Acidosis resident survival guide: Difference between revisions

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{{CMG}}
{{CMG}}; '''Associate Editor-In-Chief:''' [[User:Rim Halaby|Rim Halaby]]


==Definition==
==Overview==
[[Acidosis]] occurs when the [[pH]] is less or equal to 7.35 due to excess of [[hydrogen]] ions.
[[Acidosis]] occurs when the [[pH]] is less or equal to 7.35 due to excess of [[hydrogen]] ions.


==Causes==
==Causes==


===Life Threatening Causes===
===Life Threatening Causes===
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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?}}
{{familytree | | | | | | | | | |!| | | | | | | | }}
{{familytree | | | | | | | | | |!| | | | | | | | }}
{{familytree | | | | | | | | | B03 | | | | | |B03=Check [HCO3<sup>2-</sup>] and PaCO<sub>2</sub>}}
{{familytree | | | | | | | | | B03 | | | | | |B03=Check [HCO3<sup>-</sup>] and PaCO<sub>2</sub>}}
{{familytree | | | |,|-|-|-|-|-|-|^|-|-|-|-|-|-|.| }}
{{familytree | | | |,|-|-|-|-|-|^|-|-|-|-|-|-|-|.| }}
{{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>-</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 | | | |!| | | | | | | | | | | | | |!| }}
{{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>-</sup>] }}
{{familytree | | | |!| | | | | | | | | | | | | |!| }}
{{familytree | | | |!| | | | | | | | | | | | | |!| }}
{{familytree | | | |!| | | | | | | | | |,|-|-|-|^|-|-|-|-|.|}}
{{familytree | | | |!| | | | | | | | | |,|-|-|-|^|-|-|-|-|.|}}
{{familytree | | | D01 | | | | | | | | D02 | | | | | | D03 |D01=Decrease in PaCO<sub>2</sub>=1.25 x (24- measured HCO3<sup>2-</sup>?|D02='''Acute acidosis?'''<br><br>Increase [HCO3<sup>2-</sup>]=0.1 x (measure PaCO<sub>2</sub>-40)?|D03='''Chronic acidosis?'''<br><br>Increase [HCO3<sup>2-</sup>]=0.1 x (measure PaCO<sub>2</sub>-40)?}}
{{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 | |,|-|+|-|.| | | | | |,|-|+|-|.| | | |,|-|+|-|.| | }}
{{familytree | E01 | | E02 | | | | E03 | | E04 | | E05 | | E06 |E01=E01|E02=E02|E03=E03|E04=E04|E05=E05|E06=E06 }}
{{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}}
{{familytree/end}}



Revision as of 00:19, 13 March 2014

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief: Rim Halaby

Overview

Acidosis occurs when the pH is less or equal to 7.35 due to excess of hydrogen ions.

Causes

Life Threatening Causes

Common Causes

Management

 
 
 
 
 
 
 
 
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
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

References

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