Jung Boris, Martinez Mikaël, Claessens Yann-Erick, Darmon Michaël, Klouche Kada, Lautrette Alexandre, Levraut Jacques, Maury Eric, Oberlin Mathieu, Terzi Nicolas, Viglino Damien, Yordanov Youri, Claret Pierre-Géraud, Bigé Naïke
Département de Médecine Intensive et Réanimation, CHU Montpellier, 34000, Montpellier, France.
INSERM U-1046, CNRS U-9234 (PhyMedExp), Université de Montpellier, Montpellier, France.
Ann Intensive Care. 2019 Aug 15;9(1):92. doi: 10.1186/s13613-019-0563-2.
Metabolic acidosis is a disorder frequently encountered in emergency medicine and intensive care medicine. As literature has been enriched with new data concerning the management of metabolic acidosis, the French Intensive Care Society (Société de Réanimation de Langue Française [SRLF]) and the French Emergency Medicine Society (Société Française de Médecine d'Urgence [SFMU]) have developed formalized recommendations from experts using the GRADE methodology. The fields of diagnostic strategy, patient assessment, and referral and therapeutic management were addressed and 29 recommendations were made: 4 recommendations were strong (Grade 1), 10 were weak (Grade 2), and 15 were experts' opinions. A strong agreement from voting participants was obtained for all recommendations. The application of Henderson-Hasselbalch and Stewart methods for the diagnosis of the metabolic acidosis mechanism is discussed and a diagnostic algorithm is proposed. The use of ketosis and venous and capillary lactatemia is also treated. The value of pH, lactatemia, and its kinetics for the referral of patients in pre-hospital and emergency departments is considered. Finally, the modalities of insulin therapy during diabetic ketoacidosis, the indications for sodium bicarbonate infusion and extra-renal purification as well as the modalities of mechanical ventilation during severe metabolic acidosis are addressed in therapeutic management.
代谢性酸中毒是急诊医学和重症医学中常见的一种病症。随着有关代谢性酸中毒管理的新数据不断丰富，法国重症医学会（Société de Réanimation de Langue Française [SRLF]）和法国急诊医学会（Société Française de Médecine d'Urgence [SFMU]）运用GRADE方法，由专家制定了正式的建议。涉及诊断策略、患者评估以及转诊和治疗管理等领域，并提出了29条建议：4条为强烈推荐（1级），10条为弱推荐（2级），15条为专家意见。所有建议均获得投票参与者的强烈认可。文中讨论了应用亨德森 - 哈塞尔巴尔赫法和斯图尔特法诊断代谢性酸中毒机制，并提出了一种诊断算法。还探讨了酮症以及静脉和毛细血管血乳酸水平的应用。考虑了pH值、血乳酸水平及其变化趋势在院前和急诊科患者转诊中的价值。最后，治疗管理部分涉及糖尿病酮症酸中毒期间胰岛素治疗的方式、碳酸氢钠输注和肾外净化的指征以及严重代谢性酸中毒期间机械通气的方式。
