Discussion: (Critique)

The researcher revealed through the data gathered from the laboratory
analysis that the common cause of disorder for dogs and cats are primary metabolic
acidosis and a mixed acid base disorder of metabolic acidosis in conjunction with a
respiratory acidosis respectively. They were able to obtain this conclusions based on
the results of the arterial and venous blood blood gases of the sample. The
researcher compute the anion gap and use that to correlate the existence of
metabolic acidosis in animal patients. The researchers successfully use different
parameters in metabolic acidosis and use them to comparing and associating the
values in the involvement of the disease. They compute the anion gap which may
correlate to presence of metabolic acidosis in animal patients. Though the study had
also several limitation, the researcher were not able to measure of serum albumin
concentration and could not evaluate its influence on anion gap and the reference
range of the values of the blood gases that was generated the diagnostic criteria in
the study was based on a small group of animals. The study would be strengthened
if a larger population of animals had been included. In general the researchers were
auspiciously give the factors that may cause acidosis and determine the major
underlying disease processes at the time of blood gas analysis in animal patients in
details and compare it.

Summary:
Primary metabolic acidosis was the most common disorder identified in dogs, and a
mixed acid base disorder of metabolic acidosis in conjunction with a respiratory
acidosis was the most common disorder evident in cats in this study.
Hyperchloremic metabolic acidosis was more common
than high AG metabolic acidosis. Metabolic acidosis as a compensatory response to
primary respiratory
alkalosis was uncommon in dogs and rare in cats. Twenty-five percent of dogs and
34% of cats could
not be classified as having either a hyperchloremic metabolic acidosis or a high AG
metabolic acidosis.
These results suggest that hyperchloremia is common in small animal patients and
the underlying causes and clinical relevance of this abnormality should be
investigated. The routine categorization of metabolic acidosis based on the
presence of high AG or hyperchloremia may be inadequate in many cases,
indicating that more advanced acid base analytical tools have a role in patients with
complex disease. Arterial and venous blood samples were analyzed together in this

study, using venous results for the acid base diagnosis. Unfortunately, it is not
possible to assess the incidence of metabolic acidosis in specific disease states in
the current study, but these results do indicate that metabolic acidosis is a common
acid base abnormality in those patients for which clinicians elect to perform blood
gas analysis.
The ideal marker of metabolic acidosis remains controversial. Serum bicarbonate
concentration is the traditional indicator of metabolic acid base balance. The strong
ion approach also offers a method of metabolic acid base analysis that is considered
independent of changes in PCO2, but it requires more measured variables than
those provided by the blood gas machine and many complex equations,
making it difficult to apply in the clinical setting. The SBE is calculated from the pH,
PCO2, and
hemoglobin concentration representing the quantity of
acid or base that would need to be added to a liter of blood to normalize the pH with
a PCO2 of 40 mmHg. A simple metabolic acidosis exists when there is a decrease in
bicarbonate and a more negative SBE in conjunction with a lower than normal pH.
As a result, patients with complex metabolic acid base disorders may have been
missed using the inclusion criteria of this study .In this study, compensation in dogs
was determined using previously published criteria. Compensation in cats is not
fully understood, and the studies available to date suggest that cats do not develop
respiratory compensation to a metabolic acidosis. For this reason, compensatory
responses were not evaluated for cats in the present study. For example, the mixed
disorder of metabolic acidosis with concurrent respiratory acidosis caused the most
extreme abnormalities in pH, whereas primary metabolic acidosis was typified by
mild decreases in pH and animals with a combined metabolic acidosis with
respiratory alkalosis had normal pH. For the purposes of this study, the degree of
metabolic compensation considered appropriate for a given respiratory alkalosis
was anything that fell in the range of that reported for acute or chronic disease.
Because there was no way to accurately determine the duration of the primary
disease process in this study, it is possible that some cases were incorrectly
classified as a simple respiratory alkalosis. Primary respiratory alkalosis was only
evident in 6% of the dogs in this study, making it an unusual cause of metabolic
acidosis. Because a large number of acid base evaluations in our hospital are
performed in animals presenting to the emergency room and intensive care unit,
this finding is not surprising, because these patients tend to have complex disease
processes. A high incidence of complex acid base disorders has been demonstrated
in human emergency room and intensive care unit patients. These results suggest
that recognition of mixed acid base disorders is important and that there may be a
role for semi quantitative analysis of acid base balance in critically ill or injured
patients. Calculation of the AG can aid in determination of the underlying cause of a
metabolic acidosis. Unfortunately, in this study, we did not have measurement of
serum albumin concentration and could not evaluate its influence on AG.
Hyperlactatemia was the second most common condition associated with metabolic
acidosis in dogs and the most common cause identified in cats in this study.
Hyperlactatemia is most commonly associated within adequate oxygen delivery to
the tissues. There is a growing body of evidence in the human and veterinary
literature that serum lactate concentration also can have important prognostic

value, in particular lactate clearance over time. This study was not designed to
evaluate the impact of acid base status on outcome, but the frequent occurrence of
hyperlactatemia in this patient population suggests that lactate could be a useful
diagnostic and prognostic tool.