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Ilan Sondheimer 1 Article
Resuscitation from a pH of 6.5: A Case Report and Review of Pathophysiology and Management of Extreme Acidosis from Hypovolemic Shock after Trauma
Alexander Balmaceda, Sona Arora, Ilan Sondheimer, McKenzie M. Hollon
J Trauma Inj. 2019;32(4):238-242.   Published online December 30, 2019
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AbstractAbstract PDF

Extreme acidosis is a life-threatening physiological state that causes disturbances in the cardiovascular, pulmonary, immune, and hematological systems. Trauma patients commonly present to the operating room (OR) in hypovolemic shock, leading to tissue hypoperfusion and the development of acute metabolic acidosis with or without a respiratory component. It is often believed that trauma patients presenting to the OR in severe metabolic acidosis (pH <7.0) will have a nearly universal mortality rate despite aggressive resuscitation and damage control. The current literature does not include reports of successful resuscitations from a lower pH, which may lead providers to assume that a good outcome is not possible. However, here we describe a case of successful resuscitation from an initial pH of 6.5 with survival to discharge home 95 days after admission with almost full recovery. We describe the effects of acute acidosis on the respiratory and cardiovascular systems and hemostasis. Finally, we discuss the pillars of management in patients with extreme acute acidosis due to hemorrhage: transfusion, treatment of hyperkalemia, and consideration of buffering acidosis with bicarbonate and hyperventilation.



Citations to this article as recorded by  
  • Prognosis of patients with extreme acidosis on admission to the emergency department: A retrospective cohort study
    Amichai Gutgold, Shaden Salameh, Jeries Nashashibi, Yonatan Gershinsky
    The American Journal of Emergency Medicine.2024; 76: 36.     CrossRef
  • Successful Outcomes of Critically Ill Patients with Extreme Metabolic Acidosis Treated with Structured Approach: Case Series
    Sasa Dragic, Danica Momcicevic, Biljana Zlojutro, Milka Jandric, Tijana Kovacevic, Vlado Djajic, Ognjen Gajic, Pedja Kovacevic
    Clinical Medicine Insights: Case Reports.2021; 14: 117954762110251.     CrossRef

J Trauma Inj : Journal of Trauma and Injury