• Amichai Gutgold, Shaden Salameh, Jeries Nashashibi, and Yonatan Gershinsky.
• Medical Intensive Care Unit, Rambam Health Care Campus, Haifa, Israel. Electronic address: a_gutgold@rambam.health.gov.il.
• Am J Emerg Med. 2024 Feb 1; 76: 364036-40.

Aim Of The StudyThe development of acidosis in critically ill patients is considered to be a negative prognostic factor, and when extreme, even incompatible with life. We aimed to test the prognosis of patients with a pH lower than 6.9 on emergency department admission.MethodsA retrospective cohort study in adult patients admitted to two emergency departments with a pH < 6.9 during the first 12 h of admission. Primary outcome was mortality within 24 h from emergency department admission. We performed a regression analysis of clinical and laboratory data in order to identify factors associated with mortality in this population.ResultsWe analyzed data of 206 admissions to the emergency departments between 2008 and 2018 with extreme acidosis. pH Values ranged from 6.898 to 6.35 (mean 6.8 and median 6.83). 60 (29%) of the patients survived the first 24 h. 35 patients (58%) of those also survived to hospital discharge, and of them 80% have returned to their previous functional status. Patient's age, type of acidosis, cardio-pulmonary resuscitation on arrival, and diagnosis on admission were correlated with survival.ConclusionsA small but significant portion of patients with extreme acidosis on emergency department admission survive at least to 24 h and until hospital discharge. The clinical decision making should be based on other prognostic factors rather than pH value by itself.Copyright © 2023 Elsevier Inc. All rights reserved.

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