Acid-Base Diagnosis & Clinical Approach with Dr. Bill Bortcosh--Part 2

Nov 4, 2024

Dr. Bill Bortcosh, a pediatric critical care expert, dives deep into the acid-base status evaluation essential for patient care. He discusses the practical application of the anion gap and how it serves as a vital screening tool. The conversation explores the nuances of fluid management, focusing on the effects of normal saline versus Plasmalite on chloride levels. Bortcosh also addresses the complexities of diagnosing metabolic acidosis, including renal tubular acidosis, emphasizing the importance of continuous learning in navigating these challenges.

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Episode notes

Intro

00:00 • 5min

Navigating Fluid Management and Bicarbonate Balance in Critical Care

05:07 • 3min

Navigating Uncertainty in Acid-Base Management

08:37 • 2min

Understanding Metabolic Acidosis and Alkalosis: RTA and Pediatric Considerations

10:16 • 11min

Understanding Acid-Base Disturbances

21:08 • 15min

The Essential Role of Acid-Base Assessment in Critical Care

36:20 • 2min

Reflections on Patient Care and Continuous Learning

37:57 • 2min

Dr. Bill Bortcosh received his Doctorate of Medicine from Albany Medical School, NY. He completed his pediatric residency at the University of Massachusetts Medical School followed by pediatric critical care fellowship at Massachusetts General Hospital.
Learning Objectives:

By the end of this podcast series, listeners should be able to discuss:

Why critical evaluation of a patient’s acid-base status can be useful and practical in the acute care setting
The basic pathophysiology of each acid-base disturbance
The definition of an anion gap and how to use it as a screening tool
The use of Winter’s formula to identify a respiratory acidosis or alkalosis
The utility of the delta-delta to identify additional metabolic acidosis or alkalosis

Link to Acid/Base Handout

References

1. Carmody JB, Norwood VF. A clinical approach to paediatric acid-base disorders. Postgrad Med J. 2012;88(1037):143-51.

2. Carmody JB, Norwood VF. Paediatric acid-base disorders: A case-based review of procedures and pitfalls. Paediatr Child Health. 2013;18(1):29-32.

3. Emmett M. Approach to the Patient With a Negative Anion Gap. Am J Kidney Dis. 2016;67(1):143-50.

4. Luke RG, Galla JH. It is chloride depletion alkalosis, not contraction alkalosis. J Am Soc Nephrol. 2012;23(2):204-7.

5. https://emcrit.org/ibcc/salicylates/

Citation: Bortcosh W, Shanklin A, Hodges Z. Acid-Base Diagnosis & Clinical Approach. PedsCrit Online Podcast. 10/2024. https://www.pedscrit.com/acid-base-diagnosis-clinical-approach-with-dr-bill-bortcosh-part-1/

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Thank you for listening to this episode of PedsCrit. Please remember that all content during this episode is intended for educational and entertainment purposes only. It should not be used as medical advice. The views expressed during this episode by hosts and our guests are their own and do not reflect the official position of their institutions. If you have any comments, suggestions, or feedback-you can email us at pedscritpodcast@gmail.com. Check out http://www.pedscrit.com for detailed show notes. And visit @critpeds on twitter and @pedscrit on instagram for real time show updates.