Acidosis in a patient with cholera: a need to redefine concepts

QJM : Monthly Journal of the Association of Physicians
N ZalunardoM L Halperin

Abstract

A patient presented with cholera and a severe degree of ECF volume contraction. Despite large losses of bicarbonate (HCO3-)-containing diarrhoeal fluid, laboratory acid-base values were remarkably close to normal. A detailed analysis emphasizing principles of physiology and a quantitative approach provided new insights and eventually better definitions of metabolic and respiratory acidosis. A shift in focus from HCO3- concentration to HCO3- content in the extracellular fluid (ECF) compartment revealed the presence of metabolic acidosis. Central to this analysis was an emphasis on the haematocrit to enable a more accurate estimate of the degree of ECF volume contraction. The latter also revealed 'contraction' metabolic alkalosis, which masked the underlying metabolic acidosis. The presence of a respiratory acidosis of the tissue type was evident from the raised venous PCO2, which was not surprising once the magnitude of the ECF contraction had been appreciated. 'Bad buffering', as defined by Professor McCance, was the immediate danger and prompted swift action to restore an effective circulation. The haematocrit and the venous PCO2 also contribute valuable information to monitor the response to therapy. Nevertheless, there were ...Continue Reading

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Citations

Feb 25, 2005·QJM : Monthly Journal of the Association of Physicians·R P Cole, M L Halperin
Mar 12, 2005·QJM : Monthly Journal of the Association of Physicians·J H M GroeneveldM L Halperin
Jul 21, 2010·Nature Reviews. Nephrology·Philip D Shull, Jayson Rapoport
Oct 3, 2008·QJM : Monthly Journal of the Association of Physicians·D BockenhauerM L Halperin
Jun 30, 2007·Journal of the American Society of Nephrology : JASN·Manjula GowrishankarMitchell L Halperin
May 22, 2010·Journal of the American Society of Nephrology : JASN·Mitchell L Halperin, Kamel S Kamel
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Sep 13, 2011·Advances in Physiology Education·Mogamat Razeen DavidsMitchell L Halperin
Oct 1, 2009·NDT Plus·Andrew M Hall, Michael R Bending
Feb 15, 2007·Analytical Chemistry·Claire L SchofieldDavid A Russell

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