Taylor Dan, Durward Andrew, Tibby Shane M, Thorburn Kentigern, Holton Fiona, Johnstone Iain C, Murdoch Ian A
Paediatric Intensive Care Unit, Guy's Hospital, St Thomas Street, SE1 9RT, London, UK.
Paediatric Intensive Care Unit, Royal Liverpool Children's Hospital - Alder Hey, Eaton Road, L12 2AP, Liverpool, UK.
Intensive Care Med. 2006 Feb;32(2):295-301. doi: 10.1007/s00134-005-0009-1. Epub 2006 Jan 31.
During the acute treatment of diabetic ketoacidosis we (a) determined the temporal incidence of hyperchloraemia, and (b) quantified the influence of hyperchloraemia on interpretation of common blood gas derived acid base parameters, namely base deficit and bicarbonate.
Retrospective chart review in two regional paediatric intensive care units.
Stewart's physicochemical theory was used to develop regression equations quantifying the acidifying effect of hyperchloraemia on both base deficit and bicarbonate. These were then applied retrospectively to blood chemistry results from 18 children (median age 12.7 years, weight 43 kg) with diabetic ketoacidosis. Plasma ketonaemia was estimated using the albumin-corrected anion gap. The incidence of hyperchloraemia, as documented by a ratio of plasma chloride to sodium of greater than 0.79, increased from 6% at admission to 94% after 20 h of treatment. Correction for chloride produced a dramatic improvement in the relationship between changes in the anion gap vs. both base deficit (from R(2)=0.55 to R(2)=0.95) and bicarbonate (from R(2)=0.51 to R(2)=0.96) during treatment. After 20 h of treatment the mean base deficit had decreased from 24.7 mmol/l to 10.0 mmol/l however, the proportion that was due to hyperchloraemia increased from 2% to 98%.
It is now possible using a simple correction factor to quantify the confounding effect of hyperchloraemia on both base deficit and bicarbonate in diabetic ketoacidosis. This bedside tool may be a useful adjunct to guide therapeutic interventions.
在糖尿病酮症酸中毒的急性治疗期间，我们（a）确定高氯血症的时间发生率，以及（b）量化高氯血症对常见血气衍生酸碱参数（即碱缺失和碳酸氢盐）解释的影响。
对两个地区儿科重症监护病房进行回顾性病历审查。
采用斯图尔特物理化学理论建立回归方程，以量化高氯血症对碱缺失和碳酸氢盐的酸化作用。然后将这些方程回顾性应用于18名糖尿病酮症酸中毒儿童（中位年龄12.7岁，体重43 kg）的血液化学结果。使用白蛋白校正阴离子间隙估算血浆酮血症。血浆氯与钠的比值大于0.79记录的高氯血症发生率，从入院时的6%增加到治疗20小时后的94%。在治疗期间，校正氯后，阴离子间隙变化与碱缺失（从R² = 0.55提高到R² = 0.95）和碳酸氢盐（从R² = 0.51提高到R² = 0.96）之间的关系有显著改善。治疗20小时后，平均碱缺失从24.7 mmol/l降至10.0 mmol/l，然而，由高氯血症导致的比例从2%增加到98%。
现在可以使用一个简单的校正因子来量化高氯血症对糖尿病酮症酸中毒中碱缺失和碳酸氢盐的混杂效应。这种床边工具可能是指导治疗干预的有用辅助手段。
