Critical Care Time 19. Metabolic Acidosis w/ NephMadness
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Mar 15, 2024 Explore metabolic acidosis in critically ill patients with a focus on acid/base derangements, working up, and treating in the ICU. Learn about the similarities between Spanx and sodium bicarb, and gain insights on diagnosing and managing metabolic acidosis, including bicarbonate measurements, urine potassium significance, and renal replacement therapy modalities.
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Approach to Acid-Base Disorders
- Always start with the pH to determine acidosis or alkalosis.
- Consider patient history, medications, and physical exam for clues.
Categorizing Acidosis
- Bicarbonate and PCO2, obtained from labs, help categorize acidosis.
- Use the anion gap (sodium - chloride - bicarbonate) to further classify metabolic acidosis.
Lactic Acid vs. Lactate
- Lactic acid, a byproduct of anaerobic metabolism, is not inherently pathologic.
- Lactate, its conjugate base, is present in lactated Ringer's and is not harmful.