tailieunhanh - Báo cáo y học: "Causes and effects of hyperchloremic acidosis"

Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học Critical Care cung cấp cho các bạn kiến thức về ngành y đề tài: Causes and effects of hyperchloremic acidosis. | Available online http content 10 3 413 Letter Causes and effects of hyperchloremic acidosis Michael Eisenhut Institute of Child Health University of Liverpool Eaton Road Liverpool L12 2AP United Kingdom Corresponding author Michel Eisenhut michael_eisenhut@ Published 29 June 2006 This article is online at http content 10 3 413 2006 BioMed Central Ltd Critical Care 2006 10 413 doi cc4963 See related research by Gunnerson et al. http content 10 1 R22 Gunnerson and colleagues 1 found in their retrospective study that critically ill patients with lactate acidosis had a higher mortality compared to patients with hyperchloremic acidosis whose mortality was not significantly different from patients with no acidosis. Because of its iatrogenic etiology the authors commented that it is reassuring that hyperchloremic acidosis is not associated with an increased mortality. Previous randomized controlled trials have however generated concerns regarding the adverse effects of hyperchloremic acidosis associated with rapid isotonic saline administration. Rapid isotonic saline infusion predictably results in hyperchloremic acidosis 2 . The acidosis is due to a reduction in the strong anion gap by an excessive rise in plasma chloride as well as excessive renal bicarbonate elimination. In a randomized controlled trial with a mixed group of patients undergoing major surgery isotonic saline infusion was compared to Hartmann s solution with 6 hetastarch with a balanced electrolyte and glucose solution. Two-thirds of patients in the isotonic saline group but none in the balanced fluid group developed hyperchloremic metabolic acidosis 3 . The hyperchloremic acidosis was associated with reduced gastric mucosal perfusion on gastric tonometry. Another randomized double blind trial of isotonic saline versus lactated Ringer s in patients undergoing aortic reconstructive surgery confirmed this result and the acidosis required interventions .

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