Severe diarrhea leads to which acid-base disturbance?

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Multiple Choice

Severe diarrhea leads to which acid-base disturbance?

Severe diarrhea causes loss of bicarbonate in the intestinal fluid. Bicarbonate is a base used to buffer hydrogen ions; when it’s lost in stool, the serum bicarbonate concentration falls and the blood becomes more acidic, producing metabolic acidosis. Most cases present as a non-anion gap (hyperchloremic) metabolic acidosis, because the loss of base is balanced by an increase in chloride to maintain electroneutrality. The body attempts to compensate by increasing respiratory rate to blow off CO2, which helps raise pH somewhat. This differs from metabolic alkalosis, which comes from loss of acid (for example, from vomiting or certain diuretics) and would raise pH. Respiratory acidosis would require hypoventilation with CO2 retention, not a primary GI bicarbonate loss.

Severe diarrhea causes loss of bicarbonate in the intestinal fluid. Bicarbonate is a base used to buffer hydrogen ions; when it’s lost in stool, the serum bicarbonate concentration falls and the blood becomes more acidic, producing metabolic acidosis. Most cases present as a non-anion gap (hyperchloremic) metabolic acidosis, because the loss of base is balanced by an increase in chloride to maintain electroneutrality. The body attempts to compensate by increasing respiratory rate to blow off CO2, which helps raise pH somewhat.

This differs from metabolic alkalosis, which comes from loss of acid (for example, from vomiting or certain diuretics) and would raise pH. Respiratory acidosis would require hypoventilation with CO2 retention, not a primary GI bicarbonate loss.

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