Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học Critical Care giúp cho các bạn có thêm kiến thức về ngành y học đề tài: The nature of unmeasured anions in critically ill patients. | Available online http content 12 2 416 Letter The nature of unmeasured anions in critically ill patients Miriam AM Moviat Peter Pickkers Wim Ruitenbeek and Johannes G van der Hoeven Department of Intensive Care Medicine Radboud University Nijmegen Medical Centre Postbus 9101 6500 HB Nijmegen The Netherlands Corresponding author Miriam AM Moviat moviat@ Published 22 April 2008 This article is online at http content 12 2 416 2008 BioMed Central Ltd Critical Care 2008 12 416 doi cc6855 See related commentary by Venkatesh and Morgan http content 12 1 113 We read with interest the commentary of Venkatesh and Morgan in the February issue of Critical Care 1 in which they discuss the continuing need for clarification of the nature of unmeasured anions in critically ill patients. The questions asked in this commentary arise from the study of Bruegger and colleagues in a previous issue of this journal 2 . The main issue discussed is the ongoing uncertainty about the contribution of intermediates of the tricarboxylic acid TCA cycle to the strong ion gap SIG . As Venkatesh and Morgan accurately point out the extremely high concentrations of acetate and citrate found by Bruegger and colleagues may very well be confounded by the exogenous administration of resuscitation fluids and blood products in the animal model described. In the March issue of Critical Care Medicine we published our study conducted in critically ill patients with a metabolic acidosis with and without an increased SIG representing the absence or presence of unmeasured anions 3 . We explored the presence of and contribution to the SIG of a large variety of compounds largely organic acids and amino acids by use of several laboratory techniques such as ion-exchange column chromatography and gas chromatography. In addition proton nuclear magnetic resonance 1H-NMR spectroscopy was used to quantify intermediates of the TCA cycle. Despite our elaborate attempt
