Acid–base disorders evaluation in critically ill patients: we can improve our diagnostic ability

Boniatti, Márcio Manozzo; Cardoso, Paulo Ricardo Cerveira; Castilho, Rodrigo Kappel; Vieira, Sílvia Regina Rios

doi:10.1007/s00134-009-1496-2

Cited by 56 publications

(55 citation statements)

References 23 publications

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“…Previous studies conducted with critical patients in intensive care units have reported mean ages of 55.9±18.1 years and 70.5±17.4 years. In studies similar to our own, ABDs were more common in males (8,9,12,13 ). These rates indicate that more attention should be given to the evaluation of blood gas data, the identification of ABD and the approach to patients, especially critically ill patients, in the ED.…”

Section: Discussionsupporting

confidence: 75%

“…The AG was calculated using the standard formula of AG=Na+K-(HCO 3 +Cl). The respective normal values for AG with relatively wide ranges reported by most laboratories and studies are 16±4 mEq/L (if K is considered) and 12±4 mEq/L (if K is not considered) (6)(7)(8). Clinicians were advised to use the normal AG values reported by the laboratory.…”

Section: Study Protocolmentioning

confidence: 99%

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Acid-Base Disorders in the Emergency Department: Incidence, Etiologies and Outcomes

Köse¹,

Armağan²,

Öner³

et al. 2014

JAEM

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Objective: Acid-base disorders (ABDs) are usually correlated with high rates of morbidity and mortality. The objective of this study was to analyze the causes, outcomes, types and incidences of ABDs in patients presenting at the emergency department (ED). Material and Methods:We prospectively analyzed data from patients who presented between January 2011 and May 2011. Data on age, gender, chief complaint, and diagnosis in the ED were collected for ABD cases.Results: Of the 736 cases with an ABD, 173 patients (23.5%) had simple ABD and 563 patients (76.5%) had mixed ABD. The most common ABD was a mixed metabolic acidosis and respiratory alkalosis (MACRAL) (n=408, 55.4%). All ABD types were most commonly observed in patients over 65 years of age. Dyspnea was the most common complaint among ABD patients who presented at the ED (44.4%). In cases of ABD, pneumonia was the most common diagnosis (16.3%). Of the ABD cases, 379 patients (51.6%) were discharged, while 318 patients (43.2%) were hospitalized. Death was more commonly observed in cases with mixed metabolic and respiratory acidosis (MRAC) (n=6) and MACRAL (n=11). Conclusion:ABDs are quite common in patients presenting at the ED, especially among patients in a critical condition (71%). Mixed MACRAL was the most commonly noted ABD. Dyspnea and pneumonia were the most common diagnoses in ABD patients. Mortality was more common in cases with a mixed MRAC and MACRAL. This knowledge may provide important information concerning the diagnosis, treatment and early prognosis of patients. (JAEM 2014; 13: 4-9)

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Section: Discussionsupporting

confidence: 75%

Section: Study Protocolmentioning

confidence: 99%

Acid-Base Disorders in the Emergency Department: Incidence, Etiologies and Outcomes

Köse¹,

Armağan²,

Öner³

et al. 2014

JAEM

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“…Thus, our results support the hypothesis of a slightly greater reliability of Stewart's method to detect metabolic disorders. Previous studies (Balasubramanyan et al 1999, Fencl et Boniatti 2009) for assessing the sensitivity of Stewart's approach compared to other methods, conducted on ICU patients, report similar results. Nevertheless, the Stewart method has been criticized.…”

Section: Discussionsupporting

confidence: 56%

Comparison between bicarbonate-based and Stewart methods to assess metabolic acid-base disorders in internistic patients. A pilot study

Maria¹,

Francesca²,

Demma³

et al. 2017

IJM

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Aim: To assess the acid-base status in a cohort of internistic patients, using traditional and "modern" methods, to compare their different sensitivity to detect metabolic disorders and to evaluate a possible relationship between classical and alternative parameters. Patients and Methods: 143 assessment of acid-base and electrolytes balance on 121 internistic patients (76 males and 45 females, mean age 73.9 ± 10,8 years) were examined according to bicarbonate-based and Stewart methods. Results: The traditional method detected 81 cases (56.6 %) of metabolic alkalosis and 15 cases (10.4 %) of metabolic acidosis. The Stewart method detected 92 cases (64.3 %) of metabolic alkalosis and 22 cases (15.3%) of metabolic acidosis. Traditional method failed to detect 11 cases of metabolic alkalosis (chi square = 1.443; p = 0.226), and 7 cases of metabolic acidosis (chi square = 1.118; p = 0.290) when compared to Stewart's method. A significant relationship was observed between Strong Ion Gap (SIG) and Anion Gap corrected for albumin concentration (AGcorr) (r= 0.53; p <0.001). Conclusions: Our result showed that traditional method is useful to assess acid-base status in internistic clinical setting as well as Stewart's method because no significant difference was found between the two approaches. Nevertheless, the light disagreement observed between the two methods suggests that in a small percentage of cases the traditional method can fail to detect metabolic acid-base abnormalities.

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“…Sir: We would like to thank Dr. Dubin and colleagues for their comments about our recent article [1]. However, we disagree with most of their statements.…”

mentioning

confidence: 92%

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et al. 2009

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Acid–base disorders evaluation in critically ill patients: we can improve our diagnostic ability

Abstract: The Stewart approach, compared to the traditional evaluation, results in identification of more patients with major acid-base disturbances.

Cited by 56 publications

References 23 publications

Acid-Base Disorders in the Emergency Department: Incidence, Etiologies and Outcomes

Acid-Base Disorders in the Emergency Department: Incidence, Etiologies and Outcomes

Comparison between bicarbonate-based and Stewart methods to assess metabolic acid-base disorders in internistic patients. A pilot study

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