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Our hypothesis was that the acidifying effect of severe hyperlactatemia is frequently masked by alkalinizing processes that normalize the [BE]. The goal of the present study was therefore to quantify these disorders using both Stewart and conventional approaches.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A total of 1,592 consecutive patients were prospectively evaluated on intensive care unit admission. Patients with severe hyperlactatemia (lactate level \u2265 4.0 mmol\/l) were grouped according to low or normal [BE] values (&lt;-3 mmol\/l or &gt;-3 mmol\/l).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Severe hyperlactatemia was present in 168 of the patients (11%). One hundred and thirty-four (80%) patients had low [BE] levels while 34 (20%) patients did not. Shock was more frequently present in the low [BE] group (46% versus 24%,\n                      <jats:italic>P<\/jats:italic>\n                      = 0.02) and chronic obstructive pulmonary disease in the normal [BE] group (38% versus 4%,\n                      <jats:italic>P<\/jats:italic>\n                      &lt; 0.0001). Levels of lactate were slightly higher in patients with low [BE] (6.4 \u00b1 2.4 mmol\/l versus 5.6 \u00b1 2.1 mmol\/l,\n                      <jats:italic>P<\/jats:italic>\n                      = 0.08). According to our study design, the pH, [HCO\n                      <jats:sub>3<\/jats:sub>\n                      <jats:sup>-<\/jats:sup>\n                      ], and strong-ion difference values were lower in patients with low [BE]. Patients with normal [BE] had lower plasma [Cl\n                      <jats:sup>-<\/jats:sup>\n                      ] (100 \u00b1 6 mmol\/l versus 107 \u00b1 5 mmol\/l,\n                      <jats:italic>P<\/jats:italic>\n                      &lt; 0.0001) and higher differences between the changes in anion gap and [HCO\n                      <jats:sub>3<\/jats:sub>\n                      <jats:sup>-<\/jats:sup>\n                      ] (5 \u00b1 6 mmol\/l versus 1 \u00b1 4 mmol\/l,\n                      <jats:italic>P<\/jats:italic>\n                      &lt; 0.0001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>\n                      Critically ill patients may present severe hyperlactatemia with normal values of pH, [HCO\n                      <jats:sub>3<\/jats:sub>\n                      <jats:sup>-<\/jats:sup>\n                      ], and [BE] as a result of associated hypochloremic alkalosis.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/cc6896","type":"journal-article","created":{"date-parts":[[2008,5,8]],"date-time":"2008-05-08T15:08:43Z","timestamp":1210259323000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":31,"title":["Severe hyperlactatemia with normal base excess: a quantitative analysis using conventional and Stewart approaches"],"prefix":"10.1186","volume":"12","author":[{"given":"Graciela","family":"Tuhay","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mar\u00eda Carolina","family":"Pein","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabio Daniel","family":"Masevicius","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniela Olmos","family":"Kutscherauer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arnaldo","family":"Dubin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2008,5,8]]},"reference":[{"key":"6329_CR1","doi-asserted-by":"publisher","first-page":"1391","DOI":"10.1126\/science.6298937","volume":"219","author":"PW Hochachka","year":"1983","unstructured":"Hochachka PW, Mommsen TP: Protons and anaerobiosis. 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