FAST Session: Respiratory Alkalosis, Lactate, and Minute Volume: What to do in Metabolic Acidosis

When bicarbonate falls, the body responds by increasing minute ventilation to blow off carbon dioxide and defend pH. That compensatory respiratory alkalosis is not a side note. It is often the thing keeping the patient from falling off a cliff.

This session explores the bedside relationship between metabolic acidosis, lactate elevation, respiratory compensation, and ventilator management, with special attention to what happens when clinicians unintentionally remove the patient’s compensation during sedation, intubation, or post-intubation ventilator setup.

Participants will review the physiology behind compensation, the clinical meaning and misuse of lactate, and the practical importance of matching or approximating pre-intubation minute volume when invasive ventilation becomes necessary. The session also addresses when bicarbonate may help, when it probably will not, and why treating the cause still matters more than chasing the number.

By the end, learners will leave with a more practical framework for handling severe metabolic acidosis without accidentally making a bad problem dramatically worse.

Speaker: Charlie Swearingen