Treat source
Correct any respiratory acidosis
Bicarbonate
HCO3 dose in mEq = 0.5(wt in kg) x (24 - measured HCO3)
Each bicarb 0.5mEq/kg causes 1 meq/L rise in HCO3
Consider for:
Bicarb <4
pH <7.20 AND shock/myocardial irritability
Severe hyperchloremic acidemia
Lost bicarbonate would take days to replenish
HCO3 dose in mEq = 0.5(wt in kg) x (24 - measured HCO3)
Each bicarb 0.5mEq/kg causes 1 meq/L rise in HCO3
Consider for:
Bicarb <4
pH <7.20 AND shock/myocardial irritability
Severe hyperchloremic acidemia
Lost bicarbonate would take days to replenish
Bicarb <4
pH <7.20 AND shock/myocardial irritability
Severe hyperchloremic acidemia
Lost bicarbonate would take days to replenish
Lost bicarbonate would take days to replenish
Anion gap acidosis
Lactic acidosis
Non anion gap acidosis
Sepsis, shock, liver disease, CO, CN, metformin, methemoglobin
Metabolic alkalosis
Short bowel syndrome
Metabolic acidosis
Propylene glycol infusions for lorazepam and phenobarbital