RESUMO
BACKGROUND: Acid-base imbalance has been poorly described in patients with coronavirus disease 2019 (COVID-19). Study by the quantitative acid-base approach may be able to account for minor changes in ion distribution that may have been overlooked using traditional acid-base analysis techniques. In a cohort of critically ill COVID-19 patients, we looked for an association between metabolic acidosis surrogates and worse clinical outcomes, such as mortality, renal dialysis, and length of hospital stay. AIM: To describe the acid-base disorders of critically ill COVID-19 patients using Stewart's approach, associating its variables with poor outcomes. METHODS: This study pertained to a retrospective cohort comprised of adult patients who experienced an intensive care unit stay exceeding 4 days and who were diagnosed with severe acute respiratory syndrome coronavirus 2 infection through a positive polymerase chain reaction analysis of a nasal swab and typical pulmonary involvement observed in chest computed tomography scan. Laboratory and clinical data were obtained from electronic records. Categorical variables were compared using Fisher's exact test. Continuous data were presented as median and interquartile range. The Mann-Whitney U test was used for comparisons. RESULTS: In total, 211 patients were analyzed. The mortality rate was 13.7%. Overall, 149 patients (70.6%) presented with alkalosis, 28 patients (13.3%) had acidosis, and the remaining 34 patients (16.2%) had a normal arterial pondus hydrogenii. Of those presenting with acidosis, most had a low apparent strong ion difference (SID) (20 patients, 9.5%). Within the group with alkalosis, 128 patients (61.0%) had respiratory origin. The non-survivors were older, had more comorbidities, and had higher Charlson's and simplified acute physiology score 3. We did not find severe acid-base imbalance in this population. The analyzed Stewart's variables (effective SID, apparent SID, and strong ion gap and the effect of albumin, lactate, phosphorus, and chloride) were not different between the groups. CONCLUSION: Alkalemia is prevalent in COVID-19 patients. Although we did not find an association between acid-base variables and mortality, the use of Stewart's methodology may provide insights into this severe disease.
RESUMO
The objectives of this retrospective study were to determine the main acid-base and electrolytes disorders in hospitalized cattle, using both Henderson-Hasselbalch and the physicochemical approach and to compare their diagnostic and therapeutic utility. A total of 31 medical records were reviewed of bovines admitted to the Large Animal Hospital at Universidad Nacional de Colombia, that met the inclusion criteria of the measurement of blood gases, blood electrolytes and plasma protein on admission before providing any treatment. Using the Henderson-Hasselbalch approach, acid base abnormalities were found in 83.3% of the patients, compared to 93.5% using the physicochemical approach. The principal acid-base disorders found were strong ion acidosis (61.29%) and weak acid acidosis (38.7%); strong ion gap (SIG) acidosis was found in 73.68% of cases showing strong ion acidosis. These results highlight the importance of the diagnosis of acid-base disorders in sick cattle for proper recognition of pathophysiological phenomena and its understanding to guide treatment decisions.(AU)
Os objetivos deste estudo retrospectivo foram determinar os principais distúrbios ácido-base e eletrolíticos em bovinos internados, utilizando a abordagem Henderson-Hasselbalch e a abordagem físico-química comparando a utilidade diagnóstica e terapêutica de tais procedimentos. Foram revisados 31 prontuários de bovinos admitidos no Hospital de Animais de Grande Porte da Universidad Nacional de Colombia, que preencheram os critérios de inclusão da medição de gases sanguíneos, eletrólitos sanguíneos e proteínas plasmáticas na admissão antes de fornecer qualquer tratamento. Com o emprego da abordagem de Henderson-Hasselbalch, as anormalidades da base ácida foram encontradas em 83,3% dos pacientes, enquanto com a abordagem físico-química o valor obtido foi de 93,5%. Os principais distúrbios ácido-base encontrados foram forte acidose iônica (61,29%) e acidose ácida fraca (38,7%). A acidose com Ion Gap Forte (SIG) foi encontrada em 73,68% dos casos com forte acidose iônica. Estes resultados destacam a importância do diagnóstico de distúrbios ácido-base em bovinos doentes para o reconhecimento adequado dos fenômenos fisiopatológicos e sua compreensão para orientar as decisões de tratamento.(AU)
Assuntos
Animais , Bovinos , Acidose/veterinária , Eletrólitos/análise , Fenômenos Químicos , Hiponatremia/veterinária , Estudos Retrospectivos , Hospitais VeterináriosRESUMO
The objectives of this retrospective study were to determine the main acid-base and electrolytes disorders in hospitalized cattle, using both Henderson-Hasselbalch and the physicochemical approach and to compare their diagnostic and therapeutic utility. A total of 31 medical records were reviewed of bovines admitted to the Large Animal Hospital at Universidad Nacional de Colombia, that met the inclusion criteria of the measurement of blood gases, blood electrolytes and plasma protein on admission before providing any treatment. Using the Henderson-Hasselbalch approach, acid base abnormalities were found in 83.3% of the patients, compared to 93.5% using the physicochemical approach. The principal acid-base disorders found were strong ion acidosis (61.29%) and weak acid acidosis (38.7%); strong ion gap (SIG) acidosis was found in 73.68% of cases showing strong ion acidosis. These results highlight the importance of the diagnosis of acid-base disorders in sick cattle for proper recognition of pathophysiological phenomena and its understanding to guide treatment decisions.(AU)
Os objetivos deste estudo retrospectivo foram determinar os principais distúrbios ácido-base e eletrolíticos em bovinos internados, utilizando a abordagem Henderson-Hasselbalch e a abordagem físico-química comparando a utilidade diagnóstica e terapêutica de tais procedimentos. Foram revisados 31 prontuários de bovinos admitidos no Hospital de Animais de Grande Porte da Universidad Nacional de Colombia, que preencheram os critérios de inclusão da medição de gases sanguíneos, eletrólitos sanguíneos e proteínas plasmáticas na admissão antes de fornecer qualquer tratamento. Com o emprego da abordagem de Henderson-Hasselbalch, as anormalidades da base ácida foram encontradas em 83,3% dos pacientes, enquanto com a abordagem físico-química o valor obtido foi de 93,5%. Os principais distúrbios ácido-base encontrados foram forte acidose iônica (61,29%) e acidose ácida fraca (38,7%). A acidose com Ion Gap Forte (SIG) foi encontrada em 73,68% dos casos com forte acidose iônica. Estes resultados destacam a importância do diagnóstico de distúrbios ácido-base em bovinos doentes para o reconhecimento adequado dos fenômenos fisiopatológicos e sua compreensão para orientar as decisões de tratamento.(AU)
Assuntos
Animais , Bovinos , Acidose/veterinária , Eletrólitos/análise , Fenômenos Químicos , Hiponatremia/veterinária , Estudos Retrospectivos , Hospitais VeterináriosRESUMO
Recent studies have suggested that some blood physicochemical and urinary biochemical parameters have a standardized behavior during acute kidney injury (AKI) development. The changes in these parameters frequently begin to occur before significant rises in serum creatinine (sCr) and may help in identifying patients with more subtle decreases in glomerular filtration rate (GFR). Surgical patients have an increased risk of AKI but renal impairment is usually not evident at ICU admission. We hypothesized that the surgical patients who have AKI diagnosed in the early postoperative period have an impaired GFR since ICU admission, indirectly inferred by alterations in these blood physicochemical and urinary biochemical parameters even in the presence of a still normal sCr. We retrospectively evaluated 112 surgical patients who were categorized according to AKI development during the first 3 ICU days. Twenty-eight patients developed AKI, most of them in the first day (D1) after ICU admission (D0). AKI patients had, at D0, lower serum pH and albumin, higher C - reactive protein (CRP), lower urine sodium (NaU) and fractional excretion of urea (FEUr). Fractional excretion of potassium (FEK) was high in both groups at D0 but remained high in the subsequent days only in AKI patients. Very low CRP and high serum albumin, high NaU and FEUr values at ICU admission had a significant negative predictive value for AKI. We concluded that some easily assessed parameters in blood and urine may help to identify patients with indirect signs of increased inflammatory response and decreased GFR at ICU admission, which could help to predict the risk of postoperative AKI development.