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Acid-Base Disorders Worksheet: This Is: Na - CL - HCO) If They Do, Then They Have A Metabolic Acidosis in

This document provides a 7-step worksheet for evaluating and diagnosing acid-base disorders using arterial blood gas and electrolyte results. The steps involve analyzing the pH, PCO2, HCO3, and anion gap values to determine if a patient has a primary acidosis or alkalosis and whether it is respiratory or metabolic in nature. Additional tests are described to identify underlying contributing metabolic conditions. Differential diagnoses are provided for each type of acid-base disorder to determine the underlying cause and guide treatment.

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138 views1 page

Acid-Base Disorders Worksheet: This Is: Na - CL - HCO) If They Do, Then They Have A Metabolic Acidosis in

This document provides a 7-step worksheet for evaluating and diagnosing acid-base disorders using arterial blood gas and electrolyte results. The steps involve analyzing the pH, PCO2, HCO3, and anion gap values to determine if a patient has a primary acidosis or alkalosis and whether it is respiratory or metabolic in nature. Additional tests are described to identify underlying contributing metabolic conditions. Differential diagnoses are provided for each type of acid-base disorder to determine the underlying cause and guide treatment.

Uploaded by

Beck33ers5826
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd

Acid-Base Disorders Worksheet

Step #1: Gather the necessary data (a P1 and an ABG).


Preferably, these values are all obtained from the same blood sample. At
WRAMC, ordering an ABG and a P1 (Chem 7) will give you all of the
information you need.

pH

pCO2

pO2

HCO3

Step #2: Look at the pH. If it is > 7.4, then pt has primary alkalosis, proceed to
Step 3a. If pH < 7.4, then pt has primary acidosis, proceed to step 3b.

Patient has primary:


acidosis
| alkalosis

Step #3: Look at the PCO2.


3a: If PCO2 is > 40, then pts alkalosis is metabolic; if < 40 then respiratory.
3b: If PCO2 is > 40, then pts acidosis is respiratory; if < 40, then metabolic.

Process is:
respiratory | metabolic

Step #4: Check if patient has a significant anion gap (> 12-18). (Formula for
this is: Na Cl HCO3.) If they do, then they have a metabolic acidosis in
addition to (or confirmatory of) whatever Steps #1 and #2 yielded. If no
significant gap, then skip to Step #6.

Patient has | does not have


metabolic acidosis.

Step #5: Calculate the excess anion gap. (Pts gap 12 + pts serum bicarb)
If gap excess > 30, then pt has an underlying metabolic alkalosis in addition to
whatever disorders Steps #1 through #4 yielded.
If gap excess < 23, then pt has an underlying metabolic acidosis in addition to
whatever disorders Steps #1 through #4 yielded.

Patient has underlying


metabolic:
acidosis
| alkalosis

Step #6: Figure out whats causing the problem(s), using the differentials below.
Anion Gap
Metabolic Acidosis

Non-Gap
Metabolic Acidosis

Acute Respiratory
Acidosis

Metabolic
Alkalosis

Respiratory
Alkalosis

MUDPILERS

HARDUPS

anything that causes


hypoventilation, i.e.:

CLEVER PD

CHAMPS

Methanol
Uremia
DKA/Alcoholic KA
Paraldehyde
Isoniazid
Lactic Acidosis
Etoh/Ethylene Glycol
Rhabdo/Renal Failure
Salicylates

Hyperalimentation
Acetazolamide
Renal Tubular Acidosis
Diarrhea
Uretero-Pelvic Shunt
Post-Hypocapnia
Spironolactone

Contraction
Licorice*
Endo: (Conns/

anything that causes


hyperventilation, i.e.:

Cushings/Bartters)*

CNS disease
Hypoxia
Anxiety
Mech Ventilators
Progesterone
Salicylates/Sepsis

CNS Depression
(drugs/CVA)
Airway Obstruction
Pneumonia
Pulmonary Edema
Hemo/Pneumothorax
Myopathy
(Chronic respiratory
acidosis is caused by
COPD and restrictive
lung disease)

Vomiting
Excess Alkali*
Refeeding Alkalosis*
Post-hypercapnia
Diuretics*
*assoc with high urine CL levels

Step #7: Fix it!


Used with permission of Dr. Erik Rupard. Ref: Haber, A practical approach to acid-base disorders. West J Med 1991. Aug; 155:146-151. Last revised June 10, 2009.

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