Jul, 2006
Hyperchloremic acidosis in the critically ill: One of the strong-ion acidoses?
ANESTHESIA AND ANALGESIA
- ,
- ,
- Volume
- 103
- Number
- 1
- First page
- 144
- Last page
- 148
- Language
- English
- Publishing type
- DOI
- 10.1213/01.ane.0000221449.67354.52
- Publisher
- LIPPINCOTT WILLIAMS & WILKINS
Decreases in plasma bicarbonate are associated with hyperchloremic acidosis and lactic acidosis. According to the Stewart approach to acid-base physiology, the strong-ion difference regulates plasma bicarbonate, with chloride and lactate being the only strong anions routinely measured in clinical chemistry. We hypothesized that the plasma strong-ion difference, both with and without lactate, would have a stronger association with plasma bicarbonate than plasma chloride alone would have with bicarbonate. We used plasma acid-base data from 300 critically ill patients. The correlation with bicarbonate became progressively weaker (P < 0.001): all measured strong ions, r = 0.60; measured strong ions without lactate, r = 0.42; chloride alone, r = -0.27. In a subgroup of 26 patients with traditional hyperchloremic acidosis (base excess < -2mmol/L and anion gap < 17 mmol/L), the measured strong-ion difference (without lactate) had a stronger correlation (P < 0.001) with bicarbonate than chloride had: r = 0.85 versus r = -0.60. We conclude that hyperchloremic acidosis and lactic acidosis are strong-ion acidoses. Hyperchloremia should be viewed relative to the plasma strong cations. A practical conclusion is that both managing and preventing acid-base disorders with IV fluid therapy involves manipulating each of the plasma strong ions, particularly sodium and chloride.
- Link information
- ID information
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- DOI : 10.1213/01.ane.0000221449.67354.52
- ISSN : 0003-2999
- Web of Science ID : WOS:000238661900029