Anest. intenziv. Med. 2014;25(2):88-97
Strong ion difference (SID) in critically ill patients with normal arterial pH, pCO2, BE and HCO3- and its impact on mortalityIntensive Care Medicine - Original Paper
- Anesteziologicko-resuscitační oddělení, Krajská nemocnice Tomáše Bati, a. s., Zlín
Objective:
To identify acid-base disturbances according to the Stewart-Fencl approach in critically ill patients with normal arterial pH, pCO2, HCO3- and BE. To compare the SIDapp, SIDef, SIG and AGkor values in the patients who were vs. were not alive at three months from ITU admission.
Design:
Single-centre, retrospective, observational study.
Setting:
Anaesthesiology and Resuscitation Department of a Regional Hospital.
Materials and methods:
The criteria (normal arterial pH, pCO2, BE, HCO3-) were met by 112 critically ill patients. In these patients, the parameters needed to calculate the SID and SIG were sampled. Thirty nine of the patients died within three months of admission, 50 patients survived longer than 3 months and 23 patients were eliminated from the subsequent part of the study. SIDapp, SIDef, SIG and AGkor values were calculated in all these patients.
Results:
A total of 110 patients had abnormal SIDef values (98.21%), 107 patients had abnormal SIDapp values (95.54%), 52 patients had SIG values above 5 mmol/l (46.43%) and 4 of them over 10 mmol/l (3.57%). There was a statistically significant difference between the non-survivors and survivors in the SIDapp (p < 0.01), SIG (p < 0.005) and AGkor (p < 0.005) values. There was no statistically significant difference between the SIDef values.
Conclusion:
This study confirmed that the majority of critically ill patients admitted to the ITU with normal parameters of arterial pH, pCO2, HCO3- and BE have acid-base disturbances according to the Stewart-Fencl approach. We found a significant difference in SIDapp, SIG and AGkor values between the survivors and the non-survivors.
Keywords: acid-base disturbances; Stewart-Fencl approach; strong ion difference (SID); critically ill patients
Received: September 21, 2013; Accepted: November 15, 2013; Published: April 1, 2014 Show citation
References
- Corey, H. E. Stewart and beyond: New models of acid-base ba-lance. Kidney International, 2003, 64, p. 777-787.
Go to original source... 
Go to PubMed... - Stewart, P. A. Modern quantitative acid-base chemistry. Canad. J. Physiol. Pharmacol., 1983, 61, p. 1444-1461. Go to original source... Go to PubMed...
- Fencl, V. et al. Diagnosis of acid-base disturbances in critically ill patients. Am. J. Crit. Care, 2000, 162, p. 2246-2251. Go to original source... Go to PubMed...
- Badr, A., Nightingale, P. An alternative approach to acid-base abnormalities in critically ill patients. Contin. Educ. Anaesth. Crit. Care. Pain., 2007, 7, 4, p. 107-111. Go to original source...
- Story, D. A. et al. Hyperchloremic acidosis in the critically ill: One of the strong-ion acidoses? Anesth. Analg., 2006, 103, p. 144-148. Go to original source... Go to PubMed...
- Schück, O. et al. Vztah mezi pH a diferencí silných iontů (SID) ve vnitřním prostředí. Klin. Biochem. Metab., 2005, 1, s. 32-35.
- Nicholson, J. P. et al. The role of albumin in critical illness. Br. J. Anaesth., 2000, 85, p. 599-610. Go to original source... Go to PubMed...
- Kazda, A. Vnitřní prostředí II - acidobazická rovnováha, kyslíkové parametry, laktát. In Kazda, A. et al. Kritické stavy. Metabolická a laboratorní problematika. Praha: Galén, 2012, s. 46.
- Boniatti, M. M. et al. Acid-base disorders evaluation in critically ill patients: we can improve our diagnostic ability. Intensive Care Med., 2009, 35, 8, p. 1377-1382. Go to original source... Go to PubMed...
- Kaplan, L. J. et al. Comparison of acid-base models for prediction of hospital mortality after trauma. Shock, 2008, 29, 6, p. 662-666. Go to original source... Go to PubMed...
- Zehtabchi, S. et al. Utility of Stewart's strong ion difference as a predictor of major injury after trauma in the ED. Am. J. Emerg. Med., 2007, 25, 8, p. 938-941. Go to original source... Go to PubMed...
- Cusack, R. J. et al. The strong ion gap does not have prognostic value in critically ill patients in a mixed medical/surgical adult ICU. Intensive Care Med., 2002, 28, 7, s. 864-869. Go to original source... Go to PubMed...
- Dubin, A. et al. Comparison of three different methods of evaluation of metabolic acid-base disorders. Crit. Care. Med., 2007, 35, 5, s. 1264-1270. Go to original source... Go to PubMed...