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+

  • • Decreased serum pH (< 7.35)

    • Decreased serum HCO3

++

Epidemiology

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  • • Etiologies include:

    • -Diarrhea

      -Diuretics

      -Renal tubular disease

      -Ureterosigmoidostomy

      -Lactic acidosis

      -Diabetic ketoacidosis

      -Uremia

++

Laboratory Findings

+

  • • Decreased serum pH (< 7.35)

    • Decreased serum HCO3

+

  • • Differentiate between anion gap or hyperchloremic causes

+

  • • Serum electrolytes

    • ABG measurements

    • Calculate anion gap: Na - (Cl + HCO3)

    • Anion gap > 15: H+ excess, lactic acidosis, diabetic ketoacidosis, uremia, methanol ingestion, salicylate intoxication, ethylene glycol ingestion

    • Anion gap < 15: HCO3 loss, diarrhea, renal tubular disease, ureterosigmoidostomy, acetazolamide, NH4 Cl administration

+

  • • Treat underlying condition

    Conservative HCO3 administration: Estimate need by multiplying base deficit by one half total body water

++

Medications

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  • • Sodium bicarbonate as needed

++

Treatment Monitoring

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  • • Serial ABG measurements

++

Complications

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  • • Hypotension

    • Death

++

Prognosis

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  • • Varies with etiology

++

References

Adrogue HJ et al. Management of life-threatening acid-base disorders. (Two parts.) N Engl J Med. 1998;338:26, 107.
Ishihara K et al. Anion gap acidosis. Semin Nephrol. 1998;18:83.  [PubMed: 9459291]

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