Causes of metabolic acidosis in canine hemorrhagic shock: role of unmeasured ions

INTRODUCTION: Metabolic acidosis during hemorrhagic shock is common and conventionally considered to be due to hyperlactatemia. There is increasing awareness, however, that other nonlactate, unmeasured anions contribute 
INTRODUCTION: Metabolic acidosis during hemorrhagic shock is common and conventionally considered to be due to hyperlactatemia. There is increasing awareness, however, that other nonlactate, unmeasured anions contribute to this type of acidosis.

METHODS: Eleven anesthetized dogs were hemorrhaged to a mean arterial pressure of 45 mm Hg and were kept at this level until a metabolic oxygen debt of 120 mLO2/kg body weight had evolved. Blood pH, partial pressure of carbon dioxide, and concentrations of sodium, potassium, magnesium, calcium, chloride, lactate, albumin, and phosphate were measured at baseline, in shock, and during 3 hours post-therapy. Strong ion difference and the amount of weak plasma acid were calculated. To detect the presence of unmeasured anions, anion gap and strong ion gap were determined. Capillary electrophoresis was used to identify potential contributors to unmeasured anions.

RESULTS: During induction of shock, pH decreased significantly from 7.41 to 7.19. The transient increase in lactate concentration from 1.5 to 5.5 mEq/L during shock was not sufficient to explain the transient increases in anion gap (+11.0 mEq/L) and strong ion gap (+7.1 mEq/L), suggesting that substantial amounts of unmeasured anions must have been generated. Capillary electrophoresis revealed increases in serum concentration of acetate (2.2 mEq/L), citrate (2.2 mEq/L), alpha-ketoglutarate (35.3 microEq/L), fumarate (6.2 microEq/L), sulfate (0.1 mEq/L), and urate (55.9 microEq/L) after shock induction.

CONCLUSION: Large amounts of unmeasured anions were generated after hemorrhage in this highly standardized model of hemorrhagic shock. Capillary electrophoresis suggested that the hitherto unmeasured anions citrate and acetate, but not sulfate, contributed significantly to the changes in strong ion gap associated with induction of shock.
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Author:Dirk Steffen Brügger, Gregor I. Kemming, Matthias Jacob, Franz Georg Meisner, Christoph J. Wojtczyk, Kristian Packert, Peter E. Keipert, N Simon Faithfull, Oliver Habler, Bernhard F. Becker, Markus Rehm
URN:urn:nbn:de:hebis:30:3-267914
DOI:http://dx.doi.org/10.1186/cc6200
ISSN:1875-7081
ISSN:1574-4280
Pubmed Id:http://www.ncbi.nlm.nih.gov/pubmed?term=18081930
Parent Title (English):Critical care
Publisher:Bohn Stafleu Van Loghum
Place of publication:Houten
Document Type:Article
Language:English
Date of Publication (online):2007/12/14
Date of first Publication:2007/12/14
Publishing Institution:Univ.-Bibliothek Frankfurt am Main
Release Date:2012/10/17
Volume:11
Issue:R130
Pagenumber:14
First Page:1
Last Page:14
Note:
© 2007 Bruegger et al.; licensee BioMed Central Ltd. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 
Institutes:Medizin
Dewey Decimal Classification:610 Medizin und Gesundheit
Sammlungen:Universitätspublikationen
Licence (German):License LogoCreative Commons - Namensnennung 2.0

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