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.
ABSTRAKHemoglobin SD adalah suatu keadaan heterozigot HbS dan HbD yang merupakan bentuk penyakit sel sabit yang jarang. Pasien dengan Hb SD menunjukkan manifestasi klinis yang bervariasi. High performance liquid chromatography (HPLC) merupakan metode rujukan untuk membantu menegakkan diagnosis kelainan Hb saat ini. Anak laki-laki berusia 7 tahun mengeluh nyeri pada kedua tungkai sejak 5 hari sebelum masuk rumah sakit dan sudah muncul berulang sejak 4 tahun yang lalu. Keluhan disertai demam dan tampak pucat. Riwayat keluar cacing dari BAB usia 2 tahun. Pemeriksaan fisik menunjukkan hipertermia, konjungtiva anemis, limfadenopati dan hepatomegali. Hasil pemeriksaan hematologi menunjukkan anemia normositik normokrom dengan retikulositosis dan leukositosis dengan eosinofilia. Hasil pemeriksaan HPLC menunjukkan adanya S-window, D-window, dan peningkatan HbF. Nyeri pada kedua tungkai merupakan gambaran terjadinya proses vasooklusif akut yang dicetuskan oleh keadaan demam dan infeksi. Sumber infeksi pada pasien ini belum diketahui pasti namun diperkirakan adalah infestasi cacing yang didiagnosis banding dengan sindrom hipereosinofilik. Manifestasi klinis lainnya dihubungkan dengan anemia hemolitik yang dapat terjadi intravaskular maupun ekstravaskular. Kata kunci: eosinofilia, hemoglobin SD, HPLC, infestasi cacing ABSTRACT Haemoglobin SD is a heterozygous condition of HbS and HbD which is a rare form of sickle cell disease. Patients with haemoglobin SD shows varying clinical manifestations. High performance liquid chromatography (HPLC) method is a gold standard for diagnosing Hb disorders. A 7-year-old boy complained of pain in both limbs in the last
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