Acidosis resident survival guide: Difference between revisions
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==Management== | ==Management== | ||
{{familytree/start}} | {{familytree/start}} | ||
{{familytree | | | | | | | | | A01 | | | | | |A01='''pH < 7.35'''}} | {{familytree | | | | | | | | | A01 | | | | | |A01='''[[pH]] < 7.35'''}} | ||
{{familytree | | | | | | | | | |!| | | | | | | | }} | {{familytree | | | | | | | | | |!| | | | | | | | }} | ||
{{familytree | | | | | | | | | B01 | | | | | |B01='''Acidosis'''<br>(High [H<sup>+</sup>])}} | {{familytree | | | | | | | | | B01 | | | | | |B01='''[[Acidosis]]'''<br>(High [H<sup>+</sup>])}} | ||
{{familytree | | | | | | | | | |!| | | | | | | | }} | {{familytree | | | | | | | | | |!| | | | | | | | }} | ||
{{familytree | | | | | | | | | B02 | | | | | |B02='''Determine the primary disorder'''<br> Metabolic or respiratory?}} | {{familytree | | | | | | | | | B02 | | | | | |B02='''Determine the primary disorder'''<br> Metabolic or respiratory?}} | ||
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{{familytree | | | C01 | | | | | | | | | | | |C02|C01=Low [HCO3<sup>2-</sup>] <br>and<br> Low PaCO<sub>2</sub>|C02=High [HCO3<sup>2-</sup>] <br>and<br> High PaCO<sub>2</sub>}} | {{familytree | | | C01 | | | | | | | | | | | |C02|C01=Low [HCO3<sup>2-</sup>] <br>and<br> Low PaCO<sub>2</sub>|C02=High [HCO3<sup>2-</sup>] <br>and<br> High PaCO<sub>2</sub>}} | ||
{{familytree | | | |!| | | | | | | | | | | | | |!| }} | {{familytree | | | |!| | | | | | | | | | | | | |!| }} | ||
{{familytree | | | C03 | | | | | | | | | | | | C04 |C03='''Metabolic acidosis'''|C04='''Respiratory acidosis'''}} | {{familytree | | | C03 | | | | | | | | | | | | C04 |C03='''[[Metabolic acidosis]]'''|C04='''[[Respiratory acidosis]]'''}} | ||
{{familytree | | | |!| | | | | | | | | | | | | |!| }} | {{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>2-</sup>] }} | {{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>2-</sup>] }} | ||
Revision as of 03:14, 2 August 2013
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief: Rim Halaby
Definition
Acidosis occurs when the pH is less or equal to 7.35 due to excess of hydrogen ions.
Causes
Life Threatening Causes
Common Causes
- Diabetic ketoacidosis
- Diarrhea
- Ethylene glycol
- Lactic acidosis
- Methanol
- Renal tubular acidosis
- Salicylates
- Uremia
Management
| pH < 7.35 | |||||||||||||||||||||||||||||||||||||||||||||||||||
| Acidosis (High [H+]) | |||||||||||||||||||||||||||||||||||||||||||||||||||
| Determine the primary disorder Metabolic or respiratory? | |||||||||||||||||||||||||||||||||||||||||||||||||||
| Check [HCO32-] and PaCO2 | |||||||||||||||||||||||||||||||||||||||||||||||||||
| Low [HCO32-] and Low PaCO2 | High [HCO32-] and High PaCO2 | ||||||||||||||||||||||||||||||||||||||||||||||||||
| Metabolic acidosis | Respiratory acidosis | ||||||||||||||||||||||||||||||||||||||||||||||||||
| Check for respiratory compensation Calculate expected PCO2 | Check for renal compensation Calculate expected [HCO32-] | ||||||||||||||||||||||||||||||||||||||||||||||||||
| Decrease in PaCO2=1.25 x (24- measured HCO32-)? | Acute acidosis? Increase [HCO32-]=0.1 x (measure PaCO2-40)? | Chronic acidosis? Increase [HCO32-]=0.1 x (measure PaCO2-40)? | |||||||||||||||||||||||||||||||||||||||||||||||||
| PaCO2 too low? Mixed metabolic acidosis with respiratory alkalosis | PaCO2 too high? Mixed metabolic acidosis with respiratory acidosis | [HCO32-] too low? Mixed respiratory acidosis with metabolic acidosis | [HCO32-] too high? Mixed respiratory acidosis with metabolic alkalosis | [HCO32-] too low? Mixed respiratory acidosis with metabolic acidosis | E04=[HCO32-] too high? Mixed respiratory acidosis with metabolic alkalosis | ||||||||||||||||||||||||||||||||||||||||||||||
| Measured PaCO2 is equal to expected value? Compensated metabolic acidosis | Measured [HCO32-] is equal to expected value? Compensated respiratory acidosis | Measured [HCO32-] is equal to expected value? Compensated respiratory acidosis | |||||||||||||||||||||||||||||||||||||||||||||||||
| Click here for the management of metabolic acidosis | Click here for the management of respiratory acidosis | ||||||||||||||||||||||||||||||||||||||||||||||||||