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Anion Gap, Anion Gap Corrected for Albumin, and Base Deficit Fail to Accurately Diagnose Clinically Significant Hyperlactatemia in Critically Ill Patients

Department of Critical Care Medicine and Anesthesiology and Division of Renal Diseases and Hypertension, Department of Medicine, The George Washingto Unitversity Medical Center

Dhiraj Jagasia, MD

Department of Critical Care Medicine and Anesthesiology, The George Washington University Medical Center

Lynn M. Abell, MD

Department of Surgery The George Washington University Medical Center, Washington, DC

Michael G. Seneff, MD

Department of Critical Care Medicine and Anesthesiology, The George Washington University Medical Center, mseneff{at}mfa.gwu.edu

Melinda Egan, MD

Department of Critical Care Medicine and Anesthesiology, The George Washington University Medical Center

Natale Danino, MD

Department of Critical Care Medicine and Anesthesiology, The George Washington University Medical Center

Aline Nguyen, MD

Department of Critical Care Medicine and Anesthesiology, The George Washington University Medical Center

Mazer Ally, MD

Department of Critical Care Medicine and Anesthesiology, The George Washington University Medical Center

Paul L. Kimmel, MD

Department of Critical Care Medicine and Anesthesiology, The George Washington University Medical Center

Christopher Junker, MD

Department of Critical Care Medicine and Anesthesiology, The George Washington University Medical Center

Anion gap, anion gap corrected for serum albumin, and base deficit are often used as surrogates for measuring serum lactate. None of these surrogates is postulated to predict hyperlactatemia in the critically ill. We prospectively collected data from September 2004 through August 2005 for 1381 consecutive admissions. Patients with renal disease, ketoacidosis, or toxic ingestion were excluded. Anion gap, anion gap corrected for albumin, and base deficit were calculated for all patients. We identified 286 patients who met our inclusion or exclusion criteria. The receiver-operating characteristic area under the curve for the prediction of hyperlactatemia for anion gap, anion gap corrected for albumin, and base deficit were 0.55, 0.57, and 0.64, respectively. Anion gap, anion gap corrected for albumin, and base deficit do not predict the presence or absence of clinically significant hyperlactatemia. Serum lactate should be measured in all critically ill adults in whom hypoperfusion is suspected.

Key Words: lactate • anion gap • albumin-corrected anion gap • base deficit • shock

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