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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

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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

Lakhmir S Chawla et al. BMC Emerg Med.

Abstract

Background: Base deficit (BD), anion gap (AG), and albumin corrected anion gap (ACAG) are used by clinicians to assess the presence or absence of hyperlactatemia (HL). We set out to determine if these tools can diagnose the presence of HL using cotemporaneous samples.

Methods: We conducted a chart review of ICU patients who had cotemporaneous arterial blood gas, serum chemistry, serum albumin (Alb) and lactate(Lac) levels measured from the same sample. We assessed the capacity of AG, BD, and ACAG to diagnose HL and severe hyperlactatemia (SHL). HL was defined as Lac > 2.5 mmol/L. SHL was defined as a Lac of > 4.0 mmol/L.

Results: From 143 patients we identified 497 series of lab values that met our study criteria. Mean age was 62.2 +/- 15.7 years. Mean Lac was 2.11 +/- 2.6 mmol/L, mean AG was 9.0 +/- 5.1, mean ACAG was 14.1 +/- 3.8, mean BD was 1.50 +/- 5.4. The area under the curve for the ROC for BD, AG, and ACAG to diagnose HL were 0.79, 0.70, and 0.72, respectively.

Conclusion: AG and BD failed to reliably detect the presence of clinically significant hyperlactatemia. Under idealized conditions, ACAG has the capacity to rule out the presence of hyperlactatemia. Lac levels should be obtained routinely in all patients admitted to the ICU in whom the possibility of shock/hypoperfusion is being considered. If an AG assessment is required in the ICU, it must be corrected for albumin for there to be sufficient diagnostic utility.

Figures

Figure 1
Figure 1
Albumin lactate corrected anion gap (ALCAG) v. serum lactate.
Figure 2
Figure 2
Albumin lactate corrected anion gap (ALCAG) v. pH.

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References

    1. Emmett M, Narins RG. Clinical use of the anion gap. Medicine (Baltimore) 1977;56:38–54. doi: 10.1097/00005792-197756010-00002. - DOI - PubMed
    1. Chiolero RL, Revelly JP, Leverve X, Gersbach P, Cayeux MC, Berger MM, Tappy L. Effects of cardiogenic shock on lactate and glucose metabolism after heart surgery. Crit Care Med. 2000;28:3784–3791. doi: 10.1097/00003246-200012000-00002. - DOI - PubMed
    1. Gutierrez G, Wulf ME. Lactic acidosis in sepsis: another commentary. Crit Care Med. 2005;33:2420–2422. doi: 10.1097/01.CCM.0000183003.65144.C7. - DOI - PubMed
    1. Shoemaker WC, Appel PL, Kram HB. Role of oxygen debt in the development of organ failure sepsis, and death in high-risk surgical patients. Chest. 1992;102:208–215. doi: 10.1378/chest.102.1.208. - DOI - PubMed
    1. Husain FA, Martin MJ, Mullenix PS, Steele SR, Elliott DC. Serum lactate and base deficit as predictors of mortality and morbidity. Am J Surg. 2003;185:485–491. doi: 10.1016/S0002-9610(03)00044-8. - DOI - PubMed

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