Skip Navigation
Skip to contents

ACC : Acute and Critical Care

OPEN ACCESS
SEARCH
Search

Search

Page Path
HOME > Search
8 "acidosis"
Filter
Filter
Article category
Keywords
Publication year
Authors
Original Articles
Epidemiology
Mortality rates among adult critical care patients with unusual or extreme values of vital signs and other physiological parameters: a retrospective study
Charles Harding, Marybeth Pompei, Dmitriy Burmistrov, Francesco Pompei
Acute Crit Care. 2024;39(2):304-311.   Published online May 13, 2024
DOI: https://doi.org/10.4266/acc.2023.01361
  • 568 View
  • 37 Download
AbstractAbstract PDF
Background
We evaluated relationships of vital signs and laboratory-tested physiological parameters with in-hospital mortality, focusing on values that are unusual or extreme even in critical care settings. Methods: We retrospectively studied Philips Healthcare–MIT eICU data (207 U.S. hospitals, 20142015), including 166,959 adult-patient critical care admissions. Analyzing most-deranged (worst) value measured in the first admission day, we investigated vital signs (body temperature, heart rate, mean arterial pressure, and respiratory rate) as well as albumin, bilirubin, blood pH via arterial blood gas (ABG), blood urea nitrogen, creatinine, FiO2 ABG, glucose, hematocrit, PaO2 ABG, PaCO2 ABG, sodium, 24-hour urine output, and white blood cell count (WBC). Results: In-hospital mortality was ≥50% at extremes of low blood pH, low and high body temperature, low albumin, low glucose, and low heart rate. Near extremes of blood pH, temperature, glucose, heart rate, PaO2 , and WBC, relatively. Small changes in measured values correlated with several-fold mortality rate increases. However, high mortality rates and abrupt mortality increases were often hidden by the common practice of thresholding or binning physiological parameters. The best predictors of in-hospital mortality were blood pH, temperature, and FiO2 (scaled Brier scores: 0.084, 0.063, and 0.049, respectively). Conclusions: In-hospital mortality is high and sharply increasing at extremes of blood pH, body temperature, and other parameters. Common-practice thresholding obscures these associations. In practice, vital signs are sometimes treated more casually than laboratory-tested parameters. Yet, vitals are easier to obtain and we found they are often the best mortality predictors, supporting perspectives that vitals are undervalued.
Pediatric
Impact of the COVID-19 pandemic on diabetic ketoacidosis management in the pediatric intensive care unit
Fevzi Kahveci, Buse Önen Ocak, Emrah Gün, Anar Gurbanov, Hacer Uçmak, Ayşen Durak Aslan, Ayşegül Ceran, Hasan Özen, Burak Balaban, Edin Botan, Zeynep Şıklar, Merih Berberoğlu, Tanıl Kendirli
Acute Crit Care. 2023;38(3):371-379.   Published online August 31, 2023
DOI: https://doi.org/10.4266/acc.2023.00038
  • 1,768 View
  • 39 Download
  • 1 Web of Science
  • 1 Crossref
AbstractAbstract PDF
Background
Diabetic ketoacidosis (DKA) is a common endocrine emergency in pediatric patients. Early presentation to health facilities, diagnosis, and good management in the pediatric intensive care unit (PICU) are crucial for better outcomes in children with DKA.
Methods
This was a single-center, retrospective cohort study conducted between February 2015 and January 2022. Patients with DKA were divided into two groups according to pandemic status and diabetes diagnosis.
Results
The study enrolled 59 patients, and their mean age was 11±5 years. Forty (68%) had newly diagnosed type 1 diabetes mellitus (T1DM), and 61% received follow-up in the pre-pandemic period. Blood glucose, blood ketone, potassium, phosphorus, and creatinine levels were significantly higher in the new-onset T1DM group compared with the previously diagnosed group (P=0.01, P=0.02, P<0.001, P=0.01, and P=0.08, respectively). In patients with newly diagnosed T1DM, length of PICU stays were longer than in those with previously diagnosed T1DM (28.5±8.9 vs. 17.3±6.7 hours, P<0.001). The pandemic group was compared with pre-pandemic group, there was a statistically significant difference in laboratory parameters of pH, HCO3, and lactate and also Pediatric Risk of Mortality (PRISM) III score. All patients survived, and there were no neurologic sequelae.
Conclusions
Patients admitted during the pandemic period were admitted with more severe DKA and had higher PRISM III scores. During the pandemic period, there was an increase in the incidence of DKA in the participating center compared to that before the pandemic.

Citations

Citations to this article as recorded by  
  • Covid 19 and diabetes in children: advances and strategies
    Zhaoyuan Wu, Jinling Wang, Rahim Ullah, Minghao Chen, Ke Huang, Guanping Dong, Junfen Fu
    Diabetology & Metabolic Syndrome.2024;[Epub]     CrossRef
Trauma
Biochemical Markers as Predictors of In-Hospital Mortality in Patients with Severe Trauma: A Retrospective Cohort Study
Ha Nee Jang, Hyun Oh Park, Tae Won Yang, Jun Ho Yang, Sung Hwan Kim, Seong Ho Moon, Joung Hun Byun, Chung Eun Lee, Jong Woo Kim, Dong Hun Kang, Kyeong Hee Baek
Korean J Crit Care Med. 2017;32(3):240-246.   Published online August 31, 2017
DOI: https://doi.org/10.4266/kjccm.2017.00360
  • 8,133 View
  • 136 Download
  • 1 Web of Science
  • 2 Crossref
AbstractAbstract PDF
Background
Initial evaluation of injury severity in trauma patients is an important and challenging task. We aimed to assess whether easily measurable biochemical parameters (hemoglobin, pH, and prothrombin time/international normalized ratio [PT/INR]) can predict in-hospital mortality in patients with severe trauma. Methods: This retrospective study involved review of the medical records of 315 patients with severe trauma and an injury severity score >15 who were managed at Gyeongsang National University Hospital between January 2005 and December 2015. We extracted the following data: in-hospital mortality, injury severity score, and initial hemoglobin level, pH, and PT/INR. The predictive values of these variables were compared using receiver operation characteristic curves. Results: Of the 315 patients, 72 (22.9%) died. The in-hospital mortality rates of patients with hemoglobin levels <8.4 g/dl and ≥8.4 g/dl were 49.8% and 9.9%, respectively (P < 0.001). At a cutoff hemoglobin level of 8.4 g/dl, the sensitivity and specificity values for mortality were 81.9% and 86.4%, respectively. At a pH cutoff of 7.25, the sensitivity and specificity values for mortality were 66.7% and 77.8%, respectively; 66.7% of patients with a pH <7.25 died versus 22.2% with a pH ≥7.25 (P < 0.001). The in-hospital mortality rates for patients with PT/INR values ≥1.4 and <1.4 were 37.5% and 16%, respectively (P < 0.001; sensitivity, 37.5%; specificity, 84%). Conclusions: Using the suggested cutoff values, hemoglobin level, pH, and PT/INR can simply and easily be used to predict in-hospital mortality in patients with severe trauma.

Citations

Citations to this article as recorded by  
  • Assessment of the Initial Risk Factors for Mortality among Patients with Severe Trauma on Admission to the Emergency Department
    Hyun Oh Park, Jun Young Choi, In Seok Jang, Jong Duk Kim, Jae Won Choi, Chung Eun Lee
    The Korean Journal of Thoracic and Cardiovascular Surgery.2019; 52(6): 400.     CrossRef
  • The thorax trauma severity score and the trauma and injury severity score
    Seong Ho Moon, Jong Woo Kim, Joung Hun Byun, Sung Hwan Kim, Jun Young Choi, In Seok Jang, Chung Eun Lee, Jun Ho Yang, Dong Hun Kang, Ki Nyun Kim, Hyun Oh Park
    Medicine.2017; 96(42): e8317.     CrossRef
Case Report
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 J Crit Care Med. 2012;27(4):283-285.
DOI: https://doi.org/10.4266/kjccm.2012.27.4.283
  • 3,796 View
  • 121 Download
AbstractAbstract PDF
Metformin is an oral antidiabetic drug in the biguanide class, which is used for type 2 diabetes. The side effects of metformin are mostly limited to digestive tract symptoms, such as diarrhea, flatulence and abdominal discomfort. The most serious potential adverse effect of metformin is lactic acidosis. A 51-year-old man was admitted due to hypoglycemia as a result of an overdose of antidiabetic drugs. He took massive dose of metformin. Conservative treatment failed for metabolic acidosis without lactic acidosis accompanied by acute kidney injury. Hemodialysis was executed to correct the high anion gap metabolic acidosis and acute kidney injury, and the patient recovered fully from metabolic acidosis. This case illustrates that the presence of clinical conditions, such as metformin-induced acute kidney injury and metabolic acidosis, can be developed without lactic acidosis. Prompt recognition of metabolic acidosis and early intervention with hemodialysis can result in a successful clinical outcome.
Original 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
  • 3,761 View
  • 163 Download
  • 2 Crossref
AbstractAbstract PDF
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.
  • 1,443 View
  • 18 Download
AbstractAbstract 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.
Changes of Sodium, Potassium, Chloride and Bicarbonateion Concentrations in Apneic Rabbits
Hyun Jung Kim, Kwang Won Yum, Yong Rak Kim
Korean J Crit Care Med. 1998;13(2):186-193.
  • 1,538 View
  • 7 Download
AbstractAbstract PDF
BACKGOUND: During apnea, as in any other acid-base disturbance, ion exchanges between intra- and extracellular compartments are expected, but few studies have reported such findings. The purpose of this study was to observe serum sodium, potassium, chloride and bicarbonate concentrations during apnea until death.
METHODS
Seventeen New Zealand White Rabbits (weight 2.0~3.0 kg) were subjected to apneic oxygenation. Then we measured heart rate, blood pressure, intracranial pressure, arterial blood gas analyses and serum electrolytes (sodium, potassium, chloride and bicarbonate) concentrations during apnea until death.
RESULTS
Heart rate decreased because of sinus bradyarrythmia at 10 minutes after apnea and thereafter continued to increase. Blood pressure increased up to 30 minutes after apnea and thereafter continued to decrease. Intracranial pressure consistently increased during apnea. Serum bicarbonate and chloride ion concentrations showed reciprocal changes, but there was no significant correlation. Serum sodium and potassium concentrations increased up to 40 minutes and 30 minutes respectively, and thereafter decreased until death. All serum ion concentrations were within normal limits.
CONCLUSION
The serum sodium, potassium, chloride and bicarbonate concentrations were maintained within normal limits during apneic oxygenation until death.
Case Report
Malignant Hyperthermia Syndrome: A case report
Ji Yeon Kim, Eun Jung Kwon, Mi Kyoung Lee, Sang Ho Lim, Suk Min Yoon, Young Seok Choi
Korean J Crit Care Med. 1997;12(1):85-88.
  • 2,017 View
  • 39 Download
AbstractAbstract PDF
Malignant hyperthermia (MH) is an inherited skeletal muscle disorder characterized by hypermetabolism, muscle rigidity, rhabdomyolysis, fever, metabolic acidosis and death if untreated. The syndrome is believed to result from abnormal control of intracellular calcium ions in the skeletal muscle: on exposure to certain anesthetics, calcium level is increased, and then it activates contractile processes and biochemical events that support muscle contraction. We experienced a MH of 2 years-old male who had release of sternocleidomastoid muscle due to torticolis under general anesthesia. Anesthesia was induced with thiopental and succinylcholine, maintained with enflurane, nitrous oxide and oxygen (2 volume%: 2 L/min: 2 L/min). After induction of anesthesia, his heart rate, end-tidal CO2 tension and body temperature had been gradually increased and then those were reached to maximal value of heart rate (160~170 BPM), end-tidal CO2 tension (60~70 mmHg) and body temperature (41degrees C) 55 minutes later. He was immediately managed with symptomatic treatment such as hyperventilation with oxygen, cooling, beta-blocker, sodium bicarbonate and diuretics, so he was survived without any sequelae.

ACC : Acute and Critical Care