Acidosis resident survival guide: Difference between revisions
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{{CMG}} | {{CMG}}; '''Associate Editor-In-Chief:''' [[User:Rim Halaby|Rim Halaby]] | ||
== | ==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=== | ||
Line 27: | Line 26: | ||
==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> | {{familytree | | | | | | | | | B03 | | | | | |B03=Check [HCO3<sup>-</sup>] and PaCO<sub>2</sub>}} | ||
{{familytree | | | |,|-|-|-|-|-|- | {{familytree | | | |,|-|-|-|-|-|^|-|-|-|-|-|-|-|.| }} | ||
{{familytree | | | C01 | | | | | | | | | | | |C02|C01=Low [HCO3<sup> | {{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> | {{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> | {{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= | {{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
- 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 [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 | ||||||||||||||||||||||||||||||||||||||||||||||||||