About the book
Metabolic acidosis is one of the most common serious disturbances of acid/base balance. It is also one of the most dangerous. Lactic acidosis often accompanies severe sepsis which is the most common cause of death in a non-cardiac intensive care unit. Severe metabolic acidosis can cause poor cardiac function and hypotension, thus contributing to morbidity and mortality in cardiac intensive care units. It can contribute to the poor response after cardiac arrest. Although anion-gap metabolic acidosis is easily diagnosed, the non-anion gap metabolic acidosis is often poorly understood. The definitive treatment requires correcting the underlying cause. The combination of anion-gap and non-anion gap metabolic acidoses can also occur. Correction of one is often insufficient to successfully resuscitate the patient because the other for will remain untreated. The work up to identify these complex metabolic acidoses includes osmolal gap measurements, delta bicarbonate calculations, and urine anion gap measurement. Drug-induced metabolic acidosis can be acute or chronic. Newer medications are being identified each year to cause this clinical problem. Chronic metabolic acidosis accompanies gastrointestinal disturbances, several types of gastrointestinal surgeries, some urologic surgical procedures. Unless anticipated and managed chronic metabolic acidosis is buffered by bone creating and contributing to osteopenic states, hip fractures, vertebral fractures, and disturbed growth of bones in patients before the age of puberty.