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

Mona Boaz, Arkady Iskhakov, Alexander Tsivian, Mordechai Shimonov, Haim Berkenstadt, Alexander Izakson, Peter Szmuk, Shmuel Evron, Michael Muggia, Tiberiu Ezri

Research output: Contribution to journalArticle

3 Citations (Scopus)

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. Patientswere 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, temperature, 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.

Original languageEnglish (US)
Pages (from-to)223-230
Number of pages8
JournalJournal of Clinical Monitoring and Computing
Volume25
Issue number4
DOIs
StatePublished - Aug 2011

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Hyperphosphatemia
Intraoperative Period
Central Venous Pressure
Vital Signs
Incidence
Postoperative Period
Electrolytes
Observational Studies
Cohort Studies
Urine
Prospective Studies
Blood Pressure
Temperature
Acids

Keywords

  • Metabolic acidemia
  • Metabolic alkalemia
  • Perioperative

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine
  • Critical Care and Intensive Care Medicine
  • Health Informatics

Cite this

Perioperative metabolic alkalemia is more frequent than metabolic acidemia in major elective abdominal surgery. / Boaz, Mona; Iskhakov, Arkady; Tsivian, Alexander; Shimonov, Mordechai; Berkenstadt, Haim; Izakson, Alexander; Szmuk, Peter; Evron, Shmuel; Muggia, Michael; Ezri, Tiberiu.

In: Journal of Clinical Monitoring and Computing, Vol. 25, No. 4, 08.2011, p. 223-230.

Research output: Contribution to journalArticle

Boaz, M, Iskhakov, A, Tsivian, A, Shimonov, M, Berkenstadt, H, Izakson, A, Szmuk, P, Evron, S, Muggia, M & Ezri, T 2011, 'Perioperative metabolic alkalemia is more frequent than metabolic acidemia in major elective abdominal surgery', Journal of Clinical Monitoring and Computing, vol. 25, no. 4, pp. 223-230. https://doi.org/10.1007/s10877-011-9299-8
Boaz, Mona ; Iskhakov, Arkady ; Tsivian, Alexander ; Shimonov, Mordechai ; Berkenstadt, Haim ; Izakson, Alexander ; Szmuk, Peter ; Evron, Shmuel ; Muggia, Michael ; Ezri, Tiberiu. / Perioperative metabolic alkalemia is more frequent than metabolic acidemia in major elective abdominal surgery. In: Journal of Clinical Monitoring and Computing. 2011 ; Vol. 25, No. 4. pp. 223-230.
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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. Patientswere 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, temperature, 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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AU - Boaz, Mona

AU - Iskhakov, Arkady

AU - Tsivian, Alexander

AU - Shimonov, Mordechai

AU - Berkenstadt, Haim

AU - Izakson, Alexander

AU - Szmuk, Peter

AU - Evron, Shmuel

AU - Muggia, Michael

AU - Ezri, Tiberiu

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N2 - 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. Patientswere 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, temperature, 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.

AB - 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. Patientswere 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, temperature, 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.

KW - Metabolic acidemia

KW - Metabolic alkalemia

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