A comparison of traditional and quantitative analysis of acid-base imbalances in hypoalbuminemic dogs

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Abstract

© Veterinary Emergency and Critical Care Society 2014. Objective: To compare the traditional (HH) and quantitative approaches used for the evaluation of the acid-base balance in hypoalbuminemic dogs. Design: Prospective observational study. Setting: ICU of a veterinary teaching hospital. Animals: One hundred and five client-owned dogs. Measurements and Main Results: Jugular venous blood samples were collected from each patient on admission to determine: total plasma protein (TP), albumin (Alb), blood urea nitrogen (BUN), glucose (Glu), hematocrit (HCT), Na+, Cl-, K+, phosphate (Pi), pH, PvCO2, bicarbonate (HCO3 -), anion gap (AG), adjusted anion gap for albumin (AGalb) or phosphate (AAGalb-phos), standardized base excess (SBE), strong ion difference (SID), concentration of nonvolatile weak buffers (Atot), and strong ion gap (SIG). Patients were divided in 2 groups according to the severity of the hypoalbuminemia: mild (Alb = 21-25 g/L) and severe (Alb ≤20 g/L). All parameters were compared among groups. Patients with severe hypoalbuminemia showed significant decrease in TP (P = 0.011), Atot (P = 0.050), and a significant increase in adjusted AG (P = 0.048) and the magnitude of SIG (P = 0.011) compared to animals with mild hypoalbuminemia. According to theHHapproach, the most frequent imbalances were simple disorders (51.4%), primarily metabolic acidosis (84.7%) associated with a high AG acidosis. However, when using the quantitative method, 58.1% of patients had complex disorders, with SIG acidosis (74.3%) and Atot alkalosis (33.3%) as the most frequent acid-base imbalances. Agreement between methods only matched in 32 cases (kappa ≤ 0.20). Conclusions: The agreement between the HH and quantitative methods for interpretation of acid-base balance was poor and many imbalances detected using the quantitative approach were missed using the HH approach. Further studies are necessary to confirm the clinical utility of using the quantitative approach in the decisionmaking process of the severely ill hypoalbuminemic patients.
Original languageEnglish
Pages (from-to)509-518
JournalJournal of Veterinary Emergency and Critical Care
Volume24
DOIs
Publication statusPublished - 1 Jan 2014

Keywords

  • Albumin
  • Anion gap
  • Metabolic acidosis
  • Strong ion gap

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