Ethanol and Illicit Drugs Do Not Affect the Diagnostic Utility of Base Deficit and Lactate in Differentiating Minor from Major Injury in Trauma Patients

Zehtabchi, Shahriar; Baron, Bonny J.; Sinert, Richard; Yadav, Kabir; Lucchesi, Michael

doi:10.1111/j.1553-2712.2004.tb00669.x

Cited by 14 publications

(13 citation statements)

References 23 publications

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“…Thus, our results indicate that alcohol intoxication, acute or following a 3-day binge before or during traumatic injury, will most likely aggravate the outcome of injured victims. This is in agreement with clinical observations, rendering our model a clinically relevant approach to examine the mechanisms involved in impaired outcome from traumatic injury during alcohol intoxication (Dunham et al, 2000;Zehtabchi et al, 2004). Whether pharmacological manipulation to enhance sympathetic outflow or administer systemic vasopressors during the resuscitation period could ameliorate the hemodynamic instability resulting from alcohol intoxication is currently the focus of our studies.…”

Section: Discussionsupporting

confidence: 83%

Alcohol Intoxication Impact on Outcome from Traumatic Injury

Molina¹

2007

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ABSTRACT-The incidence of traumatic injury, frequently associated with hemorrhagic shock, is higher in the alcoholintoxicated individual. The outcome, as it pertains to both morbidity and mortality of this population, is partly dependent on duration of alcohol exposure and levels of blood alcohol at time of injury. In previous studies, we demonstrated that prolonged alcohol intoxication (15-h duration) produces marked hemodynamic instability and exacerbated early lung proinflammatory cytokine expression after hemorrhagic shock. The present study examines whether a shorter and more modest period of alcohol intoxication is sufficient to alter hemodynamic and proinflammatory responses to hemorrhagic shock. Chronically instrumented, conscious male Sprague-Dawley rats (250Y300 g) received a single intragastric bolus of alcohol (1.75 g/kg) 30 min before the administration of fixed-volume (50%) hemorrhagic shock, followed by fluid resuscitation with Ringer lactate. Time-matched controls were administered on isocaloric dextrose bolus (3 g/kg). Alcohol (blood alcohol concentration, 152 T 10 mg/dL) produced a 14% decrease in basal mean arterial blood pressure and a more profound hypotensive response to equal blood loss. The 2-fold rise in circulating norepinephrine levels was similar in alcohol-and dextrose-treated hemorrhaged animals despite greater hypotension in alcohol-treated animals. Significant upregulation in lung and spleen interleukin (IL) 1, IL-6, IL-10, and tumor necrosis factor ! expression was observed immediately after hemorrhage and fluid resuscitation, as previously reported. Only the hemorrhage-induced rise in lung IL-6 and tumor necrosis factor ! was prevented by alcohol administration. In contrast, spleen cytokine responses to hemorrhage were not altered by alcohol administration. These results indicate that moderate acute alcohol intoxication results in significant modulation of hemodynamic and neuroendocrine responses to hemorrhagic shock.

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Section: Discussionsupporting

confidence: 83%

Alcohol Intoxication Impact on Outcome from Traumatic Injury

Molina¹

2007

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“…In our study, although there were significant statistical differences between the BD in minor and major injury groups, the BD in elders was much smaller than that typically seen in younger trauma patients. 6 In fact, the mean (AESD) BD for the elder trauma patients with major injury in this study (À2.9 [AE6] mmol/L) suggests that a number of elder patients with significant injuries had initial BD that clinicians would have considered in the normal range. Interestingly, Davis and Kaups also showed that elders with so-called normal BD (2 to À2 mmol/L) had a significantly increased length of ICU stay and decreased survival compared with the younger patients.…”

Section: Discussionmentioning

confidence: 65%

“…Various studies have shown BD to be a reliable indicator of significant injuries, mortality, blood transfusion requirement, and intensive care unit (ICU) and hospital length of stay. [4][5][6] However, there is a paucity of evidence in the literature supporting its utility in elder trauma patients.…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, early recognition of injuries, together with invasive hemodynamic monitoring, assume central roles in the care of elder trauma patients. [4][5][6] Base deficit (BD) is commonly used to guide initial trauma resuscitation. BD is a calculated measure that represents the amount of base required to titrate 1 L of whole arterial blood to a pH of 7.40.…”

mentioning

confidence: 99%

“…In addition, BD is a reliable and sensitive marker of hypoperfusion and hypovolemia in trauma patients. [4][5][6] However, limited data are available to support the use of BD in elder trauma patients. Elders commonly have decreased lean body mass, decreased activity of lactate dehydrogenase, 7 and multiple comorbidities.…”

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confidence: 99%

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Utility of Base Deficit for Identifying Major Injury in Elder Trauma Patients

Zehtabchi¹,

Baron²

2007

Academic Emergency Medicine

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Assessing lactate concentration as a predictor of 28‐day in‐hospital mortality in the presence of ethanol: A retrospective study of emergency department patients

et al. 2021

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Background: Presence of ethanol (EtOH) may alter the relationship between blood lactate concentrations and mortality. This study compares lactate-associated mortality risk in the presence and absence of EtOH. Methods:We performed a retrospective cohort study including all patients, age >17 years, presenting from January 2012-December 2018, to an urban, academic emergency department, with a clinically measured lactate. Data were electronically abstracted from the medical record. The primary outcome was 28-day in-hospital mortality. Patients were grouped by EtOH test results as follows: 1) present (any EtOH detected), 2) absent (EtOH concentration measured and not detected), or 3) not ordered. Marginal analysis was used to calculated probability of mortality for fixed values of lactate and model covariates. Results: Of 40,956 adult emergency department patients with measured lactate, we excluded 768 (1.89%) for lactate >10.0 mmol/L, leaving 40,240 for analysis: 4,066 (10.1%) EtOH present, 10,819 (26.9%) EtOH absent, 25,355 (63%) EtOH not ordered. Of these, 1790 (4.4%) had 28-day in-hospital mortality. Marginal probability of mortality calculated for specific lactate values found less risk for EtOH Present patients versus EtOH absent patients at lactate 0.

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Ethanol and Illicit Drugs Do Not Affect the Diagnostic Utility of Base Deficit and Lactate in Differentiating Minor from Major Injury in Trauma Patients

Abstract: The presence of ethanol and/or illicit drugs did not affect the ability of BD or lactate to identify patients with major injuries.

Cited by 14 publications

References 23 publications

Alcohol Intoxication Impact on Outcome from Traumatic Injury

Alcohol Intoxication Impact on Outcome from Traumatic Injury

Utility of Base Deficit for Identifying Major Injury in Elder Trauma Patients

Assessing lactate concentration as a predictor of 28‐day in‐hospital mortality in the presence of ethanol: A retrospective study of emergency department patients

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