scholarly journals Metabolic acidosis in medical intensive care unit with indicators and their prognostic value- A prospective observational study

2017 ◽  
Vol 8 (3) ◽  
pp. 60-67
Author(s):  
Prem Amalraj ◽  
Arun Kumar Narayanan ◽  
Satish Balan ◽  
Mathew Thomas
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Metabolic Acidosis ◽  
Traditional Method ◽  
Traditional Approach ◽  
Serum Lactate ◽  
Anion Gap ◽  
Apache Ii Score ◽  
Acid Base ◽  
Lactate Levels

Background: Metabolic acidosis is a common abnormality in the intensive care unit. There has recently been a surge of interest in nontraditional approaches to the analysis of acid base disorders.Aims and Objectives: This study was undertaken to compare the application of the physicochemical method of Stewart and the traditional Henderson-Hasselbach equation withcorrection for albumin in quantification of acid base disorders.Materials and Methods: All patients with metabolic acidosis admitted to the ICU as defined by a base deficit of >2.5 were included in the study. The APACHE II score was calculated at admission and the predicted mortality was defined. The acid base disorders were quantified by the traditional approach with anion gap correction for serum albumin as well as by the Stewart method with calculation of the strong anion gap acidosis.Results: One-hundred forty patients were included in the study of which 58% were males. In 125 subjects (89%) acidosis was discovered by the Stewart method. The traditional method detected increased anion gap in 109 subjects (78%) but this increased to 124 (88.5%) when corrected for albumin. Both the strong ion gap (SIG) and the albumin corrected anion gap correlated strongly. Serum lactate levels and SIG predicted mortality as did albumin corrected anion gap.Conclusion: Albumin correction of the anion gap correlates well with acidosis as discovered by the SIG and therefore should be used in the ICUs rather than the traditional anion gap. With this modification, we can thus depend on the application of the intuitive traditional method rather than the more difficult to apply Stewart method for analysis of the acid base abnormalities in the ICU.Asian Journal of Medical Sciences Vol.8(3) 2017 60-67

scholarly journals Admission Anion Gap Metabolic Acidosis and Its Impact on Patients in Medical Intensive Care Unit

2021 ◽  
Author(s):  
Akshay Dafal ◽  
Sunil Kumar ◽  
Sachin Agrawal ◽  
Sourya Acharya ◽  
Apoorva Nirmal
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Metabolic Acidosis ◽  
Length Of Stay ◽  
Medical Intensive Care Unit ◽  
Anion Gap ◽  
Acid Base ◽  
Acid Base Status ◽  
Medical Intensive Care ◽  
Time Of Admission

Abstract Introduction Anion gap (AG) metabolic acidosis is common in critically ill patients. The relationship between initial AG at the time of admission to the medical intensive care unit (MICU) and mortality or length of stay is unclear. This study was undertaken to evaluate this relationship. Materials and Method We prospectively examined the acid–base status of 500 consecutive patients at the time of MICU admission and outcome was measured in terms of mortality, length of ICU stay, need of ventilator, and laboratory parameters. The patients were divided into four stages based on the severity of AG. Outcome based on the severity of AG was measured, and comparisons that adjusted for baseline characteristics were performed. Results This study showed that increased AG was associated with the higher mortality. Patients with the highest AG also had the longest length of stay in the MICU, and patients with normal acid–base status had the shortest ICU length of stays (p < 0.05). Conclusion A high AG at the time of admission to the MICU was associated with higher mortality and length of stays. Initial risk stratification based on AG and metabolic acidosis may help guide appropriate patient disposition (especially in patients without other definitive criteria for MICU admission) and assist with prognosis.

scholarly journals Acid based disorders in intensive care unit: a hospital-based study

2019 ◽  
Vol 6 (1) ◽  
pp. 62 ◽  
Author(s):  
Babu Rajendran ◽  
Seetha Rami Reddy Mallampati ◽  
Sheju Jonathan Jha J.
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Metabolic Acidosis ◽  
Infectious Diseases ◽  
Respiratory Alkalosis ◽  
Simple Type ◽  
Acid Base ◽  
Icu Patients ◽  
Mixed Acid ◽  
Base Disorder

Background: Acid base disorders are common in the ICU patients and pose a great burden in the management of the underlying condition.Methods: Identifying the type of acid-base disorders in ICU patients using arterial blood gas analysis This was a retrospective case-controlled comparative study. 46 patients in intensive care unit of a reputed institution and comparing the type of acid-base disorder amongst infectious (10) and non-infectious (36) diseases.Results: Of the study population, 70% had mixed acid base disorders and 30% had simple type of acid base disorders. It was found that sepsis is associated with mixed type of acid-base disorders with most common being metabolic acidosis with respiratory alkalosis. Non-infectious diseases were mostly associated with metabolic alkalosis with respiratory acidosis. Analysis of individual acid base disorders revealed metabolic acidosis as the most common disturbance.Conclusions: These results projected the probability of acid bases disorders in various conditions and help in the efficient management. Mixed acid base disorders are the most common disturbances in the intensive care setup which is metabolic acidosis with respiratory alkalosis in infectious diseases and metabolic acidosis is the most common simple type of acid base disorder.

Clinical significance of calculating the plasma anion gap in metabolic acidosis in newborns with neonatal sepsis

2021 ◽  
Author(s):  
О.К. Кирилочев
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Metabolic Acidosis ◽  
Neonatal Sepsis ◽  
Neonatal Period ◽  
Information Criterion ◽  
Anion Gap ◽  
Critical Conditions ◽  
Inclusion Criteria ◽  
Additional Information

При критических состояниях одним из самых частых нарушений кислотно-основного состояния является метаболический ацидоз. При этом незаслуженно забытым параметром при диагностике метаболического ацидоза является анионный пробел плазмы. Целью исследования было определить возможности использования анионного пробела плазмы для дифференциальной диагностики метаболического ацидоза у новорожденных с неонатальным сепсисом. Для реализации поставленной цели проведено обследование пациентов отделения реанимации и интенсивной терапии для новорожденных. Критериями включения в исследование были период новорожденности, наличие неонатального сепсиса, лабораторные признаки метаболического ацидоза. Всего под наблюдением находились 17 новорожденных детей с неонатальным сепсисом. Диагноз неонатального сепсиса устанавливался на основании подозреваемой или документированной инфекции в сочетании с остро возникшей органной дисфункцией, о развитии которой судили по индексу шкалы pSOFA на 2 балла и более от базового значения. Метаболический ацидоз был выявлен у 5 пациентов. У новорожденных с неонатальным сепсисом чаще регистрировался метаболический ацидоз с ростом анионного пробела плазмы, что обусловлено лактатным ацидозом в результате накопления молочной кислоты как маркера тканевой гипоксии. Уменьшение анионного пробела плазмы выявлялось реже и могло свидетельствовать о потерях бикарбонатного аниона через желудочно-кишечный тракт или в результате гипоальбуминемии. Показано, что анионный пробел плазмы может служить дополнительным информационным критерием для характеристики метаболического ацидоза. Расчет анионного пробела плазмы является недорогим и эффективным инструментом, способным помочь провести дифференциальный диагноз метаболического ацидоза у новорожденных с неонатальным сепсисом для назначения адекватной интенсивной терапии. In critical conditions, one of the most common acid-base disorders is metabolic acidosis. At the same time, an undeservedly forgotten parameter in the diagnosis of metabolic acidosis is the plasma anion gap. Purpose of the study: to determine the possibility of using the plasma anion gap for differential diagnosis of metabolic acidosis in newborns with neonatal sepsis. To achieve this goal, the patients of the intensive care unit and intensive care unit for newborns were examined. Inclusion criteria: neonatal period, presence of neonatal sepsis, laboratory signs of metabolic acidosis. In total, 17 newborns with neonatal sepsis were under observation. The diagnosis of neonatal sepsis was established on the basis of a suspected or documented infection in combination with acute organ dysfunction, the development of which was judged by the pSOFA index by 2 points or more from the baseline value. Metabolic acidosis was identified in 5 patients. In newborns with neonatal sepsis, metabolic acidosis was more often recorded with an increase in the plasma anion gap, which is due to lactic acidosis as a result of the accumulation of lactic acid, as a marker of tissue hypoxia. A decrease in the plasma anion gap was detected less frequently and could indicate a loss of bicarbonate anion through the gastrointestinal tract or as a result of hypoalbuminemia. It has been shown that the plasma anion gap can serve as an additional information criterion for characterizing metabolic acidosis. Plasma anion gap calculation is an inexpensive and effective tool that can help differentiate metabolic acidosis in newborns with neonatal sepsis for adequate intensive care.

scholarly journals Multidrug-resistant Acinetobacter baumannii infections in COVID-19 patients hospitalized in intensive care unit

Infection ◽  
2021 ◽  
Author(s):  
Alessandro Russo ◽  
Francesca Gavaruzzi ◽  
Giancarlo Ceccarelli ◽  
Cristian Borrazzo ◽  
Alessandra Oliva ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Acinetobacter Baumannii ◽  
Steroid Therapy ◽  
Multidrug Resistant ◽  
Serum Lactate ◽  
Cox Regression Analysis ◽  
Lactate Levels ◽  
The Impact

Abstract Objectives Superinfections in patients hospitalized in intensive care unit (ICU) are an important and challenging complication, also in COVID-19. However, no definitive data are available about the role of multidrug-resistant Acinetobacter baumannii (MDR-AB) in COVID-19. Methods This was a single-center, cross-sectional study including patients with MDR-AB infections admitted to ICU with or without COVID-19, between January 2019 and January 2021. The primary objective of the study was to evaluate risk factor for MDR-AB infections in ICU patients hospitalized for COVID-19 or other etiology. The secondary endpoints were 30-days mortality in all study population and risk factors associated with development of bloodstream infection (BSI). Results During the study period 32 adults with COVID-19 were enrolled and compared with 115 patients admitted in the same ICU for other reasons. We observed a total of 114 deaths, with a survival rate of 29.3%: 18.8% in COVID-19 and 32.2% in control group. Relative risk for MDR-AB infection in COVID-19 showed that serum lactate levels mmol/l > 2, Acinetobacter baumannii colonization, BSI and steroid therapy were observed more frequently in COVID-19 patients. Cox regression analysis showed that serum lactate levels > 2 mmol/l, Acinetobacter baumannii colonization, BSI, and steroid therapy were associated with 30-days mortality. Finally, patients with COVID-19, white blood cells count > 11,000 mm3, serum lactate levels > 2 mmol/l, infections at time of ICU admission, Acinetobacter baumannii colonization, and steroid therapy were independently associated with development of BSI. Conclusions Our data highlight the impact of BSI on outcome, the role of Acinetobacter baumannii colonization and the use of steroids on the risk to develop MDR-AB infections also during COVID-19.

Acid-Base Disorders

2013 ◽  
Author(s):  
Ann P. O'Rourke ◽  
James Orr ◽  
Suresh Agarwal
Keyword(s):  
Differential Diagnosis ◽  
Metabolic Acidosis ◽  
Metabolic Alkalosis ◽  
Lactate Concentration ◽  
Respiratory Acidosis ◽  
Serum Lactate ◽  
Anion Gap ◽  
Surgical Patients ◽  
Acid Base

Anticipation and early identification of conditions that alter the body's ability to compensate for acid-base disorders are vital in managing surgical patients. This review describes the general principles and classification of acid-base disorders. Metabolic acid-base disorders are presented, including metabolic acidosis and alkalosis. Respiratory acid-base disorders are also presented, including respiratory acidosis and alkalosis. Tables show the differentiation of acid-base disorders, causes of positive–anion gap acidosis, the differential diagnosis for normal–anion gap metabolic acidosis, the mechanisms associated with increased serum lactate concentration, and the differential diagnosis for metabolic alkalosis. This review contains 7 highly rendered figures, 5 tables, and 135 references.

CRITICAL CARE ISSUES FOR THE NEPHROLOGIST: Acid-base Disturbances in the Intensive Care Unit: Metabolic Acidosis

2006 ◽  
Vol 19 (6) ◽  
pp. 492-495 ◽  
Author(s):  
Anton C. Schoolwerth ◽  
Thomas M. Kaneko ◽  
Martin Sedlacek ◽  
Clay A. Block ◽  
Brian D. Remillard
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
Metabolic Acidosis ◽  
Acid Base ◽  
Critical Care Issues

scholarly journals Prognostic Value of Serum Lactate Levels in Critically Ill Patients in an Intensive Care Unit

2020 ◽  
Vol 6 (1) ◽  
pp. 59-64 ◽  
Author(s):  
Hedgar Berty Gutiérrez ◽  
Yenisey Arteaga Concepción ◽  
Jorge Soneira Pérez ◽  
Yanín Díaz Lara ◽  
Félix Mario Rivero López ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Prognostic Value ◽  
Serum Lactate ◽  
Normal Serum ◽  
Hemodynamic Support ◽  
Physiological Variables ◽  
Arterial Blood ◽  
Lactate Levels

AbstractIntroductionThe patient in critical condition, regardless of the cause of admission, continues to be a challenge for health systems due to the high mortality that it reports. There is a need to identify some marker of early obtaining, easy to interpret and with high relevance in the prognosis of these patients.ObjectiveTo determine the prognostic value of serum lactate in an Intensive Care Unit (ICU).MethodOne hundred and forty-five patients admitted to an ICU were enrolled in the study. The Acute Physiology and Chronic Health Evaluation II (APACHE) prognosis score, Sequential Organ Failure Assessment, hemodynamic support need, mechanical ventilation, cause of admission, stay in ICU, analytical and physiological variables were determined. The probability of survival of patients who had elevated and normal serum lactate levels was calculated. The risk of dying was determined using the Cox regression model.ResultsTwenty-eight patients died (19%) in the ICU. The serum lactate value was higher in the group of patients with trauma, infections, APACHE II and high creatinine levels; as well as with decreased mean arterial blood pressure, need for hemodynamic support and mechanical ventilation. The survival capacity was higher in patients who had normal serum lactate. Serum lactate was the sole independent predictor of mortality (AHR 1.28 [1.07-1.53], p = 0.008).ConclusionsPatient assessment through the determination of serum lactate levels provides useful information in the initial evaluation of the critical patient.

Serum Lactate as an Independent Predictor of In-Hospital Mortality in Intensive Care Patients

2019 ◽  
Vol 35 (11) ◽  
pp. 1257-1264 ◽  
Author(s):  
Ralphe Bou Chebl ◽  
Hani Tamim ◽  
Gilbert Abou Dagher ◽  
Musharaf Sadat ◽  
Farhan Al Enezi ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Hospital Mortality ◽  
Normal Level ◽  
Lactate Level ◽  
Serum Lactate ◽  
Lengths Of Stay ◽  
Mechanical Ventilation Duration ◽  
Lactate Levels ◽  
High Lactate

Purpose: The aim of this study was to check if serum lactate was independently associated with mortality among critically ill patients. Materials and Methods: This was a single-center, retrospective cohort study. All adult patients (>18 years of age) who had at least 1 measurement of lactate within 24 hours of admission to intensive care unit (ICU) between January 2002 and December 2017 were included in the analysis. Patients were stratified into 3 groups: those with a serum lactate of <2 mmol/L (normal level), 2 to 4 mmol/L (intermediate level), and >4 mmol/L (high level). The primary outcome was in-hospital mortality. Secondary outcomes included ICU and hospital lengths of stay and mechanical ventilation duration. To determine the association between lactate level and hospital mortality, bivariate and multivariate logistic regression analyses were performed. Results: Of the 16,447 patients admitted to the ICU, 8167 (49.65%) had normal levels, 4648 (28.26%) had an intermediate, and 3632 (22.09%) had high lactate levels. Hospital mortality was the highest in high lactate level, followed by the intermediate and the normal level group (47.4% vs 26.5% vs 19.6%; P < .0001). Intermediate and high lactate levels were independent predictors of hospital mortality (odds ratio [OR], 1.32; 95% confidence interval [CI]: 1.20-1.46, and 1.94; 95% CI, 1.75-2.16, respectively) as well as ICU mortality (OR, 1.47; 95% CI, 1.30-1.66 and 2.56; 95% CI, 2.27-2.88, respectively). Conclusions: Intensive care unit serum lactate is associated with increased ICU and hospital mortality, independent of comorbidities, organ dysfunction, or hemodynamic status.

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