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Treatment

Treatment. Pharmacologic Goals:. 1. Treat underlying cause Septic shock 2. Treat metabolic acidosis as produced by the following mechanisms: Loss of bicarbonate (Hperchloremic Non-Gap Metabolic Acidosis) Diarrhea Gain of hydrogen ions (High Anion Gap Acidosis) Lactic acidosis

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Treatment

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  1. Treatment

  2. Pharmacologic Goals: 1. Treat underlying cause • Septic shock 2. Treat metabolic acidosis as produced by the following mechanisms: • Loss of bicarbonate (Hperchloremic Non-Gap Metabolic Acidosis) • Diarrhea • Gain of hydrogen ions (High Anion Gap Acidosis) • Lactic acidosis • Diabetic Ketoacidosis

  3. Treat underlying cause Septic shock • Presence of septic shock as evidenced by fever, hypotension, tachypnea, tachycardia, high WBC count • Treatment primarily consists of the following: • Volume resuscitation. • crystalloid fluid administration • Early antibiotic administration. • consider which bacteria are most likely to be present • Rapid source identification and control. • Support of major organ dysfunction. • Dopamine or norepinephrine (which cause blood vessels to narrow), may be needed to increase blood flow to the brain, heart, and other organs.

  4. Treat metabolic acidosis (Hyperchloremic Non-Gap Metabolic Acidosis) Loss of bicarbonate - Diarrhea • In hyperchloremic acidosis, the central problem is with the reabsorption or regeneration of bicarbonate. • In these conditions, therapy with bicarbonate makes physiologic sense and is prudent in patients with severe acidosis.

  5. Treat metabolic acidosis (High Anion Gap Acidosis) Gain of hydrogen ions - Lactic acidosis • Lactic Acidosis • Alkali therapy  generally advocated for acute acidemia (pH < 7.15) to improve cardiac function and lactate utilization A reasonable approach to infuse sufficient NaHCO3 to raise arterial pHto no more than 7.2 over 30-40 minutes.

  6. Treat metabolic acidosis (High Anion Gap Acidosis) Gain of hydrogen ions –Diabetic Ketoacidosis • Diabetic Ketoacidosis • Fluid resuscitation with isotonic saline (DKA patients are volume depleted) • IV regular insulin (prevent production of ketones)

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