Acidosis resident survival guide: Difference between revisions
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{{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 PaCO<sub>2</sub>|C02=High [HCO3<sup>-</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> | {{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=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> | {{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> | {{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 | |:| |:| |:| | | | | |:| |:| |:| | | |:| |:| |:| | }} | ||
{{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''']] }} | ||
Revision as of 12:31, 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 [HCO3-] and PaCO2 | |||||||||||||||||||||||||||||||||||||||||||||||||||
| Low [HCO3-] and Low PaCO2 | High [HCO3-] and High PaCO2 | ||||||||||||||||||||||||||||||||||||||||||||||||||
| 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 | ||||||||||||||||||||||||||||||||||||||||||||||||||