A comparison of traditional and quantitative analysis of acid–base imbalances in hypoalbuminemic dogs. (20th August 2014)

• Record Type: Journal Article
• Authors: Torrente, Carlos; Manzanilla, Edgar G.; de Gopegui, Rafael Ruiz
• Is Part Of: Journal of veterinary emergency and critical care. Volume 24:Number 5(2014:Sep./Oct.)
• Page Start: 509
• Page End: 518
• Publication Date: 2014-08-20
• Subjects: Veterinary emergencies -- Periodicals; Veterinary critical care -- Periodicals; 636.089
• DOI: 10.1111/vec.12218
• Languages: English
• ISSNs: 1479-3261

Abstract

<abstract abstract-type="main"> <title>Abstract</title> <sec id="vec12218-sec-0010" sec-type="section"> <title>Objective</title> <p>To compare the traditional (HH) and quantitative approaches used for the evaluation of the acid–base balance in hypoalbuminemic dogs.</p> </sec> <sec id="vec12218-sec-0020" sec-type="section"> <title>Design</title> <p>Prospective observational study.</p> </sec> <sec id="vec12218-sec-0030" sec-type="section"> <title>Setting</title> <p>ICU of a veterinary teaching hospital.</p> </sec> <sec id="vec12218-sec-0040" sec-type="section"> <title>Animals</title> <p>One hundred and five client‐owned dogs.</p> </sec> <sec id="vec12218-sec-0050" sec-type="section"> <title>Measurements and Main Results</title> <p>Jugular venous blood samples were collected from each patient on admission to determine: total plasma protein (TP), albumin (Alb), blood urea nitrogen (BUN), glucose (Glu), hematocrit (HCT), Na<sup>+</sup>, Cl<sup>−</sup>, K<sup>+</sup>, phosphate (P<sub>i</sub>), pH, PvCO<sub>2, </sub> bicarbonate (HCO<sub>3</sub><sup>−</sup>), anion gap (AG), adjusted anion gap for albumin (AG<sub>alb</sub>) or phosphate (AG<sub>alb‐phos</sub>), standardized base excess (SBE), strong ion difference (SID), concentration of nonvolatile weak buffers (A<sub>tot</sub>), and strong ion gap (SIG). Patients were divided in 2 groups according to the severity of the hypoalbuminemia: mild (Alb = 21–25 g/L) and severe (Alb ≤20 g/L). All parameters were compared among groups. Patients with severe hypoalbuminemia showed significant decrease in TP (P = 0.011), A<sub>tot</sub> (P = 0.050), and a significant increase in adjusted AG (<italic>P</italic> = 0.048) and the magnitude of SIG (<italic>P</italic> = 0.011) compared to animals with mild hypoalbuminemia.</p> <p>According to the HH approach, the most frequent imbalances were simple disorders (51.4%), primarily metabolic acidosis (84.7%) associated with a high AG acidosis. However, when using the quantitative method, 58.1% of patients had complex disorders, with SIG acidosis (74.3%) and A<sub>tot</sub> alkalosis (33.3%) as the most frequent acid–base imbalances. Agreement between methods only matched in 32 cases (kappa < 0.20).</p> </sec> <sec id="vec12218-sec-0060" sec-type="section"> <title>Conclusions</title> <p>The agreement between the HH and quantitative methods for interpretation of acid–base balance was poor and many imbalances detected using the quantitative approach were missed using the HH approach. Further studies are necessary to confirm the clinical utility of using the quantitative approach in the decision‐making process of the severely ill hypoalbuminemic patients.</p> </sec> </abstract>