RT Book, Section
A1 Kruse, James A.
A2 Oropello, John M.
A2 Pastores, Stephen M.
A2 Kvetan, Vladimir
SR Print(0)
ID 1136414513
T1 Acid-Base Disorders
T2 Critical Care
YR 1
FD 1
PB McGraw-Hill Education
PP New York, NY
SN 9780071820813
LK accessanesthesiology.mhmedical.com/content.aspx?aid=1136414513
RD 2024/04/20
AB KEY  POINTSRecognition  of  acid-base  disturbances  through  interpretation  of  arterial  blood  gases  is  of  fundamental  importance  to  the  daily  clinical  practice  of  critical  care.The  carbonic  acid-bicarbonate  buffer  is  the  most  important  buffer  system.  The  relation  of  pH  to  this  buffering  system  is  defined  by  the  Henderson–Hasselbalch  equation.There  are  four  cardinal  acid-base  disorders:  metabolic  acidosis,  metabolic  alkalosis,  respiratory  acidosis,  and  respiratory  alkalosis.The  etiologies  of  metabolic  acidosis  can  be  classified  by  the  typical  serum  anion  gap  association  (elevated  or  normal  anion  gap  acidosis).The  serum  osmole  gap  is  often  used  as  a  screening  test  when  methanol  or  ethylene  glycol  intoxication  is  suspected.Gastric  fluid  loss,  diuretic  use,  and  extracellular  volume  contraction  are  among  the  most  common  causes  of  metabolic  alkalosis.The  etiologies  of  metabolic  alkalosis  can  be  classified  by  the  expected  urine  chloride  concentration  or  excretion  (normal,  high,  or  low  urine  chloride).Common  causes  of  respiratory  acidosis  are  pulmonary  disorders  (eg,  chronic  obstructive  lung  disease,  severe  pneumonia,  aspiration  pneumonitis,  and  smoke  inhalation),  neurologic  injury,  neuromuscular  and  metabolic  disorders,  and  narcotic  and  sedative  agents.Respiratory  alkalosis  is  common  with  severe  sepsis,  hepatic  failure,  mechanical  ventilation,  and  with  drugs  such  as  salicylates  and  illicit  stimulants  (eg,  cocaine  and  amphetamine).Mixed  acid-base  disorders  are  not  uncommon  in  critically  ill  patients  and  frequently  complicate  interpretation  of  arterial  blood  gases  in  the  intensive  care  unit  setting.