Mavrothalassitis Orestes, Thind Balkarn S, Agrawal Ashish
Department of Anesthesia and Perioperative Care, University of California San Francisco, San Francisco, CA, USA.
Case Rep Crit Care. 2022 Jul 4;2022:1285598. doi: 10.1155/2022/1285598. eCollection 2022.
Lactic acidosis is common in critically-ill surgical patients, but not all perioperative acid-base imbalances are attributable to tissue hypoperfusion. Other causes of acid-base abnormalities can be missed when focused on acute resuscitation of a surgical pathology. This report presents the case of a 60-year-old woman with no past medical history who underwent exploratory laparotomy for umbilical hernia with incarcerated and perforated bowel whose perioperative management was complicated by four acid-base disturbances, including starvation ketosis. This case highlights the importance of early recognition of acid-base imbalances to explain concurrent medical pathology and accurately predict a patient's expected post-operative course.
乳酸性酸中毒在外科重症患者中很常见，但并非所有围手术期酸碱失衡都归因于组织灌注不足。当专注于外科病理的急性复苏时，可能会漏诊其他酸碱异常的原因。本报告介绍了一名60岁无既往病史的女性病例，该患者因脐疝伴肠嵌顿和穿孔接受了剖腹探查术，其围手术期管理因四种酸碱紊乱（包括饥饿性酮症）而复杂化。该病例强调了早期识别酸碱失衡对于解释并发的内科病理情况以及准确预测患者术后预期病程的重要性。
