Investigative algorithms for disorders affecting acidosis: a narrative review
Year: 2022
Type: review
Abstract: Background and Objective: The following article forms part of a special series of articles designed to aid the reader to diagnose the cause of various electrolyte imbalances. By the end of the article, the reader will be able to request and interpret appropriate investigations when faced with an acidotic patient. Methods: A narrative, focused literature review of English language papers was performed using PubMed, OMIM and Google during September 2021 to January 2022. References were identified published from database inception to January 2022; reference lists from these articles were also used. Key Content and Findings: Acid balance in the body is tightly controlled with respiratory and renal systems, and acute and chronic compensatory mechanisms exist to help maintain acid homeostasis. Primarily, the partial pressure of carbon dioxide (pCO2) can be used to distinguish respiratory from metabolic causes taking into account the presence of compensation. If a metabolic cause is identified, calculating the anion gap can help to indicate the presence of an unmeasured anion. Subtypes of renal tubular acidosis (RTA) are best discriminated by use of urine pH and then the presence in the urine of indicators of a generalised tubulopathy, e.g., glucose. Low bicarbonate, in situations where the pH is unknown, primarily indicates a possible metabolic acidosis or respiratory alkalosis. Conclusions: Diagnostic schema will be presented and the limitations of the laboratory tests discussed. The algorithm should support healthcare professionals to efficiently and rapidly diagnose most causes of the acidotic state.
DOI: 10.21037/jlpm-22-9
Authors: George T. Allen, Kade C. Flowers, Alexa R. Shipman, Chloe Darragh-Hickey, Sukhbir Kaur, Kate E. Shipman
Language: English
Subfield: Nephrology
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W4285530232