Metabolic acidosis: Difference between revisions
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==Formula== | == Formula == | ||
*PCO2 = (1.5 x [HCO3–] + 8) ± 2 | *PCO2 = (1.5 x [HCO3–] + 8) ± 2 | ||
*In acute setting PCO2 should fall by 1 mmHg for every 1 mEq fall in HCO3 | *In acute setting PCO2 should fall by 1 mmHg for every 1 mEq fall in HCO3 | ||
==DDX== | == DDX == | ||
===Gap=== | |||
=== Gap === | |||
#Lactic acidosis | #Lactic acidosis | ||
##Sepsis, shock, liver dz, CO, CN, metformin, methemoglobin | |||
#Renal failure | #Renal failure | ||
##Uremia | |||
#Ketoacidosis | #Ketoacidosis | ||
## | ##DKA, AKA, starvation | ||
# | #Ingestions | ||
##Inc osm gap | ##Inc osm gap | ||
###Methanol | ###Methanol, ethylene glycol | ||
##Nl osm gap | ##Nl osm gap | ||
### | ###Salicylates | ||
===Non-gap=== | === Non-gap === | ||
# Hyperkalemia | |||
## Resolving DKA | #Hyperkalemia | ||
## Early uremic acidosis | ##Resolving DKA | ||
## Early obstructive | ##Early uremic acidosis | ||
## RTA Type IV | ##Early obstructive | ||
## Hypoaldo | ##RTA Type IV | ||
## K-sparing diuretics | ##Hypoaldo | ||
# Hypokalemia | ##K-sparing diuretics | ||
## RTA Type I | #Hypokalemia | ||
## RTA Type II | ##RTA Type I | ||
## Acetazolamide | ##RTA Type II | ||
## Acute diarrhea | ##Acetazolamide | ||
### (May be assoc with gap if hypoperfusion -> lactic acidosis) | ##Acute diarrhea | ||
###(May be assoc with gap if hypoperfusion -> lactic acidosis) | |||
== Treatment == | |||
Treat source | Treat source | ||
===Bicarbonate Indications=== | === Bicarbonate Indications === | ||
#Bicarb <4 | #Bicarb <4 | ||
#pH <7.10 + Sx shock/myocardial irritability | #pH <7.10 + Sx shock/myocardial irritability | ||
#Severe hyperchloremic acidemia + Sx shock/myocardial irritability | #Severe hyperchloremic acidemia + Sx shock/myocardial irritability | ||
==Source == | == Source == | ||
2/21/06 DONALDSON (adapted from Tintinalli) | 2/21/06 DONALDSON (adapted from Tintinalli) | ||
[[Category:FEN]] | <br/>[[Category:FEN]] <br/><br/> | ||
Revision as of 02:18, 27 April 2011
Formula
- PCO2 = (1.5 x [HCO3–] + 8) ± 2
- In acute setting PCO2 should fall by 1 mmHg for every 1 mEq fall in HCO3
DDX
Gap
- Lactic acidosis
- Sepsis, shock, liver dz, CO, CN, metformin, methemoglobin
- Renal failure
- Uremia
- Ketoacidosis
- DKA, AKA, starvation
- Ingestions
- Inc osm gap
- Methanol, ethylene glycol
- Nl osm gap
- Salicylates
- Inc osm gap
Non-gap
- Hyperkalemia
- Resolving DKA
- Early uremic acidosis
- Early obstructive
- RTA Type IV
- Hypoaldo
- K-sparing diuretics
- Hypokalemia
- RTA Type I
- RTA Type II
- Acetazolamide
- Acute diarrhea
- (May be assoc with gap if hypoperfusion -> lactic acidosis)
Treatment
Treat source
Bicarbonate Indications
- Bicarb <4
- pH <7.10 + Sx shock/myocardial irritability
- Severe hyperchloremic acidemia + Sx shock/myocardial irritability
Source
2/21/06 DONALDSON (adapted from Tintinalli)