Chapter 31. Approach to Acid-Base Disorders

Harold M Szerlip, MD, MS, FCCP
DOI: 10.1378/critcare.21.31
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  1. Understand a systematic approach to acid-base disorders.

  2. Identify simple and mixed acid-base disturbances.

  3. Be able to apply compensation rules.

  4. Recognize the etiology of the acid-base disorder.

  5. Be able to treat the identified disorder.


Acid-base disorders are extremely common in critically ill patients. Metabolism of fats, carbohydrates, and proteins produces both volatile carbon dioxide (CO2) and nonvolatile acids. CO2 is eliminated through the respiratory tract while nonvolatile acids are excreted by the kidneys. Acid-base disturbances can be caused by pathologic conditions that increase or decrease alveolar ventilation and by metabolic disorders in which there is either excessive production of nonvolatile acids or an inability of the kidney to excrete acid or reclaim filtered bicarbonate. Using a stepwise systematic approach, the clinician should be able to identify both simple and mixed acid-base disorders. Once the disturbance is identified, appropriate therapeutic measures can be initiated.


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