Stewart at the bedside
Quick bedside cues to orient metabolic disorders.
Stewart at the bedside
Quick bedside cues to orient metabolic disorders.
At the bedside, use Na⁺ – Cl⁻ simply.
Na⁺ – Cl⁻
> 38
mmol/L
→hypochloremic metabolic alkalosis
3 frequent causes:
- Diuretics
- Vomiting
- Hyperaldosteronism
Na⁺ – Cl⁻
< 32
mmol/L
→hyperchloremic metabolic acidosis
3 frequent causes:
- Excessive chloride infusion
- Diarrhea
- Adrenal insufficiency
Na⁺ – Cl⁻
32 – 38
mmol/L
→in metabolic acidosis:normochloremic metabolic acidosis
3 frequent causes:
- Ketoacidosis
- Lactic acidosis
- Acute kidney injury
excess unmeasured anions
Albumin
< 35 g/L
→hypoproteinemic metabolic alkalosis
3 frequent causes:
- Malnutrition
- Cirrhosis
- Nephrotic syndrome
Remember
- → These tools, although imprecise, orient toward one or more metabolic disorders.
- → They must be confirmed by a complete analysis (abg.care numerical tool).