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Taka H, Douguchi T, Miyamoto A, Shimizu K, Kimura S, Iwasaki T, Kanazawa T, Morimatsu H. Modified del Nido cardioplegia is associated with low incidence of low main strong ion difference and hyperchloremia in pediatric patients after cardiac surgery. J Anesth 2024; 38:244-253. [PMID: 38358399 DOI: 10.1007/s00540-023-03306-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 12/26/2023] [Indexed: 02/16/2024]
Abstract
PURPOSE The aims of this study were (1) to determine the associations of cardioplegic solutions with postoperative main strong ion difference (mSID), which is the difference between sodium ion concentration and chloride ion concentration ([Cl-]) and (2) to determine the associations of cardioplegic solutions with markers of organ dysfunction. METHODS In this retrospective cohort study, patients aged <5 years who underwent cardiac surgery in a tertiary teaching hospital were included. Patients were classified on the basis of the type of cardioplegic solution: modified del Nido cardioplegia (mDNC) and conventional cardioplegia (CC). The effects of mDNC on postoperative mSID and markers of organ functions were examined using propensity-matched analysis. RESULTS A total of 500 cases were included. mDNC solution was used in 163 patients (32.6%). After propensity score matching, patients in the mDNC group (n = 152) had significantly higher minimum mSID [28 (26, 30) mEq/L vs. 27 (25, 29) mEq/L, p = 0.02] and lower maximum [Cl-] [112 (109, 114) mEq/L vs. 113 (111, 117) mEq/L, p < 0.001] than patients in the CC group (n = 304). The incidences of low mSID and hyperchloremia in the mDNC group were significantly lower than those in the CC group (63.8 vs. 75.7%, p = 0.01 and 63.2 vs. 79.3%, p < 0.001, respectively). There was no significant difference in the incidence of postoperative acute kidney injury and B-type natriuretic peptide level between the two groups. CONCLUSION The use of modified del Nido cardioplegia may reduce the incidence of abnormal mSID and hyperchloremia compared with the use of a chloride-rich cardioplegic solution.
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Affiliation(s)
- Hiroshi Taka
- Department of Clinical Engineering Center, Okayama University Hospital, 2-5-1, Shikata-Cho, Kita-Ku, Okayama, 700-8558, Japan
| | - Takuma Douguchi
- Department of Clinical Engineering Center, Okayama University Hospital, 2-5-1, Shikata-Cho, Kita-Ku, Okayama, 700-8558, Japan
| | - Ayako Miyamoto
- Department of Clinical Engineering Center, Okayama University Hospital, 2-5-1, Shikata-Cho, Kita-Ku, Okayama, 700-8558, Japan
| | - Kazuyoshi Shimizu
- Department of Anesthesiology and Resuscitology, Okayama University Hospital, 2-5-1, Shikata-Cho, Kita-Ku, Okayama, 700-8558, Japan.
| | - Satoshi Kimura
- Department of Anesthesiology and Resuscitology, Okayama University Hospital, 2-5-1, Shikata-Cho, Kita-Ku, Okayama, 700-8558, Japan
| | - Tatsuo Iwasaki
- Department of Anesthesiology and Resuscitology, Okayama University Hospital, 2-5-1, Shikata-Cho, Kita-Ku, Okayama, 700-8558, Japan
| | - Tomoyuki Kanazawa
- Department of Anesthesiology and Resuscitology, Okayama University Hospital, 2-5-1, Shikata-Cho, Kita-Ku, Okayama, 700-8558, Japan
| | - Hiroshi Morimatsu
- Department of Anesthesiology and Resuscitology, Okayama University Hospital, 2-5-1, Shikata-Cho, Kita-Ku, Okayama, 700-8558, Japan
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Umbilical Cord Unmeasured Anions and Tissue Acid Levels According to Stewart’s Method in Term Newborn Infants and the Impact of Delivery Mode on these parameters. JOURNAL OF CONTEMPORARY MEDICINE 2020. [DOI: 10.16899/jcm.763338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Chaiyakulsil C, Mueanpaopong P, Lertbunrian R, Chutipongtanate S. Connecting two worlds: positive correlation between physicochemical approach with blood gases and pH in pediatric ICU setting. BMC Res Notes 2019; 12:742. [PMID: 31706359 PMCID: PMC6842531 DOI: 10.1186/s13104-019-4770-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 10/29/2019] [Indexed: 01/12/2023] Open
Abstract
Objective Physicochemical approach such as strong ion difference provides a novel concept in understanding and managing acid–base disturbance in patients. However, its application in pediatrics is limited. This study aimed to evaluate a correlation between the physicochemical approach and blood gas pH for acid–base determination in critically ill pediatric patients. Results A total of 130 pediatric patients were included, corresponding to 1338 paired measures for analyses. Of these, the metabolic subgroup (743 paired measures) was defined. Among physicochemical parameters, the effective strong ion difference showed the best correlation with the blood gas pH in the whole cohort (R = 0.398; p < 0.001) and the metabolic subgroup (R = 0.685; p < 0.001). Other physicochemical parameters (i.e., the simplified and the apparent strong ion difference, the strong ion gap, and the sodium chloride gap) and the traditional measures (standard base excess, lactate, chloride and bicarbonate) also showed varying degrees of correlation. This study revealed the positive correlation between physicochemical parameters and the blood gas pH, serving as a connecting dot for further investigations using physicochemical approach to evaluate acid–base disturbance in pediatric population.
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Affiliation(s)
- Chanapai Chaiyakulsil
- Division of Pediatric Critical Care, Department of Pediatrics, Faculty of Medicine, Thammasat University, Bangkok, Thailand
| | - Papope Mueanpaopong
- Department of Pediatrics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Rojjanee Lertbunrian
- Division of Pediatric Critical Care, Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
| | - Somchai Chutipongtanate
- Pediatric Translational Research Unit, Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand. .,Section for Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
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Zingg T, Bhattacharya B, Maerz LL. Metabolic acidosis and the role of unmeasured anions in critical illness and injury. J Surg Res 2017; 224:5-17. [PMID: 29506851 DOI: 10.1016/j.jss.2017.11.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Revised: 09/04/2017] [Accepted: 11/03/2017] [Indexed: 12/31/2022]
Abstract
Acid-base disorders are frequently present in critically ill patients. Metabolic acidosis is associated with increased mortality, but it is unclear whether as a marker of the severity of the disease process or as a direct effector. The understanding of the metabolic component of acid-base derangements has evolved over time, and several theories and models for precise quantification and interpretation have been postulated during the last century. Unmeasured anions are the footprints of dissociated fixed acids and may be responsible for a significant component of metabolic acidosis. Their nature, origin, and prognostic value are incompletely understood. This review provides a historical overview of how the understanding of the metabolic component of acid-base disorders has evolved over time and describes the theoretical models and their corresponding tools applicable to clinical practice, with an emphasis on the role of unmeasured anions in general and several specific settings.
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Affiliation(s)
- Tobias Zingg
- Department of Surgery, Section of General Surgery, Trauma & Surgical Critical Care, Yale University School of Medicine, New Haven, Connecticut.
| | - Bishwajit Bhattacharya
- Department of Surgery, Section of General Surgery, Trauma & Surgical Critical Care, Yale University School of Medicine, New Haven, Connecticut
| | - Linda L Maerz
- Department of Surgery, Section of General Surgery, Trauma & Surgical Critical Care, Yale University School of Medicine, New Haven, Connecticut
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Özdemir Z, Törer B, Hanta D, Cetinkaya B, Gulcan H, Tarcan A. Determination of tissue hypoxia by physicochemical approach in premature anemia. Pediatr Neonatol 2017; 58:425-429. [PMID: 28395879 DOI: 10.1016/j.pedneo.2016.09.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Revised: 07/10/2016] [Accepted: 09/14/2016] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND Anemia is a common problem in premature infants and its most rapid and effective therapy is erythrocyte transfusion. However, owing to inherent risks of transfusion in this population, transfusions should be administered only when adequate oxygen delivery to tissues is impaired. The aim of this study was to determine tissue acid levels using Stewart method in an attempt to evaluate the tissue oxygenation level and thereby the accuracy of transfusion timing. METHODS This study included 47 infants delivered at gestational age below 34 weeks who required erythrocyte transfusion for premature anemia. Strong ion gap (SIG), unmeasurable anions (UMA), tissue acid levels (TA), and Cl/Na ratios were calculated before and after transfusion. RESULTS The mean birth weight and gestational age of the study population were 1210 ± 365 g and 29.2 ± 2.7 weeks, respectively. Tissue acid levels were increased (TA ≥ 4) and tissue hypoxia developed in 10 (16.6%) of 60 erythrocyte transfusions administered according to the restrictive transfusion approach. The patients were divided into two groups according to tissue acid levels as low (<4) and high (≥4) tissue acid groups. The group with tissue hypoxia (TA ≥ 4) had significantly higher UMA levels but a significantly lower Cl/Na ratio; and UMA levels decreased and Cl/Na ratio increased after transfusion in this group. Tissue hypoxia secondary to anemia was shown to be improved by erythrocyte transfusion. CONCLUSION The results of the present study suggest that the determination of the level of tissue hypoxia by the Stewart approach may be an alternative to restrictive transfusion guidelines for timing of transfusion in premature anemia. It also showed that a low Cl/Na ratio can be used as a simple marker of tissue hypoxia.
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Affiliation(s)
- Zeliha Özdemir
- Baskent University Faculty of Medicine, Department of Neonatology, Seyhan, Adana, Turkey
| | - Birgin Törer
- Baskent University Faculty of Medicine, Department of Neonatology, Seyhan, Adana, Turkey.
| | - Deniz Hanta
- Baskent University Faculty of Medicine, Department of Neonatology, Seyhan, Adana, Turkey
| | - Bilin Cetinkaya
- Baskent University Faculty of Medicine, Department of Neonatology, Seyhan, Adana, Turkey
| | - Hande Gulcan
- Baskent University Faculty of Medicine, Department of Neonatology, Seyhan, Adana, Turkey
| | - Aylin Tarcan
- Baskent University Faculty of Medicine, Department of Neonatology, Seyhan, Adana, Turkey
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Atalan HK, Güçyetmez B. The effects of the chloride:sodium ratio on acid-base statusand mortality in septic patients. Turk J Med Sci 2017; 47:435-442. [PMID: 28425228 DOI: 10.3906/sag-1602-100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Accepted: 07/07/2016] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND/AIM Calculation of the chloride:sodium (Cl-:Na+) ratio is proposed to enable a quick evaluation of the effect of Cl- and 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 acid-base 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 HCO3-, standard base excess, and PaCO2 (r2 = 0.21, r2 = 0.19, and r2 = 0.17) (P < 0.001 for each). In the multivariate analysis, the ICU mortality was increased 2.6-fold (1.2-5.8) by low Cl-:Na+ ratio (P = 0.019). CONCLUSION The Cl-:Na+ ratio is a useful parameter for showing the relationship between Cl- and Na+ and their impact on acid-base status. Low Cl-:Na+ ratio at ICU admission can be used as a prognostic indicator for increased ICU mortality in septic patients.
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Affiliation(s)
| | - Bülent Güçyetmez
- Department of Anesthesiology, Acıbadem University School of Medicine, İstanbul, Turkey
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Viu J, Armengou L, Ríos J, Muñoz A, Jose-Cunilleras E. Simplified strong ion difference approach to acid-base balance in healthy foals. J Vet Emerg Crit Care (San Antonio) 2016; 26:549-58. [DOI: 10.1111/vec.12488] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Revised: 11/03/2014] [Accepted: 12/08/2014] [Indexed: 11/28/2022]
Affiliation(s)
- Judit Viu
- Servei de Medicina Interna Equina, Unitat equina FHCV, i Departament de Medicina i Cirurgia Animals, Facultat de Veterinària; Universitat Autònoma de Barcelona; Barcelona Spain
| | - Lara Armengou
- Servei de Medicina Interna Equina, Unitat equina FHCV, i Departament de Medicina i Cirurgia Animals, Facultat de Veterinària; Universitat Autònoma de Barcelona; Barcelona Spain
| | - José Ríos
- the Laboratory of Biostatistics and Epidemiology, Universitat Autònoma de Barcelona, and Statistics and Methodology Support Unit, IDIBAPS; Hospital Clínic; Barcelona Spain
| | - Anna Muñoz
- the Department of Animal Medicine and Surgery, Equine Sport Medicine Center, CEMEDE, School of Veterinary Medicine; University of Córdoba; Spain
| | - Eduard Jose-Cunilleras
- Servei de Medicina Interna Equina, Unitat equina FHCV, i Departament de Medicina i Cirurgia Animals, Facultat de Veterinària; Universitat Autònoma de Barcelona; Barcelona Spain
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Zeugswetter FK, Pagitz M, Friedrich MS. Hypochloremia in cats - prevalence and associated diseases. TIERAERZTLICHE PRAXIS AUSGABE KLEINTIERE HEIMTIERE 2016; 44:237-44. [PMID: 27074163 DOI: 10.15654/tpk-150647] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Accepted: 01/07/2016] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To describe the prevalence and possible causes of hypochloremia in the local hospital cat population. MATERIAL AND METHODS Retrospective study consisting of two parts. Data were collected from the local electronic medical records database using the search terms "chloride" and "cats" (part A), and "blood gas analysis" and "cats" (part B). The medical records of the hypochloremic cats were then reviewed to determine prior treatment or infusions and to identify major underlying disease processes. Part A included an age and gender matched non-hypochloremic control group, whereas in part B acid-base status was assessed. RESULTS Hypochloremia was detected in 367 (27%) of 1363 blood samples. The application of a correction formula to adjust for free water changes decreased the number of hypochloremic cats to 253 (19%). Only a minority had received glucocorticoids or loop diuretics and the prevalence of vomiting was 44%. Common associated disorders were gastrointestinal and respiratory diseases, as well as azotemia and diabetes mellitus. Polyuria/polydipsia, dehydration, prednisolone or furosemide pretreatment, azotemia and diabetes mellitus increased, whereas fluid therapy and the diagnosis of neoplasia decreased the prevalence of hypochloremia. An inverse correlation was found between corrected chloride and standardized base excess (rs = -0.597, p = 0.001) as well as anion gap (rs = -0.4, p = 0.026). 99% of the hypochloremic cats had derangements of acid-base balance. CONCLUSION Hypochloremia is a common electrolyte disorder in the local cat population. The correction formula is necessary to adjust for changes in plasma osmolality. Although associated with metabolic alkalosis, most of the hypochloremic cats have a normal or decreased pH. The inverse correlation of chloride and anion gap als well as the high proportion of azotemic or diabetic animals support the concept of compensatory acidosis induced hypochloremia. CLINICAL RELEVANCE Hypochloremia should prompt the clinician to performe blood-gas analysis. Diabetes mellitus (especially ketoacidosis) and renal disease should be included in current algorithms for the evaluation of hypochloremic patients.
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Affiliation(s)
- Florian K Zeugswetter
- Florian K. Zeugswetter, University of Veterinary Medicine Vienna, University Clinic for Small Animals, Internal Medicine, Veterinärplatz 1, 1210 Vienna, Austria,
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Meddour M, Lemyze M, Thévenin D, Mallat J. Les utilisations du trou anionique plasmatique corrigé pour le diagnostic de l’acidose métabolique. MEDECINE INTENSIVE REANIMATION 2015. [DOI: 10.1007/s13546-015-1097-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Hyponatremia in spinal cord injury patients: new insight into differentiating between the dilution and depletion forms. Spinal Cord 2015; 53:291-6. [PMID: 25582714 DOI: 10.1038/sc.2014.240] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2014] [Revised: 11/24/2014] [Accepted: 11/29/2014] [Indexed: 11/08/2022]
Abstract
STUDY DESIGN This is a retrospective study. OBJECTIVES The objectives of this study were to present a new model for differentiating between the dilution and depletion forms of hyponatremia in patients in the postacute phase after spinal cord injury (SCI), and to identify possible etiological factors contributing to hyponatremia in these patients. SETTING University Hospital Motol, Prague, Czech Republic. METHODS Eighty-seven of 352 patients hospitalized in 2008-2012 in the Spinal Cord Unit were hyponatremic. Seventy-four patients had SNa+=130-135 mmol l(-1) and 13 patients had SNa+ below 130 mmol l(-1). We propose a simple model of an electrolyte solution in which the Na(+) concentration is higher than the Cl(-) concentration, making it possible to compare the effects of dilution and depletion of Na(+) and Cl(-) on the Na(+) concentration. The depletion of Na(+) and Cl(-) leads to a significant increase in the Na(+)/Cl(-) ratio, with the Na(+)-Cl(-) value remaining unchanged. Dilution with water results in a decrease of Na(+)-Cl(-) with the Na(+)/Cl(-) ratio remaining unchanged. RESULTS In patients with SNa+ below 130 mmol l(-1), hyponatremia was consistent with the depletion model in 46% and with the dilution model in 32%. In patients with SNa+ ranging between 130 and 135 mmol l(-1), the respective rates were 34 and 12%. CONCLUSION Examination of SNa+-SCl- and SNa+/SCl- in patients with SCI could be helpful in considering whether hyponatremia is consistent either with the NaCl dilution model or with the NaCl depletion model. Further studies are needed for more accurate interpretation of the results, particularly with respect to volume and acid-base disorders.
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Adeva-Andany MM, Carneiro-Freire N, Donapetry-García C, Rañal-Muíño E, López-Pereiro Y. The importance of the ionic product for water to understand the physiology of the acid-base balance in humans. BIOMED RESEARCH INTERNATIONAL 2014; 2014:695281. [PMID: 24877130 PMCID: PMC4022011 DOI: 10.1155/2014/695281] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Revised: 03/31/2014] [Accepted: 04/04/2014] [Indexed: 12/13/2022]
Abstract
Human plasma is an aqueous solution that has to abide by chemical rules such as the principle of electrical neutrality and the constancy of the ionic product for water. These rules define the acid-base balance in the human body. According to the electroneutrality principle, plasma has to be electrically neutral and the sum of its cations equals the sum of its anions. In addition, the ionic product for water has to be constant. Therefore, the plasma concentration of hydrogen ions depends on the plasma ionic composition. Variations in the concentration of plasma ions that alter the relative proportion of anions and cations predictably lead to a change in the plasma concentration of hydrogen ions by driving adaptive adjustments in water ionization that allow plasma electroneutrality while maintaining constant the ionic product for water. The accumulation of plasma anions out of proportion of cations induces an electrical imbalance compensated by a fall of hydroxide ions that brings about a rise in hydrogen ions (acidosis). By contrast, the deficiency of chloride relative to sodium generates plasma alkalosis by increasing hydroxide ions. The adjustment of plasma bicarbonate concentration to these changes is an important compensatory mechanism that protects plasma pH from severe deviations.
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Affiliation(s)
| | | | | | - Eva Rañal-Muíño
- Hospital General Juan Cardona, C/ Pardo Bazán s/n, Ferrol, 15406 La Coruña, Spain
| | - Yosua López-Pereiro
- Hospital General Juan Cardona, C/ Pardo Bazán s/n, Ferrol, 15406 La Coruña, Spain
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Havlin J, Matousovic K, Schuck O, Charvat J, Horackova M. The use of sodium-chloride difference and chloride-sodium ratio in the evaluation of metabolic acidosis in critically ill patients. Eur J Pediatr 2012; 171:1719; author reply 1721-2. [PMID: 23001466 DOI: 10.1007/s00431-012-1833-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2012] [Accepted: 09/04/2012] [Indexed: 11/25/2022]
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