Acidosis, Metabolic

• • Decreased serum pH (< 7.35)

  • Decreased serum HCO3

Epidemiology

• • 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

• • Sodium bicarbonate as needed

Treatment Monitoring

• • Serial ABG measurements

Complications

• • Hypotension

  • Death

Prognosis

• • Varies with etiology

References