The influence of hyperchloraemia on acid base interpretation in diabetic ketoacidosis

Taylor, Daniel M.; Durward, Andrew; Tibby, Shane M.; Thorburn, Kentigern; Holton, F. A.; Johnstone, Iain C.; Murdoch, Ian A.

doi:10.1007/s00134-005-0009-1

Cited by 63 publications

(64 citation statements)

References 21 publications

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“…Volumenersatz mit 0,9% Kochsalzlösung oder Ringerlösung wirkt dieser günstigen Säure-Basen-Störung jedenfalls entgegen und kann bei entsprechender Dosis sogar eine bedeutsame hyperchlorä-mische Azidose erzeugen, obwohl die Ketoazidose per se erfolgreich behandelt ist [80]. Die Berücksichtigung einer derartigen hyperchlorämischen Azidose erlaubt eine genauere quantitative Einschätzung der ungemessenen Anionen und somit des Ausmaßes der Ketonämie [81].…”

Section: Diabetische Ketoazidoseunclassified

Das Säure-Basen-Modell nach Stewart

Funk

2007

Wien Klin Wochenschr

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In addition to paCO(2), Stewart's acid base model takes into account the influence of albumin, inorganic phosphate, electrolytes and lactate on acid-base equilibrium. It allows a comprehensive and quantitative analysis of acid-base disorders. Particularly simultaneous and mixed metabolic acid-base disorders, which are common in critically ill patients, can be assessed. Stewart's approach is therefore a valuable tool in addition to the customary acid-base approach based on bicarbonate or base excess. However, some chemical aspects of Stewart's approach remain controversial.

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Section: Diabetische Ketoazidoseunclassified

Das Säure-Basen-Modell nach Stewart

Funk

2007

Wien Klin Wochenschr

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“…[18]. A complication of large volume intravenous saline resuscitation during the initial treatment of DKA is the development of hyperchloremic non-anion gap metabolic acidosis, which is usually transient [18,26] and resolves within 24-48 h with enhanced renal excretion [18]. A recent randomized controlled trial failed to demonstrate superiority with Ringer's lactate when used in the acute treatment of DKA [27].…”

Section: Serum Namentioning

confidence: 99%

Diabetic Ketoacidosis: A Review and Update

Perilli¹,

Saraceni

Daniels

et al. 2012

Curr Emerg Hosp Med Rep

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Diabetic ketoacidosis (DKA) remains a significant complication of diabetes in both the United States and around the world. Diabetic ketoacidosis remains a significant complication of diabetes in both the United States and worldwide with its associated high rates of hospital admissions. Therefore, it becomes vital that the healthcare professional be able to manage the hyperglycemic crises associated with diabetes. Moreover, with increasing healthcare costs and a changing healthcare system, prevention of diabetic ketoacidosis remains essential. Though management of diabetic ketoacidosis has followed a set algorithm for many years, there are exciting management alternatives on the horizon such as subcutaneous insulin administration for uncomplicated DKA patients. By understanding DKA, including its pathogenesis, presentation, treatment, and prevention, admissions may be decreased and length of stay shortened.

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“…Schwangerschaftswoche macht sie 80% der Körpermasse aus, reduziert sich beim Termingeborenen auf 70-75%, beim Säugling auf 65 …”

Section: Konzeptionelle üBerlegungenunclassified

“…Die erste Studie untersuchte das Auftreten einer hyperchlorämen Acidose nach Rehydratation bei diabetischer Ketoacidose [65]. Initial ist der gemessene negative Basenexzess (BE) durch erhöhte Anionen (Ketonkörper oder Laktat) bedingt.…”

Section: Anwendung Des Stewart-modells In Der Praxisunclassified

Infusionstherapie bei Neugeborenen, Säuglingen und Kindern

Steurer

Berger

2010

Anaesthesist

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Intravenous administration of fluids, electrolytes and glucose are the most common interventions in hospitalized pediatric patients. Parenteral fluid administration can be life-saving, however, if used incorrectly it also carries substantial risks. Perioperatively, adequate hydration, prevention of electrolyte imbalances and maintenance of normoglycemia are the main goals of parenteral fluid therapy. Conceptionally, the distinction between maintenance requirements, deficits and ongoing loss is helpful. Although the pathophysiological basis for parenteral fluid therapy was clarified in the first half of the 20th century, some aspects still remain controversial. In newborn infants, rational parenteral fluid therapy must take into account large insensible fluid losses, adaptive changes of renal function in the first days of life and the fact that neonates do not tolerate prolonged periods of fasting. In older infants the occurrence of iatrogenic hyponatremia with the use of hypotonic solutions has led to a critical reappraisal of the validity of the Holliday-Segar method for calculating maintenance fluid requirements in the postoperative period. Pragmatically, only isotonic solutions should be used in clinical situations which are known to be associated with increases in antidiuretic hormone (ADH) secretion. In this context, it is important to realize that in contrast to lactated Ringer's solution, the use of normal saline can lead to hyperchloremic acidosis in a dose-dependent fashion. Although there is no convincing evidence that colloids are better than crystalloids, there are clinical situations where the use of the more expensive colloids seems justified. It may be reasonable to choose a solution for fluid replacement which has a composition comparable to the composition of the fluid which must be replaced. Although hypertonic saline can reduce an elevated intracranial pressure, this therapy cannot be recommended as a routine procedure because there is currently no evidence that this intervention improves long-term outcome in pediatric patients with traumatic brain injury.

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The influence of hyperchloraemia on acid base interpretation in diabetic ketoacidosis

Abstract: It is now possible using a simple correction factor to quantify the confounding effect of hyperchloraemia on both base deficit and bicarbonate in diabetic ketoacidosis. This bedside tool may be a useful adjunct to guide therapeutic interventions.

Cited by 63 publications

References 21 publications

Das Säure-Basen-Modell nach Stewart

Das Säure-Basen-Modell nach Stewart

Diabetic Ketoacidosis: A Review and Update

Infusionstherapie bei Neugeborenen, Säuglingen und Kindern

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