Comparative Quantitative Acid-Base Analysis in Coronary Artery Bypass, Severe Sepsis, and Diabetic Ketoacidosis

Omron, Edward M.

doi:10.1177/0885066605279955

Cited by 7 publications

(4 citation statements)

References 48 publications

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“…Transient perturbations in parathyroid hormone, calcium, and phosphorus [35, 36] may explain why alkalosis preceded Charcot foot 100% of the time. We also found pulmonary eosinophilia to be associated with Charcot foot, and this relationship had the fourth smallest P value for all the temporal associations we described.…”

Section: Discussionmentioning

confidence: 99%

Data Mining for Identifying Novel Associations and Temporal Relationships with Charcot Foot

Munson

Wrobel

Holmes

et al. 2014

Journal of Diabetes Research

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Introduction. Charcot foot is a rare and devastating complication of diabetes. While some risk factors are known, debate continues regarding etiology. Elucidating other associated disorders and their temporal occurrence could lead to a better understanding of its pathogenesis. We applied a large data mining approach to Charcot foot for elucidating novel associations. Methods. We conducted an association analysis using ICD-9 diagnosis codes for every patient in our health system (n = 1.6 million with 41.2 million time-stamped ICD-9 codes). For the current analysis, we focused on the 388 patients with Charcot foot (ICD-9 713.5). Results. We found 710 associations, 676 (95.2%) of which had a P value for the association less than 1.0 × 10−5 and 603 (84.9%) of which had an odds ratio > 5.0. There were 111 (15.6%) associations with a significant temporal relationship (P < 1.0 × 10−3). The three novel associations with the strongest temporal component were cardiac dysrhythmia, pulmonary eosinophilia, and volume depletion disorder. Conclusion. We identified novel associations with Charcot foot in the context of pathogenesis models that include neurotrophic, neurovascular, and microtraumatic factors mediated through inflammatory cytokines. Future work should focus on confirmatory analyses. These novel areas of investigation could lead to prevention or earlier diagnosis.

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Section: Discussionmentioning

confidence: 99%

Data Mining for Identifying Novel Associations and Temporal Relationships with Charcot Foot

Munson

Wrobel

Holmes

et al. 2014

Journal of Diabetes Research

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“…Dr Berend claims that our assessment of example 2 is probably incorrect because we did not consider that a decrease in plasma albumin by 1 g/dl results in an increase in bicarbonate by 2.8 mmol/l. As this claim is based on a simple associative relationship, 4 it provides no support for a cause-and-effect relationship of albumin to plasma bicarbonate.…”

Section: Assessment Of Acid-base Disordersmentioning

confidence: 95%

Assessment of acid–base disorders

Berend

2010

Kidney International

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“…15 Metabolic acid-base status measured as standard base excess (SBE) is a summation function of the changes in both plasma SID and A tot . 16 Standard base excess remains a useful clinical tool in the intensive care unit. 17 It is easily calculated by an arterial blood gas measurement and reduces metabolic acid-base disturbances to a simple, quantitative numerical scale.…”

Section: Introductionmentioning

confidence: 99%

A Physicochemical Model of Crystalloid Infusion on Acid-Base Status

Omron

2010

J Intensive Care Med

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The objective of this study is to develop a physicochemical model of the projected change in standard base excess (SBE) consequent to the infused volume of crystalloid solutions in common use. A clinical simulation of modeled acid-base and fluid compartment parameters was conducted in a 70-kg test participant at standard physiologic state: pH =7.40, partial pressure of carbon dioxide (PCO2) = 40 mm Hg, Henderson-Hasselbalch actual bicarbonate ([HCO3]HH) = 24.5 mEq/L, strong ion difference (SID) = 38.9 mEq/L, albumin = 4.40 g/dL, inorganic phosphate = 1.16 mmol/L, citrate total = 0.135 mmol/L, and SBE =0.1 mEq/L. Simulations of multiple, sequential crystalloid infusions up to 10 L were conducted of normal saline (SID = 0), lactated Ringer's (SID = 28), plasmalyte 148 (SID = 50), one-half normal saline þ 75 mEq/L sodium bicarbonate (NaHCO3; SID = 75), 0.15 mol/L NaHCO3 (SID = 150), and a hypothetical crystalloid solution whose SID = 24.5 mEq/L, respectively. Simulations were based on theoretical completion of steady-state equilibrium and PCO2 was fixed at 40 mm Hg to assess nonrespiratory acid-base effects. A crystalloid SID equivalent to standard state actual bicarbonate (24.5 mEq/L) results in a neutral metabolic acid-base status for infusions up to 10 L. The 5 study solutions exhibited curvilinear relationships between SBE and crystalloid infusion volume in liters. Solutions whose SID was greater than 24.5 mEq/L demonstrated a progressive metabolic alkalosis and less, a progressive metabolic acidosis. In a human model system, the effects of crystalloid infusion on SBE are a function of the crystalloid and plasma SID, volume infused, and nonvolatile plasma weak acid changes. A projection of the impact of a unit volume of various isotonic crystalloid solutions on SBE is presented. The model's validation, applications, and limitations are examined.

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Comparative Quantitative Acid-Base Analysis in Coronary Artery Bypass, Severe Sepsis, and Diabetic Ketoacidosis

Cited by 7 publications

References 48 publications

Data Mining for Identifying Novel Associations and Temporal Relationships with Charcot Foot

Data Mining for Identifying Novel Associations and Temporal Relationships with Charcot Foot

Assessment of acid–base disorders

A Physicochemical Model of Crystalloid Infusion on Acid-Base Status

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