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2.3: Acid-Base Disorders due to Drugs and Toxins

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  • Classification by Mechanism

    Drug-induced acid-base disorders:

    1. Metabolic acidosis induced by large acid loads
    - from exogenous sources (e.g. NH4Cl, or toxin ingestion)
    - from endogenous acid production (e.g. generation of ketoacids or lactic acids by alcohol or phenformin)
    - from base loss (eg laxative abuse).

    2. Renal tubular acidosis

    2. Metabolic alkalosis resulting from exogenous bicarbonate loads or effective extracellular fluid contraction, potassium depletion plus hyperaldosteronism

    4. Respiratory acidosis from drug-induced respiratory depression or neuromuscular impairment

    5. Respiratory alkalosis from drug-induced hyperventilation

    Some Drugs & Toxins which have been involved in various Acid-Base Disorders

    Respiratory Acidosis

    • CNS depressants
    • Narcotics
    • Muscle Relaxants

    High Anion Gap Metabolic Acidosis

    • Methanol
    • Ethylene glycol (due glycolic acid)
    • Salicylates
    • Paraldehyde
    • Phenformin & metformin (lactic acidosis)
    • Sodium nitroprusside (lactic acidosis due cyanide)

    Renal Tubular Acidosis

    • Amphotericin B
    • Acetazolamide
    • Toluene
    • Lithium
    • Cyclamate
    • Analgesics
    • Carbonic Anhydrase Inhibitors (eg acetazolamide)
    • Lead
    • NSAIDs
    • Outdated tetracycline
    • Pentamidine in AIDS patients

    Other causes of Hyperchloraemic Metabolic Acidosis

    • Potassium-sparing diuretics
    • Acidifying infusions (eg HCl, NH4Cl, lysine-HCl & arginine-HCl infusions)
    • CaCl2 ingestion (loss of HCO3- due to precipitation of carbonate)

    Respiratory Alkalosis

    • Salicylates
    • Propanidid

    Metabolic Alkalosis

    • Emetics
    • Diuretics
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