Abstract
The presence of acid-base disturbances, especially metabolic acidosis may negatively affect the outcome of critically ill patients. Lactic acidosis is the most frequent etiology and has largest impact on the prognosis. Since lactate measurement might not have always been available at bedside, it had been regarded as one of the unmeasured anions. Therefore, anion gap and strong ion gap has been used to as a surrogate of lactate concentration. From this perspective, the relationship between either anion gap or strong ion gap and mortality has been explored. Then, lactate became routinely measurable at bedside and the direct comparison between directly measured lactate and these surrogate parameters can be possible. Currently available evidence suggests that directly measured lactate has larger prognostic ability for mortality than albumin-corrected anion gap and strong ion gap without lactate. In this commentary, the rationale and possible clinical implications of these findings are discussed.
Highlights
Ill patients may suffer mixed acid-base disturbances, and the correct and timely evaluation and treatment of acid-base disorders is essential for the intensive care physicians
anion gap (AG) is comprised with weak anions such as charged albumin, phosphate, and lactate and other unmeasured anions
The contribution of dissociated albumin and Kotake Journal of Intensive Care (2016) 4:45 phosphate are removed from the calculation of strong ion gap (SIG); the contribution of lactate and other unmeasured anions are represented in SIG
Summary
Ill patients may suffer mixed acid-base disturbances, and the correct and timely evaluation and treatment of acid-base disorders is essential for the intensive care physicians. The degree of primary acid-base disorder and adequacy of compensatory mechanisms may reasonably affect the mortality of the critically ill patients. There are two major approaches about the interpretation of metabolic component of acid-base status, i.e., physiological approach and physicochemical (Stewart) approach [1]. The authors found no clear advantage of Stewart approach and concluded that lactate concentration played much greater role in the mortality than in acid-base parameters.
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