白蛋白校正的阴离子间隙、碱剩余变化值和乳酸清除率对多器官功能障碍综合征患者预后早期评估的临床价值

内环境中酸碱失衡、电解质紊乱是急危重症患者病情进展的重要因素,如强离子间隙(SIG)、阴离子间隙(AG)等是反映机体酸碱代谢情况的常见指标.AG、碱剩余(BE)的计算受未测定阴离子浓度的影响(如危重患者中蛋白含量和磷酸盐水平的变化),因此引入血浆白蛋白(Alb)校正的AG(ACAG)和BE变化值(ABE)的检测对于某些...     

改进高阴离子间隙代谢性酸中毒判断方法

目的改进高AG代酸的判断方法。方法通过分析人体血浆中阴离子问变化的特殊关系,提出高AG代酸判断新方法。结果到目前为止国内外在对高AG代酸的判断中的确存在明显的过度判断问题,判断方法需要改进。结论对于高AG代酸过去一直没有较好的判断方法,误判漏判现象常有发生。改进判断方法后可以防止误判漏判。     

Bicarbonate use and mortality outcome among critically ill patients with metabolic acidosis: A meta analysis

BackgroundThe use of sodium bicarbonate in the treatment of metabolic acidosis in critically ill subjects has long been a subject of debate. Despite empiric use in the setting of severe acidemia in critically ill patients, there is little data looking into the role of sodium bicarbonate in the treatment of severe metabolic acidosis in the intensive care unit (ICU) setting.MethodsWe conducted a comprehensive search of Pubmed and Cochrane Central Register of Controlled Trials addressing bicarbonate use in the metabolic acidosis in the intensive care unit (ICU) setting. We examined mortality as end point. Pooled odds ratios (OR) and their 95% confidence intervals (CI) were calculated for all outcomes using a random-effect model.ResultsThe final search yielded 202 articles of which all were screened individually. A total of 11 studies were identified but 6 studies were excluded due to irrelevance in mortality outcome and methodology. Analysis was done separately for observational studies and randomized controlled trials. The pooled OR [95% CI] for mortality with bicarbonate use in the observational studies was 1.5 [0.62–3.67] with heterogeneity of 67%, while pooled OR for mortality in the randomized trials was 0.72 [0.49–1.05] (figure 2). In combining all studies, the pooled odds ratio was 0.93 95% [0.69–1.25] but with heterogeneity of 63%. After sensitivity analysis with removing the study done by Kim et al. 2013, heterogeneity was 0% with OR 0.8 [0.59–1.10].ConclusionThere is no significant difference in mortality in the use of bicarbonate among critically ill patients with high anion gap metabolic acidosis predominantly driven by lactic acidosis.     

5-Oxoproline as a cause of high anion gap metabolic acidosis: an uncommon cause with common risk factors

High anion gap metabolic acidosis might be caused by 5-oxoproline (pyroglutamic acid). As it is very easy to treat, it might be worth drawing attention to this uncommon and probably often overlooked diagnosis. We present three cases of high anion gap metabolic acidosis due to 5-oxoproline seen within a period of six months.     

North and South: bridging the information gap

Information exchange is critical for development of health systems. The information needs of less-developed countries are especially challenging, but many factors inhibit free flow of knowledge. There is much talk about how technical fixes--such as the internet--might fill this information gap. Yet few attempts have been made to ask clinical investigators who work in resource-poor regions for their views on these difficulties and the possible solutions. The messages reported here, from a survey of Lancet editorial advisors, suggest that information, research, and publication capacities are intimately linked. Investigators, publishers, editors, and editorial organisations all have important parts to play in solving this global information poverty.     

Microdialysis--a versatile technology to perform metabolic monitoring in diabetes and critically ill patients

Continuous subcutaneous glucose monitoring has been tested in type 1 diabetes (T1D). Since in critically ill patients vascular access is granted vascular microdialysis may be preferential. To test this hypothesis comparative accuracy data for microdialysis applied for peripheral venous and subcutaneous glucose monitoring was obtained in experiments in T1D patients. Twelve T1D patients were investigated for up to 30 h. Extracorporeal vascular (MDv) and subcutaneous microdialysis (MDs) was performed. Microdialysis samples were collected in 15-60 min intervals, analyzed for glucose and calibrated to reference. MDv and MDs glucose levels were compared against reference. Median absolute relative difference was 14.0 (5.0; 28.0)% (MDv) and 9.2 (4.4; 18.4)% (MDs). Clarke Error Grid analysis showed that 100% (MDv) and 98.8% (MDv) were within zones A and B. Extracorporeal vascular and standard subcutaneous microdialysis indicated similar performance in T1D. We suggest microdialysis as a versatile technology for metabolite monitoring in subcutaneous tissue and whole blood.