A common problem in the ill or injured patient is a metabolic acidosis.   In this episode we will review the common etiology of a metabolic acidosis as well as some lesser known causes.  

Bomb and blast injuries:  In the past blast injuries were limited to the battlefield of a rare industrial accident.  The events of the past week are a reminder that civilian population centers are targets for bombing attacks.   Most civilian providers has no to limited knowledge or experience treating patients with such injuries.   This episode is dediacated to a discussion of some of the unique properties and injuries associated with blast injuries.  In the event of a terrorist attack, like those attempted in London this past week, the injuries will be in the hundreds.