Determinants and utility of the anion gap in predicting hyperlactatemia in cattle

Metabolic and blood acid-base responses to prepartum dietary cation-anion difference and calcium content in transition dairy cows

Dairy cows commonly undergo negative Ca balance accompanied by hypocalcemia after parturition. A negative dietary cation-anion difference (DCAD) strategy has been used prepartum to improve periparturient Ca homeostasis. Our objective was to determine the influence of a negative DCAD diet with different amounts of dietary Ca on the blood acid-base balance, blood gases, and metabolic adaptation to lactation. Multiparous Holstein cows (n = 81) were blocked into 1 of 3 dietary treatments from 252 d of gestation until parturition: (1) positive DCAD diet and low Ca (CON; containing +6.0 mEq/100 g DM, 0.4% DM Ca); (2) negative DCAD diet and low Ca (ND; -24.0 mEq/100 g DM, 0.4% DM Ca); or (3) negative DCAD diet plus high Ca supplementation (NDCA; -24.1 mEq/100 g DM, 2.0% DM Ca). There were 28, 27, and 26 cows for CON, ND, and NDCA, respectively. Whole blood was sampled at 0, 24, 48, and 96 h after calving for immediate determination of blood acid-base status and blood gases. Serum samples collected at -21, -14, -7, -4, -2, -1, at calving, 1, 2, 4, 7, 14, 21, and 28 d relative to parturition were analyzed for metabolic components. Results indicated that cows fed ND or NDCA had lower blood pH at calving but greater pH at 24 h after calving compared with CON. Blood bicarbonate, base excess, and total CO₂ (tCO₂) concentrations of cows in ND and NDCA groups were less than those of cows in CON at calving but became greater from 24 to 96 h postpartum. The NDCA cows had lower blood bicarbonate, base excess, and tCO₂ at 48 h and greater partial pressure of oxygen after calving compared with ND. Cows fed ND or NDCA diets had lower serum glucose concentrations than CON cows before calving but no differences were observed postpartum. Serum concentrations of total protein and albumin were greater prepartum for cows in ND and NDCA groups than for those in CON. Postpartum serum urea N and albumin concentrations tended to be higher for ND and NDCA cows. Cows fed ND or NDCA diets had elevated serum total cholesterol concentration prepartum. During the postpartum period, triglycerides and NEFA of cows fed ND or NDCA diets tended to be lower than those of CON. Cows fed the NDCA diet had greater postpartum total cholesterol in serum and lower NEFA concentration at calving than ND. In conclusion, feeding a prepartum negative DCAD diet altered blood acid-base balance and induced metabolic acidosis at calving, and improved protein and lipid metabolism. Supplementation of high Ca in the negative DCAD diet prepartum was more favorable to metabolic adaptation to lactation in dairy cows than the negative DCAD diet with low Ca.

Retrospective study on the outcomes and risk factors of right paramedian abomasopexy for right abomasal disorders in 47 dairy cows

Very few epidemiologic studies have verified the utility of the right paramedian abomasopexy (RPA) technique in cows with right abomasal disorders. This study aimed to investigate the outcomes and risk factors for non-survival in the herd within 30 days of surgery in cows with right abomasal disorders who underwent the RPA technique. Forty-seven Holstein cows with right abomasal disorders (25 with right abomasal displacement [RDA] and 22 with right abomasal volvulus [RAV]) were included. Twenty-two cows with RDA (22/25, 88.0%) and 10 cows with RAV (10/22, 45.5%) survived at 30 days post-surgery. Multivariate logistic regression analysis indicated that hyponatremia, hypokalemia, and the presence of abomasal volvulus were the major risk factors associated with non-survival.

Acid-base variables in acute and chronic form of nontuberculous mycobacterial infection in growing goats experimentally inoculated with Mycobacterium avium subsp. hominissuis or Mycobacterium avium subsp. paratuberculosis

In current literature, data assessing the acid-base equilibrium in animals and humans during bacterial infection are rare. This study aimed to evaluate acid-base deteriorations in growing goats with experimentally induced NTM (nontuberculous mycobacteria) infections by application of the traditional Henderson-Hasselbalch approach and the strong ion model. NTM-challenged animals were orally inoculated with either Mycobacterium avium subsp. hominissuis (MAH; n = 18) or Mycobacterium avium subsp. paratuberculosis (MAP; n = 48). Twenty-five goats served as non-infected controls. Until 51^st week post-inoculation (wpi), blood gas analysis, serum biochemical analysis, and serum electrophoresis were performed on venous blood. Fifty percent (9/18) of goats inoculated with MAH developed acute clinical signs like apathy, fever, and diarrhea. Those animals died or had to be euthanized within 11 weeks post-inoculation. This acute form of NTM-infection was characterized by significantly lower concentrations of sodium, calcium, albumin, and total protein, as well as significantly higher concentrations of gamma globulin, associated with reduced albumin/globulin ratio. Acid-base status indicated alkalosis, but normal base excess and HCO₃^- concentrations, besides significantly reduced levels of SID (strong ion difference), A_{tot Alb} (total plasma concentration of weak non-volatile acids, based on albumin), A_{tot TP} (A_tot based on total protein) and markedly lower SIG (strong ion gap). The remaining fifty percent (9/18) of MAH-infected goats and all goats challenged with MAP survived and presented a more sub-clinical, chronic form of infection mainly characterized by changes in serum protein profiles. With the progression of the disease, concentrations of gamma globulin, and total protein increased while albumin remained lower compared to controls. Consequently, significantly reduced albumin/globulin ratio and lower A_{tot Alb} as well as higher A_{tot TP} were observed. Changes were fully compensated with no effect on blood pH. Only the strong ion variables differentiated alterations in acid-base equilibrium during acute and chronic NTM-infection.

Acid-base disorders in sick goats and their association with mortality: A simplified strong ion difference approach

Objectives

To investigate the acid‐base status of sick goats using the simplified strong ion difference (sSID) approach, to establish the quantitative contribution of sSID variables to changes in blood pH and HCO₃⁻ and to determine whether clinical, acid‐base, and biochemical variables on admission are associated with the mortality of sick goats.

Animals

One hundred forty‐three sick goats.

Methods

Retrospective study. Calculated sSID variables included SID using 6 electrolytes unmeasured strong ions (USI) and the total nonvolatile buffer ion concentration in plasma (A_tot). The relationship between measured blood pH and HCO₃⁻, and the sSID variables was examined using forward stepwise linear regression. Cox proportional hazard models were constructed to assess associations between potential predictor variables and mortality of goats during hospitalization.

Results

Hypocapnia, hypokalemia, hyperchloremia, hyperlactatemia, and hyperproteinemia were common abnormalities identified in sick goats. Respiratory alkalosis, strong ion acidosis, and A_tot acidosis were acid‐base disorders frequently encountered in sick goats. In sick goats, the sSID variables explained 97% and 100% of the changes in blood pH and HCO₃⁻, respectively. The results indicated that changes in the respiratory rate (<16 respirations per minute), USI, and pH at admission were associated with increased hazard of hospital mortality in sick goats.

Conclusions and Clinical Importance

The sSID approach is a useful methodology to quantify acid‐base disorders in goats and to determine the mechanisms of their development. Clinicians should consider calculation of USI in sick goats as part of the battery of information required to establish prognosis.

Acid-base assessment of post-parturient German Holstein dairy cows from jugular venous blood and urine: A comparison of the strong ion approach and traditional blood gas analysis

Evaluating acid-base status is important for monitoring dairy herd health. In a field study, we aimed to compare the acid-base status measured by net acid-base excretion (NABE) in urine with results of venous blood analysis in clinically healthy, but possibly metabolically burdened cows in their transition period. For this, we sampled blood from the jugular vein and urine from 145 German Holstein cows within 1 to 76 days post-partum. In blood, the metabolic parameters non-esterified fatty acids (NEFA) and β-hydroxybutyrate (BHB), as well as numerous parameters of the acid-base status were measured. The traditional approach, based on bicarbonate concentration, base excess (BE) and anion gap (AG), was compared to the strong ion approach variables, e.g. acid total (Atot), measured strong ion difference (SIDm), strong ion gap (SIG), and unmeasured anions (XA), respectively. Results of both approaches were set against the outcome of urine analysis, i.e. the NABE, base-acid ratio and pH of urine, in a cluster analysis, which provided 7 moderately stable clusters. Evaluating and interpreting these 7 clusters offered novel insights into the pathophysiology of the acid-base equilibrium in fresh post-partum dairy cows. Especially in case of subclinical acid-base disorders, the parameters of the strong ion difference theory, particularly SIDm, Atot and SIG or XA, provided more in-depth information about acid-base status than the traditional parameters BE, bicarbonate or AG in blood. The acid-base status of fresh cows with protein aberrations in blood could be differentiated in a much better way using the strong ion approach than by traditional blood gas analysis or by the measurement of urinary excretion. Therefore, the strong ion approach seems to be a suitable supplement for monitoring acid-base balance in dairy cattle.

Evaluation of venous blood gas levels, blood chemistry and haemocytometric parameters in milk fed veal calves at different periods of livestock cycle

An evaluation of blood chemistry profile in relation to specific stages of livestock cycle can help better understand variations in physiological conditions in order to adjust management systems to animal needs. In addition to basal hematological investigation, the acid-base balance and blood gases are essential tools in evaluating metabolism in calves. The relationship between blood gas parameters, diet and growth should be further investigated. The aim of this study was to evaluate changes in acid-base status, blood gases, serum chemistry and hematological parameters in veal calves at different periods of livestock cycle. One hundred twenty-eight healthy cross breeding calves were enrolled in a farm in North-East Italy. Blood samplings were carried out from the jugular vein on day 1 (t1), 60 (t2) and 150 (t3) after arrival. Blood gas analysis was performed and hematological parameters were evaluated. One-way ANOVA and Tukey-Kramer post-hoc test were performed to assess differences between blood parameter values at the different periods. The main differences in blood gas parameter levels during the livestock cycle concerned pH, Base Excess and HCO3 with higher values recorded in t3. Urea, creatinine, gamma-glutamyl transpeptidase and bilirubin mean values were significantly higher in t1 than in t2 and t3. Aspartate aminotransferase increased from t1 to t2 and t3. Alkaline Phosphatase was higher in t2. Fe levels severely dropped in t2 and in t3, and the decrease led to a restrained but significant reduction in haemoglobin values. A correspondent decrease in the other haemocytometric parameters was found.

Quantitative physicochemical analysis of acid-base balance and clinical utility of anion gap and strong ion gap in 806 neonatal calves with diarrhea

BACKGROUND

Acid-base abnormalities in neonatal diarrheic calves can be assessed by using the Henderson-Hasselbalch equation or the simplified strong ion approach which use the anion gap (AG) or the strong ion gap (SIG) to quantify the concentration of unmeasured strong anions such as D-lactate.

HYPOTHESIS/OBJECTIVES

To determine and compare the clinical utility of AG and SIG in quantifying the unmeasured strong anion charge in neonatal diarrheic calves, and to examine the associations between biochemical findings and acid-base variables by using the simplified strong ion approach. We hypothesized that the SIG provides a more accurate prediction of unmeasured strong anions than the AG.

ANIMALS

Eight hundred and six neonatal diarrheic calves admitted to a veterinary teaching hospital.

METHODS

Retrospective study utilizing clinicopathologic findings extracted from medical records.

RESULTS

Hyperphosphatemia was an important predictor of venous blood pH. Serum inorganic phosphorus and plasma D-lactate concentrations accounted for 58% of the variation in venous blood pH and 77% of the variation in AG and SIG. Plasma D- and total lactate concentrations were slightly better correlated with SIG (rs = -0.69; -0.78) than to AG (rs = 0.63; 0.74).

CONCLUSIONS AND CLINICAL IMPORTANCE

Strong ion gap is slightly better at quantifying the unmeasured strong anion concentration in neonatal diarrheic calves than AG. Phosphorus concentrations should be included as part of the calculation of Atot when applying the simplified strong ion approach to acid-base balance to critically ill animals with hyperphosphatemia.

Physicochemical Approach to Determine the Mechanism for Acid-Base Disorders in 793 Hospitalized Foals

BACKGROUND

The quantitative effect of strong electrolytes, unmeasured strong anions (UAs), pCO2, and plasma protein concentrations in determining plasma pH can be demonstrated using the physicochemical approach. Plasma anion gap (AG) and strong ion gap (SIG) are used to assess UAs in different species.

HYPOTHESES

Strong ions are a major factor influencing changes in plasma pH of hospitalized foals. AG and SIG accurately predict severe hyper-L-lactatemia ([L-lac(-)] > 7 mmol/L).

ANIMALS

Seven hundred and ninety three hospitalized foals < 7 days old.

METHODS

Retrospective study. The relationship between measured pH and physicochemical variables, and the relationship between plasma [L-lac(-)] and AG and SIG, were determined using regression analyses. Optimal AG and SIG cut points to predict hyper-L-lactatemia were identified using an ROC curve analysis.

RESULTS

Combined, the measured strong ion difference and SIG accounted for 54-69% of the changes in the measured arterial pH of hospitalized foals. AG and SIG were significantly associated with plasma [L-lac(-)] (P < .0001). The receiver operator characteristics (ROC) AUC of AG and SIG for prediction of severe hyper-L-lactatemia were 0.89 (95%CI, 0.8-0.95; P < .0001) and 0.90 (95%CI, 0.81-0.96; P < .0001), respectively. Severe hyper-L-lactatemia was best predicted by AG > 27 mmol/L (sensitivity 80%, 95%CI, 56-94, specificity 85%, 95%CI, 73-93; P < .0001) and SIG <-15 mmol/L (sensitivity 90%, 95%CI, 68-98; specificity 80%; 95%CI, 68-90; P < .0001).

CONCLUSION AND CLINICAL RELEVANCE

Altered concentrations of strong ions (Na(+), K(+), Cl(-)) and UAs were the primary cause of acidemia of hospitalized foals. AG and SIG were good predictors of hyper-L-lactatemia and could be used as surrogate tests.

Acid-base assessment: when and how to apply the Henderson-Hasselbalch equation and strong ion difference theory

The Henderson-Hasselbalch equation is probably the most famous equation in biology but is more descriptive than mechanistic. The traditional approach to acid-base assessment using the Henderson-Hasselbalch equation provides a clinically useful and accurate method when plasma protein concentrations are within the reference range. The simplified strong ion approach is a mechanistic acid-base model that can provide new insight into complicated acid-base disturbances. The simplified strong ion approach should be used to evaluate acid-base balance whenever plasma protein concentrations are abnormal.

Contribution of unmeasured anions to acid-base disorders and its association with altered demeanor in 264 calves with neonatal diarrhea

Background

The quantitative effect of strong electrolytes, unmeasured anions (UAs), pCO₂, and plasma protein concentrations in determining plasma pH and bicarbonate (HCO₃⁻) can be demonstrated using the physicochemical approach. Demeanor of calves with diarrhea is associated with acidemia, dehydration, and hyper‐d‐lactatemia.

Hypothesis

Unmeasured anions are a major factor influencing changes in plasma pH and HCO₃⁻ of calves with diarrhea and UAs and strong UAs, estimated by anion gap (AG) and strong ion gap (SIG), respectively, are more strongly associated with alteration of demeanor compared to other acid–base variables.

Animals

A total of 264 calves with diarrhea from two data sets (DS1 and DS2).

Methods

Retrospective study. Forward stepwise regression was performed to determine the relationship between measured pH or HCO₃⁻, and physicochemical variables. A two‐way ANOVA was performed to investigate the association between acid–base variables and attitude (bright, obtunded, and stuporous), posture (standing, sternal or lateral recumbency), and strength of suckling reflex (strong, weak, or absent).

Results

Increased strong UAs estimated by SIG was the most important contributor to changes in measured pH and HCO₃⁻ (DS1: r² 66 and 59%, DS2: 39 and 42%, P < .0001). SIG and AG were correlated to deteriorating calf demeanor for all three clinical scoring categories: attitude, posture, and suckle reflex (P < .0001).

Conclusion and Clinical Relevance

Elevated concentrations of strong UAs were the primary cause of acidemia and had an important influence on the demeanor of calves with diarrhea. These findings emphasize the importance of the calculation of UAs when evaluating acid–base abnormalities in calves.

Physicochemical interpretation of acid-base abnormalities in 54 adult horses with acute severe colitis and diarrhea

BACKGROUND

The quantitative effect of strong electrolytes, pCO2 , and plasma protein concentration in determining plasma pH and bicarbonate concentrations can be demonstrated with the physicochemical approach. Plasma anion gap (AG) and strong ion gap (SIG) are used to assess the presence or absence of unmeasured anions.

HYPOTHESES

The physicochemical approach is useful for detection and explanation of acid-base disorders in horses with colitis. AG and SIG accurately predict hyperlactatemia in horses with colitis.

ANIMALS

Fifty-four horses with acute colitis and diarrhea.

METHODS

Retrospective study. Physicochemical variables were calculated for each patient. ROC curves were generated to analyze sensitivity and specificity of AG and SIG for predicting hyperlactatemia.

RESULTS

Physicochemical interpretation of acid-base events indicated that strong ion metabolic acidosis was present in 39 (72%) horses. Mixed strong ion acidosis and decreased weak acid (hypoproteinemia) alkalosis was concomitantly present in 17 (30%) patients. The sensitivity and specificity of AG and SIG to predict hyperlactatemia (L-lactate > 5 mEq/L) were 100% (95% CI, 66.4-100; P < .0001) and 84.4% (95% CI, 70.5-93.5 P < .0001). Area under the ROC curve for AG and SIG for predicting hyperlactatemia was 0.95 (95% CI, 0.86-0.99) and 0.93 (95% CI, 0.83-0.99), respectively.

CONCLUSION AND CLINICAL RELEVANCE

These results emphasize the importance of strong ions and proteins in the maintenance of the acid-base equilibria. AG and SIG were considered good predictors of clinically relevant hyperlactatemia.

Importance of the effective strong ion difference of an intravenous solution in the treatment of diarrheic calves with naturally acquired acidemia and strong ion (metabolic) acidosis

BACKGROUND

The effect of sodium bicarbonate on acid-base balance in metabolic acidosis is interpreted differently by Henderson-Hasselbalch and strong ion acid-base approaches. Application of the traditional bicarbonate-centric approach indicates that bicarbonate administration corrects the metabolic acidosis by buffering hydrogen ions, whereas strong ion difference theory indicates that the co-administration of the strong cation sodium with a volatile buffer (bicarbonate) corrects the strong ion acidosis by increasing the strong ion difference (SID) in plasma.

OBJECTIVE

To investigate the relative importance of the effective SID of IV solutions in correcting acidemia in calves with diarrhea.

ANIMALS

Twenty-two Holstein-Friesian calves (4-21 days old) with naturally acquired diarrhea and strong ion (metabolic) acidosis.

METHODS

Calves were randomly assigned to IV treatment with a solution of sodium bicarbonate (1.4%) or sodium gluconate (3.26%). Fluids were administered over 4 hours and the effect on acid-base balance was determined.

RESULTS

Calves suffered from acidemia owing to moderate to strong ion acidosis arising from hyponatremia and hyper-D-lactatemia. Sodium bicarbonate infusion was effective in correcting the strong ion acidosis. In contrast, sodium gluconate infusion did not change blood pH, presumably because the strong anion gluconate was minimally metabolized.

CONCLUSIONS

A solution containing a high effective SID (sodium bicarbonate) is much more effective in alkalinizing diarrheic calves with strong ion acidosis than a solution with a low effective SID (sodium gluconate). Sodium gluconate is ineffective in correcting acidemia, which can be explained using traditional acid-base theory but requires a new parameter, effective SID, to be understood using the strong ion approach.

Influence of Grain Processing on Acid–Base Balance in Feedlot Steers

Grain processing (e.g. grinding, steaming, pelleting, flaking) has been reported to modify the incidence of ruminal disturbances in feedlot cattle. This study investigated the effects of two grain processing methods widely used in Spanish feedlots (grinding and pelleting) on animal performance, blood acid-base balance, blood electrolyte levels and serum lactate in a 140-day feedlot experiment with double-muscled Belgian Blue steers. The main aim of the study was to evaluate the way in which these two feeds modify blood acid-base balance, which is closely associated with ruminal pH. In light of our results we conclude that the animals that received the pelleted feed showed a more stable acid-base balance over time than those fed a ground feed. Nevertheless, higher levels of L-lactate and lower base excess (BE) and HCO(3)(-) values for cattle fed pelleted grain reflect a greater risk of grain-acid overload.

Experimental determination of net protein charge, [A]tot, andKaof nonvolatile buffers in bird plasma

The quantitative mechanistic acid-base approach to clinical assessment of acid-base status requires species-specific values for [A]tot(the total concentration of nonvolatile buffers in plasma) and Ka(the effective dissociation constant for weak acids in plasma). The aim of this study was to determine [A]totand Kavalues for plasma in domestic pigeons. Plasma from 12 healthy commercial domestic pigeons was tonometered with 20% CO2at 37°C. Plasma pH, Pco2, and plasma concentrations of strong cations (Na, K, Ca), strong anions (Cl, l-lactate), and nonvolatile buffer ions (total protein, albumin, phosphate) were measured over a pH range of 6.8–7.7. Strong ion difference (SID) (SID5= Na + K + Ca − Cl − lactate) was used to calculate [A]totand Kafrom the measured pH and Pco2and SID5. Mean (±SD) values for bird plasma were as follows: [A]tot= 7.76 ± 2.15 mmol/l (equivalent to 0.32 mmol/g of total protein, 0.51 mmol/g of albumin, 0.23 mmol/g of total solids); Ka= 2.15 ± 1.15 × 10−7; and p Ka= 6.67. The net protein charge at normal pH (7.43) was estimated to be 6 meq/l; this value indicates that pigeon plasma has a much lower anion gap value than mammals after adjusting for high mean l-lactate concentrations induced by restraint during blood sampling. This finding indicates that plasma proteins in pigeons have a much lower net anion charge than mammalian plasma protein. An incidental finding was that total protein concentration measured by a multianalyzer system was consistently lower than the value for total solids measured by refractometer.

Anion Gap Correlates with Serum D- and DL-Lactate Concentration in Diarrheic Neonatal Calves

The objective of this study was to investigate the relationship between serum D- and L-lactate concentrations, and anion gap (AG) in neonatal calves. The association of AG with lactic acidosis in diarrheic calves has only been investigated by measurement of L-lactate in calves with experimentally induced diarrhea. D-lactate has recently been reported to be present in high concentrations in the serum of some diarrheic neonatal calves. The contribution of this acid to AG is not reported. The relationship between AG and L- and D-lactate concentrations was examined in 24 healthy calves and 52 calves with naturally occurring infectious diarrhea with metabolic acidosis. AG was calculated as [Na+ + K+] - [Cl- + HCO3-]. D- and L-lactate were quantified using high-performance liquid chromatography. There was no correlation between L-lactate and AG, contrary to previous reports in the literature. Moderate correlations between D-lactate concentration and AG (r = .74, P < .0001), and between DL-lactate and AG (r = .77), P < .0001) were detected. No differences existed due to the age or sex of the calf. This study indicates that AG provides information on the nature of acidosis in the diarrheic, neonatal calf and reinforces the importance of investigating clinical, in addition to experimental, populations.

Calculation of the total plasma concentration of nonvolatile weak acids and the effective dissociation constant of nonvolatile buffers in plasma for use in the strong ion approach to acid-base balance in cats

OBJECTIVE

To determine values for the total concentration of nonvolatile weak acids (Atot) and effective dissociation constant of nonvolatile weak acids (Ka) in plasma of cats.

SAMPLE POPULATION

Convenience plasma samples of 5 male and 5 female healthy adult cats.

PROCEDURE

Cats were sedated, and 20 mL of blood was obtained from the jugular vein. Plasma was tonometered at 37 degrees C to systematically vary PCO2 from 8 to 156 mm Hg, thereby altering plasma pH from 6.90 to 7.97. Plasma pH, PCO2, and concentrations of quantitatively important strong cations (Na+, K+, and Ca2+), strong anions (Cl-, lactate), and buffer ions (total protein, albumin, and phosphate) were determined. Strong ion difference was estimated from the measured strong ion concentrations and nonlinear regression used to calculate Atot and Ka from the measured pH and PCO2 and estimated strong ion difference.

RESULTS

Mean (+/- SD) values were as follows: Atot = 24.3 +/- 4.6 mmol/L (equivalent to 0.35 mmol/g of protein or 0.76 mmol/g of albumin); Ka = 0.67 +/- 0.40 x 10(-7); and the negative logarithm (base 10) of Ka (pKa) = 7.17. At 37 degrees C, pH of 7.35, and a partial pressure of CO2 (PCO2) of 30 mm Hg, the calculated venous strong ion difference was 30 mEq/L.

CONCLUSIONS AND CLINICAL RELEVANCE

These results indicate that at a plasma pH of 7.35, a 1 mEq/L decrease in strong ion difference will decrease pH by 0.020, a 1 mm Hg decrease in PCO2 will increase plasma pH by 0.011, and a 1 g/dL decrease in albumin concentration will increase plasma pH by 0.093.

Clinical assessment of acid-base status: comparison of the Henderson-Hasselbalch and strong ion approaches

The traditional approach for clinically assessing acid-base status uses the Henderson-Hasselbalch equation to categorize 4 primary acid-base disturbances: respiratory acidosis (increased PCO2), respiratory alkalosis (decreased PCO2), metabolic acidosis (decreased extracellular base excess or actual HCO3- concentration), and metabolic alkalosis (increased extracellular base excess or actual HCO3- concentration). The anion gap is calculated to detect unidentified anions in plasma. This approach works well clinically and is recommended for use whenever serum total protein, albumin, and phosphate concentrations are approximately normal. However, because the Henderson-Hasselbalch approach is more descriptive than mechanistic, when these concentrations are markedly abnormal the Henderson-Hasselbalch equation frequently provides erroneous information as to the cause of an acid-base disturbance. The new quantitive physicochemical approach to evaluating acid-base balance uses the simplified strong ion model to categorize 6 primary acid-base disturbances: respiratory acidosis (increased PCO2), respiratory alkalosis (decreased PCO2), strong ion acidosis (decreased strong ion difference), strong ion alkalosis (increased strong ion difference), nonvolatile buffer ion acidosis (increased plasma concentrations of albumin, globulins, or phosphate), and nonvolatile buffer ion alkalosis (decreased plasma concentrations of albumin, globulins, or phosphate). The strong ion gap is calculated to detect unidentified anions in plasma. The simplified strong ion approach works well clinically and is recommended for use whenever serum total protein, albumin, or phosphate concentrations are markedly abnormal. The simplified strong ion approach is mechanistic and is therefore well suited for describing the cause of any acid-base disturbance.

Calculation of variables describing plasma nonvolatile weak acids for use in the strong ion approach to acid-base balance in cattle

OBJECTIVE

To calculate values for the total concentration of nonvolatile weak acids (Atot) and the effective dissociation constant for nonvolatile weak acids (Ka) of bovine plasma and to determine the best method for quantifying the unmeasured strong anion concentration in bovine plasma.

SAMPLE POPULATION

Data sets from published and experimental studies.

PROCEDURE

The simplified strong ion model was applied to published and experimentally determined values for pH, PCO2, and strong ion difference (SID+). Nonlinear regression was used to solve simultaneously for Atot and Ka. Four methods for quantifying the unmeasured strong anion concentration in plasma (anion gap, the Fencl base excess method [BEua], the Figge unmeasured anion method [XA], and the strong ion gap [SIG]) were compared in 35 cattle with abomasal volvulus.

RESULTS

For bovine plasma at 37 C, Atot was 25 m M/L, equivalent to 76 times the albumin concentration or 3.6 times the total protein concentration; Ka was 0.87 x 10(-7), equivalent to pKa of 706. The Atot and Ka values were validated, using data sets from in vivo and in vitro studies. Plasma unmeasured strong anion concentration was most accurately predicted in critically ill cattle by calculating SIG from serum albumin (R2, 0.66) or total protein concentration (R2, 0.60), compared with BEua (R2, 0.56), [XA] (R2, 0.50), and the anion gap (R2, 0.41).

CONCLUSIONS AND CLINICAL RELEVANCE

Calculated values for Atot, Ka, and the SIG equation should facilitate application of the strong ion approach to acid-base disturbances in cattle.

Clinical assessment of acid-base status. Strong ion difference theory

The traditional approach to evaluating acid-base balance uses the Henderson-Hasselbalch equation to categorize four primary acid-base disturbances: respiratory acidosis (increased PCO2), respiratory alkalosis (decreased PCO2), metabolic acidosis (decreased extracellular base excess), or metabolic alkalosis (increased extracellular base excess). The anion gap is calculated to detect the presence of unidentified anions in plasma. This approach works well clinically and is recommended for use whenever serum total protein, albumin, and phosphate concentrations are approximately normal; however, when their concentrations are markedly abnormal, the Henderson-Hasselbalch equation frequently provides erroneous conclusions as to the cause of an acid-base disturbance. Moreover, the Henderson-Hasselbalch approach is more descriptive than mechanistic. The new approach to evaluating acid-base balance uses the simplified strong ion model to categorize eight primary acid-base disturbances: respiratory acidosis (increased PCO2), respiratory alkalosis (decreased PCO2), strong ion acidosis (decreased [SID+]) or strong ion alkalosis (increased [SID+]), nonvolatile buffer ion acidosis (increased [ATOT]) or nonvolatile buffer ion alkalosis (decreased [ATOT]), and temperature acidosis (increased body temperature) or temperature alkalosis (decreased body temperature). The strong ion gap is calculated to detect the presence of unidentified anions in plasma. This simplified strong ion approach works well clinically and is recommended for use whenever serum total protein, albumin, and phosphate concentrations are markedly abnormal. The simplified strong ion approach is mechanistic and is therefore well suited for describing the cause of any acid-base disturbance. The new approach should therefore be valuable in a clinical setting and in research studies investigating acid-base balance. The presence of unmeasured strong ions in plasma or serum (such as lactate, ketoacids, and uremic anions) is best detected by calculating the SIG. The AG, actual bicarbonate concentration, and standard bicarbonate concentration all ignore the effects that changes in plasma protein and phosphate concentration have on plasma pH, thereby inevitably leading to inaccuracies in estimating the unmeasured strong ion concentration in plasma.