title: A comparison of traditional and quantitative analysis of acid-base imbalances in hypoalbuminemic dogs.
abstract: OBJECTIVE
  To compare the traditional (HH) and quantitative approaches used for the evaluation of the acid-base balance in hypoalbuminemic dogs.
  
  
  METHODS
  Prospective observational study.
  
  
  METHODS
  ICU of a veterinary teaching hospital.
  
  
  METHODS
  One hundred and five client-owned dogs.
  
  
  RESULTS
  Jugular venous blood samples were collected from each patient on admission to determine: total plasma protein (TP), albumin (Alb), blood urea nitrogen (BUN), glucose (Glu), hematocrit (HCT), Na(+) , Cl(-) , K(+) , phosphate (Pi ), pH, PvCO2, bicarbonate (HCO3 (-) ), anion gap (AG), adjusted anion gap for albumin (AGalb ) or phosphate (AGalb-phos ), standardized base excess (SBE), strong ion difference (SID), concentration of nonvolatile weak buffers (Atot ), and strong ion gap (SIG). Patients were divided in 2 groups according to the severity of the hypoalbuminemia: mild (Alb = 21-25 g/L) and severe (Alb ≤20 g/L). All parameters were compared among groups. Patients with severe hypoalbuminemia showed significant decrease in TP (P = 0.011), Atot (P = 0.050), and a significant increase in adjusted AG (P = 0.048) and the magnitude of SIG (P = 0.011) compared to animals with mild hypoalbuminemia. According to the HH approach, the most frequent imbalances were simple disorders (51.4%), primarily metabolic acidosis (84.7%) associated with a high AG acidosis. However, when using the quantitative method, 58.1% of patients had complex disorders, with SIG acidosis (74.3%) and Atot alkalosis (33.3%) as the most frequent acid-base imbalances. Agreement between methods only matched in 32 cases (kappa < 0.20).
  
  
  CONCLUSIONS
  The agreement between the HH and quantitative methods for interpretation of acid-base balance was poor and many imbalances detected using the quantitative approach were missed using the HH approach. Further studies are necessary to confirm the clinical utility of using the quantitative approach in the decision-making process of the severely ill hypoalbuminemic patients.
authors.affiliation: Servei d'Emergències i Cures Intensives de la Fundació Hospital Clínic Veterinari-UAB, Departament de Medicina i Cirurgia Animal, and Departament de Ciència Animal i dels Aliments, Facultat de Veterinària, Universitat Autònoma de Barcelona (UAB), Bellaterra, Barcelona, Spain.
authors.forename: Carlos
authors.initials: C
authors.lastname: Torrente
authors.forename: Edgar G
authors.initials: EG
authors.lastname: Manzanilla
authors.forename: Rafael Ruiz
authors.initials: RR
authors.lastname: de Gopegui
mesh_terms: D000136:Acid-Base Equilibrium; D000137:Acid-Base Imbalance / Q000097:blood / Q000175:diagnosis / Q000662:veterinary*; D000818:Animals; D004283:Dog Diseases / Q000097:blood / Q000175:diagnosis*; D004285:Dogs; D005260:Female; D034141:Hypoalbuminemia / Q000097:blood / Q000662:veterinary*; D008297:Male
keywords: albumin; anion gap; metabolic acidosis; strong ion gap