Please use this identifier to cite or link to this item: https://ahro.austin.org.au/austinjspui/handle/1/9473
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dc.contributor.authorRocktäschel, Jen
dc.contributor.authorMorimatsu, Hiroshien
dc.contributor.authorUchino, Shigehikoen
dc.contributor.authorRonco, Claudioen
dc.contributor.authorBellomo, Rinaldoen
dc.date.accessioned2015-05-15T22:34:53Z
dc.date.available2015-05-15T22:34:53Z
dc.date.issued2003-01-01en
dc.identifier.citationThe International Journal of Artificial Organs; 26(1): 19-25en
dc.identifier.govdoc12602465en
dc.identifier.otherPUBMEDen
dc.identifier.urihttps://ahro.austin.org.au/austinjspui/handle/1/9473en
dc.description.abstractContinuous veno-venous hemofiltration (CVVH) appears to have a significant and variable impact on acid-base balance. However, the pathogenesis of these acid-base effects remains poorly understood. The aim of this study was to understand the nature of acid-base changes in critically ill patients with acute renal failure during continuous veno-venous hemofiltration by applying quantitative methods of biophysical analysis (Stewart-Figge methodology).We studied forty patients with ARF receiving CVVH in the intensive care unit. We retrieved the biochemical data from computerized records and conducted quantitative biophysical analysis. We measured serum Na+, K+, Mg2+, Cl-, HCO3-, phosphate, ionized Ca2+, albumin, lactate and arterial blood gases and calculated the following Stewart-Figge variables: Strong Ion Difference apparent (SIDa), Strong Ion Difference Effective (SIDe) and Strong Ion Gap (SIG).Before treatment, patients had mild acidemia (pH: 7.31) secondary to metabolic acidosis (bicarbonate: 19.8 mmol/L and base excess: -5.9 mEq/L). This acidosis was due to increased unmeasured anions (SIG: 12.3 mEq/L), hyperphosphatemia (1.86 mmol/L) and hyperlactatemia (2.08 mmol/L). It was attenuated by the alkalinizing effect of hypoalbuminemia (22.5 g/L). After commencing CVVH, the acidemia was corrected within 24 hours (pH 7.31 vs 7.41, p<0.0001). This correction was associated with a decreased strong ion gap (SIG) (12.3 vs. 8.8 mEq/L, p<0.0001), phosphate concentration (1.86 vs. 1.49 mmol/L, p<0.0001) and serum chloride concentration (102 vs. 98.5 mmol/L, p<0.0001). After 3 days of CVVH, however, patients developed alkalemia (pH: 7.46) secondary to metabolic alkalosis (bicarbonate: 29.8 mmol/L, base excess: 6.7 mEq/L). This alkalemia appeared secondary to a further decrease in SIG to 6.7 mEq/L (p<0.0001) and a further decrease in serum phosphate to 0.77 mmol/L (p<0.0001) in the setting of persistent hypoalbuminemia (21.0 g/L; p=0.56).CVVH corrects metabolic acidosis in acute renal failure patients through its effect on unmeasured anions, phosphate and chloride. Such correction coupled with the effect of hypoalbuminemia, results in the development of a metabolic alkalosis after 72 hours of treatment.en
dc.language.isoenen
dc.subject.otherAcid-Base Equilibriumen
dc.subject.otherAcute Kidney Injury.blood.mortality.therapyen
dc.subject.otherAdulten
dc.subject.otherAgeden
dc.subject.otherCritical Illnessen
dc.subject.otherFemaleen
dc.subject.otherHemofiltration.adverse effects.methodsen
dc.subject.otherHumansen
dc.subject.otherHydrogen-Ion Concentrationen
dc.subject.otherLactic Acid.blooden
dc.subject.otherMaleen
dc.subject.otherMiddle Ageden
dc.subject.otherPotassium.blooden
dc.subject.otherSodium.blooden
dc.subject.otherTreatment Outcomeen
dc.titleImpact of continuous veno-venous hemofiltration on acid-base balance.en
dc.typeJournal Articleen
dc.identifier.journaltitleInternational Journal of Artificial Organsen
dc.identifier.affiliationDepartment of Intensive Care, University of Melbourne, Austin and Repatriation Medical Centre, Melbourne, Australiaen
dc.description.pages19-25en
dc.relation.urlhttps://pubmed.ncbi.nlm.nih.gov/12602465en
dc.type.austinJournal Articleen
local.name.researcherBellomo, Rinaldo
item.openairecristypehttp://purl.org/coar/resource_type/c_18cf-
item.cerifentitytypePublications-
item.fulltextNo Fulltext-
item.grantfulltextnone-
item.languageiso639-1en-
item.openairetypeJournal Article-
crisitem.author.deptIntensive Care-
crisitem.author.deptData Analytics Research and Evaluation (DARE) Centre-
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