title: Drug-induced acid-base disorders.
abstract: The incidence of acid-base disorders (ABDs) is high, especially in hospitalized patients. ABDs are often indicators for severe systemic disorders. In everyday clinical practice, analysis of ABDs must be performed in a standardized manner. Highly sensitive diagnostic tools to distinguish the various ABDs include the anion gap and the serum osmolar gap. Drug-induced ABDs can be classified into five different categories in terms of their pathophysiology: (1) metabolic acidosis caused by acid overload, which may occur through accumulation of acids by endogenous (e.g., lactic acidosis by biguanides, propofol-related syndrome) or exogenous (e.g., glycol-dependant drugs, such as diazepam or salicylates) mechanisms or by decreased renal acid excretion (e.g., distal renal tubular acidosis by amphotericin B, nonsteroidal anti-inflammatory drugs, vitamin D); (2) base loss: proximal renal tubular acidosis by drugs (e.g., ifosfamide, aminoglycosides, carbonic anhydrase inhibitors, antiretrovirals, oxaliplatin or cisplatin) in the context of Fanconi syndrome; (3) alkalosis resulting from acid and/or chloride loss by renal (e.g., diuretics, penicillins, aminoglycosides) or extrarenal (e.g., laxative drugs) mechanisms; (4) exogenous bicarbonate loads: milk-alkali syndrome, overshoot alkalosis after bicarbonate therapy or citrate administration; and (5) respiratory acidosis or alkalosis resulting from drug-induced depression of the respiratory center or neuromuscular impairment (e.g., anesthetics, sedatives) or hyperventilation (e.g., salicylates, epinephrine, nicotine).
authors.affiliation: Department of Internal Medicine, Division of Nephrology, Robert Bosch Hospital, Auerbachstr. 110, 70376, Stuttgart, Germany, daniel.kitterer@rbk.de.
authors.forename: Daniel
authors.initials: D
authors.lastname: Kitterer
authors.forename: Matthias
authors.initials: M
authors.lastname: Schwab
authors.forename: M Dominik
authors.initials: MD
authors.lastname: Alscher
authors.forename: Niko
authors.initials: N
authors.lastname: Braun
authors.forename: Joerg
authors.initials: J
authors.lastname: Latus
mesh_terms: D000136:Acid-Base Equilibrium; D000137:Acid-Base Imbalance / Q000139:chemically induced / Q000145:classification / Q000175:diagnosis / Q000378:metabolism / Q000503:physiopathology / Q000628:therapy; D064420:Drug-Related Side Effects and Adverse Reactions / Q000145:classification / Q000175:diagnosis / Q000378:metabolism / Q000503:physiopathology / Q000628:therapy; D006801:Humans; D007668:Kidney / Q000378:metabolism / Q000503:physiopathology; D007671:Kidney Concentrating Ability; D054539:Medication Therapy Management; D009994:Osmolar Concentration