Diagnosis and management of metabolic acidosis: guidelines from a French expert panel

Metabolic acidosisis a disorder frequently encountered in emergency medicineand intensive care medicine. As literature has been enriched with new data concerning the management of metabolic acidosis, the French Intensive Care Society (Societe de Reanimation de Langue Francaise [SRLF]) and the French Emergency MedicineSociety (Societe Francaise de Medecine 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 acidosismechanism is discussed and a diagnostic algorithm is proposed. The use of ketosisand 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 bicarbonateinfusion and extra-renal purification as well as the modalities of mechanical ventilation during severe metabolic acidosisare addressed in therapeutic management.