The use of sodium-chloride difference and chloride-sodium ratio as strong ion difference surrogates in the evaluation of metabolic acidosis in critically ill patients

2010 ◽  
Vol 25 (3) ◽  
pp. 525-531 ◽  
Author(s):  
Danielle Nagaoka ◽  
Antonio Paulo Nassar Junior ◽  
Alexandre Toledo Maciel ◽  
Leandro Utino Taniguchi ◽  
Danilo Teixeira Noritomi ◽  
...  
Keyword(s):  
Metabolic Acidosis ◽  
Sodium Chloride ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Strong Ion Difference

scholarly journals Prediction of mortality with unmeasured anions in critically ill patients on mechanical ventilation

2014 ◽  
Vol 71 (10) ◽  
pp. 936-941 ◽  
Author(s):  
Milos Novovic ◽  
Jasna Jevdjic
Keyword(s):  
Mechanical Ventilation ◽  
Intensive Care ◽  
Metabolic Acidosis ◽  
Mortality Rate ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Apache Ii ◽  
Strong Ion Difference ◽  
Acid Base ◽  
Prediction Of Mortality

Background/Aim. Acid-base disorders are common within critically ill patients. Physicochemical approach described by Stewart and modified by Figge gives precise quantification method of metabolic acidosis and insight into its main mechanisms, as well as influence of unmeasured anion on metabolic acidosis. The aims of this study were to determine whether the conventional acid-base variables are connected with survival rate of critically ill patients at Intensive care unit; whether strong ion difference/strong ion gap (SID/SIG) is a better predictor of mortality rate comparing to conventional acid-base variables; to determine all significant predictable parameters for the 28-day mortality rate at intensive care units. Methods. This retrospective observational analytic study included 142 adult patients requiring mechanical ventilation, survivors (n = 68) and nonsurvivors (n = 74). Apparent strong ion difference (SIDapp), effective strong ion difference (SIDeff) and SIG values were calculated with the Stewart-Figge?s quantitative biophysical method. Descriptive and analytical statistical methods were used in the study [t-test, Mann-Whitney U test, ?2-test, binary logistic regression, Reciever operating characteristic (ROC) curves, calibration]. Results. Age, Na+, acute physiology and chronic health evaluation (APACHE II), Cl-, albumin, SIG, SID app, SIDeff, and aninon gap (AG) were statistically significant predictors. AG represented a model with imprecise calibration, i.e. a model with little predictive power. APACHE II had p-value more than 0.05 if it was near it, and therefore it could be considered potentially unreliable for outcome prediction. SIDeff and SIG represented models with well-defined calibration. ROC analysis results showed that APACHE II, Cl-, albumin, SIDeff, SIG i AG had the largest area bellow the curve. By creation of logistic models with calibration methods, we found that outcome depends on SIG and APACHE II score. Conclusion. Based on our data, unmeasured anions provide prediction of mortality of critically ill patients on mechanical ventilation, unlike the traditional acid-base variables which are not accurate predictors of the 28-day mortality rate.

scholarly journals The use of sodium–chloride difference and chloride–sodium ratio in the evaluation of metabolic acidosis in critically ill patients

2012 ◽  
Vol 171 (11) ◽  
pp. 1719-1719
Author(s):  
Jan Havlin ◽  
Karel Matousovic ◽  
Otto Schuck ◽  
Jiri Charvat ◽  
Miroslava Horackova
Keyword(s):  
Metabolic Acidosis ◽  
Sodium Chloride ◽  
Critically Ill ◽  
Critically Ill Patients

scholarly journals ASSOCIATION OF ACID-BASE PARAMETERS WITH LACTATE LEVEL IN CRITICALLY ILL PATIENTS WITH METABOLIC ACIDOSIS

2018 ◽  
Vol 24 (2) ◽  
pp. 141
Author(s):  
Donaliazarti Donaliazarti ◽  
Rismawati Yaswir ◽  
Hanifah Maani ◽  
Efrida Efrida
Keyword(s):  
Metabolic Acidosis ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Lactate Level ◽  
Linear Regression Analysis ◽  
P Value ◽  
Acid Base Balance ◽  
Acid Base ◽  
Base Parameters ◽  
Base Balance

Metabolic acidosis is prevalent among critically ill patients and the common cause of metabolic acidosis in ICU is lactic acidosis. However, not all ICUs can provide lactate measurement. The traditional method that uses Henderson-Hasselbach equation (completed with BE and AG) and alternative method consisting of Stewart and its modification (BDEgap and SIG), are acid-base balance parameters commonly used by clinicians to determine metabolic acidosis in critically ill patients. The objective of this study was to discover the association between acid-base parameters (BE, AGobserved, AGcalculated, SIG, BDEgap) with lactate level in critically ill patients with metabolic acidosis. This was an analytical study with a cross-sectional design. Eighty-four critically ill patients hospitalized in the ICU department Dr. M. Djamil Padang Hospital were recruited in this study from January to September 2016. Blood gas analysis and lactate measurement were performed by potentiometric and amperometric method while electrolytes and albumin measurement were done by ISE and colorimetric method (BCG). Linear regression analysis was used to evaluate the association between acid-base parameters with lactate level based on p-value less than 0.05. Fourty five (54%) were females and thirty-nine (46%) were males with participant’s ages ranged from 18 to 81 years old. Postoperative was the most reason for ICU admission (88%). Linear regression analysis showed that p-value for BE, AGobserved, AGcalculated, SIG and BDEgap were 119; 0.967; 0.001; 0.001; 0.689, respectively. Acid-base balance parameters which were mostly associated with lactate level in critically ill patients with metabolic acidosis were AGcalculated and SIG. 

scholarly journals AGREEMENT OF SIMPLIFIED FENCL-STEWART WITH FIGGESTEWART METHOD IN DIAGNOSING METABOLIC ACIDOSIS IN CRITICALLY ILL PATIENTS (Kesesuaian Metode Fencl-Stewart yang Disederhanakan dengan Figge-Stewart dalam Mendiagnosis Asidosis Metabolik di Pasien Critically Ill)

2018 ◽  
Vol 23 (3) ◽  
pp. 281
Author(s):  
Reni Lenggogeni ◽  
Rismawati Yaswir ◽  
Efrida Efrida ◽  
Desywar Desywar
Keyword(s):  
Metabolic Acidosis ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Ion Selective Electrode ◽  
Selective Electrode

Asidosis metabolik adalah kasus yang paling sering ditemukan pada pasien critically ill. Pendekatan Henderson-Hasselbalch gagalmenjelaskan gangguan metabolik yang rumit karena hanya tertuju pada kenasaban pH dengan tekanan parsial karbondioksida dan ionbikarbonat. Pendekatan keseimbangan asam-basa metode Stewart lebih akurat dan dapat menggambarkan gangguan metabolik yangrumit. Modifikasi metode Stewart yang digunakan saat ini adalah metode Figge-Stewart dan Fencl-Stewart yang disederhanakan, dapatdigunakan di tempat dengan sumber daya terbatas. Tujuan penelitian ini adalah mengetahui kesesuaian metode Fencl-Stewart yangdisederhanakan dengan Figge-Stewart dalam mendiagnosis asidosis metabolik di pasien critically ill. Penelitian analitik potong lintangterhadap 40 pasien critically ill yang dirawat di ICU, CVCU dan HCU RSUP Dr. M. Djamil Padang masa waktu Oktober–November 2015.Analisis gas darah diukur dengan potensiometri, elektrolit dengan ion selective electrode dan kadar albumin dengan immunoturbidimetri.Hasil dianalisis dengan program komputer. Kesesuaian metode Fencl-Stewart yang disederhanakan dengan Figge-Stewart dianalisisdengan uji Kappa, bermakna jika nilai p<0,05. Sebanyak 40 orang pasien (18 laki-laki, 22 perempuan) diikutkan dalam penelitian ini.Rerata umur pasien adalah 48,35(18,4) tahun dan diagnosis terbanyak adalah gagal jantung (30%). Hiponatremia, hipernatremia,hipokalemia, hiperkalemia, hipokloremia dan hipoalbuminemia ditemukan masing-masing sebanyak 37,5%, 12,5%, 2,5%, 12,5%,17,5%, 20% dan 87,5% pasien. Terdapat kesesuaian yang baik antara metode Fencl-Stewart yang disederhanakan dengan Figge-Stewartdengan nilai kappa=0,529 dan bermakna secara statistik (p<0,001). Kesesuaian metode Fencl-Stewart yang disederhanakan denganFigge-Stewart dalam mendiagnosis asidosis metabolik di pasien critically ill adalah baik.

scholarly journals Risk Potential for Organ Dysfunction Associated with Sodium Bicarbonate Therapy (SBT) in Critically Ill Patients with Hemodynamic Worsening

2021 ◽  
Author(s):  
Tiehua Wang ◽  
Lingxian Yi ◽  
Hua Zhang ◽  
Tianhao Wang ◽  
Jingjing Xi ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Metabolic Acidosis ◽  
Sodium Bicarbonate ◽  
Critically Ill ◽  
Organ Dysfunction ◽  
Critically Ill Patients ◽  
Control Group ◽  
Increased Risk ◽  
Bicarbonate Therapy ◽  
Risk Potential

Abstract Background: The role of sodium bicarbonate therapy (SBT) remains controversial. This study aimed to investigate whether hemodynamic status before SBT contributed to the heterogeneous outcomes associated with SBT in acute critically ill patients.Methods: We obtained data from patients with metabolic acidosis from the Medical Information Mart for Intensive Care (MIMIC)-III database. Propensity score matching (PSM) was applied to match the SBT group with the control group. Logistic regression and Cox regression were used to analyze a composite of newly “developed or exacerbated organ dysfunction” (d/eOD) within 7 days of ICU admission and 28-day mortality associated with SBT for metabolic acidosis.Results: A total of 1765 patients with metabolic acidosis were enrolled, and 332 pairs obtained by PSM were applied to the final analyses in the study. An increased incidence of newly d/eOD was observed in the SB group compared with the control group (54.8% vs 44.6%, p<0.01). Multivariable logistic regression indicated that the adjusted OR of SBT for this composite outcome was no longer significant [OR (95% CI): 1.39 (0.9, 1.85); p=0.164]. This effect of SBT did not change with the quintiles stratified by pH. Interestingly, SBT was associated with an increased risk of the composite of newly d/eOD in the subgroup of patients with worsening hemodynamics before SBT [adjusted OR (95% CI): 3.6 (1.84, 7.22), p< 0.001]. Moreover, the risk potential for this composite of outcomes was significantly increased in patients characterized by both worsening [adjusted OR (95% CI): 2.91 (1.54, 5.47), p< 0.001] and unchanged hemodynamics [adjusted OR (95% CI): 1.94 (1.01, 3.72), p=0.046) compared to patients with improved hemodynamics before SBT. Our study failed to demonstrate an association between SBT and 28-day mortality in acute critically ill patients with metabolic acidosis.Conclusions: Our findings suggested that SBT for metabolic acidosis was associated with an increased risk potential for subsequent d/eOD, while the hemodynamic status remained unstable during the acute phase of critical illness.

Crystalloids in critical illness

2016 ◽  
Author(s):  
Karthik Raghunathan ◽  
Andrew Shaw
Keyword(s):  
Critical Illness ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Endothelial Glycocalyx ◽  
Strong Ion Difference ◽  
Negative Consequences ◽  
Negative Effects ◽  
Randomized Controlled Studies ◽  
Preload Responsiveness ◽  
Saline Solutions

‘Crystalloid’ refers to solutions of crystalline substances that can pass through a semipermeable membrane and are distributed widely in body fluid compartments. The conventional Starling model predicts transvascular exchange based on the net balance of opposing hydrostatic and oncotic forces. Based on this model, colloids might be considered superior resuscitative fluids. However, observations of fluid behaviour during critical illness are not consistent with such predictions. Large randomized controlled studies have consistently found that colloids offer no survival advantage relative to crystalloids in critically-ill patients. A revised Starling model describes a central role for the endothelial glycocalyx in determining fluid disposition. This model supports crystalloid utilization in most critical care settings where the endothelial surface layer is disrupted and lower capillary pressures (hypovolaemia) make volume expansion with crystalloids effective, since transvascular filtration decreases, intravascular retention increases and clearance is significantly reduced. There are important negative consequences of both inadequate and excessive crystalloid resuscitation. Precise dosing may be titrated based on functional measures of preload responsiveness like pulse pressure variation or responses to manoeuvres such as passive leg raising. Crystalloids have variable electrolyte concentrations, volumes of distribution, and, consequently variable effects on plasma pH. Choosing balanced crystalloid solutions for resuscitation may be potentially advantageous versus ‘normal’ (isotonic, 0.9%) saline solutions. When used as the primary fluid for resuscitation, saline solutions may have adverse effects in critically-ill patients secondary to a reduction in the strong ion difference and hyperchloraemic, metabolic acidosis. Significant negative effects on immune and renal function may result as well.

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