Severe hyperlactatemia with normal base excess: a quantitative analysis using conventional and Stewart approachesReportar como inadecuado

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Critical Care

, 12:R66

First Online: 08 May 2008Received: 10 March 2008Revised: 28 April 2008Accepted: 08 May 2008


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 ≥ 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.

AbbreviationsAGanion gap

Atottotal concentration of plasma nonvolatile buffers

BEbase excess

HCO3bicarbonate concentration

PCO2partial pressure of carbon dioxide

Piinorganic phosphate concentration

SIDstrong-ion difference

ICUintensive care unit

SIGstrong-ion gap.

Electronic supplementary materialThe online version of this article doi:10.1186-cc6896 contains supplementary material, which is available to authorized users.

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Autor: Graciela Tuhay - María Carolina Pein - Fabio Daniel Masevicius - Daniela Olmos Kutscherauer - Arnaldo Dubin


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