Acid-Base Physiology
11.4 Overview of Treatment of Acid-Base Disorders 
(DRAFT ONLY)

EARLY DRAFT

11.4.1 The Three Aspects of Treatment

The treatment options in management of any acid-base disorder can be divided into 3 aspects: 

  • Treating the CAUSE
  • Treating the ACID-BASE ABNORMALITY (the pH)
  • Treating the COMPLICATIONS

Some examples are outlined in the table.

 

Classification of Treatments in Acid-Base Disorders

Treating the Cause

  • Insulin infusion in diabetic ketoacidosis
  • Administration of oxygen & restoration of cardiac output in type A lactic acidosis
  • Specific treatments for respiratory failure (eg antibiotics, bronchodilators, streptokinase)
  • Psychological management for anxiety-hyperventilation syndrome 
  • Dantrolene for malignant hyperthermia
  • Repair the deficit responsible for maintenance of a metabolic alkalosis (eg saline loading, administration of K+)

Treating the Acid-Base Abnormality

  • Indirectly by treating the cause
  • Administration of sodium bicarbonate (to restore pH in metabolic acidosis)
  • Intubation & ventilation for respiratory failure (to correct arterial pCO2 & pH)

Treating the Complications

  • Indirectly by treating the cause
  • Indirectly by treating the acid-base abnormality
  • Administration of K+ for hypokalaemia
  • Use of insulin-glucose treatment for hyperkalaemia
  •  

11.4.2  Treating the Cause

Often best approach as ultimately resolves the problem
Treatment depends on the cause so there is a great requirement for an accurate diagnosis
Often slow return to normal & may be too slow or inappropriate way to treat some complications
Includes aspects of prevention (eg patient education, insulin for diabetics)

11.4.3  Treating the Acid-Base Abnormality

Metabolic disorders:
Traditional approach has been to give NaHCO
3 in metabolic acidosis with little or no evidence of efficacy
Other burffers used eg THAM

Respiratory disorders:
Usefulness of ventilation to correct pH (via pCO
2)
Adverse problems due to pCO
2 can be corrected

11.4.4  Treating the Complications

May be life-threatening requiring emergency management (eg K+, CBF & ICP)
Includes treating the complications of treatment!! (such as bicarbonate problems, problems with lines)

11.4.5  Treatment Controversies & Conflicts

 To be added 

11.4.6  Trips & Traps

To be added

 

Last updated - All material Copyright - Kerry Brandis, 2002

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