Acid-Base Disturbances: An Emergency Department Approach

Acid-Base Disturbances: An Emergency Department Approach is organized by EB Medicine.

Date of Original Release: June 1, 2020
Termination Date: June 1, 2023

About This Issue:
Acid-base disturbances are diagnosed from a patient’s chemistry and blood gas results, but there are multiple approaches to determining the underlying causes and initiating treatment. This issue presents a summary of the chemistry and physiology of acid-base disturbances and uses a workbook-style format of 8 real-life cases to illustrate the approaches to diagnosing and managing these disorders. Algorithms for acidemia and alkalemia reinforce the stepwise approach.
• Primary metabolic acidosis/alkalosis or primary respiratory acidosis/alkalosis: how does diagnosis proceed from this initial characterization?
• What are the mechanisms of lactate metabolism and lactic acidosis?
• What are the mechanisms of ketone metabolism and ketoacidosis?
• The 6 primary states of acid-base disturbances: what are the 6 rules for calculating expected changes in [HCO3-] and PaCO2?
• How do the historical approaches to the characterization of acid-base disturbances differ, and how is each used?
• What are the primary features of the descriptive/Boston approach; anion gap approach; delta gap approach; Copenhagen/base excess approach; and the quantitative/Physico-chemical/Stewart approach?
• What is the current evidence on arterial blood gas versus venous blood gas sampling?
• When should sodium bicarbonate be given, and what are the recommendations for the administration of fluid types?

CME Objectives:
Upon completion of this article, you should be able to:
• Describe the basic science of acid-base principles and the cellular and physiological systems responsible for homeostasis
• Utilize differing and complementary approaches for determining and characterizing acid-base disturbances
• Recognize common clinical presentations that are likely to be associated with acid-base disturbances
• Explain current controversies in the clinical management of acid-base disturbances.