Journal of Academic Emergency Medicine (2014) 13: 4-9. HESC310 11/12/2018 Acid-Base Disorders in the Emergency Department: Incidence, Etiologies and Outcomes. Köse et al. Journal of Academic Emergency Medicine (2014) 13: 4-9. Review by W. Rose, 2018 Axial Skeleton

HESC310 11/12/2018 Axial Skeleton

Objective: Acid-base disorders (ABDs) are usually correlated with high rates of morbidity and mortality. The objective of this study was to analyze the causes, outcomes, types and incidences of ABDs in patients presenting at the emergency department (ED). Material and Methods: We prospectively analyzed data from patients who presented between January 2011 and May 2011. Data on age, gender, chief complaint, and diagnosis in the ED were collected for ABD cases.

Results: Of the 736 cases with an ABD, 173 patients (23 Results: Of the 736 cases with an ABD, 173 patients (23.5%) had simple ABD and 563 patients (76.5%) had mixed ABD. The most common ABD was a mixed metabolic acidosis and respiratory alkalosis (MACRAL) (n=408, 55.4%). All ABD types were most commonly observed in patients over 65 years of age. Dyspnea was the most common complaint among ABD patients who presented at the ED (44.4%). In cases of ABD, pneumonia was the most common diagnosis (16.3%). Of the ABD cases, 379 patients (51.6%) were discharged, while 318 patients (43.2%) were hospitalized. Death was more commonly observed in cases with mixed metabolic and respiratory acidosis (MRAC) (n=6) and MACRAL (n=11).

Conclusion: ABDs are quite common in patients presenting at the ED, especially among patients in a critical condition (71%). Mixed MACRAL was the most commonly noted ABD. Dyspnea and pneumonia were the most common diagnoses in ABD patients. Mortality was more common in cases with a mixed MRAC and MACRAL. This knowledge may provide important information concerning the diagnosis, treatment and early prognosis of patients. (JAEM 2014; 13: 4-9)

The authors used standard definition of normal: pH = 7.35-7.45 HESC310 11/12/2018 The authors used standard definition of normal: pH = 7.35-7.45 PaCO2 = 35-45 mmHg HCO3- = 22-26 mEq/L PaO2 = 80-100 mmHg Axial Skeleton

Definitions used in this study HESC310 11/12/2018 Definitions used in this study Simple acid-base disorders (SABDs) Respiratory acidosis: pH<7.35, PaCO2>45 mmHg Metabolic acidosis: pH<7.35, HCO3<22 mEq/L Respiratory alkalosis: pH>7.45, PaCO2<35 mmHg Metabolic alkalosis: pH>7.45, HCO3>26 mEq/L Mixed acid-base disorders (MABDs) Next slide Axial Skeleton

Definitions used in this study HESC310 11/12/2018 Definitions used in this study Mixed acid-base disorders (MABDs) Meta. & resp. acidosis (MRAC): pH<7.35, HCO3<22 mEq/L, PaCO2>45 mmHg Metabolic & respiratory alkalosis (MRAL): pH>7.45, HCO3>26 mEq/L, PaCO2<35 mmHg Metabolic acidosis, resp. alkalosis (MACRAL): pH=?, HCO3<22mEq/L, PaCO2<35 mmHg Metabolic alkalosis, resp. acidosis (MALRAC): pH=?, HCO3>26 mEq/L, PaCO2>45 mmHg MALRAC, MACRAL likely to be compensated states. Axial Skeleton

HESC310 metabolic variation  Acidosis Alkalosis HCO3<22 HCO3>26 11/12/2018 metabolic variation  Acidosis Alkalosis HCO3<22 HCO3>26 MRAC RespAcid MALRAC MetaAcid Normal MetaAlka MACRAL RespAlka MRAL PaCO2<35 PaCO2>45 Alkalosis Acidosis respiratory variation  Axial Skeleton

Figure 1. Outcomes of the blood gas drawn in the study and types of ABDs. ABD, SABD, MABD: Acid base disorder, simple ABD, mixed ABD. MRAC, MRAL: metabolic & respiratory acidosis, alkalosis. MACRAL: metabolic acidosis, respiratory alkalosis MALRAC: metabolic alkalosis, respiratory acidosis

Figure 2. Distribution of ABDs according to age.

HESC310 11/12/2018 Sources Köse et al. (2014). Acid-Base Disorders in the Emergency Department: Incidence, Etiologies and Outcomes. J. Acad. Emerg. Med. 13: 4-9. See also: Rose, W.C., in Fluids and Electrolytes with Clinical Applications, 8th ed., 2009. Chapter 11. Regulatory Mechanisms for pH Control. Chapter 12. Determination of Acid-Base Imbalances. Chapter 13. Metabolic Acidosis and Alkalosis. Chapter 14. Respiratory Acidosis and Alkalosis. Axial Skeleton