11.4 Treatment Overview

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

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

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)

Metabolic disorders:
Traditional approach has been to give NaHCO3 in metabolic acidosis with little or no evidence of efficacy
Other burffers used eg THAM

Respiratory disorders:
Usefulness of ventilation to correct pH (via pCO2)
Adverse problems due to pCO2 can be corrected

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