BackgroundWhile there has been numerous studies assessing both base deficit and lactate as endpoints of resuscitation and predictors of mortality, few have adequately compared two in terms of correlation, reliability, and accuracy.

Question remains whether initial lactate or base deficit values provide any insight in patient morbidity or mortality as well as discharge status.

To prove whether Serum Lactate or Base Deficit is useful indicator in initial resuscitation and prognosis of trauma victims who presented with hypovolemic shock.

Aims & Objectives

Methods

Conclusion• Lactate level is superior to

base deficit as a marker for shock and resuscitation.

• Lactate normalization time and lactate clearance are both very good predictors of mortality and good indicators for adequate fluid resuscitation in trauma patients with hypovolemic shock

COMPARISION OF SERUM LACTATE AND BASE DEFICIT AS INDICATORS OF ADEQUATE FLUID RESUSCITATION AND

PROGNOSIS IN TRAUMA PATIENTS WITH HYPOVOLEMIC SHOCK. Dr. Srinivas Reddy Banala 1; Dr. Srihari Cattamanchi 2 *; Dr. T.V. Ramakrishnan 2.

1. Star Hospitals, Banjara Hills, Hyderabad, Andhra Pradesh. India. 2. Sri Ramchandra Medical College & Research Institute, Porur, Chennai – 600116. Tamil Nadu. India.

Results

Dr. Srinivas Reddy Banala; Mobile: +447738111430; Email id: winsomedoctor@gmail.com

Study Design: Prospective analytical study .

Study Setting: Accident & Emergency Medicine Department, Sri Ramachandra Medical Centre, Chennai, an urban tertiary care University Hospital and Level I trauma centre that treats around 4000 trauma patients in a year.

Duration of Study: From January 2008 to February 2009.

Inclusion Criteria: • A patient had survived and

remained in ICU or ward for a minimum of 48 hours.

• Adult trauma patients.• Systolic blood pressure less than

90 mmHg.

Exclusion criteria: • Children.• Adult patients who are initially

resuscitated outside prior to admission.

• Patients with associated medical diseases were excluded from study

Methodology:• The arterial blood was

collected for base deficit and serum lactate on admission and at 3, 6, 12, 24, 48 hours later.

• A normal lactate level was defined as ≤ 2 mmol/L. The time of the first normal lactate was recorded as “clearance time.”

• Normal base excess/deficit was defined as that between 2 and -2 mmol/L.

• Initial and 24-hour lactate and base deficit levels, as well as time to lactate clearance were compared among survivors and non-survivors.

• The patients were divided into three groups based on the time following admission until serum lactate-levels had normalized.

• The first group had normal lactate levels within 24 hours, the second group during the ensuing 24 hours, and the final group continued to have abnormal lactate levels at 48 hours.

Data Analysis:The Data were compiled into a spreadsheet (Microsoft Office Excel 2007; Microsoft Corporation, Redmond, WA), and the above analysis was performed using statistical software (SPSS Release 15.0.0 [6th September 2006]; SPSS Inc, Chicago, Illinois).

• Mean lactate level was 2.45 with SD of 2.25.

• All patients whose Lactate levels normalized within 24 hours survived, if lactate levels cleared to normal between 24 and 48 hours, survival rate was 83.3%.

• Where as lactate levels with more than 48 hours to normalize had survival rate of only 20%.