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1. Young – M- RODENTICIDES poisoning – zinc phosphide.
2. Young – M- RODENTICIDES poisoning – Warfarin type-
3. 31 yrs- M – Alprazolam , Apnea –
4. 23 yrs- M – loc , methadone , Alcohol
5. Young- F – clonazepam – Alprazolam – opium
6. 40 yrs- M- dyspnea and whizzing fallowing Heroin inhalation
7. 23 yrs - M – Abdominal fullness , Alcohol use last day
8. Young – M – drug overuse : Olanzapine, lorazepam, citalopram
9. Young – M – Cannabis inhalation -
general approach
• reversal of the underlying disease
• the aim is to maintain the arterial pH above 7.1 until the primary
process causing the metabolic acidosis can be reversed.
• give 1 to 2 meq/kg sodium bicarbonate as an intravenous bolus. We
repeat this dose after 30 to 60 minutes if the pH is still less than 7.1.
Adverse effects
● Increased arterial and tissue capillary PCO2
● Acceleration of lactate generation
● Reduced ionized calcium
● Hypernatremia
● Extracellular fluid (ECF) volume expansion
Metabolic Acidosis
General approach
General approach

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General approach

  • 1. 1. Young – M- RODENTICIDES poisoning – zinc phosphide. 2. Young – M- RODENTICIDES poisoning – Warfarin type- 3. 31 yrs- M – Alprazolam , Apnea – 4. 23 yrs- M – loc , methadone , Alcohol 5. Young- F – clonazepam – Alprazolam – opium 6. 40 yrs- M- dyspnea and whizzing fallowing Heroin inhalation 7. 23 yrs - M – Abdominal fullness , Alcohol use last day 8. Young – M – drug overuse : Olanzapine, lorazepam, citalopram 9. Young – M – Cannabis inhalation -
  • 2. general approach • reversal of the underlying disease • the aim is to maintain the arterial pH above 7.1 until the primary process causing the metabolic acidosis can be reversed. • give 1 to 2 meq/kg sodium bicarbonate as an intravenous bolus. We repeat this dose after 30 to 60 minutes if the pH is still less than 7.1.
  • 3. Adverse effects ● Increased arterial and tissue capillary PCO2 ● Acceleration of lactate generation ● Reduced ionized calcium ● Hypernatremia ● Extracellular fluid (ECF) volume expansion