Quantitative Physicochemical Analysis of Acid-Base Balance and Clinical Utility of Anion Gap and Strong Ion Gap in 806 Neonatal Calves with Diarrhea

AbstractApart from the HH equation, the acid-base balance of an organism is also described by the Stewart model, which assumes that the proper insight into the ABB of the organism is given by an analysis of: pCO2, the difference of concentrations of strong cations and anions in the blood serum – SID, and the total concentration of nonvolatile weak acids – Acid total. The notion of an anion gap (AG), or the apparent lack of ions, is closely related to the acid-base balance described according to the HH equation. Its value mainly consists of negatively charged proteins, phosphates, and sulphates in blood. In the human medicine, a modified anion gap is used, which, including the concentration of the protein buffer of blood, is, in fact, the combination of the apparent lack of ions derived from the classic model and the Stewart model. In brachycephalic dogs, respiratory acidosis often occurs, which is caused by an overgrowth of the soft palate, making it impossible for a free air flow and causing an increase in pCO2– carbonic acid anhydride The aim of the present paper was an attempt to answer the question whether, in the case of systemic respiratory acidosis, changes in the concentration of buffering ions can also be seen. The study was carried out on 60 adult dogs of boxer breed in which, on the basis of the results of endoscopic examination, a strong overgrowth of the soft palate requiring a surgical correction was found. For each dog, the value of the anion gap before and after the palate correction procedure was calculated according to the following equation: AG = ([Na+mmol/l] + [K+mmol/l]) – ([Cl−mmol/l]+[HCO3−mmol/l]) as well as the value of the modified AG – according to the following equation: AGm= calculated AG + 2.5 × (albuminsr– albuminsd). The values of AG calculated for the dogs before and after the procedure fell within the limits of the reference values and did not differ significantly whereas the values of AGmcalculated for the dogs before and after the procedure differed from each other significantly. Conclusions: 1) On the basis of the values of AGmobtained it should be stated that in spite of finding respiratory acidosis in the examined dogs, changes in ion concentration can also be seen, which, according to the Stewart theory, compensate metabolic ABB disorders 2) In spite of the fact that all the values used for calculation of AGmwere within the limits of reference values, the values of AGmin dogs before and after the soft palate correction procedure differed from each other significantly, which proves high sensitivity and usefulness of the AGmcalculation as a diagnostic method.

Download Full-text

Acid-base disorders in calves with chronic diarrhea

Polish Journal of Veterinary Sciences ◽

10.1515/pjvs-2015-0026 ◽

2015 ◽

Vol 18 (1) ◽

pp. 207-215 ◽

Cited By ~ 1

Author(s):

M. Bednarski ◽

R. Kupczyński ◽

P. Sobiech

Keyword(s):

Plasma Concentration ◽

Chronic Diarrhea ◽

Plasma Concentrations ◽

Anion Gap ◽

Acid Base Balance ◽

Acid Base ◽

Group Iii ◽

Classic Model ◽

Blood Ph ◽

Base Balance

AbstractThe aim of this study was to analyze disorders of acid-base balance in calves with chronic diarrhea caused by mixed, viral, bacterial andCryptosporydium parvuminfection. We compared results obtained with the classic model (Henderson-Hasselbalch) and strong ion approach (the Steward model). The study included 36 calves aged between 14 and 21 days. The calves were allocated to three groups: I – (control) non-diarrheic calves, group II – animals with compensated acid-base imbalance and group III calves with compensated acid-base disorders and hypoalbuminemia. Plasma concentrations of Na+, K+, Cl−, Cl2+, Mg2+, P, albumin and lactate were measured. In the classic model, acid-base balance was determined on the basis of blood pH, pCO2, HCO3−, BE and anion gap. In the strong ion model, strong ion difference (SID), effective strong anion difference, total plasma concentration of nonvolatile buffers (ATot) and strong ion gap (SIG) were measured.The control calves and the animals from groups II and III did not differ significantly in terms of their blood pH. The plasma concentration of HCO3−, BE and partial pressure of CO2 in animals from the two groups with chronic diarrhea were significantly higher than those found in the controls. The highest BE (6.03 mmol/l) was documented in calves from group II. The animals from this group presented compensation resulted from activation of metabolic mechanisms. The calves with hypoalbuminemia (group III) showed lower plasma concentrations of albumin (15.37 g/L), Cl−(74.94 mmol/L), Mg2+(0.53 mmol/L), P (1.41 mmol/L) and higher value of anion gap (39.03 mmol/L). This group III presented significantly higher SID3(71.89 mmol/L), SID7(72.92 mmol/L) and SIG (43.53 mmol/L) values than animals from the remaining groups (P<0.01), whereas ATot(6.82 mmol/L) were significantly lower. The main finding of the correlation study was the excellent relationship between the AGcorrand SID3, SID7, SIG. In conclusion, chronic diarrhea leads to numerous water-electrolyte disorders. Characterization of acid-base disturbance in these cases suggests that classic model have some limitations. This model can not be recommended for use whenever serum albumin or phosphate concentrations are markedly abnormal.

Download Full-text

Between analyser differences in chloride measurements and thus anion gap cause different interpretations of the acid-base balance

Clinical Chemistry and Laboratory Medicine (CCLM) ◽

10.1515/cclm-2015-0477 ◽

2016 ◽

Vol 54 (3) ◽

Author(s):

Nienke Geerts ◽

Nick Wlazlo ◽

Volkher Scharnhorst

Keyword(s):

Anion Gap ◽

Acid Base Balance ◽

Acid Base ◽

Base Balance

Download Full-text

Diagnostic utility of different models used to assess the acid–base balance in cats with chronic kidney disease

Acta Veterinaria Hungarica ◽

10.1556/004.2020.00032 ◽

2020 ◽

Vol 68 (2) ◽

pp. 169-176

Author(s):

Piotr Sławuta ◽

Agnieszka Sikorska-Kopyłowicz ◽

Grzegorz Sapikowski

Keyword(s):

Chronic Kidney Disease ◽

Metabolic Acidosis ◽

Kidney Disease ◽

Anion Gap ◽

Control Group ◽

Acid Base Balance ◽

Acid Base ◽

Classic Model ◽

Arterial Blood ◽

Base Balance

AbstractMetabolic acidosis is diagnosed based on the concentration of bicarbonate ions and partial pressure of carbon dioxide in arterial blood, although acid–base balance (ABB) disorders may also be diagnosed based on the serum ion concentrations in order to determine the values of strong ion difference (SID), anion gap (AG), corrected anion gap (AGcorr) and chloride/sodium ratio (Cl−/Na+). The aim of this study was to assess and compare the classic model, the value of the AG, AGcorr, and Cl−/Na+ in the diagnosis of ABB disorders in cats with chronic kidney disease (CKD). The study group consisted of 80 cats with CKD, divided into four groups based on the guidelines of the International Renal Interest Society (IRIS). The control group (C) included 20 healthy cats. Metabolic acidosis – diagnosed based on the classic model (Hendersson–Hasselbalch equation) – was found in IRIS group IV. AG, AGcorr, SID calculated for IRIS groups II, III and IV were lower than in group C, while the value of AGdiff and Cl−/Na+ in those groups was higher than in group C. We can conclude that ABB analysis using the classic model enabled the detection of ABB disorders in cats in stage IV CKD. However, the analysis of the AG, AGcorr and Cl−/Na+ values enabled the diagnosis of acid–base balance disorders in cats with IRIS stage II, III and IV CKD.

Download Full-text

Impact of Continuous Veno-venous Hemofiltration on Acid-base Balance

The International Journal of Artificial Organs ◽

10.1177/039139880302600104 ◽

2003 ◽

Vol 26 (1) ◽

pp. 19-25 ◽

Cited By ~ 54

Author(s):

J. Rocktäschel ◽

H. Morimatsu ◽

S. Uchino ◽

C. Ronco ◽

R. Bellomo

Keyword(s):

Renal Failure ◽

Acute Renal Failure ◽

Metabolic Alkalosis ◽

Base Excess ◽

Strong Ion Difference ◽

Acid Base Balance ◽

Strong Ion Gap ◽

Acid Base ◽

Biophysical Analysis ◽

Base Balance

Background Continuous veno-venous hemofiltration (CVVH) appears to have a significant and variable impact on acid-base balance. However, the pathogenesis of these acid-base effects remains poorly understood. The aim of this study was to understand the nature of acid-base changes in critically ill patients with acute renal failure during continuous veno-venous hemofiltration by applying quantitative methods of biophysical analysis (Stewart-Figge methodology). Methods We studied forty patients with ARF receiving CVVH in the intensive care unit. We retrieved the biochemical data from computerized records and conducted quantitative biophysical analysis. We measured serum Na+, K+, Mg2+, Cl-, HCO3-, phosphate, ionized Ca2+, albumin, lactate and arterial blood gases and calculated the following Stewart-Figge variables: Strong Ion Difference apparent (SIDa), Strong Ion Difference Effective (SIDe) and Strong Ion Gap (SIG). Results Before treatment, patients had mild acidemia (pH: 7.31) secondary to metabolic acidosis (bicarbonate: 19.8 mmol/L and base excess: −5.9 mEq/L). This acidosis was due to increased unmeasured anions (SIG: 12.3 mEq/L), hyperphosphatemia (1.86 mmol/L) and hyperlactatemia (2.08 mmol/L). It was attenuated by the alkalinizing effect of hypoalbuminemia (22.5 g/L). After commencing CVVH, the acidemia was corrected within 24 hours (pH 7.31 vs 7.41, p <0.0001). This correction was associated with a decreased strong ion gap (SIG) (12.3 vs. 8.8 mEq/L, p <0.0001), phosphate concentration (1.86 vs. 1.49 mmol/L, p <0.0001) and serum chloride concentration (102 vs. 98.5 mmol/L, p <0.0001). After 3 days of CVVH, however, patients developed alkalemia (pH: 7.46) secondary to metabolic alkalosis (bicarbonate: 29.8 mmol/L, base excess: 6.7 mEq/L). This alkalemia appeared secondary to a further decrease in SIG to 6.7 mEq/L (p <0.0001) and a further decrease in serum phosphate to 0.77 mmol/L (p <0.0001) in the setting of persistent hypoalbuminemia (21.0 g/L; p=0.56). Conclusions CVVH corrects metabolic acidosis in acute renal failure patients through its effect on unmeasured anions, phosphate and chloride. Such correction coupled with the effect of hypoalbuminemia, results in the development of a metabolic alkalosis after 72 hours of treatment.

Download Full-text

Higher Dietary Acidity is Associated with Lower Bone Mineral Density in Postmenopausal Iranian Women, Independent of Dietary Calcium Intake

International Journal for Vitamin and Nutrition Research ◽

10.1024/0300-9831/a000207 ◽

2014 ◽

Vol 84 (3-4) ◽

pp. 0206-0217 ◽

Cited By ~ 8

Author(s):

Seyedeh-Elaheh Shariati-Bafghi ◽

Elaheh Nosrat-Mirshekarlou ◽

Mohsen Karamati ◽

Bahram Rashidkhani

Keyword(s):

Calcium Intake ◽

Dietary Calcium ◽

Dietary Calcium Intake ◽

Dietary Intakes ◽

Iranian Women ◽

Acid Base Balance ◽

Mineral Density ◽

Acid Base ◽

Base Balance ◽

Dietary Acid

Findings of studies on the link between dietary acid-base balance and bone mass are relatively mixed. We examined the association between dietary acid-base balance and bone mineral density (BMD) in a sample of Iranian women, hypothesizing that a higher dietary acidity would be inversely associated with BMD, even when dietary calcium intake is adequate. In this cross-sectional study, lumbar spine and femoral neck BMDs of 151 postmenopausal women aged 50 - 85 years were measured using dual-energy x-ray absorptiometry. Dietary intakes were assessed using a validated food frequency questionnaire. Renal net acid excretion (RNAE), an estimate of acid-base balance, was then calculated indirectly from the diet using the formulae of Remer (based on dietary intakes of protein, phosphorus, potassium, and magnesium; RNAERemer) and Frassetto (based on dietary intakes of protein and potassium; RNAEFrassetto), and was energy adjusted by the residual method. After adjusting for potential confounders, multivariable adjusted means of the lumbar spine BMD of women in the highest tertiles of RNAERemer and RNAEFrassetto were significantly lower than those in the lowest tertiles (for RNAERemer: mean difference -0.084 g/cm2; P=0.007 and for RNAEFrassetto: mean difference - 0.088 g/cm2; P=0.004). Similar results were observed in a subgroup analysis of subjects with dietary calcium intake of >800 mg/day. In conclusion, a higher RNAE (i. e. more dietary acidity), which is associated with greater intake of acid-generating foods and lower intake of alkali-generating foods, may be involved in deteriorating the bone health of postmenopausal Iranian women, even in the context of adequate dietary calcium intake.

Download Full-text