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Critical Care
Published in: Critical Care 1/2015

Open Access 01-12-2015 | Research

Renal tubular acidosis is highly prevalent in critically ill patients

Authors: Richard Brunner, Andreas Drolz, Thomas-Matthias Scherzer, Katharina Staufer, Valentin Fuhrmann, Christian Zauner, Ulrike Holzinger, Bruno Schneeweiß

Published in: Critical Care | Issue 1/2015

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Abstract

Introduction

Hyperchloremic acidosis is frequent in critically ill patients. Renal tubular acidosis (RTA) may contribute to acidemia in the state of hyperchloremic acidosis, but the prevalence of RTA has never been studied in critically ill patients. Therefore, we aimed to investigate the prevalence, type, and possible risk factors of RTA in critically ill patients using a physical-chemical approach.

Methods

This prospective, observational trial was conducted in a medical ICU of a university hospital. One hundred consecutive critically ill patients at the age ≥18, expected to stay in the ICU for ≥24 h, with the clinical necessity for a urinary catheter and the absence of anuria were included.
Base excess (BE) subset calculation based on a physical-chemical approach on the first 7 days after ICU admission was used to compare the effects of free water, chloride, albumin, and unmeasured anions on the standard base excess. Calculation of the urine osmolal gap (UOG) - as an approximate measure of the unmeasured urine cation NH4 + - served as determinate between renal and extrarenal bicarbonate loss in the state of hyperchloremic acidosis.

Results

During the first week of ICU stay 43 of the patients presented with hyperchloremic acidosis on one or more days represented as pronounced negative BEChloride. In 31 patients hyperchloremic acidosis was associated with RTA characterized by a UOG ≤150 mosmol/kg in combination with preserved renal function. However, in 26 of the 31 patients with RTA metabolic acidosis was neutralized by other acid-base disturbances leading to a normal arterial pH.

Conclusions

RTA is highly prevalent in critically ill patients with hyperchloremic acidosis, whereas it is often neutralized by the simultaneous occurrence of other acid-base disturbances.

Trial registration

Clinicaltrials.gov NCT02392091. Registered 17 March 2015
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Metadata
Title
Renal tubular acidosis is highly prevalent in critically ill patients
Authors
Richard Brunner
Andreas Drolz
Thomas-Matthias Scherzer
Katharina Staufer
Valentin Fuhrmann
Christian Zauner
Ulrike Holzinger
Bruno Schneeweiß
Publication date
01-12-2015
Publisher
BioMed Central
Published in
Critical Care / Issue 1/2015
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/s13054-015-0890-0

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