title: Acid-base balance, serum electrolytes and need for non-invasive ventilation in patients with hypercapnic acute exacerbation of chronic obstructive pulmonary disease admitted to an internal medicine ward.
abstract: BACKGROUND
  Hypoventilation produces or worsens respiratory acidosis in patients with hypercapnia due to acute exacerbations of chronic obstructive pulmonary disease (AECOPD). In these patients acid-base and hydroelectrolite balance are closely related. Aim of the present study was to evaluate acid-base and hydroelectrolite alterations in these subjects and the effect of non-invasive ventilation and pharmacological treatment.
  
  
  METHODS
  We retrospectively analysed 110 patients consecutively admitted to the Internal Medicine ward of Cava de' Tirreni Hospital for acute exacerbation of hypercapnic chronic obstructive pulmonary disease. On admission all patients received oxygen with a Venturi mask to maintain arterial oxygen saturation at least >90 %, and received appropriate pharmacological treatment. Non-Invasive Ventilation (NIV) was started when, despite optimal therapy, patients had severe dyspnea, increased work of breathing and respiratory acidosis. Based on Arterial Blood Gas (ABG) data, we divided the 110 patients in 3 groups: A = 51 patients with compensated respiratory acidosis; B = 36 patients with respiratory acidosis + metabolic alkalosis; and C = 23 patients with respiratory acidosis + metabolic acidosis. 55 patients received only conventional therapy and 55 had conventional therapy plus NIV.
  
  
  RESULTS
  The use of NIV support was lower in the patients belonging to group B than in those belonging to group A and C (25 %, vs 47 % and 96 % respectively; p < 0.01). A statistically significant association was found between pCO2 values and serum chloride concentrations both in the entire cohort and in the three separate groups.
  
  
  CONCLUSIONS
  Our study shows that in hypercapnic respiratory acidosis due to AECOPD, differently from previous studies, the metabolic alkalosis is not a negative prognostic factor neither determines greater NIV support need, whereas the metabolic acidosis in addition to respiratory acidosis is an unfavourable element, since it determines an increased need of NIV and invasive mechanical ventilation support.
authors.affiliation: Division of Internal Medicine, Cava de' Tirreni Hospital, University of Salerno, Cava de' Tirreni, SA, Italy.
authors.forename: Alfonso
authors.initials: A
authors.lastname: Schiavo
authors.affiliation: Division of Internal Medicine, Cava de' Tirreni Hospital, University of Salerno, Cava de' Tirreni, SA, Italy.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Renis
authors.affiliation: Division of Pulmonary Medicine, Scafati Hospital, Salerno, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Polverino
authors.affiliation: Division of Internal Medicine, A. Cardarelli Hospital, Naples, Italy.
authors.forename: Arcangelo
authors.initials: A
authors.lastname: Iannuzzi
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA USA.
authors.forename: Francesca
authors.initials: F
authors.lastname: Polverino
keywords: Acid–base balance; COPD; Hypercapnia; NIV