Physicochemical Evaluation of Acid–Base Disorders After Liver Transplantation and the Contribution From Administered Fluids

Boniatti, Márcio Manozzo; Filho, Édison Moraes Rodrigues; Cardoso, Paulo Ricardo Cerveira; Vieira, S

doi:10.1016/j.transproceed.2013.03.044

Cited by 7 publications

(7 citation statements)

References 19 publications

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“…The incidence of hypoglycemia during pediatric LT is relatively high, so we routinely use 100 mL of 5% glucose and adjust the rate to blood glucose levels. Normal saline is not recommended for pediatric LT, given the potential for hyperchloric acidosis[ 27 ]. Red blood cell suspensions are infused at hemoglobin (Hb) levels < 7 g/dL to maintain Hb within a specified range (> 8 g/dL and < 10 g/dL).…”

Section: Discussionmentioning

confidence: 99%

Perioperative anesthesia management in pediatric liver transplant recipient with atrial septal defect: A case report

Liu¹,

Chen²,

Fang³

et al. 2022

World J Clin Cases

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BACKGROUND Preoperative conditions in pediatric liver transplant recipients are understandably complex. Compared with adults, children have lesser compensatory abilities and demand greater precision during procedural executions. In the setting of end-stage liver disease, the heightened perioperative risk of coexistent cardiovascular pathology may impact graft survival as well. Requirements for anesthesia and perioperative management are thus more rigorous, calling for individualized treatments that reflect specific cardiovascular constraints and proposed surgical plans. CASE SUMMARY Reports of perioperative anesthesia management and liver transplant prognostication in pediatric patients with concurrent atrial septal defects are scarce. Herein, we detail the course of liver transplantation in a child with dual afflictions, focusing on perioperative anesthesia management and the important contributions of the anesthesiologist (pre- and perioperatively) to a positive therapeutic outcome, despite the clinical hurdles imposed. CONCLUSION Children with atrial septal defects bear substantially more than customary perioperative risk during orthotopic liver transplants, given their compromised cardiopulmonary reserves and functional states. Comprehensive preoperative cardiovascular assessments, including use of agitated-saline contrast echocardiography (to characterize intracardiac shunting) and multidisciplinary deliberation, may offer insights into structural cardiac pathophysiologic effects and transplant-related hemodynamic changes that impact new grafts. At the same time, active and effective monitoring and other measures should be taken to maintain hemodynamic stability in the perioperative period, avoid entry of bubbles into the circulation, and ease congestion in newly grafted livers. Such efforts are crucial for transplantation success and graft survival.

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Section: Discussionmentioning

confidence: 99%

Perioperative anesthesia management in pediatric liver transplant recipient with atrial septal defect: A case report

Liu¹,

Chen²,

Fang³

et al. 2022

World J Clin Cases

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“…High lactate levels are related to hypoperfusion, while hyperchloremia may be the result of aggressive resuscitation using chloride-rich solutions. (20-23) The latter consideration may be particularly important because hyperchloremia has been suggested to be associated with mortality. (24) The association between unmeasured anions and hypoperfusion, however, is less clear.…”

Section: Discussionmentioning

confidence: 99%

Anion gap corrected for albumin, phosphate and lactate is a good predictor of strong ion gap in critically ill patients: a nested cohort study

Zampieri¹,

Park²,

Ranzani³

et al. 2013

Revista Brasileira De Terapia Intensiva

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ObjectiveCorrected anion gap and strong ion gap are commonly used to estimate unmeasured anions. We evaluated the performance of the anion gap corrected for albumin, phosphate and lactate in predicting strong ion gap in a mixed population of critically ill patients. We hypothesized that anion gap corrected for albumin, phosphate and lactate would be a good predictor of strong ion gap, independent of the presence of metabolic acidosis. In addition, we evaluated the impact of strong ion gap at admission on hospital mortality. MethodsWe included 84 critically ill patients. Correlation and agreement between the anion gap corrected for albumin, phosphate and lactate and strong ion gap was evaluated by the Pearson correlation test, linear regression, a Bland-Altman plot and calculating interclass correlation coefficient. Two subgroup analyses were performed: one in patients with base-excess <-2mEq/L (low BE group - lBE) and the other in patients with base-excess >-2mEq/L (high BE group - hBE). A logistic regression was performed to evaluate the association between admission strong ion gap levels and hospital mortality. ResultsThere was a very strong correlation and a good agreement between anion gap corrected for albumin, phosphate and lactate and strong ion gap in the general population (r2=0.94; bias 1.40; limits of agreement -0.75 to 3.57). Correlation was also high in the lBE group (r2=0.94) and in the hBE group (r2=0.92). High levels of strong ion gap were present in 66% of the whole population and 42% of the cases in the hBE group. Strong ion gap was not associated with hospital mortality by logistic regression. ConclusionAnion gap corrected for albumin, phosphate and lactate and strong ion gap have an excellent correlation. Unmeasured anions are frequently elevated in critically ill patients with normal base-excess. However, there was no association between unmeasured anions and hospital mortality.

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“…Os resultados mostraram prevalência de acidose metabólica em mais de 70% dos pacientes no pósoperatório imediato, e sua forma severa foi apresentada em quase 50% deles, enquanto apenas um paciente apresentou alcalose metabólica. 4 A acidose metabólica, quando avaliada dentro desse modelo, apresenta diversas variáveis que a influenciam, e devido a isso, seu desenvolvimento é bastante complexo. Em linhas gerais, ela pode ser classificada em: acidose de baixo SID, com quantidades de cátions totalmente dissociados no plasma maior que os ânions, e acidose de alto strong ion gap (SIG), que significa a diferença entre o SID e as contribuições dos ácidos fracos no plasma, e que ao ser positivo, indica quantidade elevada de ânions não mensurados no plasma.…”

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“…-O equilíbrio hidroeletrolítico é de grande importância ao paciente cirúrgico, sendo definidor no pré, intra e pós-operatório. É fundamental entender toda dinâmica hidroeletrolítica do paciente para realizar a hidratação correta e necessária 4,9,10. A hipoalbuminemia foi citada em 11,11% (2/18) dos artigos, apresentando relação com o estado de acidose e com a hipercloremia presente nos pacientes após o TF 4,11.…”

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“…É fundamental entender toda dinâmica hidroeletrolítica do paciente para realizar a hidratação correta e necessária 4,9,10. A hipoalbuminemia foi citada em 11,11% (2/18) dos artigos, apresentando relação com o estado de acidose e com a hipercloremia presente nos pacientes após o TF 4,11. Dos artigos, 16,66% (3/18) levantaram a hipótese de que a infusão de soluções salinas com cloreto e ácidos fracos durante o perioperatório dos transplantes poderia contribuir para o desenvolvimento da acidose metabólica e hipercloremia nos pacientes [10][11][12].…”

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Alterações Hidroeletrolíticas E Acidobásicas No Pós-Operatório Imediato Do Transplante De Fígado: Uma Revisão Qualitativa

Martins

Fonseca-Neto

2021

bjt

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Introdução: O pós-operatório imediato do transplante de fígado (TF) é um período instável e que necessita de controle e monitorização do paciente. Alterações hidroeletrolíticas e acidobásicas são apenas uma das várias complicações do pós-operatório imediato de TF, mas chamam muita atenção, e precisam de rápido e correto manejo. Objetivo: Busca-se através desta revisão avaliar as principais alterações acidobásicas e hidroeletrolíticas no pós-operatório imediato dos pacientes transplantados de fígado. Métodos: Trata-se de uma revisão, um estudo qualitativo com pesquisa em bancos de dados do MEDLINE, através do National Center of Biotechnology Information, acessando o site Pubmed. Os critérios de inclusão foram: (1) publicações em língua inglesa, (2) serem artigos originais ou revisão de literatura e (3) estarem em concordância com tema. Resultados: Cerca de mais de 70% dos pacientes, segundo os artigos analisados, apresentam acidose metabólica no pós-operatório imediato do TF, associada à hipercloremia. Os níveis de sódio são os mais alterados com a hiponatremia. Em média, 20% dos pacientes apresentam hipercalemia após transplante de fígado. Hipocalcemia, hipomagnesemia e hipofosfatemia são distúrbios muito frequentes nesses pacientes. Conclusões: Acidose metabólica associada à hipercloremia, hiponatremia, hipocalcemia e hipercalemia são os distúrbios mais comuns no pós-operatório mediato de TF.

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Physicochemical Evaluation of Acid–Base Disorders After Liver Transplantation and the Contribution From Administered Fluids

Cited by 7 publications

References 19 publications

Perioperative anesthesia management in pediatric liver transplant recipient with atrial septal defect: A case report

Perioperative anesthesia management in pediatric liver transplant recipient with atrial septal defect: A case report

Anion gap corrected for albumin, phosphate and lactate is a good predictor of strong ion gap in critically ill patients: a nested cohort study

Alterações Hidroeletrolíticas E Acidobásicas No Pós-Operatório Imediato Do Transplante De Fígado: Uma Revisão Qualitativa

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