Mortalitas Asidosis Metabolik Laktat dan Non-laktat di Unit Perawatan Intensif Pediatrik RSUP Sanglah
Sari
Latar belakang. Hiperlaktasemia terjadi pada pasien sakit berat disebabkan karena peningkatan produksi
laktat dan hambatan pengeluaran laktat. Konsentrasi laktat serum >5 mmol/L disertai pH darah <7,35
disebut asidosis laktat. Prognosis asidosis metabolik laktat lebih buruk dibandingkan asidosis metabolik
non-laktat meskipun kadar asidosis lebih ringan.
Tujuan. Membandingkan angka mortalitas pasien asidosis metabolik laktat dan non-laktat yang dirawat di Unit
Perawatan Intensif Pediatrik RSUP Sanglah, serta mengetahui peran beberapa parameter laboratotium.
Metode. Rancangan penelitian kohort prospektif dengan pembanding internal. Pasien yang mengalami
asidosis metabolik, dianalisis dan angka mortalitas dibandingkan antara asidosis metabolik laktat dan
asidosis metabolik non-laktat. Risiko relatif dihitung untuk mencari hubungan antara asidosis metabolik
laktat dengan mortalitas. Hubungan antara beberapa variabel independen terhadap variabel dependen
dilakukan analisis multivariat regresi logistik.
Hasil. Di antara 80 pasien, terdapat perbedaan bermakna mortalitas kelompok asidosis metabolik laktat
(p= 0,025; RR= 2,81; IK 95% 1,129-6,991). Kadar laktat (p: 0.007; IK 95% 0.037-0.121) dan pH darah
(p: 0.013; IK 95% -2.264- -0.361) menunjukkan hubungan yang bermakna terhadap mortalitas. Kadar
laktat >10 mmol/L dan pH darah <7,1 memperlihatkan mortalitas 100%
Kesimpulan. Asidosis metabolik laktat memiliki risiko relatif 2,81 terhadap mortalitas, kadar laktat dan
pH darah memiliki hubungan dengan kejadian mortalitas. Terdapat perbedaan proporsi mortalitas pada
kadar laktat >10 mmol/L dan pH darah <7,1.
Kata Kunci
Teks Lengkap:
PDFReferensi
Agrawal S, Sachdev A, Gupta D, Chugh K. Role of
lactate in critically ill children. Indian J Crit Care Med
;8:173-81.
Forsythe SM, Schmidt GA. Sodium bicarbonate for the
treatment of lactic acidosis. Chest 2000;117:260-7.
Benjamin E. Management of metabolic acidosis in
critically ill patients: an etiological approach to the
therapeutic strategy. Réanim Urgences 1999;8:514-24.
Gunnerson KJ, Saul M, He S, Kellum JA. Lactate versus nonlactate metabolic acidosis:a retrospective outcome evaluation
of critically ill patients. Critical Care 2006;10:R22.
Gunn VL, Nechyba C. The harriet lane handbook. Edisi
ke-16. Missouri: Mosby; 2002. h. 553.
Kraut JA, Madias NE. Serum anion gap: Its uses and
limitations in clinical medicine. Clin J Am Soc Nephrol
;2:162-74.
Aduen J, Berstein WK, Khastgir T. The use and clinical
importance of a substrate-specific electrode for rapid
determination of blood lactate concentration. JAMA
; 272:1678-84.
Adrogue HJ, Madias NE. Management of life-threatening
acid-base disorders. N Engl J Med 1998; 338:26-34.
Stacpoole PW, Lorenz AC, Thomas RG, Harman EM.
Dicholoacetate in the treatment of lactic acidosis. Ann
Intern Med 1988;108:58-63.
/"RIEN *- !LI .! !BEREGG 3+ !BRAHAM % 3EPSIS
Am J Med 2007;120:1012-22.
Vincent JL. Lactate and biochemical indexes of
oxygenation. Dalam: Tobin MJ, penyunting. Principles
and practice of intensive care monitoring. New York:
McGraw-Hill Companies; 1998. h.369-75.
Bakker J, Coffernils M, Leon M, Gris P, Vincent JL.
Blood lactate levels are superior to oxygen-derived
variables in predicting outcome in human septic shock.
Chest 1991; 99:956-62.
Siswanto JE. Kadar asam laktat darah pada penderita
sepsis. Tesis. Semarang: Bagian Ilmu Kesehatan Anak
FKUNDIP, 1997.
Matthews JG, Lisbon A. Lactate metabolism in the
critically ill patient. Dalam: Cerra FB, penyunting.
Pharmacology, metabolism and nutrition. Current
/PINION IN #RIT #ARE
Arieff AL. Lactic acidosis: pathophysiology, classification
and therapy of acid-base disturbances. Dalam: Arieff
AI, DeFronzo RA, penyunting. Fluid, electrolyte and
acid-base disorders. Edisi ke-2. New York: Churchill
Livingstone; 1995. h.130-6
Iberti TJ, Leibowitz AB, Papadakos PJ, Fischer EP. Low
sensitivity of the anion gap as a screen to detect hyperlactatemia
in critically ill patients. Crit Care Med 1990; 18:275-77.
Stacpoole PW. Lactic acidosis. Endocrinol Metabol Clin
North Am 1993; 22:221-45.
Mustafa I. Pintas jantung paru pada bedah jantung
menyebabkan gangguan metabolisme laktat di hati.
Disertasi. Jakarta: Universitas Indonesia, 2002.
Bakker J, Gris P, Coffernils M, Kahn RJ, Vincent JL.
Serial blood lactate levels can predict the the development
of multiple organ failure following septic shock. Am J
Surg 1996; 171:221-6.
UTH 6* 2AIVIO +/ 0ERINATAL BRAIN DAMAGE PREDICTIVE
value of metabolic acidosis and the apgar score. Br Med
J 1988; 297:24-7.
ENTRE +- /XYGENATION )NDEX 0REDICT /UTCOME OF
Acute Hypoxemic Respiratory Failure. JAAP Grand
Rounds 2006; 15:20-4.
Farah A. Husein. Serum Lactate and Base Deficit as
Predictor of Mortality and Morbidity. Am J Surg 2003;
:485-91.
Renhardt GF, Myscofski JW, Wilkens DB. Incidence and
mortality of hypoalbuminaemia in disease and injury.
Lancet 1985; 8432:357-9.
Prasad SVSS, Sunit Singhi, KS Chugh. Hyponatremia in
sick children seeking pediatric emergency care. J Indian
Pediatric 1994; 31:287-94.
Claridge JA, Crabtree TD, Pelletier SJ. Persistent occult
hypoperfusion is associated with a significant increase in
infection rate and mortality in major trauma patients. J
Trauma 2000; 48:8-14.
Aslah AK, Kuzu MA, Elhan AH, Tanik A, Hengirmen
S. Admission lactate level and the APACHE II score are
the most useful predictors of prognosis following torso
trauma. Int. J. Care Injured 2004;35:746-52.
Deshpande SA, Platt MP. Association between blood lactate
and acid-base status and mortality in ventilated babies.
Archives of Disease in Childhood 1997;76:F15-20.
Koliski A, Cat I, Giraldi DJ, Cat ML. Blood lactate
concentration as prognostic marker in critically ill
children. J Pediatr (Rio J) 2005;81:287-92.
Douzinas EE, Tsidemiadou PD, Pitaridis MT. The regional
production of cytokines and lactate in sepsis-related multiple
organ failure. Am J Respir Crit Care Med 1997; 155:53-9.
Luft FC. Lactic acidosis update for critical care clinicians.
J Am Soc Nephorl 2001; 12:S15-9.
Myers J, Ashley. Dangerous curves: a perspective on
Exercise, lactate, and the anaerobic threshold. Chest
; 111:787-95
DOI: http://dx.doi.org/10.14238/sp13.5.2012.351-6
Refbacks
- Saat ini tidak ada refbacks.
##submission.copyrightStatement##
##submission.license.cc.by-nc-sa4.footer##
Email: editorial [at] saripediatri.org
Sari Pediatri diterbitkan oleh Badan Penerbit Ikatan Dokter Anak Indonesia
Ciptaan disebarluaskan di bawah Lisensi Creative Commons Atribusi-NonKomersial-BerbagiSerupa 4.0 Internasional.