Skip to main content

Abstract

In most cases, the metabolic disorders of acid-base homeostasis are helpful to highlight the main or associated diagnosis in the critically ill. As the physiopathology and the diagnostic aspects are fully covered elsewhere in these proceedings, it seems reasonable to focus here only on the monitoring value of the metabolic derangements of blood gas analysis (BGA) and on some controversial aspects of therapeutics.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 109.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Narins RG, Emmett M (1980) Simple and mixed acid-base disorders: A practical approach. Medicine S9:161–187

    Google Scholar 

  2. Narins RG, Jones ER et al (1982) Diagnostic strategies in disorders of fluid, electrolyte and acid-base homeostasis. Am J Med 72:469–512

    Article  Google Scholar 

  3. Schiraldi F (1995) Time to abandon base excess as a reliable index in the ICU? Int J Int Care 2:23

    Google Scholar 

  4. Zhang H, Vincent JL (1993) Arteriovenous differences in PCO2 and pH are good indicators of critical hypoperfusion. Am Rev Respir Dis 148:867–871

    Article  PubMed  CAS  Google Scholar 

  5. Bircher NG (1992) Acidosis of cardiopulmonary resuscitation: Carbon dioxide transport and anaerobios. Crit Care Med 20;9:1203–1204

    Article  PubMed  CAS  Google Scholar 

  6. Van der Linden P, Rausin I et al (1995) Detection of tissue hypoxia by arterio-venous gradient for PCO2 and pH in anesthetized dogs during progressive hemorrhage. Anesth Analg 80: 269–275

    PubMed  Google Scholar 

  7. Kette F, Weil MH et al (1993) Intramyocardial hypercarbic acidosis during cardiac arrest and resuscitation. Crit Care Med 21:901–906

    Article  PubMed  CAS  Google Scholar 

  8. Adrogué HJ, Rashad MN, Gorin AB et al (1989) Assessing acid-base status in circulatory failure. Differences between arterial and central venous blood. N Engl J Med 320:1312–1318

    Article  PubMed  Google Scholar 

  9. Schlitig R, Pinsky MR (1991) Defining the hypoxic threshold. Crit Care Med 19:147–149

    Article  Google Scholar 

  10. Vincent JL, Dufaye P et al (1983) Serial lactate determinations during circulatory shock. Crit Care Med 11:449–451

    Article  PubMed  CAS  Google Scholar 

  11. Mahutte CK, Jaffe MB et al (1991) Cardiac output from carbon dioxide production and arterial and venous oximetry. Crit Care Med 19:1270–1277

    Article  PubMed  CAS  Google Scholar 

  12. American Heart Association (1994) Textbook of Advanced Cardiac Life Support

    Google Scholar 

  13. Stacpoole PW, Harman EM et al (1983) Treatment of lactic acidosis with dichloroacetate. N Engl J Med 309:390–396

    Article  PubMed  CAS  Google Scholar 

  14. Stacpoole PW, Wright EC et al (1992) A controlled clinical trial of DCA for treatment of lactic acidosis in adults. N Engl J Med 327:1564–1569

    Article  PubMed  CAS  Google Scholar 

  15. Arieff AI (1993) Managing metabolic acidosis: Update on the sodium bicarbonate controversy. J Crit Illness 8:224–229

    Google Scholar 

  16. Rhee K, Toro LO et al (1993) Carbicarb, sodium carbonate, sodium chloride in hypoxic lactic acidosis. Chest 104:913–918

    Article  PubMed  CAS  Google Scholar 

  17. Adrogué HJ, Madias NE (1998) Management of life-threatening acid-base disorders. II parts. N Engl J Med 338;1:26–34, 338;2:107–111

    Article  PubMed  Google Scholar 

  18. Gabow P (1985) Disorders associated with an altered anion gap. Kidney Int 27:472–483

    Article  PubMed  CAS  Google Scholar 

  19. Smithline N, Gardner KD (1976) Gaps — anionic and osmolal. JAMA 236:1594–1597

    Article  PubMed  CAS  Google Scholar 

  20. Faber MD, Kupin WL et al (1994) Common fluid-electrolyte and acid-base problems in the intensive care unit: Selected issues. Semin Nephrol 14(1):8–22

    PubMed  CAS  Google Scholar 

  21. Adroguè HJ, Madias NE (1981) Changes in plasma potassium concentration during acute acid-base disturbances. Am J Med 71:456–467

    Article  PubMed  Google Scholar 

  22. Steiner RW (1984) Interpreting the fractional excretion of sodium. Am J Med 77:699–702

    Article  PubMed  CAS  Google Scholar 

  23. Laterre PF, Mallie JP (1993) The fractional excretion of chloride instead of sodium indicates hypovolemia: A comparative study of bedside assessment of true or effective intravascular depletion. Clin Intens Care 4:112–115

    Google Scholar 

  24. Idris AH, Staples ED et al (1994) Effect of ventilation on acid-base balance and oxygenation in low blood-flow states. Crit Care Med 22:1827–1834

    PubMed  CAS  Google Scholar 

  25. Rimmer JM, Gennari FJ (1987) Metabolic alkalosis. J Intensive Care Med 2:137–150

    Article  Google Scholar 

  26. Gennari FJ (1998) Current concepts: Hypokalemia. N Engl J Med 339;7:451–458

    Article  PubMed  CAS  Google Scholar 

  27. Kamel KS, Ethier JH et al (1990) Urine electrolytes and osmolality: When and how to use them. Am J Nephrol 10:89–102

    Article  PubMed  CAS  Google Scholar 

  28. Seldin DW, Rector FC (1972) The generation and maintenance of metabolic alkalosis. Kidney Int 1:306–320

    Article  PubMed  CAS  Google Scholar 

  29. Madias NE, Cohen JJ, Adrogué HJ (1990) Influence of acute and chronic respiratory alkalosis on preexisting chronic metabolic alkalosis. Am J Physiol 258:F479–F485

    PubMed  CAS  Google Scholar 

  30. Tomsic M, Horvart M (1991) Torsade de pointes associated with combined severe metabolic and respiratory alkalosis. Clin Int Care 2;1:47–50

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 1999 Springer-Verlag Italia

About this paper

Cite this paper

Schiraldi, F., Ferraro, P., Paladino, F. (1999). Metabolic Acidosis and Metabolic Alkalosis in the Critically Ill. In: Gullo, A. (eds) Anaesthesia, Pain, Intensive Care and Emergency Medicine — A.P.I.C.E.. Springer, Milano. https://doi.org/10.1007/978-88-470-2145-7_41

Download citation

  • DOI: https://doi.org/10.1007/978-88-470-2145-7_41

  • Publisher Name: Springer, Milano

  • Print ISBN: 978-88-470-0051-3

  • Online ISBN: 978-88-470-2145-7

  • eBook Packages: Springer Book Archive

Publish with us

Policies and ethics