Metabolic Acidosis

# Metabolic Acidoiss
Checklist
-- ABCs: pH <7.2 --> ICU for bicarb, possible intubation if resp distress
-- VBG: confirm pH <7.36 and bicarb <24 (did PCO2 go down by 1 for each decrease in bicarb?)
-- HPI Intake: meds and adherence, alcohol use, other ingestions, immunosuppression, infectious symptoms
-- Can't Miss: sepsis/shock, DKA
-- Admission Orders: lactate, BHB, UA
-- Initial Treatment to Consider: *** bicarb, fluids, antibiotics,

Assessment:
-- History: *** alcohol use, CKD, diabetes, infections, ingestions
-- Clinical: *** confusion, dyspnea, vision changes, localizing infectious symptoms, N/V/D
-- Exam: *** AMS, WOB, overload
-- Data: *** VBG (pH, PCO2), bicarb, potassium,
-- Etiology/DDx: *** Anion Gap: lactic acidosis, uremia, DKA, intoxication; Non-Anion Gap: renal failure, diarrhea, saline infusion, RTA

The patient's HPI is notable for ***. Exam showed ***. Labwork and data were notable for ***. Taken together, the patient's presentation is most concerning for ***, with a differential including ***.

Plan:
Workup
-- f/u CBC, BMP, VBG, UA
-- if anion gap - lactate, BHB

Treatment
-- IVF: ***
-- Treat underlying cause - DKA, sepsis, renal failure, etc.
-- If c/f intoxication, consult renal for dialysis and fomepizole