO2 by ventilation, preventing H accumulation. For the greater part, Western diets will impose a net acid load of 50–100 meq/day to the body. The dietary acid load is primarily due to the generation of H2SO4 from the metabolism of sulphurcontaining amino acids besides incomplete oxidation of fat and carbohydrates also producing a net H load. Large fluctuations in H concentration (and thus pH) would be incompatible with life and thus the regulation of extraand intracellular pH is vital for the preservation of normal cellular function and life in general. The protons delivered to the body by means of non-volatile acids (50–100 meq/day) are immediately buffered in the plasma by the bicarbonate buffer system (see equation). Hþ þ HCO3 $ H2CO3 $ H2O þ CO2

Keywords: approach patient; patient presenting; presenting metabolic; co2; metabolic acidosis; load

Journal Title: Acta Clinica Belgica
Year Published: 2018

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