# Metabolic Acidoiss
-- ABCs: pH <7.2 --> ICU for bicarb, possible intubation if resp distress
-- VBG: confirm pH <7.36 and bicarb <24 (did PCO2 go down by 1 for each decrease in bicarb?)
-- HPI Intake: meds and adherence, alcohol use, other ingestions, immunosuppression, infectious symptoms
-- Can't Miss: sepsis/shock, DKA
-- Admission Orders: lactate, BHB, UA
-- Initial Treatment to Consider: *** bicarb, fluids, antibiotics,
-- History: *** alcohol use, CKD, diabetes, infections, ingestions
-- Clinical: *** confusion, dyspnea, vision changes, localizing infectious symptoms, N/V/D
-- Exam: *** AMS, WOB, overload
-- Data: *** VBG (pH, PCO2), bicarb, potassium,
-- Etiology/DDx: *** Anion Gap: lactic acidosis, uremia, DKA, intoxication; Non-Anion Gap: renal failure, diarrhea, saline infusion, RTA
The patient's HPI is notable for ***. Exam showed ***. Labwork and data were notable for ***. Taken together, the patient's presentation is most concerning for ***, with a differential including ***.
-- f/u CBC, BMP, VBG, UA
-- if anion gap - lactate, BHB
-- IVF: ***
-- Treat underlying cause - DKA, sepsis, renal failure, etc.
-- If c/f intoxication, consult renal for dialysis and fomepizole
PDF coming soon!
While acid-base distrubances can be confusing to think through, most patients who have metabolic acidosis in the hospital have lactic acidosis, renal failure, or ketoacidodis (DKA, EtOH, starvation). However, you can't miss ingestions or a respiratory acidosis from overdose or central process. Treatment involves addressing the underyling process and intubation or dialysis when appropriate.