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Identifier

000393376

Title

Η φυσικοχημική προσέγγιση των οξεοβασικών διαταραχών

Alternative Title

The physicochemical approach of acid base disturbances

Author

Αντωνογιαννάκη, Ελβίρα-Μαρκέλα

Thesis advisor

Γεωργόπουλος, Δημήτριος

Reviewer

Κονδύλη, Ευμορφία
De Bree, Eelco
Αγγουριδάκης, Παναγιώτης
Τζανάκης, Νικόλαος
Αντωνίου, Αικατερίνη
Γκίκας, Αχιλλέας

Abstract

Aim: The aim of this thesis is to evaluate the value of physicochemical, base excess (BE) and plasma bicarbonate concentration ([HCO3-]) approaches on the assessment of acid-base status in patients presented to the Emergency Department (ED). Methods: Upon presentation at ED, patients whose arterial blood was deemed in need of analysis were studied. Arterial blood gases, serum electrolytes and proteins were measured and used to derive [HCO3-], BE, anion gap (AG), AG adjusted for albumin (AGadj), strong ion difference, strong ion gap (SIG) and SIG corrected for water excess/deficit (SIGcor). Results: A total of 365 patients were studied. Compared to BE (n=202) and [HCO3-] (n=151), physicochemical approach (n=279) identified significantly more patients with metabolic acid-base disturbances (p<0.0001). Significantly fewer patients with unmeasured anions acidosis were identified with AGadj than with SIGcor (p<0.0001). On the basis of BE, 75 patients had normal acid base balance and 65(87%) of them exhibited at least one hidden acid-base disturbance, identified by the physicochemical approach. The corresponding values with [HCO3-] approach were 108 and 95(88%) patients. When patients with high AGadj were excluded, 44 patients with BE and 67 with [HCO3-] approach had normal acid-base status, and the majority of them exhibited at least one acid-base disturbance with the physicochemical approach, while 12 and 21 patients, respectively, had high SIGcor. Mortality was 10.7% and logistic regression analysis identified only Sepsis–related Organ Failure Assessment and SIGcor as predictors of mortality. Conclusion: In patients presented to ED, compared to BE and [HCO3-] methods, physicochemical approach has a better diagnostic accuracy to identify metabolic acid-base disturbances and may predict mortality.

Physical description

πίν. ; 30 εκ.

Language

Greek

Subject

Base excess

Bicardonate

Emergency department

Διττανθρακικά

Ελλειμα βάσης

Issue date

2015-07-17