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Dougherty N, Gartrell B, Walsh V, Chatterton J, Lenting B. SERIAL CHANGES IN METABOLIC ACID-BASE STATUS IN THREE SPECIES OF ANESTHETIZED CAPTIVE LARGE FELID. J Zoo Wildl Med 2024; 55:602-610. [PMID: 39255201 DOI: 10.1638/2022-0072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/07/2024] [Indexed: 09/12/2024] Open
Abstract
Determination of acid-base status contributes important information about patient health, including for patients under anesthesia. There is a paucity of information about the determinants of acid-base status of large felids managed under anesthesia, and advancement of such knowledge may contribute to patient safety. This study serially monitored the individual metabolic acid-base status of 11 large felids, including lions (Panthera leo), tigers (Panthera tigris), and cheetahs (Acinonyx jubatus), under general anesthesia. We analyzed the contributions of measured strong ions (sodium, chloride, potassium, lactate), weak acids and buffers (albumin, phosphate and bicarbonate), and unmeasured anions to standardized extracellular base excess (SBE). A general linear model assessed for species differences in these parameters, with time since immobilization, SBE, and mean arterial pressure as covariates. By employing a Stewart-based analytical approach, it was possible to separate chloremic and unmeasured anion contributions to metabolic acid base status. This provided a basis for identifying mixed metabolic processes, generating differentials for underlying causes. Using normal acid base parameters for domestic felids, metabolic acidosis was found to be prevalent. Frequent evidence of unmeasured anion accumulation was also found, with unmeasured anions occasionally exceeding 5mmol/L. These findings warrant further inquiry into the drivers and clinical significance of metabolic acidosis and unmeasured anion accumulations in anesthetized large felids, encouraging further anion identity studies to elucidate possible causes. Reference ranges need to be established for acid-base parameters in large felids as a foundation for interpreting more controlled, prospective research into determinants of metabolic acid-base status in these animals under anesthesia.
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Affiliation(s)
- Nigel Dougherty
- Wildbase Hospital, School of Veterinary Science, Massey University, Palmerston North, Manawatū, Aotearoa New Zealand 4410,
| | - Brett Gartrell
- Wildbase Hospital, School of Veterinary Science, Massey University, Palmerston North, Manawatū, Aotearoa New Zealand 4410
| | - Vicki Walsh
- Department of Anesthesia, School of Veterinary Science, Massey University, Palmerston North, Manawatū, Aotearoa New Zealand 4410
| | - James Chatterton
- New Zealand Centre for Conservation Medicine, Auckland Zoo, Western Springs, Auckland, Aotearoa New Zealand
| | - Baukje Lenting
- The Nest Te Kōhanga, Wellington Zoo, Newtown, Wellington, Aotearoa New Zealand 6021
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Hussain M, Zaki KE, Asef MA, Song H, Treger RM. Unmeasured Organic Anions as Predictors of Clinical Outcomes in Lactic Acidosis due to Sepsis. J Intensive Care Med 2023; 38:975-982. [PMID: 37264611 DOI: 10.1177/08850666231177602] [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] [Indexed: 06/03/2023]
Abstract
Background and Objectives: In lactic acidosis, lactate can only explain 30% of the variance in the anion gap (AG), and the elevated AG not explained by lactate is due to unmeasured organic anions (UOAs). Some studies using less precise surrogates for UOA have suggested that UOA may predict clinical outcomes better than lactate. The aim of this study was to determine whether UOA predicts clinical outcomes better than lactate levels. Design, Setting, Participants, & Measurements: This was a retrospective cohort study of adult ICU patients with sepsis. Baseline AG and albumin measurements were obtained. An albumin-corrected delta AG was calculated. UOAs were estimated using the formula: Delta AG - serum lactate. A multivariate logistic regression model with its respective ROC curve was constructed to explore the relationship between in-hospital mortality, UOA, and lactate. Results: 526 patients were included. In the combined model examining both lactate and UOA, the odds ratio (OR) [95% CI] for predicting ICU length of stay (LOS) was 1.050 [1.029-1.072] and 1.022 [1.009-1.035], respectively; the OR [95% CI] for predicting in-hospital mortality was 1.224 [1.104-1.358] and 0.997 [0.943-1.054], respectively. The ROC curve for in-hospital mortality demonstrated that the Area Under the Curve (AUC) for lactate, UOA, and combined lactate and UOA was 0.7726, 0.7486, and 0.7732, respectively. The AUC for combined lactate and UOA were not statistically significantly higher than the AUC for lactate alone (P .9193). Conclusions: As expected, serum lactate predicted both ICU LOS and in-hospital mortality. UOA did predict ICU LOS, although the reason for this association is not known. UOA did not predict in-hospital mortality based on the OR and the ROC curve's AUC, contrary to some previous studies. However, our study used a more precise quantitative estimate of UOA, including the use of baseline albumin-corrected AG. Prior studies attempting to identify UOA have identified Krebs cycle intermediates including citrate and isocitrate, suggesting that in our study these anions associated with the Krebs cycle contributed to the UOA.
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Affiliation(s)
- Marvi Hussain
- Department of Nephrology and Hypertension, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA, USA
| | - Kirollos E Zaki
- Department of Nephrology and Hypertension, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA, USA
| | - Mark A Asef
- Department of Nephrology and Hypertension, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA, USA
| | - Hubert Song
- Kaiser Permanente Department of Research and Evaluation, Pasadena, CA, USA
| | - Richard M Treger
- Department of Nephrology and Hypertension, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA, USA
- Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA, USA
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3
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Comparison of a modified Story approach to traditional evaluation of acid-base disturbances in patients with shock: a cohort study. J Clin Monit Comput 2021; 36:817-822. [PMID: 33934281 DOI: 10.1007/s10877-021-00713-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 04/23/2021] [Indexed: 10/21/2022]
Abstract
To compare whether the diagnostic evaluation of metabolic acidosis can be improved by using a modified Story method compared to the traditional evaluation in a population of critically ill patients with shock. This prospective cohort study included shock patients admitted to the ICU of a tertiary hospital in Brazil between May 2018 and November 2019. We collected laboratory data necessary for traditional evaluation and the simplified Stewart's method. During the study period, 149 patients were included in the final analysis. Of the 17 patients with a normal SBE and AGcorrected, 13 (76.5%) presented with metabolic acidosis according to the modified Story assessment. Therefore, of the 149 patients included in the study, the traditional approach failed to identify metabolic acidosis that was identified by the modified Story assessment in 13 (8.7%) patients. In addition, the determination of the severity of metabolic acidosis also differed between the two methods by a mean of - 7.8 mEq/L. We found that a modified Story method can identify and quantify metabolic acidosis in patients with disorders that were not revealed by the traditional approach.
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Song I, Cha JK, Oh TK, Lee YJ, Jo YH, Lee D, Min H, Choi YY, Lee EY, Yun M, Lee D. Post-operative alarm signs in the rapid response system and hospital mortality after non-cardiac surgery. Acta Anaesthesiol Scand 2020; 64:1431-1437. [PMID: 32659862 DOI: 10.1111/aas.13668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 06/10/2020] [Accepted: 07/02/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND A variety of rapid response systems (RRSs) based on the systematic assessment of vital signs and laboratory tests have been developed to reduce hospital mortality through the early detection of alarm signs, while deterioration may still be reversible. This study aimed to determine the association between alarm signs and post-operative hospital mortality during post-operative days (POD) 0-3 in patients undergoing non-cardiac surgery. METHODS This retrospective observational study used data from the registry of a single tertiary academic hospital. The study population included patients who were ≥18 years old, admitted between 1 January 2013 and 30 June 2018 for non-cardiac surgery, and subsequently transferred to the general ward. RESULTS A total of 116 329 patients were included in the analysis. Among them, 10 099 patients (8.7%) showed positive alarm criteria and triggered the RRS in the post-operative ward during POD 0-3. In the multivariate logistic regression model, PaO2 <55 mm Hg, SpO2 <90%, and total CO2 <15 mmol/L were associated with a 3.57-, 3.46-, and 12.53-fold increase in post-operative hospital mortality, respectively. Moreover, when compared to the no alarm signs group, patients with 1, 2, 3, and ≥4 alarm signs showed a 2.79-, 2.76-, 6.54-, and 20.02-fold increase in hospital mortality, respectively. CONCLUSION Increased post-operative hospital mortality was found to be associated with alarm signs detected by the RRS during POD 0-3. The post-operative alarm signs detected by the RRS may therefore be useful in determining high-risk patients who require medical interventions in the surgical ward.
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Affiliation(s)
- In‐Ae Song
- Department of Anesthesiology and Pain Medicine Seoul National University Bundang Hospital Seongnam Korea
| | - Jun Kwon Cha
- Department of Emergency Medicine Hallym University Sacred Heart Hospital Anyang Korea
| | - Tak Kyu Oh
- Department of Anesthesiology and Pain Medicine Seoul National University Bundang Hospital Seongnam Korea
| | - Yeon Joo Lee
- Division of Pulmonary and Critical Care Medicine Department of Internal Medicine Seoul National University Bundang Hospital Seongnam Korea
| | - You Hwan Jo
- Department of Emergency Medicine Seoul National University Bundang Hospital Seongnam Korea
| | - Dong‐Seon Lee
- Interdepartment of Critical Care Medicine Seoul National University Bundang Hospital Seongnam Korea
| | - Hyunju Min
- Interdepartment of Critical Care Medicine Seoul National University Bundang Hospital Seongnam Korea
| | - Yun Young Choi
- Interdepartment of Critical Care Medicine Seoul National University Bundang Hospital Seongnam Korea
| | - Eun Young Lee
- Interdepartment of Critical Care Medicine Seoul National University Bundang Hospital Seongnam Korea
| | - Mi‐Ae Yun
- Interdepartment of Critical Care Medicine Seoul National University Bundang Hospital Seongnam Korea
| | - Da‐Yun Lee
- Interdepartment of Critical Care Medicine Seoul National University Bundang Hospital Seongnam Korea
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5
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Gomez DE, Bedford S, Darby S, Palmisano M, MacKay RJ, Renaud DL. Acid-base disorders in sick goats and their association with mortality: A simplified strong ion difference approach. J Vet Intern Med 2020; 34:2776-2786. [PMID: 33140905 PMCID: PMC7694813 DOI: 10.1111/jvim.15956] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 10/23/2020] [Accepted: 10/23/2020] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVES To investigate the acid-base status of sick goats using the simplified strong ion difference (sSID) approach, to establish the quantitative contribution of sSID variables to changes in blood pH and HCO3 - and to determine whether clinical, acid-base, and biochemical variables on admission are associated with the mortality of sick goats. ANIMALS One hundred forty-three sick goats. METHODS Retrospective study. Calculated sSID variables included SID using 6 electrolytes unmeasured strong ions (USI) and the total nonvolatile buffer ion concentration in plasma (Atot ). The relationship between measured blood pH and HCO3 - , and the sSID variables was examined using forward stepwise linear regression. Cox proportional hazard models were constructed to assess associations between potential predictor variables and mortality of goats during hospitalization. RESULTS Hypocapnia, hypokalemia, hyperchloremia, hyperlactatemia, and hyperproteinemia were common abnormalities identified in sick goats. Respiratory alkalosis, strong ion acidosis, and Atot acidosis were acid-base disorders frequently encountered in sick goats. In sick goats, the sSID variables explained 97% and 100% of the changes in blood pH and HCO3 - , respectively. The results indicated that changes in the respiratory rate (<16 respirations per minute), USI, and pH at admission were associated with increased hazard of hospital mortality in sick goats. CONCLUSIONS AND CLINICAL IMPORTANCE The sSID approach is a useful methodology to quantify acid-base disorders in goats and to determine the mechanisms of their development. Clinicians should consider calculation of USI in sick goats as part of the battery of information required to establish prognosis.
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Affiliation(s)
- Diego E. Gomez
- Department of Large Animal Clinical SciencesCollege of Veterinary Medicine, University of FloridaGainesvilleFloridaUSA
- Department of Clinical StudiesOntario Veterinary College, University of GuelphGuelphOntarioCanada
| | - Sofia Bedford
- Department of Clinical StudiesOntario Veterinary College, University of GuelphGuelphOntarioCanada
| | - Shannon Darby
- Department of Large Animal Clinical SciencesCollege of Veterinary Medicine, University of FloridaGainesvilleFloridaUSA
| | - Megan Palmisano
- Department of Large Animal Clinical SciencesCollege of Veterinary Medicine, University of FloridaGainesvilleFloridaUSA
| | - Robert J. MacKay
- Department of Large Animal Clinical SciencesCollege of Veterinary Medicine, University of FloridaGainesvilleFloridaUSA
| | - David L. Renaud
- Department of Population MedicineOntario Veterinary College, University of GuelphGuelphOntarioCanada
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Schaefer JD, Reminga CL, Reineke EL, Drobatz KJ. Evaluation of the rectal-interdigital temperature gradient as a diagnostic marker of shock in dogs. J Vet Emerg Crit Care (San Antonio) 2020; 30:670-676. [PMID: 32965089 DOI: 10.1111/vec.12992] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 12/23/2018] [Accepted: 01/28/2019] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To evaluate the difference in the rectal-interdigital temperature gradient (RITG) between dogs that were presented to an emergency room with clinical signs of shock compared to those without signs of shock, and if this gradient can be used as a diagnostic marker for shock. DESIGN Prospective, single center, observational study conducted from 2014 to 2015. SETTING University veterinary teaching hospital. ANIMALS Twenty dogs with a clinical diagnosis of shock and 60 dogs without a clinical diagnosis of shock (controls). MEASUREMENTS AND MAIN RESULTS Upon presentation to the emergency room and prior to intervention, measurements of rectal temperature, interdigital temperature, ambient temperature, systemic markers of perfusion (capillary refill time [CRT], heart rate [HR], respiratory rate [RR], Doppler blood pressure [DBP], and venous plasma lactate concentration), and venous blood gas analytes were recorded. Dogs were initially determined to be in shock by the attending clinician, and post hoc inclusion criteria were applied. Shock was defined as abnormalities in ≥3 of the 6 following criteria: HR > 120/min, RR > 40/min, CRT > 2 seconds, rectal temperature <37.8°C (100.0°F), venous plasma lactate concentration >2.5 mmol/L, or DBP < 90 mm Hg. Animals with circulatory shock had a significantly increased RITG. An increased RITG was also correlated with individual perfusion parameters including prolonged CRT (ρ = .353, P = 0.0013), tachycardia (ρ = .3485, P = 0.0015), decreased DBP (ρ = -0.6162, P = 0.0003), and shock index (ρ = 0.6168, P = 0.0003). Receiver operator curve analysis indicated a RITG cutoff point of 11.6°F had 90% specificity for the diagnosis of shock (area under the curve = 0.7604). CONCLUSIONS The RITG in this study was associated with a diagnosis of shock and therefore may serve as a diagnostic marker of circulatory shock. Future studies with larger sample sizes to validate the use of temperature gradients and other peripheral perfusion abnormalities as diagnostic and monitoring tools are warranted.
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Affiliation(s)
- Jonathan D Schaefer
- School of Veterinary Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Christin L Reminga
- School of Veterinary Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Erica L Reineke
- School of Veterinary Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Kenneth J Drobatz
- School of Veterinary Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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7
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Rauserova-Lexmaulova L, Vanova-Uhrikova I, Rehakova K. Acid-Base, Electrolyte and Lactate Abnormalities as Well as Gastric Necrosis and Survival in Dogs With Gastric Dilation-Volvulus Syndrome. A Retrospective Study in 75 Dogs. Top Companion Anim Med 2020; 39:100403. [PMID: 32482282 DOI: 10.1016/j.tcam.2020.100403] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 01/02/2020] [Accepted: 01/08/2020] [Indexed: 11/29/2022]
Abstract
Gastric dilation-volvulus (GDV) syndrome in dogs is associated with complex metabolic, acid-base, and electrolyte abnormalities. The aim of this study was to evaluate previously analyzed factors (lactate and BE) in combination with other acid-base parameters (pH, pCO2, bicarbonate, base excess [BE], anion gap [AG], and strong ion difference) and electrolyte concentrations and to evaluate their association with the incidence of gastric necrosis and outcome in dogs with GDV. A retrospective study in 75 dogs with gastric dilation-volvulus syndrome, University veterinary teaching hospital. Medical records were reviewed including signalment, history, initial plasma lactate, acid-base parameters, and electrolyte concentrations, surgical findings and outcome. The overall mortality was 18.7%. In dogs with gastric necrosis, higher initial plasma lactate (median 5.84 vs. 3.36 mmol/L) and AG (20.7 vs. 16.55 mmol/L) and lower pH (7.29 vs. 7.36), bicarbonate (18.7 vs. 22.9 mmol/L), and BE concentration (-8.1 vs. -1.85 mmol/L) were found compared to dogs without gastric necrosis. Anorganic phosphorus was the only electrolyte investigated for which a significant difference was noted between dogs with and without gastric necrosis (1.93 vs. 1.39 mmol/L). The initial plasma lactate concentration (3.36 mmol/L vs. 9.68 mmol/L) and AG (16.8 vs. 20.95 mmol/L) were lower in survivors than nonsurvivors. Survivors had higher pH (7.35 vs. 7.27), bicarbonate concentrations (22.9 vs. 17.35 mmol/L), and BE (-1.9 vs. -9.55 mmol/L) compared to nonsurvivors. Anorganic phosphorus was ultimately the only electrolyte with a significant difference between survivors and nonsurvivors (1.4 vs. 1.84 mmol/L). A multivariate logistic regression model of combination lactate, pH, bicarbonate, BE, AG, and anorganic phosphorus identified pH ≤7.331 and bicarbonate as factors independently associated with gastric necrosis. Similarly, pH ˃7.331, bicarbonate and anorganic phosphorus were independently associated with outcome. Higher initial plasma lactate, AG and anorganic phosphorus levels, and lower pH, BE and bicarbonate concentrations were found in GDV dogs with gastric necrosis. Similarly, initially higher plasma lactate, AG and anorganic phosphorus concentrations, and lower pH, BE and bicarbonate were found in GDV dogs who required euthanasia or who died after surgery. Of these parameters, pH and bicarbonate were strongly and independently associated with gastric necrosis, and pH, bicarbonate and phosphorus were independently associated with outcome.
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Affiliation(s)
- Leona Rauserova-Lexmaulova
- Department of Surgery and Orthopedics, Small Animal Clinic, Faculty of Veterinary Medicine, University of Veterinary and Pharmaceutical Sciences Brno, Brno, Czech Republic.
| | - Ivana Vanova-Uhrikova
- Small Animal Clinical Laboratory, Faculty of Veterinary Medicine, University of Veterinary and Pharmaceutical Sciences Brno, Brno, Czech Republic
| | - Kristina Rehakova
- Small Animal Clinical Laboratory, Faculty of Veterinary Medicine, University of Veterinary and Pharmaceutical Sciences Brno, Brno, Czech Republic
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Kirberger RM, Leisewitz AL, Rautenbach Y, Lim CK, Stander N, Cassel N, Arnot L, deClercq M, Burchell R. Association between computed tomographic thoracic injury scores and blood gas and acid-base balance in dogs with blunt thoracic trauma. J Vet Emerg Crit Care (San Antonio) 2019; 29:373-384. [PMID: 31231948 DOI: 10.1111/vec.12863] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Revised: 06/21/2017] [Accepted: 06/28/2017] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To determine the association between thoracic injuries evaluated by computed tomography (CT) and arterial blood gas and acid-base status in dogs with blunt thoracic trauma caused by motor vehicle accidents. DESIGN Prospective observational clinical study. SETTING University teaching hospital. ANIMALS Thirty-one client owned traumatized dogs and 15 healthy dogs. PROCEDURES All trauma group dogs underwent a CT scan and simultaneous arterial blood gas analysis within 24 hours, but not before 4 hours, after the traumatic incident within a 45-month enrollment period. MEASUREMENTS AND MAIN RESULTS Thorax injuries were classified as pulmonary, pleural space, or rib cage and each of these components was scored for severity using a CT composite pulmonary, pleural, and rib score. The trauma group arterial blood gas and acid-base status were evaluated for statistical difference from the control group. The pulmonary-arterial oxygen pressure was significantly lower in the trauma group compared to the control group that was supported by significant differences in the calculated variables of arterial blood oxygenation as well. There was also a significant correlation between the composite lung score and pleural score and the variables of arterial oxygen status. The pulmonary-arterial carbon dioxide pressure was not significantly different to any of the thoracic injury variables indicating normal alveolar ventilation. Acid-base imbalances were generally mild, insignificant, and variable. CONCLUSIONS AND CLINICAL RELEVANCE Blunt thoracic trauma causes significant pulmonary and pleural injury and the blood oxygen economy is significantly affected by this. The functional measures of arterial blood oxygenation were well correlated with thoracic CT pathology. Alveolar ventilation was mostly spared but a clinically significant ventilation perfusion mismatch was present.
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Affiliation(s)
- Robert M Kirberger
- Faculty of Veterinary Science, Department of Companion Animal Clinical Studies, University of Pretoria, Onderstepoort, South Africa
| | - Andrew L Leisewitz
- Faculty of Veterinary Science, Department of Companion Animal Clinical Studies, University of Pretoria, Onderstepoort, South Africa
| | - Yolandi Rautenbach
- Faculty of Veterinary Science, Department of Companion Animal Clinical Studies, University of Pretoria, Onderstepoort, South Africa
| | - Chee Kin Lim
- Faculty of Veterinary Science, Department of Companion Animal Clinical Studies, University of Pretoria, Onderstepoort, South Africa
| | - Nerissa Stander
- Faculty of Veterinary Science, Department of Companion Animal Clinical Studies, University of Pretoria, Onderstepoort, South Africa
| | - Nicky Cassel
- Faculty of Veterinary Science, Department of Companion Animal Clinical Studies, University of Pretoria, Onderstepoort, South Africa
| | - Luke Arnot
- Faculty of Veterinary Science, Department of Companion Animal Clinical Studies, University of Pretoria, Onderstepoort, South Africa
| | - Marizelle deClercq
- Faculty of Veterinary Science, Department of Companion Animal Clinical Studies, University of Pretoria, Onderstepoort, South Africa
| | - Richard Burchell
- Veterinary and Biomedical Sciences, James Cook University, Townsville, Australia
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9
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Walton RAL, Hansen BD. Venous oxygen saturation in critical illness. J Vet Emerg Crit Care (San Antonio) 2018; 28:387-397. [PMID: 30071148 DOI: 10.1111/vec.12749] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Accepted: 01/03/2017] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To review clinically relevant features of systemic oxygen delivery and consumption and the technique and use of venous oxygenation monitoring in human and veterinary medicine. DATA SOURCES Veterinary and human peer-reviewed medical literature including scientific reviews, clinical and laboratory research articles, and authors' clinical research experience. SUMMARY Measurement of venous hemoglobin oxygen saturation (venous oxygenation) provides insight into the balance between oxygen supply and tissue demand. In people, measurement of venous oxygen saturation can reveal decompensation that is missed by physical examination and other routinely monitored parameters. Therefore, measurement of mixed or central venous oxygenation measurement may help guide therapy and predict outcome of critically ill patients. In dogs, low central venous oxygen saturation has been associated with impaired cardiopulmonary function and poor outcome in several small studies of experimental shock or severe clinical illness, suggesting that monitoring this variable may assist the treatment of severe illness in this species as well. CONCLUSION Venous oxygenation reflects systemic oxygenation status and can be used to guide treatment and estimate prognosis in critically ill patients. Measurement of venous oxygenation in veterinary patients is feasible and is a potentially valuable tool in the management of patients with severe disease. This review is intended to increase the understanding and awareness of the potential role of venous oxygen measurement in veterinary patients.
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Affiliation(s)
- Rebecca A L Walton
- Department of Clinical Sciences, North Carolina State University, College of Veterinary Medicine, Raleigh, NC, 27607
| | - Bernie D Hansen
- Department of Clinical Sciences, North Carolina State University, College of Veterinary Medicine, Raleigh, NC, 27607
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10
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Drolz A, Horvatits T, Roedl K, Rutter K, Brunner R, Zauner C, Schellongowski P, Heinz G, Funk GC, Trauner M, Schneeweiss B, Fuhrmann V. Acid-base status and its clinical implications in critically ill patients with cirrhosis, acute-on-chronic liver failure and without liver disease. Ann Intensive Care 2018; 8:48. [PMID: 29675709 PMCID: PMC5908779 DOI: 10.1186/s13613-018-0391-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2017] [Accepted: 04/12/2018] [Indexed: 12/21/2022] Open
Abstract
Background Acid–base disturbances are frequently observed in critically ill patients at the intensive care unit. To our knowledge, the acid–base profile of patients with acute-on-chronic liver failure (ACLF) has not been evaluated and compared to critically ill patients without acute or chronic liver disease. Results One hundred and seventy-eight critically ill patients with liver cirrhosis were compared to 178 matched controls in this post hoc analysis of prospectively collected data. Patients with and without liver cirrhosis showed hyperchloremic acidosis and coexisting hypoalbuminemic alkalosis. Cirrhotic patients, especially those with ACLF, showed a marked net metabolic acidosis owing to increased lactate and unmeasured anions. This metabolic acidosis was partly antagonized by associated respiratory alkalosis, yet with progression to ACLF resulted in acidemia, which was present in 62% of patients with ACLF grade III compared to 19% in cirrhosis patients without ACLF. Acidemia and metabolic acidosis were associated with 28-day mortality in cirrhosis. Patients with pH values < 7.1 showed a 100% mortality rate. Acidosis attributable to lactate and unmeasured anions was independently associated with mortality in liver cirrhosis. Conclusions Cirrhosis and especially ACLF are associated with metabolic acidosis and acidemia owing to lactate and unmeasured anions. Acidosis and acidemia, respectively, are associated with increased 28-day mortality in liver cirrhosis. Lactate and unmeasured anions are main contributors to metabolic imbalance in cirrhosis and ACLF. Electronic supplementary material The online version of this article (10.1186/s13613-018-0391-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Andreas Drolz
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria. .,Department of Intensive Care Medicine, University Medical Center, Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
| | - Thomas Horvatits
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria.,Department of Intensive Care Medicine, University Medical Center, Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Kevin Roedl
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria.,Department of Intensive Care Medicine, University Medical Center, Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Karoline Rutter
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria.,Department of Intensive Care Medicine, University Medical Center, Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Richard Brunner
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Christian Zauner
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Peter Schellongowski
- Division of Oncology and Infectious Diseases, Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria
| | - Gottfried Heinz
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Georg-Christian Funk
- Department of Respiratory and Critical Care Medicine, and Ludwig Boltzmann Institute for COPD, Otto-Wagner Hospital, Vienna, Austria
| | - Michael Trauner
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Bruno Schneeweiss
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Valentin Fuhrmann
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria.,Department of Intensive Care Medicine, University Medical Center, Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
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11
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Katirai A, Landau MJ, Berger JM. The utility of abnormal initial arterial blood gas values in determining clinical futility of trauma cases with severe hemorrhage. Am J Emerg Med 2018; 36:1253-1256. [PMID: 29606404 DOI: 10.1016/j.ajem.2018.03.063] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Revised: 03/22/2018] [Accepted: 03/22/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Patients who experience trauma with severe hemorrhage requiring immediate surgery and massive blood transfusion often present with markedly abnormal laboratory values. These cases require valuable resources; however, little is known regarding prognostic factors that correlate with mortality. The purpose of this study was to determine whether abnormal initial arterial blood gas (ABG) pH, a marker for severe blood loss, could serve as a prognostic indicator for these patients. METHODS An IRB approved retrospective study was performed at LAC+USC Medical Center Level I Trauma Center. Data was collected from trauma patients with severe hemorrhage admitted between June 2015 and April 2016 who were immediately admitted to the OR following entry into the ER. Baseline variables of age, sex and mechanism of trauma were collected. The pH readings from the initial three ABG data were obtained, and mortality was determined for each patient. RESULTS We identified 247 patients, 84.2% of which were male. Ages ranged from 1 to 91years (average=38.4). Overall mortality was 13.8%. The average initial pH value for non-survivors (7.10±0.13) was significantly lower than for survivors (7.34±0.07) [p<0.001]. Among patients whose initial three ABG pH values averaged ≤7.15, the survival rate was 8.7%. Ten patients had any single recorded pH value≤6.91. The mortality rate among these patients was 90%. CONCLUSIONS Consideration should be given to initial pH values when resuscitating "red blanket" patients. However, the pH values alone cannot reliably be used to determine clinical futility in individual patients in the early period after injury.
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Affiliation(s)
- Andrew Katirai
- Department of Anesthesiology, Keck School of Medicine of USC, 1520 San Pablo St, Suite 3451, Los Angeles, CA, USA
| | - Mark J Landau
- Department of Anesthesiology, Keck School of Medicine of USC, 1520 San Pablo St, Suite 3451, Los Angeles, CA, USA
| | - Jack M Berger
- Department of Anesthesiology, Keck School of Medicine of USC, 1520 San Pablo St, Suite 3451, Los Angeles, CA, USA.
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12
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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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13
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Lee MY, Yang DK, Kim SJ. Alterations of Mg 2+ After Hemorrhagic Shock. Biol Trace Elem Res 2017; 180:120-126. [PMID: 28315119 DOI: 10.1007/s12011-017-0994-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Accepted: 03/08/2017] [Indexed: 10/19/2022]
Abstract
Hemorrhagic shock is generally characterized by hemodynamic instability with cellular hypoxia and diminishing cellular function, resulting from an imbalance between systemic oxygen delivery and consumption and redistribution of fluid and electrolytes. Magnesium (Mg) is the fourth most abundant cation overall and second most abundant intracellular cation in the body and an essential cofactor for the energy production and cellular metabolism. Data for blood total Mg (tMg; free-ionized, protein-bound, and anion-bound forms) and free Mg2+ levels after a traumatic injury are inconsistent and only limited information is available on hemorrhagic effects on free Mg2+ as the physiologically active form. The aim of this study was to determine changes in blood Mg2+ and tMg after hemorrhage in rats identifying mechanism and origin of the changes in blood Mg2+. Hemorrhagic shock produced significant increases in blood Mg2+, plasma tMg, Na+, K+, Cl-, anion gap, partial pressures of oxygen, glucose, and blood urea nitrogen but significant decreases in RBC tMg, blood Ca2+, HCO3-, pH, partial pressures of carbon dioxide, hematocrit, hemoglobin, total cholesterol, and plasma/RBC ATP. During hemorrhagic shock, K+, anion gap, and BUN showed significant positive correlations with changes in blood Mg2+ level, while Ca2+, pH, and T-CHO correlated to Mg2+ in a negative manner. In conclusion, hemorrhagic shock induced an increase in both blood-free Mg2+ and tMg, resulted from Mg2+ efflux from metabolic damaged cell with acidosis and ATP depletion.
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Affiliation(s)
- Mun-Young Lee
- Department of Occupational Therapy, College of Health Science, Honam University, Kwangju, 62399, Republic of Korea
| | - Dong Kwon Yang
- Department of Veterinary Pharmacology and Toxicology, College of Veterinary Medicine, Chonbuk National University, Iksan Campus, 79 Gobong-ro, Iksan-si, Jeollabuk-do, 54596, Republic of Korea
| | - Shang-Jin Kim
- Department of Veterinary Pharmacology and Toxicology, College of Veterinary Medicine, Chonbuk National University, Iksan Campus, 79 Gobong-ro, Iksan-si, Jeollabuk-do, 54596, Republic of Korea.
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Gomez DE, Lofstedt J, Arroyo LG, Wichtel M, Muirhead T, Stämpfli H, McClure JT. Association of unmeasured strong ions with outcome of hospitalized beef and dairy diarrheic calves. THE CANADIAN VETERINARY JOURNAL = LA REVUE VETERINAIRE CANADIENNE 2017; 58:1086-1092. [PMID: 28966359 PMCID: PMC5603936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Increased systemic concentrations of L-lactate and unmeasured strong ions (USI) are associated with an increased risk of mortality in human neonates and adults suffering from various diseases. This exploratory study aimed to investigate if values of certain acid-base parameters, especially L-lactate and USI, on admission to hospital are associated with mortality in diarrheic calves. Fifty-five calves < 28 days old admitted to 2 teaching hospitals for diagnosis and treatment of diarrhea were included. Admission demographic, physical examination, blood gas and biochemistry analysis, and outcome data were recorded. Admission acid-base values associated with outcome were assessed using multivariable regression modeling. Calves with elevated plasma L-lactate (OR: 1.30, 95% CI: 1.08 to 1.55; P = 0.005) and USI (OR: 1.40, 95% CI: 1.12 to 1.74; P = 0.003) at admission were more likely to die or to be euthanized. This study revealed that elevated concentrations of L-lactate and USI at admission were positively associated with mortality.
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15
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Muir W. Effect of Intravenously Administered Crystalloid Solutions on Acid-Base Balance in Domestic Animals. J Vet Intern Med 2017; 31:1371-1381. [PMID: 28833697 PMCID: PMC5598900 DOI: 10.1111/jvim.14803] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Revised: 06/30/2017] [Accepted: 07/13/2017] [Indexed: 12/28/2022] Open
Abstract
Intravenous fluid therapy can alter plasma acid-base balance. The Stewart approach to acid-base balance is uniquely suited to identify and quantify the effects of the cationic and anionic constituents of crystalloid solutions on plasma pH. The plasma strong ion difference (SID) and weak acid concentrations are similar to those of the administered fluid, more so at higher administration rates and with larger volumes. A crystalloid's in vivo effects on plasma pH are described by 3 general rules: SID > [HCO3-] increases plasma pH (alkalosis); SID < [HCO3-] decreases plasma pH (alkalosis); and SID = [HCO3-] yields no change in plasma pH. The in vitro pH of commercially prepared crystalloid solutions has little to no effect on plasma pH because of their low titratable acidity. Appreciation of IV fluid composition and an understanding of basic physicochemical principles provide therapeutically valuable insights about how and why fluid therapy can produce and correct alterations of plasma acid-base equilibrium. The ideal balanced crystalloid should (1) contain species-specific concentrations of key electrolytes (Na+ , Cl- , K+ , Ca++ , Mg++ ), particularly Na+ and Cl- ; (2) maintain or normalize acid-base balance (provide an appropriate SID); and (3) be isosmotic and isotonic (not induce inappropriate fluid shifts) with normal plasma.
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Affiliation(s)
- W. Muir
- College of Veterinary MedicineLincoln Memorial UniversityHarrogateTN
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16
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Romano TG, Correia MDT, Mendes PV, Zampieri FG, Maciel AT, Park M. Metabolic acid-base adaptation triggered by acute persistent hypercapnia in mechanically ventilated patients with acute respiratory distress syndrome. Rev Bras Ter Intensiva 2017; 28:19-26. [PMID: 27096672 PMCID: PMC4828087 DOI: 10.5935/0103-507x.20160009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2015] [Accepted: 01/22/2016] [Indexed: 01/23/2023] Open
Abstract
Objective Hypercapnia resulting from protective ventilation in acute respiratory
distress syndrome triggers metabolic pH compensation, which is not entirely
characterized. We aimed to describe this metabolic compensation. Methods The data were retrieved from a prospective collected database. Variables
from patients' admission and from hypercapnia installation until the third
day after installation were gathered. Forty-one patients with acute
respiratory distress syndrome were analyzed, including twenty-six with
persistent hypercapnia (PaCO2 > 50mmHg > 24 hours) and 15
non-hypercapnic (control group). An acid-base quantitative physicochemical
approach was used for the analysis. Results The mean ages in the hypercapnic and control groups were 48 ± 18
years and 44 ± 14 years, respectively. After the induction of
hypercapnia, pH markedly decreased and gradually improved in the ensuing 72
hours, consistent with increases in the standard base excess. The metabolic
acid-base adaptation occurred because of decreases in the serum lactate and
strong ion gap and increases in the inorganic apparent strong ion
difference. Furthermore, the elevation in the inorganic apparent strong ion
difference occurred due to slight increases in serum sodium, magnesium,
potassium and calcium. Serum chloride did not decrease for up to 72 hours
after the initiation of hypercapnia. Conclusion In this explanatory study, the results indicate that metabolic acid-base
adaptation, which is triggered by acute persistent hypercapnia in patients
with acute respiratory distress syndrome, is complex. Furthermore, further
rapid increases in the standard base excess of hypercapnic patients involve
decreases in serum lactate and unmeasured anions and increases in the
inorganic apparent strong ion difference by means of slight increases in
serum sodium, magnesium, calcium, and potassium. Serum chloride is not
reduced.
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Affiliation(s)
- Thiago Gomes Romano
- Departamento de Nefrologia, Faculdade de Medicina do ABC, Santo André, SP, Brazil
| | - Mario Diego Teles Correia
- Unidade de Terapia Intensiva, Disciplina de Emergências Clínicas, Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | | | - Fernando Godinho Zampieri
- Unidade de Terapia Intensiva, Disciplina de Emergências Clínicas, Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | | | - Marcelo Park
- Unidade de Terapia Intensiva, Disciplina de Emergências Clínicas, Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
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Gucyetmez B, Atalan HK. Non-lactate strong ion difference: a clearer picture. J Anesth 2016; 30:391-6. [PMID: 26961820 DOI: 10.1007/s00540-016-2158-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2015] [Accepted: 02/21/2016] [Indexed: 11/26/2022]
Abstract
PURPOSE The recommended method for elucidating the effects of strong ions other than lactate on acid-base balance is to calculate the non-lactate strong ion difference (SIDnl). A relationship between HCO3 (-) and SIDnl in hyperchloremic patients has already been demonstrated; in the present study, the relationships between SIDnl, the apparent strong ion difference (SIDa), and mortality at intensive care unit (ICU) admission were investigated. METHODS In our two-center study, 2691 patients admitted to the ICU were retrospectively evaluated, including 1069 critically ill patients. These patients were divided into three subgroups according to their SIDnl levels at admission to the ICU: low (<38 mmol L(-1)), normal (38-40 mmol L(-1)), and high (>40 mmol L(-1)). Patient age, gender, diagnosis, blood gas values, length of ICU stay, and mortality were recorded. RESULTS The low-SIDnl group included 768 patients (71.8 %), the normal-SIDnl group consisted of 127 patients (11.9 %), and the high-SIDnl group contained 174 patients (16.3 %). There was no significant difference in lactate levels among the SIDnl groups (p = 0.635). In a multivariate logistic regression model, likelihood of mortality was increased 1.24-fold (1.20-1.28), 2.56-fold (1.61-4.08) and 2.55-fold (1.003-6.47) by APACHE II, lactate level ≥2mmol L(-) and low SIDnl (p < 0.001, p < 0.001, and p = 0.049, respectively). CONCLUSIONS SIDnl can be used to determine the effects of strong ions other than lactate on SIDa values and acid-base balance. Furthermore, a low SIDnl at ICU admission can be a prognostic indicator of mortality.
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Affiliation(s)
- Bulent Gucyetmez
- Department of Anesthesiology, Acıbadem University School of Medicine, Kerem Aydınlar Kampüsü Kayışdağı Cad. No:32, Ataşehir, 34752, Istanbul, Turkey.
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Frantz TL, Gaski GE, Terry C, Steenburg SD, Zarzaur BL, McKinley TO. The effect of pH versus base deficit on organ failure in trauma patients. J Surg Res 2015; 200:260-5. [PMID: 26233689 DOI: 10.1016/j.jss.2015.07.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Revised: 06/25/2015] [Accepted: 07/01/2015] [Indexed: 01/20/2023]
Abstract
BACKGROUND Base deficit (BD) calculations are affected by trauma-related changes in circulating concentrations of anions after injury. In contrast, pH is a direct measurement that corresponds to hypoperfusion. We hypothesized that changes in pH would more closely correspond to organ dysfunction compared with changes in BD. MATERIALS AND METHODS BD and pH values were collected for the first 48 h after injury from a retrospective cohort of 74 multiply injured adult patients who were admitted to the surgical intensive care unit for a minimum of 1 wk. Mean and extreme (minimum pH and maximum BD) values of pH and BD were determined for day 1 (0-24 h) and for day 2 (24-48 h) after injury. Organ dysfunction was measured by averaging daily sequential organ failure assessment scores over the entire duration of intensive care unit admission. BD and pH values were compared with mean modified sequential organ failure assessment scores by univariate and multivariate linear regression. RESULTS Organ dysfunction corresponded more closely with changes in pH compared with those in BD. Minimum pH and maximum BD showed better correspondence to organ dysfunction compared with mean values. Minimum pH values at 24-48 h had the highest univariate (r(2) = 0.43) correspondence to organ dysfunction. In contrast, mean BD values at 24-48 h showed no correspondence (r(2) = 0.07) to organ dysfunction. Multivariate analysis demonstrated that 24-48 h of minimum pH had the highest numerical effect on organ dysfunction. CONCLUSIONS Correspondence between organ dysfunction and BD deteriorated in contrast to increasing correspondence between organ dysfunction and pH measured within 48 h after injury.
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Affiliation(s)
- Travis L Frantz
- Department of Orthopaedic Surgery, The Ohio State University Hospital, Columbus, Ohio
| | - Greg E Gaski
- Department of Orthopaedic Surgery, Indiana University School of Medicine, IU Health Methodist Hospital, Indianapolis, Indiana
| | - Colin Terry
- Methodist Research Institute, IU Health Methodist Hospital, Indianapolis, Indiana
| | - Scott D Steenburg
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, IU Health Methodist Hospital, Indianapolis, Indiana
| | - Ben L Zarzaur
- Center for Outcomes Research in Surgery, Department of Surgery, Indiana University School of Medicine, IU Health Methodist Hospital, Indianapolis, Indiana
| | - Todd O McKinley
- Department of Orthopaedic Surgery, Indiana University School of Medicine, IU Health Methodist Hospital, Indianapolis, Indiana.
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Pathologic metabolism: an exploratory study of the plasma metabolome of critical injury. J Trauma Acute Care Surg 2015; 78:742-51. [PMID: 25807403 DOI: 10.1097/ta.0000000000000589] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND Severe trauma is associated with massive alterations in metabolism. Thus far, investigations have relied on traditional bioanalytic approaches including calorimetry or nuclear magnetic resonance. However, recent strides in mass spectrometry (MS)-based metabolomics present enhanced analytic opportunities to characterize a wide range of metabolites in the critical care setting. METHODS MS-based metabolomics analyses were performed on plasma samples from severely injured patients' trauma activation field blood and plasma samples obtained during emergency department thoracotomy. These were compared against the metabolic profiles of healthy controls. RESULTS Few significant alterations were observed between trauma activation field blood and emergency department thoracotomy patients. In contrast, we identified trauma-dependent metabolic signatures, which support a state of hypercatabolism, driven by sugar consumption, lipolysis and fatty acid use, accumulation of ketone bodies, proteolysis and nucleoside breakdown, which provides carbon and nitrogen sources to compensate for trauma-induced energy consumption and negative nitrogen balance. Unexpectedly, metabolites of bacterial origin (including tricarballylate and citramalate) were detected in plasma from trauma patients. CONCLUSION In the future, the correlation between metabolomics adaptation and recovery outcomes could be studied by MS-based approaches, and this work can provide a method for assessing the efficacy of alternative resuscitation strategies.
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20
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Cave NJ, Koo ST. Quantitative accuracy of the simplified strong ion equation to predict serum pH in dogs. J Vet Intern Med 2015; 29:781-5. [PMID: 25976610 PMCID: PMC4895425 DOI: 10.1111/jvim.12579] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Revised: 02/02/2015] [Accepted: 02/25/2015] [Indexed: 11/30/2022] Open
Abstract
Background Electrochemical approach to the assessment of acid‐base states should provide a better mechanistic explanation of the metabolic component than methods that consider only pH and carbon dioxide. Hypothesis/Objectives Simplified strong ion equation (SSIE), using published dog‐specific values, would predict the measured serum pH of diseased dogs. Animals Ten dogs, hospitalized for various reasons. Methods Prospective study of a convenience sample of a consecutive series of dogs admitted to the Massey University Veterinary Teaching Hospital (MUVTH), from which serum biochemistry and blood gas analyses were performed at the same time. Serum pH was calculated (Hcal+) using the SSIE, and published values for the concentration and dissociation constant for the nonvolatile weak acids (Atot and Ka), and subsequently Hcal+ was compared with the dog's actual pH(Hmeasured+). To determine the source of discordance between Hcal+ and Hmeasured+, the calculations were repeated using a series of substituted values for Atot and Ka. Results The Hcal+ did not approximate the Hmeasured+ for any dog (P = 0.499, r2 = 0.068), and was consistently more basic. Substituted values Atot and Ka did not significantly improve the accuracy (r2 = 0.169 to <0.001). Substituting the effective SID(Atot−[HCO3−]) produced a strong association between Hcal+ and Hmeasured+ (r2 = 0.977). Conclusions and clinical importance Using the simplified strong ion equation and the published values for Atot and Ka does not appear to provide a quantitative explanation for the acid‐base status of dogs. Efficacy of substituting the effective SID in the simplified strong ion equation suggests the error lies in calculating the SID.
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Affiliation(s)
- N J Cave
- Institute of Veterinary, Animal and Biomedical Sciences, Massey University, Palmerston North, New Zealand
| | - S T Koo
- Department of Clinical Sciences, College of Veterinary Medicine Oregon State University, Corvallis, Oregon, USA
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Sławuta P, Glińska-Suchocka K, Cekiera A. The use of elements of the Stewart model (Strong Ion Approach) for the diagnostics of respiratory acidosis on the basis of the calculation of a value of a modified anion gap (AGm) in brachycephalic dogs. Pol J Vet Sci 2015; 18:217-22. [DOI: 10.1515/pjvs-2015-0027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AbstractApart from the HH equation, the acid-base balance of an organism is also described by the Stewart model, which assumes that the proper insight into the ABB of the organism is given by an analysis of: pCO2, the difference of concentrations of strong cations and anions in the blood serum – SID, and the total concentration of nonvolatile weak acids – Acid total. The notion of an anion gap (AG), or the apparent lack of ions, is closely related to the acid-base balance described according to the HH equation. Its value mainly consists of negatively charged proteins, phosphates, and sulphates in blood. In the human medicine, a modified anion gap is used, which, including the concentration of the protein buffer of blood, is, in fact, the combination of the apparent lack of ions derived from the classic model and the Stewart model. In brachycephalic dogs, respiratory acidosis often occurs, which is caused by an overgrowth of the soft palate, making it impossible for a free air flow and causing an increase in pCO2– carbonic acid anhydride The aim of the present paper was an attempt to answer the question whether, in the case of systemic respiratory acidosis, changes in the concentration of buffering ions can also be seen. The study was carried out on 60 adult dogs of boxer breed in which, on the basis of the results of endoscopic examination, a strong overgrowth of the soft palate requiring a surgical correction was found. For each dog, the value of the anion gap before and after the palate correction procedure was calculated according to the following equation: AG = ([Na+mmol/l] + [K+mmol/l]) – ([Cl−mmol/l]+[HCO3−mmol/l]) as well as the value of the modified AG – according to the following equation: AGm= calculated AG + 2.5 × (albuminsr– albuminsd). The values of AG calculated for the dogs before and after the procedure fell within the limits of the reference values and did not differ significantly whereas the values of AGmcalculated for the dogs before and after the procedure differed from each other significantly. Conclusions: 1) On the basis of the values of AGmobtained it should be stated that in spite of finding respiratory acidosis in the examined dogs, changes in ion concentration can also be seen, which, according to the Stewart theory, compensate metabolic ABB disorders 2) In spite of the fact that all the values used for calculation of AGmwere within the limits of reference values, the values of AGmin dogs before and after the soft palate correction procedure differed from each other significantly, which proves high sensitivity and usefulness of the AGmcalculation as a diagnostic method.
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Hopper K, Epstein SE, Kass PH, Mellema MS. Evaluation of acid-base disorders in dogs and cats presenting to an emergency room. Part 2: Comparison of anion gap, strong ion gap, and semiquantitative analysis. J Vet Emerg Crit Care (San Antonio) 2014; 24:502-8. [DOI: 10.1111/vec.12214] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2013] [Accepted: 07/04/2014] [Indexed: 11/29/2022]
Affiliation(s)
- Kate Hopper
- Departments of Veterinary Surgical and Radiological Sciences; School of Veterinary Medicine; University of California at Davis; Davis CA 95616
| | - Steven E. Epstein
- Departments of Veterinary Surgical and Radiological Sciences; School of Veterinary Medicine; University of California at Davis; Davis CA 95616
| | - Philip H. Kass
- Population, Health and Reproduction; School of Veterinary Medicine; University of California at Davis; Davis CA 95616
| | - Matthew S. Mellema
- Departments of Veterinary Surgical and Radiological Sciences; School of Veterinary Medicine; University of California at Davis; Davis CA 95616
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Williams KB, Christmas AB, Heniford BT, Sing RF, Messick J. Arterial vs venous blood gas differences during hemorrhagic shock. World J Crit Care Med 2014; 3:55-60. [PMID: 24892020 PMCID: PMC4038813 DOI: 10.5492/wjccm.v3.i2.55] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2013] [Accepted: 03/04/2014] [Indexed: 02/06/2023] Open
Abstract
AIM: To characterize differences of arterial (ABG) and venous (VBG) blood gas analysis in a rabbit model of hemorrhagic shock.
METHODS: Following baseline arterial and venous blood gas analysis, fifty anesthetized, ventilated New Zealand white rabbits were hemorrhaged to and maintained at a mean arterial pressure of 40 mmHg until a state of shock was obtained, as defined by arterial pH ≤ 7.2 and base deficit ≤ -15 mmol/L. Simultaneous ABG and VBG were obtained at 3 minute intervals. Comparisons of pH, base deficit, pCO2, and arteriovenous (a-v) differences were then made between ABG and VBG at baseline and shock states. Statistical analysis was applied where appropriate with a significance of P < 0.05.
RESULTS: All 50 animals were hemorrhaged to shock status and euthanized; no unexpected loss occurred. Significant differences were noted between baseline and shock states in blood gases for the following parameters: pH was significantly decreased in both arterial (7.39 ± 0.12 to 7.14 ± 0.18) and venous blood gases (7.35 ± 0.15 to 6.98 ± 0.26, P < 0.05), base deficit was significantly increased for arterial (-0.9 ± 3.9 mEq/L vs -17.8 ± 2.2 mEq/L) and venous blood gasses (-0.8 ± 3.8 mEq/L vs -15.3 ± 4.1 mEq/L, P < 0.05). pCO2 trends (baseline to shock) demonstrated a decrease in arterial blood (40.0 ± 9.1 mmHg vs 28.9 ± 7.1 mmHg) but an increase in venous blood (46.0 ± 10.1 mmHg vs 62.8 ± 15.3 mmHg), although these trends were non-significant. For calculated arteriovenous differences between baseline and shock states, only the pCO2 difference was shown to be significant during shock.
CONCLUSION: In this rabbit model, significant differences exist in blood gas measurements for arterial and venous blood after hemorrhagic shock. A widened pCO2 a-v difference during hemorrhage, reflective of poor tissue oxygenation, may be a better indicator of impending shock.
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Kneidinger N, Funk GC, Lindner G, Drolz A, Schenk P, Fuhrmann V. Unmeasured anions are associated with short-term mortality in patients with hypoxic hepatitis. Wien Klin Wochenschr 2013; 125:474-80. [DOI: 10.1007/s00508-013-0400-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2012] [Accepted: 06/23/2013] [Indexed: 02/06/2023]
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Darlington DN, Kheirabadi BS, Scherer MR, Martini WZ, Dubick MA. Acidosis and correction of acidosis does not affect rFVIIa function in swine. INTERNATIONAL JOURNAL OF BURNS AND TRAUMA 2012; 2:145-157. [PMID: 23272296 PMCID: PMC3523398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 11/02/2012] [Accepted: 11/16/2012] [Indexed: 06/01/2023]
Abstract
BACKGROUND Hemorrhagic shock and trauma are associated with acidosis and altered coagulation. A fall in pH has been reported to attenuate the activity of recombinant activated Factor VII (rFVIIa) in vitro. However, it is not known if acidosis induced by hemorrhagic shock or infusion of HCl attenuates FVIIa activity in vivo. The purpose of this study was to determine if acidosis, induced by two methods, affects recombinant FVIIa (rFVIIa) activity in swine, and if correction of the pH restores rFVIIa activity to normal. METHODS Acidosis was induce in anesthetized swine in two separate models: 1) HCl infusion (n=10) and 2) hemorrhage/hypoventilation (n=8). Three groups per model were used: Control (pH7.4), Acidosis (arterial pH7.1) and Acidosis-Corrected (bicarbonate infusion to return pH from 7.1 to 7.4). Pigs were then injected with rFVIIa (90 μg/kg) or vehicle (saline) at target pH and arterial blood samples were taken for measurement of coagulation function, including Thromboelastography -TEG, Thrombin Generation, Activated Clotting Time, Prothrombin Time, activated Partial Thromboplastin Time, Fibrinogen Concentration and Platelet count before and 5min after injection of rFVIIa. RESULTS Acidosis led to a hypocoagulation as measured by almost all coagulation parameters in both models. Furthermore, the change in coagulation function produced after infusion of rFVIIa was not different between control, acidosis and acidosis-corrected groups for all coagulation parameters measured. CONCLUSION Acidosis associated with hemorrhagic shock or HCl infusion led to a hypocoagulation that was not corrected with bicarbonate infusion. Furthermore, acidosis did not affect rFVIIa function, and correction of the acidosis with bicarbonate had no effect on rFVIIa function in these models. This suggests that in vivo acidosis did not diminish rFVIIa function.
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Annecke T, Rehm M, Bruegger D, Kubitz JC, Kemming GI, Stoeckelhuber M, Stoekelhuber M, Becker BF, Conzen PF. Ischemia-reperfusion-induced unmeasured anion generation and glycocalyx shedding: sevoflurane versus propofol anesthesia. J INVEST SURG 2012; 25:162-8. [PMID: 22583012 DOI: 10.3109/08941939.2011.618524] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
INTRODUCTION Vascular leakage after ischemia-reperfusion (IR) is largely attributed to the destruction of the endothelial barrier and its associated negatively charged glycocalyx. In vitro, sevoflurane attenuates these changes. Therefore, we compared sevoflurane with propofol with regard to the protection of the glycocalyx and the release of negatively charged substances in vivo. METHODS After surgical preparation under midazolam-fentanyl, nine pigs each received either propofol or sevoflurane. Ischemia of 90 min was induced by a balloon catheter in the thoracic aorta. After 120 min of reperfusion, the anesthetics were changed back to midazolam-fentanyl. Five animals, each without aortic occlusion, served as time controls. Blood electrolyte parameters were measured, from which the strong ion gap (SIG) was calculated. Serum heparan sulfate concentrations and immunohistology served as a marker of glycocalyx destruction. RESULTS Immediately after reperfusion, SIG increased significantly only in the propofol group (+6.7 mEq/l versus baseline; p < .05), remaining stable in sevoflurane and both time-controlled groups. Initially, heparan sulfate concentration increased comparably in both experimental groups, but after 120 min, it became stable in sevoflurane-anesthetized animals, while increasing further in the propofol group (p < .05). CONCLUSIONS Unmeasured anions, predictive of negative outcome in previous studies, did not increase significantly in sevoflurane-anesthetized animals. Additionally, there was less heparan sulfate shedding over time, signaling less destruction of the glycocalyx. Therefore, in this in-vivo situation, sevoflurane proves to be superior to propofol in protecting the endothelium from IR injury.
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Affiliation(s)
- Thorsten Annecke
- Department of Anesthesiology, University Hospital, Ludwig-Maximilians University Munich, Munich, Germany.
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Fettig PK, Bailey DB, Gannon KM. Determination of strong ion gap in healthy dogs. J Vet Emerg Crit Care (San Antonio) 2012; 22:447-52. [PMID: 22809147 DOI: 10.1111/j.1476-4431.2012.00772.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2010] [Accepted: 05/23/2012] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To determine and compare reference intervals of the strong ion gap (SIG) in a group of healthy dogs determined with 2 different equations. DESIGN Prospective observational study. SETTING Tertiary referral and teaching hospital. ANIMALS Fifty-four healthy dogs. INTERVENTIONS None. MEASUREMENTS Serum biochemistry and blood gas analyses were performed for each dog. From these values, SIG was calculated using 2 different equations: SIG(1) = SID(a) {[Na (+)] + [K(+)] - [Cl(-)]+ [2 × Ca(2+)] + [2 × Mg(2+)] - [L-lactate]}- SID(e) {TCO(2) + A(-)} and SIG(2) = [albumin] × 4.9-anion gap. Reference intervals were established for each SIG equation using the mean ± 1.96 × standard deviation (SD). RESULTS For SIG(1), the median was 7.13 mEq/L (range, 1.05-11.30 mEq/L) and the derived reference interval was 1.85-10.61 mEq/L. Median SIG(2) was -0.22 mEq/L (range, -5.34-6.61 mEq/L) and the mean SIG(2) was -0.09 mEq/L (95% confidence interval for the mean, -0.82-0.65 mEq/L). The derived reference interval was -5.36-5.18 mEq/L. The results of the SIG calculations were significantly different (P < 0.0001) between the 2 equations used. CONCLUSION The 2 equations used to calculate SIG yielded significantly different results and cannot be used interchangeably. The authors believe SIG(2) to be a more accurate reflection of acid-base status in healthy dogs, and recommend that this calculation be used for future studies.
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Hofmann-Kiefer KF, Chappell D, Kammerer T, Jacob M, Paptistella M, Conzen P, Rehm M. Influence of an acetate- and a lactate-based balanced infusion solution on acid base physiology and hemodynamics: an observational pilot study. Eur J Med Res 2012; 17:21. [PMID: 22769740 PMCID: PMC3479046 DOI: 10.1186/2047-783x-17-21] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2011] [Accepted: 06/04/2012] [Indexed: 12/14/2022] Open
Abstract
Background The current pilot study compares the impact of an intravenous infusion of Ringer’s lactate to an acetate-based solution with regard to acid–base balance. The study design included the variables of the Stewart approach and focused on the effective strong ion difference. Because adverse hemodynamic effects have been reported when using acetate buffered solutions in hemodialysis, hemodynamics were also evaluated. Methods Twenty-four women who had undergone abdominal gynecologic surgery and who had received either Ringer’s lactate (Strong Ion Difference 28 mmol/L; n = 12) or an acetate-based solution (Strong Ion Difference 36.8 mmol/L; n = 12) according to an established clinical protocol and its precursor were included in the investigation. After induction of general anesthesia, a set of acid–base variables, hemodynamic values and serum electrolytes was measured three times during the next 120 minutes. Results Patients received a mean dose of 4,054 ± 450 ml of either one or the other of the solutions. In terms of mean arterial blood pressure and norepinephrine requirements there were no differences to observe between the study groups. pH and serum HCO3- concentration decreased slightly but significantly only with Ringer’s lactate. In addition, the acetate-based solution kept the plasma effective strong ion difference more stable than Ringer’s lactate. Conclusions Both of the solutions provided hemodynamic stability. Concerning consistency of acid base parameters none of the solutions seemed to be inferior, either. Whether the slight advantages observed for the acetate-buffered solution in terms of stability of pH and plasma HCO3- are clinically relevant, needs to be investigated in a larger randomized controlled trial.
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Sun L, Zhang GF, Zhang X, Liu Q, Liu JG, Su DF, Liu C. Combined administration of anisodamine and neostigmine produces anti-shock effects: involvement of α7 nicotinic acetylcholine receptors. Acta Pharmacol Sin 2012; 33:761-6. [PMID: 22580739 DOI: 10.1038/aps.2012.26] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
AIM To evaluate the anti-effects of anisodamine and neostigmine in animal models of endotoxic and hemorrhagic shock. METHODS Kunming mice were injected with lipopolysaccharide (LPS 30 mg/kg, ip) to induce endotoxic shock. Anisodamine (12.5, 25, and 50 mg/kg, ip) and neostigmine (12.5, 25, and 50 μg/kg, ip) were administered immediately after LPS injection. Survival rate was monitored, and the serum levels of TNF-α and IL-1β were analyzed using ELISA assays. The effects of anisodamine and neostigmine were also examined in α7 nicotinic acetylcholine receptor (α7 nAChR) knockout mice with endotoxic shock and in Beagle dogs with hemorrhagic shock. RESULTS In mice with experimental endotoxemia, combined administration of anisodamine and neostigmine significantly increased the survival rate and decreased the serum levels of inflammatory cytokines, as compared to those produced by either drug alone. The anti-shock effect of combined anisodamine and neostigmine was abolished in α7 nAChR knockout mice. On the other hand, intravenous injection of the combined anisodamine and neostigmine, or the selective α7 nAChR agonist PNU282987 exerted similar anti-shock effects in dogs with hemorrhagic shock. CONCLUSION The results demonstrate that combined administration of anisodamine and neostigmine produces significant anti-shock effects, which involves activation of α7 nAChRs.
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Traditional resuscitative practices fail to resolve metabolic acidosis in morbidly obese patients after severe blunt trauma. ACTA ACUST UNITED AC 2010; 68:317-30. [PMID: 20154544 DOI: 10.1097/ta.0b013e3181caab6c] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Obesity is a risk factor for postinjury complications; in particular, obese patients develop multiple organ failure (MOF) at a greater rate than do normal weight counterparts. Evaluation of differences in resuscitative practices altered by body mass index (BMI) might provide an explanation for the increased risk of MOF seen in these high-risk patients. METHODS We used prospectively collected multicenter data to retrospectively compare patients grouped by BMI with regard to resuscitation volumes and traditional end points during the first 48 hours after injury. Marshall MOF score was used as the primary outcome measure. RESULTS One thousand sixty-six patients were analyzed, with 877 meeting inclusion and exclusion criteria. All patients received similar volumes of resuscitation per kilogram lean and ideal body weight. Morbidly obese patients attained greater central venous pressures but otherwise differed little in attainment of standard cardiovascular end points. Despite this, morbidly obese patients resolved base deficit more slowly and remained in metabolic acidosis for 48 hours postinjury. Morbidly obese patients with persistent metabolic acidosis developed MOF at a significantly greater rate than did normal weight patients with or without persistent metabolic acidosis. CONCLUSIONS Morbidly obese trauma patients show prolonged metabolic acidosis despite receiving similar volumes and attaining similar end points of resuscitation when compared with patients in other BMI groups. Inadequate resuscitation based on inaccurate end points and metabolic disturbances associated with increased BMI are likely responsible; identification of the etiology, sources, and consequences of this acidosis may provide further insight into the susceptibility of the morbidly obese patient to develop postinjury organ failure.
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[Acid-base concepts]. Anaesthesist 2009; 58:307-9; author reply 309. [PMID: 19415365 DOI: 10.1007/s00101-009-1509-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Year in review 2007: Critical Care--shock. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2008; 12:227. [PMID: 18983707 PMCID: PMC2592773 DOI: 10.1186/cc6949] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
The research papers on shock published in Critical Care throughout 2007 are related to three major subjects: the modulation of the macrocirculation and microcirculation during shock, focusing on arginine vasopressin, erythropoietin and nitric oxide; studies on metabolic homeostasis (acid–base status, energy expenditure and gastrointestinal motility); and basic supportive measures in critical illness (fluid resuscitation and sedation, and body-temperature management). The present review summarizes the key results of these studies and provides a brief discussion in the context of the relevant scientific and clinical background.
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The nature of unmeasured anions in critically ill patients. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2008; 12:416. [PMID: 18439325 PMCID: PMC2447592 DOI: 10.1186/cc6855] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Venkatesh B, Morgan TJ. Unmeasured anions: the unknown unknowns. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2008; 12:113. [PMID: 18304373 PMCID: PMC2374602 DOI: 10.1186/cc6768] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Evidence is emerging that elevated concentrations of the intermediates of the citric acid cycle may contribute to unmeasured anions in critical illness. Both the anion gap and the strong ion gap are used as scanning tools for recognition of these anions. The mechanisms underlying these elevations and their significance require further clarification.
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