Acid-Base Compensation: What is it, and how to prevent it?

Acid-base Compensation is the relative constancy of the acid-base relationship of the internal environment of a living organism, particularly when it comes to the renal system. Also called acid-base balance, acid-base balance, equilibrium of acids and bases. It is an integral part of homeostasis. Quantitatively it is characterized either by the concentration of hydrogen ions in moles per one liter or by the hydrogen pH. The tissues of a living organism are very sensitive to fluctuations in the pH value – outside the permissible range, protein denaturation occurs: cells are destroyed, enzymes lose their ability to perform their functions, and the body can die. Therefore, the acid-base balance in the body is tightly regulated. There are several buffer systems that reversibly bind hydrogen ions and prevent any changes in pH. The bicarbonate buffer system (the most powerful and most controllable among buffer systems) is particularly important: an excess of protons interacts with bicarbonate ions (metabolic alkalosis) to form carbonic acid. Further decrease in the amount of carbonic acid occurs as a result of an accelerated release of carbon dioxide as a result of hyperventilation of the lungs (concentration is determined by the pressure in the alveolar gas mixture.)

There are several approaches for the evaluation and classification of acid-base balance alterations. The physicochemical proposal is the most recent and is based on the difference of strong ions, the total concentration of weak plasma acids and the partial pressure of arterial carbon dioxide. Of great acceptance among anesthesiologists and intensivists, it is a tremendous complex approach, both technical and interpretation. Therefore, in this post, the physiological approach will be used, based on pH, and plasma bicarbonate, which is the simplest, most rigorous and practical way to systematically classify and treat alterations in the acid-base balance.

First of all acid-base disorder must answer three basic questions. The first has to do with what disorder it is. The second, if the secondary response is adequate. The third, about the cause of the disorder. Metabolic acidosis is divided according to the value of the anionic hiatus. Acidosis with increased anionic hiatus: acid gain, endogenous or exogenous, predominates. They are normochloremic acidosis. Acidosis with normal anionic hiatus: the loss of bicarbonate outside the body predominates. They are called hyperchloremic acidosis.

Approximately three-quarters of the value of the anion hiatus correspond to serum albumin, which is an anion, so in the assessment of the anion, hiatus should be taken into account if hypoalbuminemia, as well as other circumstances.

The acid-base balance of the organism is possible thanks to the interrelation of three systems: intracellular and extracellular tampons, which cushion in a minute the acute changes of acid-base balance; respiratory compensation, which starts in minutes and is completed in hours, and renal excretion of excess acids, which takes more time. The total buffer capacity of the organism is about one thousand mMol (forty percent in the extracellular space, and sixty in the intracellular space.)

To plan an adequate treatment, and as in any acid-base disorder, it is essential to identify secondary responses (compensation mechanisms), whether these are adequate or not, and whether there are other acid-base mixed disorders or associated electrolyte disorders.

Read also: How to reduce the chances of suffering renal failure, by Joe Cosgrove

In metabolic acidosis, the key aspect of treatment lies in blocking the source of acid production (eg, by providing insulin in diabetic ketoacidosis,) always taking into account the compensations that exist, the rate of acid production and its cause (lactic acidosis due to hypoxia or alcohol intoxication are more serious due to its rapid evolution.) Special caution when planning treatment deserves the detection of hypokalemia since it implies a serious potassium deficit. The replacement of bicarbonate should be very cautious, applied only in certain circumstances (eg, extreme hyperkalemia, potentially fatal drops in pH,) and always assessing the risks and benefits. The only objective is to gain time until the homeostatic mechanisms manage to increase the pH.

To the problem of acidosis due to keto acids caused by insulin deficiency, water deficit, circulating volume deficit, the coexistence of lactic acidosis and potassium deficit, which in turn depends on the duration and magnitude of polyuria secondary to poor glycemic control, and the degree of replacement of losses.

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The general treatment plan should include, therefore: Insulin, re-expansion of the extracellular volume, correction of possible potassium deficit, and the decision to administer or not bicarbonate should be valued with great caution. The alterations in the bicarbonate concentration or the partial pressure of carbon dioxide in the arterial blood are accompanied by a compensatory response in the other element. If the compensation is adequate or it will not allow detecting if there is a second or third associated disorder, in what constitute the mixed disorders that are very frequent in clinical practice and that implies a greater severity.

In order to detect mixed disorders, it must be taken into account that a compensation will never be able to normalize the pH. Its treatment and the priority of the actions to follow will depend on the cause and predominant acid-base disorder, always taking into account the associated electrolyte alterations.

Recommended: Acid-Base Disorders

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Two of the most important dialysis procedures

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As we have seen in previous articles, one of the most important terms in medicine, more specifically in the renal system is dialysis. This is one of the most significant procedures for those people with kidney problems, which gives to them the possibility of having a better health quality and the opportunity for living a more normal life. In other words, thanks to this medical process, people with kidney failures can have a new chance for passing better days.

In this post, we will talk about the two principal dialysis types: the peritoneal dialysis and the Hemodialysis. Before talking about these two vital medical procedures, it is important to have a better context about what a dialysis is and why it is important for those persons with kidney issues. In addition, it is significant to show some other alternatives for the treatment of kidney diseases.

Dialysis and other treatments

We can define dialysis as the medical procedure for cleaning the blood of those people with kidney failures. Put differently, it is the artificial way for eliminating waste and other components in the blood in those persons that have problems in their renal system with the impossibility for removing all these elements by themselves. Usually, the people who need dialysis are the ones with critical renal failures. For those that do not have chronic issues, there are different and less traumatic treatments.

It is important to say, as we have mentioned in this blog, that the renal system is in charge of keeping the right levels of water and minerals in the blood. Through this vital part of the body, elements like potassium, sodium, calcium, chloride, magnesium, phosphorus and sulfate are metabolized, maintaining the required levels of these minerals for the correct performance of the human body. When kidneys and other components of this system are not working correctly for doing this, then a medical treatment is needed. If it is critical, a dialysis procedure will be required.

Having clear what a dialysis is and when it is needed, then we can talk about other renal treatments. Sometimes, when the kidney failure is not so critical, there are medicines that let the renal system to keep the adequate mineral and water levels in the blood. Another alternative is a surgery. One of the best solutions for those persons with kidney failures is a transplant, giving to the affected the possibility of having a normal working in its renal system. However, this is a more complex alternative, due to the high demand of kidneys in the world.

Hemodialysis

Under this procedure, the patient or the affected is connected into a medical dispositive called dialyzer. This mechanism cleans the blood after receiving it from the body. Here, the blood is purified, removing from it all those wasting elements which can not be eliminated by the renal system of the patient. After the blood is cleaned, it is introduced in the body, giving into it the right levels of water and minerals. In other words, through a hemodialysis, the blood is extracted for being filtered and purified in a dialyzer, then it is returned to the body.

Usually, the hemodialysis process is executed in hospitals or medical institutions, but there is the possibility of doing it at home. Some clinics give this alternative to their patients, but it requires a specialized person that understands and know how to make this procedure. It is important to say that a dialysis is usually an outpatient process and can take a few hours to be accomplished.

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Peritoneal dialysis

With a Peritoneal dialysis, the patient can clean its blood through a medical element called dialysate. Basically, with this process, it is introduced glucose through the peritoneal cavity with a tiny tube, so the peritoneal membrane works as a filter, cleaning the blood and purifying it.

This procedure is designed for being applied between 4 or 5 times in a day and for some experts, it is less efficient than an hemodialysis. The Peritoneal dialysis is used not only for cleaning the blood from toxins and other elements, but also for removing excessive fluids and to correct electrolyte problems.

However, this procedure can bring some issues to the patient, like high blood sugar levels, abdominal infections, hernias, abdomen bleeding, or catheter blocking. In other words, the Peritoneal dialysis is an excellent alternative, but for being a medical procedure where a tube is introduced into the peritoneal cavity, some problems may occur.

We have seen in this article two of the principal alternatives for treating kidney issues with dialysis, but there are other processes like the Hemofiltration, the Hemodiafiltration, the Intestinal dialysis or the Pediatric dialysis, which are excellent options depending on the patient and the condition of its renal system. In addition, it is important to say that for those situations where the renal failure is not chronic, other alternatives must be considered, like medicines or surgeries.

Related: Everything You Need to Know About Pediatric Dialysis by Joe Cosgrove

Some kidney facts you need to know

In previous articles, we have talked about a lot of topics related to kidney and its functioning, but there are a lot of information around this you need to know and understand for this vital organ.

In this article, we will see significant facts and statistics about the renal system and other concerning information of kidney and its diseases. These stats are very important because it lets us to comprehend in a better way how this vital organ is in the United States, giving us important insights about it.

Before talking about renal statistics and other facts, it is important to describe barely some kidney functioning information and its illnesses for a better insights appreciation.

Kidney and its disease

As we have said in other articles, the kidney is the organ what regulates the body’s fluid levels, cleaning it from multiple toxins and wastes. In other words, the kidney is in charge of filtering and cleaning the blood from multiple impurities. Besides its main function, the renal system releases a vital hormone to regulate blood pressure and produce red blood cells, keeping it in the perfect balance and with the needed minerals, like sodium, phosphorus, and potassium

The kidney is the principal figure for the renal system, being who regulates and controls everything in it. It is in charge for filter impurities in every piece of blood presented in the body. In resume, it is the organ who take all the blood from the body and cleans it to keep it with the correct fluid levels.

Currently, in the United States, there is one in three Americans with risk for suffering some kidney disease, due to their food habits or other conditions, like diabetes, hereditary illnesses, elevated blood pressure, smoking, obesity and alcohol drinking. Presently, in the United States, there are more than 26 million people with some renal failure, where more than the 60% of these affectations is caused by diabetes or elevated blood pressure. These failures are considered one of the deadliest causes in this country, killing approximately 55.000 persons per year, most of them men.

How to detect kidney failure?

Those persons who are at risk for suffering some kidney disease must take periodically blood and urine tests to check if they have renal problems. In addition, those people who have painful urination, dark urine, swollen hands, and feet or elevated thirst, could be at risk for suffering some renal sickness and should take some of the mentioned exams to verify if they have problems or not.

Principal kidney diseases facts

Kidney stones

As we have mentioned in other posts, kidney stones are produced for the accumulation of different minerals in the renal system, producing intense pain for the person who are suffering this illness. Renal stones are formed most of the times for bad food habits or kidney failures.

In the United States, more than 500.000 persons per year are treated in hospitals due to this affectation and more than 60% of them are men. According to some medical studies, one in ten Americans will suffer from kidney stones during their lives.

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Nephropathy

This is one of the most serious kidney diseases because it makes that the person who suffers it, requires dialysis processes for the rest of its life. Currently, from the more than 600.000 persons with some renal failure, the 65% of them must live with dialysis. Moreover, the 35% of them have a kidney transplant.

In the United States, there are more than 100.000 individuals waiting for a kidney transplant and just the 20% of these people receive a newly transplanted kidney per year. Every day, more than 10 persons die due to Nephropathy and waiting for a kidney replacement.

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Related: Dialysis: When and what it is by Joe Cosgrove

Principal kidney disease causes

As we mentioned before, elevated blood pressure and diabetes are the two principal reasons for kidney failures, being this last one the main cause among the two of them.

The diabetes is responsible for more than 50.000 kidney failures per year in the United States and there are more than 250.000 persons living with these failures due to diabetes. Presently, more than 30 million people in the United States have diabetes, which means a high risk for suffering a kidney disease.

The another principal reason for kidney diseases is the elevated blood pressure, which is been responsible for more than 30.000 kidney failures per year in the United States. Today, there are more than 170.000 persons with some renal illness produced for high blood pressure.

In the United States, there are more than 70 million people with elevated blood pressure, where approximately the 20% do not know it has it.

The facts mentioned in this post are just a little sample of what kidney diseases mean for Americans and what we must expect for these illnesses in the future. These affectations are increasing more and more and we must know and understand them to deal with them in the right way.