Name
ACIDOSIS
DESCRIPTION
DETAIL
CAUSES : * CHR. RENAL FAILURE * COPD * CHRONIC USE OF DIURETIC LIKE ACETAZOLAMIDE * CHR. DIARRHOEAOTHER TESTS - * ARTERIAL BLOOD GASES - PACO2 & SERUM BICARBONATES - LOW * BLOOD PH - DECREASED OR NORMAL IN RESPIRATORY ACIDOSIS * BLOOD UREA , BUN , SERUM CREATININE, SERUM POTASSIUM - RAISED IN CHR, RENAL FAILURE * SERUM POTASSIUM - LOW IN CHR DIURETIC USE, DIARRHOEA * SERUM SODIUM - LOW IN CHR DIURETIC USE, DIARRHOEA * PUL FUNCTION TEST - ABNORMAL IN COPD * ULTRA SOUND ABDOMEN - SHOWS RENAL STATUS
TYPENOTES
Emergency Department Care: The initial therapeutic goal for patients with severe acidemia is to raise the systemic pH above 7.1-7.2, a level at which dysrhythmias become less likely and cardiac contractility and responsiveness to catecholamines will be restored. Metabolic acidosis can be reversed by treating the underlying condition or by replacing the bicarbonate. The decision to give bicarbonate should be based upon the pathophysiology of the specific acidosis, the clinical state of the patient, and the degree of acidosis. Treating the underlying conditions in high AG states usually is sufficient in reversing the acidosis. Treatment with bicarbonate is unnecessary, except in extreme cases of acidosis when the pH is less than 7.1-7.2. For all cases of diabetic ketoacidosis, the role of bicarbonate is controversial, regardless of the pH or bicarbonate level. In hyperchloremic acidosis, the central problem is with the reabsorption or regeneration of bicarbonate. In these conditions, therapy with bicarbonate makes physiologic sense and is prudent in patients with severe acidosis. Caution with bicarbonate therapy is indicated because of its potential complications, including the following: Volume overload Hypokalemia CNS acidosis Hypercapnia Tissue hypoxia via leftward shift of hemoglobin-oxygen dissociation curve Alkali stimulation of organic acidosis (lactate) Overshoot alkalosis Consultations: Metabolic acidosis secondary to ingestions (eg, salicylate, methanol, ethylene glycol) often requires dialysis therapy, and a nephrologist should be consulted early in the case management. Toxicologic consultation also should be considered in such cases. Dialysis is the preferred treatment for patients with significant metabolic acidosis in the setting of renal failure. MEDICATION : 1. ALKALINISING AGENTS : - SODIUM BICARBONATE : Total bicarbonate deficit = Base deficit X bicarbonate (0.5-0.8) X body weight (kg) . Although this represents total bicarbonate deficit, replacement of this amount is never necessary since the unmeasured anions will be converted back to bicarbonate once the underlying condition is treated; the goal of IV bicarbonate is only to emergently raise the pH above 7.1-7.2; this generally can be accomplished by small boluses of IV bicarbonate equalling 50-100 mEq; continuous monitoring of pH and electrolytes is required to judge the adequacy of bicarbonate therapy PAEDIATRIC PATIENTS : The following formula may be used to estimate dose to be administered in children: HCO3- (mEq) = 0.5 X weight (kg) X [24 - serum HCO3- (mEq/L)] Formula has many limitations but practitioner can roughly determine amount of bicarbonate required and subsequently titrate against pH and anion gap.
RELATED DISEASE
Not Available Disease
DISEASE
INVESTIGATION
BLOOD SUGAR ( FASTING ), BLOOD UREA, SERUM CREATININE, SERUM SODIUM, SERUM POTASSIUM, SERUM CHLORIDE, ULTRA SOUND WHOLE ABDOMEN - FEMALE, BLOOD SUGAR ( AFTER MEALS ), BUN, COMPLETE BLOOD COUNT, PULMONARY FUNCTION TEST