ArticleCritical care (London, England)2007
Causes of metabolic acidosis in canine hemorrhagic shock: role of unmeasured ions.
Article in Critical care (London, England), 2007. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 20 papers.
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Who cites it
20 citing papers in PubMed, 48 citations in OpenAlex.
- Impact of anion gap on in-hospital mortality in trauma-induced coagulopathy patients: a MIMIC-IV study.European journal of medical research · 2025Article
- Comparison of a modified Story approach to traditional evaluation of acid-base disturbances in patients with shock: a cohort study.Journal of clinical monitoring and computing · 2022Article
- Acid-base disorders in sick goats and their association with mortality: A simplified strong ion difference approach.Journal of veterinary internal medicine · 2020Article
- Acid-base status and its clinical implications in critically ill patients with cirrhosis, acute-on-chronic liver failure and without liver disease.Annals of intensive care · 2018Article
- Association of unmeasured strong ions with outcome of hospitalized beef and dairy diarrheic calves.The Canadian veterinary journal = La revue veterinaire canadienne · 2017Article
- Effect of Intravenously Administered Crystalloid Solutions on Acid-Base Balance in Domestic Animals.Journal of veterinary internal medicine · 2017Review
- Non-lactate strong ion difference: a clearer picture.Journal of anesthesia · 2016Article
- Pathologic metabolism: an exploratory study of the plasma metabolome of critical injury.The journal of trauma and acute care surgery · 2015Article
- Arterial vs venous blood gas differences during hemorrhagic shock.World journal of critical care medicine · 2014Article
- Unmeasured anions are associated with short-term mortality in patients with hypoxic hepatitis.Wiener klinische Wochenschrift · 2013Article
- Influence of an acetate- and a lactate-based balanced infusion solution on acid base physiology and hemodynamics: an observational pilot study.European journal of medical research · 2012Article
- Combined administration of anisodamine and neostigmine produces anti-shock effects: involvement of α7 nicotinic acetylcholine receptors.Acta pharmacologica Sinica · 2012Article
- Acidosis and correction of acidosis does not affect rFVIIa function in swine.International journal of burns and trauma · 2012Article
- Traditional resuscitative practices fail to resolve metabolic acidosis in morbidly obese patients after severe blunt trauma.The Journal of trauma · 2010Article
- [Acid-base concepts].Der Anaesthesist · 2009Article
- Unmeasured anions: the unknown unknowns.Critical care (London, England) · 2008Article
- The nature of unmeasured anions in critically ill patients.Critical care (London, England) · 2008Article
- Year in review 2007: Critical Care--shock.Critical care (London, England) · 2008Review
- Metabolic acid-base adaptation triggered by acute persistent hypercapnia in mechanically ventilated patients with acute respiratory distress syndrome.Revista Brasileira de terapia intensivaArticle
- Quantitative accuracy of the simplified strong ion equation to predict serum pH in dogs.Journal of veterinary internal medicineArticle
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Authors and funding
11 authors at 5 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
introductionMetabolic acidosis during hemorrhagic shock is common and conventionally considered to be due to hyperlactatemia. There is increasing awareness, however, that other nonlactate, unmeasured anions contribute to this type of acidosis.
methodsEleven anesthetized dogs were hemorrhaged to a mean arterial pressure of 45 mm Hg and were kept at this level until a metabolic oxygen debt of 120 mLO2/kg body weight had evolved. Blood pH, partial pressure of carbon dioxide, and concentrations of sodium, potassium, magnesium, calcium, chloride, lactate, albumin, and phosphate were measured at baseline, in shock, and during 3 hours post-therapy. Strong ion difference and the amount of weak plasma acid were calculated. To detect the presence of unmeasured anions, anion gap and strong ion gap were determined. Capillary electrophoresis was used to identify potential contributors to unmeasured anions.
resultsDuring induction of shock, pH decreased significantly from 7.41 to 7.19. The transient increase in lactate concentration from 1.5 to 5.5 mEq/L during shock was not sufficient to explain the transient increases in anion gap (+11.0 mEq/L) and strong ion gap (+7.1 mEq/L), suggesting that substantial amounts of unmeasured anions must have been generated. Capillary electrophoresis revealed increases in serum concentration of acetate (2.2 mEq/L), citrate (2.2 mEq/L), alpha-ketoglutarate (35.3 microEq/L), fumarate (6.2 microEq/L), sulfate (0.1 mEq/L), and urate (55.9 microEq/L) after shock induction.
conclusionLarge amounts of unmeasured anions were generated after hemorrhage in this highly standardized model of hemorrhagic shock. Capillary electrophoresis suggested that the hitherto unmeasured anions citrate and acetate, but not sulfate, contributed significantly to the changes in strong ion gap associated with induction of shock.
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