Acid-Base Disorders

I.  Program Content

1. Trainees must acquire knowledge and understanding of the following areas during the course of their training:

1. Acid-base chemistry and buffering.

2. Determinants of arterial carbon dioxide tension and carbon dioxide balance.

3. Determinants of plasma bicarbonate concentration and hydrogen ion balance, including renal acidification processes and the physiology of bicarbonate reabsorption, titratable acid excretion, and ammonium excretion.

4. Clinical evaluation of acid-base disorders.

5. Renal tubular acidosis:  pathogenesis, clinical features, causes, diagnosis, and management.

6. Uremic acidosis.  Acid-base homeostasis in end-stage renal disease.

7. Other types of metabolic acidosis: pathogenesis, clinical features, causes, diagnosis, and management.

8. Metabolic alkalosis: pathogenesis, clinical features, causes, diagnosis, and management.

9. Respiratory alkalosis:  pathogenesis, clinical features, causes, diagnosis, and management.

10. Mixed acid-base disturbances.

II.   Patient Care Experience

1. Trainees should be familiar with and have experience in the direct diagnosis and management of the following areas in both the outpatient and inpatient setting:

1. Trainees must assess the accuracy of the acid-base parameters and interpret serum and urine acid-base data including the anion gap.

2. Trainees must determine from the patient’s history physical findings and laboratory data the nature of the prevailing acid-base disorder and whether a simple or mixed acid-base disorder is present.

3. Trainees must have experience managing renal tubular acidosis, uremic acidosis, and acid-base homeostasis in end-stage renal disease.

4. Trainees must have experience managing all other types of metabolic acidosis.

5. Trainees must have experience in the management of metabolic alkalosis.

6. Trainees must have experience in the management of respiratory acidosis and alkalosis.

7. Trainees must have experience in the management of mixed acid-base disorders.