Treatment

Treatment of acid-base disorders should target the underlying cause.

Medications (e.g., sodium bicarbonate, acetazolamide) used to correct acid-base abnormalities should be initiated in consultation with a specialist (e.g., nephrologist).

Mechanical ventilation may be indicated in severe respiratory disorders and severe metabolic acidosis.

Electrolyte imbalances should be corrected: See “Disorders of potassium balance” and “Electrolyte repletion.”

Severe acute respiratory acidosis: Consider noninvasive or invasive mechanical ventilation.

See also “COPD,” “Opioid intoxication,” and “Benzodiazepine overdose.”

Acute respiratory alkalosis accompanied by increased work of breathing: Consider mechanical ventilation.

See also “Treatment of congestive heart failure,” “Treatment of pulmonary embolism,” and “Salicylate toxicity.”

Acute severe metabolic acidosis

• Consider intravenous sodium bicarbonate and mechanical ventilation (see “High-risk indications for mechanical ventilation”)

• See also “Diabetic ketoacidosis” and “Salicylate toxicity.”

Chronic metabolic acidosis

• Consider oral sodium bicarbonate

• See also “Chronic kidney disease,” and “Diarrhea.”

Chloride-responsive metabolic alkalosis

• Start isotonic saline to increase urinary bicarbonate excretion and correct extracellular volume loss

• See “Intravenous fluid therapy” and “Treatment” in “Dehydration and hypovolemia.”

Chloride-resistant metabolic alkalosis

• Consider bicarbonate excess as a potential cause and administer acetazolamide.

• See also “Cushing Syndrome” and “Primary hyperaldosteronism.”