title: Evaluation of the efficacy of simplified Fencl-Stewart equation in analyzing the changes in acid base status following resuscitation with two different fluids.
abstract: BACKGROUND
  Metabolic acid-base disorders in critically ill patients may not be identified by base excess (BE) approach. Anion gap method can detect approximately 1/3 hidden "gap acidosis". In such conditions, when adjusted for hypoalbuminemia, Fencl-Stewart's approach can reliably detect the hidden abnormal anions.
  
  
  OBJECTIVE
  Evaluate the efficacy of simplified Fencl-Stewart equation in identifying the changes in acid-base status of sepsis patients following resuscitation with two different fluids.
  
  
  METHODS
  Intensive care unit, randomized, prospective, interventional study.
  
  
  METHODS
  Three hundred adult patients of both sexes presenting with abdominal sepsis, requiring fluid resuscitation were randomly assigned into normal saline (NS) and Ringer's lactate (RL) group, each comprising of 150 patients. 20 ml/kg of NS or RL were administered over a period of 30 min. The changes in the acid-base status were calculated applying the simplified Fencl-Stewart equation and was compared with the measured values obtained through arterial blood gas.
  
  
  METHODS
  Paired t-test for intra-group while unpaired t-test for inter-group comparison.
  
  
  RESULTS
  Blood pH and standard BE decreased and the serum Na(+) and Cl(-) level increased significantly in NS group. The serum albumin level significantly decreased in both the groups. Sodium chloride effect on BE significantly increased in NS group. Albumin effect on BE significantly increased in both the groups. Unmeasured ion effect on BE did not significantly change in both the groups. Measured standard BE level was significantly less as compared to unmeasured anion effect on BE, in both the groups.
  
  
  CONCLUSIONS
  Simplified Fencl-Stewart equation is effective in identifying a mixed acid-base disorder, which otherwise would remain undetected.
authors.affiliation: Department of Anaesthesiology and Critical Care, JN Medical College, AMU, Aligarh, India.
authors.forename: S Moied
authors.initials: SM
authors.lastname: Ahmed
authors.affiliation: Department of Anaesthesiology and Critical Care, JN Medical College, AMU, Aligarh, India.
authors.forename: P
authors.initials: P
authors.lastname: Maheshwari
authors.affiliation: Department of Anaesthesiology and Critical Care, JN Medical College, AMU, Aligarh, India.
authors.forename: S
authors.initials: S
authors.lastname: Agarwal
authors.affiliation: Department of Anaesthesiology and Critical Care, JN Medical College, AMU, Aligarh, India.
authors.forename: Abu
authors.initials: A
authors.lastname: Nadeem
authors.affiliation: Department of Pulmonary Medicine and Critical Care, SRMS, Bareilley, India.
authors.forename: L
authors.initials: L
authors.lastname: Singh
keywords: Acid-base status; Fencl-Stewart equation; strong ion difference