Junaid Mahmood Alam, Jawaid Altaf Baig, Rabia Shaheen, Aijaz Ahmed, Syed Riaz Mahmood, Saud Naheed, Ishrat Sultana, Siddiqua Jamall.
Assessment of Hyperlactatemia and Acidosis in Patients with Cardiac Dysfunctions.
Baqai J Health Sci Jan ;11(2):29-34.

Background: It has been postulated that hyperlactatemia is not the only cause of acidosis in cardiac dysfunction and there are other factors such as un-measured anions also that significantly participate in its development. Aim: The present study is designed to determine different components of metabolic acidosis in cardiac dysfunctions and cardiac arrest patients in order to assess the degree to which lactate is responsible for the acidosis. Methods and Materials: Forty two patients with out-of-hospital cardiac dysfunctions and cardiac arrest, admitted to the hospital were included in present study. All arterial blood gases and plasma biochemical parameters were estimated by standard methods on automated analyzers. Modified [by Figge and colleagues] form of Stewart's quantitative biophysical methods including formula for apparent strong ion difference “SIDa” and strong ionic gap “SIG” were used to evaluate un-measured and measured ions. Results: The mean age of patients were 57.2 years and included 33 (78.6%) males and 9 (21.4%) females. Except for sodium, ionized calcium and SIDa, all variables were significantly different between the two groups. Patients with cardiac dysfunctions and arrest were also hyperkalemic, hypochloremic and hyperlactatemic. The anion gap and SIG were also higher in patients with cardiac arrest. Lactate was the strongest determinant of acidemia. Conclusion: It was concluded that lactate accounts for only less than 50% of the metabolic acidosis and consequent acidemia seen in such patients and that an increase in unmeasured anions and phosphate also accounts for major portion of acidemia.

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