Descripción del estado acido base en pacientes con quemaduras térmicas agudas: serie de casos

Abstract

Introduction: Patients with acute thermal injuries have physiological disorders that make difficult characterizing their acid-base status and identifying factors of poor prognosis. Studies with non-conclusive results have being done on base deficit (BD) and a serum lactate. Due to the complexity of the pathophysiological characteristics that define burn patients; the physic-chemical analysis of the acid-base status may hypothetically provide a higher accuracy in detecting metabolic and perfusion disturbances as well as in predicting bad outcomes than the other methods.

Methodology: We performed the acid-base analysis of 15 patients older than 15 years-old, with a burned body surface area greater than 20% that were admitted to a burn intensive care unit within 48 hours after the injury. The analysis was performed by using three methods: 1) Conventional method based on Henderson-Hasselbalch’s theory, 2) Anion-Gap (AG),and albumin-corrected AG, and 3) Physic-chemical approach of Stewart’s acid-base state theory.

Results: After using the Henderson-Haselbach’s method: 8 patients had metabolic acidosis, 4 patients had a low BD, 5 patients had medium BD, and 5 patients had severe BD elevations. When AG analysis was performed, only 5 patients showed an abnormal AG. In contrast, implementing the albumin-corrected AG it increased the number of patients with abnormal AG to 13 patients. Strong-ion difference was abnormally elevated in all the patients.

Conclusions:A higher agreement between abnormal acid-base statuses was observed when using the albumin-corrected AG method and Physic-chemical approach of Stewart’s acid-base state theory.