title: Comprehensive diagnosis of whole-body acid-base and fluid-electrolyte disorders using a mathematical model and whole-body base excess.
abstract: A mathematical model of whole-body acid-base and fluid-electrolyte balance was used to provide information leading to the diagnosis and fluid-therapy treatment in patients with complex acid-base disorders. Given a set of measured laboratory-chemistry values for a patient, a model of their unique, whole-body chemistry was created. This model predicted deficits or excesses in the masses of Na(+), K(+), Cl(-) and H2O as well as the plasma concentration of unknown or unmeasured species, such as ketoacids, in diabetes mellitus. The model further characterized the acid-base disorder by determining the patient's whole-body base excess and quantitatively partitioning it into ten components, each contributing to the overall disorder. The results of this study showed the importance of a complete set of laboratory measurements to obtain sufficient accuracy of the quantitative diagnosis; having only a minimal set, just pH and PCO2, led to a large scatter in the predicted results. A computer module was created that would allow a clinician to achieve this diagnosis at the bedside. This new diagnostic approach should prove to be valuable in the treatment of the critically ill.
authors.affiliation: Department of Pharmacology, Physiology and Neuroscience, School of Medicine, University of South Carolina, Columbia, SC, 29209, USA, matt.wolf@uscmed.sc.edu.
authors.forename: Matthew B
authors.initials: MB
authors.lastname: Wolf
mesh_terms: D000136:Acid-Base Equilibrium; D000137:Acid-Base Imbalance / Q000097:blood*; D000328:Adult; D000465:Algorithms; D000471:Alkalosis / Q000097:blood; D001784:Blood Gas Analysis / Q000379:methods*; D001826:Body Fluids; D016638:Critical Illness; D003920:Diabetes Mellitus / Q000097:blood; D016883:Diabetic Ketoacidosis / Q000097:blood; D004573:Electrolytes; D005260:Female; D006801:Humans; D006863:Hydrogen-Ion Concentration; D008297:Male; D008962:Models, Theoretical; D008991:Monitoring, Physiologic; D011237:Predictive Value of Tests; D018805:Sepsis / Q000097:blood; D014883:Water-Electrolyte Imbalance
chemical_list: D004573:Electrolytes