Palange P, Carlone S, Galassetti P, Felli A, Serra P
Cattedra di Patologia medica II, Università La Sapienza, Roma.
Recenti Prog Med. 1990 Dec;81(12):788-91.
To establish the overall frequency distribution and combination of acid-base and electrolyte disturbances as they occur in a general population requiring hospital care, we studied arterial blood gases and plasma electrolytes (sodium, potassium and chloride) in 110 consecutive patients (age = 68 +/- 8 SE; 64 M, 46 F) at the time of admission to a general medical ward. Disturbances were defined on the basis of the standard pH/pCO2 plot and the normal (mean +/- 2 SD) electrolyte range for our laboratory. Sixty-two patients (56%) showed a disturbance in acid base equilibrium: acidosis: respiratory 16, metabolic 6; alkalosis: respiratory 26, metabolic 10; in 4/62 the acid base disturbance was mixed. In 47 of the 62 patients, the acid base imbalance were associated with electrolyte derangements (low PNa+, 12; high PNa+, 1; low PK+, 10; high pK+, 7; increased anion gap, 17). Electrolyte disturbances with a normal acid base status were detected in only 2 patients. Of significance, in 7 of the 58 individuals considered to have a "pure" acid base disturbance on the basis of the pH/pCO2 plot (5 respiratory alkalosis; 1 respiratory acidosis; 1 metabolic alkalosis), a widened anion gap revealed that the acid-base change was mixed, i.e. there was a concomitant component of metabolic acidosis. Thus, the total number of mixed acid base equilibrium disorders were eleven. This study emphasizes the frequent incidence of acid base and electrolyte disorders, very often in combination, among unselected adult patients admitted to a general medical ward. In addition it reinforces that a high prevalence of hidden cases of mixed acid base disturbances can be recognized by concomitant analysis of acid base and electrolyte parameters, including anion gap calculation.
为了确定在需要住院治疗的普通人群中酸碱和电解质紊乱的总体频率分布及组合情况，我们对110例连续入住普通内科病房的患者（年龄 = 68±8岁，标准误；男性64例，女性46例）入院时的动脉血气和血浆电解质（钠、钾和氯）进行了研究。根据标准pH/pCO₂图以及我们实验室的正常（均值±2标准差）电解质范围来定义紊乱情况。62例患者（56%）出现酸碱平衡紊乱：酸中毒：呼吸性16例，代谢性6例；碱中毒：呼吸性26例，代谢性10例；62例中有4例为混合性酸碱紊乱。62例患者中有47例酸碱失衡与电解质紊乱相关（低血钠，12例；高血钠，1例；低钾，10例；高钾，7例；阴离子间隙增加，17例）。仅2例患者检测到酸碱状态正常的电解质紊乱。值得注意的是，在根据pH/pCO₂图被认为有“单纯”酸碱紊乱的58例个体中，有7例（5例呼吸性碱中毒；1例呼吸性酸中毒；1例代谢性碱中毒）阴离子间隙增宽表明酸碱变化为混合性，即存在代谢性酸中毒伴随成分。因此，混合性酸碱平衡紊乱的总数为11例。本研究强调了在未经过挑选的入住普通内科病房的成年患者中，酸碱和电解质紊乱经常发生，且常常同时出现。此外，该研究还强化了通过同时分析酸碱和电解质参数（包括计算阴离子间隙）可以识别出高比例的隐匿性混合性酸碱紊乱病例。
