Hyperlactacemia in critically ill children: comparison of traditional and Fencl-Stewart methods
Keywords:
Hyperlactacemia, Fencyl-Stewart method, acid base status
Abstract
Background Base excess is a single variable used to quantifymetabolic component of acid base status. Several researches have
combined the traditional base excess method with the Stewart
method for acid base physiology called as Fencl-Stewart method.
Objective The purpose of the study was to compare two different
methods in identifying hyperlactacemia in pediatric patients with
critical illness.
Methods The study was performed on 43 patients admitted to
the pediatric intensive care unit of Cipto Mangunkusumo
Hospital, Jakarta. Sodium, potassium, chloride, albumin, lactate
and arterial blood gases were measured. All samples were taken
from artery of all patients. Lactate level of >2 mEq/L was defined
as abnormal. Standard base excess (SBE) was calculated from
the standard bicarbonate derived from Henderson-Hasselbalch
equation and reported on the blood gas analyzer. Base excess
unmeasured anions (BE UA ) was calculated using the Fencl-Stewart
method simplified by Story (2003). Correlation between lactate
levels in traditional and Fencl-Stewart methods were measured
by Pearson’s correlation coefficient .
Results Elevated lactate levels were found in 24 (55.8%) patients.
Lactate levels was more strongly correlated with BE UA (r = - 0.742,
P<0.01) than with SBE (r = - 0.516, P<0.01).
Conclusion Fencl-Stewart method is better than traditional
method in identifying patients with elevated lactate levels, so the
Fencl-Stewart method is suggested to use in clinical practice.
References
1. Kellum JA. Diagnosis and treatment of acid-base disorders.
In: Grenvik A, Ayres SM, Holbrook PR, Shoemaker WC,
editors. Textbook of critical care. 4th Ed. Philadelphia: WB
Saunders; 2000.p.839-53.
2. McNamara J, Worthley LIG. Acid-Base Balance: Part II.
Pathophysiology. Crit Care Resusc 2001;3:188-201.
3. Ichikawa L, Narins RG, Harris HW. Acid-base disorders. In:
Ichikawa L, Editor. Pediatric Textbook of fluids and electrolytes.
Baltimore: Williams & Wilkins; 1990. p. 187-217.
4. Kellum JA. Determinants of blood pH in health and disease.
Crit Care 2000;4:6-14.
5. Constable PD. Clinical assessment of acid-base status:
comparison of the Henderson-Hasselbalch and strong ion
approaches. Veterin Clin Pathol 2000;29:115-28.
6. Kellum JA. Metabolic acidosis in the critically ill: lessons
from physical chemistry. Kidney Int 1998;53:S81-6.
7. Stewart PA. How to understand acid-base. In: Stewart PA,
editor. A quantitative acid-base primer for biology and
medicine. New York: Elsevier; 1981. p. 1-286.
8. Gilfix BM, Bique M, Magder S. A physical chemical approach
to the analysis of acid-base balance in the clinical setting. J
Crit Care 1993;8:187-97.
9. Figge J, Rossing TH, Fencl V. The role of serum proteins in
acid base equilibria. J Lab Clin Med 1991;117:453-67.
10. Figge J, Mydosh T, Fencl V. Serum proteins and acid base
equilibria: a follow up. J Lab Clin Med 1992; 120:713-9.
11. Balasubramanyan N, Havens PL, Hoffman GM. Unmeasured
anions identified by the Fencl-Stewart method predict
mortality better than base excess, anion gap, and lactate in
patients in the pediatric intensive care unit. Crit Care Med
1999;27:1577-81.
12. Story DA, Morimatsu H, Bellomo R. Strong ions, weak acids
and base excess: a simplified Fencl-Stewart approach to clinical
acid-base disorders. Br J Anaesth 2004;92:54-60.
13. Astrup P, Siggaard-Andersen O, Jorgensen K, Engel K. The acid-
base metabolism. A new approach. Lancet 1960;1:1035-9.
14. Fencl V, Jabor A, Kazda A, Figge J. Diagnosis of metabolic
acid-base disturbances in critically ill patients. Am J Respir Crit
Care Med 2000; 162:2246-51.
15. McAuliffe JJ, Lind LJ, Leith DE, Fencl V. Hypoprotein-emic
alkalosis. Am J Med 1986;81:86-90.
16. Cusack RJ, Rhodes A, Lochhead P, Jordan B, Perry S, Ball
JAS, et al. The strong ion gap does not have prognostic value
in critically ill patients in a mixed medical/surgical adult
ICU. Intensive Care Med 2002;28:864-9.
17. Kellum JA, Bellomo R, Kramer DJ, Pinsky MR. Etiology of
metabolic acidosis during saline resuscitation in endotoxemia.
Shock 1998;9:364-8.
18. Kellum JA. Fluid resuscitation and hyperchloremic acidosis
in experimental sepsis: improved short term survival and
acid base balance with Hextend compared with saline. Crit
Care Med 2002;30:300-5.
19. Hatherill M, Waggie Z, Purves L, Reynolds L, Argent A.
Correction of the anion gap for albumin in order to detect
occult tissue anions in shock. Arch Dis Child 2002;87:526-9.
20. Durward A, Mayer A, Skellett S, Taylor D, Hanna S, Tibby
SM, et al. Hypoalbuminaemia in critically ill children:
incidence, prognosis, and influence on the anion gap. Arch
Dis Child 2003;88:419-22.
21. Wilkes P. Hypoproteinemia, strong ion difference, and acid
base status in critically ill patients. J Appl Physiol 1998;
84:1740-8.
In: Grenvik A, Ayres SM, Holbrook PR, Shoemaker WC,
editors. Textbook of critical care. 4th Ed. Philadelphia: WB
Saunders; 2000.p.839-53.
2. McNamara J, Worthley LIG. Acid-Base Balance: Part II.
Pathophysiology. Crit Care Resusc 2001;3:188-201.
3. Ichikawa L, Narins RG, Harris HW. Acid-base disorders. In:
Ichikawa L, Editor. Pediatric Textbook of fluids and electrolytes.
Baltimore: Williams & Wilkins; 1990. p. 187-217.
4. Kellum JA. Determinants of blood pH in health and disease.
Crit Care 2000;4:6-14.
5. Constable PD. Clinical assessment of acid-base status:
comparison of the Henderson-Hasselbalch and strong ion
approaches. Veterin Clin Pathol 2000;29:115-28.
6. Kellum JA. Metabolic acidosis in the critically ill: lessons
from physical chemistry. Kidney Int 1998;53:S81-6.
7. Stewart PA. How to understand acid-base. In: Stewart PA,
editor. A quantitative acid-base primer for biology and
medicine. New York: Elsevier; 1981. p. 1-286.
8. Gilfix BM, Bique M, Magder S. A physical chemical approach
to the analysis of acid-base balance in the clinical setting. J
Crit Care 1993;8:187-97.
9. Figge J, Rossing TH, Fencl V. The role of serum proteins in
acid base equilibria. J Lab Clin Med 1991;117:453-67.
10. Figge J, Mydosh T, Fencl V. Serum proteins and acid base
equilibria: a follow up. J Lab Clin Med 1992; 120:713-9.
11. Balasubramanyan N, Havens PL, Hoffman GM. Unmeasured
anions identified by the Fencl-Stewart method predict
mortality better than base excess, anion gap, and lactate in
patients in the pediatric intensive care unit. Crit Care Med
1999;27:1577-81.
12. Story DA, Morimatsu H, Bellomo R. Strong ions, weak acids
and base excess: a simplified Fencl-Stewart approach to clinical
acid-base disorders. Br J Anaesth 2004;92:54-60.
13. Astrup P, Siggaard-Andersen O, Jorgensen K, Engel K. The acid-
base metabolism. A new approach. Lancet 1960;1:1035-9.
14. Fencl V, Jabor A, Kazda A, Figge J. Diagnosis of metabolic
acid-base disturbances in critically ill patients. Am J Respir Crit
Care Med 2000; 162:2246-51.
15. McAuliffe JJ, Lind LJ, Leith DE, Fencl V. Hypoprotein-emic
alkalosis. Am J Med 1986;81:86-90.
16. Cusack RJ, Rhodes A, Lochhead P, Jordan B, Perry S, Ball
JAS, et al. The strong ion gap does not have prognostic value
in critically ill patients in a mixed medical/surgical adult
ICU. Intensive Care Med 2002;28:864-9.
17. Kellum JA, Bellomo R, Kramer DJ, Pinsky MR. Etiology of
metabolic acidosis during saline resuscitation in endotoxemia.
Shock 1998;9:364-8.
18. Kellum JA. Fluid resuscitation and hyperchloremic acidosis
in experimental sepsis: improved short term survival and
acid base balance with Hextend compared with saline. Crit
Care Med 2002;30:300-5.
19. Hatherill M, Waggie Z, Purves L, Reynolds L, Argent A.
Correction of the anion gap for albumin in order to detect
occult tissue anions in shock. Arch Dis Child 2002;87:526-9.
20. Durward A, Mayer A, Skellett S, Taylor D, Hanna S, Tibby
SM, et al. Hypoalbuminaemia in critically ill children:
incidence, prognosis, and influence on the anion gap. Arch
Dis Child 2003;88:419-22.
21. Wilkes P. Hypoproteinemia, strong ion difference, and acid
base status in critically ill patients. J Appl Physiol 1998;
84:1740-8.
Published
2007-02-28
How to Cite
1.
Kushartono H, Pudjiadi A, Purwanto S, Chair I, Darwis D, Latief A. Hyperlactacemia in critically ill children: comparison of traditional and Fencl-Stewart methods. PI [Internet]. 28Feb.2007 [cited 22Nov.2024];47(1):35-1. Available from: https://paediatricaindonesiana.org/index.php/paediatrica-indonesiana/article/view/340
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Received 2016-08-25
Accepted 2016-08-25
Published 2007-02-28
Accepted 2016-08-25
Published 2007-02-28
