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Acidosis, Emergency Medicine

Reviewed 06/2017
 


Basics

Description

Respiratory acidosis. 
  • Reduced pH owing to alveolar hypoventilation with elevated PaCO2

  • Defined as PaCO2 >45 mm Hg or higher than expected for calculated respiratory compensation fo...

Diagnosis

Signs and Symptoms

  • Nonspecific findings

  • Vital signs:

    • Tachypnea or Kussmaul respirations with metabolic acidosis

    • Hypoventilation with respiratory acidosis

    • Tachycardia

  • Somnolence

  • Confusion

  • Altered men...

Treatment

Initial Stabilization/Therapy

Airway, breathing, and circulation (ABCs): 
  • Early intubation for severe metabolic acidosis with progressive/potential weakening of respiratory compensation

  • Naloxon...

Follow-Up

Disposition

Admission Criteria

Consider ICU admission if: 
  • pH <7.1

  • Altered mental status

  • Respiratory acidosis

  • Hemodynamic instability

  • Dysrhythmias

  • Electrolyte abnormalities

Discharge Criteria

Resol...

Pearls and Pitfalls

  • Failure to appreciate acidosis in mixed acid–base disorders

  • Failure to appreciate inadequate respiratory compensation for metabolic acidosis and need for ventilatory support

  • Clues to...

Additional Reading

  • Ayers  C, Dixon  P. Simple Acid-Base Tutorial. J Parenter Enteral Nutr.  2012;36(1):18–23.

  • Kellum  JA. Determinants of plasma acid-base balance. Crit Care Clin.  2005;21(2)...

Codes

ICD9

276.2 Acidosis 

ICD10

E87.2 Acidosis 

SNOMED

  • 51387008 Acidosis (disorder)

  • 12326000 Respiratory acidosis (disorder)

  • 59455009 Metabolic acidosis (disorder)

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