Sunday 30 September 2012

a case a metabolic acidosis

Hope everyone had a good good weekend

Friday, we started with a good example of Anion Gap Metabolic acidosis and reveiwed how to approach acid base problems.

1. pH: acidemia vs alkalosis
2. is it primary met or resp:

3. is there compensation? and is it appropriate? (for acute met acidosis compensation should be ~1:1)
For met acidosis:
4. is there an anion gap? (what is the albumin- if low then anion gap is bigger than appears)--> for every drop of albumin by 10, add 3 to your AG
5. What caused the anion gap? Really the 4 things to think about are:
- Lactic acidosis (hypoperfusion or liver disease)
-Ketone (diabetes, alcohol or starvation)
-Uremia
-Poison/Toxin- ethanol, methanol, ethylene glycol, ASA, isopropyl alcohol

(Think about how many AG points each of the above would raise your gap!!-- Ketone 1:1, Creatitinine 100:1, Lactate 1:2)

6. is there an osmole gap? 

7.Check the delta delta to see if another disorder is also going on.
Basically you just compare the delta AG (e.g. 6 if your AG is 18) to the delta bicarb (e.g. 8 if the bicarb is 17). If they are equal then this is a pure met acidosis.
If delta AG is bigger than delta bicarb: also met ALKALOSIS
if delta AG is smaller than delta bicarb: there is also a non AG met acidosis 



I will review DKA in another post soon.

:O)






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