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Acidosis

  • Criteria

    • pH < 7.38
  • Initial labs

    • ABG, BMP, UA
  • Tx for resp acidosis

    • naloxone if narcotic OD
    • ventilation
    • intubation if AMS
  • Tx for metabolic acidosis

    • treat underlying cause
    • give bicarb if pH < 7.1
  • Ddx

    • respiratory acidosis (hypoventilation, PCO2 > 40)
      • acute:
        • BZD overdose
        • narcotic overdose
        • acute obstruction, weakness
      • chronic:
        • COPD
        • obesity
    • metabolic acidosis (bicarb < 22)
      • high anion gap (Na - Cl & bicarb > 13)
        • DKA, ketoacidosis
        • lactic acidosis (hx of shock, seizure, hypoxia)
        • uremia, renal failure
        • toxic ingestion
          • methanol (high osm gap)
          • propylene glycol
          • isoniazid
          • ethylene glycol (high osm gap)
          • salicylates
      • low anion gap (Na - Cl - bicarb < 13)
        • RTA
        • diarrhea
        • HCl infusion
  • MUDPILES mnemonic for high anion gap acidosis

    • methanol, uremia, DKA, propylene glycol, isoniazid, lactic acidosis, ethylene glycol, salicylates
  • Anion gap formula

    • Na - (Cl + bicarb). Normal < 10
  • Osmolal gap

    • measured serum osm - calculated serum osm. Normal < 10
  • Calculated serum osm

    • 2*Na + glc/18 + urea/2.8

  • Print | Citations

    Disclaimer: MDHero Workups is for educational use only, and is not meant to replace the clinical judgement of a professional. We do not guarantee the accuracy of any information on this website.