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To investigate whether the difference between sodium and chloride ([Na + ] – [Cl − ]) and anion gap corrected for albumin and lactate (AG corr ) could be used as apparent strong ion difference (SID app ) and strong ion gap (SIG) surrogates (respectively) in critically ill patients.    Methods  A total of 341 patients were prospectively observed; 161 were allocated to the modeling group, and 180 to the validation group. Simple regression analysis was used to construct a mathematical model between SID app  and [Na + ] – [Cl − ] and between SIG and AG corr  in the modeling group. Area under the receiver operating characteristic (ROC) curve was also measured. The mathematical models were tested in the validation group.    Results  in the modeling group, SID app  and SIG were well predicted by [Na + ] – [Cl − ] and AG corr  (R 2  = 0.973 and 0.96, respectively). Accuracy values of [Na + ] – [Cl − ] for the identification of SID app  acidosis (<42.7 mEq/L) and alkalosis (>47.5 mEq/L) were 0.992 (95% confidence interval [CI], 0.963–1) and 0.998 (95%CI, 0.972–1), respectively. The accuracy of AG corr  in revealing SIG acidosis (>8 mEq/L) was 0.974 (95%CI: 0.936–0.993). These results were validated by showing excellent correlations and good agreements between predicted and measured SID app  and between predicted and measured SIG in the validation group (R 2  = 0.977; bias = 0±1.5 mEq/L and R 2  = 0.96; bias = −0.2±1.8 mEq/L, respectively).    Conclusions  SID app  and SIG can be substituted by [Na + ] – [Cl − ] and by AG corr  respectively in the diagnosis and management of acid-base disorders in critically ill patients.

Use of Sodium-Chloride Difference and Corrected Anion Gap as Surrogates of Stewart Variables in Critically Ill Patients