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Crit Care. 2003 Jun;7(3):R41-5. Epub 2003 May 1.

Conventional or physicochemical approach in intensive care unit patients with metabolic acidosis.

Author information

1
Department of Intensive Care Medicine, University Medical Centre St Radboud, Nijmegen, The Netherlands.

Abstract

INTRODUCTION:

Metabolic acidosis is the most frequent acid-base disorder in the intensive care unit. The optimal analysis of the underlying mechanisms is unknown.

AIM:

To compare the conventional approach with the physicochemical approach in quantifying complicated metabolic acidosis in patients in the intensive care unit.

PATIENTS AND METHODS:

We included 50 consecutive patients with a metabolic acidosis (standard base excess < or = -5). We measured sodium, potassium, calcium, magnesium, chloride, lactate, creatinine, urea, phosphate, albumin, pH, and arterial carbon dioxide and oxygen tensions in every patient. We then calculated HCO3-, the base excess, the anion gap, the albumin-corrected anion gap, the apparent strong ion difference, the effective strong ion difference and the strong ion gap.

RESULTS:

Most patients had multiple underlying mechanisms explaining the metabolic acidosis. Unmeasured strong anions were present in 98%, hyperchloremia was present in 80% and elevated lactate levels were present in 62% of patients. Calculation of the anion gap was not useful for the detection of hyperlactatemia. There was an excellent relation between the strong ion gap and the albumin-corrected and lactate-corrected anion gap (r2 = 0.934), with a bias of 1.86 and a precision of 0.96.

CONCLUSION:

Multiple underlying mechanisms are present in most intensive care unit patients with a metabolic acidosis. These mechanisms are reliably determined by measuring the lactate-corrected and albumin-corrected anion gap. Calculation of the more time-consuming strong ion gap according to Stewart is therefore unnecessary.

Comment in

PMID:
12793889
PMCID:
PMC270679
DOI:
10.1186/cc2184
[Indexed for MEDLINE]
Free PMC Article

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