Journal
JOURNAL OF CLINICAL MEDICINE
Volume 11, Issue 15, Pages -Publisher
MDPI
DOI: 10.3390/jcm11154273
Keywords
renal; kidney; tubular; pregnancy; acidosis; intensive care unit; acid-base
Categories
Funding
- Institute of Intensive Care Medicine, University Hospital of Zurich, Zurich, Switzerland
- DFG [DA1209/4-3, DA1209/7-1]
- Schweizerischer Nationalfonds [SNF 310030 208100]
- Deutsches Zentrum Lungenforschung (DZL)
- Terumo
- Octapharma
- Cytosorbents
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This study analyzed the clinical course of metabolic acidosis in critically ill pregnant COVID-19 patients, finding it to be common with some patients meeting diagnostic criteria for RTA. All patients recovered spontaneously within less than 7 days.
Background: Renal tubular acidosis (RTA) is an extremely rare cause of metabolic acidosis (10 in 100,000). RTA has been linked neither to pregnancy nor to severe coronavirus disease 2019 (COVID-19). The purpose of this study was to analyze the prevalence and clinical course of normal anion gap metabolic acidosis in critically ill pregnant COVID-19 patients and to compare them to an age-matched nonpregnant female patient cohort. Methods: Secondary analysis was conducted on a prospective observational cohort of critically ill patients suffering from COVID-19 consecutively admitted to a tertiary intensive care unit (ICU) between February 2020 and April 2021. Results: A total of 321 COVID-19 patients required admission to the ICU; 95 (30%) were female, and 18 (19%) were of childbearing age. Seven of eight (88%) pregnant women (all in the last trimester) required advanced respiratory support due to COVID-19. The estimated glomerular filtration rate was 135 (123-158) mL/min/m(2) body surface area, and six pregnant women (86%) were diagnosed with a normal, respiratory compensated, anion gap metabolic acidosis (pH(min) 7.3 (7.18-7.31), HCO3min- 14.8 (12.8-18.6) mmol/L, and paCO(2) 3.4 (3.3-4.5) kPa). Three (43%) acidotic pregnant women fulfilled diagnostic criteria for RTA. All women recovered spontaneously within less 7 days. Conclusions: Metabolic acidosis seems to be very common (85%) in pregnant critically ill COVID-19 patients, and the prevalence of RTA might be higher than normal. It remains to be demonstrated if this observation is an indirect epiphenomenon or due to a direct viral effect on the tubular epithelium.
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