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Perioperative metabolic alkalemia is more frequent than metabolic acidemia in major elective abdominal surgery

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Abstract

Objective

To investigate the incidence, type and etiology of perioperative metabolic disturbances associated with major abdominal surgery. We hypothesized that metabolic alkalemia is more frequent than metabolic acidemia.

Methods

This was a prospective, observational study, performed in a university-affiliated hospital. 98 consecutive patients undergoing major abdominal surgery were included in the study. Patients were observed by serial vital signs and laboratory measurements during the preoperative, intraoperative, PACU and the first three postoperative day periods. Central venous pressure, systolic pressure variation, fluid input, urine output, temper- ature, electrolytes, and acid–base variables were recorded. The primary endpoint of the study was the incidence of metabolic alkalemia or acidemia. Metabolic alkalemia was defined as pH >7.45 and BE >+3. Metabolic acidemia was defined as pH <7.35 and BE <−3. Continuous variables were described as mean ± standard deviation. Distributions of continuous variables was assessed for normalty using the Kolmogorov–Smirnov test (cut off at P = 0.01). The frequency of metabolic acidemia or alkalemia was compared across time points using Cochran’s Q test and between time points using the binomial distribution.

Results

Metabolic acidemia occurred only intraoperatively and in the PACU. Subjects with metabolic acidemia were older, (74 ± 9 yr. vs. 66 ± 12, P = 0.01). Intraoperative body temperature was inversely associated with PACU lactate (P = 0.035). Blood loss >500 mL was more frequent in acidemic patients (42% vs. 19%, P = 0.033). More patients with hyperphosphatemia had acidemia than subjects without hyperphosphatemia (39% vs. 17%, P = 0.019). Metabolic alkalemia occurred more frequently than metabolic acidemia (49% vs. 23%, P < 0.0001) and was correlated with hypochloremia. The incidence of metabolic alkalemia decreased from baseline to intraoperative and PACU periods (13% vs. 3%, P = 0.003) and increased from the PACU to the three postoperative days (3% vs. 45%, P = 0.007).

Conclusions

Metabolic alkalemia occurred more frequently than metabolic acidemia and occurred mainly preoperatively and postoperatively, while acidemia occurred mainly during surgery and in the PACU.

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References

  1. Tan HL, Liew QY, Loo S, Hawkins R. Severe hyperphosphataemia and associated electrolyte and metabolic derangement following the administration of sodium phosphate for bowel preparation. Anaesthesia. 2002;57:478–83.

    Article  PubMed  CAS  Google Scholar 

  2. Waters JH, Miller LR, Clack S, Kim JV. Cause of metabolic acidemia in prolonged surgery. Crit Care Med. 1999;27:2142–6.

    Article  PubMed  CAS  Google Scholar 

  3. Okusawa S, Aikawa N, Abe O. Postoperative metabolic alkalemia following general surgery: its incidence and possible etiology. Jpn J Surg. 1989;19:312–8.

    Article  PubMed  CAS  Google Scholar 

  4. Marko P, Gabrielli A, Caruso LJ. Too much lactate or too little liver? J Clin Anesth. 2004;16:389–95.

    Article  PubMed  Google Scholar 

  5. Bastian PJ, Albers P, Haferkamp A, Schumacher S, Muller SC. Modified ureterosigmoidostomy (Mainz Pouch II) in different age groups and with different techniques of ureteric implantation. BJU Int. 2004;94:345–9.

    Article  PubMed  Google Scholar 

  6. Aker J, O’Sullivan C. The selection and administration of perioperative intravenous fluids for the pediatric patient. J Perianesth Nurs. 1998;13:172–81.

    Article  PubMed  CAS  Google Scholar 

  7. Jones D, Baldwin I, Bellomo R. A technique for the determination of systolic pressure variation in the systemic and pulmonary arterial circulations. Crit Care Resusc. 2004;6:204–8.

    PubMed  CAS  Google Scholar 

  8. Marino PL. Acid-base interpretations. In: Marino PL, editor. The ICU book 3rd ed. Philadelphia: Lippincott !illiams & Wilkins; 2007. p. 540, 568.

  9. Durbin CG. Arterial blood gas analysis and monitoring. In: Lake LC, Hines RL, Blitt CD, editors. Clinical monitoring. Philadelphia: W.B.Saunders Comp; 2001. p. 347.

  10. Klein S, Sakurai Y, Romijn JA, Carroll RM. Progressive alterations in lipid and glucose metabolism during short-term fasting in young adult men. Am J Physiol. 1998;265:E801–6.

    Google Scholar 

  11. Maekawa N, Mikawa K, Yaku H, Nishina K, Obara H. Effects of 2-, 4- and 12-hour fasting intervals on preoperative gastric fluid pH and volume, and plasma glucose and lipid homeostasis in children. Acta Anaesthesiol Scand. 1993;37:783–7.

    Article  PubMed  CAS  Google Scholar 

  12. Chambrier C, Aouifi A, Bon C, Saudin F, Paturel B, Bouletreau P. Effects of intraoperative glucose administration on circulating metabolites and nitrogen balance during prolonged surgery. J Clin Anesth. 1999;11:646–51.

    Article  PubMed  CAS  Google Scholar 

  13. Schricker T, Carli F, Lattermann R, Wachter U, Georgieff M. Glucose infusion does not suppress increased lipolysis after abdominal surgery. Nutrition. 2001;17:85–90.

    Article  PubMed  CAS  Google Scholar 

  14. Freeman BD. Fluid and electrolyte abnormalities. In: Mulholland MW, Doherty GM, editors. Complications in surgery. Philadelphia: Lippincott Williams & Wilkins; 2006. p. 148.

  15. Morgan TJ. The meaning of acid-base abnormalities in the intensive care unit: part III–effects of fluid administration. Crit Care. 2005;9:204–11.

    Article  PubMed  Google Scholar 

  16. Chappell D, Jacob M, Hofmann-Kiefer K, Conzen P, Rehm M. A rational approach to perioperative fluid management. Anesthesiology. 2008;109:723–40.

    Article  PubMed  Google Scholar 

  17. Beloosesky Y, Grinblat J, Weiss A, Grosman B, Gafter U, Chagnac A. Electrolyte disorders following oral sodium phosphate administration for bowel cleansing in elderly patients. Arch Intern Med. 2003;163:803–8.

    Article  PubMed  Google Scholar 

  18. Amlal H, Wang Z, Soleimani M. Potassium depletion downregulates chloride-absorbing transporters in rat kidney. J Clin Invest. 1998;101:1045–54.

    Article  PubMed  CAS  Google Scholar 

  19. McAuliffe JJ, Lind L, Leith DE, Fencl V. Hypoproteinemic alkalemia. Am J Med. 1986;81:86–90.

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Epidemiology and Research Unit, The Edith Wolfson Medical Center, Holon, Israel

    Mona Boaz PhD

  2. Departments of Surgery B, The Edith Wolfson Medical Center, Holon, Israel

    Arkady Iskhakov MD & Michael Muggia MD

  3. Departments of Urology, The Edith Wolfson Medical Center, Holon, Israel

    Alexander Tsivian MD

  4. Departments of Surgery A, The Edith Wolfson Medical Center, Holon, Israel

    Mordechai Shimonov MD

  5. Department of Anesthesiology, The Chaim Sheba Medical Center, Tel Hashomer, Sackler Medical School, Tel Aviv University, Tel Aviv, Israel

    Haim Berkenstadt MD

  6. Department of Anesthesiology, Rebecca Sief Medical Center, Safed, Israel

    Alexander Izakson MD

  7. Department of Anesthesiology, University of Texas Southwestern, and Children’s Medical Center, Dallas, TX, USA

    Peter Szmuk MD

  8. Departments of Anesthesia, The Edith Wolfson Medical Center, 58100, Holon, Israel

    Shmuel Evron MD & Tiberiu Ezri MD

  9. Outcomes Research Consortium, Cleveland, OH, USA

    Peter Szmuk MD, Shmuel Evron MD & Tiberiu Ezri MD

Authors
  1. Mona Boaz PhD
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  2. Arkady Iskhakov MD
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  3. Alexander Tsivian MD
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  4. Mordechai Shimonov MD
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  5. Haim Berkenstadt MD
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  6. Alexander Izakson MD
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  7. Peter Szmuk MD
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  8. Shmuel Evron MD
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  9. Michael Muggia MD
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  10. Tiberiu Ezri MD
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Corresponding author

Correspondence to Tiberiu Ezri MD.

Additional information

Boaz M, Iskhakov A, Tsivian A, Shimonov M, Berkenstadt H, Izakson A, Szmuk P, Evron S, Muggia M, Ezri T. Perioperative metabolic alkalemia is more frequent than metabolic acidemia in major elective abdominal surgery.

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Boaz, M., Iskhakov, A., Tsivian, A. et al. Perioperative metabolic alkalemia is more frequent than metabolic acidemia in major elective abdominal surgery. J Clin Monit Comput 25, 223–230 (2011). https://doi.org/10.1007/s10877-011-9299-8

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  • DOI: https://doi.org/10.1007/s10877-011-9299-8

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