Severe Alkalosis in Critically Ill Surgical Patients

Abstract

Of 1,415 critically ill or injured patients studied by the shock unit of the Detroit General Hospital, 177 developed an arterial pH value of 7.55 or higher. Of these 142 were assisted by respirators, 57 had had severe trauma, 52 were severely septic, and 40 had surgery which required cardiopulmonary bypass. When the pH value of 7.55 was exceeded, the mortality rose progressively. Of 61 patients with a pH value of 7.55 to 7.56, 25 (41%) died; of 61 with a pH of 7.57 to 7.59, 29 (47%) died; of 40 with a pH value of 7.60 to 7.64, 26 (65%) died; and of 15 with a pH of 7.65 to 7.70, 12 (80%) died. The most common acid-base pattern was combined alkalosis. The mortality was highest in the patients with severe sepsis, metabolic alkalosis, and respiratory failure.