Severe metabolic acidosis in critically Ill patients and its association with the outcome in North Karnataka

Background: Outcomes of metabolic acidosis remain unsure and needs to be explored deeply. This article presents a rational approach to diagnosis and management of metabolic acidosis. The data focusing specifically on severe metabolic acidosis (pH<7.20) is scanty. Methods: It was a prospective observational study. A total of 50 consecutive critically ill patients (APACHE II score of 18 or more) with single severe metabolic acidosis (pH<7.20) admitted to the intensive care units (ICUs) of Shri BM Patil Medical College, Vijayapura. Arterial blood gas analysis along with other relevant investigations was done within first 24 h of ICU admission.Results: Among 50 patients, 32 patients expired compared to 18 patients who were discharged from hospital in stable condition. Out of 29 patients, who had lactic acidosis, 21 (72%) patients died compared to 8 (28%) patients who were discharged in stable condition. Out of 22 patients who have low Strong Ion Difference (SID) 16 patients had expired (76%) remaining 6 (24%) patients are discharged at stable condition. Out of 27 patients who were put on mechanical ventilator on the first day, 22 (80%) patients expired. 18 patients required vasopressor support on admission out of which 16 (90%) patients had lactic acidosis. Conclusions: Lactic acidosis and strong ion gap are found to be associated with higher mortality. Hypotensive patients required vasopressor support on admission. Monitoring of serum pH, HCO3−, lactate levels and strong ion gap may have prognostic and therapeutic implications.

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Corrigendum to “Metabolic Acidosis and Strong Ion Gap in Critically Ill Patients with Acute Kidney Injury”

BioMed Research International ◽

10.1155/2018/6380951 ◽

2018 ◽

Vol 2018 ◽

pp. 1-1

Author(s):

Cai-Mei Zheng ◽

Wen-Chih Liu ◽

Jing-Quan Zheng ◽

Min-Tser Liao ◽

Wen-Ya Ma ◽

...

Keyword(s):

Acute Kidney Injury ◽

Metabolic Acidosis ◽

Critically Ill ◽

Critically Ill Patients ◽

Kidney Injury ◽

Strong Ion Gap

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Clinical utility of standard base excess in the diagnosis and interpretation of metabolic acidosis in critically ill patients

Brazilian Journal of Medical and Biological Research ◽

10.1590/s0100-879x2006005000199 ◽

2008 ◽

Vol 41 (3) ◽

pp. 241-249 ◽

Cited By ~ 14

Author(s):

M Park ◽

L.U Taniguchi ◽

D.T Noritomi ◽

A.B. Libório ◽

A.T Maciel ◽

...

Keyword(s):

Metabolic Acidosis ◽

Critically Ill ◽

Critically Ill Patients ◽

Clinical Utility ◽

Base Excess ◽

Standard Base Excess ◽

Standard Base

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

INDONESIAN JOURNAL OF CLINICAL PATHOLOGY AND MEDICAL LABORATORY ◽

10.24293/ijcpml.v24i2.1313 ◽

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.

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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)

INDONESIAN JOURNAL OF CLINICAL PATHOLOGY AND MEDICAL LABORATORY ◽

10.24293/ijcpml.v23i3.1211 ◽

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.

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

10.21203/rs.3.rs-182629/v1 ◽

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.

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Serum potassium levels and outcomes in critically ill patients in the medical intensive care unit

Journal of International Medical Research ◽

10.1177/0300060517744427 ◽

2018 ◽

Vol 46 (3) ◽

pp. 1254-1262 ◽

Cited By ~ 3

Author(s):

Surat Tongyoo ◽

Tanuwong Viarasilpa ◽

Chairat Permpikul

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Critically Ill ◽

Serum Potassium ◽

Critically Ill Patients ◽

Medical Intensive Care Unit ◽

Apache Ii ◽

Apache Ii Score ◽

Icu Mortality ◽

Medical Intensive Care

Objective To compare the outcomes of patients with and without a mean serum potassium (K+) level within the recommended range (3.5–4.5 mEq/L). Methods This prospective cohort study involved patients admitted to the medical intensive care unit (ICU) of Siriraj Hospital from May 2012 to February 2013. The patients’ baseline characteristics, Acute Physiology and Chronic Health Evaluation II (APACHE II) score, serum K+ level, and hospital outcomes were recorded. Patients with a mean K+ level of 3.5 to 4.5 mEq/L and with all individual K+ values of 3.0 to 5.0 mEq/L were allocated to the normal K+ group. The remaining patients were allocated to the abnormal K+ group. Results In total, 160 patients were included. Their mean age was 59.3±18.3 years, and their mean APACHE II score was 21.8±14.0. The normal K+ group comprised 74 (46.3%) patients. The abnormal K+ group had a significantly higher mean APACHE II score, proportion of coronary artery disease, and rate of vasopressor treatment. An abnormal serum K+ level was associated with significantly higher ICU mortality and incidence of ventricular fibrillation. Conclusion Critically ill patients with abnormal K+ levels had a higher incidence of ventricular arrhythmia and ICU mortality than patients with normal K+ levels.

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APACHE II Score and Multiple Organ Failure Score as Predictors of Mortality Rate of Critically Ill Patients

Korean Journal of Anesthesiology ◽

10.4097/kjae.1997.32.5.754 ◽

1997 ◽

Vol 32 (5) ◽

pp. 754

Author(s):

Eun Chi Bang ◽

Shin Ok Koh ◽

Jai Won Jung

Keyword(s):

Mortality Rate ◽

Multiple Organ Failure ◽

Organ Failure ◽

Critically Ill ◽

Critically Ill Patients ◽

Multiple Organ ◽

Apache Ii ◽

Apache Ii Score ◽

Predictors Of Mortality ◽

Organ Failure Score

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Continuous infusion versus intermittent administration of ceftazidime in critically ill patients with suspected gram-negative infections.

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.40.3.691 ◽

1996 ◽

Vol 40 (3) ◽

pp. 691-695 ◽

Cited By ~ 97

Author(s):

A S Benko ◽

D M Cappelletty ◽

J A Kruse ◽

M J Rybak

Keyword(s):

Steady State ◽

Continuous Infusion ◽

Clinical Isolate ◽

Critically Ill ◽

Critically Ill Patients ◽

Apache Ii Score ◽

Serum Drug Concentration ◽

Gram Negative ◽

Intermittent Bolus ◽

Standard Deviations

The pharmacodynamics and pharmacokinetics of ceftazidime administered by continuous infusion and intermittent bolus over a 4-day period were compared. We conducted a prospective, randomized, crossover study of 12 critically ill patients with suspected gram-negative infections. The patients were randomized to receive ceftazidime either as a 2-g intravenous (i.v.) loading dose followed by a 3-g continuous infusion (CI) over 24 h or as 2 g i.v. every 8 h (q8h), each for 2 days. After 2 days, the patients were crossed over and received the opposite regimen. Each regimen also included tobramycin (4 to 7 mg/kg of body weight, given i.v. q24h). Eighteen blood samples were drawn on study days 2 and 4 to evaluate the pharmacokinetics of ceftazidime and its pharmacodynamics against a clinical isolate of Pseudomonas aeruginosa (R288). The patient demographics (means +/- standard deviations) were as follows: age, 57 +/- 12 years; sex, nine males and three females; APACHE II score, 15 +/- 3; diagnosis, 9 of 12 patients with pneumonia. The mean pharmacokinetic parameters for ceftazidime given as an intermittent bolus (IB) (means +/- standard deviations) were as follows: maximum concentration of drug in serum, 124.4 +/- 52.6 micrograms/ml; minimum concentration in serum, 25.0 +/- 17.5 micrograms/ml; elimination constant, 0.268 +/- 0.205 h-1; half-life, 3.48 +/- 1.61 h; and volume of distribution, 18.9 +/- 9.0 liters. The steady-state ceftazidime concentration for CI was 29.7 +/- 17.4 micrograms/ml, which was not significantly different from the targeted concentrations. The range of mean steady-state ceftazidime concentrations for the 12 patients was 10.6 to 62.4 micrograms/ml. Tobramycin peak concentrations ranged between 7 and 20 micrograms/ml. As expected, the area under the curve for the 2-g q8h regimen was larger than that for CI (P = 0.003). For IB and CI, the times that the serum drug concentration was greater than the MIC were 92 and 100%, respectively, for each regimen against the P. aeruginosa clinical isolate. The 24-h bactericidal titers in serum, at which the tobramycin concentrations were < 1.0 microgram/ml in all patients, were the same for CI and IB (1:4). In the presence of tobramycin, the area under the bactericidal titer-time curve (AUBC) was significantly greater for IB than CI (P = 0.001). After tobramycin was removed from the serum, no significant difference existed between the AUBCs for CI and IB. We conclude that CI of ceftazidime utilizing one-half the IB daily dose was equivalent to the IB treatment as judged by pharmacodynamic analysis of critically ill patients with suspected gram-negative infections. No evaluation comparing the clinical efficacies of these two dosage regimens was performed.

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