Acid-base disorders in patients with hypoproteinemia

Hypoproteinemia is a common disturbance in patients suffering from various diseases. It can be accompanied by hypovolemia and hypotension that influences the volume space of drugs in the body as well as the acid-base balance. In the present study, 22 patients with hypoproteinemia (8F, 14M) constituted group A. In this group the acid-base disorders as well as their importance were evaluated. From group A, 10 patients suffered from nephrotic syndrome, while 17/22 from chronic renal failure (CRF). The level of serum proteins varied from 46 gr/L to 64 gr/L, while the levels of albumin ranged from 13 to 32 gr/L. Furthermore, 15 normal individuals were used as controls (group B) aging from 24 to 72 years old with normal levels of serum proteins. The results suggested that in group A, 21/22 patients had acid-base disorders. Moreover, 11/22 patients had a mixed disturbance (metabolic alkalosis combined with respiratory alkalosis). Only 4/22 patients had metabolic alkalosis, 4/22 had metabolic acidosis (mixed) and 2/22 respiratory alkalosis. In particular, the blood’s pH appeared to be slightly alkaline. In group A the patients’ anion gap ranged from 5,7 to 18,5 mmol/L. Based on this fact, group A patients were divided in two sub-groups. The first one (sub-group A1) consisted of 12 patients measuring an anion gap higher than 10 mmol/L, while the second group (sub-group A2) consisted of 10 patients with an anion gap lower than 10 mmol/L. The comparison of the pH between the two sub-groups suggested that A1 had respiratory alkalosis, while A2 had metabolic alkalosis. It can be concluded, that patients with hypoproteinemia appear to have disturbances of acid-base balance (mainly metabolic alkalosis), because of the reduction in serum proteins, which improves the pH levels in patients with CRF. The second most common acid-base disorder that appears in hypoproteinemic patients is respiratory alkalosis.