<?xml version="1.0" encoding="UTF-8"?>
<opml version="2.0">
  <head>
    <title>019-01 Foundations</title>
    <ownerName>Integrated Medical Foundations</ownerName>
  </head>
  <body>
    <outline text="Acid-base physiology and clinical interpretation">
      <outline text="Why hydrogen ion concentration matters">
        <outline text="Proteins, enzymes, membrane excitability"/>
        <outline text="Vascular tone, potassium, oxygen binding"/>
        <outline text="Buffers, lungs and kidneys in sequence"/>
        <outline text="Disorders are processes, not numbers">
          <outline text="Coexisting disorders conceal one another"/>
        </outline>
      </outline>
      <outline text="Bicarbonate and carbon dioxide">
        <outline text="Carbon dioxide and water make carbonic acid"/>
        <outline text="Carbonic anhydrase in red cells and kidney"/>
        <outline text="pH follows bicarbonate over dissolved gas"/>
        <outline text="Lungs act in minutes, kidneys over days"/>
        <outline text="Bicarbonate is abundant and regulated"/>
        <outline text="Haemoglobin, plasma proteins, phosphate also buffer"/>
        <outline text="Bone buffers chronic load at mineral cost"/>
      </outline>
      <outline text="Renal acid handling">
        <outline text="Proximal tubule reclaims filtered bicarbonate">
          <outline text="Hydrogen secretion recovers existing buffer"/>
        </outline>
        <outline text="New bicarbonate needs urinary buffers"/>
        <outline text="Phosphate becomes titratable acid"/>
        <outline text="Glutamine yields ammonium and bicarbonate">
          <outline text="Ammonia trapped in the collecting system"/>
          <outline text="Acidosis increases ammoniagenesis"/>
        </outline>
        <outline text="Acidic urine may still mean low ammonium"/>
      </outline>
      <outline text="Systematic interpretation">
        <outline text="Assess the pH first"/>
        <outline text="Find the component explaining the direction"/>
        <outline text="Test whether compensation is appropriate"/>
        <outline text="Calculate the anion gap when acidotic"/>
        <outline text="Compare delta changes for mixtures"/>
        <outline text="Integrate electrolytes, history and treatment"/>
        <outline text="Compensation never overcorrects past normal"/>
        <outline text="Unexpected compensation means another disorder"/>
      </outline>
      <outline text="Metabolic acidosis">
        <outline text="Primary fall in bicarbonate"/>
        <outline text="Kussmaul breathing is respiratory compensation"/>
        <outline text="Gap: sodium minus chloride and bicarbonate">
          <outline text="Low albumin lowers the expected gap"/>
        </outline>
        <outline text="High gap: lactate, ketones, toxic alcohols"/>
        <outline text="Normal gap: loss or impaired excretion">
          <outline text="Diarrhoea, tubular acidosis, chloride-rich fluid"/>
        </outline>
        <outline text="Lactate when production exceeds clearance"/>
        <outline text="Ketoacidosis from insulin deficiency"/>
      </outline>
      <outline text="Metabolic alkalosis">
        <outline text="Primary rise in bicarbonate"/>
        <outline text="Generated by vomiting, diuretics, mineralocorticoid"/>
        <outline text="Persists when kidneys cannot excrete bicarbonate">
          <outline text="Volume, chloride and potassium depletion"/>
        </outline>
        <outline text="Urine chloride separates the two groups"/>
        <outline text="Severe alkalosis cuts cerebral and coronary flow"/>
        <outline text="Saline harms volume-overloaded alkalosis"/>
      </outline>
      <outline text="Respiratory disorders">
        <outline text="Acidosis from inadequate alveolar ventilation">
          <outline text="Sedation, weakness, obstruction, fatigue"/>
          <outline text="Acute retention, small bicarbonate rise"/>
          <outline text="Chronic retention brings renal compensation"/>
          <outline text="Acute-on-chronic hides behind normal pH"/>
        </outline>
        <outline text="Alkalosis when ventilation exceeds production">
          <outline text="Hypoxaemia, embolism, sepsis, salicylate"/>
          <outline text="Do not call hyperventilation anxiety first"/>
        </outline>
      </outline>
      <outline text="Mixed disorders and delta analysis">
        <outline text="Sepsis: lactic acidosis with hyperventilation"/>
        <outline text="Vomiting added to ketoacidosis"/>
        <outline text="Lung disease with diuretic alkalosis"/>
        <outline text="Compare gap rise with bicarbonate fall">
          <outline text="Larger fall adds a normal-gap acidosis"/>
          <outline text="Smaller fall suggests coexisting alkalosis"/>
        </outline>
      </outline>
      <outline text="Toxicological patterns">
        <outline text="Salicylate: alkalosis plus high-gap acidosis">
          <outline text="Tinnitus, fever, confusion, pulmonary oedema"/>
        </outline>
        <outline text="Toxic alcohols generate organic acids">
          <outline text="Osmolar gap falls as anion gap rises"/>
          <outline text="Visual toxicity points to methanol"/>
          <outline text="Oxalate and kidney injury with ethylene glycol"/>
        </outline>
      </outline>
      <outline text="Contexts, potassium and treatment">
        <outline text="Pregnancy lowers carbon dioxide physiologically">
          <outline text="Adult normal values may mean impairment"/>
        </outline>
        <outline text="Strong-ion difference complements bedside judgement"/>
        <outline text="Mineral acidosis shifts potassium outward"/>
        <outline text="Insulin drives potassium into cells"/>
        <outline text="Bicarbonate suits selected disorders only"/>
        <outline text="Definitive treatment corrects the cause"/>
      </outline>
    </outline>
  </body>
</opml>
