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Acid\u2013base disturbances are common in critically ill patients, yet their distribution and impact in SE patients remain poorly understood.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>This was an observational cohort study including non-hypoxic SE patients with available blood gas analysis within the first 24\u00a0h of SE, treated at the University Hospital of Geneva, Switzerland between 2015 and 2023. Acid\u2013base disturbances were classified using the Henderson\u2013Hasselbalch equation, with prevalent metabolic alkalosis confirmed through the Stewart approach. Primary outcomes were in-hospital mortality, Glasgow Outcome Scale (GOS) at discharge, and return to premorbid neurologic function.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Findings<\/jats:title>\n                <jats:p>Among 540 SE patients, 365 were included. Half of patients exhibited acid\u2013base disturbances within the initial 24\u00a0h of SE, with metabolic and respiratory acidosis being the most prevalent, though not prognostically significant. After correction for possible confounders, metabolic alkalosis (6%) was associated with increased in-hospital mortality (<jats:italic>P<\/jats:italic>\u2009=\u20090.011; OR\u2009=\u20094.87, 95% CI\u2009=\u20091.29\u20137.84), worse GOS (<jats:italic>P<\/jats:italic>\u2009=\u20090.012; OR\u2009=\u20093.18, 95% CI\u2009=\u20091.29\u20137.84), and reduced likelihood of returning to premorbid function (<jats:italic>P<\/jats:italic>\u2009=\u20090.017; OR\u2009=\u20093.30, CI95%\u2009=\u20091.24\u20138.80). Following the Stewart approach, 9% of patients had predominant metabolic alkalosis, associated with worse GOS (<jats:italic>P<\/jats:italic>\u2009=\u20090.005; OR:3.37, 95%CI\u2009=\u20091.45\u20137.82), and reduced chance of returning to baseline (<jats:italic>P<\/jats:italic>\u2009=\u20090.012; OR\u2009=\u20093.29, CI95%\u2009=\u20091.30\u20138.32). Metabolic alkalosis was related to hypoalbuminemia and lower serum potassium.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusion<\/jats:title>\n                <jats:p>Metabolic alkalosis strongly predicts mortality and adverse functional outcome in SE patients. Prospective studies should assess whether early detection and correction of metabolic alkalosis and related electrolyte imbalances can improve SE prognosis.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1007\/s00415-024-12603-x","type":"journal-article","created":{"date-parts":[[2024,7,27]],"date-time":"2024-07-27T04:01:52Z","timestamp":1722052912000},"page":"6172-6180","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Metabolic alkalosis: a new red flag in status epilepticus"],"prefix":"10.1007","volume":"271","author":[{"given":"Francesco","family":"Misirocchi","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Herv\u00e9","family":"Quintard","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Margitta","family":"Seeck","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7979-0994","authenticated-orcid":false,"given":"Pia","family":"De Stefano","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2024,7,27]]},"reference":[{"key":"12603_CR1","doi-asserted-by":"publisher","first-page":"1515","DOI":"10.1111\/epi.13121","volume":"56","author":"E Trinka","year":"2015","unstructured":"Trinka E, Cock H, Hesdorffer D et al (2015) A definition and classification of status epilepticus: report of the ILAE Task Force on classification of status epilepticus. 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HQ declares no competing interests. MS is a shareholder of Epilog NV (Ghent, Belgium). She received grants from the Swiss National Science Foundation (163398, CRS115- 180365). PDS was supported by the Swiss National Science Foundation (163398, CRS115-180365) and is supported by the 2022 Swiss League Against Epilepsy Research Support Prize.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflicts of interest"}},{"value":"The study protocol was reviewed and approved by the local ethic committee (CCER 2019\u201300836), and patients\u2019 consent was waived in compliance with the Declaration of Helsinki first published in 1964 and its following amendments.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical standards"}}]}}