Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2019 Aug 15;9(1):92.
doi: 10.1186/s13613-019-0563-2.

Diagnosis and management of metabolic acidosis: guidelines from a French expert panel

Boris Jung  1   2 , Mikaël Martinez  3   4 , Yann-Erick Claessens  5 , Michaël Darmon  6   7   8 , Kada Klouche  9   10 , Alexandre Lautrette  11   12 , Jacques Levraut  13   14 , Eric Maury  15   16   17 , Mathieu Oberlin  18 , Nicolas Terzi  19   20 , Damien Viglino  21   22 , Youri Yordanov  23   24   25 , Pierre-Géraud Claret  26 , Naïke Bigé  15 ; Société de Réanimation de Langue Française (SRLF); Société Française de Médecine d’Urgence (SFMU)
Affiliations
Review

Diagnosis and management of metabolic acidosis: guidelines from a French expert panel

Boris Jung et al. Ann Intensive Care. .

Abstract

Metabolic acidosis is a disorder frequently encountered in emergency medicine and intensive care medicine. As literature has been enriched with new data concerning the management of metabolic acidosis, the French Intensive Care Society (Société de Réanimation de Langue Française [SRLF]) and the French Emergency Medicine Society (Société Française de Médecine d'Urgence [SFMU]) have developed formalized recommendations from experts using the GRADE methodology. The fields of diagnostic strategy, patient assessment, and referral and therapeutic management were addressed and 29 recommendations were made: 4 recommendations were strong (Grade 1), 10 were weak (Grade 2), and 15 were experts' opinions. A strong agreement from voting participants was obtained for all recommendations. The application of Henderson-Hasselbalch and Stewart methods for the diagnosis of the metabolic acidosis mechanism is discussed and a diagnostic algorithm is proposed. The use of ketosis and venous and capillary lactatemia is also treated. The value of pH, lactatemia, and its kinetics for the referral of patients in pre-hospital and emergency departments is considered. Finally, the modalities of insulin therapy during diabetic ketoacidosis, the indications for sodium bicarbonate infusion and extra-renal purification as well as the modalities of mechanical ventilation during severe metabolic acidosis are addressed in therapeutic management.

Keywords: Anion gap; Blood gas analysis; Hyperlactatemia; Ketoacidosis; Metabolic acidosis; Renal replacement therapy; Sodium bicarbonate.

PubMed Disclaimer

Conflict of interest statement

The authors declare the following competing interests: B. Jung: Sedana Medical, Medtronic; M. Martinez: Astra Zeneca, Actélion; YE Claessens: Roche diagnostics, BioMérieux, Sanofi, Pfizer; M. Darmon: Sanofi, Gilead-Kite, Astute Medical, MSD, Astellas; A. Lautrette: Baxter, Frésénius; J. Levraut: LFB, Nova-Biomedical; E. Maury: General Electric Healthcare, Doran International, Vygon, AstraZeneca; N. Terzi: Boehringer Ingelheim, Pfizer; D. Viglino: Astra Zeneca, Mundipharma; Y. Yordanov: Mundipharma, Sanofi; PG Claret: Aspen, AstraZeneca, Daiichi Sankyo, Roche Diagnostics, Sanofi, Thermo Fisher Scientific. The remaining authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Algorithm recommended by the experts for etiological diagnosis of metabolic acidemia (EXPERT OPINION)
See this image and copyright information in PMC

References

    1. Kimmoun A, Novy E, Auchet T, Ducrocq N, Levy B. Hemodynamic consequences of severe lactic acidosis in shock states: from bench to bedside. Crit Care Lond Engl. 2015;19:175. doi: 10.1186/s13054-015-0896-7. - DOI - PMC - PubMed
    1. Kraut JA, Madias NE. Treatment of acute metabolic acidosis: a pathophysiologic approach. Nat Rev Nephrol. 2012;8(10):589–601. doi: 10.1038/nrneph.2012.186. - DOI - PubMed
    1. Kraut JA, Madias NE. Metabolic acidosis: pathophysiology, diagnosis and management. Nat Rev Nephrol. 2010;6(5):274–285. doi: 10.1038/nrneph.2010.33. - DOI - PubMed
    1. Asch MJ, Dell RB, Williams GS, Cohen M, Winters RW. Time course for development of respiratory compensation in metabolic acidosis. J Lab Clin Med. 1969;73(4):610–615. - PubMed
    1. Fulop M. A guide for predicting arterial CO2 tension in metabolic acidosis. Am J Nephrol. 1997;17(5):421–424. doi: 10.1159/000169134. - DOI - PubMed