Diagnosis and Management of Metabolic Acidosis

Authors

  • B. Jung Département de médecine intensive et réanimation, Inserm U1046 / CNRS U9234 (PhyMedExp), Université de Montpellier, CHU de Montpellier
  • M. Martinez Réseau d’urgence Ligérien Ardèche Nord (REULIAN), centre hospitalier Le Corbusier
  • Y.-E. Claessens Département de médecine d’urgence, centre hospitalier Princesse-Grace
  • M. Darmon Inserm, ECSTRA team, UMR 1153, centre d’épidémiologie et de biostatistique, Sorbonne–Paris-Cité, CRESS, Biostatistics and Clinical Epidemiology
  • K. Klouche PhyMedExp, Inserm U1046, CNRS UMR 9214, université de Montpellier
  • A. Lautrette UFR médecine de Clermont-Ferrand, université Clermont-Auvergne
  • J. Levraut UFR de Médecine, université de Nice Côte d’Azur
  • E. Maury Inserm U1136 -Equipe 1 : « Surveillance et Modélisation des maladies infectieuses »
  • M. Oberlin Structure des urgences, centre hospitalier de Cahors
  • N. Terzi Inserm, U1042, université Grenoble-Alpes, HP2
  • D. Viglino Inserm U1042, laboratoire HP2 Hypoxie-Physiopathologies, université Grenoble-Alpes
  • Y. Yordanov Service des urgences, hôpital Saint-Antoine, Assistance publique–Hôpitaux de Paris (AP–HP)
  • P.-G. Claret Pôle anesthésie réanimation douleur urgences, centre hospitalier universitaire de Nîmes
  • N. Bigé Service de médecine intensive–réanimation, hôpital Saint-Antoine, Assistance publique–Hôpitaux de Paris

DOI:

https://doi.org/10.3166/rea-2019-0126

Abstract

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.

Published

2019-11-01

How to Cite

Jung, B., Martinez, M., Claessens, Y.-E., Darmon, M., Klouche, K., Lautrette, A., Levraut, J., Maury, E., Oberlin, M., Terzi, N., Viglino, D., Yordanov, Y., Claret, P.-G., & Bigé, N. (2019). Diagnosis and Management of Metabolic Acidosis. Médecine Intensive Réanimation, 28(6), 481-502. https://doi.org/10.3166/rea-2019-0126

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