Journal Dr Vera

8/12/2019 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



keywords

Acid-base imbalance

Chloride

Critical illness



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



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



methods

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

8.2, SAS Institute Inc., Cary, NC)



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



results



results



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.



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.



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



Renal loss of chloride is a common cause of

hypochloraemic alkalosis diuretics, gastric

and intestinal losses





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.



Assessment of chloride-related acidbase

disorders might be helpful in diagnosis,

prevention and treatment of metabolic

disorders in critically ill patients





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



Pertanyaan

www.acidbase.org

Documents

Journal Dr Vera