Similar to the sodium-water balance ADS, this ADS covered another topic that I found challenging to grasp and undestand during my undergraduate. Dr. Brown walked us through several cases to help build our approach into acid-base disorders. My notes ended up being too long to include in my post and have attached here instead: Acid-Base Notes.
As I go forward in my rotations, I will consider the following when approaching acid-base disorders:
- Look at pH
- Look at HCO3 and CO2
- Consider expected compensatory changes in primary acid base disorders
- If metabolic acidosis, calculate the anion gap.
AG = Na – (Cl + HCO3); normal: 8-12 mmoles/L and if increased by >5 = likely metabolic acidosis
Every mmol/L increase in AG = decrease in bicarbonate
- Calculate the osmolar gap
OG = measured osmolality – calculated osmolality (2Na + urea + glucose)
- Consider patient’s history and identify potential pathophysiology
(e.g. inability to eat (e.g. proteins = acid), diarrhea (lost bicarbonate), vomiting (lost HCl), toxic poisoning)
- Identify Drug Therapy Problems