Partitioning evolutive standard base excess determinants in septic shock patients

Park, Marcelo; Noritomi, Danilo Teixeira; Toledo-Maciel, A; Azevedo, Luciano César Pontes; Pizzo, Vladimir Ribeiro Pinto; Cruz-Neto, Luiz M.

doi:10.1590/s0103-507x2007000400006

Cited by 2 publications

(4 citation statements)

References 23 publications

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“…Therefore, the high SIG levels were compensated for by a reduction in SIDe that was mainly caused by decreased albumin ( Table 2 ) and a reduction in PCO 2 , highlighting the complex acid-base behavior in critical illness. ( 25 ) AGCAPL still had an excellent correlation with SIG in these patients (r 2 =0.95).…”

Section: Discussionmentioning

confidence: 74%

Anion gap corrected for albumin, phosphate and lactate is a good predictor of strong ion gap in critically ill patients: a nested cohort study

Zampieri¹,

Park²,

Ranzani³

et al. 2013

Revista Brasileira De Terapia Intensiva

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ObjectiveCorrected anion gap and strong ion gap are commonly used to estimate unmeasured anions. We evaluated the performance of the anion gap corrected for albumin, phosphate and lactate in predicting strong ion gap in a mixed population of critically ill patients. We hypothesized that anion gap corrected for albumin, phosphate and lactate would be a good predictor of strong ion gap, independent of the presence of metabolic acidosis. In addition, we evaluated the impact of strong ion gap at admission on hospital mortality. MethodsWe included 84 critically ill patients. Correlation and agreement between the anion gap corrected for albumin, phosphate and lactate and strong ion gap was evaluated by the Pearson correlation test, linear regression, a Bland-Altman plot and calculating interclass correlation coefficient. Two subgroup analyses were performed: one in patients with base-excess <-2mEq/L (low BE group - lBE) and the other in patients with base-excess >-2mEq/L (high BE group - hBE). A logistic regression was performed to evaluate the association between admission strong ion gap levels and hospital mortality. ResultsThere was a very strong correlation and a good agreement between anion gap corrected for albumin, phosphate and lactate and strong ion gap in the general population (r2=0.94; bias 1.40; limits of agreement -0.75 to 3.57). Correlation was also high in the lBE group (r2=0.94) and in the hBE group (r2=0.92). High levels of strong ion gap were present in 66% of the whole population and 42% of the cases in the hBE group. Strong ion gap was not associated with hospital mortality by logistic regression. ConclusionAnion gap corrected for albumin, phosphate and lactate and strong ion gap have an excellent correlation. Unmeasured anions are frequently elevated in critically ill patients with normal base-excess. However, there was no association between unmeasured anions and hospital mortality.

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Section: Discussionmentioning

confidence: 74%

Anion gap corrected for albumin, phosphate and lactate is a good predictor of strong ion gap in critically ill patients: a nested cohort study

Zampieri¹,

Park²,

Ranzani³

et al. 2013

Revista Brasileira De Terapia Intensiva

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“…It can be derived as the difference of SBE with SID and the albumin effect. 6 Metabolic acidosis was characterized by the decreasing pH and bicarbonate level, which was caused by decreased SID or increased weak acids concentration. Mean SID in the BES group had more superior values significantly than in the NS group at every hour.…”

Section: Discussionmentioning

confidence: 99%

“…Blood urea nitrogen (BUN) and creatinine level were measured every 24 hours for the first 48 hours. Corrected sodium was measured by formula: 6 Corrected sodium = measured sodium + (random blood glucose -100) x 0.016 Subjects received adequate antibiotics if there were signs of infection, oxygen supplementation if pO 2 <80 mmHg, and heparin if there was disseminated intravascular coagulation (DIC) or severe hyperosmolarity (>380 mOsm/L). Management of the patients included fluid resuscitation, insulin, potassium, and bicarbonate correction, as showed in Figure 2.…”

Section: Methodsmentioning

confidence: 99%

“…The severity of metabolic acidosis was calculated by the standard base excess (SBE), and the improvement of SBE was associated with better outcome in critically ill patients. 6 The strong ion difference (SID) was calculated to show the influence of chloride level on hyperchloremic metabolic acidosis. The aim of this present study was to compare balanced electrolyte solution (BES) Ringerfundin ® to normal saline in inducing of hyperchloremic metabolic acidosis in DKA, based on mean SID and SBE as primary endpoints.…”

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The effect of balanced electrolyte solution versus normal saline in the prevention of hyperchloremic metabolic acidosis in diabetic ketoacidosis patients: a randomized controlled trial

2017

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The effect of balanced electrolyte solution versus normal saline in the prevention of hyperchloremic metabolic acidosis in diabetic ketoacidosis patients: a randomized controlled trial Keywords: balanced electrolyte solution, diabetic ketoacidosis, hyperchloremic acidosis, normal saline, standard base excess, strong ion difference (-4,88±5,69 vs -9,68±5,64; p=0,009), 24 jam (-3,99±4,27 vs -8,7± 5,35; p=0,023), dan 48 jam (-4,06±4,11 vs -7,01±5,46; p=0,009) . Selisih nilai BES dan SID tiap pengukuran dengan nilai awal jam 0 (delta BES dan delta SID) lebih tinggi pada kelompok BES, tetapi tidak signifikan. Kesimpulan: Penelitian ini menunjukkan bahwa balanced electrolyte solution (BES) sebagai cairan alternatif untuk resusitasi pasien KAD dapat mengurangi efek asidosis hiperkloremik dengan rerata aktual dan delta SID dan SBEyang lebih tinggi, tetapi tidak secara signifikan lebih superior dibandingkan dengan normal saline. ABSTRACTBackground: In resuscitation, normal saline could cause hyperchloremic metabolic acidosis, while balanced electrolyte solution is a crystalloid fluid resembling blood plasma with lower chloride content. This study compared the effect of normal saline and balanced electrolyte solution Ringerfundin (BES) as the resuscitation fluid in diabetic ketoacidosis (DKA) patients. Parameters applied in this study were standard base excess (SBE) as resuscitation's result indicator and strong ion difference (SID) to measure chloride's influence in developing hyperchloremic acidosis. Methods:A prospective, randomized, single blind controlled trial was conducted at the Emergency Department of Cipto Mangunkusumo Hospital. Thirty subjects with blood sugar >250 mg/dl, arterial pH <7.35 mg/dl, and positive blood ketone were randomly allocated to receive either normal saline (NS) or RingerfundinÒ (BES) as the standardized resuscitation protocol. Data analysis was performed using the unpaired T-test and the Mann Whitney test to compare the SBE and the SID means between both groups. Additional parameters were the level of consciousness, blood sugar level, vital signs, blood gas analysis, lactate, electrolyte, and blood ketone. Results:The mean SID in the BES group was significantly greater than the NS group of all measurements (p<0.05). The BES group had significantly higher mean SBE compared to the NS group at 18 hours (-4.88±5.69 vs -9.68±5.64; p=0.009), 24 hours (-3.99±4.27 vs -8.7±5.35; p=0.023), and 48 hours (-4.06±4.11 vs -7.01±5.46; p=0.009). BES resulted in nonsignificant higher delta SBE and SID than NS. Additional parameters were not different between both groups. Conclusion:This study showed that fluid resuscitation of DKA patients with BES resulted in slightly but not significantly higher mean actual SBE and SID than NS. suggesting that BES as an alternative fluid resuscitation to prevent hyperchloremic acidosis in diabetic ketoacidosis patients was not superior to NS.

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Partitioning evolutive standard base excess determinants in septic shock patients

Cited by 2 publications

References 23 publications

Anion gap corrected for albumin, phosphate and lactate is a good predictor of strong ion gap in critically ill patients: a nested cohort study

Anion gap corrected for albumin, phosphate and lactate is a good predictor of strong ion gap in critically ill patients: a nested cohort study

The effect of balanced electrolyte solution versus normal saline in the prevention of hyperchloremic metabolic acidosis in diabetic ketoacidosis patients: a randomized controlled trial

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