Skellett S, Mayer A, Durward A, Tibby S M, Murdoch I A
Paediatric Intensive Care Unit, Guy's and St Thomas' Hospital, London SE1 9RT, UK.
Arch Dis Child. 2000 Dec;83(6):514-6. doi: 10.1136/adc.83.6.514.
Base deficit is a parameter often used to guide further treatment in acidotic children and is taken as a measure of how "sick" they are. Five children with septic shock are presented who had persisting base deficit after large volume resuscitation with 0.9% saline. Stewart's strong ion theory of acid-base balance is able to quantify the causes of metabolic acidosis and is used to show that our patients had a hyperchloraemic metabolic acidosis. We show how the chloride content of the saline loads given to our patients caused this hyperchloraemia. It is concluded that 0.9% saline and other chloride rich fluids may not be ideal resuscitation fluids; if used, clinicians must be aware of their potential to cause a persistent base deficit.
碱缺失是常用于指导酸中毒患儿进一步治疗的参数，被视为衡量患儿病情严重程度的指标。本文介绍了5例感染性休克患儿，他们在接受大量0.9%生理盐水复苏后仍存在持续的碱缺失。Stewart酸碱平衡的强离子理论能够量化代谢性酸中毒的病因，并用于表明我们的患者存在高氯性代谢性酸中毒。我们展示了给予患者的生理盐水负荷中的氯含量是如何导致这种高氯血症的。得出的结论是，0.9%生理盐水和其他富含氯的液体可能不是理想的复苏液体；如果使用，临床医生必须意识到它们可能导致持续碱缺失的可能性。
