Sandbox: sadaf: Difference between revisions
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{{familytree | |:| |:| |:| | | | | |:| |:| |:| | | |:| |:| |:| | }} | {{familytree | |:| |:| |:| | | | | |:| |:| |:| | | |:| |:| |:| | }} | ||
{{familytree | |L| F01 |J| | | | | |L|~|A|~|A| F02 |A|~|A|~|J| | F01=[[Metabolic acidosis resident survival guide|'''Click here for the management of metabolic acidosis''']]|F02=[[Respiratory acidosis resident survival guide|'''Click here for the management of respiratory acidosis''']] }} | {{familytree | |L| F01 |J| | | | | |L|~|A|~|A| F02 |A|~|A|~|J| | F01=[[Metabolic acidosis resident survival guide|'''Click here for the management of metabolic acidosis''']]|F02=[[Respiratory acidosis resident survival guide|'''Click here for the management of respiratory acidosis''']] }} | ||
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==Approach to Metabolic Acidosis== | |||
{{familytree/start}} | |||
{{familytree | | | | | | | | | | | A01 | | | | | |A01='''[[pH]]<7.35''' <br> And <br> ['''HCO3<sup>-</sup>]<24 meq/L'''}} | |||
{{familytree | | | | | | | | | | | |!| | | | | | | | }} | |||
{{familytree | | | | | | | | | | | B01 | | | | | |B01='''[[Metabolic acidosis]]'''}} | |||
{{familytree | | | | | | | | | | | |!| | | | | | | | }} | |||
{{familytree | | | | | | | | | | | B02 | | | | | |B02='''Calculate the [[anion gap]] (AG)''' <br><br> Na<sup>+</sup> - Cl<sup>-</sup> - HCO3<sup>-</sup>}} | |||
{{familytree | | | |,|-|-|-|-|-|-|-|+|-|-|-|-|-|-|-|-|.| }} | |||
{{familytree | | | C01 | | | | | | C02 | | | | | | | C03 |C01='''Low AG'''<br> AG<8|C02= '''Normal AG''' <br> 8<AG<16 |C03= '''High AG''' <br> AG>16 }} | |||
{{familytree | |,|-|^|-|.| | | | | |!| | | | | | | | |!| }} | |||
{{familytree | D01 | | D02 | | | | |!| | | | | | | | |!| | |D01='''Check [[albumin]]'''<br><br>Correct the AG if albumin is low<br>For every decrease of 1 g/dl of albumin, AG is decreased by 2.5 meg/L|D02='''Check Ca<sup>2+</sup>, Mg<sup>2+</sup>, K<sup>+</sup>, [[immunoglobulins]]'''<br><br> High levels of these unmeasured cations decrease the AG}} | |||
{{familytree | | | | | | | | | | | E01 | | | | | | | E02 |~|~| E03 |E01='''Check urine AG'''<br>Na<sup>+</sup> + K<sup>+</sup> - Cl<sup>-</sup>|E02='''Check ΔAG/ΔHCO3<sup>-</sup>'''|E03= R/O low Ca<sup>2+</sup>, Mg<sup>2+</sup>, K<sup>+</sup>}} | |||
{{familytree | | | | | | | | |,|-|-|^|-|-|.| | | |,|-|^|-|v|-|-|-|.| | }} | |||
{{familytree | | | | | | | | F01 | | | | F02 | | F03 | | F04 | | F05 |F01='''Negative urine AG'''<br><br> [[GI]] causes<br>[[RTA|RTA type II]]|F02='''Positive urine AG'''<br><br> [[Renal failure]] <br> [[RTA|RTA type I]] <br> [[RTA|RTA type IV]] |F03=Δ'''AG/ΔHCO3<sup>-</sup><1'''<br><br>High AG metabolic acidosis combined with normal AG metabolic acidosis|F04= '''1<ΔAG/ΔHCO3<sup>-</sup><2'''<br><br> Pure high AG metabolic acidosis|F05='''ΔAG/ΔHCO3<sup>-</sup>>2'''<br><br> High AG metabolic acidosis combined with [[metabolic alkalosis]]}} | |||
{{familytree/end}} | {{familytree/end}} | ||
== Metabolic Acidosis == | == Metabolic Acidosis == | ||
Revision as of 20:04, 1 May 2018
Acid Base Disorders
Approach
Normal range
Algorithm
Compensation formula
Approach to acid-base disorders
| Check pH on ABG | |||||||||||||||||||||||||||||||||||||||||
| pH<7.35=Acidosis | pH>7.45=Alkalosis | ||||||||||||||||||||||||||||||||||||||||
| Check PaCO2 | |||||||||||||||||||||||||||||||||||||||||
| PaCO2 > 45mm Hg = Respiratory acidosis Primary cause: hypoventilation | PaCO2 Normal or < 35mm Hg = Metabolic acidosis | Check PaCO2 | |||||||||||||||||||||||||||||||||||||||
| PaCO2 > 45mm Hg = Metabolic alkalosis | PaCO2 < 35mm Hg = Respiratory alkalosis Primary cause: hyperventilation | ||||||||||||||||||||||||||||||||||||||||
| HCO3- > 29 eg. vomiting | Check HCO3- | ||||||||||||||||||||||||||||||||||||||||
| Normal or slight decrease = Acute respiratory alkalosis eg. fever, panic attack | Decreased < 24 = Chronic respiratory alkalosis eg. Anemia, CNS causes | ||||||||||||||||||||||||||||||||||||||||
Management of Acidosis
| pH < 7.35 | |||||||||||||||||||||||||||||||||||||||||||||||||||
| Acidosis (High [H+]) | |||||||||||||||||||||||||||||||||||||||||||||||||||
| Determine the primary disorder Metabolic or respiratory? | |||||||||||||||||||||||||||||||||||||||||||||||||||
| Check [HCO3-] and PaCO2 | |||||||||||||||||||||||||||||||||||||||||||||||||||
| Low [HCO3-] and Low to normal PaCO2 | High PaCO2 and High to normal [HCO3-] | ||||||||||||||||||||||||||||||||||||||||||||||||||
| Metabolic acidosis | Respiratory acidosis | ||||||||||||||||||||||||||||||||||||||||||||||||||
| Check for respiratory compensation Calculate expected PCO2 | Check for renal compensation Calculate expected [HCO3-] | ||||||||||||||||||||||||||||||||||||||||||||||||||
| Decrease in PaCO2=1.25 x (24- measured HCO3-)? | Acute acidosis? Increase [HCO3-]=0.1 x (measure PaCO2-40)? | Chronic acidosis? Increase [HCO3-]=0.1 x (measure PaCO2-40)? | |||||||||||||||||||||||||||||||||||||||||||||||||
| PaCO2 too low? Mixed metabolic acidosis with respiratory alkalosis | PaCO2 too high? Mixed metabolic acidosis with respiratory acidosis | [HCO3-] too low? Mixed respiratory acidosis with metabolic acidosis | [HCO3-] too high? Mixed respiratory acidosis with metabolic alkalosis | [HCO3-] too low? Mixed respiratory acidosis with metabolic acidosis | E04=[HCO3-] too high? Mixed respiratory acidosis with metabolic alkalosis | ||||||||||||||||||||||||||||||||||||||||||||||
| Measured PaCO2 is equal to expected value? Compensated metabolic acidosis | Measured [HCO3-] is equal to expected value? Compensated respiratory acidosis | Measured [HCO3-] is equal to expected value? Compensated respiratory acidosis | |||||||||||||||||||||||||||||||||||||||||||||||||
| Click here for the management of metabolic acidosis | Click here for the management of respiratory acidosis | ||||||||||||||||||||||||||||||||||||||||||||||||||
Approach to Metabolic Acidosis
| pH<7.35 And [HCO3-]<24 meq/L | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Metabolic acidosis | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Calculate the anion gap (AG) Na+ - Cl- - HCO3- | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Low AG AG<8 | Normal AG 8<AG<16 | High AG AG>16 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Check albumin Correct the AG if albumin is low For every decrease of 1 g/dl of albumin, AG is decreased by 2.5 meg/L | Check Ca2+, Mg2+, K+, immunoglobulins High levels of these unmeasured cations decrease the AG | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Check urine AG Na+ + K+ - Cl- | Check ΔAG/ΔHCO3- | R/O low Ca2+, Mg2+, K+ | |||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Negative urine AG GI causes RTA type II | Positive urine AG Renal failure RTA type I RTA type IV | ΔAG/ΔHCO3-<1 High AG metabolic acidosis combined with normal AG metabolic acidosis | 1<ΔAG/ΔHCO3-<2 Pure high AG metabolic acidosis | ΔAG/ΔHCO3->2 High AG metabolic acidosis combined with metabolic alkalosis | |||||||||||||||||||||||||||||||||||||||||||||||||||||
Metabolic Acidosis
| Disease | PH | Fever | Poisoning | |||||
|---|---|---|---|---|---|---|---|---|