medigraphic.com
ISSN 2448-8909 (Print)

2019, Number 4

<< Back Next >>

Med Crit 2019; 33 (4)

Origin of metabolic acidosis according to the determinants of the base deficit in patients with septic shock as a risk factor for mortality

Márquez RE, Sánchez DJS, Peniche MKG, Martínez REA, Villegas DJE, Calyeca SMV

Language: Spanish
References: 30
Page: 182-188
PDF size: 220.68 Kb.


ABSTRACT

Introduction: In patients with septic shock, metabolic acidosis is the most frequent acid-base disorder and the main causative ion will determine the prognosis in this group of patients. Studies have focused on the estimation of lactate to determine the prognosis, although today we know that metabolic acidosis in these patients may be caused by the effect not only of lactate but also by the effect of water, effect of chlorine, effect of albumin and effect of unmeasured anions.
Material and methods: A cohort study was performed, ambispective, longitudinal, descriptive and analytical. In patients diagnosed with septic shock and metabolic acidosis, admitted to the Intensive Care Unit (ICU) in the period from June 15, 2015 to July 30, 2018. The risk for mortality of the variables was evaluated: lactate, the effect of water, the effect of chlorine, the effect of albumin and the effect of unmeasured anions. All statistical analyzes were performed with the SPSSTM 22.0 program.
Results: In the period considered, 87 patients met the inclusion criteria, of which 46% were male and 54% were female. 44.8% of patients died during their stay. In the multivariate analysis, the variables with statistical significance, measures at admission as a risk factor for mortality were: the effect of water with cut-off point › -0.75 mEq/L, presents an OR 7.227 (CI95%: 1.831-28.5; p = 0.005), the effect of albumin with cut-off point of › -4.75 mEq/L, presents an OR 6.163 (CI95%: 1.786-21.2, p = 0.004).
Conclusion: Metabolic acidosis goes beyond the addition or removal of solutes, the dissociation of water having great importance.


REFERENCES

  1. Al-Jaghbeer M, Kellum JA. Acid-base disturbances in intensive care patients: etiology, pathophysiology and treatment. Nephrol Dial Transplant. 2014:30(7):1104-1111.

  2. Kishen R, Honoré PM, Jacobs R, Joannes-Boyau O, De Waele E, De Regt J, et al. Facing acid–base disorders in the third millennium-the Stewart approach revisited. Int J Nephrol Renovasc Dis. 2014;7:209-217.

  3. Sánchez-Díaz JS, Martínez-Rodríguez EA, Méndez-Rubio LP, Peniche-Moguel KG, Huanca-Pacaje JM, López-Guzmán C, et al. Equilibrio ácido-base. Puesta al día. Teoría de Henderson-Hasselbalch. Med Int Mex. 2016;32(6):646-660.

  4. Gunnerson KJ, Saul M, He S, Kellum JA. Lactate versus non-lactate metabolic acidosis: a retrospective outcome evaluation of critically ill patients. Crit Care. 2006;10(1):R22.

  5. Gunnerson KJ, Saul M, Kellum JA. Lactic versus non-lactic metabolic acidosis: outcomes in critically ill patients. Crit Care. 2003;7(Suppl 2):P017.

  6. Kruse O, Grunnet N, Barfod C. Blood lactate as a predictor for in-hospital mortality in patients admitted acutely to hospital: a systematic review. Scand J Trauma Resusc Emerg Med. 2011;19:74.

  7. 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.

  8. Adrogué HJ, Gennari FJ, Galla JH, Madias NE. Assessing acid-base disorders. Kidney Int. 2009;76(12):1239-1247.

  9. Berend K, de Vries AP, Gans RO. Physiological approach to assessment of acid-base disturbances. N Engl J Med. 2014;371(15):1434-1445.

  10. Sánchez DJ, Monares ZE, Meneses OC, Rodríguez ME, García MR, Peniche MK, et al. Soluciones balanceadas: cloro el “nuevo villano”. Med Crit. 2017;31(3):152-158.

  11. Emmett M, Narins RG. Clinical use of the anion gap. Medicine (Baltimore). 1977;56(1):38-54.

  12. Andersen OS. The pH-log pCO2 blood acid-base nomogram revised. Scand J Clin Lab Invest. 1962;14:598-604.

  13. Dimeski G, Badrick T, John AS. Ion selective electrodes (ISEs) and interferences-a review. Clin Chim Acta. 2010;411(5-6):309-317.

  14. Berend K, van Hulsteijn LH, Gans RO. Chloride: the queen of electrolytes? Eur J Intern Med. 2012;23(3):203-211.

  15. Figge J, Mydosh T, Fencl V. Serum proteins and acid-base equilibria: a follow-up. J Lab Clin Med. 1992;120(5):713-719.

  16. Dubin A, Menises MM, Masevicius FD, Moseinco MC, Kutscherauer DO, Ventrice E, et al. Comparison of three different methods of evaluation of metabolic acid-base disorders. Crit Care Med. 2007;35(5):1264-1270.

  17. Kellum J, Elbers P. Stewart’s textbook of acid-base. 2a. ed. Amsterdam, NE : AcidBase.org, 2009.

  18. Guggenheim EA. Thermodynamics, an advanced treatment for chemists and physicist. Amsterdam: Noth Holland Publishing Company; 1957. p. 372.

  19. Kellum JA. Determinants of plasma acid-base balance. Crit Care Clin. 2005;21(2):329-346.

  20. Sánchez DJ, Peniche MK, Martínez RE, Cortés RJ, Rivera SG, Díaz GS, et al. Falsas creencias de los trastornos ácido-base. Acta Colomb Cuid Intensivo. 2018;18(4):243-250.

  21. Noritomi DT, Soriano FG, Kellum JA, Cappi SB, Biselli PJ, Liborio AB, et al. Metabolic acidosis in patients with severe sepsis and septic shock: a longitudinal quantitative study. Crit Care Med. 2009;37(10):2733-2739.

  22. Smith I, Kumar P, Molloy S, Rhodes A, Newman PJ, Grounds RM, et al. Base excess and lactate as prognostic indicators for patients admitted to intensive care. Intensive Care Med. 2001;27(1):74-83.

  23. Stewart PA. How to understand acid-base: a quantitative acid-base primer for biology and medicine. New York, NY: Elsevier, 1981.

  24. Gunnerson KJ. Clinical review: The meaning of acid-base abnormalities in the intensive care unit part I - epidemiology. Crit Care. 2005;9(5):508-516.

  25. Kishen R, Honoré PM, Jacobs R, Joannes-Boyau O, De Waele E, De Regt J, et al. Facing acid-base disorders in the third millennium - the Stewart approach revisited. Int J Nephrol Renovasc Dis. 2014;7:209-17.26.

  26. Meza M. Disturbios del estado ácido-básico en el paciente crítico. Acta Med Per. 2011;28(1):46-58.

  27. Masevicius F, Dubin, A. Has Stewart approach improved our ability to diagnose acid-base disorders in critically ill patients. World J Crit Care Med. 2001;4(1):62-70.

  28. Cortés-Román JS, Sánchez-Díaz JS, García-Méndez RC, Martínez-Rodríguez EA, Peniche-Moguel KG, Díaz-Gutiérrez SP, et al. Diferencia sodio-cloro e índice cloro/sodio como predictores de mortalidad en choque séptico. Med Int Méx. 2017;33(3):335-343.

  29. 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):2018-24.

  30. Feldman M, Soni N, Dickson B. Influence of hypoalbuminemia or hyperalbuminemia on the serum anion gap. J Lab Clin Med. 2005;146(6):317-320.




2020     |     www.medigraphic.com