This is the podcast, Surgery I See Rounds. My name is Jeff Guy.

The topic today is a metabolic acidosis and the test care unit.

It's something that we see commonly in the ICU, but I think few really have much of command

of what the problem is, how to identify a metabolic acidosis, identify what the etiology is, and then what do you do about it once you've identified a patient how to identify a metabolic acidosis, identify what the etiology is, and then what do you

do about it once you've identified a patient has one.

A normal blood pH is typically identified between 7.38 and 7.42.

A typical geek question, useless information that you would never need to know, is that

really corresponds to a hydrogen ion concentration between 42 to 38 animals per liter. geek question, useless information that you would never need to know, is that really

corresponds to a hydrogen ion concentration between 42 to 38 animals per liter.

It would seem self-evident, but a metabolic acidosis is really caused by one of really

two processes.

You have an increased accumulation of acids, or you have a decrease, excuse me, an increase accumulation of acids or you have a decrease, excuse me,

an increase accumulation of acids or an increase in the wasting of a base of sodium bicarbonate.

You can typically lose sodium bicarbonate either in the GI tract and form of diarrhea or through the kidney

in the various forms of renal tubular acidosis. If you look at people who are typically in intensive care, the very nature of what puts

them in an intensive care unit makes the finding of a metabolic acidosis

an an acritically ill patient a reasonably common occurrence.

Typically people will compensate or try to compensate with a metabolic acidosis by increasing

their metavitination this is known as respiratory compensation if patient has a metabolic

acidosis they'll try to compensate by increasing the respiratory rate this will typically

you can typically see near completecomplete respiratory compensation within hours.

But compensatory hyperventilation is not as quick as many people may think,

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