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Respect the Hydrogen Ion +



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The consequences of missing a severe metabolic acidosis in the patient you’re about to intubate can be devastating. The apnea caused by RSI will exacerbate the low pH. To safely navigate this situation, here are some rules of the road.

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Identifying Metabolic Acidosis

What to look for

The first goal should be to identify a severe metabolic acidosis BEFORE you intubate and take away your patient’s ability to compensate. Kaussmal breathing is a classic example of respiratory compensation in metabolic acidosis with rapid, deep breaths. A rapid respiratory rate without a clear cardio-pulmonary cause should make you wonder…


Here is another great curated example of Kussmal Breathing in DKA

Matching Minute Ventilation

You must match their minute ventilation in a patient with severe metabolic acidosis. What is minute ventilation? Well, I’m glad you asked.

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Here are some key takeaways from this space that you should incorporate into your peri-intubation care of a critically ill patient.

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