ArticleCritical care (London, England)2008
Severe hyperlactatemia with normal base excess: a quantitative analysis using conventional and Stewart approaches.
Article in Critical care (London, England), 2008. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 15 papers.
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Who cites it
15 citing papers in PubMed.
- Base Excess and Beyond: Evolving Concepts in Acid-base Analysis.Turkish journal of anaesthesiology and reanimation · 2026Article
- Severe hyperlactatemia in the emergency department: clinical characteristics, etiology and mortality.BMC emergency medicine · 2024Article
- Strong ion gap and anion gap corrected for albumin and lactate in patients with sepsis in the intensive care unit.International journal of physiology, pathophysiology and pharmacology · 2024Article
- Association between delta anion gap and hospital mortality for patients in cardiothoracic surgery recovery unit: a retrospective cohort study.BMC surgery · 2022Article
- Admission Anion Gap Metabolic Acidosis and Its Impact on Patients in Medical Intensive Care Unit.Journal of laboratory physicians · 2021Article
- Diagnosis and management of metabolic acidosis: guidelines from a French expert panel.Annals of intensive care · 2019Review
- Lactic Acid Inhibits Lipopolysaccharide-Induced Mast Cell Function by Limiting Glycolysis and ATP Availability.Journal of immunology (Baltimore, Md. : 1950) · 2019Article
- Modern and traditional approaches combined into an effective gray-box mathematical model of full-blood acid-base.Theoretical biology & medical modelling · 2018Article
- A comparison of prognostic significance of strong ion gap (SIG) with other acid-base markers in the critically ill: a cohort study.Journal of intensive care · 2016Article
- Has Stewart approach improved our ability to diagnose acid-base disorders in critically ill patients?World journal of critical care medicine · 2015Review
- Association of low non-invasive near-infrared spectroscopic measurements during initial trauma resuscitation with future development of multiple organ dysfunction.World journal of emergency medicine · 2015Article
- WITHDRAWN: The association between initial anion gap and outcomes in medical intensive care unit patients.Journal of critical care · 2012Article
- Severe metabolic or mixed acidemia on intensive care unit admission: incidence, prognosis and administration of buffer therapy. A prospective, multiple-center study.Critical care (London, England) · 2011Article
- Quantitative accuracy of the simplified strong ion equation to predict serum pH in dogs.Journal of veterinary internal medicineArticle
- Retrospective Evaluation of Acid-Base Disorders in Dogs With Hyperlactatemia Using Traditional and Semiquantitative Analysis: 3866 Cases.Journal of veterinary emergency and critical care (San Antonio, Tex. : 2001)Article
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Authors and funding
5 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
introductionCritically ill patients might present complex acid-base disorders, even when the pH, PCO2, [HCO3-], and base excess ([BE]) levels are normal. Our hypothesis was that the acidifying effect of severe hyperlactatemia is frequently masked by alkalinizing processes that normalize the [BE]. The goal of the present study was therefore to quantify these disorders using both Stewart and conventional approaches.
methodsA total of 1,592 consecutive patients were prospectively evaluated on intensive care unit admission. Patients with severe hyperlactatemia (lactate level > or = 4.0 mmol/l) were grouped according to low or normal [BE] values (<-3 mmol/l or >-3 mmol/l).
resultsSevere hyperlactatemia was present in 168 of the patients (11%). One hundred and thirty-four (80%) patients had low [BE] levels while 34 (20%) patients did not. Shock was more frequently present in the low [BE] group (46% versus 24%, P = 0.02) and chronic obstructive pulmonary disease in the normal [BE] group (38% versus 4%, P < 0.0001). Levels of lactate were slightly higher in patients with low [BE] (6.4 +/- 2.4 mmol/l versus 5.6 +/- 2.1 mmol/l, P = 0.08). According to our study design, the pH, [HCO3-], and strong-ion difference values were lower in patients with low [BE]. Patients with normal [BE] had lower plasma [Cl-] (100 +/- 6 mmol/l versus 107 +/- 5 mmol/l, P < 0.0001) and higher differences between the changes in anion gap and [HCO3-] (5 +/- 6 mmol/l versus 1 +/- 4 mmol/l, P < 0.0001).
conclusionCritically ill patients may present severe hyperlactatemia with normal values of pH, [HCO3-], and [BE] as a result of associated hypochloremic alkalosis.
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