Metabolic Acidosis

Posted by e-Medical PPT Monday, June 4, 2012
Case Presentation 1
54 year old man with fever and abnormal liver function for liver biopsy
Biopsy “well tolerated” until 3 hours afterwards when he developed abdominal distension , with systolic BP 40 and Hg 4.6

Case Presentation 2
Vasopressin and bicarbonate infusions and blood transfusion restored BP to 85/40
The patient was rushed to the OR for exploratory laparotomy

Case Presentation 3
Arterial blood analysis:
pH 6.95, paO2 337, paCO2 44, TCO2 10  H+102nM
Na 142, K 6.3, Cl 106  anion gap 26
Albumin 1.2g/dl
Expected anion gap 6 because of low albumin
Anion gap 20 above expected
Lactate 18.3meq/l
Minute ventilation 6.4 liters

Case Presentation 4
The problem:   high H+
Cerebral enzyme dysfunction
Cardiac enzyme dysfunction
Myocardial dysfunction in the face of hemorrhagic shock
Downward spiral from more than just blood loss

Metabolic Acidosis
Acid-Base physiology
Anion gap
Differential diagnosis of metabolic acidosis with high anion gap
Lactic acidosis
Oxidative phosphorylation
Types of Lactic acidosis
Treatment of Lactic Acidosis

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