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

Park, M.; Taniguchi, Leandro Utino; Noritomi, Danilo Teixeira; Libório, Alexandre Braga; Maciel, Alexandre Toledo; Cruz-Neto, Luiz M.

doi:10.1590/s0100-879x2011000300016

Cited by 7 publications

(11 citation statements)

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“…This study explored the correlation between the two most commonly used markers of acid-base disturbances in critically ill patients: the value value of BD and serum lactate. Metabolic acidosis remains one of the most common acid-base disorders and often marks the beginning of tissue hypoxia and organ hypoperfusion [6,7,10,18 ]. Serum lactate levels have been used to detect the presence of tissue hypoperfusion and as a prognosticating marker in different subgroups of patients [3,8,10,12,13].…”

Section: Discussionmentioning

confidence: 99%

“…An elevated BD represents the presence of unmeasured anions and this is usually taken as a surrogate marker of lactic acidosis [4,5]. BD is a sensible and easy tool to disclose clinically significant metabolic acidosis [6]. Many authors have shown that BD values correlate with the development of multiple organ failure and mortality [7,8,9].…”

Section: Introductionmentioning

confidence: 99%

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Usefulness of base deficit in the assessment of serum lactate levels in critically ill patients on mechanical ventilation

Novović¹,

Zunic²,

Janković³

et al. 2013

Ser J Exp Clin Res

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Background/aim: Acid-base disturbances are common in critically ill patients. Some of the most commonly used markers of metabolic acidosis are base defi cit and lactate. Th e aim of this study was to evaluate the correlation between base defi cit and serum lactate and the utility of base defi cit in the assessment of serum lactate levels in critically ill patients on mechanical ventilation. Methods: Th is study was designed as a retrospective, analytical study. We reviewed all arterial gas analyses (base defi cit and lactate levels) of patients on mechanical ventilation. Th e correlation between base defi cit and lactate was assessed by calculation of the Pearson correlation coeffi cient (r) and coeffi cient of determination (R 2). Receiver operating characteristic (ROC) curves were created for base defi cit to detect the presence of hyperlactatemia. Th e SPSS 12.0 software package (Chicago, Illinois) was used for statistical analyses. Results: One hundred forty-two patients participated in the study: including survivors (n=68) and non-survivors (n=74). Th e mean value of base defi cit was 0.512 ± 6.10 mmol/L, and the mean value of serum lactate was 2.04 ± 2.07 mmol/L. Th ere was no diff erence in lactate and base defi cit values between the groups (p=0.101, p=0.106, respectively). Hyperlactatemia was observed in 44 patients (30.98 %). In ROC curve analysis, the area under the curve for base defi cit to detect hyperlactatemia was 0.527. Conclusion: Th is study indicates that base defi cit is not an appropriate marker in the evaluation of real serum lactate values.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Usefulness of base deficit in the assessment of serum lactate levels in critically ill patients on mechanical ventilation

Novović¹,

Zunic²,

Janković³

et al. 2013

Ser J Exp Clin Res

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“…Through the physicochemical interpretation of the metabolic component of acid-base equilibrium, changes in SBE can be explained by changes in lactate, SIG, SIDai, SIG, albumin and phosphate levels. (8,9,(16)(17)(18) Based on this premise, any change in SBE between the two measurements can be explained by changes in these components; therefore, the SBE change that is ascribable to lactate, SIG, SIDai, albumin and phosphate is the difference between these ionic forms at the two evaluation times. The magnitude of the difference is related to the influence of each variable in relation to the final SBE.…”

Section: Physicochemical Analysismentioning

confidence: 99%

“…(4)(5)(6) The actual implications of metabolic acidosis in patients with severe sepsis and septic shock is currently uncertain; (7) however, metabolic acidosis and hyperchloremia at admission and unimproved metabolic acidosis that are associated with lactate and unmeasurable anions within 5 days of admission are related to an increased mortality rate. (8) Overall, in septic patients, improving metabolic acidosis as measured by standard base excess (SBE) is associated with less severe organ dysfunction (9) and a decreased risk of death. (10) Acid-base equilibrium can be analyzed using various approaches with slightly different points of view showing the very same changes.…”

Section: Introductionmentioning

confidence: 99%

“…(11) The physicochemical technique provides a quantification of the influence of both organic and nonorganic components on pH. (12) In this method, strong ions (e.g., sodium, potassium, magnesium, calcium and chloride), unmeasurable anions, lactate, albumin and phosphates act to regulate metabolic pH control, (9,12) where as the partial pressure of carbon dioxide modulates respiratory pH control. (12) Therefore, considering the widespread use of volume expansion with 30 mL/kg normal saline solution in patients with severe sepsis and septic shock, (2) we hypothesized that significant metabolic acidosis occurs after infusion of normal saline.…”

Section: Introductionmentioning

confidence: 99%

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Caracterização físico-química da acidose metabólica induzida pela expansão volêmica inicial com solução salina a 0,9% em pacientes com sepse grave e choque séptico

Park¹,

Calabrich²,

Maciel³

et al. 2011

Rev. bras. ter. intensiva

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Objetivos de la reanimación hemodinámica

Mesquida¹,

Borrat²,

Lorente³

et al. 2011

Medicina Intensiva

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Cardiovascular failure or shock, of any etiology, is characterized by ineffective perfusion of body tissues, inducing derangements in the balance between oxygen delivery and consumption. Impairment in oxygen availability on the cellular level causes a shift to anaerobic metabolism, with an increase in lactate and hydrogen ion production that leads to lactic acidosis. The degree of hyperlactatemia and metabolic acidosis will be directly correlated to the development of organ failure and poor outcome of the individuals. The amount of oxygen available at the tissues will depend fundamentally on an adequate level of perfusion pressure and oxygen delivery. The optimization of these two physiologic parameters can re-establish the balance between oxygen delivery and consumption on the cellular level, thus, restoring the metabolism to its aerobic paths. Monitoring variables such as lactate and oxygen venous saturations (either central or mixed) during the initial resuscitation of shock will be helpful to determine whether tissue hypoxia is still present or not. Recently, some new technologies have been developed in order to evaluate local perfusion and microcirculation, such as gastric tonometry, near-infrared spectroscopy and videomicroscopy. Although monitoring these regional parameters has demonstrated its prognostic value, there is a lack of evidence regarding to its usefulness during the resuscitation process. In conclusion, hemodynamic resuscitation is still based on the rapid achievement of adequate levels of perfusion pressure, and then on the modification of oxygen delivery variables, in order to restore physiologic values of ScvO(2)/SvO(2) and resolve lactic acidosis and/or hyperlactatemia.

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

Cited by 7 publications

References 0 publications

Usefulness of base deficit in the assessment of serum lactate levels in critically ill patients on mechanical ventilation

Usefulness of base deficit in the assessment of serum lactate levels in critically ill patients on mechanical ventilation

Caracterização físico-química da acidose metabólica induzida pela expansão volêmica inicial com solução salina a 0,9% em pacientes com sepse grave e choque séptico

Objetivos de la reanimación hemodinámica

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