Acid base disturbances mini-lecture (3/3): diuretics induced metabolic alkalosis
Channel: Remco Jongkind & Dave Speijer - Medical Education
Date: 2020-02-28

This video will cover:
1. Which type of diuretics can lead to metabolic alkalosis. 
2. How these diuretics cause metabolic alkalosis on a molecular level. 
3. Which treatment alternatives there are to using these diuretics. 

Bullet point summary mini-lecture 3: 
-Diuretics can be used to reduce edema. 
-Loop and thiazide diuretics increase urine secretion by increasing the osmolarity of the urine. 
-Loop and thiazide diuretics as a side effect can cause metabolic alkalosis. 
-This side effect is caused by increased secretion of protons on the urine, thus increasing the blood pH. 
-An alternative type of diuretics which don't have these side effects are potassium sparing diuretics. 

Bullet point summary mini-lecture 2: 
-Diabetes melitus type 1 is caused by an insulin deficiency and glucagon excess. This leads to reduced glucose uptake by the cells and increased glycogen breakdown by the liver. 
-This insulin deficiency and glucagon excess also leads to increased release of free fatty acids (FFA) and the synthesis of ketone bodies from these FFA. 
-These ketone bodies cause the blood pH to drop, leading to a metabolic acidosis. 
-The body tries to bring back the blood pH to normal levels by breathing deeper and exhaling more carbondioxide (Kussmaul breathing). 
-If Kussmaul breathing is not sufficient to compensate the pH shift the patient may end up in a coma or even die. 
-Treatment consists of fluid and electrolyte replacement and insulin administration. 

Bullet point summary mini-lecture 1: 
-Physiological pH is 7.4. 
-When your pH is higher than 7.4 you have a metabolic alkalosis or respiratory alkalosis. 
-When your pH is lower than 7.4 you have a metabolic acidosis or respiratory acidosis.
-Blood pH is mainly buffered by the phosphate, hemoglobin and carbonate buffers. 
-Phosphate and hemoglobin are closed buffer systems. The constituents of the buffers are not exchanged with the environment. 
-The carbonate-bicarbonate buffer is an open buffer system. The constituents of the buffer are exchanged with the environment. This is done by the kidneys and by the lungs. 
-Davenport diagram is an often used tool to evaluate acid-base disturbances. 
-Hyperventilation causes a drop in carbondioxide levels in the blood, leading to a rise in pH. 
-COPD causes a rise in carbondioxide levels, leading to a drop in pH.