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Open Access Highly Accessed Research article

Utilization of base deficit and reliability of base deficit as a surrogate for serum lactate in the peri-operative setting

Lakhmir S Chawla12*, Amirali Nader1, Todd Nelson1, Trusha Govindji1, Ryan Wilson1, Sonia Szlyk1, Aline Nguyen1, Christopher Junker1 and Michael G Seneff1

Author Affiliations

1 Department of Critical Care Medicine and Anesthesiology George Washington University Medical Center, Washington D.C., USA

2 Division of Renal Diseases and Hypertension, Department of Medicine George Washington University Medical Center, Washington D.C., USA

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BMC Anesthesiology 2010, 10:16  doi:10.1186/1471-2253-10-16

Published: 9 September 2010

Abstract

Background

Base deficit (BD) is commonly used in the operating room (OR) as an endpoint of resuscitation. BD is used as a surrogate marker for the accumulation of lactic acid(Lac). However, the BD can be affected by large amounts of saline.

Methods

We conducted a survey of anesthesiologists regarding the use of BD. We also studied the reliability of BD to determine the presence of hyperlactatemia (HL). Patients undergoing general anesthesia were eligible for enrollment if they were receiving an arterial line as part of their routine care. If an arterial blood gas was drawn by the operative team as part of the routine care, the remainder of the unused blood was also used to measure Lac.

Results

Survey: 73 staff anesthesiologists were surveyed. Over 70% of respondents used BD as an endpoint of resuscitation.

Base Deficit Study: 35 patients were enrolled resulting in 88 arterial blood gases with corresponding Lac. Mean age was 61.4 ± 14.3 years, 43% were male. Mean pH was 7.39 ± 0.05, the mean bicarbonate was 23.0 ± 2.3 meq/L, the mean BD 1.34 ± 2.3, and the mean Lac was 1.58 ± 0.71 mmol/L. Mean ASA risk score was 3.16 ± 0.71. ROC area under the curve for base deficit to detect HL was 0.58.

Conclusion

BD can often mislead the clinician as to the actual Lac. Lac can now be measured in the OR in real time. Therefore, if clinicians in the operative setting want to know the Lac, it should be measured directly.