6/15/16: Acid/Base Problems

For Acid Base Disorders:

  • Check for internal consistency
  • Use pH to determine the primary disorder
  • Calculate the AG
  • Determine the presence of additional disorders
  • Calculate the expected pCO2 for any metabolic acidosis to evaluate for additional respiratory acidosis.

Winter’s Formula: expected pCO2 = 1.5 (HCO3) + 8 +/-2

  • Remember vagal maneuvers for SVT: carotid massage, valsalva, diving reflect
  • Remember the trial of DKA:
    • Hyperglycemia
    • Anion Gap Metabolic Acidosis
    • Ketonemia
  • DKA management:
    • Fluids: usually 3-6L deficient
    • Insulin: 0.1 U/kg bolus followed by a rate of 0.1 U/kg/hr; adjust as needed
    • Electrolytes: watch for K and phosphate – typically appear normal initially, but are actually “total body” deplete – likely to drop quickly with insulin administration

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