Hypoalbuminaemia in critically ill children: incidence, prognosis, and influence on the anion gap. Archives of disease in childhood. [Arch Dis Child] Journal article | | Title | Hypoalbuminaemia in critically ill children: incidence, prognosis, and influence on the anion gap. | | Author(s) | Durward A, Mayer A, Skellett S, Taylor D, Hanna S, Tibby SM, Murdoch IA | | Institution | Paediatric Intensive Care Unit, Guy's Hospital, London, UK. adurward@doctors.org.uk | | Source | Arch Dis Child 2003 May; 88(5):419-22. | | MeSH | Acid-Base Imbalance
Child
Child, Preschool
Critical Illness
Humans
Hypoalbuminemia
Infant
Length of Stay
Prognosis
Prospective Studies
Respiration, Artificial
Serum Albumin
| | Abstract | AIMS: Hypoalbuminaemia has significance in adult critical illness as an independent predictor of mortality. In addition, the anion gap is predominantly due to the negative charge of albumin, thus hypoalbuminaemia may lead to its underestimation. We examine this phenomenon in critically ill children, documenting the incidence, early evolution, and prognosis of hypoalbuminaemia (<33 g/l), and quantify its influence on the anion gap.
METHODS: Prospective descriptive study of 134 critically ill children in the paediatric intensive care unit (ICU). Paired arterial blood samples were taken at ICU admission and 24 hours later, from which blood gases, electrolytes, and albumin were measured. The anion gap (including potassium) was calculated and then corrected for albumin using Figge's formula.
RESULTS: The incidence of admission hypoalbuminaemia was 57%, increasing to 76% at 24 hours. Neither admission hypoalbuminaemia, nor extreme hypoalbuminaemia (<20 g/l) predicted mortality; however, there was an association with increased median ICU stay (4.9 v 3.6 days). After correction for albumin the incidence of a raised anion gap (>18 mEq/l) increased from 28% to 44% in all samples (n = 263); this discrepancy was more pronounced in the 103 samples with metabolic acidosis (38% v 73%). Correction produced an average increase in the anion gap of 2.7 mEq/l (mean bias), with limits of agreement of +/-3.7 mEq/l.
CONCLUSION: Admission hypoalbuminaemia is common in critical illness, but is not an independent predictor of mortality. However, failure to correct the anion gap for albumin may underestimate the true anion gap, producing error in the interpretation of acid-base abnormalities. This may have treatment implications. | | Language | eng | | Pub Type(s) | Journal Article
| | PubMed ID | 12716714 |
|
|
| |
Advertise on this site.
| | |
|
