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.

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 Acid-Base Effects of a Bicarbonate-Balanced Priming Fluid during Cardiopulmonary Bypass: Comparison with Plasma-Lyte 148. A Randomised Single-Blinded Study

2008 ◽  
Vol 36 (6) ◽  
pp. 822-829 ◽  
Author(s):  
T. J. Morgan ◽  
G Power ◽  
B. Venkatesh ◽  
M. A. Jones
Keyword(s):  
Metabolic Acidosis ◽  
Cardiopulmonary Bypass ◽  
Base Excess ◽  
Strong Ion Difference ◽  
Acid Base ◽  
Elective Cardiac Surgery ◽  
Standard Base Excess ◽  
Acid Base Status ◽  
Standard Base ◽  
Normal Acid

Fluid-induced metabolic acidosis can be harmful and can complicate cardiopulmonary bypass. In an attempt to prevent this disturbance, we designed a bicarbonate-based crystalloid circuit prime balanced on physico-chemical principles with a strong ion difference of 24 mEq/l and compared its acid-base effects with those of Plasma-Lyte 148, a multiple electrolyte replacement solution containing acetate plus gluconate totalling 50 mEq/l. Twenty patients with normal acid-base status undergoing elective cardiac surgery were randomised 1:1 to a 2 litre prime of either bicarbonate-balanced fluid or Plasma-Lyte 148. With the trial fluid, metabolic acid-base status was normal following bypass initiation (standard base excess 0.1 (1.3) mEq/l, mean, SD), whereas Plasma-Lyte 148 produced a slight metabolic acidosis (standard base excess -2.2 (2.1) mEq/l). Estimated group difference after baseline adjustment was 3.6 mEq/l (95% confidence interval 2.1 to 5.1 mEq/l, P=0.0001). By late bypass, mean standard base excess in both groups was normal (0.8 (2.2) mEq/l vs. -0.8 (1.3) mEq/l, P=0.5). Strong ion gap values were unaltered with the trial fluid, but with Plasma-Lyte 148 increased significantly on bypass initiation (15.2 (2.5) mEq/l vs. 2.5 (1.5) mEq/l, P <0.0001), remaining elevated in late bypass (8.4 (3.4) mEq/l vs. 5.8 (2.4) mEq/l, P <0.05). We conclude that a bicarbonate-based crystalloid with a strong ion difference of 24 mEq/l is balanced for cardiopulmonary bypass in patients with normal acid-base status, whereas Plasma-Lyte 148 triggers a surge of unmeasured anions, persisting throughout bypass. These are likely to be gluconate and/or acetate. Whether surges of exogenous anions during bypass can be harmful requires further study.

Human PaCO2 and standard base excess compensation for acid-base imbalance

1998 ◽  
Vol 26 (7) ◽  
pp. 1173-1179 ◽  
Author(s):  
Robert Schlichtig ◽  
Alan W. Grogono ◽  
John W. Severinghaus
Keyword(s):  
Base Excess ◽  
Acid Base ◽  
Standard Base Excess ◽  
Standard Base

scholarly journals Effect of the Independent Acid Base Variables on Anion Gap Variation in Cardiac Surgical Patients: A Stewart-Figge Approach

2014 ◽  
Vol 2014 ◽  
pp. 1-6 ◽  
Author(s):  
Michalis Agrafiotis ◽  
Ilias Keklikoglou ◽  
Sofia Papoti ◽  
George Diminikos ◽  
Konstantinos Diplaris ◽  
...  
Keyword(s):  
Carbon Dioxide ◽  
Retrospective Study ◽  
Linear Regression ◽  
Linear Regression Model ◽  
Multiple Linear Regression Model ◽  
Anion Gap ◽  
Surgical Patients ◽  
Strong Ion Difference ◽  
Strong Ion Gap ◽  
Acid Base

Purpose. To determine the effect of each of independent acid base variables on the anion gap (AG) value in cardiac surgical patients.Methods. This retrospective study involved 128 cardiac surgical patients admitted for postoperative care. The variation of AG (AGvar) between the day of admission and the first postoperative day was correlated via a multiple linear regression model with the respective variations of the independent acid base variables, that is, apparent strong ion difference (SIDa), strong ion gap (SIG), carbon dioxide (PCO2), and albumin and phosphate concentrations.Results. The variations of all the above variables contributed significantly to the prediction ofAGvar(adjustedR2=0.9999,F=201890.24, andP<0.001). According to the standardized coefficients (β),  SIGvar(β= 0.948,P<0.001),[Albumin]var(β= 0.260,P<0.001), and[Phosphate]var(β= 0.191,P<0.001) were the major determinants ofAGvarwith lesser contributions fromSIDa, var(β= 0.071,P<0.001) andPCO2, var(β= −0.067,P<0.001).Conclusions. All the independent acid base variables contribute to the prediction of the AG value. However, albumin and phosphate and SIG variations seem to be the most important predictors, while AG appears to be rather stable with changes in PCO2andSIDa.

Acid-base analysis during experimental anemia in rats

2000 ◽  
Vol 78 (10) ◽  
pp. 774-780 ◽  
Author(s):  
J Pesquero ◽  
V Alfaro ◽  
L Palacios
Keyword(s):  
Base Excess ◽  
Respiratory Alkalosis ◽  
Physicochemical Analysis ◽  
Weak Acid ◽  
Strong Ion Difference ◽  
Acid Base ◽  
Experimental Conditions ◽  
Physiological Relevance ◽  
Base Analysis ◽  
Acid Base Status

The present study evaluated the acid-base status of anemic rats by using two approaches of acid-base analysis: one based on the base excess (BE) calculation and the other based on Stewart's physicochemical analysis. Two sets of experimental data, derived from two different methods of inducing anemia, were used: repetitive doses of phenylhydrazine (PHZ) and bleeding (BL). A significant uncompensated respiratory alkalosis was found in both groups of anemic rats. BE increased slightly, whereas strong ion difference ([SID]) and weak acid buffers ([ATOT]) remained unchanged in anemic rats. The reasons for the absence of compensation for hypocapnia and the differences in the behaviour of acid-base variables are discussed. BE increase was considered paradoxical; its calculation was affected by the experimental conditions and BE had little physiological relevance during anemia. The absence of metabolic renal compensation in anemic rats could be due to a lower pH in the kidney due to anemic hypoxia. Finally, the changes in buffer strength related to low Hb and low Pc02 might influence plasma [SID] through counteracted shifts of strong ions between erythrocytes and plasma, finally resulting in unchanged [SID] during anemia.Key words: anemia, phenylhydrazine, bleeding, base excess, strong ion difference, non-carbonic buffers.

Sign in / Sign up

Export Citation Format

Share Document