Diagnosis and Management of Metabolic Acidosis
Metabolic acidosis is a disorder frequently encountered in emergency medicine and intensive care medicine. As the literature has been enriched with new data on the management of metabolic acidosis, the French-speaking Intensive Care Society (SRLF) and the French Society of Emergency Medicine (SFMU) have developed formalized recommendations from experts using the GRADE methodology. The fields of diagnostic strategy, guidance and therapeutic management were addressed and 29 recommendations were made: four strong recommendations (Grade 1), ten weak recommendations (Grade 2) and fifteen expert opinions. All of them have reached a strong agreement. The application of Henderson–Hasselbalch and Stewart methods for the diagnosis of the metabolic acidosis mechanism is discussed and a diagnostic algorithm is proposed. The use of ketosis and venous and capillary lactatemia is also treated. The value of pH, lactatemia and its kinetics for the referral of patients in pre-hospital and emergency departments is considered. Finally, the modalities of insulin therapy during diabetic ketoacidosis, the indications for sodium bicarbonate infusion and extra-renal purification as well as the modalities of mechanical ventilation during severe metabolic acidosis are addressed in therapeutic management.