Metabolic acidosis in the critically ill: Part 2. Causes and treatment

Summary The correct identification of the cause, and ideally the individual acid, responsible for metabolic acidosis in the critically ill ensures rational management. In Part 2 of this review, we examine the elevated (corrected) anion gap acidoses (lactic, ketones, uraemic and toxin ingestion) and...

Full description

Saved in:
Bibliographic Details
Published in:Anaesthesia 2008-04, Vol.63 (4), p.396-411
Main Authors: Morris, C. G., Low, J.
Format: Article
Language:English
Subjects:
Acid-Base Equilibrium
Acidosis - diagnosis
Acidosis - etiology
Acidosis - therapy
Acidosis, Lactic - etiology
Acidosis, Lactic - therapy
Acidosis, Renal Tubular - etiology
Acidosis, Renal Tubular - therapy
Anesthesia
Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy
Anesthesiology
Biological and medical sciences
Critical care
Critical Illness
Drug therapy
Humans
Medical disorders
Medical sciences
Medical treatment
Prognosis
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:Summary The correct identification of the cause, and ideally the individual acid, responsible for metabolic acidosis in the critically ill ensures rational management. In Part 2 of this review, we examine the elevated (corrected) anion gap acidoses (lactic, ketones, uraemic and toxin ingestion) and contrast them with nonelevated conditions (bicarbonate wasting, renal tubular acidoses and iatrogenic hyperchloraemia) using readily available base excess and anion gap techniques. The potentially erroneous interpretation of elevated lactate signifying cell ischaemia is highlighted. We provide diagnostic and therapeutic guidance when faced with a high anion gap acidosis, for example pyroglutamate, in the common clinical scenario ‘I can’t identify the acid – but I know it's there'. The evidence that metabolic acidosis affects outcomes and thus warrants correction is considered and we provide management guidance including extracorporeal removal and fomepizole therapy.
ISSN:0003-2409
1365-2044
DOI:10.1111/j.1365-2044.2007.05371.x