Four Acid-Base Disturbances in a Critically-Ill Patient Undergoing Emergent Abdominal Surgery

Area of Science:

• Critical Care Medicine
• Surgical Pathology
• Acid-Base Physiology

Background:

• Lactic acidosis is a frequent complication in critically-ill surgical patients, often linked to tissue hypoperfusion.
• However, other acid-base disturbances can occur perioperatively and may be overlooked during acute resuscitation efforts.
• Focusing solely on surgical pathology can lead to missed diagnoses of concurrent medical conditions.

Observation:

• A 60-year-old woman with no prior medical history underwent exploratory laparotomy for a perforated umbilical hernia.
• Her perioperative management was complicated by multiple acid-base disturbances.
• Notably, starvation ketosis was identified as one of the concurrent metabolic abnormalities.

Findings:

• The case demonstrates that perioperative acid-base imbalances are multifactorial.
• Multiple concurrent acid-base disturbances, including starvation ketosis, can affect surgical patients.
• These imbalances require careful diagnosis beyond the immediate surgical issue.

Implications:

• Early and comprehensive recognition of acid-base disturbances is vital in surgical critical care.
• Accurate identification of all acid-base abnormalities aids in understanding concurrent medical pathology.
• This diagnostic approach improves the prediction of a patient's post-operative course and management strategy.