METABOLIC ACIDOSIS

METABOLIC ACIDOSIS
Three Mechanisms High anion gap metabolic acidosis Normal anion gap metabolic acidosis Treatment of metabolic acidosis Three mechanisms: -consumption of HC03- by a strong acid leading to a primary decrease in [HC03-] -renal or GI wasting of HC03- -rapid dilution of ECF compartment of fluid lacking bicarbonate Anion Gap = [Na+] – ([Cl-] + [HC03-]) Normal range = 7 – 14 mEq/L High anion gap metabolic acidosis -failure to excrete endogenous nonvolatile acids -increased production of nonvolatile acids -ingestion of exogenous nonvolatile anesthetics Normal anion gap metabolic acidosis -increased GI loss of HC03- -increased renal loss of HC03- -hyperchloremic acidosis Treatment of metabolic acidosis -desired PaC02 of low 30's to help normalize the pH -arterial pH < 7.20 may benefit from 7.5 % NaHC03 -monitor serial ABG's -pH > 7.25 is the goal to avoid adverse effect of acidemia -acute hemodialysis is required for profound or refractory academia