Effect of alcohol on the utility of base deficit in trauma.

OBJECTIVE: Base deficit (BD) is an indicator of metabolic acidosis and is used as an index of shock and resuscitation for trauma patients. Ethanol causes an increase in lactate production and may cause metabolic acidosis in otherwise normal patients. The effects of alcohol on BD have not been investigated. This study was performed to determine the effects of ethanol on the utility of BD for assessing shock and resuscitation among trauma patients.
DESIGN: Retrospective review of trauma registry, blood bank, and medical records data.
METHODS: Data were collected for trauma patients admitted to the University Medical Center Level I trauma service from July 1990 through August 1995 with an arterial blood gas and blood alcohol level obtained within 1 hour of admission.
MEASUREMENTS AND MAIN RESULTS: The Trauma Score and the Revised Trauma Score were slightly higher (p < 0.001), and the Injury Severity Score was significantly lower (p < 0.001) in the presence of alcohol. These changes were present until patients reached the severe BD category (< or = -10), at which point there were no significant differences across all blood alcohol levels. In spite of these changes, there was no difference in intensive care unit or hospital length of stay in any BD or blood alcohol group. In patients with a BD < or = -6, there was a decreased requirement for transfusion in the presence of alcohol (57 vs. 78%; p < 0.001, chi2), but the majority of patients in both groups required blood transfusion.
CONCLUSION: Ethanol can contribute significantly to metabolic acidosis among trauma patients and may confound the utility of BD to some degree. There was no difference in intensive care unit or overall length of stay, however, regardless of ethanol level, and the majority of patients with a BD < or = -6 still required transfusion. Even in the presence of ethanol, a BD < or = -6 remains a powerful indicator of major injury, increased length of stay, and transfusion requirement.