Acid base imbalance causes altered mental status;

Acid base imbalance can cause syndromes of altered mood, altered locomotor activity and altered mental status; Psychiatrists have a lot of time to begin [in the 21st century] investigating the real “chemical imbalances” underlying severe bipolar depressive episodes. Maybe they should learn more about the Neurologic Presentations of Acid-Base Imbalance, Electrolyte Abnormalities, and Endocrine Emergencies described in the clinical article Paula and I have helpfully provided below:

Neurologic Presentations of Acid-Base Imbalance, Electrolyte Abnormalities, and Endocrine Emergencies Neurol Clinics  2010 Feb;28(1):1-16. doi: 10.1016/j.ncl.2009.09.002

Alan H Yee 1Alejandro A Rabinstein


Accurate identification of nervous system dysfunction is vital in the assessment of any multisystem disorder. The neurologic manifestations of acid-base disturbances, abnormal electrolyte concentrations, and acute endocrinopathies are protean and typically determined by the acuity of the underlying derangement. Detailed history and physical examination may guide appropriate laboratory testing and lead to prompt and accurate diagnosis. Neurologic manifestations of primary and secondary systemic disorders are frequently encountered in all subspecialties of medicine. This article focuses on key neurologic presentations of respiratory and metabolic acid-base derangements and potentially life-threatening endocrinopathies.

The medical investigation, in our opinion, must include measurements of respiratory rate at rest , and if possible, measurements of tidal volume in order to calculate minute volume. Abnormal results will dictate the need for an arterial blood gas test to get PCO2 and pH results.

Kraepelin’s and Paula’s hypothesis is that unconscious respiratory deficits affecting control of breathing results in difficulty maintaining normal PCO2 during further injury, blood loss, infection or other physiological problems.

This will result in further development of effective treatments to restore baseline mental and physical health, as existed before the attack- despite the abnormal breathing at rest.


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