Säure-Basen-Störungen

Kernaussagen

• Säure-Basen-Störungen in der Intensivmedizin sind häufig komplex und bedürfen einer differenzierteren Betrachtung.

• Die Konzentration der Wasserstoffionen und damit der pH-Wert hängt vom Verhältnis zwischen CO₂ und Bikarbonat ab.

• Schnell zu bestimmende Parameter wie die Anionenlücke und ΔGap sind hilfreich bei differenzialtherapeutischen Entscheidungen.

• Bei metabolischen Azidosen sollte man zwischen Bikarbonatverlust (hyperchlorämische metabolische Azidose mit normaler Anionenlücke) und Säurezufuhr (metabolische Azidose mit erhöhter Anionenlücke) unterscheiden.

• Die klinische Manifestation von Säure-Basen-Störungen wird im Wesentlichen von der Dynamik der Entstehung und ihrer Ursache geprägt, weniger von den Zahlenwerten per se.

• Die Therapie von Säure-Basen-Störungen sollte sich auf die Ursache konzentrieren und insbesondere bei der Bikarbonatgabe damit einhergehende Sekundärveränderungen berücksichtigen.

• Akute respiratorische Störungen wirken sich aufgrund der erst verzögert einsetzenden renalen Kompensation stärker auf den pH-Wert aus als chronische.

• Für die Entwöhnung von der Beatmung sollte man bei chronischen respiratorischen Störungen die initiale Bikarbonatkonzentration beachten.

• Elektrolytveränderungen (Na, K, Cl, ionisiertes Ca) sind eng mit Säure-Basen-Störungen assoziiert und sowohl diagnostisch als auch therapeutisch in den Behandlungsprozess und die Überwachung zu integrieren.

• Literatur

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