Causes of acidbase disturbances

• Respiratory acidosis — excess C02 production and/or inadequate excretion, e.g. hypoventilation, excess narcotic

• Respiratory alkalosis — reduction in PaC02 due to hyperventilation

• Metabolic acidosis — usually lactic, keto, renal or tubular. Consider tissue hypoperfusion, ingestion of acids (e.g. aspirin), loss of alkali (e.g. diarrhoea, renal tubular acidosis), diabetic ketoacidosis and hyperchloraemia (e.g. from excess normal saline administration)

• Metabolic alkalosis. Consider excess alkali (e.g. bicarbonate or buffer infusion), loss of acid (e.g. large gastric aspirates, renal), hypokalaemia, drugs (e.g. diuretics)

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