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Title: Quantitative relationships among plasma lactate, inorganic phosphorus, albumin, unmeasured anions and the anion gap in lactic acidosis.
Austin Authors: Figge, James;Bellomo, Rinaldo ;Egi, Moritoki
Affiliation: School of Medicine, University of Melbourne, Parkville, Victoria, Australia
Department of Intensive Care, Austin Health, Heidelberg, Victoria, Australia
Department of Medicine, Division of Endocrinology, St. Peter's Health Partners, Albany, NY, United States
Department of Anesthesiology, Kobe University Hospital, Kobe City, Hyogo 650-0017, Japan
Issue Date: Apr-2018 2017-10-13
Publication information: Journal of Critical Care 2018; 44: 101-110
Abstract: Quantitative relationships among plasma [Lactate], [Pi], [Albumin], unmeasured anions ([UA]) and the anion gap (AGK) in lactic acidosis (LA) are not well defined. A mathematical model featuring compensatory potassium and chloride shifts and respiratory changes in LA demonstrated: (1) AGK=[Lactate]+Zp×[Pi]+2.4×[Albumin]+constant1+e, where Zp is a function of pH, and e reflects unmeasured anions and cations plus pH-related variations. Eq. (1) can be algebraically rearranged to incorporate the albumin-corrected anion gap, cAGK: (2) cAGK=[Lactate]+Zp×[Pi]+constant2+e. Eq. (1) was tested against 948 data sets from critically ill patients with [Lactate] 4.0mEq/L or greater. AGK and cAGK were evaluated against 12,341 data sets for their ability to detect [Lactate]>4.0mEq/L. Analysis of Eq. (1) revealed r2=0.5950, p<0.001. cAGk>15mEq/L exhibited a sensitivity of 93.0% [95% CI: 91.3-94.5] in detecting [Lactate]>4.0mEq/L, whereas AGK>15mEq/L exhibited a sensitivity of only 70.4% [67.5-73.2]. Additionally, [Lactate]>4.0mEq/L and cAGK>20mEq/L were each strongly associated with intensive care unit mortality (χ2>200, p<0.0001 for each). In LA, cAGK is more sensitive than AGK in predicting [Lactate]>4.0mEq/L.
DOI: 10.1016/j.jcrc.2017.10.007
ORCID: 0000-0002-1650-8939
PubMed URL: 29080515
Type: Journal Article
Appears in Collections:Journal articles

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