This study analyzed 621 patients with acute heart failure (AHF) admitted to the intensive care unit to evaluate the clinical significance of acid-base balance in an emergency setting. The results showed factors associated with acidosis included high white blood cell count, glucose, blood pressure, and heart rate. Factors linked to alkalosis were high C-reactive protein, bilirubin, and low albumin. Patients with alkalosis were less likely to have orthopnea and had lower blood pressure and heart rate. Alkalosis was an independent risk factor for in-hospital mortality and poorer long-term survival rates compared to patients with normal acid-base balance.

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15. • The pH of a fluid reflects its degree of acidity or alkalinity PH normal ranges from 7.35 to
7.45.
• A high pH indicates alkaline (basic). A low pH indicates acidic
• Three major mechanisms regulate the acid–base status of the body: buffers, the respiratory
system, and the renal system.
• There are two abnormalities of acid-base balance:
• Acidosis: The blood has too much acid (or too little base), resulting in a decrease in
blood pH.
• Alkalosis: The blood has too much base (or too little acid), resulting in an increase in
blood pH.
• Acidosis and alkalosis are categorized depending on their primary cause as
• Metabolic
• Respiratory
• Metabolic acidosis and metabolic alkalosis are caused by an imbalance in the production of
acids or bases and their excretion by the kidneys.
• Respiratory acidosis and respiratory alkalosis are caused by changes in carbon dioxide
exhalation due to lung or breathing disorders
• Each acid-base disturbance provokes automatic compensatory mechanisms that push the
blood pH back toward normal. In general, the respiratory system compensates for metabolic
disturbances while metabolic mechanisms compensate for respiratory disturbances.

16.  BANASIK and COPSTEAD, (2019)
pathophysiology, sixth edition chapter (25) Acid–
Base Homeostasis and Imbalances

17. Clinical significance of acid–base balance
in an emergency setting in patients
with acute heart failure
Introduction
Clinical Question
Methods
Discussion
Results
References
Implications
This study analyzed six hundred twenty-one
consecutive patients with AHF who were
admitted to the intensive care unit of Chiba
Hokusoh Hospital, Nippon Medical School
between January 2000 and April 2011. The data
were retrospectively evaluated from the hospital
medical records, and all AHF patients for
whom ABG samples could be obtained were
enrolledAll data were statistically analyzed using
the StatView 5 software package (SAS Institute,
Cary, NC, USA), and the SPSS 14.0 J software
program (SPSS Japan Institute, Tokyo, Japan).
There are several limitations associated with this
study. First, determination of brain natriuretic peptide and
other biomarker-related variables were not assessed on all
patients’ arrival to the emergency department.
Second, most patients underwent transthoracic
echocardiography at the time of admission and after HF
was stabilized, however it was difficult to compare these
data because they were recorded under different
conditions.
Third, the patients with cardiogenic shock were reported to
reveal poor tissue perfusion with lactate acidosis and renal
dysfunction with metabolic acidosis.
Fourth, the present study was a single center study, with a
small number of patients included in each of the groups
used to evaluate the prognosis, therefore, there might be a
patient bias.
The present study showed the factors associated with acidosis upon
the patients’ arrival to the emergency department to be a
high WBC and high glucose, and the specific vital signs were a
high SBP and fast HR. Almost all patients had orthopnea They
suggested that the duration of decomposition might be short in
patients with acidosis AHF. the factors associated with alkalosis AHF
patients include a high CRP and high total bilirubin, and these
patients also had low total protein and albumin levels
The factors associated with alkalosis AHF were
high CRP, bilirubin, and low WBC, glucose,
total protein, and albumin. The patients with
alkalosis AHF were less likely to have
orthopnea with low SBP and HR. They
suggested that the patients with alkalosis AHF
might have experienced AHF for a few days and
were associated with high mortality.
AkihiroS, Nobuaki K (October 2012, ) . Original article
Clinical significance of acid–base balance in an
emergency setting in patients with acute heart failure
Author links open overlay panel .
https://doi.org/10.1016/j.jjcc.2012.06.004 Get rights
and content Under an Elsevier user license
Conclusion
What is the Clinical significance of acid–base
balance in an emergency setting in patients
with acute heart failure?
The clinical findings on admission and outcomes (in-hospital mortality and
any-cause death within 2 years) were compared between the three groups.
The white blood cell counts (WBC), serum levels of total protein, albumin
and glucose were significantly lower, and the serum levels of C-reactive
protein (CRP) and total bilirubin were significantly higher in the alkalosis
group. Patients with orthopnea were significantly fewer, and the systolic
blood pressure (SBP) and heart rate (HR) were significantly lower in the
alkalosis group. The results of a multivariate logistic regression model for
in-hospital mortality found that alkalosis was an independent risk factor
(p = 0.017, odds ratio: 2.589; 95% confidence interval: 1.186–5.648). The
Kaplan–Meier curves showed the prognosis for any-cause death to be
significantly poorer in the alkalosis group than in the normal group
(p = 0.026).
Acute HF (AHF) as a rapid onset of or deterioration in
the signs and symptoms of HF . therefore, dyspnea is
the most frequent complaint of patients with
AHF.An arterial blood gas analysiss (ABG) is one of
the main tools for decision-making in patients with
dyspnea, such as chronic obstructive pulmonary
diseases exacerbation or bronchial asthma in an
emergency setting. Furthermore, the ABG is usually
performed to evaluate acid–base balance for the
treatment of patients with AHF in the emergency
setting. The ESC guidelines also recommended
assessing ABG in patients with AHF .However, the
role of the acid–base balance is rarely considered in
AHF, since there is little evidence in the literature
demonstrating any association with the clinical
findings, including a poor prognosis. Miñana et al.
Reported that po2, pco2, and ph at the time of
admission are not associated with all-cause long-term
mortality . in addition, the prognostic value of ABG in
patients with AHF has not yet been established.
The Kaplan–Meier curves showed that the prognosis with regard to
any-cause death was significantly poorer among the patients with
alkalosis in comparison with the patients who had normal acid–base
balance (p = 0.026, Fig. 1A), furthermore, the prognosis was not
different between the patients with acidosis and normal acid–base
balance Fig. 1B),