PulmCrit (EMCrit)

Non-Anion Gap Metabolic Acidosis (NAGMA) has a broad differential diagnosis.  Often the cause is obvious, but otherwise this leads to a rat’s nest of various forms of renal tubular acidosis (RTA).  Fortunately, appropriate treatment generally doesn’t require immediate diagnosis of the specific cause of the NAGMA.  So have no fear – give the evaluation an […]

Anion gap metabolic acidosis is generally the most worrisome pH abnormality.  Many of the causes of anion gap elevation reflect a life-threatening problem (e.g. hyperlactatemia, shock, diabetic ketoacidosis, toxic alcohol poisoning).  Particularly if the anion gap elevation is a new finding, this mandates immediate investigation (and sometimes, simultaneous resuscitation).  This chapter explores the causes of […]

According to Albert Einstein, “Everything should be made as simple as possible, but not simpler.”  This is a similar sentiment to Occam’s Razor.  Acid-base analysis is a good example of this principle.  It’s possible to make things extraordinarily fancy and complex.  To analyze pH status we could obtain an ABG, complete blood count, calcium, magnesium, […]

PE is the third leading cause of vascular mortality, after myocardial infarction and stroke.  It is an enormously heterogeneous and unpredictable disease, which makes treatment difficult.  As such, it should not be surprising that PE therapy remains highly controversial.  For example, the new European Society of Cardiology guidelines recommend anticoagulation and watchful waiting for high-risk […]

We are frequently faced with patients who require reversal of anticoagulation due to hemorrhage or an emergent procedure.  This has grown rather complicated, due to the emergence of numerous new anticoagulants and reversal agents.  Furthermore, new evidence is emerging regarding the reversal of old agents (e.g. the PATCH trial regarding platelet transfusion in patients on aspirin).