Which of the following statement(s) is/are true concerning the compensatory mechanisms and treatment of metabolic acidosis?
A. Maximal renal compensation for metabolic acidosis occurs before full respiratory compensation can occur B. All patients with lactic acidosis should receive prompt treatment with bicarbonate C. Potassium replacement is essential even in the face of normal or high serum potassium when treating diabetic ketoacidosis D. Sodium bicarbonate administration should begin simultaneous with volume resuscitation in patients with hypoxia secondary to shock
Potassium replacement is essential even in the face of normal or high serum potassium when treating diabetic ketoacidosis-the kidney is extremely sensitive to changes in serum bicarbonate concentration and responds by increasing net acid excretion primarily by increasing ammonia excretion. maximal renal compensation requires 2 to 4 days. delay in achieving maximal renal response to an increased acid load causes blood ph to decline, which stimulates hyperventilation. although effective in promptly raising blood ph, ventilatory compensation is only partial, and full respiration compensation requires 12 to 24 hours. the major principal of treatment for mild to moderate acute metabolic acidosis is correction of the underlying cause. in surgical and trauma patients, metabolic acidosis is often the result of hypoxia secondary to inadequate tissue perfusion and subsequent lactic acidosis. volume and/or blood resuscitation alone may be enough to correct the acidosis. attempts to correct acidosis with exogenous bicarbonate before correction of inadequate tissue perfusion are usually unsuccessful. the use of bicarbonate for the treatment of lactic acidosis is controversial at best. in several studies the use of bicarbonate in patients with lactic acidosis does not improve clinical parameters or outcome. the correction of both acidosis and hypoglycemia of diabetic ketoacidosis is best achieved by the administration of insulin. volume resuscitation is also required. potassium replacement is essential, even in the face of normal or high serum potassium, and as hypokalemia develops as acidosis in hyperglycemia are corrected