Journal Dr Vera

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CHANGES OF SERUM CHLORIDE AND

METABOLIC ACID-BASE STATE

IN CRITICAL ILLNESS

Hani Amalia (030.08.114). Muthi Melatiara (030.09.161).

G.-C. Funk, D. Doberer, G. Heinze, C. Madl, U. Holzinger and B. Schneeweiss

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keywords

 Acid-base imbalance

Chloride

Critical illness

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methods

Patients and sampling• Medical Intensive Care Unit of the Vienna Medical University

• Samples taken from arterial lines in patients requiring intensive care management

•  Arterial blood gases were measured when clinically indicated (min twice : 06:00 & 22:00)

•

Plasma concentration of albumin, Mg, inorganic phosphate

 Once (06:00)• pH , PaCO2, Ca, Lactate blood gas analyser ABL 725, Radiometer, Copenhagen,

Denmark

• Na, K, Cl, Mg, inorganic phosphate, albumin Hitachi 917, Roche Diagnostic GmbH,

Mannheim, Germany

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methods

 Acid base analysis

• Standard base excess is composed of four subsets:

• Base ExcessSodium 

•

Base ExcessChloride • Base Excess Albumin 

• Base ExcessUnmeasured anions 

Severe hypochloraemic alkalosis BEChloride = - 5 mmol/l

Severe hypochloraemic acidosis BEChloride = 5 mmol/l

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methods

Statistics• autoregressive error model implemented in the statistical software (SAS Version

8.2, SAS Institute Inc., Cary, NC)

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results

30 patients (21 males, 9 females) were included in the study in 7 days

556 blood samples were analysed

Mean daily increases :

Standard Base Excess : 0.95 mmol/l Base ExcessChloride  : 0.58 mmol/l

Base Excess Albumin : 0.16 mmol/l

 progressive development of a hypochloraemic and hypoalbuminaemicalkalosis metabolic alkalosis 

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results

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results

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results

Severe hyperchloraemic acidosis was present in 56 out of 68 (82%) samples with

severe metabolic acidosis.

Severe hypochloraemic alkalosis was present in 44 out of 103 (43%) samples with

severe metabolic alkalosis.

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discussion

 Aim determine what extent components of bloodplasma influence metabolic acid base state duringcritical illness.

Mild metabolic alkalosis developed within 7 days afterICU admission.

Base ExcessChloride have the greatest impact on theoverall metabolic acid-base state.

Hypoalbuminaemia also contributed to the metabolicalkalosis.

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Hypoalbuminaemia is almost ubiquitous in

critically ill patients due to plasma dilution or

hepatic failure

In a previous report, hypoalbuminaemic

alkalosis was suspected to be the cause of a

mild metabolic alkalosis in 100 critically illpatients

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Renal loss of chloride is a common cause of

hypochloraemic alkalosis diuretics, gastric

and intestinal losses

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Hyperchloremic infusion normal saline a

poor outcome in experimental sepsis and is no

longer recommended for volume resuscitation

in diabetic ketoacidosis.

Loop diuretics are capable of reducing serum

chloride with little effect on serum sodium.

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 Assessment of chloride-related acidbase

disorders might be helpful in diagnosis,

prevention and treatment of metabolic

disorders in critically ill patients

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Stewart approach

Strong Cation

• Na

• K

• Mg

•

Ca

Strong Anion

• Cl

• Sulfat

• Lactate

•

Uric

3 independent variables :-Strong Ion Difference (SID)

-Total Weak Acid

-PCO2

Normal : 40 ± 2 mEq/L

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Pertanyaan

www.acidbase.org