2022, Number 4
<< Back Next >>
Med Crit 2022; 36 (4)
Advanced gasometric interpretation in critical patient
Toquiantzi AMA, Ramírez BM, Aguilar CI, Canaán PD, Juárez BFJ, Pezzat SEB
Language: Spanish
References: 16
Page: 235-239
PDF size: 215.46 Kb.
ABSTRACT
The interpretation of a gasometry of rapid form is very useful in an emergency department since to establish in an opportune way a diagnosis performs supreme importance. There exists hardware that allows us to equal the sensibility of the complex m ethods of Stewart. To evaluate the gasometry of a traditional way, depending on the favorite school: using only the bicarbonate or the base excess, it has low diagnostic sensibility when we face stages where more than one metabolic associate disorder exists. We propose the following five steps: to evaluate the pH, deficit of base, anion gap, excess of base, and the index chlorine/sodium, which are important to identify rapidly and sensitively a gasometry in critical patients.
REFERENCES
Malkin HM. Historical review: concept of acid-base balance in medicine. Ann Clin Lab Sci. 2003;33(3):337-344.
Henderson LJ, Black OF. A study of the equilibrium between carbonic acid, sodium bicarbonate, mono-sodium phosphate, and di-sodium phosphate at body temperature. Am J Physiol. 1908;21(4):420-426.
Story DA. Bench-to-bedside review: a brief history of clinical acid-base. Crit Care. 2004;8(4):253-258.
Kurtz I, Kraut J, Ornekian V, Nguyen MK. Acid-base analysis: a critique of the Stewart and bicarbonate-centered approaches. Am J Physiol Renal Physiol. 2008;294(5):F1009-F1031.
Durward A, Skellett S, Mayer A, et al. The value of the chloride: sodium ratio in differentiating the etiology of metabolic acidosis. Intensive Care Med. 2001;27(5):828-835.
Berend K. Diagnostic use of base excess in acid–base disorders. N Engl J Med. 2018;378:1419-1428.
Magder S, Emami A. Practical approach to physical-chemical acid-base management. Stewart at the bedside. Ann Am Thorac Soc. 2015;12(1):111-117.
Story DA, Morimatsu H, Bellomo R. Strong ions, weak acids and base excess: a simplified Fencl-Stewart approach to clinical acid-base disorders. Br J Anaesth. 2004;92(1):54-60.
Dubin A, Menises MM, Masevicius FD, et al. Comparison of three different methods of evaluation of metabolic acid-base disorders. Crit Care Med. 2007;35(5):1264-1270.
Kuppasani K, Rajan D, Reddi AS. Serum anion gap: an important tool in patients with acid-base disorders. JAAPA. 2011;24(7):E4-E7.
Kraut JA, Nagami GT. The serum anion gap in the evaluation of acid-base disorders: what are its limitations and can its effectiveness be improved? Clin J Am Soc Nephrol. 2013;8(11):2018-2024.
Rastegar M, Nagami GT. Non-anion gap metabolic acidosis: a clinical approach to evaluation. Am J Kidney Dis. 2017;69(2):296-301.
Emmett M. Approach to the patient with a negative anion gap. Am J Kidney Dis. 2016;67(1):143-150.
Márquez H, Cárdenas J, Muñoz M, et al. Los gaps, una inteligente herramienta para interpretar el desequilibrio ácido base. Residente. 2015;10(2):93-100.
Cortés JS, Sánchez JS, García RC, et al. Diferencia sodio-cloro e índice cloro/sodio como predictores de mortalidad en choque séptico. Med Int Méx. 2017;33(3):335-343.
Gattinoni L, Vasques F, Camporota L, et al. Understanding Lactatemia in Human Sepsis. Potential Impact for Early Management. Am J Respir Crit Care Med. 2019;200(5):582-589.