Acid base disorders in patients with COVID-19

Giaroni, Francesco; Giovanella, Silvia; Ligabue, Giulia; Cazzato, Silvia; Gaetano, Margherita Di; Mussini, Cristina; Guaraldi, Giovanni; Bacca, Erica; Bedini, A.; Borghi, Vanni; Burastero, Giulia; Carli, Federica; Ciusa, Giacomo; Corradi, Luca; Cuomo, Gianluca; Digaetano, Margherita; Dolci, Giovanni; Faltoni, Matteo; Fantini, Riccardo; Franceschi, Giacomo; Franceschini, Erica; Iadisernia, Vittorio; Larnè, Damiano; Menozzi, Marianna; Meschiari, Marianna; Milić, Jovana; Orlando, Gabriella; Pellegrino, Francesco; Raimondi, Alessandro; Rogati, Carlotta; Santoro, Antonella; Tonelli, Roberto; Tutone, Marco; Volpi, Sara; Yaacoub, Dina; Cappelli, Gianni; Magistroni, Riccardo; Ferrari, Annachiara; Fontana, Francesco; Marco, Ballestri; Mori, Giacomo; Pulizzi, Roberto; Ascione, Elisabetta; Leonelli, Marco; Facchini, Fiorenzo; Damiano, Francesca; Girardis, Massimo; Andreotti, Alberto; Biagioni, Emanuela; Bondi, Filippo; Busani, Stefano; G, Chierego; Scotti, Marzia; Serio, Lucia; Cossarizza, Andrea; Bellinazzi, Caterina; Borella, Rebecca; Biasi, Sara De; Gaetano, Anna De; Fidanza, Lucia; Gibellini, Lara; Iannone, Anna; Tartaro, Domenico Lo; Mattioli, Marco; Nasi, Milena; Paolini, Annamaria

doi:10.1007/s11255-021-02855-1

Cited by 34 publications

(37 citation statements)

References 18 publications

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“…The prevalence of inappropriate responders is consistent with estimates of respiratory alkalosis in 28.7–55.4% from other studies that investigated blood gas analysis in hospitalized COVID-19 patients [( 5 ) (55.4%); ( 6 ) (28.7%); ( 7 ) (30.3%); ( 8 ) (40.4%)]. Wu et al ( 6 ) found higher inflammatory markers in respiratory alkalosis group, and other studies corroborate admission hypocapnia as a marker of severe disease ( 17 , 18 ).…”

Section: Discussionsupporting

confidence: 88%

“…Of the total cohort, 38% (74/194), had a 6-week follow-up after hospital discharge, of which 34 (17.5%) were face-to-face consultations which allowed full clinical assessment. A new diagnosis of breathing pattern disorder (BPD) was made in 23.5% (8/34), with a BPAT score of 6 ( 5 – 7 ). None had a past medical history of respiratory, neurological or psychiatric disorder.…”

Section: Resultsmentioning

confidence: 99%

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Inappropriate Ventilatory Homeostatic Responses in Hospitalized COVID-19 Patients

et al. 2022

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BackgroundThe clinical presentation of COVID-19 suggests altered breathing control - tachypnoea, relative lack of dyspnoea, and often a discrepancy between severity of clinical and radiological findings. Few studies characterize and analyse the contribution of breathing drivers and their ventilatory and perceptual responses.AimTo establish the prevalence of inappropriate ventilatory and perceptual response in COVID-19, by characterizing the relationships between respiratory rate (RR), dyspnoea and arterial blood gas (ABG) in a cohort of COVID-19 patients at presentation to hospital, and their post-Covid respiratory sequelae at follow-up.MethodsWe conducted a retrospective cohort study including consecutive adult patients admitted to hospital with confirmed COVID-19 between 1st March 2020 and 30th April 2020. In those with concurrent ABG, RR and documented dyspnoea status on presentation, we documented patient characteristics, disease severity, and outcomes at hospital and 6-week post-discharge.ResultsOf 492 admissions, 194 patients met the inclusion criteria. Tachypnoea was present in 75% pronounced (RR>30) in 36%, and persisted during sleep. RR correlated with heart rate (HR) (r = 0.2674), temperature (r = 0.2824), CRP (r = 0.2561), Alveolar-arterial (A-a) gradient (r = 0.4189), and lower PaO2/FiO2 (PF) ratio (r = −0.3636). RR was not correlated with any neurological symptoms. Dyspnoea was correlated with RR (r = 0.2932), A-a gradient (r = 0.1723), and lower PF ratio (r = −0.1914), but not correlated with PaO2 (r = −0.1095), PaCO2 (r = −0.0598) or any recorded neurological symptom except for altered consciousness. Impaired ventilatory homeostatic control of pH/PaCO2 [tachypnoea (RR>20), hypocapnia (PaCO2 <4.6 kPa), and alkalosis (pH>7.45)] was observed in 29%. This group, of which 37% reported no dyspnoea, had more severe respiratory disease (A-a gradient 38.9 vs. 12.4 mmHg; PF ratio 120 vs. 238), and higher prevalence of anosmia (21 vs. 15%), dysgeusia (25 vs. 12%), headache (33 vs. 23%) and nausea (33 vs. 14%) with similar rates of new anxiety/depression (26 vs. 23%), but lower incidence of past neurological or psychiatric diagnoses (5 vs. 21%) compared to appropriate responders. Only 5% had hypoxia sufficiently severe to drive breathing (i.e. PaO2 <6.6 kPa). At 6 weeks post-discharge, 24% (8/34) showed a new breathing pattern disorder with no other neurological findings, nor previous respiratory, neurological, or psychiatric disorder diagnoses.ConclusionsImpaired homeostatic control of ventilation i.e., tachypnoea, despite hypocapnia to the point of alkalosis appears prevalent in patients admitted to hospital with COVID-19, a finding typically accompanying more severe disease. Tachypnoea prevalence was between 12 and 29%. Data suggest that excessive tachypnoea is driven by both peripheral and central mechanisms, but not hypoxia. Over a third of patients with impaired homeostatic ventilatory control did not experience dyspnoea despite tachypnoea. A subset of followed-up patients developed post-covid breathing pattern disorder.

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Section: Discussionsupporting

confidence: 88%

Section: Resultsmentioning

confidence: 99%

Inappropriate Ventilatory Homeostatic Responses in Hospitalized COVID-19 Patients

et al. 2022

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“…Low levels of PaCO 2 in 55.8% of patients show that mostly respiratory alkalosis occurs during severe COVID-19. While comparing the metabolic findings to other studies, metabolic alkalosis (33.6%) was the main modification in the study of Alfano et al which showed a lower prevalence of metabolic alkalosis than our study [17]. The causes of respiratory acid-base problems were quickly identified.…”

Section: Discussionsupporting

confidence: 46%

Study of Arterial Blood Gas Analysis in Moderate-to-Severe COVID-19 Patients

Sanghani¹,

Bansal²,

Parmar³

et al. 2022

Cureus

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BackgroundThe high prevalence of pneumonia and renal involvement in coronavirus disease 2019 leads to frequent acid-base abnormalities in serious patients and affects prognosis. In this study, we aimed to assess the arterial blood gas (ABG) and acid-base patterns in COVID-19 patients admitted to a tertiary care hospital. MethodologyA retrospective observational study was conducted in a designated COVID-19 hospital involving 267 reverse transcription-polymerase chain reaction-positive COVID-19 patients. Demographic and laboratory data including ABG data within the first day after admission and in patients with multiple ABG analyses, only the first measurement was collected and analyzed statistically, including its association with comorbidities. ResultsThe most common age group of the patients was 51-60 years (30.8%), with a male predominance (male:female = 2.7:1). The most common comorbidities were hypertension, diabetes mellitus, and chronic obstructive pulmonary disease found in 147 (55%) COVID-19 patients. Alkalosis and acidosis were observed in 145 (54.3%) and 50 (18.7%) patients, respectively. The most common ABG abnormality observed was primary respiratory alkalosis with secondary metabolic acidosis in 67 (25.1%) patients, followed by primary respiratory alkalosis with secondary metabolic alkalosis in 54 (20.2%) patients. Statistically significant negative correlation was found with PaCO 2 and pH (r = -0.530, p < 0.0001), statistically significant positive correlation was found between pH and base (r = 0.533, p < 0.0001), pH and TCO 2 (r = 0.260, p < 0.0001), and pH and HCO 3 (r = 0.354, p < 0.0001). ConclusionsAcid-base abnormalities are commonly encountered in COVID-19 patients. Respiratory alkalosis as a part of a single or mixed pattern on ABG was the most common pattern found in critically ill COVID-19 patients. ABG on admission in moderate-to-severe COVID-19 patients can help in the early correction of metabolic abnormalities leading to improved patient outcomes.

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“…COVID-19 patients experience a variety of acid-base balance disorders during their course of disease. The assessment and research on the acid-base balance disorders of COVID-19 patients is still insufficient (3), which is different from our conventional understanding-the main target of damage due to COVID-19 The organ is the lung, which may cause respiratory acid-base balance disorders. A retrospective blood gas analysis study showed that the most common acid-base balance disorder in patients with COVID-19 is keratogenic alkalosis(3).…”

Section: Discusstionmentioning

confidence: 99%

“…The assessment and research on the acid-base balance disorders of COVID-19 patients is still insufficient (3), which is different from our conventional understanding-the main target of damage due to COVID-19 The organ is the lung, which may cause respiratory acid-base balance disorders. A retrospective blood gas analysis study showed that the most common acid-base balance disorder in patients with COVID-19 is keratogenic alkalosis(3). A report from South Africa has been shown that metabolic alkalosis is more common in COVID-19 virus-positive patients(4).…”

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confidence: 99%

Metabolic alkalosis and mortality in COVID-19

Jiang

2022

Preprint

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Background As a new infectious disease affecting the world, COVID-19 has caused a huge impact on countries around the world. At present, its specific pathophysiological mechanism has not been fully clarified. We found in the analysis of the arterial blood gas data of critically ill patients that the incidence of metabolic alkalosis in such patients is high. Method We retrospectively analyzed the arterial blood gas analysis results of a total of 16 critically ill patients in the intensive ICU area of Xiaogan Central Hospital and 42 severe patients in the intensive isolation ward, and analyzed metabolic acidosis and respiratory acidosis. Metabolic alkalosis and respiratory alkalosis, and the relationship between metabolic alkalosis and death. Result Among the 16 critically ill patients, the incidence of metabolic alkalosis was 100%, while the incidence of metabolic alkalosis in severe patients was 50%; the mortality rate in critically ill patients was 81.3%, and 21.4% in severe patients ; The mortality of all patients with metabolic alkalosis is 95.5%,and 4.5% in without metabolic alkalosis. Conclusion The incidence of metabolic alkalosis in critically ill COVID-19 patients is high, and it is associated with high mortality.

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Acid base disorders in patients with COVID-19

Cited by 34 publications

References 18 publications

Inappropriate Ventilatory Homeostatic Responses in Hospitalized COVID-19 Patients

Inappropriate Ventilatory Homeostatic Responses in Hospitalized COVID-19 Patients

Study of Arterial Blood Gas Analysis in Moderate-to-Severe COVID-19 Patients

Metabolic alkalosis and mortality in COVID-19

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