高齢患者血漿内強イオン濃度較差及びアニオンギャップの解析

概要

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The amount of positively charged ions in blood plasma is given by the strong ion difference, i.e. [Na^+]+[K^+]-[Cl^-] designated by [SID]. [SID] is balanced by the sum of [HCO_3^-] and an anion gap, i.e. [SID]-[HCO_3^-] designated by [AG]. Since [HCO_3^-] has a Pco2-dependent component [HCO_3^-]^* and a metabolic component [HCO_3^-]^o, it was proposed that [SID] and [AG] also have Pco_2-dependent and metabolic components. This hypothesis has been tested in elderly patients with blood of a normal pH, where [HCO_3^-]^o was distributed closely around zero, the correlation coefficient of [SID] against [HCO_3^-]^* was 0.74, thus, the Pco_2-dependent component of [SID], [SID]^* was derived from its regression function. The same component of [AG], [AG]^* was obtained by subtracting [HCO_3^-]^* from [SID]^*. In acidotic and alkakotic patients, the correlation coefficient of [AG]-[AG]^* against [HCO_3^-]^o was 0.9, thus, the metabolic component of [AG], [AG]^o was obtained from its regression function. The metabolic component of [SID], [SID]^o was then derived by adding [HCO_3^-]^o to [AG]^o. Designating the error component of [SID] and [AG], respectively, by i[SID] (= [SID]-[SID]^*-[SID]^o) and i[AG] (= [AG]-[AG]^*-[AG]^o), these became equal to each other. The Pco^2-dependent and metabolic components of [H^+] and pH were not linear against either [HCO_3^-]^* and [HCO_3^-]^o.
2009-08-15