tailieunhanh - Access: Acid-Base, Fluids, and Electrolytes - part 7

Điều trị Điều trị nhiễm kiềm chuyển hóa, như với tất cả các rối loạn acid-base, bản lề sửa chữa tình trạng bệnh cơ bản mức độ nghiêm trọng của sự rối loạn acid-căn cứ có thể đe dọa tính mạng trong một số trường hợp, và yêu cầu cụ thể điều trị, điều này đặc biệt đúng trong hỗn hợp acid-base | METABOLIC ALKALOSIS 285 TREATMENT TABLE 7-18 Treatment Treatment of metabolic alkalosis as with all acid-base disturbances hinges on correction of the underlying disease state The severity of the acid-base disturbance itself may be life threatening in some cases and require specific therapy this is especially true in mixed acid-base disturbances where pH changes are in the same direction such as a respiratory alkalosis from sepsis and a metabolic alkalosis secondary to vomiting Emergent control of systemic pH In the setting of a clinical emergency controlled hypoventilation must be employed In this clinical condition intubation sedation and controlled hypoventilation with a mechanical ventilator sometimes using inspired CO2 and or supplemental oxygen to prevent hypoxia is often lifesaving Urgent control of systemic pH Once the situation is no longer critical partial or complete correction of metabolic alkalosis over the ensuing 6-8 h with HCl administered as a solution through a central vein is preferred arginine hydrochloride can also be used The effect of HCl is not rapid enough to prevent or treat life-threatening complications continued 286 METABOLIC ALKALOSIS TABLE 7-18 Continued Generally the acid deficit is calculated assuming a bicarbonate distribution space of times body weight in liters and about half of this amount of HCl is given with frequent monitoring of blood gases and electrolytes These agents can result in significant potential complications hydrochloric acid may cause intravascular hemolysis and tissue necrosis while ammonium chloride may result in ammonia toxicity Noncritical situations In less urgent settings metabolic alkalosis is treated after examining whether it is Cl--responsive or not Cl--responsive metabolic alkalosis is responsive to volume repletion coexistent hypokalemia should also be corrected Cl--resistant metabolic alkaloses are treated by antagonizing the mineralocorticoid or mineralocorticoid-like substance that .