Acid Base Disorders

Contents

1. 1 Definitions

1. 1.1 Normal values

2. 2 Acid Base One Pager (from onepagericu.com)

3. 3 General Approach to Diagnosis

4. 4 Treatment

5. 5 References

Definitions
 Acidemia: Arterial blood pH below the normal range (<7.36)

 Alkalemia: Arterial blood pH above the normal range (>7.44)

 Acidosis: a process that tends to lower the pH (can be caused by fall in serum bicarbonate or a rise in PCO2

 Alkalosis: a process that tends to raise the pH (can be caused by increase in serum bicarbonate or a decrease in

 Base Excess: the amount of strong acid needed to bring a solution back to a pH of 7.4 while keeping PCO2 at 4

 Anion gap: A calculated value that indicates the presence of typically unmeasured anions (AG= Na -Cl -HCO3

 Corrected anion gap: Albumin is negatively charged, effectively an "anion." In cases of hypoalbuminemia, Cl a
hypoalbuminemia. Thus, you can correct for this: AGcorr=AG + 2.5 (normal albumin of 4 g/dl - measured alb

 Strong Ion Difference (alternative to the traditional bicarbonate based model of acid-base): Strong ions are catio
Thus, these ions are “strong” because their ionization state is independent of pH. The Strong Ion Difference (SI
Integration of Acid Base Disorders, NEJM 2014)

o SID = [strong cations] – [strong anions] = [Na+ + K+ + Ca2+ + Mg2+] – [Cl- + lactate-]
o Disturbances that increase the SID increase the blood pH (alkalosis) while disorders

Normal values

 Arterial samples: pH 7.36-7.44, HCO3 21-27, PCO2 36-44

 Venous: pH 0.03 units lower, HCO3 similar, PCO2 3-8 higher

 Capillary: similar to arterial (assuming no prolonged tourniquet use, ischemia, etc)

Acid Base One Pager (from onepagericu.com)