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Metabolic acidosis in the critically ill: Part 1. Classification and pathophysiology
Summary Metabolic acidaemia (pH
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| Published in: | Anaesthesia 2008-03, Vol.63 (3), p.294-301 |
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| Main Authors: | , |
| Format: | Article |
| Language: | English |
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| cited_by | cdi_FETCH-LOGICAL-c4910-9200a0baf7297bafc1625c09c8259c7316944e6abed8f626acce9ca25f71a8263 |
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| cites | cdi_FETCH-LOGICAL-c4910-9200a0baf7297bafc1625c09c8259c7316944e6abed8f626acce9ca25f71a8263 |
| container_end_page | 301 |
| container_issue | 3 |
| container_start_page | 294 |
| container_title | Anaesthesia |
| container_volume | 63 |
| creator | Morris, C. G. Low, J. |
| description | Summary
Metabolic acidaemia (pH |
| doi_str_mv | 10.1111/j.1365-2044.2007.05370.x |
| format | article |
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Metabolic acidaemia (pH < 7.35 not primarily related to hypoventilation) is common amongst the critically ill and it is essential that clinicians caring for such patients have an understanding of the common causes. The exclusive elimination routes of volatile (carbon dioxide), organic (lactic and ketone) and inorganic (phosphate and sulphate) acids mean compensation for a defect in any one is limited and requires separate provision during critical illness. We discuss the models available to diagnose metabolic acidosis including CO2/HCO3– and physical chemistry‐derived (Stewart or Fencl‐Stewart) approaches, but we propose that the base excess and anion gap, corrected for hypoalbuminaemia and iatrogenic hyperchloraemia, remain most appropriate for clinical usage. Finally we provide some tips for interpreting respiratory responses to metabolic acidosis and how to reach a working diagnosis, the consequences of which are considered in Part 2 of this review.</description><identifier>ISSN: 0003-2409</identifier><identifier>EISSN: 1365-2044</identifier><identifier>DOI: 10.1111/j.1365-2044.2007.05370.x</identifier><identifier>PMID: 18289237</identifier><identifier>CODEN: ANASAB</identifier><language>eng</language><publisher>Oxford, UK: Blackwell Publishing Ltd</publisher><subject>Acid-Base Equilibrium ; Acidosis - classification ; Acidosis - diagnosis ; Acidosis - physiopathology ; Acids ; Anesthesia ; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy ; Biochemistry ; Biological and medical sciences ; Chemical Phenomena ; Chemistry, Physical ; Critical care ; Critical Illness - classification ; Humans ; Hydrogen-Ion Concentration ; Medical diagnosis ; Medical sciences ; Metabolism</subject><ispartof>Anaesthesia, 2008-03, Vol.63 (3), p.294-301</ispartof><rights>2008 The Authors</rights><rights>2008 INIST-CNRS</rights><rights>2008 The Association of Anaesthetists of Great Britain and Ireland</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4910-9200a0baf7297bafc1625c09c8259c7316944e6abed8f626acce9ca25f71a8263</citedby><cites>FETCH-LOGICAL-c4910-9200a0baf7297bafc1625c09c8259c7316944e6abed8f626acce9ca25f71a8263</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27923,27924</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=20123348$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/18289237$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Morris, C. G.</creatorcontrib><creatorcontrib>Low, J.</creatorcontrib><title>Metabolic acidosis in the critically ill: Part 1. Classification and pathophysiology</title><title>Anaesthesia</title><addtitle>Anaesthesia</addtitle><description>Summary
Metabolic acidaemia (pH < 7.35 not primarily related to hypoventilation) is common amongst the critically ill and it is essential that clinicians caring for such patients have an understanding of the common causes. The exclusive elimination routes of volatile (carbon dioxide), organic (lactic and ketone) and inorganic (phosphate and sulphate) acids mean compensation for a defect in any one is limited and requires separate provision during critical illness. We discuss the models available to diagnose metabolic acidosis including CO2/HCO3– and physical chemistry‐derived (Stewart or Fencl‐Stewart) approaches, but we propose that the base excess and anion gap, corrected for hypoalbuminaemia and iatrogenic hyperchloraemia, remain most appropriate for clinical usage. Finally we provide some tips for interpreting respiratory responses to metabolic acidosis and how to reach a working diagnosis, the consequences of which are considered in Part 2 of this review.</description><subject>Acid-Base Equilibrium</subject><subject>Acidosis - classification</subject><subject>Acidosis - diagnosis</subject><subject>Acidosis - physiopathology</subject><subject>Acids</subject><subject>Anesthesia</subject><subject>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</subject><subject>Biochemistry</subject><subject>Biological and medical sciences</subject><subject>Chemical Phenomena</subject><subject>Chemistry, Physical</subject><subject>Critical care</subject><subject>Critical Illness - classification</subject><subject>Humans</subject><subject>Hydrogen-Ion Concentration</subject><subject>Medical diagnosis</subject><subject>Medical sciences</subject><subject>Metabolism</subject><issn>0003-2409</issn><issn>1365-2044</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2008</creationdate><recordtype>article</recordtype><recordid>eNqNkU2LFDEQhoMo7rj6FyQIeuu2knR3Eg_CMKy7wvpxWM-hJpN2MmQ6Y9LDbv97086wgidzqUA9Vbw8RQhlULPy3u9qJrq24tA0NQeQNbRCQv3whCweG0_JAgBExRvQF-RFzjsAxhVTz8kFU1xpLuSC3H1xI65j8Jai9ZuYfaZ-oOPWUZv86C2GMFEfwgf6HdNIWU1XAXP2fWmNPg4Uhw094LiNh-2UfQzx5_SSPOsxZPfqXC_Jj09Xd6ub6vbb9efV8rayjWZQ6RIdYY295FqWYlnHWwvaKt5qKwXrdNO4Dtduo_qOd2it0xZ520uGinfikrw77T2k-Ovo8mj2PlsXAg4uHrORUHa0cgbf_APu4jENJZthWhZ1oGSB1AmyKeacXG8Oye8xTYaBmbWbnZntmtmumbWbP9rNQxl9fd5_XO_d5u_g2XMB3p4BzEVpn3CwPj9yvFxGiEYV7uOJu_fBTf8dwCy_Lq_mr_gNW9Wc3w</recordid><startdate>200803</startdate><enddate>200803</enddate><creator>Morris, C. G.</creator><creator>Low, J.</creator><general>Blackwell Publishing Ltd</general><general>Blackwell</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7T5</scope><scope>7U7</scope><scope>C1K</scope><scope>H94</scope><scope>K9.</scope><scope>7X8</scope></search><sort><creationdate>200803</creationdate><title>Metabolic acidosis in the critically ill: Part 1. Classification and pathophysiology</title><author>Morris, C. G. ; Low, J.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4910-9200a0baf7297bafc1625c09c8259c7316944e6abed8f626acce9ca25f71a8263</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2008</creationdate><topic>Acid-Base Equilibrium</topic><topic>Acidosis - classification</topic><topic>Acidosis - diagnosis</topic><topic>Acidosis - physiopathology</topic><topic>Acids</topic><topic>Anesthesia</topic><topic>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</topic><topic>Biochemistry</topic><topic>Biological and medical sciences</topic><topic>Chemical Phenomena</topic><topic>Chemistry, Physical</topic><topic>Critical care</topic><topic>Critical Illness - classification</topic><topic>Humans</topic><topic>Hydrogen-Ion Concentration</topic><topic>Medical diagnosis</topic><topic>Medical sciences</topic><topic>Metabolism</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Morris, C. G.</creatorcontrib><creatorcontrib>Low, J.</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Immunology Abstracts</collection><collection>Toxicology Abstracts</collection><collection>Environmental Sciences and Pollution Management</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><jtitle>Anaesthesia</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Morris, C. G.</au><au>Low, J.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Metabolic acidosis in the critically ill: Part 1. Classification and pathophysiology</atitle><jtitle>Anaesthesia</jtitle><addtitle>Anaesthesia</addtitle><date>2008-03</date><risdate>2008</risdate><volume>63</volume><issue>3</issue><spage>294</spage><epage>301</epage><pages>294-301</pages><issn>0003-2409</issn><eissn>1365-2044</eissn><coden>ANASAB</coden><abstract>Summary
Metabolic acidaemia (pH < 7.35 not primarily related to hypoventilation) is common amongst the critically ill and it is essential that clinicians caring for such patients have an understanding of the common causes. The exclusive elimination routes of volatile (carbon dioxide), organic (lactic and ketone) and inorganic (phosphate and sulphate) acids mean compensation for a defect in any one is limited and requires separate provision during critical illness. We discuss the models available to diagnose metabolic acidosis including CO2/HCO3– and physical chemistry‐derived (Stewart or Fencl‐Stewart) approaches, but we propose that the base excess and anion gap, corrected for hypoalbuminaemia and iatrogenic hyperchloraemia, remain most appropriate for clinical usage. Finally we provide some tips for interpreting respiratory responses to metabolic acidosis and how to reach a working diagnosis, the consequences of which are considered in Part 2 of this review.</abstract><cop>Oxford, UK</cop><pub>Blackwell Publishing Ltd</pub><pmid>18289237</pmid><doi>10.1111/j.1365-2044.2007.05370.x</doi><tpages>8</tpages></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0003-2409 |
| ispartof | Anaesthesia, 2008-03, Vol.63 (3), p.294-301 |
| issn | 0003-2409 1365-2044 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_70316576 |
| source | Wiley-Blackwell Read & Publish Collection |
| subjects | Acid-Base Equilibrium Acidosis - classification Acidosis - diagnosis Acidosis - physiopathology Acids Anesthesia Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy Biochemistry Biological and medical sciences Chemical Phenomena Chemistry, Physical Critical care Critical Illness - classification Humans Hydrogen-Ion Concentration Medical diagnosis Medical sciences Metabolism |
| title | Metabolic acidosis in the critically ill: Part 1. Classification and pathophysiology |
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