Base Excess and Strong Ion Difference: Clinical Limitations Related to Inaccuracy

2004 ◽  
Vol 100 (2) ◽  
pp. 459-460 ◽  
Author(s):  
Rolf Zander ◽  
Werner Lang
Keyword(s):  
Base Excess ◽  
Strong Ion Difference

scholarly journals Base-excess chloride; the best approach to evaluate the effect of chloride on the acid-base status: A retrospective study

PLoS ONE ◽  
2021 ◽  
Vol 16 (4) ◽  
pp. e0250274
Author(s):  
Bulent Gucyetmez ◽  
Filiz Tuzuner ◽  
Hakan Korkut Atalan ◽  
Uğur Sezerman ◽  
Kaan Gucyetmez ◽  
...  
Keyword(s):  
Linear Regression ◽  
Regression Model ◽  
Linear Regression Model ◽  
Base Excess ◽  
Tertiary Care ◽  
Strong Ion Difference ◽  
Acid Base ◽  
Entire Cohort ◽  
Acid Base Status ◽  
Evaluation Approaches

To practically determine the effect of chloride (Cl) on the acid-base status, four approaches are currently used: accepted ranges of serum Cl values; Cl corrections; the serum Cl/Na ratio; and the serum Na-Cl difference. However, these approaches are governed by different concepts. Our aim is to investigate which approach to the evaluation of the effect of Cl is the best. In this retrospective cohort study, 2529 critically ill patients who were admitted to the tertiary care unit between 2011 and 2018 were retrospectively evaluated. The effects of Cl on the acid-base status according to each evaluative approach were validated by the standard base excess (SBE) and apparent strong ion difference (SIDa). To clearly demonstrate only the effects of Cl on the acid-base status, a subgroup that included patients with normal lactate, albumin and SIG values was created. To compare approaches, kappa and a linear regression model for all patients and Bland-Altman test for a subgroup were used. In both the entire cohort and the subgroup, correlations among BECl, SIDa and SBE were stronger than those for other approaches (r = 0.94 r = 0.98 and r = 0.96 respectively). Only BECl had acceptable limits of agreement with SBE in the subgroup (bias: 0.5 mmol L-1) In the linear regression model, only BECl in all the Cl evaluation approaches was significantly related to the SBE. For the evaluation of the effect of chloride on the acid-base status, BECl is a better approach than accepted ranges of serum Cl values, Cl corrections and the Cl/Na ratio.

scholarly journals Electrolyte Concentrations and Blood Gas Values in Neonatal Calves With Diarrhea

2021 ◽  
Author(s):  
Kyoung-Seong Choi ◽  
Kwang-Man Park ◽  
Jin-Hee Kang ◽  
Ji-yeong Ku ◽  
Seung-Eon Cha ◽  
...  
Keyword(s):  
Base Excess ◽  
Blood Chemistry ◽  
Strong Ion Difference ◽  
Blood Gas ◽  
Adult Cattle ◽  
Diagnosis And Prognosis ◽  
Standard Values ◽  
Newborn Calves ◽  
Neonatal Calves ◽  
Diarrheic Calves

Abstract Portable blood analyzers, which recently have been introduced to veterinary medicine, can facilitate immediate identification of sick calves in livestock farms. However, no appropriate standard values exist for neonatal calves; therefore, reference values for adult cattle guide diagnosis and treatment of newborn calves. Our goal was to determine electrolyte, blood chemistry, and blood gas values from healthy calves and compare them to those for diarrheic calves, thus providing useful information for diagnosis and prognosis. We evaluated 193 calves (£1 month old), including those with (n = 88) and without diarrhea (n = 105), using two-tailed, independent t tests after determining normality (Shapiro−Wilk test). Electrolyte measurements in the diarrheic calves included significant decreases in sodium and significant increases in potassium, chloride, and blood urea nitrogen. Strong ion difference (SID), pH, bicarbonate, partial pressure of carbon dioxide, and base excess (BE) were significantly lower in the diarrheic calves (p < 0.001); the anion gap (AG) was significantly higher among diarrheic calves aged 1-10 days (p < 0.001) compared to healthy calves. Our results demonstrate that SID, pH, bicarbonate, and BE correlated strongly with metabolic acidosis, suggesting that these indicators, including AG, can be important tools for evaluating calves’ health status and for providing useful information to diagnose diarrhea.

Equivalent Metabolic Acidosis with Four Colloids and Saline on Ex Vivo Haemodilution

2009 ◽  
Vol 37 (3) ◽  
pp. 407-414 ◽  
Author(s):  
T. J. Morgan ◽  
M. Vellaichamy ◽  
D. M. Cowley ◽  
S. L. Weier ◽  
B. Venkatesh ◽  
...  
Keyword(s):  
Metabolic Acidosis ◽  
Base Excess ◽  
Ex Vivo ◽  
Venous Blood ◽  
Weak Acid ◽  
Strong Ion Difference ◽  
Strong Ion Gap ◽  
Acid Base ◽  
Acid Properties

Colloid infusions can cause metabolic acidosis. Mechanisms and relative severity with different colloids are incompletely understood. We compared haemodilution acid-base effects of 4% albumin, 3.5% polygeline, 4% succinylated gelatin (all weak acid colloids, strong ion difference 12 mEq/l, 17.6 mEq/l and 34 mEq/l respectively), 6% hetastarch (non-weak acid colloid, strong ion difference zero) and 0.9% saline (crystalloid, strong ion difference zero). Gelatin weak acid properties were tracked via the strong ion gap. Four-step ex vivo dilutions of pre-oxygenated human venous blood were performed to a final [Hb] near 50% baseline. With each fluid, base excess fell to approximately −13 mEq/l. Base excess/[Hb] relationships across dilution were linear and direct (R2 ≥0.96), slopes and intercepts closely resembling saline. Baseline strong ion gap was −0.3 (2.1) mEq/l. Post-dilution increases occurred in three groups: small with saline, hetastarch and albumin (to 3.5 (02) mEq/l, 4.3 (0.3) mEq/l, 3.3 (1.4) mEq/l respectively), intermediate with polygeline (to 12.2 (0.9) mEq/l) and greatest with succinylated gelatin (to 20.8 (1.4) mEq/l). We conclude that, despite colloid weak acid activity ranging from zero (hydroxyethyl starch) to greater than that of albumin with both gelatin preparations, ex vivo dilution causes a metabolic acidosis of identical severity to saline in each case. This uniformity reflects modifications to the albumin and gelatin saline vehicles, in part aimed at pH correction. By proportionally increasing the strong ion difference, these modifications counter deviations from pure saline effects caused by colloid weak acid activity. Extrapolation in vivo requires further investigation.

Plasma Acid-base Changes in Chronic Renal Failure: A Stewart Analysis

2005 ◽  
Vol 28 (10) ◽  
pp. 961-965 ◽  
Author(s):  
D.A. Story ◽  
A. Tosolini ◽  
R. Bellomo ◽  
M. Leblanc ◽  
L. Bragantini ◽  
...  
Keyword(s):  
Renal Failure ◽  
Metabolic Acidosis ◽  
Chronic Renal Failure ◽  
Base Excess ◽  
Chloride Ions ◽  
Minor Role ◽  
Strong Ion Difference ◽  
Acid Base ◽  
Failure Group ◽  
Stewart Approach

The bicarbonate centered approach to acid-base physiology involves complex explanations for the metabolic acidosis associated with chronic renal failure. We used the alternate Stewart approach to acid-base physiology to quantify the acid-base chemistry of patients with chronic renal failure. We examined the plasma and urine chemistry of 19 patients with chronic renal failure who were predialysis and 20 healthy volunteers. We compared the plasma strong-ion-difference due to sodium, potassium, and chloride ions as well as the weak acids albumin and phosphate. We used a simplified Fencl-Stewart approach to quantify the effects of sodium-chloride, albumin, and unmeasured ions on base-excess. The chronic renal failure group had a greater metabolic acidosis, with a base-excess that differed from the healthy group by a mean of −2.7 mmol/L, p= 0.04. This was associated with a strong ion acidosis due to both increased chloride and decreased sodium. The anion gap, strong-ion-gap, and base-excess effect of unmeasured ions were similar in both groups suggesting that unmeasured ions had only a minor role in the acid-base status in this group of patients.

Physiological response to fluid resuscitation with Ringer lactate versus Plasmalyte in critically ill burn patients

2020 ◽  
Vol 128 (3) ◽  
pp. 709-714 ◽  
Author(s):  
Maïté Chaussard ◽  
François Dépret ◽  
Oriane Saint-Aubin ◽  
Mourad Benyamina ◽  
Maxime Coutrot ◽  
...  
Keyword(s):  
Critically Ill ◽  
Fluid Resuscitation ◽  
Base Excess ◽  
Total Body Surface Area ◽  
Ionized Calcium ◽  
Strong Ion Difference ◽  
Special Focus ◽  
Burn Patients ◽  
Ringer Lactate ◽  
Tertiary Teaching

The metabolic consequences in vivo of various balanced solutions are poorly known in critically ill patients. The main objective of this study was to describe the metabolic consequences of Plasmalyte versus Ringer lactate (RL) in critically ill burn patients, with a special focus on the plasma clearance of buffer anions (i.e., gluconate, acetate, and lactate). We conducted a randomized trial between August 2017 and October 2018 in a tertiary teaching hospital in Paris, France. Patients with burn total body surface area >30% were randomized to receive Plasmalyte or RL. The primary end point was the base excess 24 h after inclusion. The secondary end points were acetate, gluconate, and lactate plasma concentration, the strong ion difference (SID). Twenty-eight patients were randomized. Twenty-four hours after inclusion, plasma BE was not significantly different in the Plasmalyte and RL groups {−0.9 [95% confidence interval (95% CI): −1.8–0.9] vs. −2.1 [95% CI: −4.6–0.6] mmol/L, respectively, P = 0.26}. Plasma gluconate concentration was higher in the Plasmalyte group ( P < 0.001), with a maximum level of 1.86 (95% CI: 0.98–4.0) mmol/L versus 0 (95% CI: 0–0.15) mmol/L. Plasma acetate and lactate were not significantly different. Ionized calcium level was lower in the Plasmalyte group ( P = 0.002). Hemodynamics did not differ between groups. To conclude, the alkalinizing effect of Plasmalyte was less important than expected with no difference in base excess compared with RL, in part due to gluconate accumulation. Acetate and lactate did not significantly accumulate. Plasmalyte led to significantly lower ionized calcium levels. NEW & NOTEWORTHY During fluid resuscitation in burns the alkalinizing effect of Plasmalyte was less important than expected, with no difference in base excess compared with Ringer lactate (RL), in part due to gluconate accumulation. Acetate and lactate did not significantly accumulate. Plasmalyte led to significantly lower ionized calcium levels.

Base excess, strong ion difference, and expected compensations

2014 ◽  
Vol 21 (6) ◽  
pp. 403-408 ◽  
Author(s):  
Fernando Schiraldi ◽  
Giovanna Guiotto
Keyword(s):  
Base Excess ◽  
Strong Ion Difference

scholarly journals Base-excess chloride; the best approach to evaluating the effect of chloride on the acid- base status: a retrospective study

2020 ◽  
Author(s):  
Bulent Gucyetmez ◽  
Filiz Tuzuner ◽  
Hakan Korkut Atalan ◽  
Ugur Sezerman ◽  
Kaan Gucyetmez ◽  
...  
Keyword(s):  
Linear Regression ◽  
Regression Model ◽  
Linear Regression Model ◽  
Base Excess ◽  
Strong Ion Difference ◽  
Acid Base ◽  
Standard Base Excess ◽  
Serum Chloride ◽  
Acid Base Status ◽  
Standard Base

Abstract Background: To determine the effect of chloride on the acid-base status, four approaches are currently used: 1) accepted ranges of serum chloride values; 2) chloride corrections, such as chloride deficiency/excess and chloride modification; 3) the Cl/Na ratio; and 4) the sodium- chloride difference, such as base-excess chloride. However, these approaches are governed by different concepts, and they can evaluate the effects of chloride on the acid-base status differently. Our aim is to investigate which approach to the evaluation of the effect of chloride is the best.Methods: In this retrospective cohort study, 2529 critically ill patients who were admitted to the tertiary care unit were evaluated between 2011 and 2018. Patient characteristics and blood gas parameters at the ICU admission and outcomes were recorded. The effects of chloride on the acid-base status according to each evaluative approach were validated by the standard base excess and apparent strong ion difference. To compare approaches, kappa and Bland-Altman tests and a linear regression model were used. Results: In the linear regression model for all patients, only base-excess chloride in all the chloride evaluation approaches was significantly related to the standard base excess. In the subgroup, the correlation and limits of agreement between base-excess chloride and the standard base excess were the strongest (r2=0.92 p<0.001 bias: 0.5mmol/L). Conclusions: For the evaluation of the effect of chloride on the acid-base status, base-excess chloride is a better approach than accepted ranges of serum chloride values, chloride corrections and the Cl/Na ratio.

Analytic calculation of physiological acid-base parameters in plasma

1999 ◽  
Vol 86 (1) ◽  
pp. 326-334 ◽  
Author(s):  
E. Wrenn Wooten
Keyword(s):  
Base Excess ◽  
Equilibrium Constants ◽  
Anion Gap ◽  
Ion Concentration ◽  
Strong Ion Difference ◽  
Buffer Concentration ◽  
Acid Base ◽  
Ion Concentrations ◽  
Base Parameters ◽  
Analytic Expressions

Analytic expressions for plasma total titratable base, base excess (ΔCB), strong-ion difference, change in strong-ion difference (ΔSID), change in Van Slyke standard bicarbonate (ΔVSSB), anion gap, and change in anion gap are derived as a function of pH, total buffer ion concentration, and conditional molar equilibrium constants. The behavior of these various parameters under respiratory and metabolic acid-base disturbances for constant and variable buffer ion concentrations is considered. For constant noncarbonate buffer concentrations, ΔSID = ΔCB = ΔVSSB, whereas these equalities no longer hold under changes in noncarbonate buffer concentration. The equivalence is restored if the reference state is changed to include the new buffer concentrations.

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