scholarly journals P0274 / #743: AGREEMENT OF APPARENT STRONG ION DIFFERENCE (SIDAPP) WITH ANION GAP IN DIAGNOSING ACID-BASE DISORDER IN CRITICAL ILL CHILDREN IN RESOURCE LIMITED SETTINGS: AN OBSERVATIONAL STUDY

2021 ◽  
Vol 22 (Supplement 1 3S) ◽  
pp. 154-154
Author(s):  
E. Farias ◽  
C. Costa ◽  
A. Leão ◽  
L. Pinto
Keyword(s):  
Observational Study ◽  
Anion Gap ◽  
Strong Ion Difference ◽  
Acid Base ◽  
Resource Limited Settings ◽  
Resource Limited ◽  
Base Disorder ◽  
Critical Ill

Regional anesthesia training model for resource-limited settings: a prospective single-center observational study with pre–post evaluations

2020 ◽  
Vol 45 (7) ◽  
pp. 528-535
Author(s):  
Mark A Brouillette ◽  
Alfred J Aidoo ◽  
Maria A Hondras ◽  
Nana A Boateng ◽  
Akwasi Antwi-Kusi ◽  
...  
Keyword(s):  
Observational Study ◽  
Needs Assessment ◽  
Regional Anesthesia ◽  
Training Model ◽  
Single Center ◽  
Clinical Practices ◽  
Resource Limited Settings ◽  
Resource Limited ◽  
Limb Injuries ◽  
Single Center Observational Study

Background and objectivesEducational initiatives are a sustainable means to address provider shortages in resource-limited settings (RLS), yet few regional anesthesia curricula for RLS have been described. We sought to design a reproducible training model for RLS called Global Regional Anesthesia Curricular Engagement (GRACE), implement GRACE at an RLS hospital in Ghana, and measure training and practice-based outcomes associated with GRACE implementation.MethodsFourteen of 15 physician anesthesiologists from the study location and three from an outside orthopedic specialty hospital consented to be trainees and trainers, respectively, for this prospective single-center observational study with pre–post evaluations. We conducted an initial needs assessment to determine current clinical practices, participants’ learning preferences, and available resources. Needs assessment findings, expert panel recommendations, and investigator consensus were then used to generate a site-specific curriculum that was implemented during two 3-week periods. We evaluated trainee satisfaction and changes in knowledge, clinical skill, and peripheral nerve block (PNB) utilization using the Kirkpatrick method.ResultsThe curriculum consisted of didactic lectures, simulations, and clinical instruction to teach ultrasound-guided PNB for limb injuries. Pre–post evaluations showed trainees were satisfied with GRACE, median knowledge examination score improved from 62.5% (15/24) to 91.7% (22/24) (p<0.001), clinical examination pass rate increased from 28.6% (4/14) to 85.7% (12/14) (p<0.01), and total PNB performed in 3 months grew from 48 to 118.ConclusionsGRACE applied in an RLS hospital led to the design, implementation, and measurement of a regional anesthesia curriculum tailored to institutional specifications that was associated with positive Kirkpatrick outcomes.

scholarly journals Stability of the Strong Ion Gap versus the Anion Gap over Extremes of PCO2 and pH

2007 ◽  
Vol 35 (3) ◽  
pp. 370-373 ◽  
Author(s):  
T. J. Morgan ◽  
D. M. Cowley ◽  
S. L. Weier ◽  
B. Venkatesh
Keyword(s):  
Negative Charge ◽  
Respiratory Acidosis ◽  
Anion Gap ◽  
Normal Blood ◽  
Strong Ion Difference ◽  
Blood Gas ◽  
Strong Ion Gap ◽  
Acid Base ◽  
Buffer Base

The strong ion gap (SIG) is under evaluation as a scanning tool for unmeasured ions. SIG is calculated by subtracting [buffer base], which is ([A-]+[HCO3-]), from the apparent strong ion difference, which is ([Na+] + [K+]+[Ca++]+[Mg++]-[Cl-]-[L-lactate]). A- is the negative charge on albumin and phosphate. We compared the pH stability of the SIG with that of the anion gap (AG). In normal and hypoalbuminaemic hyperlactaemic blood, PCO2 was reduced stepwise in vitro from >200 mmHg to < 20 mmHg, with serial blood gas and electrolyte analyses, and [albumin] and [phosphate] measurement on completion. Respective [haemoglobin], [albumin], [phosphate] and [lactate] in normal blood were 156 (0.9) g/l, 44 (2) g/l, 1.14 (0.06) mmol/l and 1.7 (0.8) mEq/l, and in hypoalbuminaemic blood 116 (0.9) g/l, 24 (2) g/l, 0.78 (0.06) mmol/l and 8.5 (0.5) mEq/l. pH increased from <6.85 to >7.55, causing significant falls in [Na+] and elevations in [Cl-]. Initial and final SIG values did not differ, showing no correlation with pH. Mean SIG was 0.5±1.5 mEq/l. AG values were directly correlated with pH (normal: R2=0.51, hypoalbuminaemic: R2=0.65). Final AG values significantly exceeded initial values (normal blood: 15.9 (1.7) mEq/l versus 8.9 (1.8) mEq/l, P<0.01; hypoalbuminaemic blood: 16.5 (0.8) mEq/l versus 11.8 (2.0) mEq/l, P<0.05). We conclude that, unlike the AG, the SIG is not affected by severe respiratory acidosis and alkalosis, enhancing its utility in acid-base disturbances.

Acute mild hypothermia in awake unrestrained rats induces a mixed acid-base disorder

1996 ◽  
Vol 80 (6) ◽  
pp. 2143-2150 ◽  
Author(s):  
V. Alfaro ◽  
L. Palacios
Keyword(s):  
Plasma Protein ◽  
Mild Hypothermia ◽  
Plasma Osmolality ◽  
Blood Gases ◽  
Strong Ion Difference ◽  
Ionic Exchange ◽  
Acid Base ◽  
Plasma Protein Concentration ◽  
Arterial Blood ◽  
Base Disorder

The interactions between components that contribute to acid-base homeostasis were studied in the first steps of acute hypothermia [body temperature (Tb) 37-31 degrees C] in awake unrestrained rats as an experimental model of accidental hypothermia in mammals. The concurrent changes in blood gases, plasma ions, and plasma protein concentrations in arterial blood were analyzed. Acute decreases in Tb decreased PCO2 and increased pH. The ratio of Na+ concentration to Cl- concentration increased at 35-33 degrees C Tb, leading to an increase in the plasma strong ion difference ([SID]). These increases were transient, and levels returned to baseline at lower Tb (31 degrees C). Lack of change in hematocrit, hemoglobin, plasma osmolality, or plasma protein concentration indicated stability in plasma volume. Therefore, [SID] changes were related to ionic shifts with respect to the extravascular space and not to ionic depletion. A feasible role in this ionic exchange for contracting skeletal muscle during shivering thermogenesis is given. Significant decrease in HCO3- concentration at lower Tb (31 degrees C) was related to an apparent increase in relative ventilation (lung ventilation per unit of CO2 removed). It is concluded that, during the first stages of body cooling, the blood acid-base status of conscious hypothermic rats is affected by PCO2 changes, apparently because of uncoupled changes between ventilation and metabolism, but it is also affected by a transitory metabolic disorder due to ion imbalance.

Comparison of Point-of-Care Versus  Central Laboratory Measurement of Electrolyte Concentrations on Calculations of the Anion Gap and the Strong Ion Difference

2003 ◽  
Vol 98 (5) ◽  
pp. 1077-1084 ◽  
Author(s):  
Hiroshi Morimatsu ◽  
Jens Rocktäschel ◽  
Rinaldo Bellomo ◽  
Shigehiko Uchino ◽  
Donna Goldsmith ◽  
...  
Keyword(s):  
Point Of Care ◽  
Measurement Techniques ◽  
Chloride Concentration ◽  
Anion Gap ◽  
Plasma Sodium ◽  
Strong Ion Difference ◽  
Blood Gas ◽  
Central Laboratory ◽  
Acid Base ◽  
Chloride Concentrations

Background Clinicians calculate the anion gap (AG) and the strong ion difference (SID) to make acid-base diagnoses. The technology used is assumed to have limited impact. The authors hypothesized that different measurement technologies markedly affect AG and SID values. Methods SID and AG were calculated using values from the point-of-care blood gas and electrolyte analyzer and the central hospital laboratory automated blood biochemistry analyzer. Simultaneously measured plasma sodium, potassium, and chloride concentrations were also compared. Results Mean values for central laboratory and point-of-care plasma sodium concentration were significantly different (140.4 +/- 5.6 vs. 138.3 +/- 5.9 mm; P &lt; 0.0001), as were those for plasma chloride concentration (102.4 +/- 6.5 vs. 103.4 +/- 6.0 mm; P &lt; 0.0001) but not potassium. Mean AG values calculated with the two different measurement techniques differed significantly (17.6 +/- 6.2 mEq/l for central laboratory vs. 14.5 +/- 6.0 mEq/l for point-of-care blood gas analyzer; P &lt; 0.0001). Using the Stewart-Figge methodology, SID values also differed significantly (43.7 +/- 4.8 vs. 40.7 +/- 5.6 mEq/l; P &lt; 0.0001), with mean difference of 3.1 mEq/l (95% limits of agreement, -3.4, 9.5 mEq/l). For 83 patients (27.6%), differences in AG values were as high as 5 mEq/l or more, and for 46% of patients whose AG value was outside the reference range with one technology, a value within normal limits was recorded with the other. Conclusions Results with two different measurement technologies differed significantly for plasma sodium and chloride concentrations. These differences significantly affected the calculated AG and SID values and might lead clinicians to different assessments of acid-base and electrolyte status.

Approach to Acid-Base Disorders

2017 ◽  
Author(s):  
Horacio J Adrogué ◽  
Nicolaos E Madias
Keyword(s):  
Metabolic Disorders ◽  
Respiratory Acidosis ◽  
Respiratory Alkalosis ◽  
Carbon Dioxide Tension ◽  
Anion Gap ◽  
Secondary Response ◽  
Simultaneous Occurrence ◽  
Acid Base ◽  
Respiratory Disorders ◽  
Base Disorder

This review on the approach to acid-base disorders uses the physiologic approach to assessing acid-base status, namely that based on the H2CO3/[HCO3–] buffer pair. A simple acid-base disorder is characterized by a primary abnormality in either carbon dioxide tension (Pco2) or serum [HCO3–] accompanied by the appropriate secondary response in the other component. The four cardinal, simple acid-base disorders are categorized into respiratory disorders and metabolic disorders. Respiratory disorders are expressed as primary changes in Pco2 and include respiratory acidosis or primary hypercapnia (primary increase in Pco2) and respiratory alkalosis or primary hypocapnia (primary decrease in Pco2). Metabolic disorders are expressed as primary changes in serum [HCO3–]) and include metabolic acidosis (primary decrease in serum [HCO3–]) and metabolic alkalosis (primary increase in serum [HCO3–]). A mixed acid-base disorder denotes the simultaneous occurrence of two or more simple acid-base disorders. Arriving at an accurate acid-base diagnosis rests with assessment of the accuracy of the acid-base variables, calculation of the serum anion gap, and identification of the dominant acid-base disorder and whether a simple or mixed disorder is present. Identifying the cause of the acid-base disorder depends on a detailed history and physical examination as well as obtaining additional testing, as appropriate.   Key words: acid-base disorders; simple disorders; mixed disorders; anion gap; physiologic approach; physicochemical approach; base-excess approach

Approach to Acid-Base Disorders

2017 ◽  
Author(s):  
Horacio J Adrogué ◽  
Nicolaos E Madias
Keyword(s):  
Metabolic Disorders ◽  
Respiratory Acidosis ◽  
Respiratory Alkalosis ◽  
Carbon Dioxide Tension ◽  
Anion Gap ◽  
Secondary Response ◽  
Simultaneous Occurrence ◽  
Acid Base ◽  
Respiratory Disorders ◽  
Base Disorder

This review on the approach to acid-base disorders uses the physiologic approach to assessing acid-base status, namely that based on the H2CO3/[HCO3–] buffer pair. A simple acid-base disorder is characterized by a primary abnormality in either carbon dioxide tension (Pco2) or serum [HCO3–] accompanied by the appropriate secondary response in the other component. The four cardinal, simple acid-base disorders are categorized into respiratory disorders and metabolic disorders. Respiratory disorders are expressed as primary changes in Pco2 and include respiratory acidosis or primary hypercapnia (primary increase in Pco2) and respiratory alkalosis or primary hypocapnia (primary decrease in Pco2). Metabolic disorders are expressed as primary changes in serum [HCO3–]) and include metabolic acidosis (primary decrease in serum [HCO3–]) and metabolic alkalosis (primary increase in serum [HCO3–]). A mixed acid-base disorder denotes the simultaneous occurrence of two or more simple acid-base disorders. Arriving at an accurate acid-base diagnosis rests with assessment of the accuracy of the acid-base variables, calculation of the serum anion gap, and identification of the dominant acid-base disorder and whether a simple or mixed disorder is present. Identifying the cause of the acid-base disorder depends on a detailed history and physical examination as well as obtaining additional testing, as appropriate.   Key words: acid-base disorders; simple disorders; mixed disorders; anion gap; physiologic approach; physicochemical approach; base-excess approach

Adaptations to the participatory learning and action cycle in resource-limited settings: an observational study

The Lancet ◽  
2017 ◽  
Vol 390 ◽  
pp. S63 ◽  
Author(s):  
Jennifer S Martin ◽  
Edward Fottrell ◽  
Georgia Black ◽  
Cecilia Vindrola ◽  
Monica Lakhanpaul
Keyword(s):  
Observational Study ◽  
Resource Limited Settings ◽  
Participatory Learning ◽  
Resource Limited ◽  
Participatory Learning And Action

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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