Please use this identifier to cite or link to this item: https://ahro.austin.org.au/austinjspui/handle/1/9714
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dc.contributor.authorNaka, Toshioen
dc.contributor.authorBellomo, Rinaldoen
dc.date.accessioned2015-05-15T22:54:34Z
dc.date.available2015-05-15T22:54:34Z
dc.date.issued2004-02-17en
dc.identifier.citationCritical Care 2004; 8(2): 108-14en
dc.identifier.govdoc15025771en
dc.identifier.otherPUBMEDen
dc.identifier.urihttps://ahro.austin.org.au/austinjspui/handle/1/9714en
dc.description.abstractAcid-base disorders are common in critically ill patients. Metabolic acid-base disorders are particularly common in patients who require acute renal replacement therapy. In these patients, metabolic acidosis is common and multifactorial in origin. Analysis of acid-base status using the Stewart-Figge methodology shows that these patients have greater acidemia despite the presence of hypoalbuminemic alkalosis. This acidemia is mostly secondary to hyperphosphatemia, hyperlactatemia, and the accumulation of unmeasured anions. Once continuous hemofiltration is started, profound changes in acid-base status are rapidly achieved. They result in the progressive resolution of acidemia and acidosis, with a lowering of concentrations of phosphate and unmeasured anions. However, if lactate-based dialysate or replacement fluid are used, then in some patients hyperlactatemia results, which decreases the strong ion difference and induces an iatrogenic metabolic acidosis. Such hyperlactatemic acidosis is particularly marked in lactate-intolerant patients (shock with lactic acidosis and/or liver disease) and is particularly strong if high-volume hemofiltration is performed with the associated high lactate load, which overcomes the patient's metabolic capacity for lactate. In such patients, bicarbonate dialysis seems desirable. In all patients, once hemofiltration is established, it becomes the dominant force in controlling metabolic acid-base status and, in stable patients, it typically results in a degree of metabolic alkalosis. The nature and extent of these acid-base changes is governed by the intensity of plasma water exchange/dialysis and by the 'buffer' content of the replacement fluid/dialysate, with different effects depending on whether lactate, acetate, citrate, or bicarbonate is used. These effects can be achieved in any patient irrespective of whether they have acute renal failure, because of the overwhelming effect of plasma water exchange on nonvolatile acid balance. Critical care physicians must understand the nature, origin, and magnitude of alterations in acid-base status seen with acute renal failure and during continuous hemofiltration if they wish to provide their patients with safe and effective care.en
dc.language.isoenen
dc.subject.otherAcetatesen
dc.subject.otherAcid-Base Imbalance.diagnosis.physiopathology.therapyen
dc.subject.otherBicarbonatesen
dc.subject.otherCritical Care.methodsen
dc.subject.otherCritical Illness.therapyen
dc.subject.otherHemofiltrationen
dc.subject.otherHumansen
dc.subject.otherIntensive Care Unitsen
dc.subject.otherLactatesen
dc.subject.otherRenal Replacement Therapyen
dc.titleBench-to-bedside review: treating acid-base abnormalities in the intensive care unit--the role of renal replacement therapy.en
dc.typeJournal Articleen
dc.identifier.journaltitleCritical Careen
dc.identifier.affiliationDepartment of Intensive Care, Austin Hospital, Heidelberg, Victoria, Australiaen
dc.identifier.doi10.1186/cc2821en
dc.description.pages108-14en
dc.relation.urlhttps://pubmed.ncbi.nlm.nih.gov/15025771en
dc.type.austinJournal Articleen
local.name.researcherBellomo, Rinaldo
item.openairetypeJournal Article-
item.openairecristypehttp://purl.org/coar/resource_type/c_18cf-
item.grantfulltextopen-
item.fulltextWith Fulltext-
item.cerifentitytypePublications-
item.languageiso639-1en-
crisitem.author.deptIntensive Care-
crisitem.author.deptData Analytics Research and Evaluation (DARE) Centre-
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