Etiology And Treatment

Arterial blood gases, serum electrolytes, physical examination findings, the clinical history, and the patient's recent medications must be reviewed in order to establish the etiology of a given acid-base disturbance. Tables 28-3 through 28-7 outline the most commonly encountered causes for each of the primary acid-base disorders. The therapeutic approach to each of these acid-base derangements should emphasize a search for the cause, as opposed to immediate attempts to normalize the pH.

© It is critical to treat the underlying causative process to effectively resolve most observed acid-base disorders. However, supportive treatment of the pH and electrolytes is often needed until the underlying disease state is improved.12, 3

All patients with significant disturbances in their acid-base status require continuous cardiovascular and hemodynamic monitoring. Because frequent assessment of the patient's response to treatment is critical, an arterial line is often placed to minimize patient discomfort with serial ABG collections. If the anion gap was initially abnormal, serial chemistries should be followed to ensure that the anion gap resolves with treatment. Specific treatment decisions depend on the underlying pathophysiologic state (e.g., dialysis for renal failure, insulin for diabetic ketoacidosis, or improving tissue perfusion and oxygenation for lactic acidosis).

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