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Journal of Intensive Care Medicine
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*Coronary Artery Bypass Surgery
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Comparative Quantitative Acid-Base Analysis in Coronary Artery Bypass, Severe Sepsis, and Diabetic Ketoacidosis

Edward M. Omron, MD, MPH, FCCP

Division of Pulmonary Medicine, National Naval Medical Center, Bethesda, MD, edwardomron{at}hotmail.com

The main objective of this study was to assess the relationship of standard base excess (SBE) to delta strong ion difference effective ({Delta}SIDe) in critical illness. Critical illness is characterized by variable plasma nonvolatile weak acid components ({Delta}A-), and SBE becomes discordant with {Delta}SIDe. The author hypothesized that both acid-base models are equivalent when SBE and {Delta}SIDe are corrected for {Delta}A-. A retrospective chart review was performed to assess this hypothesis by looking at changes in SBE, {Delta}SIDe, and {Delta}A- in 30 coronary artery bypass graft surgery patients, 30 severe sepsis patients, and 15 diabetic ketoacidosis patients. SBE equals the sum of the {Delta}SIDe and {Delta}A-. The SBE quantifies the magnitude of the metabolic acid-base derangement, the {Delta}SIDe quantifies the plasma strong cation/anion imbalance, and the {Delta}A- quantifies the magnitude of the hypoalbuminemic alkalosis. The partitioning of SBE into physicochemical components can facilitate analyses of complex acid-base disorders in critical illness.

Key Words: acidosis • alkalosis • anion gap • buffers • hypoalbuminemia

Journal of Intensive Care Medicine, Vol. 20, No. 6, 269-278 (2005)
DOI: 10.1177/0885066605279955
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