quackdoc

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Does anyone know of a good book or online resource for acid base balance?
Further I was looking for the answer but couldnt get.Why does rapidly changing sodium concenteration cause myelinosis?
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I will look a little later for a good acid base website, as I'm interested in finding one too. In the mean time, here's a theory about central pontine myelinolysis from emedicine.com (the exact mechanism is unknown):

"CPM is concentrated, frequently symmetric, noninflammatory demyelination within the central basis pontis. In at least 10% of patients with CPM, demyelination also occurs in extrapontine regions, including the mid brain, thalamus, basal nuclei, and cerebellum. The exact mechanism that strips the myelin sheath is unknown.

One theory proposes that in regions of compact interdigitation of white and gray matter, cellular edema, which is caused by fluctuating osmotic forces, results in compression of fiber tracts and induces demyelination. Prolonged hyponatremia followed by rapid sodium correction results in edema. During the period of hyponatremia, the concentration of intracellular charged protein moieties is altered; reversal cannot parallel a rapid correction of electrolyte status. The term "osmotic myelinolysis" is more appropriate than "central pontine myelinolysis" for demyelination occurring in extrapontine regions after the correction of hyponatremia."
http://www.emedicine.com/neuro/topic50.htm
 
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quackdoc

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Thanks for the references.It is the cliical management thats difficult.Its easy to diagnose the same as long as the case is not a triple acid base disorder.
However one problem:If suppose a hypothetical scenario.suppose the Na+ is 122 meq/l.Then how would you calculate the deficit assuming that other parameters are normal? This is a case of say hyponatremia.Isolated.However in metabolic acidosis if one has to calculate the ion defcts how to go about it?
 
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