Anion gap, anion gap corrected for albumin, base deficit and unmeasured anions in critically ill patients: implications on the assessment of metabolic acidosis and the diagnosis of hyperlactatemia
2008

Assessing Metabolic Acidosis in Critically Ill Patients

Sample size: 143 publication Evidence: moderate

Author Information

Author(s): Lakhmir S. Chawla, Shirley Shih, Danielle Davison, Christopher Junker, Michael G. Seneff

Primary Institution: George Washington University Medical Center

Hypothesis

Can anion gap, base deficit, and albumin-corrected anion gap accurately diagnose hyperlactatemia in critically ill patients?

Conclusion

Anion gap and base deficit are not reliable for detecting hyperlactatemia, while albumin-corrected anion gap can help rule it out under certain conditions.

Supporting Evidence

  • AG and BD were found to be poor tests for diagnosing hyperlactatemia.
  • ACAG showed improved sensitivity for diagnosing hyperlactatemia compared to AG and BD.
  • Routine measurement of serum lactate is recommended for ICU patients.

Takeaway

Doctors used some tests to check if patients had high levels of lactate, which can be dangerous, but those tests didn't work well. A different test might help doctors know if patients are okay.

Methodology

Chart review of ICU patients with cotemporaneous arterial blood gas, serum chemistry, serum albumin, and lactate levels.

Limitations

The study was limited to 143 patients and could not assess unmeasured anions due to lack of physical chemistry assessments.

Participant Demographics

{"mean_age":62.2,"gender_distribution":{"female":41.3,"male":58.7},"ethnicity_distribution":{"African American":51.0,"European American":42.7,"Hispanic":4.9,"Asian American":0.7}}

Digital Object Identifier (DOI)

10.1186/1471-227X-8-18

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