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__NOTOC__
__NOTOC__
==Acid Base Disorders==


== Approach ==
[[Sandbox: wdx]]
Normal range


{|
[[Xyz]]
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Blood gas analysis
 
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Vessel
[[Abc]]
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Range
# [[Sandbox:Preeti]]
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Interpretation
# [[Lymphoma]]
# [[Breast lumps differential diagnosis]]
# [[Neck masses differential diagnosis]]
# [[Leukemia]]
{| class="wikitable"
|+
|-
| colspan="2" |[[:Category:Risk calculator]]
[[Category:Risk calculator]]
|-
| colspan="2" |[[Deep vein thrombosis assessment of clinical probability and risk scores]]
|-
| colspan="2" |[[Pulmonary embolism assessment of clinical probability and risk scores]]
|-
|[[Padua prediction score]]
|[[widget:PaduaVTEscore]]
|-
|[[IMPROVE risk score calculator]]
|[[Widget:IMPROVEScore]]
|-
|[[IMPROVEDD risk score calculator]]
|[[Widget:IMPROVEDDScore]]
|-
|[[Caprini score calculator]]
|[[Widget:CapCal]]
|-
|[[Wells score calculator for DVT]]
|[[Widget:DVT Wells score calculator]]
|-
|[[Modified Wells score calculator for DVT]]
|[[Widget:DVT Modified Wells score calculator]]
|-
|[[Pulmonary embolism Wells score calculator]]
|[[widget:PE_calculator]]
|-
|-
! rowspan="3" align="center" style="background:#DCDCDC;" + |Oxygen Partial Pressure (pO2)
|[[Pulmonary embolism modified Wells score calculator]]
| rowspan="2" align="center" style="background:#DCDCDC;" + |Arterial
|[[Widget:PE Modified Wells score calculator]]
| align="left" style="background:#F5F5F5;" + |80 to 100 mmHg (10.6 to 13.3 kPa)
| align="left" style="background:#F5F5F5;" + |Normal
|-
|-
| align="left" style="background:#F5F5F5;" + |<80  mmHg
|[[AMUSE score calculator]]
| align="left" style="background:#F5F5F5;" + |Hypoxia
|[[Widget:AMUSE_score_calculator]]
|-
|-
| align="center" style="background:#DCDCDC;" + |Venous
|[[HAMILTON score calculator]]
| align="left" style="background:#F5F5F5;" + |35 to 40 mmHg
|[[Widget:HAMILTON_score_calculator]]
| align="left" style="background:#F5F5F5;" + |Normal
|-
|-
! rowspan="3" align="center" style="background:#DCDCDC;" + |Oxygen Saturation (SO2)
|[[Geneva score calculator]]
| rowspan="2" align="center" style="background:#DCDCDC;" + |Arterial
|[[Widget:Geneva_score_calculator]]
| align="left" style="background:#F5F5F5;" + |>95%
| align="left" style="background:#F5F5F5;" + |Normal
|-
|-
| align="left" style="background:#F5F5F5;" + |<95%
|[[Revised Geneva score calculator]]
| align="left" style="background:#F5F5F5;" + |Hypoxia
|[[Widget:Revised_Geneva_score_calculator]]
|-
|-
|align="center" style="background:#DCDCDC;" + |Venous
|[[Simplified Geneva Score calculator]]
| align="left" style="background:#F5F5F5;" + |70 to 75%
|[[Widget:Simplified_Geneva_score_calculator]]
| align="left" style="background:#F5F5F5;" + |Normal
|-
|-
! rowspan="4" align="center" style="background:#DCDCDC;" + |pH
|[[TIMI Risk Score for Unstable Angina or NSTEMI]]
| rowspan="3" align="center" style="background:#DCDCDC;" + |Arterial
|[[Widget:TIMI_UA_NSTEMI]]
| align="left" style="background:#F5F5F5;" + |<7.35
| align="left" style="background:#F5F5F5;" + |Acidemia
|-
|-
| align="left" style="background:#F5F5F5;" + |7.35 to 7.45 (H+ 35 to 45 nmol/L)
|[[TIMI Risk Score for STEMI]]
| align="left" style="background:#F5F5F5;" + |Normal
|[[Widget:TIMI_STEMI]]
|-
|-
| align="left" style="background:#F5F5F5;" + |>7.45
|[[Tygerberg score]]
| align="left" style="background:#F5F5F5;" + |Alkalemia
|[[widget:Tygerberg_score]]
|-
|-
| align="center" style="background:#DCDCDC;" + |Venous
|[[CHA2DS2-VASc Score]]
| align="left" style="background:#F5F5F5;" + |7.26 to 7.46
|[[Widget:CHA2DS2VASc]]
| align="left" style="background:#F5F5F5;" + |Normal
|-
|-
! rowspan="4" align="center" style="background:#DCDCDC;" + |Carbon Dioxide Partial Pressure (pCO2)
|[[CHADS2 score]]
| rowspan="3" align="center" style="background:#DCDCDC;" + |Arterial
|[[Widget:CHADS2score]]
| align="left" style="background:#F5F5F5;" + |<35 mmHg
| align="left" style="background:#F5F5F5;" + |Low
|-
|-
| align="left" style="background:#F5F5F5;" + |35 to 45 mmHg (4.7 to 6.0 kPa)
|[[HAS-BLED score]]
| align="left" style="background:#F5F5F5;" + |Normal
|[[Widget:HASBLEDscore]]
|-
|-
| align="left" style="background:#F5F5F5;" + |>45 mmHg
|[[The GRACE risk score]]
| align="left" style="background:#F5F5F5;" + |High
|[[Widget:GRACEscore]]
|-
|-
| align="center" style="background:#DCDCDC;" + |Venous
|
| align="left" style="background:#F5F5F5;" + |40 to 45 mmHg
|
| align="left" style="background:#F5F5F5;" + |Normal
|-
|-
! rowspan="4" align="center" style="background:#DCDCDC;" + |HCO3−
|[[Ranson criteria]]
| rowspan="3" align="center" style="background:#DCDCDC;" + |Arterial
[[Acute pancreatitis diagnostic criteria]]
| align="left" style="background:#F5F5F5;" + |<22 mmol/L
|[[Widget:RansonScore]]
| align="left" style="background:#F5F5F5;" + |Low
|-
|-
| align="left" style="background:#F5F5F5;" + |22 to 26 mmol/L
|[[Apgar score]]
| align="left" style="background:#F5F5F5;" + |Normal
|[[Widget:Apgarscore]]
|-
|-
| align="left" style="background:#F5F5F5;" + |>26 mmol/L
|[[Glasgow coma scale]]
| align="left" style="background:#F5F5F5;" + |High
|[[Widget:Adult_GCS]]
|-
|-
| align="center" style="background:#DCDCDC;" + |Venous
|[[Pediatric Glasgow Coma Scale]]
| align="left" style="background:#F5F5F5;" + |19 to 28 mmol/L
|[[Widget:PGCS]]
| align="left" style="background:#F5F5F5;" + |Normal
|-
|-
! rowspan="4" align="center" style="background:#DCDCDC;" + |Base Excess (BE)
|[[Cincinnati stroke scale]]
| rowspan="3" align="center" style="background:#DCDCDC;" + |Arterial
|[[Widget:Cincinnati_Stroke_Scale]]
| align="left" style="background:#F5F5F5;" + |<-3.4
| align="left" style="background:#F5F5F5;" + |Acidemia
|-
|-
| align="left" style="background:#F5F5F5;" + |<nowiki>-3.4 to +2.3 mmol/L</nowiki>
|[[DIPSS Plus Score]]
| align="left" style="background:#F5F5F5;" + |Normal
|[[Widget:DIPSS_Plus_Score]]
|-
|-
| align="left" style="background:#F5F5F5;" + |>2.3
| colspan="2" |[[ICU scoring systems]]
| align="left" style="background:#F5F5F5;" + |Alkalemia
|-
|-
| align="center" style="background:#DCDCDC;" + |Venous
|[[APACHE II]]
| align="left" style="background:#F5F5F5;" + |<nowiki>-2 to -5 mmol/L</nowiki>
|[[Widget:APACHEII]]
| align="left" style="background:#F5F5F5;" + |Normal
|-
|-
! colspan="2" align="center" style="background:#DCDCDC;" + |Osmolar Gap
|[[SAPS II]]
(Osmolality – Osmolarity)
|[[Widget:SAPSII]]
| align="left" style="background:#F5F5F5;" + |>10
| align="left" style="background:#F5F5F5;" + |Abnormal
|-
|-
! colspan="2" rowspan="3" align="center" style="background:#DCDCDC;" + |Anion gap
|[[SAPS III]]
[Na] – {[Cl]+[HCO3–]}
|[[Widget:SAPSIII]]
| align="left" style="background:#F5F5F5;" + |<8
| align="left" style="background:#F5F5F5;" + |Low
|-
|-
| align="left" style="background:#F5F5F5;" + |8 to 16
|[[PIM2]]
| align="left" style="background:#F5F5F5;" + |Normal
|
|}
==Table==
{|
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Complications
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Polymyositis
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Dermatomyositis
|-
|-
| align="left" style="background:#F5F5F5;" + |>16
! align="center" style="background:#DCDCDC;" + |[[Cancer|Malignancy]]
| align="left" style="background:#F5F5F5;" + |High
| align="left" style="background:#F5F5F5;" + |
*[[Lung]]
| align="left" style="background:#F5F5F5;" + |
*[[Lung]]
|}
|}
Compensation formula
<br>
===Calculation of the Padua Prediction Score===
Shown below is a calculator using the predictive score for VTE among hospitalized medical patients. Check all boxes that apply to your patient:


{|
{| style="border: 0; float: left; width: 45%; position: float; background: #104E8B; border-radius: 10px 10px 10px 10px; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: 0 1px 1px rgba(0, 0, 0, 0.5); margin: 0 0 0 0; padding: 5px 5px; font-weight: bold;"
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Primary disorder
| colspan="2" style="text-align: center; color: #FFFFFF; font-size: 120%;" | IMPROVE Bleeding Risk Score
! align="center" style="background:#4479BA; color: #FFFFFF;" + |PH
|-
! align="center" style="background:#4479BA; color: #FFFFFF;" + |CO2
! style=" text-align: left; color: #4479BA; background: #FFFFFF; padding: 2px 10px; border-radius: 5px 5px 5px 5px; text-shadow: 0 0 0 rgba(0, 0, 0, 0.2); box-shadow: 0 1px 1px rgba(0, 0, 0, 0.5);" |Variable
! align="center" style="background:#4479BA; color: #FFFFFF;" + |HCO3–
! style=" text-align: center; color: #4479BA; background: #FFFFFF; border-radius: 5px 5px 5px 5px; text-shadow: 0 0 0 rgba(0, 0, 0, 0.2); box-shadow: 0 1px 1px rgba(0, 0, 0, 0.5);" |Score
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Compensation
|-
! style=" text-align: left; color: #FFFFFF; background: #4479BA; padding: 2px 10px; border-radius: 5px 5px 5px 5px; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: 0 1px 1px rgba(0, 0, 0, 0.5);" |Active gastric or duodenal ulcer
| style=" text-align: center; color: #FFFFFF; background: #4479BA; padding: 2px 10px; border-radius: 5px 5px 5px 5px; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: 0 1px 1px rgba(0, 0, 0, 0.5);" |4.5
|-
! style=" text-align: left; color: #FFFFFF; background: #4479BA; padding: 2px 10px; border-radius: 5px 5px 5px 5px; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: 0 1px 1px rgba(0, 0, 0, 0.5);" |Prior bleeding within the last 3 months
| style=" text-align: center; color: #FFFFFF; background: #4479BA; padding: 2px 10px; border-radius: 5px 5px 5px 5px; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: 0 1px 1px rgba(0, 0, 0, 0.5);" |4
|-
! style=" text-align: left; color: #FFFFFF; background: #4479BA; padding: 2px 10px; border-radius: 5px 5px 5px 5px; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: 0 1px 1px rgba(0, 0, 0, 0.5);" |Thrombocytopenia (<50x10<sup>9</sup>/L)
| style=" text-align: center; color: #FFFFFF; background: #4479BA; padding: 2px 10px; border-radius: 5px 5px 5px 5px; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: 0 1px 1px rgba(0, 0, 0, 0.5);" |4
|-
! style=" text-align: left; color: #FFFFFF; background: #4479BA; padding: 2px 10px; border-radius: 5px 5px 5px 5px; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: 0 1px 1px rgba(0, 0, 0, 0.5);" |Age ≥ 85 years
| style=" text-align: center; color: #FFFFFF; background: #4479BA; padding: 2px 10px; border-radius: 5px 5px 5px 5px; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: 0 1px 1px rgba(0, 0, 0, 0.5);" |3.5
|-
! style=" text-align: left; color: #FFFFFF; background: #4479BA; padding: 2px 10px; border-radius: 5px 5px 5px 5px; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: 0 1px 1px rgba(0, 0, 0, 0.5);" |Liver failure (INR>1.5)
| style=" text-align: center; color: #FFFFFF; background: #4479BA; padding: 2px 10px; border-radius: 5px 5px 5px 5px; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: 0 1px 1px rgba(0, 0, 0, 0.5);" |2.5
|-
! style=" text-align: left; color: #FFFFFF; background: #4479BA; padding: 2px 10px; border-radius: 5px 5px 5px 5px; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: 0 1px 1px rgba(0, 0, 0, 0.5);" |Severe kidney failure (GFR< 30 mL/min/m<sup>2</sup>)
| style=" text-align: center; color: #FFFFFF; background: #4479BA; padding: 2px 10px; border-radius: 5px 5px 5px 5px; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: 0 1px 1px rgba(0, 0, 0, 0.5);" |2.5
|-
! style=" text-align: left; color: #FFFFFF; background: #4479BA; padding: 2px 10px; border-radius: 5px 5px 5px 5px; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: 0 1px 1px rgba(0, 0, 0, 0.5);" |Admission to ICU or CCU
| style=" text-align: center; color: #FFFFFF; background: #4479BA; padding: 2px 10px; border-radius: 5px 5px 5px 5px; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: 0 1px 1px rgba(0, 0, 0, 0.5);" |2.5
|-
! style=" text-align: left; color: #FFFFFF; background: #4479BA; padding: 2px 10px; border-radius: 5px 5px 5px 5px; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: 0 1px 1px rgba(0, 0, 0, 0.5);" |Central venous catheter
| style=" text-align: center; color: #FFFFFF; background: #4479BA; padding: 2px 10px; border-radius: 5px 5px 5px 5px; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: 0 1px 1px rgba(0, 0, 0, 0.5);" |2
|-
! style=" text-align: left; color: #FFFFFF; background: #4479BA; padding: 2px 10px; border-radius: 5px 5px 5px 5px; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: 0 1px 1px rgba(0, 0, 0, 0.5);" |Rheumatic disease
| style=" text-align: center; color: #FFFFFF; background: #4479BA; padding: 2px 10px; border-radius: 5px 5px 5px 5px; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: 0 1px 1px rgba(0, 0, 0, 0.5);" |2
|-
! style=" text-align: left; color: #FFFFFF; background: #4479BA; padding: 2px 10px; border-radius: 5px 5px 5px 5px; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: 0 1px 1px rgba(0, 0, 0, 0.5);" |Active malignancy
| style=" text-align: center; color: #FFFFFF; background: #4479BA; padding: 2px 10px; border-radius: 5px 5px 5px 5px; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: 0 1px 1px rgba(0, 0, 0, 0.5);" |2
|-
! style=" text-align: left; color: #FFFFFF; background: #4479BA; padding: 2px 10px; border-radius: 5px 5px 5px 5px; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: 0 1px 1px rgba(0, 0, 0, 0.5);" |Age: 40-84 years
| style=" text-align: center; color: #FFFFFF; background: #4479BA; padding: 2px 10px; border-radius: 5px 5px 5px 5px; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: 0 1px 1px rgba(0, 0, 0, 0.5);" |1.5
|-
|-
! align="center" style="background:#DCDCDC;" + |Metabolic acidosis
! style=" text-align: left; color: #FFFFFF; background: #4479BA; padding: 2px 10px; border-radius: 5px 5px 5px 5px; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: 0 1px 1px rgba(0, 0, 0, 0.5);" |Male
| align="center" style="background:#F5F5F5;" + |↓
| style=" text-align: center; color: #FFFFFF; background: #4479BA; padding: 2px 10px; border-radius: 5px 5px 5px 5px; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: 0 1px 1px rgba(0, 0, 0, 0.5);" |1
| align="center" style="background:#F5F5F5;" + |↓
| align="center" style="background:#F5F5F5;" + |↓
| align="left" style="background:#F5F5F5;" + |Respiratory
|-
|-
! align="center" style="background:#DCDCDC;" + |Metabolic alkalosis
! style=" text-align: left; color: #FFFFFF; background: #4479BA; padding: 2px 10px; border-radius: 5px 5px 5px 5px; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: 0 1px 1px rgba(0, 0, 0, 0.5);" |Moderate kidney failure (GFR: 30-59 mL/min/m<sup>2</sup>)
| align="center" style="background:#F5F5F5;" + |↑
| style=" text-align: center; color: #FFFFFF; background: #4479BA; padding: 2px 10px; border-radius: 5px 5px 5px 5px; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: 0 1px 1px rgba(0, 0, 0, 0.5);" |1
| align="center" style="background:#F5F5F5;" + |↑
| align="center" style="background:#F5F5F5;" + |↑
| align="left" style="background:#F5F5F5;" + |Respiratory
|-
|-
! align="center" style="background:#DCDCDC;" + |Respiratory acidosis
! colspan="2" style=" text-align: left; color: #4479BA; background: #FFFFFF; padding: 2px 10px; border-radius: 5px 5px 5px 5px; text-shadow: 0 0 0 rgba(0, 0, 0, 0.2); box-shadow: 0 1px 1px rgba(0, 0, 0, 0.5);" |Result:
| align="center" style="background:#F5F5F5;" + |↓
| align="center" style="background:#F5F5F5;" + |↑
| align="center" style="background:#F5F5F5;" + |↑
| align="left" style="background:#F5F5F5;" + |Renal
|-
|-
! align="center" style="background:#DCDCDC;" + |Respiratory alkalosis
! colspan="2" style=" text-align: left; color: #4479BA; background: #FFFFFF; padding: 2px 10px; border-radius: 5px 5px 5px 5px; text-shadow: 0 0 0 rgba(0, 0, 0, 0.2); box-shadow: 0 1px 1px rgba(0, 0, 0, 0.5);" |Interpretation:
| align="center" style="background:#F5F5F5;" + |↑
| align="center" style="background:#F5F5F5;" + |↓
| align="center" style="background:#F5F5F5;" + |↓
| align="left" style="background:#F5F5F5;" + |Renal
|}
|}
<br style="clear:left" />


==Approach to acid–base disorders==
===Calculation of the test Prediction Score===
{{familytree/start |summary=Sample 1}}
Shown below is a calculator using the predictive score for VTE among hospitalized medical patients. Check all boxes that apply to your patient:
{{familytree | | | | | | | | A01 |A01=Check pH on ABG}}
{{familytree | | | | |,|-|-|-|^|-|-|-|-|.| | | }}
{{familytree | | | B01 | | | | | | | |B02| | |B01=pH<7.35=Acidosis|B02=pH>7.45=Alkalosis}}
{{familytree | | | |!| | | | | | | | | |!| }}
{{familytree | | | C01 | | | | | | | | |!| |C01=Check PaCO2}}
{{familytree | |,|-|^|.| | | | | | | | |!| }}
{{familytree | D01 | | D02 | | | | | | D03 |D01=PaCO2 > 45mm Hg = Respiratory acidosis    Primary cause: hypoventilation|D02= PaCO2 Normal or < 35mm Hg = Metabolic acidosis|D03=Check PaCO2}}
{{familytree | | | | | | | | | | | |,|-|^|.| }}
{{familytree | | | | | | | | | | |E02| | E03 | |E02=PaCO2 > 45mm Hg = Metabolic alkalosis|E03=PaCO2 < 35mm Hg = Respiratory alkalosis    Primary cause: hyperventilation}}
{{familytree | | | | | | | | | | |!| | | | |!| }}
{{familytree | | | | | | | | | | F01 | | | F02 |F01=HCO3- > 29 eg. vomiting|F02=Check HCO3-}}
{{Familytree | | | | | | | | | | | | |,|-|-|^|-|-|.| | }}
{{Familytree | | | | | | | | | | | |C01 | | | | C02 |C01= Normal or slight decrease = Acute respiratory alkalosis eg. fever, panic attack| C02= Decreased < 24 = Chronic respiratory alkalosis eg. Anemia, CNS causes}}
{{familytree/end}}


==Management of Acidosis==
{| style="border: 0; float: left; width: 45%; position: float; background: #104E8B; border-radius: 10px 10px 10px 10px; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: 0 1px 1px rgba(0, 0, 0, 0.5); margin: 0 0 0 0; padding: 5px 5px; font-weight: bold;"
{{familytree/start}}
| colspan="2" style="text-align: center; color: #FFFFFF; font-size: 120%;" | IMPROVE Bleeding Risk Score
{{familytree | | | | | | | | | A01 | | | | | |A01='''[[pH]] < 7.35'''}}
{{familytree | | | | | | | | | |!| | | | | | | | }}
{{familytree | | | | | | | | | B01 | | | | | |B01='''[[Acidosis]]'''<br>(High [H<sup>+</sup>])}}
{{familytree | | | | | | | | | |!| | | | | | | | }}
{{familytree | | | | | | | | | B02 | | | | | |B02='''Determine the primary disorder'''<br> Metabolic or respiratory?}}
{{familytree | | | | | | | | | |!| | | | | | | | }}
{{familytree | | | | | | | | | B03 | | | | | |B03=Check [HCO3<sup>-</sup>] and PaCO<sub>2</sub>}}
{{familytree | | | |,|-|-|-|-|-|^|-|-|-|-|-|-|-|.| }}
{{familytree | | | C01 | | | | | | | | | | | |C02|C01=Low [HCO3<sup>-</sup>] <br>and<br> Low to normal PaCO<sub>2</sub>|C02= High PaCO<sub>2</sub> <br>and<br> High to normal [HCO3<sup>-</sup>] }}
{{familytree | | | |!| | | | | | | | | | | | | |!| }}
{{familytree | | | C03 | | | | | | | | | | | | C04 |C03='''[[Metabolic acidosis]]'''|C04='''[[Respiratory acidosis]]'''}}
{{familytree | | | |!| | | | | | | | | | | | | |!| }}
{{familytree | | | C05 | | | | | | | | | | | | C06 |C05='''Check for respiratory compensation'''<br><br>Calculate expected PCO<sub>2</sub>|C06='''Check for renal compensation'''<br><br> Calculate expected [HCO3<sup>-</sup>] }}
{{familytree | | | |!| | | | | | | | | | | | | |!| }}
{{familytree | | | |!| | | | | | | | | |,|-|-|-|^|-|-|-|-|.|}}
{{familytree | | | D01 | | | | | | | | D02 | | | | | | D03 |D01=Decrease in PaCO<sub>2</sub>=1.25 x (24- measured HCO3<sup>-</sup>)?|D02='''Acute acidosis?'''<br><br>Increase [HCO3<sup>-</sup>]=0.1 x (measure PaCO<sub>2</sub>-40)?|D03='''Chronic acidosis?'''<br><br>Increase [HCO3<sup>-</sup>]=0.1 x (measure PaCO<sub>2</sub>-40)?}}
{{familytree | |,|-|+|-|.| | | | | |,|-|+|-|.| | | |,|-|+|-|.| | }}
{{familytree | E01 |!| E02 | | | | E03 |!| E04 | | E05 |!| E06 |E01=PaCO<sub>2</sub> too low?<br><br> '''Mixed metabolic acidosis with respiratory alkalosis'''|E02=PaCO<sub>2</sub> too high?<br><br> '''Mixed metabolic acidosis with respiratory acidosis'''|E03=[HCO3<sup>-</sup>] too low? <br><br> '''Mixed respiratory acidosis with metabolic acidosis'''|E04=[HCO3<sup>-</sup>] too high? <br><br> '''Mixed respiratory acidosis with metabolic alkalosis'''|E05=[HCO3<sup>-</sup>] too low? <br><br> '''Mixed respiratory acidosis with metabolic acidosis'''|E06=E04=[HCO3<sup>-</sup>] too high? <br><br> '''Mixed respiratory acidosis with metabolic alkalosis''' }}
{{familytree | |:| E07 |:| | | | | |:| E08 |:| | | |:| E09 |:|E07=Measured PaCO<sub>2</sub> is equal to expected value?<br><br> '''Compensated metabolic acidosis'''|E08=Measured [HCO3<sup>-</sup>] is equal to expected value? <br><br> '''Compensated respiratory acidosis'''|E09=Measured [HCO3<sup>-</sup>] is equal to expected value? <br><br> '''Compensated respiratory acidosis''' }}
{{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/end}}
 
==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}}
== Metabolic Acidosis ==
{| class="wikitable"
!Disease
!PH
!Poisoning
!AG
!Loss of consciousness
!Fever
!
!
!
!
|-
|-
|Methanol
! style=" text-align: left; color: #4479BA; background: #FFFFFF; padding: 2px 10px; border-radius: 5px 5px 5px 5px; text-shadow: 0 0 0 rgba(0, 0, 0, 0.2); box-shadow: 0 1px 1px rgba(0, 0, 0, 0.5);" |Variable
|Low
! style=" text-align: center; color: #4479BA; background: #FFFFFF; border-radius: 5px 5px 5px 5px; text-shadow: 0 0 0 rgba(0, 0, 0, 0.2); box-shadow: 0 1px 1px rgba(0, 0, 0, 0.5);" |Score
|Yes
|High
|
|
|
|
|
|
|-
|-
|Metformin
! rowspan="2" style=" text-align: left; color: #FFFFFF; background: #4479BA; padding: 2px 10px; border-radius: 5px 5px 5px 5px; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: 0 1px 1px rgba(0, 0, 0, 0.5);" |Gender
|Low
| style=" text-align: center; color: #FFFFFF; background: #4479BA; padding: 2px 10px; border-radius: 5px 5px 5px 5px; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: 0 1px 1px rgba(0, 0, 0, 0.5);" |Female
|
|High
|
|
|
|
|
|
|-
|-
|Uremia
| style=" text-align: center; color: #FFFFFF; background: #4479BA; padding: 2px 10px; border-radius: 5px 5px 5px 5px; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: 0 1px 1px rgba(0, 0, 0, 0.5);" |Male
|Low
|
|High
|
|
|
|
|
|
|-
|-
|Diabetic ketoacidosis
! rowspan="4" style=" text-align: left; color: #FFFFFF; background: #4479BA; padding: 2px 10px; border-radius: 5px 5px 5px 5px; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: 0 1px 1px rgba(0, 0, 0, 0.5);" |Age
|Low
| style=" text-align: center; color: #FFFFFF; background: #4479BA; padding: 2px 10px; border-radius: 5px 5px 5px 5px; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: 0 1px 1px rgba(0, 0, 0, 0.5);" |0-70
|
|High
|
|
|
|
|
|
|-
|-
|Paraldehyde
| style=" text-align: center; color: #FFFFFF; background: #4479BA; padding: 2px 10px; border-radius: 5px 5px 5px 5px; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: 0 1px 1px rgba(0, 0, 0, 0.5);" |71-80
|Low
|Yes
|High
|
|
|
|
|
|
|-
|-
|Propylene glycol
| style=" text-align: center; color: #FFFFFF; background: #4479BA; padding: 2px 10px; border-radius: 5px 5px 5px 5px; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: 0 1px 1px rgba(0, 0, 0, 0.5);" |81-90
|Low
|Yes
|High
|
|
|
|
|
|
|-
|-
|Infection
| style=" text-align: center; color: #FFFFFF; background: #4479BA; padding: 2px 10px; border-radius: 5px 5px 5px 5px; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: 0 1px 1px rgba(0, 0, 0, 0.5);" |>90
|Low
|
|High
|
|
|
|
|
|
|-
|-
|Ischemia
! rowspan="5" style=" text-align: left; color: #FFFFFF; background: #4479BA; padding: 2px 10px; border-radius: 5px 5px 5px 5px; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: 0 1px 1px rgba(0, 0, 0, 0.5);" |Hgb ('''g/dL)'''
|Low
| style=" text-align: center; color: #FFFFFF; background: #4479BA; padding: 2px 10px; border-radius: 5px 5px 5px 5px; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: 0 1px 1px rgba(0, 0, 0, 0.5);" |>17 '''g/dL'''
|
|High
|
|
|
|
|
|
|-
|-
|Isoniazid
| style=" text-align: center; color: #FFFFFF; background: #4479BA; padding: 2px 10px; border-radius: 5px 5px 5px 5px; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: 0 1px 1px rgba(0, 0, 0, 0.5);" |15.5-17 '''g/dL'''
|Low
|
|High
|
|
|
|
|
|
|-
|-
|Ethylene glycol
| style=" text-align: center; color: #FFFFFF; background: #4479BA; padding: 2px 10px; border-radius: 5px 5px 5px 5px; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: 0 1px 1px rgba(0, 0, 0, 0.5);" |12.5-15.5 '''g/dL'''
|Low
|Yes
|High
|
|
|
|
|
|
|-
|-
|Ethanol
| style=" text-align: center; color: #FFFFFF; background: #4479BA; padding: 2px 10px; border-radius: 5px 5px 5px 5px; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: 0 1px 1px rgba(0, 0, 0, 0.5);" |12.5-11 '''g/dL'''
|Low
|Yes
|High
|
|
|
|
|
|
|-
|-
|Salicylates
| style=" text-align: center; color: #FFFFFF; background: #4479BA; padding: 2px 10px; border-radius: 5px 5px 5px 5px; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: 0 1px 1px rgba(0, 0, 0, 0.5);" |<11 '''g/dL'''
|Low/high
|Yes
|High
|
|
|
|
|
|
|-
|Starvation
|Low
|
|High
|
|
|
|
|
|
|-
|-
|Diarrhea
! rowspan="2" style=" text-align: left; color: #FFFFFF; background: #4479BA; padding: 2px 10px; border-radius: 5px 5px 5px 5px; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: 0 1px 1px rgba(0, 0, 0, 0.5);" |CrCl (mL/min)
|Low
| style=" text-align: center; color: #FFFFFF; background: #4479BA; padding: 2px 10px; border-radius: 5px 5px 5px 5px; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: 0 1px 1px rgba(0, 0, 0, 0.5);" |30-60 mL/min
|
|Nl
|
|
|
|
|
|
|-
|Ureteral diversion
|Low
|
|Nl
|
|
|
|
|
|
|-
|Renal tubular acidosis
|Low
|
|Nl
|
|
|
|
|
|
|-
|-
|Hyperalimentation
| style=" text-align: center; color: #FFFFFF; background: #4479BA; padding: 2px 10px; border-radius: 5px 5px 5px 5px; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: 0 1px 1px rgba(0, 0, 0, 0.5);" |15-30 mL/min
|Low
|
|Nl
|
|
|
|
|
|
|-
|-
|Addison's disease
! rowspan="2" style=" text-align: left; color: #FFFFFF; background: #4479BA; padding: 2px 10px; border-radius: 5px 5px 5px 5px; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: 0 1px 1px rgba(0, 0, 0, 0.5);" |Albumin
|Low
| style=" text-align: center; color: #FFFFFF; background: #4479BA; padding: 2px 10px; border-radius: 5px 5px 5px 5px; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: 0 1px 1px rgba(0, 0, 0, 0.5);" |>3.5 g/dL
|
|Nl
|
|
|
|
|
|
|-
|-
|Acetazolamide
| style=" text-align: center; color: #FFFFFF; background: #4479BA; padding: 2px 10px; border-radius: 5px 5px 5px 5px; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: 0 1px 1px rgba(0, 0, 0, 0.5);" |≤3.5 g/dL
|Low
|
|Nl
|
|
|
|
|
|
|-
|-
|Ammonium chloride
! rowspan="2" style=" text-align: left; color: #FFFFFF; background: #4479BA; padding: 2px 10px; border-radius: 5px 5px 5px 5px; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: 0 1px 1px rgba(0, 0, 0, 0.5);" |D-dimer
|Low
| style=" text-align: center; color: #FFFFFF; background: #4479BA; padding: 2px 10px; border-radius: 5px 5px 5px 5px; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: 0 1px 1px rgba(0, 0, 0, 0.5);" |≥1 µg/mL
|
|Nl
|
|
|
|
|
|
|-
|-
|Congenital chloride diarrhea
| style=" text-align: center; color: #FFFFFF; background: #4479BA; padding: 2px 10px; border-radius: 5px 5px 5px 5px; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: 0 1px 1px rgba(0, 0, 0, 0.5);" |<1 µg/mL
|Low
|
|Nl
|
|
|
|
|
|
|-
|-
|Amphotericin B
! style=" text-align: left; color: #FFFFFF; background: #4479BA; padding: 2px 10px; border-radius: 5px 5px 5px 5px; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: 0 1px 1px rgba(0, 0, 0, 0.5);" |ICU admission
|Low
| style=" text-align: center; color: #FFFFFF; background: #4479BA; padding: 2px 10px; border-radius: 5px 5px 5px 5px; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: 0 1px 1px rgba(0, 0, 0, 0.5);" |
|
|Nl
|
|
|
|
|
|
|-
|-
|Toluene
! style=" text-align: left; color: #FFFFFF; background: #4479BA; padding: 2px 10px; border-radius: 5px 5px 5px 5px; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: 0 1px 1px rgba(0, 0, 0, 0.5);" |Acute stroke on hospitalization
|Low
| style=" text-align: center; color: #FFFFFF; background: #4479BA; padding: 2px 10px; border-radius: 5px 5px 5px 5px; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: 0 1px 1px rgba(0, 0, 0, 0.5);" |
|
|Nl
|
|
|
|
|
|
|-
|-
|Cholestyramine
! style=" text-align: left; color: #FFFFFF; background: #4479BA; padding: 2px 10px; border-radius: 5px 5px 5px 5px; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: 0 1px 1px rgba(0, 0, 0, 0.5);" |History of VTE
|Low
| style=" text-align: center; color: #FFFFFF; background: #4479BA; padding: 2px 10px; border-radius: 5px 5px 5px 5px; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: 0 1px 1px rgba(0, 0, 0, 0.5);" |
|
|Nl
|
|
|
|
|
|
|-
|-
|post hypocapnea
! colspan="2" style=" text-align: left; color: #4479BA; background: #FFFFFF; padding: 2px 10px; border-radius: 5px 5px 5px 5px; text-shadow: 0 0 0 rgba(0, 0, 0, 0.2); box-shadow: 0 1px 1px rgba(0, 0, 0, 0.5);" |Result:
|Low
|
|Nl
|
|
|
|
|
|
|-
|-
|
! colspan="2" style=" text-align: left; color: #4479BA; background: #FFFFFF; padding: 2px 10px; border-radius: 5px 5px 5px 5px; text-shadow: 0 0 0 rgba(0, 0, 0, 0.2); box-shadow: 0 1px 1px rgba(0, 0, 0, 0.5);" |Interpretation:
|
|
|
|
|
|
|
|
|
|}
|}
<br style="clear:left" />


== Metabolic Alkalosis ==
===Interpretation of the Padua Prediction Score===
 
The interpretation of the score is as follows:
== Respiratory Acidosis ==
* Score ≥ 4: High risk for VTE
 
* Score < 4: Low risk for VTE
== Respiratory Alkalosis ==
==References==
==Related Chapters==
<references />
* [[Acid-base homeostasis|Acid–base homeostasis]]
* [[Acid-base imbalance|Acid–base imbalance]]
* [[Arterial blood gas]]
* [[Metabolic acidosis]]
* [[Metabolic alkalosis]]
* [[Respiratory acidosis]]
* [[Respiratory alkalosis]]
* [[Anion gap]]

Latest revision as of 18:11, 14 January 2019


Sandbox: wdx

Xyz

Abc

  1. Sandbox:Preeti
  2. Lymphoma
  3. Breast lumps differential diagnosis
  4. Neck masses differential diagnosis
  5. Leukemia
Category:Risk calculator
Deep vein thrombosis assessment of clinical probability and risk scores
Pulmonary embolism assessment of clinical probability and risk scores
Padua prediction score widget:PaduaVTEscore
IMPROVE risk score calculator Widget:IMPROVEScore
IMPROVEDD risk score calculator Widget:IMPROVEDDScore
Caprini score calculator Widget:CapCal
Wells score calculator for DVT Widget:DVT Wells score calculator
Modified Wells score calculator for DVT Widget:DVT Modified Wells score calculator
Pulmonary embolism Wells score calculator widget:PE_calculator
Pulmonary embolism modified Wells score calculator Widget:PE Modified Wells score calculator
AMUSE score calculator Widget:AMUSE_score_calculator
HAMILTON score calculator Widget:HAMILTON_score_calculator
Geneva score calculator Widget:Geneva_score_calculator
Revised Geneva score calculator Widget:Revised_Geneva_score_calculator
Simplified Geneva Score calculator Widget:Simplified_Geneva_score_calculator
TIMI Risk Score for Unstable Angina or NSTEMI Widget:TIMI_UA_NSTEMI
TIMI Risk Score for STEMI Widget:TIMI_STEMI
Tygerberg score widget:Tygerberg_score
CHA2DS2-VASc Score Widget:CHA2DS2VASc
CHADS2 score Widget:CHADS2score
HAS-BLED score Widget:HASBLEDscore
The GRACE risk score Widget:GRACEscore
Ranson criteria

Acute pancreatitis diagnostic criteria

Widget:RansonScore
Apgar score Widget:Apgarscore
Glasgow coma scale Widget:Adult_GCS
Pediatric Glasgow Coma Scale Widget:PGCS
Cincinnati stroke scale Widget:Cincinnati_Stroke_Scale
DIPSS Plus Score Widget:DIPSS_Plus_Score
ICU scoring systems
APACHE II Widget:APACHEII
SAPS II Widget:SAPSII
SAPS III Widget:SAPSIII
PIM2

Table

Complications Polymyositis Dermatomyositis
Malignancy


Calculation of the Padua Prediction Score

Shown below is a calculator using the predictive score for VTE among hospitalized medical patients. Check all boxes that apply to your patient:

IMPROVE Bleeding Risk Score
Variable Score
Active gastric or duodenal ulcer 4.5
Prior bleeding within the last 3 months 4
Thrombocytopenia (<50x109/L) 4
Age ≥ 85 years 3.5
Liver failure (INR>1.5) 2.5
Severe kidney failure (GFR< 30 mL/min/m2) 2.5
Admission to ICU or CCU 2.5
Central venous catheter 2
Rheumatic disease 2
Active malignancy 2
Age: 40-84 years 1.5
Male 1
Moderate kidney failure (GFR: 30-59 mL/min/m2) 1
Result:
Interpretation:


Calculation of the test Prediction Score

Shown below is a calculator using the predictive score for VTE among hospitalized medical patients. Check all boxes that apply to your patient:

IMPROVE Bleeding Risk Score
Variable Score
Gender Female
Male
Age 0-70
71-80
81-90
>90
Hgb (g/dL) >17 g/dL
15.5-17 g/dL
12.5-15.5 g/dL
12.5-11 g/dL
<11 g/dL
CrCl (mL/min) 30-60 mL/min
15-30 mL/min
Albumin >3.5 g/dL
≤3.5 g/dL
D-dimer ≥1 µg/mL
<1 µg/mL
ICU admission
Acute stroke on hospitalization
History of VTE
Result:
Interpretation:


Interpretation of the Padua Prediction Score

The interpretation of the score is as follows:

  • Score ≥ 4: High risk for VTE
  • Score < 4: Low risk for VTE

References

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