Design and application of arterial blood gas analysis assisted by electronic computation: analysis of two cases attached / 中国小儿急救医学

Objective:To make Excel spreadsheet of arterial blood gas analysis to judge the types of acid-base imbalance quickly and accurately, and guide the clinical treatment of acid-base disorders.Methods:According to the Henderson-Hasselbalch equation, the compensation formula of acid-base imbalance prediction, the theory of acid-base balance and the related research progress, the analysis process of acid-base balance disorder was settled, and the IF function in Microsoft Office Excel 2003 was used to edit the formula to make Excel spreadsheet for arterial blood gas analysis.Once the pH value, artery blood carbon dioxide pressure (PaCO 2), actual bicarbonate (HCO 3-), sodiumion (Na + ), chlorineion (Cl -) and compensatory time-limited parameters were input, the types of acid-base imbalance can be shown.Arterial blood gas analysis of 185 cases from intensive care unit at Xuzhou Central Hospital was determined by Excel spreadsheet group and manual group respectively, the results and time of judging the type of acid-base imbalance were compared between two groups for statistical analysis. Results:The results of acid-base imbalance between two groups were compared, and 42 cases were normal and simple acid-base and the consistent rate was 100%, double acid-base imbalances of 107 cases with the consistent rate of 97.20%, triple acid-base imbalances of 36 cases with the consistent rate of 91.67%.After Kappa consistency test (Kappa value=0.944) and Pair chi-square Test (McNemar-Bowker Test)( P=0.223), the results of two groups were consistent.It took less time to judge the results of normal or simple acid-base imbalance[(32.32±4.26)s vs.(75.88±19.22)s], double acid-base imbalance[(31.28±5.31)s vs.(137.56±37.64)s] and triple acid-base imbalance[(32.98±4.23)s vs.(315.09±89.37)s] by the Excel spreadsheet group compared with the manual group, and the differences were statistically significant ( P<0.01). Conclusion:The automatic judging of Excel spreadsheet for arterial blood gas analysis can quickly and accurately determine the types of acid-base imbalance in arterial blood gas analysis and has more advantages for triple acid and base imbalance especially with simple interface and simple operation.And it can avoid the missing judgment of acid and base imbalance when pH is 7.35 to 7.45.

Acid-base imbalance: a review with proposed unified diagnostic algorithm / Desequilibrio ácido-base: una revisión con el algoritmo de diagnóstico unificado propuesto

Abstract Introduction: Alterations in the acid-base balance are studied in all medical specialties. Although most cases derive from a preexisting pathology, they can also manifest themselves in a primary context. The proper identification of the acid-base disorder allows the pathological process to be characterized. The correct interpretation of the blood gasometry as a technique for monitoring the ventilatory status, oxygenation and acid-base balance of a patient requires the integration of various physicochemical approaches in order to specify a diagnosis, quantify a therapeutic response, and monitor the severity or the progression of a pathological process. Methodology: A literature review was conducted in the PubMed, Scopus and Science Direct databases. The articles were selected according to the title and the abstract and sorted by topics relevant by pathophysiology, divergences, clinical approach, diagnosis, and management. Results: A guide the clinical correlation of the critical patient with the blood gasometry parameters to characterize the acid-base disorder through the proposition of a diagnostic algorithm. Conclusion: The incorporation of the three theories in a diagnostic algorithm facilitates a greater understanding of the pathophysiological mechanisms and allows us to identify a more precise therapeutic objective to correct the underlying disorder in the different clinical contexts of the patient.

Resumen Introducción: las alteraciones del equilibrio ácido-base se estudian en todas las especialidades médicas. Aunque la mayoría de los casos derivan de una patología preexistente, también pueden manifestarse en un contexto primario, por lo que la identificación adecuada del trastorno ácido-base permite caracterizar su proceso patológico. La correcta interpretación de la gasometría sanguínea como técnica para monitorizar el estado ventilatorio, la oxigenación y el equilibrio ácido-base de un paciente requiere la integración de varios enfoques fisicoquímicos para precisar un diagnóstico, cuantificar una respuesta terapéutica y monitorizar la gravedad o la progresión de un proceso patológico. Materiales y métodos: se realizó una revisión de la literatura en las bases de datos PubMed, Scopus y ScienceDirect. Los artículos fueron seleccionados según el título y el resumen, y ordenados por tópicos relevantes por fisiopatología, divergencias, abordaje clínico, diagnóstico y manejo. Resultados: en la literatura consultada se evidenció que el uso de un enfoque lógico y sistemático es necesario para interpretar adecuadamente los parámetros de la gasometría sanguínea e identificar oportunamente el trastorno ácido-base. Conclusión: la incorporación de las tres teorías en un algoritmo diagnóstico facilita una mayor comprensión de los mecanismos fisiopatológicos y permite identificar un objetivo terapéutico más preciso para corregir el trastorno de base en los diferentes contextos clínicos del paciente.

Situación del estado ácido-base de pacientes incidentes a la emergencia de Medicina de un hospital nacional de Lima Perú y su asociación a variables clínicas / Situation of the acid-base disorders and their association with clinical variables in incident patients at the emergency room in a national hospital in Lima, Peru

Objetivos: Determinar la frecuencia de trastornos del estado ácido-base de pacientes admitidos al Departamento de Emergencia de un hospital general de Lima-Perú y su asociación con enfermedades prevalentes. Material y métodos: Estudio transversal descriptivo y analítico cuyo tamaño de muestra calculado fue en 108 pacientes a quienes el médico tratante solicitó estudio de gasometría arterial. La muestra fue obtenida por saturación hasta alcanzar el tamaño mínimo calculado. Resultados: El disturbio ácido-base más frecuentemente hallado fue el trastorno mixto de la acidosis metabólica asociado con la alcalosis respiratoria (50% casos) coexistiendo en pacientes con disfunción renal aguda o crónica y shock, seguido del disturbio único de alcalosis respiratoria (26,2% casos) asociada a enfermedad respiratoria y gastrointestinal. Conclusiones: Los trastornos mixtos de acidosis metabólica con alcalosis respiratoria son altamente relevantes y la alcalosis respiratoria es el fenómeno puro más frecuente. (AU)

Objectives: To determine the frequency of acid-base disorders and their association with prevalent diseases in patients admitted to the emergency department of a national hospital in Lima. Methods: Cross-sectional study with a sample size of 108 patients in whom the treating physician requested arterial blood gases determination. The sample was attained by saturation until reaching the targeted sample size. Results: The most common acid-base disorder was mixed metabolic acidosis (50%) co-existing in patients with acute or chronic renal dysfunction and shock, followed by respiratory alkalosis (26.2%) associated to respiratory and gastro-intestinal disorders. Conclusions: Mixed metabolic acidosis and respiratory alkalosis are the most frequent acid-base abnormalities observed in this setting, respiratory alkalosis is the most common single acid-base disorder found. (AU)

Enteral fluid therapy in neonatal calves and features of commercially available electrolyte solutions in Brazil / Hidratação enteral em bezerros neonatos e características das soluções eletrolíticas disponíveis comercialmente no Brasil

ABSTRACT: According to the World Health Organization, the development of orally replacement fluids and electrolytes was one of the most significant advances of the twentieth century, markedly reducing mortality from diarrheal children. In veterinary medicine, oral electrolyte solutions (OES) are routinely used to treat diarrheic neonatal calves in order to correct water, electrolyte and acid base imbalances. In North America, the use of OES is routine and there are at least 20 commercial alternatives. Use of OES has increased in recent years in Brazil, but just five commercial products are currently available. The OES should contain, in suitable concentrations, electrolytes, glucose and an alkalizing agent to ensure its therapeutic efficacy. This review aimed to address the therapeutic importance of OES for neonatal calves and to evaluate the compositions and characteristics of those commercially available in Brazil.

RESUMO: De acordo com a Organização Mundial da Saúde, o desenvolvimento da reposição de fluidos e eletrólitos por via oral foi um dos avanços mais significativos da medicina no século XX, reduzindo marcadamente a mortalidade de crianças diarreicas. Na medicina veterinária, as soluções eletrolíticas orais (SEO) são rotineiramente utilizadas no tratamento de bezerros neonatos diarreicos com o intuito de corrigir os desequilíbrios hidroeletrolíticos e ácido base. Na América do Norte, o emprego de SEO é habitual e existem, pelo menos, 20 alternativas comerciais. O uso das SEO se expandiu nos últimos anos, no Brasil, havendo, atualmente, cinco produtos disponíveis no comércio. As SEO devem veicular eletrólitos, glicose e um agente alcalinizante em concentrações apropriadas para garantir a sua eficácia terapêutica. Essa revisão tem o objetivo de abordar a importância e uso terapêutico das SEO para bezerros neonatos, além de avaliar as composições e características das disponíveis comercialmente no mercado brasileiro.

Equilibrio Ácido-Base: el mejor enfoque clínico / Acid-base equilibrium: The best clinical approach

Acid-base balance disorders can be found in a primary or secondary form in patients with a disease process such as Diabetes Mellitus or acute renal failure, among others. The objective of this article is to explain and guide the correlation ship between the clinical findings in the patient and the parameters of arterial blood gases in a simple and precise manner, in order to make the correct acid-base balance diagnosis and adequate therapeutic interventions. A non-systematic review of the scientific literature was conducted through a search in the PubMed, Science Direct, Scopus, and OvidSP databases. The conclusion was that base excess or deficit in arterial blood gases is a useful tool which along with the clinical history, pH, and partial pressure of CO2, provides an accurate estimate of the metabolic component of the acid-base balance.

Las alteraciones del Equilibrio Ácido-Base se pueden presentar en pacientes de forma primaria o secundaria a un proceso patológico como la Diabetes Mellitus o la falla renal entre otros. El objetivo es explicar y orientar la correlación clínica del paciente con los parámetros de los gases arteriales de manera sencilla y precisa, para realizar un diagnóstico de las alteraciones del Equilibrio Ácido-Base correcto, que permita efectuar intervenciones terapéuticas adecuadas y oportunas. Se realizó una revisión no sistemática de la literatura científica en la cual se consultaron las siguientes bases de datos: PubMed, ScienceDirect, Scopus y OvidSP en busca de artículos relevantes. Se concluyó que el exceso o déficit de base es una herramienta útil de los gases arteriales, que aunada a la historia clínica, el pH y la presión parcial de CO2 estima de forma muy precisa el componente metabólico del Equilibrio Ácido-Base.

Lactated Ringer's solution or 0.9 por cento sodium chloride as fluid therapy in pigeons (Columba livia) submitted to humerus osteosynthesis / Fluidoterapia com Ringer lactato ou cloreto de sódio 0.9 percent em pombos (Columbia livia) submetidos à osteossíntese de úmero

The study aimed to compare the effects of intraosseous infusion of lactated Ringer's and 0.9% sodium chloride solutions on the electrolytes and acid-base balance in pigeons submitted to humerus osteosynthesis. Eighteen pigeons were undergoing to isoflurane anesthesia by an avalvular circuit system. They were randomly assigned into two groups (n=9) receiving lactated Ringer's solution (LR) or 0.9% sodium chloride (SC), in a continuous infusion rate of 20mL/kg/h, by using an intraosseous catheter into the tibiotarsus during 60-minute anesthetic procedure. Heart rate (HR), and respiratory rate (RR) were measured every 10 min. Venous blood samples were collected at 0, 30 and 60 minutes to analyze blood pH, PvCO2, HCO3 -, Na+ and K+. Blood gases and electrolytes showed respiratory acidosis in both groups during induction, under physical restraint. This acidosis was evidenced by a decrease of pH since 0 min, associated with a compensatory response, observed by increasing of HCO3 - concentration, at 30 and 60 min. It was not observed any changes on Na+ and K+ serum concentrations. According to the results, there is no reason for choosing one of the two solutions, and it could be concluded that both fluid therapy solutions do not promote any impact on acid-base balance and electrolyte concentrations in pigeons submitted to humerus osteosynthesis...

O presente estudo avaliou os efeitos da infusão das soluções de Ringer lactato ou cloreto de sódio 0,9%, no equilíbrio ácido-base e hidroeletrolítico de pombos submetidos à osteossíntese de úmero. Foram utilizados 18 animais, os quais foram submetidos à anestesia por isofluorano, e mantidos em circuito avalvular durante o período anestésico (60 min). Os animais foram distribuídos aleatoriamente em dois grupos (n=9) recebendo Ringer lactato (LR) ou cloreto de sódio 0,9% (SC), administradas na taxa de 20mL/kg/h pela via intraóssea (tibiotarso). Foram monitoradas as frequências cardíaca e respiratória a cada 10 minutos e colhidas amostras sanguíneas venosas aos 0, 30 e 60 min de anestesia, obtendo-se a partir destas, valores de pH sanguíneo, bicarbonato (HCO3), pressão venosa de CO2 (PvCO2), sódio (Na+) e potássio (K+). Os valores referentes ao equilíbrio ácido-base indicam que houve acidose respiratória em ambos os grupos, a qual foi decorrente do processo de indução sob contenção física, caracterizada por diminuição no pH desde o 0 min, associado ao aumento compensatório nos valores de HCO3 -, nos momentos 30 e 60 min. No entanto, no que se refere aos valores obtidos de Na+ e K+ séricos, durante a infusão de ambos os fluidos, não foram observadas alterações que justifiquem a predileção por alguma destas soluções. Diante destes resultados conclui-se que a escolha entre uma das soluções avaliadas não promoveu impacto sob o equilíbrio ácido-base e hidroeletrolítico de pombos submetidos a osteossíntese de úmero...

Blood gas analysis in Mangalarga Marchador horses with colic / Análisis de gases sanguíneos en caballos Mangalarga Marchador con cólico

Objective. This study aims to distinguish blood gas changes in horses with colic syndrome in which small or large intestine is affected. Materials and methods. Thirty Mangalarga Marchador horses were assessed, divided into groups according to the affected intestinal segment in episodes of colic syndrome (ECS): a group (N=10) of horses suffering from ECS with lesions only in the small intestine, a group (N=10) of horses suffering from ECS with lesions only in the large intestine and a group (N=10) of healthy horses (control). All the animals with ECS were submitted to exploratory laparotomy in order to establish the intestinal segment affected. Blood samples were collected by venipuncture, before surgical procedure to determine sodium, potassium, chloride, urea, glucose, hematocrit, hemoglobin, pH, carbon dioxide partial pressure, total carbon dioxide concentration, bicarbonate, base excess and anion gap. Results. No significant changes were found in plasma levels of Na+, K+, Cl-, pCO2 and anion gap in any type of ECS. Horses with small intestine injuries presented higher levels of tCO2, urea and bicarbonate compared to those with large intestine injuries and to the control group, as well as higher levels of glucose and base excess than the control group. Conclusions. Horses with colic syndrome bearing small intestine injuries show wider variations in the blood gas parameters than horses with large bowel lesions.

Objetivo. El presente estudio tuvo como objetivo diferenciar las alteraciones de gases sanguíneos que ocurren en casos de cólico equino con comprometimiento en intestino delgado o grueso. Material y métodos. Fueron evaluados 30 caballos Mangalarga Marchador con sindrome de colico equino (SCE) divididos en grupos según el segmento intestinal afectado con episodios de cólico: un grupo de animales (N=10) con SCE solo en el intestino delgado, un grupo (N=10) con SCE solo en el intestino grueso y un grupo (N=10) de animales sanos (control). Todos los animales fueron sometidos a laparotomía exploratoria para identificar el segmento intestinal afectado. Muestras de sangre fueron recogidas antes del procedimiento quirúrgico para determinar la concentración: sodio, potasio, cloro, urea, glucosa, hematocrito, hemoglobina, pH, presión parcial de dióxido de carbono, concentración total de dióxido de carbono bicarbonato, exceso de base y anión gap. Resultados. No fueron observadas alteraciones significativas en los niveles plasmáticos de Na+, K+, Cl-, pCO2 ni anión gap, independiente de la localización intestinal del SCE. Los equinos con lesiones en el intestino delgado presentaron niveles superiores de tCO2, urea y HCO3- con relación a los que tuvieron lesiones de intestino grueso y al control, así como niveles superiores de glucosa y de exceso de base con relación al control. Conclusiones. Equinos con síndrome de cólico con lesión de intestino delgado presentaron variaciones más amplias en los parámetros de gases sanguíneos que equinos con cólico afectados en el intestino grueso.

Alteraciones del equilibrio ácido-básico en pacientes operados por oclusión intestinal mecánica / Alterations of the acid-base balance in patients surgically treated for mechanical intestinal obstruction

Introducción: las alteraciones del medio interno conducen a una alta morbilidad y mortalidad, en pacientes portadores de oclusión intestinal, consideradas como una complicación grave si no se realiza una adecuada evaluación y corrección de estas. Objetivo: caracterizar el comportamiento de las principales alteraciones del medio interno relacionado con el balance ácido-básico en pacientes operados por oclusión intestinal mecánica. Métodos: se realizó un estudio observacional, descriptivo de serie de casos, de todos los pacientes operados por oclusión intestinal desde el 1ro de enero del año 2009 al 31 de diciembre del año 2012 en el Hospital Saturnino Lora Torres". El universo fue constituido por un total de 257 pacientes. Se seleccionó una muestra de 207. Fue calculada la prueba chi cuadrado de independencia para identificar asociación estadísticamente significativa entre variables seleccionadas. Resultados: existió predominio del sexo masculino así como los mayores de 61 años. Las bridas fueron la causa más frecuente de la oclusión. La etiología tumoral tuvo el resultado más significativo vinculado con la mayoría de las alteraciones del equilibrio ácido básico. El tiempo de evolución de los síntomas fue directamente proporcional a la aparición de los trastornos identificados. La mortalidad de la serie estuvo dominada por pacientes con diagnóstico de oclusión por neoplasia. Se identificó una alta incidencia de alteraciones hemogasométricas en pacientes que fallecieron. Conclusiones: la presencia de alteraciones ácido.básicas entorpece el curso y pronóstico de los pacientes con oclusión intestinal mecánica(AU)

Introduction: alterations of the internal environment leading to high morbidity and mortality in patients who suffer intestinal obstruction are considered serious complication if they are not adequately evaluated and corrected. Objective: to characterize the behavior of the main alterations in the internal environment related to the acid-base balance in patients operated on for intestinal mechanical obstruction. Methods: observational and descriptive case series study in patients operated on for intestinal obstruction from January 1st 2009 to December 31st 2012 in Saturnino Lora Torres hospital. The universe of study was made up of 257 patients, being the final sample 207 individuals. The chi-square statistic tests of independence were calculated to identify statistically significant association among the selected variables. Results: males as well as over 61 years-old patients prevailed. The intestinal adhesions were the most common cause of obstruction. The tumor etiology was the most significant outcome associated with most of the acid-base alterations. The length of progression of symptoms was directly proportional to the occurrence of identified disorders. The mortality of the series mainly occurred in patients with cancer occlusion due to high incidence of hemogasometric alterations present in deceased patients. Conclusions: the presence of acid-base alterations makes the course and prognosis of patients with mechanical intestinal obstruction gloomy(AU)

Postperfusion lung syndrome: physiopathology and therapeutic options / Síndrome pós-perfusão pulmonar: fisiopatologia e opções terapêuticas

Postperfusion lung syndrome is rare but can be lethal. The underlying mechanism remains uncertain but triggering inflammatory cascades have become an accepted etiology. A better understanding of the pathophysiology and the roles of inflammatory mediators in the development of the syndrome is imperative in the determination of therapeutic options and promotion of patients' prognosis and survival. Postperfusion lung syndrome is similar to adult respiratory distress syndrome in clinical features, diagnostic approaches and management strategies. However, the etiologies and predisposing risk factors may differ between each other. The prognosis of the postperfusion lung syndrome can be poorer in comparison to acute respiratory distress syndrome due to the secondary multiple organ failure and triple acid-base imbalance. Current management strategies are focusing on attenuating inflammatory responses and preventing from pulmonary ischemia-reperfusion injury. Choices of cardiopulmonary bypass circuit and apparatus, innovative cardiopulmonary bypass techniques, modified surgical maneuvers and several pharmaceutical agents can be potential preventive strategies for acute lung injury during cardiopulmonary bypass.

Síndrome pós-perfusão pulmonar é rara, mas pode ser letal. O mecanismo subjacente permanece incerto, mas desencadear cascatas inflamatórias tornou-se uma etiologia aceita. É imperativo uma melhor compreensão da fisiopatologia e os papéis de mediadores inflamatórios no desenvolvimento da síndrome na determinação de opções terapêuticas e de promoção do prognóstico e sobrevida dos pacientes. Síndrome pós-perfusão pulmonar é semelhante à síndrome da angústia respiratória do adulto em características clínicas, métodos diagnósticos e estratégias de gestão. No entanto, as etiologias e fatores de risco predisponentes podem ser diferentes entre si. O prognóstico da síndrome pós-perfusão pulmonar pode ser mais pobres em comparação com síndrome da angústia respiratória aguda, devido à falência de múltiplos órgãos secundária e desequilíbrio ácido-base triplo. Estratégias de gestão atuais centram-se em atenuar reações inflamatórias e impedir lesão pulmonar de isquemia-reperfusão. Escolhas do circuito de circulação extracorpórea e aparelhos, técnicas inovadoras de circulação extracorpórea, manobras cirúrgicas modificadas e vários agentes farmacêuticos podem ser potenciais estratégias preventivas para lesão pulmonar aguda durante a circulação extracorpórea.

Development and practice evaluation of blood acid-base imbalance analysis software / 中华危重病急救医学

Objective To develop a blood gas,acid-base imbalance analysis computer software to diagnose systematically,rapidly,accurately and automatically determine acid-base imbalance type,and evaluate the clinical application. Methods Using VBA programming language,a computer aided diagnostic software for the judgment of acid-base balance was developed. The clinical data of 220 patients admitted to the Second Affiliated Hospital of Guangzhou Medical University were retrospectively analyzed. The arterial blood gas〔pH value,HCO3-,arterial partial pressure of carbon dioxide(PaCO2)〕and electrolytes included data(Na+and Cl-)were collected. Data were entered into the software for acid-base imbalances judgment. At the same time the data generation was calculated manually by H-H compensation formula for determining the type of acid-base imbalance. The consistency of judgment results from software and manual calculation was evaluated,and the judgment time of two methods was compared. Results The clinical diagnosis of the types of acid-base imbalance for the 220 patients:65 cases were normal,90 cases with simple type,mixed type in 41 cases,and triplex type in 24 cases. The accuracy of the judgment results of the normal and triplex types from computer software compared with which were calculated manually was 100%,the accuracy of the simple type judgment was 98.9% and 78.0% for the mixed type,and the total accuracy was 95.5%. The Kappa value of judgment result from software and manual judgment was 0.935,P=0.000. It was demonstrated that the consistency was very good. The time for software to determine acid-base imbalances was significantly shorter than the manual judgment(seconds:18.14±3.80 vs. 43.79±23.86,t=7.466,P=0.000),so the method of software was much faster than the manual method. Conclusion Software judgment can replace manual judgment with the characteristics of rapid,accurate and convenient,can improve work efficiency and quality of clinical doctors and has great clinical application promotion value.

Multi-center randomized and controlled study of oral calcium carbonate suspension in the treatment of acid-related diseases / 中华消化杂志

Objective To study the efficacy and safety of oral calcium carbonate suspension and proton pump inhibitors (PPI) in symptoms relief of acid related diseases.Methods The multi-center,randomized and controlled study was carried out.A total of 400 acid-related diseases patients from 14 to 70 years old with at least one of moderate or severe symptoms such as acid regurgitation,epigastric pain,epigastric discomfort,upper abdominal burning or distension were equally divided into two groups and treated with oral calcium carbonate suspension or omeprazole enteric-coated tablets.The onset of symptoms relief of all patients of the first time after taking medicine was observed.The relief of clinical symptoms at the third day and seventh day after taking medicine was also observed.The adverse events were recorded.Analysis of variance was performed for statistical analysis.Results The onset of symptoms relief of oral calcium carbonate suspension group in acid regurgitation,epigastric pain,epigastric discomfort,upper abdominal burning or distension of the first time after taking medicine were significantly faster than those of PPI group (F=4.866,8.142,41.366,6.955,35.252; all P＜0.05).At the third day after taking medicine,the treatment efficiency of oral calcium carbonate suspension group and PPI group were 69.50％ and 72.50％,and at the seventh day the treatment efficiency of oral calcium carbonate suspension group and PPI group were 92.00％ and 96.50％.There was no significant difference in treatment efficiency and comprehensive efficacy between two groups at day three and seven after taking medicine (both P＞ 0.05).There were 14 cases of mild adverse events and two cases of moderate adverse events in oral calcium carbonate suspension group.There were 10 cases of mild adverse events in PPI group.There was no significant difference between two groups (P＞0.05).Conclusion Oral calcium carbonate suspension provides faster symptom relief than PPI and can effectively improve the symptoms of acid-related diseases.

Comparison of Hamm and Zhoushousheng's formulae for expected compensation in acid-base imbalance / 中国小儿急救医学

Objective To compare the difference and rationalities between Harmm and Zhou' s formulae for expected acid-base compensation in acid-base imbalance. Methods 745 cases of arterial blood gas analysis results of acid-base disorder were evaluated respectively by Hamm and Zhou' s formulae, and the concordance was judged. Results For metabolic acidosis ( 108 cases), the concordance rate was 70. 4% between Hamm and Zhou's( Kappa value =0. 41 ,P ＜0. 01 ) ;for metabolic alkalosis ( 132 cases) ,the concordance rate was 59. 1% ( Kappa value =0. 18 ,P ＜0. 05) ;for acute respiratory acidosis(81 cases) ,the concordance rate was 65.43% ( Kappa value = 0. 31, P ＜ 0. 01 ) ;for acute respiratory alkalosis ( 168 cases), the concordance rate was 54. 8% ( Kappa value = 0. 24%, P ＜ 0. 01 ); for chronic respiratory acidosis ( 119 cases ), the concordance rate was 67.2% ( Kappa value = 0. 41, P ＜ 0. 01 ) ;for chronic respiratory alkalosis( 137 cases), the concordance rate was 66. 6% ( Kappa value = 0. 43, P ＜ 0. 01 ). Conclusion The difference between Hamm and Zhou' s formulae for expected acid-base compensation in acid-base imbalance was obvious. The Zhou' s expected max compensation coefficient were slightly higher than the primary adopted compensation coefficient.

Acid-base Balance and Metabolic Acidosis in Neonates

Metabolic acidosis is commonly encountered issues in the management of critically ill neonates and especially of preterm infants during early neonatal days. In extremely premature infants, low glomerular filtration rate and immaturity of renal tubules to produce new bicarbonate causes renal bicarbonate loss. Higher intake of amino acids, relatively greater contribution of protein to the energy metabolism and mineralization process in growing bones are also responsible for higher acid load in premature infant than in adult. Despite widespread use of sodium bicarbonate in the management of severe metabolic acidosis, use of sodium bicarbonate in premature infants should be restricted to a reasonable but unproven exception such as ongoing renal loss. Despite concern about the low pH value (<7.2) which can compromise cellular metabolic function, no treatment guideline has been established regarding the management of metabolic acidosis in premature infants. Appropriately powered randomized controlled trials of base therapy to treat metabolic acidosis in critically ill newborn infants are demanding.

Detection of arterial blood gas and its clinical signification in the early stage of patients with acute pancreatitis / 中国基层医药

Objective To study the significance of acute pancreatitis AP complications by acid-base distur-bance. Methods The arterial blood gas, serum electrolytes parameter and clinical data of 85 patients were analyzed.Results Acid-base disturbance of different types commonly existed in the early stage of AP patients. There are sig-nificant statistical differences in the indices of PaO2, PaCO2, SaO2 between group MAP and group SAP( P < 0.05 or P < 0.01 ). Conclusion Acid-base disturbance are very common in the AP patients and this-will make the condition worse,they should be treated promptly.

Analysis of the acid-base disorders of critically ill patients in the medical intensive care unit / 대한내과학회지

BACKGROUND: Acid-base imbalances are common in critically ill patients; however, the incidence of acid-base imbalances in the medical intensive care units has not been fully determined. In this study, we investigated the incidence and the type of acid-base imbalances in critically ill patients and we assessed which variables were associated with the patients' outcome. METHODS: One hundred eighty-seven patients (122 men, age: 61.2+/-12.8 years) were enrolled. All the patients were admitted to the medical intensive care unit between January 2005 and December 2005. All the data sets included simultaneous measurements of an arterial blood gas with base excess, the serum electrolytes, the anion gap and the APACHE II scores. RESULTS: The mortality rate was 56.7%. The incidence of acid-base imbalances was as follows: 25.1% were single disorders that existed with only a single primary acid-base imbalance, 48.7% were double disorders, 13.4% were triple disorders and 12.8% were normal (no disorders). The incidence of metabolic acidosis was 57.8% and the mortality rate was not different according to the type of acid-base imbalances. There were significant differences between the nonsurvivors and survivors according to the pH (7.34 vs. 7.41, respectively), HCO(-)3 (20.68 mmol/L vs. 25.90 mmol/L, respectively), ECF base excess (-5.19 vs. 1.19, respectively), the anion gap (18.57 mmol/L vs. 13.77 mmol/L, respectively), the corrected anion gap (23.63 mmol/L vs. 17.96 mmol/L, respectively), the serum albumin (2.37 g/dL vs. 2.74 g/dL, respectively), and the APACHE II scores (20.7 vs 17.2, respectively). However, on the Cox proportional hazard regression analysis, only the APAHCE II scores affected the patients' outcome. CONCLUSIONS: There were diverse acid-base imbalances in the critically ill patients and the incidence of metabolic acidosis was highest among the acid-base imbalances. The best predictor of the patients' outcome was the APACHE II scores.

Varying Dialysate Bicarbonate Concentrations in Maintenance Hemodialysis Patients Affect Post-dialysis Alkalosis but not Pre-dialysis Acidosis

This study aimed to assess the effects of different dialysate bicarbonate concentrations in correcting acid-base imbalance in 53 stable hemodialysis patients in a university-hemodialysis unit. Three different bicarbonate concentrations were assigned, i.e. 25 mEq/L in 10, 30 mEq/L in 30, and 35 mEq/L in 13 patients. Blood gas analyses from arterial line blood samples before and after dialysis in the mid-week were performed for the determination of pH and serum bicarbonate concentration ([HCO3-]). The mean values of predialysis arterial [HCO3-] were mildly acidotic in all 3 groups, but not significantly different among them, whereas those of post-dialysis arterial [HCO3-] were alkalotic, especially in the group of 35 mEq/L as compared with the other two groups. The mean blood pH was not significantly different among the 3 groups. As expected, there was a positive correlation between pre-dialysis pH and post-dialysis pH (r=0.45, p=0.001), and pre-dialysis [HCO3-] and post-dialysis [HCO3-] (r=0.58, p=0.000), but with a negative correlation between pre-dialysis [HCO3-] and the increment of intradialytic [HCO3-] following hemodialysis (r=-0.46, p=0.001). In conclusion, this study shows that the impact of conventional dialysate bicarbonate concentrations ranging from 25 to 35 mEq/L is not quite different on the mild degree of predialysis acidemia, but the degree of postdialysis alkalemia is more prominent in higher bicarbonate concentrations. Base supply by hemodialysis alone does not seem to be the main factor to determine the predialysis acidosis in end-stage renal disease patients on chronic maintenance hemodialysis.

Diagnosis of Acid-base Imbalance by Stewart's Physicochemical Approach and Mortality Prediction in Severe Burn Patients with Inhalation Injury / 대한구급학회지

BACKGROUND: Acid-base derangement are commonly encountered in critically ill patients. This study is to investigate underlying mechanisms of acid-base imbalance and also to examine whether they can predict mortality in burn patients. METHODS: We retrospectively reviewed 73 severely burned patients who had admitted to burn intensive care unit, from January to July in 2004. All the patients had inhalation injury, identified by bronchoscopic examination. We analyzed the type and nature of the acid-base imbalances from arterial blood gas analysis, electrolytes and other biological tests between survivors and non-survivors for 30 days after admission. RESULTS: Acidosis was the most common disorder during the early and late hospital periods. Large fractions of those showed decreased strong ion difference (SID), increased anion gap corrected by albumin (AGc) and [Cl-]corrected. Mixed disorder and alkalosis emerged after the 7(th) hospital day. As time went by, albumin, PaO2/FiO2 ratio, pH and SID were more decreased in non-survivors (n=28) than in survivors (n=45) while [Cl-] corrected, alveolar-arterial oxygen tension gradients, peripheral WBC counts and CRP were more increased in non-survivors than in survivors. In the area under the receiver operating characteristic curves for mortality prediction, APACHE II score and % of total body surface area (%TBSA) burn were high: 0.866 (95% CI; 0.785~0.946) for APACHE II score, 0.817 (95% CI; 0.717~0.918) for %TBSA burn. CONCLUSIONS: In burned patients with inhalation injury, various types of acid-base imbalances and electrolytes abnormalities emerged after resuscitation and so, more careful attentions pursued for correcting underlying acid-base derangement.

Clinical Features of Cord and Artery Blood Gas Analysis in Neonate with Acid-Bas eImbalance / 实用儿科临床杂志

Objective To discuss clinical features and harmfulness of acid-base imbalance in newborn by investigating the changes in blood gas of cord and artery blood,and to establish more appropriate prevention measures. Methods One hundred and ninety-two cord blood and 113 peripheral artery blood of neonates were measured for blood gas analysis by automatic blood gas analysis instrument from America;meanwhile,the concentrations of K~+,Na~+ and Cl~- were detected by biochemical analyzer.Results Among 192 neonates,179 were normal labor and 13 neonates underwent acidosis of different degrees.The incidence was 79.9%.Among the 13 ca-(ses),2 cases had severe asphyxia and both of them got serious mixed acidosis.For all the neonates, 156 cases got acidosis, 84 neonates underwent respiratory acidosis (43.8%), 47 cases with metabolic acidosis (24.5%) and 25 cases with mixed acidosis (13.0%).The left 113 neonates were abnormal labor.Among them,99 cases had acid-base disturbance of different degrees (87.6%). Among the 99 acid-base disturbance cases, 50 cases were single metabolic acidosis (44.2%) and presented the most common changes; the second was single respiratory acidosis, totally 20 cases (17.7%).The third was metabolic acidosis combined with respiratory alkalosis, totally 16 neonates (14.2%).Eleven cases had mixed acidosis (9.7%) and 2 cases were respiratory alkalosis combined with metabolic alkalosis (1.8%).Conclusions While the normal labor neonates still got acidosis of different degrees,the acid-base imbalance of abnormal labor is much more prominent,and the critical neonates often got mixed acid-base imbalance.Serious acid-base imbalance can cause fatal pathological changes in body.The dangers of acidosis and alkalosis can not ignore either. The condition of acid-base imbalance can be judged more accurately by the combination of blood gas analysis and anion gap.The perinatal health cares are important measures to prevent acid-base imbalance.

Diagnosis of hyperchloremic triple acid-base disorders in burn patients and its mechanisms / 中国病理生理杂志

AIM:To study the diagnosis of hyperchloremic triple acid-base disorders (hyperchloremic TABD) and its mechanisms and to find out the cause of hyperchloremic TABD of the burn patients. METHODS:① 154 concomitant arterial blood gas and electrolyte panel of 113 burn patients were diagnosed by clinical approach. ② The plasma aldosterone concentrations of burn patients were tested by radioimmunoassay. RESULTS:9 cases of the 113 burn patients were hyperchloremic TABD. Their plasma aldosterone's values were significantly higher than that of the natural ( P

The Effects of Experimental Acid - base Imbalance on the Neuromuscular Blocking Action of Atracurium of Vecuronium / 대한마취과학회지

Action of neuromuscular blocking agents are known to be largely affected by acid-base imbalance. In general, acidosis potentiates and alkalosis antagonizes the action of the neuromuscular blockers. To evaJuate the effects of acid-base imbalance on the neuromuscular actions of atracurium or vecuronium in 24 cats, we induced respiratory and metabolic acid-base imbalance and performed cumulative dose response studies. The results are as follows; 1) ED(50) and ED(95) of the atracurium was smaller in metabolic acidosis than those of respiratory and metabolic alkalosis. 2) ED(50) of vecuronium was not affected by acid-base imbalance in either agent. 3) Duration and recovery index were not affected by acid-base imbalance in either agent. 4) In atracurium group, serum potassium and calcium values during respiratory or metabolic alkalosis were smaller than those of control, but did not influence the neuromuscular action of atracurium. 5) Dose-response curve of the atracurium shifted to the right with metabolic acidosis, respiratory acidosis, metabolic alkalosis and respiratory alkalosis in order, but acid-base imbalance did not influence the dose-response curve of the vecuronium. In conclusion, the potency might be increased in respiratory and metabolic acidosis with atracurium, but not with vecuronium. However, action and recovery were not influenced by a experimental imbalance in either agent.