Successful Outcomes of Critically Ill Patients with Extreme Metabolic Acidosis Treated with Structured Approach: Case Series
Introduction: Hydrogen ion concentration which is expressed as pH value is in human blood maintained in narrow physiological range (7.36-7.44 in arterial blood). This range is crucial for normal functioning of most biochemical reactions. Extreme acidosis with pH < 6.8 is incompatible with life, u...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
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SAGE Publishing
2021-06-01
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| Series: | Clinical Medicine Insights: Case Reports |
| Online Access: | https://doi.org/10.1177/11795476211025138 |
| _version_ | 1819142220314312704 |
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| author | Sasa Dragic Danica Momcicevic Biljana Zlojutro Milka Jandric Tijana Kovacevic Vlado Djajic Ognjen Gajic Pedja Kovacevic |
| author_facet | Sasa Dragic Danica Momcicevic Biljana Zlojutro Milka Jandric Tijana Kovacevic Vlado Djajic Ognjen Gajic Pedja Kovacevic |
| author_sort | Sasa Dragic |
| collection | DOAJ |
| description | Introduction: Hydrogen ion concentration which is expressed as pH value is in human blood maintained in narrow physiological range (7.36-7.44 in arterial blood). This range is crucial for normal functioning of most biochemical reactions. Extreme acidosis with pH < 6.8 is incompatible with life, unless pathophysiologic process is rapidly reversed. Timely, standardized, and structured approach to assessment and management of extreme critical illness is essential to maximize the chances of patient’s survival. Cases: We present a series of 3 critically ill patients admitted to Medical intensive care unit (MICU) diagnosed with extreme metabolic acidosis (pH ⩽ 6.8). Each patient was treated using C hecklist for E arly R ecognition and T reatment of A cute I llness and I N jury (CERTAIN) which is a standard decision support tool in our MICU. Causes of extreme metabolic acidosis included hemorrhagic shock, sepsis, and acute renal failure and diabetic ketoacidosis. Rapid assessment, prompt resuscitation (IV fluids, vasopressors, mechanical ventilation, and renal replacement), and application of specific causal treatment led to positive outcomes in all 3 patients. Discussion: Medical physiology textbooks set the lower limit of pH value at which life is possible to 6.8. However, examples from clinical practice show that if adequate resuscitation measures are taken early in the acute phase of the disease, the biochemical cascade of reactions that are considered irreversible (at pH ⩽ 6.8) may be reversed after all. Conclusion: Critical care approach to extreme metabolic acidosis is a prime example of applied clinical physiology where basic science and clinical practice connect. With these case series we show that timely and structured approach to critical illness shifts the boundaries of reversibility for some of the most severe physiologic derangements. |
| first_indexed | 2024-12-22T12:06:53Z |
| format | Article |
| id | doaj.art-d96b28eabfae458b99e0c195c689dd72 |
| institution | Directory Open Access Journal |
| issn | 1179-5476 |
| language | English |
| last_indexed | 2024-12-22T12:06:53Z |
| publishDate | 2021-06-01 |
| publisher | SAGE Publishing |
| record_format | Article |
| series | Clinical Medicine Insights: Case Reports |
| spelling | doaj.art-d96b28eabfae458b99e0c195c689dd722022-12-21T18:26:25ZengSAGE PublishingClinical Medicine Insights: Case Reports1179-54762021-06-011410.1177/11795476211025138Successful Outcomes of Critically Ill Patients with Extreme Metabolic Acidosis Treated with Structured Approach: Case SeriesSasa Dragic0Danica Momcicevic1Biljana Zlojutro2Milka Jandric3Tijana Kovacevic4Vlado Djajic5Ognjen Gajic6Pedja Kovacevic7Medical Intensive Care Unit, University Clinical Centre of the Republic of Srpska, Bosnia and HerzegovinaMedical Intensive Care Unit, University Clinical Centre of the Republic of Srpska, Bosnia and HerzegovinaMedical Intensive Care Unit, University Clinical Centre of the Republic of Srpska, Bosnia and HerzegovinaMedical Intensive Care Unit, University Clinical Centre of the Republic of Srpska, Bosnia and HerzegovinaClinical Pharmacy, University Clinical Centre of the Republic of Srpska, Bosnia and HerzegovinaManagement, University Clinical Centre of the Republic of Srpska, Bosnia and HerzegovinaMayo Clinic, Rochester, USAMedical Intensive Care Unit, University Clinical Centre of the Republic of Srpska, Bosnia and HerzegovinaIntroduction: Hydrogen ion concentration which is expressed as pH value is in human blood maintained in narrow physiological range (7.36-7.44 in arterial blood). This range is crucial for normal functioning of most biochemical reactions. Extreme acidosis with pH < 6.8 is incompatible with life, unless pathophysiologic process is rapidly reversed. Timely, standardized, and structured approach to assessment and management of extreme critical illness is essential to maximize the chances of patient’s survival. Cases: We present a series of 3 critically ill patients admitted to Medical intensive care unit (MICU) diagnosed with extreme metabolic acidosis (pH ⩽ 6.8). Each patient was treated using C hecklist for E arly R ecognition and T reatment of A cute I llness and I N jury (CERTAIN) which is a standard decision support tool in our MICU. Causes of extreme metabolic acidosis included hemorrhagic shock, sepsis, and acute renal failure and diabetic ketoacidosis. Rapid assessment, prompt resuscitation (IV fluids, vasopressors, mechanical ventilation, and renal replacement), and application of specific causal treatment led to positive outcomes in all 3 patients. Discussion: Medical physiology textbooks set the lower limit of pH value at which life is possible to 6.8. However, examples from clinical practice show that if adequate resuscitation measures are taken early in the acute phase of the disease, the biochemical cascade of reactions that are considered irreversible (at pH ⩽ 6.8) may be reversed after all. Conclusion: Critical care approach to extreme metabolic acidosis is a prime example of applied clinical physiology where basic science and clinical practice connect. With these case series we show that timely and structured approach to critical illness shifts the boundaries of reversibility for some of the most severe physiologic derangements.https://doi.org/10.1177/11795476211025138 |
| spellingShingle | Sasa Dragic Danica Momcicevic Biljana Zlojutro Milka Jandric Tijana Kovacevic Vlado Djajic Ognjen Gajic Pedja Kovacevic Successful Outcomes of Critically Ill Patients with Extreme Metabolic Acidosis Treated with Structured Approach: Case Series Clinical Medicine Insights: Case Reports |
| title | Successful Outcomes of Critically Ill Patients with Extreme Metabolic Acidosis Treated with Structured Approach: Case Series |
| title_full | Successful Outcomes of Critically Ill Patients with Extreme Metabolic Acidosis Treated with Structured Approach: Case Series |
| title_fullStr | Successful Outcomes of Critically Ill Patients with Extreme Metabolic Acidosis Treated with Structured Approach: Case Series |
| title_full_unstemmed | Successful Outcomes of Critically Ill Patients with Extreme Metabolic Acidosis Treated with Structured Approach: Case Series |
| title_short | Successful Outcomes of Critically Ill Patients with Extreme Metabolic Acidosis Treated with Structured Approach: Case Series |
| title_sort | successful outcomes of critically ill patients with extreme metabolic acidosis treated with structured approach case series |
| url | https://doi.org/10.1177/11795476211025138 |
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