Zusammenfassung
Hintergrund
Mit weitgehender Akzeptanz des Stewart-Säure-Basen-Modells wird die „hyperchlorämische Acidose“ als definierte Störung des Säure-Basen-Haushalts betrachtet. Nicht bekannt ist, ob der Hypernatriämie eine gegenläufige Rolle bei der Entwicklung von Alkalosen zukommt.
Material und Methoden
Bei 201 Intensivpatienten wurde nach hypernatriämischen Episoden gesucht. Einschlusskriterium war eine Serum-Natrium-Konzentration ([Na+])von mehr als 145 mmol/l.
Ergebnisse
Bei 20 Patienten fand sich an 78 Tagen zumindest einmal eine Serum-Na+-Konzentration >145 mmol/l. In 86% dieser Episoden war die Serum-Chorid-Konzentration ([Cl−]) ebenfalls erhöht. Die Entwicklung einer Alkalose korrelierte mit der „strong ion difference“ (r=0,80, p<0,01), nicht jedoch mit der Na+-Konzentration (r=−0,031, p=0,78). Fehlte die begleitende Hyperchlorämie (13%), kam es regelmäßig zur Entwicklung einer Alkalose, und eine Korrelation zwischen dem Na+-Spiegel und dem „base excess“ war nachweisbar (r=0,66, p=0,03). Betrug die Strong ion difference mehr als 39 mmol/l, fand sich in 84% der Fälle eine Alkalose.
Schlussfolgerung
Eine „hypernatriämische Alkalose“ als eigenständige metabolische Erkrankung lässt sich aus den hier vorgestellten Daten nicht ableiten. Sinnvoller scheint es, diese Form der Alkalose unter dem Oberbegriff der „strong ion alkalosis“ zu subsumieren.
Abstract
Background
With broad acceptance of Stewart’s acid-base model “hyperchloremic acidosis” is regarded as an independent form of metabolic disorder. It is unknown whether hypernatremia plays a corresponding role with respect to the development of alkalosis.
Methods
A total of 201 artificially ventilated, critically ill patients were monitored for hypernatremic episodes. Inclusion criterion was a serum sodium concentration above 145 mmol/l.
Results
In 20 patients a total of 78 periods of elevated plasma sodium levels lasting at least 24 h were observed. In 86% of these cases sodium and chloride concentrations were simultaneously increased. The development of alkalosis correlated with the strong ion difference (r=0.80, p<0.01) but not with the serum sodium concentration (r=−0.031, p=0.78). In cases without accompanying hyperchloremia (13%) metabolic alkalosis regularly occurred and a correlation between serum sodium concentration and base excess could be verified (r=0.66, p=0.03). Alkalosis occurred in 84.8% of cases where the strong on difference exceeded 39 mmol/l.
Conclusion
From the available data hypernatremic alkalosis could not be defined as an independent metabolic disorder. In would seem more appropriate to use the term “strong ion alkalosis” in this context.
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Danksagung
Diese Studie wurde aus Mitteln finanziert, die das Bayerische Ministerium für Forschung und Wissenschaft zur Verfügung stellte.
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Dr. K. Hofmann-Kiefer und Dr. Daniel Chappell haben zu gleichen Teilen zur Erstellung der vorgelegten Publikation beigetragen.
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Hofmann-Kiefer, K., Chappell, D., Jacob, M. et al. Hypernatriämische Alkalose. Anaesthesist 58, 1210–1215 (2009). https://doi.org/10.1007/s00101-009-1640-y
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DOI: https://doi.org/10.1007/s00101-009-1640-y