Base Excess question

[sonofva]

Hello! My understanding of base excess is that it is a reflection of how much metabolic derangement is contributing to altered pH status, and how bad that derangement is. But let's say I see a pH of 7.1 with base excess of -10. Is there some other utility to the base excess number other than to say "dang that's a bad metabolic acidosis."? Thanks!

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[jdh71]

 

[deleted171991]

Yes. It's also the measure of the IQ of the surgical people who still use it in 2018.

 

[sonofva]

Yes. It's also the measure of the IQ of the surgical people who still use it in 2018.

I get it. I just want to be able to speak the same language as my consultants...

 

[DrDrummer]

NEJM - Diagnostic Use of Base Excess (NEJM - Error)

This was just published last week in the NEJM. I used it as a pre-shift teaching point because of how confusing this topic is to many of our residents -- our trauma surgeons particularly love to know what the base excess (or in their parlance, base deficit) is as soon as a VBG is run, yet most physicians are totally unable to explain what this number actually means. I found this to be an excellent review, and it summarizes the literature well that supports its role in prognostication / risk stratification (read the section "Base Excess in the Acute Care Setting").

I agree with above posters who expressed skepticism about its utility, but if you want to know why the surgeons care or be able to explain what the base excess is if you're pimped on it during rounds, this is a solid article.

 

[sunealoneal]

NEJM - Diagnostic Use of Base Excess (NEJM - Error)

This was just published last week in the NEJM. I used it as a pre-shift teaching point because of how confusing this topic is to many of our residents -- our trauma surgeons particularly love to know what the base excess (or in their parlance, base deficit) is as soon as a VBG is run, yet most physicians are totally unable to explain what this number actually means. I found this to be an excellent review, and it summarizes the literature well that supports its role in prognostication / risk stratification (read the section "Base Excess in the Acute Care Setting").

I agree with above posters who expressed skepticism about its utility, but if you want to know why the surgeons care or be able to explain what the base excess is if you're pimped on it during rounds, this is a solid article.

Thank you!!! This has been bothering me all year!

 

[Dr.CCM]

You can see if there is an additional metabolic process without having to do the Delta Gap in a metabolic acidosis. Otherwise that’s really about it.

 

[deleted171991]

The problem is not that the surgeons use the BD to look for metabolic acidosis. The problem is that they give fluids or, even worse, bicarb, based on it. That's just the embodiment of human stupidity in 2018.