Acute and Critical Care

Kyoung Min Lee

6 Articles

Influence of Blood Glucose Level on Acid-Base Balance: Kyoung Min Lee; Korean J Crit Care Med. 2009;24(1):17-21.; DOI: https://doi.org/10.4266/kjccm.2009.24.1.17

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BACKGROUND
This study was performed to evaluate whether blood glucose concentrations have a significant influence on acid-base balance.
METHODS
We studied 157 adult patients who underwent intra-abdominal operations under general anesthesia. Postoperative blood samples were withdrawn from radial artery and blood glucose concentrations, gas values, and chemistry values were measured. All patients were divided into three groups according to the postoperative blood glucose level. The group 1 contained the patients who had postoperative blood glucose level lower than 126 mg/dl, the group 2, the patients with glucose level higher than 126 mg/dl, lower than 180 mg/dl, and the group 3, the patients with glucose level higher than 180 mg/dl.
RESULTS
Metabolic acidosis rate was significantly higher in group 3 than in group 1, group 2 and arterial blood pH was significantly lower in group 3 than that in group 1, group 2. Regression analysis showed that [H+] was correlated with blood glucose level. Strong ion difference (SID) was significantly lower in group 3 than group 1 and PaCO2 level was significantly lower in group 2 and group 3 than that in group 1. In regression analysis, there was a negative correlation between blood glucose concentration and SID. [H+] had a negative correlation with SID and PaCO2 was correlated with SID.
CONCLUSIONS
These findings suggest that blood glucose level affects acid-base balance and a disturbance in SID is accompanied with respiratory compensation.

Citations

Citations to this article as recorded by

Hidden chronic metabolic acidosis of diabetes type 2 (CMAD): Clues, causes and consequences
Hayder A. Giha
Reviews in Endocrine and Metabolic Disorders.2023; 24(4): 735. CrossRef
A Case of Metformin-Induced Acute Kidney Injury without Lactic Acidosis - A Case Report -
Hae Ryong Jeong, Jeong Im Choi, Jung Hwan Park, Sang Mo Hong, Joon Sung Park, Chang Beom Lee, Yong Soo Park, Dong Sun Kim, Woong Hwan Choi, You Hern Ahn
Korean Journal of Critical Care Medicine.2012; 27(4): 283. CrossRef

Influence of Unmeasured Anions Identified by Stewart Principle on the Length of Postoperative Hospital Stay: Kyoung Min Lee, Sung Ho Seo, Seung Yun Lee, Jun Geol Lee, Tae Yop Kim, Ka young Rhee; Korean J Crit Care Med. 2005;20(2):152-158.

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Abstract PDF: BACKGROUND
Calculation of the base excess (BE) and the anion gap (AG) is commonly used to identify the presence and to analyze the cause of metabolic acidosis in critically ill patients. However, the calculation of BE assumes normal water content, electrolytes, and albumin, changes in these values will change the calculated BE. Calculation of the AG does not control for changes in albumin and cannot distinguish plasma concentration changes of negatively charged protein (albumin) from that of other anions. Based on Stewart's physicochemical principles, Gilfix et al developed equations to calculate the BE caused by unmeasured anions (BEua) taking into account changes in free water, chloride, albumin, and PCO2 that theoretically should reflect metabolic changes better than the less complete biochemical measurements. This study was designed to evaluate the influence of BEua and other variables on the length of postoperative hospital stay. METHODS: The data from 100 consecutive patients were collected prospectively in patients who underwent intra-abdominal operations under general anesthesia and admitted to the adult intensive care unit. All samples were routine samples taken from arterial lines postoperatively and analyzed for arterial blood gas, plasma electrolytes, inorganic phosphates and albumin concentrations. BEua was calculated from the equations developed by Gilfix et al. We also calculated AGNa, K (Na++K+-Cl--HCO3-) and AGNa (Na+-Cl--HCO3-). Correlations between the length of postoperative hospital stay and these variables were studied using linear regression analysis.
RESULTS
BEua and BE were significantly correlated with the length of ICU stay (r=0.295, p<0.01 and r=0.249, p<0.05). Neither AGNa, K nor AGNa was correlated with the length of ICU stay. Significant correlation was observed between the length of postoperative hospital stay and BEua (r=0.316, p<0.01), BE (r=0.288, p<0.01), AGNa, K (r=0.284, p<0.01), and AGNa (r=0.263, p<0.05). CONCLUSIONS: In this study BEua was significantly correlated with the length of ICU stay and postoperative hospital stay compared with other variables. This finding suggests that BEua may be used as a more reliable predictor of outcome in ICU patients.

Physiologic Changes Induced with Lipopolysaccharide in Rats: Kyoung Min Lee, Kwang Ho Lee, Kong Been Im, Jong Taek Park, Young Bok Lee; Korean J Crit Care Med. 1999;14(2):137-142.

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Abstract PDF: BACKGOUND: Bacterial endotoxin or lipopolysaccharide (LPS) is believed to mediate the tissue damage and shock observed in Gram-negative sepsis (GNS) by initiating a cascade of events, including activation of the coagulation, fibrinolytic and complement systems, and release of proinflammatory cytokines. However, the clinical pictures that result from GNS and endotoxin are quite different. The physiologic changes induced with LPS were investigated in this study.
METHODS
Fifty two male Sprague-Dawley rats were injected intraperitoneally with Escherichia coli LPS. Blood samples and bronchoalveolar lavage (BAL) fluid were obtained at baseline and at 2, 4, 8, 16, 24, and 48 hours after injection. Nitrate/nitrite levels were measured from plasma and BAL samples. Lipid peroxide (LPO) levels were measured from plasma. We measured also protein concentration and number of polymorphonuclear leukocytes (PMNL) and macrophages from BAL samples.
RESULTS
Administration of LPS caused significant increase in nitrate/nitrite concentrations of plasma and BAL fluid (p<0.01). ED50 of LPS was 1.76 mg/kg in plasma nitrate/nitrite assay. Plasma LPO levels were increased slightly after administration of LPS, but no statistical significance. Protein concentration was increased significantly (p<0.01) 4 hours after the administration of LPS. LPS induced increase of the number of PMNLs and macrophages of BAL samples significantly (p<0.05).
CONCLUSIONS
LPS increased NO production and alveolar permeability in rats. Also, LPS increased the number of inflammatory cells in the lung.

Sepsis and Cachexia: Kyoung Min Lee; Korean J Crit Care Med. 1999;14(2):121-125.

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Abstract PDF: No abstract available.

Delayed Development of Pulmonary Embolism after Total Hip Replacement: A case report: Hyun Kyo Lim, Young Bok Lee, Kwang Ho Lee, Chun Gyung Kim, Kyoung Min Lee, Chong Kweon Chung; Korean J Crit Care Med. 1998;13(2):239-242.

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Abstract PDF: Though anticoagulant therapy has been shown to improve outcomes dramatically, pulmonary embolism is a potentially fatal disease. A 82 years old female underwent elective operation for left femur neck fracture under general anesthesia. At the twenty-two postoperative days, she suddenly developed cyanosis with hypotension. She was transferred to intensive care unit and pulmonary embolism was diagnosed by pulmonary perfusion scan and echocardiography. Despite of diagnosis and treatment of pulmonaly embolism, she expired 29 hours after onset of symptom.

Comparison of Initial Weaning Success Rates and Weaning Periods between Synchronized Intermittent Mandatory Ventilation and Pressure Support Ventilation: Joong Hyuk Yang, Kyoung Min Lee, Hyun Kyung Lim, Dae Ja Um, Ryung Choi; Korean J Crit Care Med. 1997;12(1):31-36.

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Abstract PDF: BACKGOUND: SIMV (synchronized intermittent mandatory ventilation) mode is comprised of a ventilator that intermittently enters the volume assist/control mode in conjunction with circuitry that allows for spontaneous ventilation by a demand flow system. There is additional work of breathing caused by the endotracheal tube and demand valve in SIMV. However, PSV (pressure support ventilation) has the ability to decrease work of breathing and to augment spontaneous breaths with a variable amount of inspiratory positive pressure with a clinician-selected level of inspiratory airway pressure.
METHODS
To compare the initial weaning success rates and weaning periods between SIMV and PSV, we reviewed medical records of 103 intensive care unit patients, who had received mechanical ventilatory support and performed weaning. We compared the patients' characteristics, initial weaning success rates and ventilatory periods, weaning periods, weaning periods/ventilatory periods, ICU stays according to the weaning process (SIMV and PSV). And then we compared the same variables as the above between the initial weaning success group and initial weaning failure group.
RESULTS
Patients' characteristics, ventilatory periods, weaning periods, ICU stays were similar, but there was significantly shorter weaning periods/ventilatory periods on PSV group. Initial weaning success rates according to the weaning process were similar. Ventilatory periods, weaning periods, weaning periods/ventilatory periods, ICU stays were significantly shorter on initial weaning success group.
CONCLUSIONS
PSV could be used effectively as one of the weaning modes, and further studies are required about weaning criteria, weaning start time and weaning methods.

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