Changes of serum chloride and metabolic acid-base state in critical illness.
Alterations of electrolytes and albumin cause metabolic acid-base disorders. It is unclear, however, to what degree these plasma components affect the overall metabolic acid-base state in the course of critical illness. We performed serial analyses of the metabolic acid-base state in 30 critically ill patients over the course of 1 week. We applied a physical-chemical acid-base model and used a linear regression model to determine the influence of sodium, chloride, unmeasured anions and albumin on the net metabolic acid-base state. Progressive hypochloraemia was identified as the main cause of developing metabolic alkalosis. Changes in serum chloride and unmeasured anions were responsible for changes of 41% and 22% in the metabolic acid-base state, respectively. Sodium and albumin played a minor role. In conclusion, chloride is the major determinant of metabolic acid-base state in critical illness.
Department of Pulmonary Medicine, Medical University of Vienna, AKH, Waehringerguertel 18-20, A-1090 Vienna, Austria. georg-christian.funk@meduniwien.ac.at
G-C
GC
Funk
D
D
Doberer
G
G
Heinze
C
C
Madl
U
U
Holzinger
B
B
Schneeweiss
D000137:Acid-Base Imbalance / Q000097:blood*; D000471:Alkalosis / Q000097:blood; D002712:Chlorides / Q000097:blood*; D016638:Critical Illness; D005260:Female; D006801:Humans; D016014:Linear Models; D008297:Male; D011446:Prospective Studies; D012709:Serum Albumin / Q000378:metabolism; D012964:Sodium / Q000097:blood
D002712:Chlorides; D012709:Serum Albumin; D012964:Sodium