Abstract
In the surgical intensive care unit (SICU), both mild and significant acid-base disorders are common and an understanding of their management is key to caring for critically ill and injured patients. Under normal conditions, serum pH is the tightly controlled result of homeostatic buffering mechanisms. Mild, transient aberrations in pH may be physiologic, but if persistent, even subtle pH change may point to underlying pathology. As pH strays outside the normal range, acidemia or alkalemia may become harmful. Often this harm results from taxing attempts at compensation, such as tachypnea in response to metabolic acidosis, or through direct effects, such as systemic or pulmonary vasoregulatory changes, cerebral edema, and arrhythmias. While the intensivist may rush to correct pH, acidosis or alkalosis is ultimately a marker of an underlying disease process, and correcting the pH, while important, is insufficient if the driving pathology is not also identified and corrected. This chapter will review a practical approach to acid-base disorders typically encountered in the SICU, with a focus on diagnosis and initial management strategies.
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References
Kellum JA. Acid-base disorders. In: Vincent J-L, Abraham E, Kochanek P, Moore FA, Fink MP, editors. Textbook of critical care. 6th ed. Philadelphia: Elsevier Health Sciences; 2011. p. 43–52.
Dubose TD, Daeihagh P. Metabolic acidosis and alkalosis. In: Vincent J-L, Abraham E, Kochanek P, Moore FA, Fink MP, editors. Textbook of critical care. 6th ed. Philadelphia: Elsevier Health Sciences; 2011. p. 823–40.
Goldfarb S, Reilly JB. Metabolic acidoses and alkaloses. 2nd ed. Philadelphia: Elsevier Health Sciences; 2013.
FitzSullivan E, Salim A, Demetriades D, Asensio J, Martin MJ. Serum bicarbonate may replace the arterial base deficit in the trauma intensive care unit. Am J Surg. 2005;190(6):941–6.
Martin MJ, FitzSullivan E, Salim A, Berne TV, Towfigh S. Use of serum bicarbonate measurement in place of arterial base deficit in the surgical intensive care unit. Arch Surg. 2005;140(8):745–51.
Seifter JL. Acid-base disorders. In: Goldman L, Schafer AI, editors. Cecil textbook of medicine. 22nd ed. Philadelphia: Saunders; 2004. p. 688–99.
Juran P, Cheng S. Metabolic acid-base disorders. In: Kollef MH, Bedient TJ, Isakow W, editors. The Washington manual of critical care. Philadelphia: Lippincott Williams & Wilkins; 2008. p. 209–21.
Kline JA, Weisberg LS. Acid-base, electrolyte, and metabolic abnormalities. In: Parrillo JE, Dellinger RP, editors. Critical care medicine: principles of diagnosis and management in the adult. 4th ed. Philadelphia: Elsevier Health Sciences; 2013. p. 993–1028.
Ungerer J, Ungerer M, Vermaak W. Discordance between measured and calculated total carbon dioxide. Clin Chem. 1990;36(12):2093–6.
Morgan T. Acid-base balance and disorders. In: Bersten AD, Soni N, editors. Oh’s intensive care manual. 7th ed. Philadelphia: Elsevier Health Sciences; 2013. p. 937–48.
Neligan PJ. How should acid-base disorders be diagnosed and managed? In: Deutschman CS, Neligan PJ, editors. Evidence-based practice of critical care. 2nd ed. Philadelphia: Elsevier Health Sciences; 2015. p. 409–18.
Schmidt GA. Acid-base disorders. In: Ivy ME, Lipsett PA, editors. Adult multiprofessional critical care review. Des Plaines, Society of Critical Care Medicine; 2005. p. 279–86.
Martin MJ, FitzSullivan E, Salim A, Brown CVR, Demetriades D, Long W. Discordance between lactate and base deficit in the surgical intensive care unit: which one do you trust? Am J Surg. 2006;191(5):625–30.
Cooper JD, Higgins AM, Nichol AD. Lactic acidosis. In: Bersten AD, Soni N, editors. Oh’s intensive care manual. Philadelphia: Elsevier Health Sciences; 2013. p. 158–64.
Gale SC, Kocik JF, Creath R, Crystal JS, Dombrovskiy VY. A comparison of initial lactate and initial base deficit as predictors of mortality after severe blunt trauma. J Surg Res. 2016;205(2):446–55.
O’Keefe KP, Sanson TG. Mesenteric ischemia. In: Adams JG, editor. Emergency medicine: clinical essentials. 2nd ed. Philadelphia: Elsevier Health Sciences; 2012. p. 292–8.
Warnock DG. Uremic acidosis. Kidney Int. 1988;34(2):278–87.
Kraut JA, Madias NE. Metabolic acidosis of CKD: an update. Am J Kidney Dis. 2016;67(2):307–17.
Cosgriff N, Moore EE, Sauaia A, Kenny-Moynihan M, Burch JM, Galloway B. Predicting life-threatening coagulopathy in the massively transfused trauma patient: hypothermia and acidoses revisited. J Trauma Acute Care Surg. 1997;42(5):857–62.
Galla JH. Metabolic alkalosis. J Am Soc Nephrol JASN. 2000;11(2):369–75.
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Sava, J., Beyene, R. (2018). Acid-Base Disorders. In: Salim, A., Brown, C., Inaba, K., Martin, M. (eds) Surgical Critical Care Therapy . Springer, Cham. https://doi.org/10.1007/978-3-319-71712-8_50
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DOI: https://doi.org/10.1007/978-3-319-71712-8_50
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