Alkalosis
Description:
Alkalosis - increase in pH of blood (and other body tissues) due to accumulation of alkaline substances.
Alkalosis (late lat. alcali alkali, from арабск. al-quali) - the disturbance of acid-base equilibrium of an organism which is characterized by absolute or relative surplus of the bases.
Alkalosis symptoms:
Symptoms of a gas alkalosis reflect the main disturbances caused by a hypocapny - a hypertension of brain arteries, hypotonia of peripheral veins with secondary decrease in cordial emission and the ABP, loss of cations and water with urine. And leading symptoms of diffusion ischemia of a brain are the earliest - patients are often excited, disturbing, can complain of dizziness, paresthesias on a face and extremities, quickly get tired from contact with people around, concentration of attention and memory are weakened. Faints are in some cases observed. Skin is pale, gray diffusion cyanosis (is possible at the accompanying anoxemia). At survey the reason of a gas alkalosis - a hyperventilation due to frequent breath (till 40-60 respiratory cycles in 1 min.) usually is defined, for example: at a thromboembolism of pulmonary arteries; pathology of lungs, a hysterical asthma (so-called dog breath) or owing to the mode of artificial ventilation of the lungs is higher than 10 have some. As a rule, tachycardia, sometimes a pendulum rhythm of cordial tones is noted; pulse is small. Systolic and pulse by the ABP it is a little lowered at horizontal position of the patient, at his transfer in a sitting position the orthostatic collapse is possible. The diuresis is increased. At the long and expressed gas alkalosis (rso2 less than 25 mm of mercury.) organism dehydration, emergence of spasms as a result of the developing hypocalcemia can be noted. At patients with organic pathology of TsNS and "epileptic readiness" the gas alkalosis can provoke an epileptic seizure. Increase in amplitude and decrease in frequency of the main rhythm, bilateral synchronous categories of slow waves are defined on EEG. On an ECG diffusion changes of repolarization of a myocardium often are found.
The metabolic alkalosis which is quite often appearing at use of mercury diuretics and at massive infusions to the patient of alkaline solutions or nitrate blood, usually happens compensated, has passing character and has no the expressed clinical manifestations (some respiratory depression, emergence of puffiness are possible). The Dekompensirovanny metabolic alkalosis develops usually owing to primary (at long vomiting) or secondary (from losses of potassium at massive hemolysis, diarrhea) losses by a chlorine organism, and also at the terminal states which are especially followed by organism dehydration. The progressing weakness, fatigue, thirst are noted, anorexia, a headache, small hyperkinesias of face muscles, extremities develop. Spasms owing to a hypocalcemia are possible. Skin is usually dry, turgor of fabrics is reduced (at plentiful injection of liquid hypostases are possible). Breath is superficial, rare (if pneumonia or heart failure does not join). As a rule, tachycardia, sometimes an embryocardia comes to light. Patients become apathetic in the beginning, then slowed down, sleepy; further disorders of consciousness are aggravated up to development of a coma. On an ECG the low voltage of teeth of T, hypopotassemia signs often come to light. In blood the hypochloraemia, a hypopotassemia, a hypocalcemia are defined. Urine reaction in most cases alkaline (at And. owing to primary losses of potassium - acid).
The chronic metabolic alkalosis developing at patients with a peptic ulcer owing to long reception in large amounts of alkalis and milk is known as Burnett's syndrome, or a milk and alkaline syndrome. It is shown by the general weakness, a loss of appetite with disgust for milk food, nausea and vomiting, block, apathy, a skin itch, in hard cases - an ataxy, adjournment of salts of calcium in fabrics (it is frequent in a conjunctiva and a cornea), and also in tubules of kidneys that leads to gradual development of a renal failure.
Alkalosis reasons:
By origin an alkalosis allocate sleduyushche groups.
Gas alkalosis.
Arises owing to the hyperventilation of lungs leading to excess removal of CO2 from an organism and falling of partial tension of carbon dioxide in an arterial blood is lower than 35 has some., that is to a hypocapny. The hyperventilation of lungs can be observed at organic lesions of a brain (encephalitis, tumors, etc.), action on a respiratory center of various toxic and pharmacological agents (for example, some microbic toxins, caffeine, Corazolum), at the increased body temperature, acute blood loss, etc.
Not gas alkalosis.
The main forms of not gas alkalosis are: secretory, exogenous and metabolic. The secretory alkalosis can arise, for example, owing to big losses of an acid gastric juice at gastric fistulas, pernicious vomiting, etc. The secretory alkalosis can develop at long reception of diuretics, some diseases of kidneys, and also at the endocrine frustration leading to an excess delay of sodium in an organism. In certain cases the secretory alkalosis is connected with the strengthened sweating.
The exogenous alkalosis is most often observed at excess administration of sodium bicarbonate for the purpose of correction of a metabolic acidosis or neutralization of a hyperoxemia of a gastric juice. The moderate compensated alkalosis can be caused by the long use of the food containing many bases.
The metabolic alkalosis meets at some patol. the states which are followed by disturbances of exchange of electrolytes. So, it is noted at hemolysis, in the postoperative period after some extensive operative measures, at the children having rickets, inherited disorders of regulation of electrolytic exchange.
The mixed alkalosis.
The mixed alkalosis - (a combination of a gas and not gas alkalosis) can be observed, e.g., at the brain injuries which are followed by an asthma, a hypocapny and vomiting an acid gastric juice.
Treatment of the Alkalosis:
Therapy of a gas alkalosis consists in elimination of the reason which caused a hyperventilation and also in direct normalization of gas composition of blood by inhalation of the mixes containing carbon dioxide (for example - Carbogenum). Therapy of not gas alkalosis is carried out depending on its look. Apply solutions of ammonium chlorides, potassium, calcium, insulin, the means oppressing a karboangidraza and promoting allocation by kidneys of ions of sodium and a hydrocarbonate.
Patients with a metabolic alkalosis, and also with the gas alkalosis which developed against the background of a serious illness, for example a thromboembolism of pulmonary arteries are hospitalized. The gas alkalosis owing to a neurogenic hyperventilation in most cases manages to be eliminated on site assistance to the patient. At a considerable hypocapny inhalation of Carbogenum - oxygen mix (92-95%) and carbon dioxide (8-5%) is shown. At spasms intravenously enter calcium chloride. Whenever possible eliminate a hyperventilation, for example with introduction of Seduxenum, morphine, and at the wrong mode of artificial ventilation of the lungs - its correction.
At a dekompensirovanny metabolic alkalosis to the patient intravenously enter solutions of sodium chloride and calcium chloride. At a hypopotassemia appoint intravenously potassium drugs - Pananginum, potassium chloride solution (simultaneous administration of glucose with insulin is desirable), and also kaliysberegayushchy drugs (Spironolactonum). In all cases inside it is possible to appoint ammonium chloride, and the prialkaloz caused by excess administration of alkalis - Diacarbum. The treatment of a basic disease directed to elimination of a prichinalkaloz is carried out (vomitings, diarrheas, hemolysis, etc.).
