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2011, Number 4

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Med Crit 2011; 25 (4)

Strong ion gap in septic shock

Soriano OR, Gómez GMN, Olvera GC, Aguirre SJ, Franco GJ

Language: Spanish
References: 15
Page: 255-261
PDF size: 96.49 Kb.


ABSTRACT

Introduction: Henderson-Hasselbach model is the most useful way to evaluate acid-base disorders in the critically ill but it doesn’t evaluate substances that change electro-neutrality. Stewart’s model detects disorders induced by these substances; it has been used in septic shock to detect disorders produced by solutions and continuous hypoperfusion.
Methods: Retrospective study of septic shock patients in which Strong ions gap (SIG) was determined at admittance and 24 hours after reanimation.
Results: 30 patients were studied. At admittance, mean SIG was 30 ± 2.6 mEq, with cationic gap induced by HCO3 depletion secondary to deficient anionic supply of plasmatic proteins. 24 hours later, SIG diminished when compared to admittance values with mean SIG of 23 ± 2, with a trend towards electro-neutrality, but still with SIG mismatch.
Conclusions: Strong ion gap shows HCO3 depletion secondary to dehydration and hypoperfusion; after reanimation, SIG has a trend to neutrality.


REFERENCES

  1. Mohammed I. Mechanisms, detection, and potential management of microcirculatory disturbances in sepsis. Crit Care Clin - 01-APR-2010;26(2):393-408.

  2. Worthley L. Strong ion difference: A new paradigm of new clothes for the acid-base emperor. Crit Care Resuse 1999;1:211-214.

  3. Story DA. Bench-to-bedside review: a brief history of clinical acid-base. Crit Care 2004;8:253-258.

  4. Carrillo ER, Carrillo CJR, Carrillo CLD. Modelo fisicoquímico del equilibrio ácido-base. Conceptos actuales. Rev Fac Med (Mex) 2008;51 supp(1,2,3).

  5. Stewart PA. Modern quantitative acid-base chemistry. Can J Physiol Pharmacol 1983;61:1444-1461.

  6. Kaplan LJ, Kellum JA. Comparison of acid base models for prediction of hospital mortality following trauma. Shock 2008.

  7. Kaplan LJ, Frangos S. Clinical Rewiew: Acid-base abnormalities in the intensive care unit. Critical Care 2005;9:198-203.

  8. Figge J, Rossing T, Fencl V. Serum proteins and acid-base equilibrium: A follow up. J Lab Clin Med 1992;120:713-719.

  9. Mc Auliffe JJ, Lind LJ, Leith DE. Hypoproteinemic alkalosis. Am J Med 1986;81:86-90.

  10. Constable PD. Total weak acid concentration and effective dissociation constant of nonvolatile buffers in human plasma. J Appl Physiol 2001;91:1364-1371.

  11. Fencl V. Diagnosis of metabolic acid-base disturbances in critically ill patients. Am J Respir Crit Care Med 2000;162(6):2246-2251.

  12. Story DA, Poustie S, Bellomo R. Quantitative physical chemistry analysis of acid-base disorders in critically ill patients. Anesthesia 2001;56:530-533.

  13. Mathes DD, Morell RC, Rorh MS. Dilutional acidosis: Is it a real clinical entity? Anesthesiology 1997;86:501-503.

  14. Miller LR, Waters JH. Mechanism of hyperchloremic nonunion gap acidosis. Anesthesiology 1997;87:1009-1010.

  15. Storey DA. Intravenous fluid administration and controversies in acid-base. Crit Care Resusc 1999;1:151-156.




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