Institutional members access full text with Ovid®

Share this article on:

Metabolic acidosis in patients with severe sepsis and septic shock: A longitudinal quantitative study

Noritomi, Danilo T. MD, PhD; Soriano, Francisco G. MD, PhD; Kellum, John A. MD, PhD; Cappi, Sylas B. MD; Biselli, Paolo J. C. MD, PhD; Libório, Alexandre B. MD, PhD; Park, Marcelo MD, PhD

doi: 10.1097/CCM.0b013e3181a59165
Clinical Investigations

Objective: To describe the composition of metabolic acidosis in patients with severe sepsis and septic shock at intensive care unit admission and throughout the first 5 days of intensive care unit stay.

Design: Prospective, observational study.

Setting: Twelve-bed intensive care unit.

Patients: Sixty patients with either severe sepsis or septic shock.

Interventions: None.

Measurements and Main Results: Data were collected until 5 days after intensive care unit admission. We studied the contribution of inorganic ion difference, lactate, albumin, phosphate, and strong ion gap to metabolic acidosis. At admission, standard base excess was −6.69 ± 4.19 mEq/L in survivors vs. −11.63 ± 4.87 mEq/L in nonsurvivors (p < .05); inorganic ion difference (mainly resulting from hyperchloremia) was responsible for a decrease in standard base excess by 5.64 ± 4.96 mEq/L in survivors vs. 8.94 ± 7.06 mEq/L in nonsurvivors (p < .05); strong ion gap was responsible for a decrease in standard base excess by 4.07 ± 3.57 mEq/L in survivors vs. 4.92 ± 5.55 mEq/L in nonsurvivors with a nonsignificant probability value; and lactate was responsible for a decrease in standard base excess to 1.34 ± 2.07 mEq/L in survivors vs. 1.61 ± 2.25 mEq/L in nonsurvivors with a nonsignificant probability value. Albumin had an important alkalinizing effect in both groups; phosphate had a minimal acid-base effect. Acidosis in survivors was corrected during the study period as a result of a decrease in lactate and strong ion gap levels, whereas nonsurvivors did not correct their metabolic acidosis. In addition to Acute Physiology and Chronic Health Evaluation II score and serum creatinine level, inorganic ion difference acidosis magnitude at intensive care unit admission was independently associated with a worse outcome.

Conclusions: Patients with severe sepsis and septic shock exhibit a complex metabolic acidosis at intensive care unit admission, caused predominantly by hyperchloremic acidosis, which was more pronounced in nonsurvivors. Acidosis resolution in survivors was attributable to a decrease in strong ion gap and lactate levels.

From the Intensive Care Unit (DTN, FGS, PJCB), Hospital Universitario, University of Sao Paulo, Sao Paulo, Brazil; Intensive Care Unit (SBC, MP), Hospital das Clinicas, University of Sao Paulo Medical School, Sao Paulo, Brazil; Department of Internal Medicine (ABL), University of Fortaleza, Ceara, Brazil; and Department of Critical Care Medicine (JAK), University of Pittsburgh, Pittsburgh, PA.

The study was conducted in the ICU of Hospital Universitario of the University of Sao Paulo in Brazil.

The authors have not disclosed any potential conflicts of interest.

For information regarding this article, E-mail: dnoritomi@hotmail.com

© 2009 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins