There is a wealth of literature about the use of anion
gap in the stepwise evaluation of acid base
disturbance. Just go to medline and enter"high anion
gap acidosis" and see the evidence for yourself. I
will be grateful if you would provide me with
published evidence to the contrary.
--- Philip Hyde <[log in to unmask]> wrote: > I don't
agree that our colleagues on the wards need
> our help very often with
> blood gas/acid-base interpretation. They simply
> don't ask, hardly ever.
> Chloride is only ever useful in targeted cases - if
> there is a problem with
> acid-base balance do the correct thing and take a
> correct arterial sample
> and go from there. Perusing lots of Cl/HCo3 results
> and anion gaps is not a
> good thing - it isn't, its a waste of time. The
> continued propagation of the
> "need" for both of these analytes is, I believe,a
> continuation of old
> practice, with little evidence base.
>
>
> >From: Janet McIlroy
> <[log in to unmask]>
> >Reply-To: Janet McIlroy
> <[log in to unmask]>
> >To: [log in to unmask]
> >Subject: Re: usefulness of chloride
> >Date: Mon, 8 Jan 2001 20:01:54 -0000
> >
> >We probably cannot justify the blanket measurement
> of Cl and bicarb in all
> >U
> >& E profiles (certainly, not in the cash strapped
> South!).
> >But they are extremely useful in the dissecting out
> of acid-base disorders.
> >Our clinical colleagues are not very good at this -
> they often need our
> >advice.
> >So we must ensure that we create the time to
> identify these patients (via
> >referral from clinical colleagues ideally). We
> must become universally
> >recognised sources of useful advice on these
> patients. Thus we add quality
> >to the clinical management process.
> >
> >However this means that we must be educated to
> understand acid-base
> >disorders and the contribution of these
> measurements to their diagnosis.
> >I "grew up" with Cl and bicarb measurements in all
> patients. I learned to
> >recognise the normal and understand the abnormal
> with the help of senior
> >colleagues. I am concerned that the rationalisation
> of profiles may
> >compromise this process for those in training. Have
> we an alternative
> >educational method?
> >
> >Janet McIlroy
> >Stoke Mandeville Hospital
>
>
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=====
Dr. M A Al-Jubouri
Consultant Chemical Pathologist
Whiston Hospital
Prescot
Merseyside L35 5DR
UK
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