Abstract:
Background. Acid-base balance (ABB) analysis is a fundamental component in the
assessment of critically ill patients in the Emergency Department (ED). It enables rapid
identification of metabolic and respiratory disturbances, contributing to the evaluation of
case severity and guiding optimal therapeutic management.
Objective(s). This study evaluates the role of acid-base parameters as diagnostic and
prognostic markers in Emergency Department patients, aiming to improve diagnosis,
monitoring, and clinical management.
Materials and methods. A retrospective analysis was conducted on ABB parameters from
1930 patients admitted to the ED’s red zone (out of 2146 total). Parameters assessed
included pH, base excess (BE), bicarbonate (HCO₃⁻), anion gap (AG), lactate levels, and
physicochemical patterns per Stewart’s method. Correlations with clinical status and
outcomes were examined.
Results. Among the 1930 patients evaluated, 28.4% exhibited severe metabolic acidosis,
defined by a base excess (BE) below –6 mEq/L, while 16.2% had elevated lactate levels
above 4 mmol/L. Both parameters coexisted in 9.5% of patients and correlated with a
mortality rate of 27.1%. An anion gap (AG) exceeding 12 mEq/L was detected in 39.7% of
cases, with 61.3% of those also exhibiting hyperlactatemia. In trauma patients, a strong
correlation among BE, AG, and lactate (r > 0.7) facilitated early shock detection. Stewart’s
method revealed hidden acid-base disturbances in 14.8% of cases undetected by
conventional diagnostic methods.
Conclusion(s). Integrated analysis of ABB parameters—pH, base excess (BE), bicarbonate
(HCO₃⁻), anion gap (AG), and lactate—is vital for accurate and timely diagnosis in the
Emergency Department. Utilizing Stewart’s method alongside POCT enhances diagnostic
accuracy, guides treatment, and lowers mortality.
