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Updated: Mar 26, 2026

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Disproportionate Acidosis After Traumatic Bladder Rupture: A Case-Control Study.

Subhash Reddy1, John Alfred Carr2,3

  • 1Department of Surgery, Michigan State University, Lansing, MI, 48912, USA.

European Journal of Trauma and Emergency Surgery : Official Publication of the European Trauma Society
|January 28, 2016
PubMed
Summary

Metabolic acidosis in trauma patients, particularly those with pelvic fractures, can be a sensitive early marker for bladder injury. Persistent acidosis warrants further evaluation for bladder trauma.

Keywords:
AcidosisBladder injuryBladder rupturePelvic fracture

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Area of Science:

  • Trauma surgery
  • Urology
  • Emergency medicine

Background:

  • Traumatic bladder injury is uncommon and frequently overlooked during initial patient assessment.
  • Early identification of sensitive markers for bladder injury is crucial.

Purpose of the Study:

  • To identify early, sensitive indicators of traumatic bladder injury.
  • To assess the diagnostic value of metabolic acidosis in bladder trauma.

Main Methods:

  • Retrospective review of trauma patient data from 1999 to 2008.
  • Comparison of patients with traumatic bladder injury versus a matched cohort without bladder rupture.
  • Analysis of clinical parameters including pH, hemoglobin, and Injury Severity Score (ISS).

Main Results:

  • 93% of patients with traumatic bladder injury presented with significant metabolic acidosis.
  • Patients with bladder rupture showed a significantly lower arrival pH compared to a non-ruptured cohort (intraperitoneal pH 7.22 vs. 7.33, p=0.008; extraperitoneal pH 7.22 vs. 7.33, p=0.02).
  • Metabolic acidosis was present in the absence of hemorrhagic shock, suggesting it as a specific indicator.

Conclusions:

  • Disproportionate metabolic acidosis in trauma patients, especially with pelvic fractures or hematuria, is a sensitive sign of bladder injury.
  • Trauma patients with persistent acidosis and a relevant injury mechanism should be evaluated for bladder injury.