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This lecture was conducted during the Nephrology Unit Grand Ground by a
Sub-intern under Nephrology Division, Department of Medicine in King Saud
University. Nephrology Division is NOT responsible for the content of the presentation for
it is intended for learning and /or education purpose only.
HOW TO APPROACH PATIENTS WITH ACIDOSIS
Hadeel Salah Al Jamei
• Definitions• Brief Physiology• Etiology• Presentation Of The Patient• How To Approach The Patient• Investigations
• Treatment
OUTLINE
• Acid, Acidosis, Acidemia?• pH?
• Base, Alkalosis, Alkalemia?• pH?
DEFINITIONS
• Buffer Systems (Buffer + H+ HBuffer)• Bicarbonate exatracellular
• CO2 + H2O H2CO3
• H2CO3 H+ + HCO3-
• Phospahte exatracellular
• Protiens intracellualr
• Respiratory Systems• Hypoventilation vs. hyperventilation
• Renal System
MEANS OF REGULATING H+
CAUSES OF ACIDOSIS
Causes Of Acidosis
Respiratory
Acute
Chronic
Metabolic
Normal Anion Gap
Increased Anion Gap
What is the anion gap?How to calculate it? [Na+] – [HCO3
-] – [Cl-]
SIGNS AND SYMPTOMS
Hx is V.IMP
Renal compensation
Respiratory compensation
respiratoryMetabolic
AlkalosisAcidosis
pH
Arterial blood sample
Metabolicrespiratory
Respiratory compensation
Renal compensation
pH < 7.35 pH > 7.45
HCO3- < 22
HCO3- < 22
HCO3- > 26 PCO2 > 45
PCO2 > 45 HCO3- > 26
PCO2 < 35
PCO2 < 35
OTHER MODALITIES OF INVESTIGATIONS
Metabolic
Anion gap
serum chemistry
Urinalysis
Ketone levels
Lactate levels
Salicylate levels
ECG
Respiratory
Chest X-ray
Ct scan
Drug toxicology
CT scan
MRI
PFTs
EMG
NCV
TREATMENT
Metabolic Acidosis
Treat the underlying cause
NaHCO3
Respiratory Acidosis
Treat the underlying cause
Pharmacological
Oxygen
Ventilatory support
ABC and Vitals
• History Is Important• Acidemia Or Alkalemia• Respiratory Or Metabolic• If respiratory: acute or chronic• If metabolic: normal or increased anion gap?
• Is There A Compensation?
SUMMARY
Acidosis App
Qx Calculate App
• Textbook of medical physiology by Guyton and Hall 11th edition
• Pocket medicine by marc sabatine 4th edition.• Step up to medicine 2nd edition.• http://emedicine.medscape.com/article/768268-
overview#a0104• http://emedicine.medscape.com/article/301574-overview• http://cmbi.bjmu.edu.cn/uptodate/critical%20care/
Intoxications/Approach%20to%20the%20patient%20with%20metabolic%20acidosis.htm
• http://fitsweb.uchc.edu/student/selectives/TimurGraham/Welcome.html
REFERENCES