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Evaluation of acid-base status in patients admitted to ED-physicochemical vs traditional approaches.

Abstract

BACKGROUND

The aim of this study is to evaluate the value of physicochemical, base excess (BE), and plasma bicarbonate concentration ([HCO3(-)]) approaches on the assessment of acid-base status in patients presented to the emergency department (ED).

METHODS

Upon presentation at ED, patients whose arterial blood was deemed in need of analysis were studied. Arterial blood gases, serum electrolytes, and proteins were measured and used to derive [HCO3(-)], BE, anion gap (AG), AG adjusted for albumin (AGadj), strong ion difference, strong ion gap (SIG) and SIG corrected for water excess/deficit (SIGcor). In each patient the acid-base status was evaluated using the BE, [HCO3(-)], and physicochemical approaches.

RESULTS

A total of 365 patients were studied. Compared with BE (n = 202) and [HCO3(-)] (n = 151), physicochemical approach (n = 279) identified significantly more patients with metabolic acid-base disturbances (P < .0001). Significantly fewer patients with unmeasured anions acidosis were identified with AGadj than with SIGcor (164 vs 230; P < .0001). On the basis of BE, 75 patients had normal acid-base balance, and 65 (87%) of them exhibited at least 1 hidden acid-base disturbance, identified by the physicochemical approach. The corresponding values with [HCO3(-)] approach were 108 and 95 (88%) patients. When patients with high AGadj were excluded, 44 patients with BE and 67 with [HCO3(-)] approach had normal acid-base status, and most of them exhibited at least 1 acid-base disturbance with the physicochemical approach, whereas 12 and 21 patients, respectively, had high SIGcor.

CONCLUSION

Compared with the BE and [HCO3(-)] methods, the physicochemical approach has a better diagnostic accuracy to identify metabolic acid-base disturbances.

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  • Authors+Show Affiliations

    ,

    Intensive Care Medicine Department, University Hospital of Heraklion, Medical School, University of Crete, Heraklion, Crete, 71110 Greece. Electronic address: kantonogiannaki@gmail.com.

    ,

    Pulmonary Department, University Hospital of Heraklion, Medical School, University of Crete, Heraklion, Crete, 71110 Greece. Electronic address: mitrouska@med.uoc.gr.

    ,

    Intensive Care Medicine Department, University Hospital of Heraklion, Medical School, University of Crete, Heraklion, Crete, 71110 Greece. Electronic address: vamargian@gmail.com.

    Intensive Care Medicine Department, University Hospital of Heraklion, Medical School, University of Crete, Heraklion, Crete, 71110 Greece. Electronic address: georgop@med.uoc.gr.

    Source

    MeSH

    Acid-Base Equilibrium
    Acid-Base Imbalance
    Aged
    Aged, 80 and over
    Anions
    Bicarbonates
    Blood Gas Analysis
    Chlorides
    Cohort Studies
    Emergency Service, Hospital
    Female
    Humans
    Magnesium
    Male
    Middle Aged
    Models, Chemical
    Potassium
    Prospective Studies
    Serum Albumin
    Sodium
    Water-Electrolyte Balance
    Water-Electrolyte Imbalance

    Pub Type(s)

    Journal Article
    Observational Study

    Language

    eng

    PubMed ID

    25592251