[The anion gap--screening for hyperlactatemia in critically ill children?]
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1Kinderintensivstation, Universitäts-Kinderklinik, Wien.
Insights
The anion gap is a fair screening tool for detecting hyperlactatemia in critically ill children, but it is not a perfect indicator. Hyperlactatemia should be considered in diagnosing metabolic acidosis, even without an elevated anion gap.
Area of Science:
- Pediatric Critical Care Medicine
- Clinical Chemistry
- Biochemical Markers
Context:
- Serum lactate is a key indicator of tissue perfusion in critically ill patients.
- Hyperlactatemia is a common concern in pediatric intensive care units (PICUs).
- Early detection of hyperlactatemia is crucial for timely intervention.
Purpose:
- To evaluate the effectiveness of the anion gap as a screening method for detecting hyperlactatemia in a PICU setting.
- To assess the sensitivity and specificity of the anion gap in identifying elevated lactate levels in infants and children.
- To determine if the anion gap's performance varies across different age groups and diagnoses.
Summary:
- This study assessed the anion gap's utility in screening for hyperlactatemia in pediatric patients.
- Blood gases, electrolytes, and lactate levels were measured in infants and children.
- The anion gap showed increasing sensitivity with rising hyperlactatemia, with an overall sensitivity of 64% and specificity of 76% across all age groups.
Impact:
- The anion gap provides a fair, though imperfect, screening method for hyperlactatemia in pediatric critical care.
- Results suggest that hyperlactatemia should be considered in the differential diagnosis of non-anion gap metabolic acidosis.
- This highlights the importance of comprehensive diagnostic approaches in critically ill children.
Abstract:
Serum lactate provides important information about tissue perfusion in critically ill patients. Aim of this study is to evaluate anion gap as a screening method to detect hyperlactatemia at a pediatric intensive care unit. In infants and children of different ages and diagnosis we determined blood gases, electrolytes and lactate. Sensitivity of anion gap was increasing with increasing hyperlactatemia. For the total population the test exhibited a sensitivity of 64% and a specificity of 76%, respectively. The power of anion gap as a screening method to detect hyperlactatemia was similarly fair for all age groups. Therefore hyperlactatemia has also to be included in the differential diagnosis of non-anion gap metabolic acidosis.