Acid-base status of critically ill patients with acute renal failure: analysis based on Stewart-Figge methodology

Jens Rocktaeschel, Hiroshi Morimatsu, Shigehiko Uchino, Donna Goldsmith, Stephanie Poustie, David Story, Geoffrey Gutteridge, Rinaldo Bellomo

Research output: Contribution to journalArticle

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Abstract

RESULTS: Intensive care unit patients with ARF had a mild acidemia (mean pH 7.30 +/- 0.13) secondary to metabolic acidosis with a mean base excess of -7.5 +/- 7.2 mEq/l. However, one-half of these patients had a normal anion gap. Quantitative acid-base assessment (Stewart-Figge methodology) revealed unique multiple metabolic acid-base processes compared with controls, which contributed to the overall acidosis. The processes included the acidifying effect of high levels of unmeasured anions (13.4 +/- 5.5 mEq/l) and hyperphosphatemia (2.08 +/- 0.92 mEq/l), and the alkalinizing effect of hypoalbuminemia (22.6 +/- 6.3 g/l).

CONCLUSIONS: The typical acid-base picture of ARF of critical illness is metabolic acidosis. This acidosis is the result of the balance between the acidifying effect of increased unmeasured anions and hyperphosphatemia and the lesser alkalinizing effect of hypoalbuminemia.

INTRODUCTION: The aim of the present study is to understand the nature of acid-base disorders in critically ill patients with acute renal failure (ARF) using the biophysical principles described by Stewart and Figge. A retrospective controlled study was carried out in the intensive care unit of a tertiary hospital.

MATERIALS AND METHODS: Forty patients with ARF, 40 patients matched for Acute Physiology and Chronic Health Evaluation II score (matched control group), and 60 consecutive critically ill patients without ARF (intensive care unit control group) participated. The study involved the retrieval of biochemical data from computerized records, quantitative biophysical analysis using the Stewart-Figge methodology, and statistical comparison between the three groups. We measured serum sodium, potassium, magnesium, chloride, bicarbonate, phosphate, ionized calcium, albumin, lactate and arterial blood gases.

Original languageEnglish
Pages (from-to)R60
JournalCritical care (London, England)
Volume7
Issue number4
Publication statusPublished - Aug 1 2003
Externally publishedYes

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Acute Kidney Injury
Critical Illness
Acidosis
Acids
Hyperphosphatemia
Intensive Care Units
Hypoalbuminemia
Anions
Control Groups
Magnesium Chloride
APACHE
Potassium Chloride
Acid-Base Equilibrium
Information Storage and Retrieval
Bicarbonates
Tertiary Care Centers
Albumins
Research Design
Retrospective Studies
Gases

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Rocktaeschel, J., Morimatsu, H., Uchino, S., Goldsmith, D., Poustie, S., Story, D., ... Bellomo, R. (2003). Acid-base status of critically ill patients with acute renal failure: analysis based on Stewart-Figge methodology. Critical care (London, England), 7(4), R60.

Acid-base status of critically ill patients with acute renal failure : analysis based on Stewart-Figge methodology. / Rocktaeschel, Jens; Morimatsu, Hiroshi; Uchino, Shigehiko; Goldsmith, Donna; Poustie, Stephanie; Story, David; Gutteridge, Geoffrey; Bellomo, Rinaldo.

In: Critical care (London, England), Vol. 7, No. 4, 01.08.2003, p. R60.

Research output: Contribution to journalArticle

Rocktaeschel, J, Morimatsu, H, Uchino, S, Goldsmith, D, Poustie, S, Story, D, Gutteridge, G & Bellomo, R 2003, 'Acid-base status of critically ill patients with acute renal failure: analysis based on Stewart-Figge methodology', Critical care (London, England), vol. 7, no. 4, pp. R60.
Rocktaeschel, Jens ; Morimatsu, Hiroshi ; Uchino, Shigehiko ; Goldsmith, Donna ; Poustie, Stephanie ; Story, David ; Gutteridge, Geoffrey ; Bellomo, Rinaldo. / Acid-base status of critically ill patients with acute renal failure : analysis based on Stewart-Figge methodology. In: Critical care (London, England). 2003 ; Vol. 7, No. 4. pp. R60.
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