Hyperlactacemia in critically ill children: comparison of traditional and Fencl-Stewart methods

Abstract

Background Base excess is a single variable used to quantify metabolic component of acid base status. Several researches have combined the traditional base excess method with the Stewart method for acid base physiology called as Fencl-Stewart method. Objective The purpose of the study was to compare two different methods in identifying hyperlactacemia in pediatric patients with critical illness. Methods The study was performed on 43 patients admitted to the pediatric intensive care unit of Cipto Mangunkusumo Hospital, Jakarta. Sodium, potassium, chloride, albumin, lactate and arterial blood gases were measured. All samples were taken from artery of all patients. Lactate level of >2 mEq/L was defined as abnormal. Standard base excess (SBE) was calculated from the standard bicarbonate derived from Henderson-Hasselbalch equation and reported on the blood gas analyzer. Base excess unmeasured anions (BE UA ) was calculated using the Fencl-Stewart method simplified by Story (2003). Correlation between lactate levels in traditional and Fencl-Stewart methods were measured by Pearson’s correlation coefficient . Results Elevated lactate levels were found in 24 (55.8%) patients. Lactate levels was more strongly correlated with BE UA (r = - 0.742, P<0.01) than with SBE (r = - 0.516, P<0.01). Conclusion Fencl-Stewart method is better than traditional method in identifying patients with elevated lactate levels, so the Fencl-Stewart method is suggested to use in clinical practice.

Keywords

• Hyperlactacemia
• Fencyl-Stewart method
• acid base status