Patient: [Patient Name]
MRN: [Medical Record Number]
Date: [Date of Encounter]
Chief Complaint:
New or follow-up for metabolic acidosis
(Specify) Symptoms suggestive of underlying cause (e.g., nausea, vomiting, Kussmaul respirations, lethargy, confusion)
History of Present Illness:
Onset, duration, and severity of symptoms.
Potential precipitating factors (e.g., medication use, dietary changes, recent illness).
Inquiry about risk factors for specific types of metabolic acidosis (e.g., diabetes, chronic kidney disease, diarrhea, alcohol abuse).
Past Medical History:
Underlying conditions that may predispose to metabolic acidosis (e.g., diabetes, chronic kidney disease, chronic diarrhea, liver disease).
Previous episodes of metabolic acidosis.
Medications that can contribute to metabolic acidosis (e.g., metformin, salicylates).
Medications:
List all current medications, including any medications suspected to contribute to acidosis.
Social History:
Alcohol intake (risk factor for lactic acidosis).
Dietary habits (prolonged ketosis due to starvation or high-fat, low-carb diets).
Family History:
Family history of inherited metabolic disorders (less common).
Physical Exam:
Vital signs: Assess for respiratory rate (increased in Kussmaul respirations), blood pressure, and temperature.
General examination: Assess for signs of dehydration (dry mucous membranes), illness (fever), or altered mental status (confusion, lethargy).
Lung examination: Listen for Kussmaul respirations (deep, rapid breaths).
Laboratory Tests:
Arterial blood gas (ABG): Primary test to diagnose metabolic acidosis, revealing decreased pH, low bicarbonate (HCO3-), and potentially compensatory respiratory alkalosis.
Serum electrolytes: May reveal anion gap elevation suggestive of anion gap acidosis or normal anion gap suggestive of non-anion gap acidosis.
Lactate level: Elevated lactate can indicate lactic acidosis.
Other laboratory tests may be indicated based on suspected cause (e.g., ketones for diabetic ketoacidosis, renal function tests for chronic kidney disease).
Assessment:
Metabolic acidosis: Based on ABG findings and clinical presentation.
Anion gap: Evaluate the anion gap to differentiate between anion gap acidosis and non-anion gap acidosis.
Potential underlying cause: Consider the clinical picture, laboratory findings, and risk factors to identify the most likely cause of metabolic acidosis (e.g., diabetic ketoacidosis, lactic acidosis, renal tubular acidosis).
Plan:
Treatment depends on the underlying cause and severity of acidosis:
Correcting the underlying disorder: This is the primary goal of treatment. For example, administration of insulin in diabetic ketoacidosis or treatment of the inciting illness in lactic acidosis.
Fluid resuscitation: Correct dehydration to improve perfusion and promote acid excretion.
Electrolyte replacement: Address electrolyte imbalances based on laboratory findings.
Specific therapies for certain causes: e.g., bicarbonate therapy may be used cautiously in severe metabolic acidosis with significant hemodynamic compromise.
Critical care management: May be necessary for patients with severe metabolic acidosis and life-threatening complications.
Consultations: Depending on the suspected cause, consultations with specialists (e.g., endocrinology, nephrology, critical care) may be necessary.
Follow-up:
Monitor response to treatment with serial ABG measurements and electrolyte panels.
Address the underlying cause of metabolic acidosis to prevent recurrence.
Provide education on the importance of adherence to treatment plans and recognizing symptoms of recurrent acidosis.
Disclaimer: This template is for informational purposes only and should be adapted to the specific needs of each patient. Metabolic acidosis is a complex condition with various causes. Prompt diagnosis and treatment of the underlying disorder are crucial to prevent serious complications.