Comparative Study between Traditional Approach and Physico-Chemical Approach in Acid Base Disorders Interpretation in Critically Ill Patients

Abstract

Objective: The traditional approach for acid base interpretation is based on Handerson-Hasselbalch formula and includes Base Excess (BE), bicarbonate (HCO 3 ), albumin corrected anion gap. The Physicochemical approach is centered on the Carbon Dioxide tension (PCO 2 ), the strong ion difference (SID), strong ion gap (SIG) = SID apparent-SID effective and totally weak acids (Atot). The study aims to compare between the traditional approach and the physicochemical approach in acid base disorder interpretation. Design: Prospective observational study in an adult Intensive Care Unit (ICU) recruiting six hundred and sixty one patients. Methods: Arterial blood samples were analyzed to measure pH, PaCO 2 sodium, potassium, chloride and lactate. Venous blood samples were analyzed to measure ionized calcium, magnesium, phosphorous and albumin. These samples were interpreted by both techniques. Results: Normal HCO 3 and BE were detected by traditional approach in 49 cases of which SIG acidosis was detected in 22 cases (46%) and Hyperchloremic acidosis was detected in 29 cases (60%) by physicochemical method. SIG was elevated in 72 cases (58%) of 124 cases with high anion gap acidosis. SIDeff and BE were strongly correlated, r = 0.8, p < 0.0001, while SIG and Albumin corrected Anion Gap (ALAG) were moderately correlated r = 0.56, p < 0.0001. Conclusion: Both approaches are important for interpretation of the acid base status. Traditional approach identifies the diagnostic description without many calculations and detects body compensatory response to acid base disorders. Physicochemical approach is essential to identify the exact causation and the severity of the acid base disorders.