Contribution of various metabolites to the "unmeasured" anions in critically ill patients with metabolic acidosis.


OBJECTIVE:The physicochemical approach, described by Stewart to investigate the acid-base balance, includes the strong ion gap (SIG), a quantitative measure of "unmeasured" anions, which strongly correlates to the corrected anion gap. The chemical nature of these anions is for the most part unknown. We hypothesized that amino acids, uric acid, and organic acids could contribute to the SIG. DESIGN:Prospective observational study. SETTING:Intensive care department of an academic hospital. PATIENTS:Consecutive intensive care unit patients (n = 31) with metabolic acidosis, defined as a pH of < 7.35 and a base excess of < or = -5 mmol/L. INTERVENTIONS:A single arterial blood sample was collected. MEASUREMENTS:The SIG was calculated and two groups were compared: patients with SIG of < or = 2 mEq/L and patients with SIG of > or = 5 mEq/L. "Unmeasured" anions were examined by ion-exchange column chromatography, reverse-phase high-performance liquid chromatography, and gas chromatography/mass spectrometry measuring amino acids, uric acid, and organic acids, respectively. MAIN RESULTS:Comparison of patient characteristics of both SIG groups showed that age, sex, Acute Physiology and Chronic Health Evaluation II, pH, base excess, and lactate were not significantly different. Renal insufficiency and sepsis were more prevalent in the SIG > or = 5 mEq/L group (n = 12; median SIG, 8.3 mEq/L), associated with higher mortality. Concentrations of the anionic compounds aspartic acid, uric acid, succinic acid, pyroglutamic acid, p-hydroxyphenyllactic acid, and the semiquantified organic acid homovanillic acid were all statistically significantly elevated in the SIG > or = 5 mEq/L group compared with the SIG < or = 2 mEq/L group (n = 8; median SIG, 0.6 mEq/L). Overall, the averaged difference between both SIG groups in total anionic amino acids, uric acid, and organic acids concentrations contributed to the SIG for, respectively, 0.07% (5 microEq/L, p = not significant), 2.2% (169 microEq/L, p = .021), and 5.6% (430 microEq/L, p = .025). CONCLUSIONS:Amino acids, uric acid, and organic acids together accounted for only 7.9% of the SIG in intensive care unit patients with metabolic acidosis.


Crit Care Med


Critical care medicine


Moviat M,Terpstra AM,Ruitenbeek W,Kluijtmans LA,Pickkers P,van der Hoeven JG




Has Abstract


2008-03-01 00:00:00












  • The effect of hypermetabolism induced by burn trauma on the ethanol-oxidizing capacity of the liver.

    abstract:OBJECTIVE:To study the rate of elimination of ethanol after a major burn trauma. DESIGN:Prospective, controlled study. SETTING:National burns unit in a Swedish university hospital. PATIENTS AND SUBJECTS:Eight consecutive patients suffering from 18%-72% total burned surface area and nine healthy male control subjects...

    journal_title:Critical care medicine

    pub_type: 临床试验,杂志文章


    authors: Zdolsek HJ,Sjöberg F,Lisander B,Jones AW

    更新日期:1999-12-01 00:00:00

  • Pretransport Pediatric Risk of Mortality (PRISM) score underestimates the requirement for intensive care or major interventions during interhospital transport.

    abstract:OBJECTIVE:To test the hypothesis that a pretransport Pediatric Risk of Mortality (PRISM) score underestimates the requirement for both intensive care and interventions during pediatric interhospital transport. DESIGN:Prospective, descriptive study. SETTING:All children were treated in a regional hospital and then tra...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Orr RA,Venkataraman ST,Cinoman MI,Hogue BL,Singleton CA,McCloskey KA

    更新日期:1994-01-01 00:00:00

  • Inotropic Effects of Experimental Hyperthermia and Hypothermia on Left Ventricular Function in Pigs-Comparison With Dobutamine.

    abstract:OBJECTIVES:The results from the recent Targeted Temperature Management trial raised the question whether cooling or merely the avoidance of fever mediates better neurologic outcome in resuscitated patients. As temperature per se is a major determinant of cardiac function, we characterized the effects of hyperthermia (4...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Alogna A,Manninger M,Schwarzl M,Zirngast B,Steendijk P,Verderber J,Zweiker D,Maechler H,Pieske BM,Post H

    更新日期:2016-03-01 00:00:00

  • Impact of Initial Central Venous Pressure on Outcomes of Conservative Versus Liberal Fluid Management in Acute Respiratory Distress Syndrome.

    abstract:OBJECTIVES:In acute respiratory distress syndrome, conservative fluid management increases ventilator-free days without affecting mortality. Response to fluid management may differ based on patients' initial central venous pressure. We hypothesized that initial central venous pressure would modify the effect of fluid m...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Semler MW,Wheeler AP,Thompson BT,Bernard GR,Wiedemann HP,Rice TW,National Institutes of Health National Heart, Lung, and Blood Institute Acute Respiratory Distress Syndrome Network.

    更新日期:2016-04-01 00:00:00

  • Beyond the Team: Understanding Interprofessional Work in Two North American ICUs.

    abstract:OBJECTIVE:To examine the ways in which healthcare professionals work together in the ICU setting, through a consideration of the contextual, organizational, processual, and relational factors that impact their interprofessional collaboration. DESIGN:Data from over 350 hours of ethnographic observation and 35 semistruc...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Alexanian JA,Kitto S,Rak KJ,Reeves S

    更新日期:2015-09-01 00:00:00

  • Influence of direct and indirect etiology on acute outcome and 6-month functional recovery in acute respiratory distress syndrome.

    abstract:OBJECTIVE:To assess the possibility that acute respiratory distress syndrome (ARDS) of pulmonary and nonpulmonary origins represent two distinct syndromes. DESIGN:Analysis of data collected prospectively from an inception cohort of 117 patients with ARDS. SETTING:Adult intensive care unit (ICU), university/postgradua...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Suntharalingam G,Regan K,Keogh BF,Morgan CJ,Evans TW

    更新日期:2001-03-01 00:00:00

  • Effects of levosimendan, a novel inotropic calcium-sensitizing drug, in experimental septic shock.

    abstract:OBJECTIVE:Levosimendan is a novel inodilator that improves cardiac contractility by sensitizing troponin C to calcium. This drug has proved to be effective in treating advanced congestive heart failure but has not been evaluated in septic settings. The purpose of the present study was to study the effects of this drug ...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Oldner A,Konrad D,Weitzberg E,Rudehill A,Rossi P,Wanecek M

    更新日期:2001-11-01 00:00:00

  • Therapeutic hypercapnia enhances the inflammatory response to endotoxin in the lung of spontaneously breathing rats.

    abstract:OBJECTIVE:To test the hypothesis that therapeutic hypercapnia enhances the proinflammatory responses to endotoxemia in the lung and spleen of rats. DESIGN:Prospective randomized study. SETTINGS:Hospital research institute. SUBJECTS:Forty-eight adult male rats. INTERVENTIONS:Rats were randomly assigned for a 24-hr p...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Norozian FM,Leoncio M,Torbati D,Meyer K,Raszynski A,Totapally BR

    更新日期:2011-06-01 00:00:00

  • Tracheostomy does not improve the outcome of patients requiring prolonged mechanical ventilation: a propensity analysis.

    abstract:OBJECTIVE:To examine the association between the performance of a tracheostomy and intensive care unit and postintensive care unit mortality, controlling for treatment selection bias and confounding variables. DESIGN:Prospective, observational, cohort study. SETTING:Twelve French medical or surgical intensive care un...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Clec'h C,Alberti C,Vincent F,Garrouste-Orgeas M,de Lassence A,Toledano D,Azoulay E,Adrie C,Jamali S,Zaccaria I,Cohen Y,Timsit JF

    更新日期:2007-01-01 00:00:00

  • Consequences of bed rest.

    abstract::Bed rest is frequently prescribed for critically ill patients because it is assumed to be beneficial for preventing complications, for conserving scarce metabolic resources, and for providing patient comfort. Furthermore, higher levels of physical activity in critically ill patients have been assumed to be impractical...

    journal_title:Critical care medicine

    pub_type: 杂志文章,评审


    authors: Brower RG

    更新日期:2009-10-01 00:00:00

  • Comparison of the performance of two general and three specific scoring systems for meningococcal septic shock in children.

    abstract:OBJECTIVE:To evaluate the performance at admission to the pediatric intensive care unit (PICU) of five severity scores, two general (the Pediatric Risk of Mortality [PRISM] II and III scores) and three specific for meningococcal septic shock (Leclerc, Glasgow Meningococcal Septicemia Prognostic Score [GMSPS], and Gedde...

    journal_title:Critical care medicine

    pub_type: 杂志文章,多中心研究


    authors: Castellanos-Ortega A,Delgado-Rodríguez M

    更新日期:2000-08-01 00:00:00

  • Associations between intramucosal acidosis in the gut and organ failure.

    abstract:OBJECTIVE:To alert health professionals to the need for early detection and prevention of shock in critically ill patients. By describing the associations between intramucosal acidosis in the gut and multiple system organ failure, the author demonstrates how noninvasive measurement of gut intramucosal pH can be used to...

    journal_title:Critical care medicine

    pub_type: 杂志文章,评审


    authors: Fiddian-Green RG

    更新日期:1993-02-01 00:00:00

  • Comparison Between Revised Atlanta Classification and Determinant-Based Classification for Acute Pancreatitis in Intensive Care Medicine. Why Do Not Use a Modified Determinant-Based Classification?

    abstract:OBJECTIVE:To compare the classification performance of the Revised Atlanta Classification, the Determinant-Based Classification, and a new modified Determinant-Based Classification according to observed mortality and morbidity. DESIGN:A prospective multicenter observational study conducted in 1-year period. SETTING:F...

    journal_title:Critical care medicine

    pub_type: 杂志文章,多中心研究


    authors: Zubia-Olaskoaga F,Maraví-Poma E,Urreta-Barallobre I,Ramírez-Puerta MR,Mourelo-Fariña M,Marcos-Neira MP,Epidemiology of Acute Pancreatitis in Intensive Care Medicine Study Group.

    更新日期:2016-05-01 00:00:00

  • Evaluation of an "in vivo" PaO2 and PaCO2 monitor in the management of respiratory failure.

    abstract::A commercially available gas-chromatograph (Sentorr Gas Analyzer, Ohio Medical Products, Madison, WI) was tested, featuring continuous measurement of in vivo PaO2 and PaCO2 by means of a thin, heparin-coated catheter, inserted through an indwelling arterial line. Gas tensions are displayed every 4 min. The probes had ...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Carlon GC,Kahn RC,Ray C Jr,Howland WS

    更新日期:1980-07-01 00:00:00

  • Symptom experiences of family members of intensive care unit patients at high risk for dying.

    abstract:OBJECTIVE:To describe the symptom experiences of family members of patients at high risk for dying in the intensive care unit and to assess risk factors associated with higher symptom burden. DESIGN:Prospective, cross-sectional study. SETTING:Three intensive care units at a large academic medical center. PARTICIPANT...

    journal_title:Critical care medicine

    pub_type: 杂志文章,多中心研究


    authors: McAdam JL,Dracup KA,White DB,Fontaine DK,Puntillo KA

    更新日期:2010-04-01 00:00:00

  • Induction of the heat shock response prevents tissue injury during acute inflammation of the rat ileum.

    abstract:OBJECTIVES:To determine if prior total body hyperthermia protected against subsequent acute ileitis induced by the cytotoxic lectin, ricin, in rats. The time course of heat shock mRNA and protein expression in the ileum was determined. The effects of heat stress on small intestinal mucosal integrity, arachidonic acid m...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Stojadinovic A,Kiang J,Goldhill J,Matin D,Smallridge R,Galloway R,Shea-Donohue T

    更新日期:1997-02-01 00:00:00

  • Intensive care unit morbidity and mortality from eclampsia: an evaluation of the Acute Physiology and Chronic Health Evaluation II score and the Glasgow Coma Scale score.

    abstract:OBJECTIVE:To determine the maternal morbidity and mortality in patients with eclampsia admitted to an intensive care unit (ICU), and to establish the efficacy of the Acute Physiology and Chronic Health Evaluation (APACHE) II score, the organ system failure score as defined by Knaus, and the Glasgow Coma Scale (GCS) sco...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Bhagwanjee S,Paruk F,Moodley J,Muckart DJ

    更新日期:2000-01-01 00:00:00

  • Influence of political power, medical provincialism, and economic incentives on the rationing of surgical intensive care unit beds.

    abstract:OBJECTIVE:To determine factors influencing rationing decisions in a surgical ICU during a temporary nursing shortage when two to six of the unit's 16 beds were closed. DESIGN:Blinded, concurrent data collection, retrospective chart review. SETTING:Surgical ICU. PATIENTS:All patients (n = 308) for whom a surgical ICU...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Marshall MF,Schwenzer KJ,Orsina M,Fletcher JC,Durbin CG Jr

    更新日期:1992-03-01 00:00:00

  • Exacerbation by granulocyte colony-stimulating factor of prior acute lung injury: implication of neutrophils.

    abstract:OBJECTIVE:Granulocyte colony-stimulating factor is widely prescribed to hasten recovery from cancer chemotherapy-induced neutropenia and has been reported to induce pulmonary toxicity. However, circumstances and mechanisms of this toxicity remain poorly known. DESIGN:To reproduce a routine situation in cancer patients...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Azoulay E,Attalah H,Yang K,Jouault H,Schlemmer B,Brun-Buisson C,Brochard L,Harf A,Delclaux C

    更新日期:2002-09-01 00:00:00

  • The Fragility and Reliability of Conclusions of Anesthesia and Critical Care Randomized Trials With Statistically Significant Findings: A Systematic Review.

    abstract:OBJECTIVES:The Fragility Index, which represents the number of patients responsible for a statistically significant finding, has been suggested as an aid for interpreting the robustness of results from clinical trials. A small Fragility Index indicates that the statistical significance of a trial depends on only a few ...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Grolleau F,Collins GS,Smarandache A,Pirracchio R,Gakuba C,Boutron I,Busse JW,Devereaux PJ,Le Manach Y

    更新日期:2019-03-01 00:00:00

  • Molecular biology of inflammation and sepsis: a primer.

    abstract:BACKGROUND:Remarkable progress has been made during the last decade in defining the molecular mechanisms that underlie septic shock. This rapidly expanding field is leading to new therapeutic opportunities in the management of severe sepsis. AIM:To provide the clinician with a timely summary of the molecular biology o...

    journal_title:Critical care medicine

    pub_type: 杂志文章,评审


    authors: Cinel I,Opal SM

    更新日期:2009-01-01 00:00:00

  • Multiple organ dysfunction syndrome: exploring the paradigm of complex nonlinear systems.

    abstract:OBJECTIVES:The objectives of this article are to introduce and explore a novel paradigm based on complex nonlinear systems, and to evaluate its application to critical care research regarding the systemic host response and multiple organ dysfunction syndrome (MODS). DATA SOURCES:Published original work, review article...

    journal_title:Critical care medicine

    pub_type: 杂志文章,评审


    authors: Seely AJ,Christou NV

    更新日期:2000-07-01 00:00:00

  • Management of aneurysmal subarachnoid hemorrhage.

    abstract:OBJECTIVE:Acute aneurysmal subarachnoid hemorrhage (SAH) is a complex multifaceted disorder that plays out over days to weeks. Many patients with SAH are seriously ill and require a prolonged intensive care unit stay. Cardiopulmonary complications are common. The management of patients with SAH focuses on the anticipat...

    journal_title:Critical care medicine

    pub_type: 杂志文章,评审


    authors: Diringer MN

    更新日期:2009-02-01 00:00:00

  • Randomized ICU trials do not demonstrate an association between interventions that reduce delirium duration and short-term mortality: a systematic review and meta-analysis.

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    journal_title:Critical care medicine

    pub_type: 杂志文章,meta分析,评审


    authors: Al-Qadheeb NS,Balk EM,Fraser GL,Skrobik Y,Riker RR,Kress JP,Whitehead S,Devlin JW

    更新日期:2014-06-01 00:00:00

  • Prediction of Large Vessel Occlusions in Acute Stroke: National Institute of Health Stroke Scale Is Hard to Beat.

    abstract:OBJECTIVES:Endovascular treatment for acute ischemic stroke with a large vessel occlusion was recently shown to be effective. We aimed to develop a score capable of predicting large vessel occlusion eligible for endovascular treatment in the early hospital management. DESIGN:Retrospective, cohort study. SETTING:Two t...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Vanacker P,Heldner MR,Amiguet M,Faouzi M,Cras P,Ntaios G,Arnold M,Mattle HP,Gralla J,Fischer U,Michel P

    更新日期:2016-06-01 00:00:00

  • Prehospital Hypotension Is Associated With Altered Inflammation Dynamics and Worse Outcomes Following Blunt Trauma in Humans.

    abstract:OBJECTIVE:To define the impact of prehospital hypotension on the dynamic, systemic acute inflammatory response to blunt trauma. DESIGN:Retrospective study. SETTINGS:Tertiary care institution. PATIENTS:Twenty-two hypotensive blunt trauma patients matched with 28 normotensive blunt trauma patients. INTERVENTION:None....

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Almahmoud K,Namas RA,Zaaqoq AM,Abdul-Malak O,Namas R,Zamora R,Sperry J,Billiar TR,Vodovotz Y

    更新日期:2015-07-01 00:00:00

  • Observational Research for Therapies Titrated to Effect and Associated With Severity of Illness: Misleading Results From Commonly Used Statistical Methods.

    abstract:OBJECTIVES:In critically ill patients, treatment dose or intensity is often related to severity of illness and mortality risk, whereas overtreatment or undertreatment (relative to the individual need) may further increase the odds of death. We aimed to investigate how these relationships affect the results of common st...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: de Grooth HJ,Girbes ARJ,van der Ven F,Oudemans-van Straaten HM,Tuinman PR,de Man AME

    更新日期:2020-12-01 00:00:00

  • Therapeutic potential of intraluminal oxygenation.

    abstract:OBJECTIVE:To discuss the potential therapeutic value of intraluminal oxygenation of the gut in critical illness. DATA SOURCES:Relevant articles published in the English language literature. STUDY SELECTION:No special study has been carried out for the present presentation. DATA EXTRACTION:Information from the litera...

    journal_title:Critical care medicine

    pub_type: 杂志文章,评审


    authors: Haglund U

    更新日期:1993-02-01 00:00:00

  • Critical care medicine use and cost among Medicare beneficiaries 1995-2000: major discrepancies between two United States federal Medicare databases.

    abstract:OBJECTIVE:A comparison of federal Medicare databases to identify critical care medicine (CCM) use, cost discrepancies, and their possible causes. DESIGN:A 6-yr (1995-2000) retrospective analysis of Medicare hospital and CCM use and cost, comparing the Hospital Cost Report Information System (HCRIS) with Medicare Provi...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Halpern NA,Pastores SM,Thaler HT,Greenstein RJ

    更新日期:2007-03-01 00:00:00

  • High dose epinephrine in refractory pediatric cardiac arrest.

    abstract::Cardiac arrest has a poor prognosis, regardless of age group. Children who fail to respond to two standard doses of epinephrine (0.01 mg/kg) rarely survive to hospital discharge, and most die without the return of spontaneous circulation (ROSC). We treated seven consecutive children in cardiac arrest with high dose ep...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Goetting MG,Paradis NA

    更新日期:1989-12-01 00:00:00