Medical Treatment:- If the acid and the osmolar gap is increased:[ measured osmolarity minus calculated( 2{ sodium+potassium},+ urea+ glucose)], dialysis should be initiated as soon as possible
- Hemodialysis is the choice treatment for severe deep acidosis poisoning.
Ethanol Where access to dialysis facilities is not readily available in other patients:
- Ethanol 95% BP, IV, diluted to 10% dextrose 5%.
- Administer 10 mL/kg of dilute solution over 30-45 minutes (0.6-0.7 g/kg ethanol).
- For non- drinkers, follow the dilute solution at 1 mL / kg / hour.
-
2 mL / kg / hour for hepatic enzyme induction patients, such as chronic users of alcohol.
Ethanol 95% BP, orally, diluted to 20% in any suitable liquid if intravenous ethanol can not be given.
- Administer dilute solution 1 mL / kg.
- Follow the dilute solution for non- drinkers at: 0,1 mL / kg / hour. 0.2 mL / kg / h for hepatic enzyme induction patients, such as chronic alcohol users, etc.
If ethanol is not available at 95 percent BP, administer orally any commercially available alcoholic beverage with an alcohol content of with or without 40 percent, e.g. vodka( 80 evidence), at the above oral dose.
Note: Co- operative or nasogastric tube administration may be required. The objective is to maintain ethanol plasma levels of 1-1,3 g / L( 0,1-0,13 g / dL). Ethanol therapy may take several days. Continue treatment until improvements in clinical condition.
- Thiamine, oral, daily 100 mg.
Metabolic acidosis
The aim is to increase the pH to 7.2:
- Sodium bicarbonate, IV, 50-100 mmol/L administered over 30-45 minutes.
Note: - The rapid infusion of large volumes of sodium bicarbonate in an already oliguric patient may precipitate pulmonary oedema and cardiac dysrhythmias.
-
Monitor glucose levels and correct hypoglycaemia, if necessary.
- Correct severe or clinical evident hypocalcaemia.
