DOI: http://dx.doi.org/10.18203/2349-3933.ijam20210595

Severe metabolic acidosis in critically Ill patients and its association with the outcome in North Karnataka

S. M. Biradar, Renuka Holyachi, V. Ravi Teja

Abstract


Background: Outcomes of metabolic acidosis remain unsure and needs to be explored deeply. This article presents a rational approach to diagnosis and management of metabolic acidosis. The data focusing specifically on severe metabolic acidosis (pH<7.20) is scanty.  

Methods: It was a prospective observational study. A total of 50 consecutive critically ill patients (APACHE II score of 18 or more) with single severe metabolic acidosis (pH<7.20) admitted to the intensive care units (ICUs) of Shri BM Patil Medical College, Vijayapura. Arterial blood gas analysis along with other relevant investigations was done within first 24 h of ICU admission.

Results: Among 50 patients, 32 patients expired compared to 18 patients who were discharged from hospital in stable condition. Out of 29 patients, who had lactic acidosis, 21 (72%) patients died compared to 8 (28%) patients who were discharged in stable condition. Out of 22 patients who have low Strong Ion Difference (SID) 16 patients had expired (76%) remaining 6 (24%) patients are discharged at stable condition. Out of 27 patients who were put on mechanical ventilator on the first day, 22 (80%) patients expired. 18 patients required vasopressor support on admission out of which 16 (90%) patients had lactic acidosis.  

Conclusions: Lactic acidosis and strong ion gap are found to be associated with higher mortality. Hypotensive patients required vasopressor support on admission. Monitoring of serum pH, HCO3, lactate levels and strong ion gap may have prognostic and therapeutic implications.

 


Keywords


Acid-base disorders, Critical illness, Metabolic acidosis

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