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Acidosis, Metabolic

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    Disclaimer: These citations have been automatically generated based on the information we have and it may not be 100% accurate. Please consult the latest official manual style if you have any questions regarding the format accuracy.

    AMA Citation
    Acidosis, Metabolic. In: Doherty GM. Doherty G.M.(Ed.),Ed. Gerard M. Doherty.eds. Quick Answers Surgery. McGraw-Hill; Accessed July 04, 2020. https://accesssurgery.mhmedical.com/content.aspx?bookid=853&sectionid=49661973
    APA Citation
    Acidosis, metabolic. Doherty GM. Doherty G.M.(Ed.),Ed. Gerard M. Doherty. (2010). Quick Answers Surgery. McGraw-Hill. https://accesssurgery.mhmedical.com/content.aspx?bookid=853&sectionid=49661973
    MLA Citation
    "Acidosis, Metabolic." Quick Answers Surgery Doherty GM. Doherty G.M.(Ed.),Ed. Gerard M. Doherty. McGraw-Hill, 2010, https://accesssurgery.mhmedical.com/content.aspx?bookid=853&sectionid=49661973.

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  • • 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

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

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