Ottaviani Irene, Tantillo Simona, Miggiano Lorenzo, Guarnera Martina, Menghini Marco, Talarico Francesco, Mazzanti Federica, Cilloni Nicola
Department of Anesthesia, Intensive Care and Prehospital Emergency, Maggiore Hospital Carlo Alberto Pizzardi, Bologna, Italy.
J Anesth Analg Crit Care. 2024 Sep 16;4(1):63. doi: 10.1186/s44158-024-00199-7.
Metabolic acidosis is a frequent finding in patients admitted to the intensive care unit (ICU). It can be caused by prolonged fasting due to surgical procedures or by medical conditions that lead to starvation ketoacidosis (SKA). Early recognition and treatment of SKA could prevent several life-threatening complications, improving survival and reducing the ICU length of stay.
We retrospectively screened all medical records of patients admitted to the ICU (Maggiore Hospital, Bologna, North Italy) from May 2022 to April 2023. We included patients aged 18 years or older who presented ketonuria detected in the urine sample.
We analyzed 190 patients with ketonuria at ICU admission. Postsurgical patients showed lower levels of albumin and a higher rate of shock compared to medical patients. Ketonuric patients with shock had a lower body mass index (BMI) compared to patients without shock (24 versus 26 kg/m2, respectively). There were no differences within groups regarding mortality and ICU readmission rate. Medical patients had a significantly higher ICU length of stay.
This retrospective observational descriptive study showed that patients with ketonuria, hypoalbuminemia, and low BMI at ICU admission have high risk of hemodynamic instability and shock. Surgical patients compared to medical patients are exposed to a catabolic trigger that could worsen a state of malnutrition and induce anabolic resistance; elective and urgent surgical patients did not differ in terms of risk of shock and mortality, probably due to the activation of this catabolic pathway. Early recognition and treatment of starvation ketoacidosis and perioperative nutritional optimization could reduce incidence of hemodynamic and metabolic complications.
代谢性酸中毒在重症监护病房（ICU）收治的患者中很常见。它可能由手术导致的长期禁食或导致饥饿性酮症酸中毒（SKA）的疾病引起。早期识别和治疗SKA可预防多种危及生命的并发症，提高生存率并缩短ICU住院时间。
我们回顾性筛查了2022年5月至2023年4月期间入住ICU（意大利北部博洛尼亚马焦雷医院）的所有患者的病历。我们纳入了年龄在18岁及以上且尿样中检测出酮尿的患者。
我们分析了190例入院时存在酮尿的患者。与内科患者相比，外科手术后患者的白蛋白水平较低，休克发生率较高。与无休克的酮尿患者相比，休克的酮尿患者体重指数（BMI）较低（分别为24与26kg/m²）。各组在死亡率和ICU再入院率方面无差异。内科患者的ICU住院时间显著更长。
这项回顾性观察性描述性研究表明，入院时存在酮尿、低白蛋白血症和低BMI的患者有血流动力学不稳定和休克的高风险。与内科患者相比，外科手术患者面临一种分解代谢触发因素，这可能会使营养不良状态恶化并导致合成代谢抵抗；择期和急诊手术患者在休克风险和死亡率方面没有差异，这可能是由于这种分解代谢途径的激活。早期识别和治疗饥饿性酮症酸中毒以及围手术期营养优化可降低血流动力学和代谢并发症的发生率。
