Asidosis metabolik

Essentials of Diagnosis
• Penurunan pH serum  (<7.35)
• penurunan serum HCO3
• penyebabnya termasuk diarrhea, diuretics, renal tubular disease,
ureterosigmoidostomy, lactic acidosis, diabetic ketoacidosis,
uremia
• Diagnosis termasuk pengukuran arterial blood gas (ABG)
• Penghitungan anion gap: Na – (Cl + HCO3)
• Anion gap >15: H+ meningkat, lactic acidosis, diabetic ketoacidosis,
uremia, methanol ingestion, salicylate intoxication, ethylene
glycol ingestion
• Anion gap <15: HCO3 hilang, diarrhea, renal tubular disease,
ureterosigmoidostomy, acetazolamide, NH4 Cl administration

Differential Diagnosis
• Differentiate between anion gap or hyperchloremic causes

Treatment
• Konservatif: Pengaturan HCO3
• Memperkirakan kebutuhan dgn mengalikan deficit basa dengan satu setengah total body
water

Pearls
Gap acidosis = SLUMPED: salicylates, lactate, uremia, methanol, paraldehyde,
ethylene glycol, diabetes.
Non-gap acidosis = 2 renal (renal tubular acidosis, renal failure), 2
gastrointestinal (enterocutaneous fistula, urine diversion to gastrointestinal
tract), and 2 drugs (ammonium chloride, acetazolamide).
Reference
Adrogue HJ et al: Management of life-threatening acid-base disorders [two
parts]. N Engl J Med 1998;338:26, 107.