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Informatics in Pharmacy

Acid-Base Disturbances

August 12, 2018 By Dr. G, PharmD

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Summary of Acid-Base Disturbances

 pH (7.3 – 7.4)H+HCO3 (22-26)pCO2 (34-45)K+
metabolic acidosis↓↑↓↓↓↓↑
metabolic alkalosis↑↓↑↑↑↑↓
respiratory acidosis↓↑↑↑↑↑↑
respiratory alkalosis↑↓↓↓↓↓↓

Multiple arrows means it is a compensatory mechanism.

  • PCo2 is usually 1.5 times the bicarb + 8, if it’s higher it’s compensated
  • Gap = Sodium – (Cl + Bicarb) = normal is 6-12, greater than 12 is metabolic acidosis
  • Normal respiratory rate is 12-20

Acidosis: pH < 7.38

  • PCO2 < 38 – metabolic acidosis with respiratory compensation.  “Hyperventilation” compensates (blowing off carbon dioxide, which is an acid), decrease in bicarb
  • PCO2 38-42 – pure metabolic acidosis
  • PCO2 > 42 – primary respiratory acidosis. Need bicarb to say if primary metabolic acidosis (HCO3 < 24) or compensated respiratory acidosis (HCO3 > 28).

Alkalosis: pH < 7.42

  • PCO2 <38 – primary respiratory acidosis.  Need bicarbonate to see if the patient has primary metabolic acidosis too (HC03 > 28)
  • PCO2 38-42 – primary alkalosis without respiratory compensation
  • PCo2 > 42 – primary metabolic acidosis with respiratory compensation

Causes of Anion Gap Acidosis:

  • MUDPILES – methanol, uremia, diabetic ketoacidosis, paraldehyde, iron, isoniazid, inhalants, lactic acidosis, ethylene glycol (the propylene glycol in lorazepam can cause it too), ethanol and salicylates
  • or MULEPAKS: methanol, uremia, lactic acidosis, ethylene glycol, paraldehyde, aspirin, ketoacidosis, starvation

How to work an acid-base problem:

  1. Assess pH (acid or base)
  2. Determine if it’s respiratory or metabolic (pCO2 and HCO3)
  3. Calculate anion gap (can help determine cause).

Filed Under: Critical Care Tagged With: acid base, acidosis, alkalosis

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acid base acidosis acute coronary syndrome alkalosis analgesics anaphylaxis aortic dissection arrhythmia Beta-Blockers biostatistics blood pressure cardiac markers CHA2DS2-VasC cocaine COVID-19 diabetes diabetes inspidius Guidelines heart failure Heparin hypersensitivity hypertension hypovolemic shock intubation ionotropes journal club lipids LMWH medication safety morphine conversions myocardial infarction needs work NOAC NSTEMI obstructive shock pharmacoeconomics pheochromocytoma pressors reference materials right mi sedation septic shock shock STEMI Updated 2020