IBCC Episode 54 - Approach to Acid Base Disorders

The Internet Book of Critical Care Podcast

Adam Thomas

Foam, Medicine, Health & Fitness, Science, Criticalcare, Medicaleducation

5 • 714 Ratings

🗓️ 12 September 2019

⏱️ 20 minutes

🔗️ Recording | iTunes | RSS

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Summary

In this episode, we cover the foundations to every day clinical medicine in the ICU: Acid base. As our patients are either often too sick to regulate their own homeostasis, or what we are doing to them prevents their lungs or kidneys from doing so, we give you the approach to recognizing Acid Base disorders.

Step 1: Calculate the Anion Gap

Step 2: Look at the Bicarbonate level

Step 3: Compare the change in Anion Gap to the Change in Bicarbonate

Transcript

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0:00.0	All right, so welcome back to the Internet Book of Critical Care podcast.
0:07.0	I'm here with Adam Thomas and we're going to talk about the approach to acid-based disorders.
0:12.0	Don't sigh. I heard all of you collectively sigh and you know this is important.
0:16.0	We can't get by a single day in the unit without figuring this out.
0:20.0	So let's start with the basics.
0:22.1	Today we'll talk about the diagnosis of metabolic acid-based disorders, and we're going to go
0:26.9	through the usual.
0:28.0	Is it metabolic?
0:29.1	Is it respiratory?
0:30.4	Is it both?
0:31.3	We'll help out with the an end gap.
0:33.3	We'll go to the delta delta.
0:35.0	We'll talk about compensations.
0:36.5	And we'll even throw the strong
0:38.8	iron difference under the bus, won't we, Josh?
0:41.8	Yep, that's to be done.
0:43.3	Let's start off. Give me the boots on the ground, the lunchbox intensivist approach to acid
0:50.1	base disorders because I got to work every day and I got to have this down pat.
0:54.1	It also kind of just for terminology, when we talk about metabolic pH disorders, we're acid-based disorders because I got to work every day and I got to have this down pat.
0:58.1	It also kind of just for terminology, when we talk about metabolic pH disorders,
1:02.9	we're kind of talking about predominant abnormalities of the bicarbate level in the anion gap as opposed to respiratory disorders, which are predominantly abnormalities of the PCO2 level and ventilation.
1:08.6	So if I need to know the difference between the two, I always need
	...

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