SHM's Clinical Quick Talks-Acid-Base Disorders

Pdf Summary

The document provides a comprehensive overview of acid-base disorders, authored by George Wuni, MD, and Ritesh Patel, MD. It outlines four primary acid-base disorders divided into metabolic (metabolic acidosis and metabolic alkalosis) and respiratory (respiratory acidosis and respiratory alkalosis) categories. Metabolic disorders involve disturbances in bicarbonate levels ([HCO3-]), while respiratory disorders involve alterations in PCO2 levels.<br /><br />Metabolic acidosis can be further categorized into anion gap and non-anion gap acidosis. The anion gap is used to differentiate between various causes of metabolic acidosis, with common causes for anion gap acidosis summarized by the mnemonic MUDPILES, including conditions like methanol poisoning and diabetic ketoacidosis. Normal anion gap acidosis is covered by DURHAM, representing causes like diarrhea and renal tubular acidosis.<br /><br />The document also details the evaluation process for acid-base disorders using a 5-step approach to analyze clinical data and laboratory results, such as arterial blood gas and serum electrolytes. Diagnostics involve determining the primary disorder, calculating the anion gap, examining compensation mechanisms, and identifying mixed disorders.<br /><br />Clinical pearls emphasize that a normal pH does not exclude disorders and the utility of serum anion and osmolar gaps in diagnosis. The document includes formulas for estimating expected PCO2 in different scenarios and conversions for venous blood gases to arterial estimates.<br /><br />An illustrative clinical example describes diagnosing a patient with dual metabolic acidosis conditions: elevated anion gap metabolic acidosis and normal anion gap acidosis, with diarrhea as the likely secondary cause. These diagnostic methods and insights are essential for effective management of acid-base imbalances in a clinical setting.

Asset Subtitle

George Wuni, Ritesh Patel

Keywords

acid-base disorders

metabolic acidosis

respiratory alkalosis

anion gap

MUDPILES mnemonic

diagnostic evaluation

serum electrolytes

clinical pearls

PCO2 estimation

acid-base management