Ver el código de «Metabolic acidosis»

== Background ==

==Clinical Features==

== Differential Diagnosis==
{{Anion gap metabolic acidosis}}

=== Non-gap ===
*[[Hyperkalemia]]
**Resolving [[DKA]]
**Early uremic acidosis
**Early obstructive uropathy
**RTA Type IV
**Hypoaldosteronism
**K-sparing diuretics
*[[Hypokalemia]]
**RTA Type I
**RTA Type II
**[[Acetazolamide]]
**Acute [[diarrhea]]
***(May be assoc with gap if hypoperfusion -> lactic acidosis)

==Diagnosis==
;Osm gap = measured osm - calculated osm (normal 10-15)
;Calculated Osm = 2(Na)+(glucose/18)+(BUN/2.8)+(BAL/5)

*Primary acidosis if pH <7.38
*HCO3 <24 = metabolic acidosis
*Always determine if there is another acid/base process occurring
**Primary respiratory acidosis if pCO2 > pCO2expected
**Primary respiratory alkalosis if pCO2 < pCO2expected 
***use Winter's formula: PCO2 (expected) = (1.5 x [HCO3–] + 8) ± 2
***In acute setting PCO2 should fall by 1 mmHg for every 1 mEq fall in HCO3
**Concurrent metabolic alkalosis if delta-delta > 28
**Delta-Delta = (AG - 12) + HCO3

== Treatment ==
*Treat source
*Correct any [[respiratory acidosis]]
*[[Bicarbonate]]
**HCO3 dose in mEq = 0.5(wt in kg) x (24 - measured HCO3)
**Each bicarb 0.5mEq/kg causes 1 meq/L rise in HCO3
**Consider for:
***Bicarb <4
***pH <7.20 AND shock/myocardial irritability
***Severe hyperchloremic acidemia
***lower threshold with non-AG acidosis (greater HCO3 loss)
****Lost bicarbonate would take days to replenish

==See Also==
*[[Acid-base disorders]]

==References ==

[[Category:FEN]]
[[Category:Tox]]