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
lower threshold with non-AG acidosis (greater HCO3 loss)
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
lower threshold with non-AG acidosis (greater HCO3 loss)
Lost bicarbonate would take days to replenish
Bicarb <4
pH <7.20 AND shock/myocardial irritability
Severe hyperchloremic acidemia
lower threshold with non-AG acidosis (greater HCO3 loss)
Lost bicarbonate would take days to replenish
Lost bicarbonate would take days to replenish
Metabolic acidosis
Lactic acidosis
Metabolic alkalosis
Sepsis, shock, liver disease, CO, CN, metformin, methemoglobin
Respiratory acidosis
Short bowel syndrome
Anion gap acidosis
Propylene glycol infusions for lorazepam and phenobarbital