Non - anion - gap metabolic acidosis Uremic acidosis Acute metabolic alkalosis No pH disorder treatable with crystalloid If remains substantially hypovolemic then repeat… Patient who requires large - volume fluid resuscitation pH - guided resuscitation 0.9% saline Lactated Ringers, Plasmalyte, Normosol, or any other balanced crystalloid Isotonic Bicarbonate (D5W with 150 mEq /L sodium bicarbonate ) Assess metabolic acid - base abnormalities alkalinize acidify maintain pH - guided fluid resuscitation refers to the concept that resuscitation represents a one - time opportunity to fix certain pH abnormalities that are responsive to acidic or alkali fluid infusion. Since such therapies typically require a large volume of infused fluid, treatment of the pH abnormality must occur simultaneous with the initial fluid resuscitation. - The Internet Book of Critical Care, by @PulmCrit Reassess electrolytes & volume status