2025 Multiprofessional Critical Care Review: Adult Online-Complex Acid Base Disorders

Video Transcription

Video Summary

Dr. Khashoggi presents a thorough review of acid-base disorders focusing on the roles of the lungs and kidneys in maintaining pH balance. He explains the six-step approach to diagnosing acid-base disturbances, emphasizing the distinction between respiratory and metabolic causes, the acuity of respiratory conditions, and the significance of anion gap calculations. Metabolic acidosis is discussed extensively, including its impact on cardiovascular, respiratory, neurologic, and metabolic systems, and the importance of identifying underlying causes such as lactic acidosis, ketoacidosis, and toxin-induced acidosis. He highlights common causes of high anion gap metabolic acidosis using the GOLD MARK mnemonic and explores types of lactic acidosis (type A and B). Management strategies for diabetic ketoacidosis, starvation ketoacidosis, alcoholic ketoacidosis, and toxin-related acidoses (ethylene glycol, methanol, salicylate) are reviewed. The talk covers non-anion-gap metabolic acidosis, renal tubular acidosis subtypes, and their diagnostic urine findings. He also addresses metabolic alkalosis mechanisms and respiratory acidosis management. Clinical use of bicarbonate is cautioned; it is reserved for severe acidemia (pH <7.15) to correct pH temporarily, not as a primary treatment. For toxin intoxications, fomepizole is preferred over ethanol. Dr. Khashoggi advises careful interpretation of acid-base abnormalities in ICU and highlights current research on bicarbonate therapy efficacy.

Keywords

acid-base disorders

lungs and kidneys

pH balance

anion gap

metabolic acidosis

ketoacidosis

renal tubular acidosis

bicarbonate therapy

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