1. Journal of Academic Emergency Medicine (2014) 13: 4-9.
HESC310
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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
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2. HESC310
11/12/2018
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3. 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 Data on age, gender, chief complaint, and diagnosis in the ED were collected for ABD cases.

4. 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).

5. 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)

6. The authors used standard definition of normal: pH = 7.35-7.45
HESC310
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The authors used standard definition of normal:
pH =
PaCO2 = mmHg
HCO3- = mEq/L
PaO2 = mmHg
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7. 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)
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8. 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.
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9. HESC310 metabolic variation  Acidosis Alkalosis HCO3<22 HCO3>26
11/12/2018
metabolic variation 
Acidosis Alkalosis
HCO3< HCO3>26
MRAC
RespAcid
MALRAC
MetaAcid
Normal
MetaAlka
MACRAL
RespAlka
MRAL
PaCO2< PaCO2>45
Alkalosis Acidosis
respiratory variation 
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10. 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

11. Figure 2. Distribution of ABDs according to age.

12. 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.,
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.
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