In defense of the Stewart approach to acid–base analysis

Gatz, Rainer; Elbers, Paul

doi:10.1038/ki.2010.245

Cited by 1 publication

(1 citation statement)

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“…(8) However, its use has been generally restricted to plasma SID, and few studies have focused on SIDu and the relevant information it may provide. (9)(10)(11) Urinary electrolyte measurements are usually utilized in the intensive care unit (ICU) for the differential diagnosis of natremia disorders, the diagnosis of prerenal versus acute tubular necrosis, and determining the etiology of hyperchloremic metabolic acidosis.…”

Section: Introductionmentioning

confidence: 99%

Monitorização de eletrólitos urinários em pacientes críticos: estudo preliminar observacional

Maciel¹,

Park²,

Macedo³

2012

Rev. bras. ter. intensiva

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Objective: Intensive care unit survivors and non-survivors have distinct acid-base profiles. The kidney's regulation of urinary electrolytes and the urinary strong ion difference plays a major role in acid-base homeostasis. The aim of this study was to evaluate the potential utility of daily spot urinary electrolyte measurement in acid-base and renal function monitoring. Methods:We prospectively recorded daily plasma acid-base parameters and traditional markers of renal function in parallel with spot urinary electrolyte measurements in patients with urinary catheters admitted to our intensive care unit. Patients who remained in the intensive care unit for at least 4 days with a urinary catheter were included in the study.Results: Of the 50 patients included in the study, 22% died during their intensive care unit stay. The incidence of acute kidney injury was significantly higher in nonsurvivors during the 4-day observation period (64% vs. 18% in survivors).Urinary chloride and sodium were lower and urinary strong ion difference was higher on day 1 in patients who developed acute kidney injury among both survivors and non-survivors. Both groups had similar urine output, although non-survivors had persistently higher urinary strong ion difference on all days. Survivors had a progressive improvement in metabolic acid-base profile due to increases in the plasma strong ion difference and decreases in weak acids. These changes were concomitant with decreases in urinary strong ion difference. In nonsurvivors, acid-base parameters did not significantly change during follow-up.Conclusions: Daily assessment of spot urinary electrolytes and strong ion difference are useful components of acid-base and renal function evaluations in critically ill patients, having distinct profiles between intensive care unit survivors and non-survivors.

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Section: Introductionmentioning

confidence: 99%