Acid-base interpretation. Part 2: applying five rules to simplify complex cases.
Female; Male; Aged; Middle Age; Diagnosis; Differential; Rules and Regulations; Acid-Base Imbalance – Diagnosis; Acidosis – Diagnosis; Alkalosis – Diagnosis
Thorough investigation of complex cases of acid-base disturbances indudes verification of pH, determination of respiratory and metabolic components, calculation of the anion gap, assessment of the degree of compensation; and analysis of the relationship among anions in the blood. In patients with suspected metabolic alkolosis, use the urinary chloride level to help differentiate between a saline-responsive and saline-resistant condition. In the evaluation of normal union gap metabolic acidemia, urinary electrolytes and the calculation of the urine delta gap may help differentiate between renal and stool biocarbonate wasting. In cases of severe acidemia, knowledge of the patient's serum potassium level is critical to formulation of the appropriate treatment strategy.
Rutecki G W; Whittier F C
Consultant (00107069)
1998
1998-01
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
Acid-base interpretation: part 1: applying five rules in everyday cases.
Female; Male; Aged; Outpatients; Reference Values; Blood Gas Analysis; Inpatients; Middle Age; Cations; Anions; Acid-Base Imbalance – Diagnosis; Acidosis – Diagnosis; Alkalosis – Diagnosis; Acid-Base Equilibrium – Physiology; Carbon Dioxide – Analysis; Hydrogen-Ion Concentration – Evaluation
The interpretation of acid-base data can be greatly facilitated by applying five rules: (1) use the blood gas to identify acidemia or alkalemia, (2) determine whether the underlying cause of acidemia or alkalemia is respiratory or metabolic, (3) calculate the anion gap, (4) check for the degree of compensation, and (5) assess the relationship between anions (there should be a 1:1 relationship of acid to base). Alkalemia has an underlying respiratory cause if the partial pressure of carbon dioxide (PCO2) is substantially less than 40 min Hg. It has a metabolic cause if the bicarbonate content is greater than 25 mEq/L Acidemia has a respiratory cause if the PC02 is greater than 40/min Hg. It has a metabolic cause if the bicarbonate content is less than 25 mEq/L.Calculating the acidbase ratio may reveal a metabolic alkalosis not detected by rules 1 through 4.
Rutecki G W; Whittier F C
Consultant (00107069)
1997
1997-12
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).