Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học Critical Care cung cấp cho các bạn kiến thức về ngành y đề tài: Unmeasured anions in metabolic acidosis: unravelling the mystery. | Available online http content 10 4 220 Review Unmeasured anions in metabolic acidosis unravelling the mystery Lui G Forni1 2 William McKinnon3 and Philip J Hilton3 1 Department of Critical Care Worthing Hospital Worthing West Sussex BN11 2DH UK 2Brighton and Sussex Medical School University of Sussex Brighton East Sussex BN1 9PX UK 3Renal Laboratory St Thomas Hospital London SE1 7EH UK Corresponding author Lui G Forni Published 12 July 2006 This article is online at http content 10 4 220 2006 BioMed Central Ltd Critical Care 2006 10 220 doi cc4954 Abstract In the critically ill metabolic acidosis is a common observation and in clinical practice the cause of this derangement is often multifactorial. Various measures are often employed to try and characterise the aetiology of metabolic acidosis the most popular of which is the anion gap. The purpose of the anion gap can be perceived as a means by which the physician is alerted to the presence of unmeasured anions in plasma that contribute to the observed acidosis. In many cases the causative ion may be easily identified such as lactate but often the causative ion s remain unidentified even after exclusion of the classic causes. We describe here the various attempts in the literature that have been made to address this observation and highlight recent studies that reveal potential sources of such hitherto unmeasured anions. Introduction Metabolic acidosis remains a common problem in acute medicine and is frequently encountered on the intensive care unit ICU 1-3 . Although many classic causes of metabolic acidosis are known including diabetic ketoacidosis lactic acidosis and the ingestion of acid-generating poisons the origin is often multifactorial and indeed often cannot be ascribed solely to such classic causes or a single causative anion. In such cases the source of the acidosis remains unidentified or unmeasured. For example given that hydroxybutyrate is seldom
