The value of the chloride:sodium ratio in differentiating the aetiology of metabolic acidosis

Durward, Andrew; Skellett, Sophie; Mayer, Anton; Taylor, Daniel M.; Tibby, SM; Murdoch, IA

doi:10.1007/s001340100915

Cited by 110 publications

(103 citation statements)

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“…30 Whereas several other studies had demonstrated that delay of academia recovery as opposed to initial pH value was associated with increased mortality in the ICU. 31,32 In our study, we were able to demonstrate that pH was able to predict the risk of death with a RR of 2.94 (CI, 1.14-7.59) In our study we had found that hypoalbuminemia (serum albumin <3.5 g/dl) were present in 101/140 (72%) of all patients and 24/26 (92.3%) of those who had died. Hypoalbuminemia as a predictor of mortality with a RR of 4.8 (95% CI, 1.02 -23.1), PPV 21.8%, NPV 93.3%.…”

Section: 22supporting

confidence: 49%

“…However, 109 (78%) of these patients had increased anion gap and 124 (88.5%) had increased albumin corrected anion gap. Consequently the use of albumin corrected anion gap among 32 critically ill patients permitted the additional diagnosis of 15 patients with metabolic acidosis. SIG and albumin corrected AG strongly correlated and showed narrow 95% limits of agreement (0.77-0.95) in critically ill patients.…”

Section: 22mentioning

confidence: 99%

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Metabolic acidosis in medical intensive care unit with indicators and their prognostic value- A prospective observational study

et al. 2017

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Background: Metabolic acidosis is a common abnormality in the intensive care unit. There has recently been a surge of interest in nontraditional approaches to the analysis of acid base disorders. Aims and Objectives: This study was undertaken to compare the application of the physicochemical method of Stewart and the traditional Henderson-Hasselbach equation with correction for albumin in quantification of acid base disorders. Materials and Methods: All patients with metabolic acidosis admitted to the ICU as defined by a base deficit of >2.5 were included in the study. The APACHE II score was calculated at admission and the predicted mortality was defined. The acid base disorders were quantified by the traditional approach with anion gap correction for serum albumin as well as by the Stewart method with calculation of the strong anion gap acidosis. Results: One-hundred forty patients were included in the study of which 58% were males. In 125 subjects (89%) acidosis was discovered by the Stewart method. The traditional method detected increased anion gap in 109 subjects (78%) but this increased to 124 (88.5%) when corrected for albumin. Both the strong ion gap (SIG) and the albumin corrected anion gap correlated strongly. Serum lactate levels and SIG predicted mortality as did albumin corrected anion gap. Conclusion: Albumin correction of the anion gap correlates well with acidosis as discovered by the SIG and therefore should be used in the ICUs rather than the traditional anion gap. With this modification, we can thus depend on the application of the intuitive traditional method rather than the more difficult to apply Stewart method for analysis of the acid base abnormalities in the ICU.

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Section: 22supporting

confidence: 49%

Section: 22mentioning

confidence: 99%

Metabolic acidosis in medical intensive care unit with indicators and their prognostic value- A prospective observational study

et al. 2017

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“…Therefore, methods enabling fast and accurate bedside assessment are needed. Recently, simpler and more practical approaches, such as assessments of Cl -and Na + differences, Cl -:Na + ratio evaluation, and base excesschloride (BE Cl ) calculations, have been used (5,6). Duward et al (6) evaluated acid-base disorders in accordance with pH, pCO 2 , and Cl -changes.…”

Section: Introductionmentioning

confidence: 99%

“…Recently, simpler and more practical approaches, such as assessments of Cl -and Na + differences, Cl -:Na + ratio evaluation, and base excesschloride (BE Cl ) calculations, have been used (5,6). Duward et al (6) evaluated acid-base disorders in accordance with pH, pCO 2 , and Cl -changes. According to Duward et al (6), the main reason for the changes in the HCO 3 -pool is changes in Cl -.…”

Section: Introductionmentioning

confidence: 99%

“…Duward et al (6) evaluated acid-base disorders in accordance with pH, pCO 2 , and Cl -changes. According to Duward et al (6), the main reason for the changes in the HCO 3 -pool is changes in Cl -. Moreover, Cl -must always be interpreted together with Na + , and the simplest method of achieving this interpretation is calculation of the Cl -:Na + ratio.…”

Section: Introductionmentioning

confidence: 99%

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The effects of the chloride:sodium ratio on acid-base statusand mortality in septic patients

Atalan¹,

Güçyetmez²

2017

Turk J Med Sci

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IntroductionAcid-base disorder is an important issue that requires an urgent solution in the intensive care unit (ICU) (1). Stewart's physiochemical approach provides practical solutions for the understanding of metabolic acid-base disorders (2-4). However, this approach has limitations that prevent intensivists from completing a fast bedside assessment. Therefore, methods enabling fast and accurate bedside assessment are needed. Recently, simpler and more practical approaches, such as assessments of Cland Na + differences, Cl -:Na + ratio evaluation, and base excesschloride (BE Cl ) calculations, have been used (5,6). Duward et al. (6) evaluated acid-base disorders in accordance with pH, pCO 2 , and Clchanges. According to Duward et al. (6), the main reason for the changes in the HCO 3 pool is changes in Cl -. Moreover, Clmust always be interpreted together with Na + , and the simplest method of achieving this interpretation is calculation of the Cl -:Na + ratio. Hypochloremia or hyperchloremia should be considered in accordance with the Cl -:Na + ratio. Regardless of the individual Cland Na + concentrations, the Cl -:Na + ratio may be low or high. This notion makes the contribution of Clto acid-base disorder more comprehensible. It is indicated that a strong ion difference (SID) is related to mortality (7,8). Hypochloremia, hyperchloremia, and dysnatremia are also known to be associated with increased mortality (9-11). Thus, the Cl:Na + ratio can also be associated with increased mortality. In the present study, the relationship between the Cl -:Na + ratio in septic patients at ICU admission and each of the other components of the acid-base balance and ICU mortality was investigated. Material and methods Study designEthics committee approval was obtained from the Acıbadem University Medical Research Council for the present study. A total of 2691 patients admitted to the Acıbadem International Hospital ICU and Ataşehir Memorial ICU between 1 January 2006 and 31 December 2012 were retrospectively evaluated. Patients who were Background/aim: Calculation of the chloride:sodium (Cl -:Na + ) ratio is proposed to enable a quick evaluation of the effect of Cland Na + on the acid-base balance in critically ill patients. In the present study, the relationship of the Cl -:Na + ratio of septic patients with acidbase status and ICU mortality were investigated. Materials and methods:In our two-center study, 434 patients who were diagnosed with sepsis were included. The patients were divided into three groups: low (<0.75), normal (≥0.75, <0.80), and high (≥0.80) Cl -:Na + ratio groups. Patients' demographic data, blood gas values, length of ICU stay, and ICU mortality were recorded. Results:In the low and high groups, ICU mortality was significantly higher than in the normal group (29.3%, 37.1%) (P = 0.005). There was a negative correlation between the Cl:Na + ratio and each of HCO 3 -, standard base excess, and PaCO 2 (r 2 = 0.21, r 2 = 0.19, and r 2 = 0.17) (P < 0.001 for each). In the multivariate analysis, the ICU mortal...

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Mixed Acid–Base Disorders

Acierno¹

2011

Nephrology and Urology of Small Animals

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The value of the chloride:sodium ratio in differentiating the aetiology of metabolic acidosis

Abstract: In metabolic acidosis due to TA, plasma Cl concentration decreases relative to sodium. The Cl:Na ratio is a simple alternative to the AG for detecting TA in this setting.

Cited by 110 publications

References 0 publications

Metabolic acidosis in medical intensive care unit with indicators and their prognostic value- A prospective observational study

Metabolic acidosis in medical intensive care unit with indicators and their prognostic value- A prospective observational study

The effects of the chloride:sodium ratio on acid-base statusand mortality in septic patients

Mixed Acid–Base Disorders

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