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Following the accidental feeding of a compound feed containing the coccidiostat nicarbacin in layer breeder flocks (Lohmann Brown Classic), the birds displayed distinct clinical signs within a few hours. Mortality increased during the following 5 days, whereas laying performance and hatching rate of eggs during this period decreased markedly. Egg shell discoloration was observed as early as during the first day. As a consequence, an association between feeding of the coccidiostat nicarbacin and the observed symptoms was assumed. Recent studies indicate that Nicarbacin reduces the activity of aminolevulinic acid synthase type 1 (ALAS 1), which is responsible for the synthesis of protoporphyrin IX in the shell gland as main compound of brown egg shells. Reduced laying performance and increased mortality was likely due to nicarbacin-induced deregulated body temperature homeostasis and concomitant imbalances in acid-base status of the animals. The case reveals that the accidental feeding of nicarbacin to non-target animals such as laying hens and their parents may result in acute clinical symptoms. This highlights the necessity of appropriate care in handling feed additives and their premixes for specific non-target animals and should sensitize farmers and veterinarians., Competing Interests: Die Autoren erklären, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

Background: Several reports have confirmed the efficacy of Intralipid® (containing soya bean oil, egg phospholipids, glycerin and water) in the therapy of systemic local anesthetic intoxication. Pretreatment with Intralipid® shifted the dose-response to bupivacaine-induced asystole in rats. Whether intravenous anesthesia with propofol in the widely used medium chain triglyceride lipid emulsion increases the therapeutic range of systemically administered bupivacaine or not is unknown and was investigated in this study., Methods: A total of 30 piglets aged 2-6 weeks and weighing 4.5-6.5 kg were randomized into 2 groups and anesthetized with sevoflurane (group S) alone or with propofol 10 mg/kg body weight (BW)/h plus sevoflurane (group PS). After 60 min of steady state anesthesia arterial blood was sampled for assessment of blood gases, acid-base state and triglyceride plasma concentrations. Thereafter bupivacaine 0.125% was continuously infused by an infusion syringe pump through a central venous line at a rate of 4 mg/kg BW/min until invasively measured mean arterial pressure (MAP) was reduced by 50% of initial value. The bupivacaine infusion was stopped, blood for assessment of bupivacaine plasma concentration was drawn and the spontaneous hemodynamic course was observed. Resuscitation was not attempted. Results are presented as median and range. The Mann-Whitney U-test was used to assess differences between the two groups for triglyceride as well as for bupivacaine plasma concentrations measured at MAP 50%. A p-value≤0.05 was considered to be significant., Results: Baseline conditions (arterial blood pH, plasma protein and triglyceride plasma concentrations) did not differ significantly between the two groups. After 1 h of anesthesia, triglyceride plasma concentrations were significantly increased in group PS (median 0.69 mmol/l) compared to the corresponding baseline values (median 0.14 mmol/l; p<0.001) and to the 1 h values of group S (median 0.16 mmol/l; p<0.001). The total amount of bupivacaine administered was 9 mg/kg BW in both groups (6-13 mg/kg BW in group S, 5-13 mg/kg BW in group PS). Resulting bupivacaine plasma concentrations were 180 μmol/l (83-686 μmol/l) in group S and 185 μmol/l (130-465 μmol/l) in group PS. However, the total amount of bupivacaine administered and bupivacaine plasma concentrations at MAP 50% did not reveal statistically significant differences between the two groups but a huge variability of both parameters within each group was observed. None of the 30 piglets spontaneously recovered and they died from pulseless electrical activity or from asystolic cardiac arrest. The time from MAP 50% until cardiac arrest demonstrated a large variability but did not reveal significant differences between the two groups. The time to cardiac arrest was similar in both groups., Conclusion: Medium/long chain triglyceride lipid emulsion (50:50) as widely used in propofol solutions did not increase therapeutic safety in cases of intravascular bupivacaine administration in this piglet model.

Intravenous administration of fluids, electrolytes and glucose are the most common interventions in hospitalized pediatric patients. Parenteral fluid administration can be life-saving, however, if used incorrectly it also carries substantial risks. Perioperatively, adequate hydration, prevention of electrolyte imbalances and maintenance of normoglycemia are the main goals of parenteral fluid therapy. Conceptionally, the distinction between maintenance requirements, deficits and ongoing loss is helpful. Although the pathophysiological basis for parenteral fluid therapy was clarified in the first half of the 20th century, some aspects still remain controversial. In newborn infants, rational parenteral fluid therapy must take into account large insensible fluid losses, adaptive changes of renal function in the first days of life and the fact that neonates do not tolerate prolonged periods of fasting. In older infants the occurrence of iatrogenic hyponatremia with the use of hypotonic solutions has led to a critical reappraisal of the validity of the Holliday-Segar method for calculating maintenance fluid requirements in the postoperative period. Pragmatically, only isotonic solutions should be used in clinical situations which are known to be associated with increases in antidiuretic hormone (ADH) secretion. In this context, it is important to realize that in contrast to lactated Ringer's solution, the use of normal saline can lead to hyperchloremic acidosis in a dose-dependent fashion. Although there is no convincing evidence that colloids are better than crystalloids, there are clinical situations where the use of the more expensive colloids seems justified. It may be reasonable to choose a solution for fluid replacement which has a composition comparable to the composition of the fluid which must be replaced. Although hypertonic saline can reduce an elevated intracranial pressure, this therapy cannot be recommended as a routine procedure because there is currently no evidence that this intervention improves long-term outcome in pediatric patients with traumatic brain injury.

Objective: Development of a two-buffer model which simulates the acid-base properties of blood and allows comparison of the different acidbase concepts according to Stewart and to Siggaard-Andersen., Methods: The two-buffer model consisted of different aqueous solutions of bicarbonate/CO(2) (pCO(2), sCO(2), pK(1)), HEPES buffer (A(tot), pK(a)) and electrolytes. These were used to calculate the pH from the independent variables according to Stewart - strong ion difference (SID), pCO(2) and total concentration of the weak acids (A(tot)) - from which all other dependent variables (cHCO(3)(-), cA(-), BB, BE) were obtained and compared with the measured values., Results: The normal pH (7.408) was calculated from the normal values for SID (48 mmol/l), pCO(2) (40 mmHg) and A(tot) (45.2 mmol/l) and agreed perfectly with the measured value (7.409+/-0.001). This was also valid for all calculated and measured pH values when the SID was varied: non-respiratory alkalosis ( upward arrow) or acidosis ( downward arrow), pCO(2):respiratory acidosis ( upward arrow) or alkalosis ( downward arrow) and A(tot):hyperproteinemic acidosis ( upward arrow) or hypoproteinemic alkalosis ( downward arrow) were varied and the sum of the buffer bases (BB) was always equal to the SID. All changes and hence BE were also equal, providing that A(tot) was normal. This was not the case, however, if A(tot) was outside the normal range, when BE was then the difference from the normal BB at the respective reference point. Whereas the deviation of the measured pCO(2) was acceptable (1.74+/-0.86 mmHg), this was not the case for the SID (-6.18+/-3.58 mmol/l) calculated from the measured ion concentrations (Na, K, Ca, Cl)., Conclusions: Despite controversial discussions, both concepts are much closer than might be expected. Whereas in the Stewart approach the focus of analysis is on plasma, with the Siggaard-Andersen approach it is on blood. Hence, a combined analysis of the blood gases (pH, pCO(2), pO(2), sO(2), cHb, BE) and of the strong ion gap (SIG) may be useful.

In this study, the influence of simultaneous application of anionic salts (AS) and rumen buffer (RB) on the metabolism of dairy cows was examined. Eleven rumen fistulated, non-pregnant and non-lactating dairy cows received equal amounts of one AS (CaCl2 or CaSO4) and one RB (NaHCO3 or KHCO3) via rumen cannula during feeding time over a period of eight days. Before the first application of AS and RB and on day eight of the treatment period, blood, urine and rumen fluid samples were taken. The following parameters were measured: whole blood: pH, base excess, bicarbonate; serum: sodium, potassium, chloride, calcium; urine: pH, net acid base excretion, sodium, potassium, chloride, calcium; rumen fluid: pH. The changes of each parameter were compared via ANOVA. The changes in acid-base balance on day eight were very small, although significant. But p-values showed that the statistical evidence was low. The most changes occurred when NaHCO3 was fed in combination with one of the AS used. In this case a small acidogenic load was seen in blood (p < 0.05), and calcium concentrations increased slightly (p < 0.05). No alkalotic reaction could be detected when any combination of AS and RB were given to the cows. Simultaneous application of AS and RB results in a loss of effectivity of AS. Neither an adequate acidification of blood nor an activation of calcium metabolism occurred. In feed ration for cows in the last weeks of pregnancy, rumen buffer must not be fed, if anionic salts are given for prevention of parturient paresis.

Lactic acidosis is a life-threatening complication of antiretroviral therapy with an incidence of about 1% per year. Its clinical onset is often abrupt, with uncharacteristic muscular, cardiac or hepatic symptoms. Lactic acidosis is caused by nucleoside analogue reverse transcriptase inhibitors (mainly didanosine, stavudine and zalcitabine), which are relatively strong inhibitors of gamma polymerase, the enzyme responsible for the replication of mitochondrial DNA. Zidovudine is also a mitochondrial toxin, but its toxicity probably reflects several mechanisms unrelated to mtDNA-depletion. When lactic acidosis is diagnosed, nucleoside analogues and other mitochondrial toxins, such as valproic acid and acetylsalicylic acid, must be discontinued immediately. Uridine should be supplemented, a cocktail consisting of vitamins, L-carnitine and coenzyme Q10, may be given.

Background: Preterm infants should be delivered with as little trauma as possible. Fetal extraction during cesarean delivery can be facilitated by modification of the incision or by use of short-term tocolytic agents. A possible alternative to intravenous administration of beta-mimetics is i.v. application of nitroglycerin to induce rapid uterine relaxation. This has been recommended by various clinical teams, but with relatively little experience being available regarding preterm births., Patients and Methods: Retrospective analysis of the perinatal data for all single neonates weighing 500 to 1500 g delivered by cesarean section at the Berlin-Neukölln Hospital in the period from 6/1995 to 9/1999 following prophylactic intraoperative i.v. application to the mother of 0.2 mg nitroglycerin (n = 55). Control groups: 1. All infants weighing 500 to 1500 g delivered by cesarean section at the Berlin-Neukölln Hospital with no intraoperative application of nitroglycerin (n = 38); 2. All infants weighing 500 to 1500 g delivered by cesarean section included in Berlin perinatal statistics (BePE) 1993-1998 (n = 715)., Results: There were no differences between the groups in terms of Apgar scores or the incidence of arterial umbilical pH values < or = 7.10 or of maternal blood loss > 1000 ml. Within the nitroglycerin group, in a shorter interval between nitroglycerin application and cutting of umbilical cord (< or = 3 min: n = 42; > 3 min: n = 13) 1-minute Apgar scores < 7 were observed more rarely, but no differences in arterial umbilical pH values < or = 7.10., Conclusions: 1. Intraoperative nitroglycerin application during cesarean section has no unfavorable effect on the condition of newborns < 32 SSW or between 500 and 1500 g. 2. The incidence of intraoperative maternal blood loss > 1000 ml was not increased. 3. Differences in the interval between nitroglycerin application and cutting of the umbilical cord have no clinically relevant effects on Apgar scores or arterial umbilical pH.

Starting on the 7th day post partum, 200 mg prednisolone were given daily to four healthy cows over a period of five days in order to examine how fat metabolism and liver function were influenced. Samples of blood and urine were taken daily as well as liver biopsies on the third and fifth day. These findings in the cows of the experimental group were compared to those in the four untreated cows (control group). Prednisolone induced a significant increase in glucose and insulin serum concentrations and a decrease of FFA and bilirubin concentrations as well as lipid and rising glycogen concentrations in the liver. The ASAT and GLDH activities as well as the thyroxin concentration decreased tendentiously. The cortisol concentration decreased shortly insignificantly. Acid base status, calcium as well as anorganic phosphorus concentrations were not noticeably influenced. Signs of a higher risk of infection were not observed. The results show that the effect of prednisolone is indirect antilipolytic and protects the liver. They therefore do not support the idea that glucocorticoids lead to an increased lipolysis and fat accumulation in the liver of cows.

Objective: A new portable device for blood gas analyses (BGA) has been examined for prehospital application., Methods: After a 1 h introduction to the procedure, two physicians used the blood gas analyzer in the emergency medical system in Graz, Austria, for 7 months. The indications for prehospital BGA were prolonged cardiopulmonary resuscitation, mechanical ventilation, hyperventilation for reducing increased intracranial pressure, respiratory failure and metabolic disorders. All patients tested were also checked with pulse oximetry and capnography. TECHNICAL SPECIFICATION: The device measures pO2, pCO2 and pH using the fluorescence method. The innovation of a single-use cassette system makes it unnecessary to do any calibrations or transport any test substances. The storage battery measures eight samples without recharge. The time spent on one measurement is 3-6 min., Results: We took 49 samples from 24 patients and found 16 indications for therapeutical intervention, such as buffering metabolic acidosis and adjusting mechanical ventilation by means of BGA. In all cases the analyzer worked reliably., Conclusions: One advantage of BGA over the non-invasive methods pulse oximetry and capnography is that it does not interfere with factors like peripheral vasoconstriction or inequality of the pulmonary ventilation/ perfusion ratio. Moreover, it is the only method for controlled buffering of acid-base disturbances. This means more security in diagnostics and therapeutical interventions for the patient in danger of dying. The device has proved to be a useful addition to the monitoring methods for prehospital application.

In a 7-year-old boy, ichthyosis vulgaris was treated with a 10% ointment for application over a large area of the body surface. In this way, the child received 400 g salicylic acid (0.6 g/kg body weight per day) percutaneously over a period of 4 weeks. The patient was referred to hospital by the family doctor: he was in a deep somnolent state, apparently caused by hyperventilation following wheezing, vomiting, tinnitus and vertigo. Salicylate intoxication was suspected because of metabolic acidosis, an anion gap and respiratory overcompensation. The diagnosis was confirmed by a serum salicylate level of 985 micrograms/ml (therapeutic level 150-300 micrograms/ml). Following forced diuresis and alkalization with sodium bicarbonate, haemodialysis was unnecessary. As the salicylate level declined to values within the therapeutic range, the patient started to recover consciousness, waking on the 4th day. By day 6 there were still obvious neurological deficiencies. Fecal incontinence, bilateral ptosis and intermittent diverging strabismus on the right persisted for some weeks. It was 6 months before complete neurological resolution was achieved. The pathogenesis of salicylate toxicity and the need for safer therapies for ichthyosis vulgaris are discussed.

The use of diuretics leads to a negative sodium and fluid balance without primary effects on serum sodium concentration. This parameter is regulated by the activity of the antidiuretic hormone (ADH) system. Secondary changes in other electrolyte systems and in acid base homeostasis also are induced by diuretic therapy. Especially diuretic induced hypokalemia is important as it is responsible for the excess mortality observed in patients with diuretic treated essential hypertension and cardiac abnormalities. All adverse metabolic effects of diuretic therapy are, in contrast to the antihypertensive action, dose dependent. Changes in fluid and electrolyte metabolism induced by diuretics occur within the first 2 or 3 weeks after initiation of medication. Counterregulatory mechanisms are activated and a new steady state is established. Serial laboratory determinations after this period are not necessary as long as this steady state is not affected by additional events (like a change in therapy or diet as well as the occurrence of vomiting or diarrhea).

Method: Eighteen hospitalized patients with candiduria were treated with oral potassium-sodium-hydrogen citrate to alkalinize the urine. The results obtained were compared with those observed in an untreated retrospective control group. Dosage was adjusted in accordance with the pH of the urine measured immediately before treatment with the aim of achieving a pH of 7 to 7.5., Results: All patients had an indwelling catheter, which is a predisposing factor for candiduria. In 16 out of 18 patients (89%) treatment with potassium-sodium-hydrogen citrate raised pH and resulted in the disappearance of candiduria. Duration of treatment varied between two days and one month (mean: seven days). In four patients the urine became completely sterile; during treatment 12 out of 18 patients developed significant bacteriuria (in eight cases of these the indwelling catheter had been left in place)., Conclusions: Alkalinization of the urine is a simple and effective method of treating candiduria in patients with an indwelling catheter. An additional advantage is the metaphylaxis and prophylaxis of renal stone formation in immobilized patients.

The mucosal barrier in the stomach is complete only when the mucous layer has become saturated with bicarbonate. The latter arises as a waste product, as it were, of acid production in the parietal cell, but is then actively secreted via the surface epithelial cells and tight junctions. If the acid secretion is inhibited by means of drugs, the bicarbonate concentration also decreases. This situation probably occurs only when the bicarbonate batteries in the mucous layer and the surface epithelial cells have become "discharged" after a period of about 24 hours, which indicates an intermittent, non-maximum block. In the region between the surface epithelial cells and the mucous layer, Helicobacter pylori has its ecological niche. As studies with, for example, ranitidine nocte, amoxycillin and metronidazole have shown, a 12 hour alternation between acid secretion inhibition and the physiological buildup of the gastric mucosal barrier appears to promote the eradication of Helicobacter pylori. Hypotheses about the role of sudden ammonia production on the part of the pathogen and on the regulation of bicarbonate and acid production in humans underscore these findings.

Intracervical application of prostaglandin E2 gel is considered to be effective in the induction of cervical ripening (priming). Within an 2-years period 244 perinatal risk patients primed with PGE2 were compared with matched paired controls retrospectively. These 244 controls were matched for age, gestational age, parity, birth weight and maternal body mass index and delivered spontaneously. PGE2 gel (Prepidil) was administered intracervically. Basis criteria of perinatal quality, such as neonatal umbilical cord pH and APGAR-score were significantly (p < 0.01) worse in the patients treated with PGE2 gel. In the priming group cord pH was 7.28 (+/- 0.085) and 7.30 (+/- 0.070) in the control group. APGAR 1 min. was found to be 7.56 +/- 1.86 (priming) and 8.18 +/- 1.23 (control); APGAR 5 min. 8.56 +/- 0.90 (priming) and 8.78 +/- 0.54 (control). Contraction disorders, such as hyperactivity and dyscoordination, combined with cardiotocographic pathology was found in 42% (priming) and 19% (control) resp. Severe bradycardia occurred significantly more often in the priming group, whereas no differences were found concerning fever under labor and in puerperium.

In order to answer the question of whether there is an optimal buffer system for the preservation and reoxygenation period in liver transplantation, sodium/potassium phosphate, HEPES, TRIS (THAM), MOPS and histidine/His-HCl buffers were investigated. The buffers were added to an "extracellular" electrolyte composition of preservation solution. The solutions were incubated with in vitro cultures of pig hepatocytes in two different models. I: during cold hypoxia (4 degrees C, PO2 < 0.1 mmHg) for 24 h, and II. during the reoxygenation period of 3 h after preservation in UW solution. Cell viability, cell detachment rate, and LDH and GOT liberation were used as parameters of cell alteration. The lowest amount of enzyme release during the preservation period and reoxygenation was obtained using sodium or potassium phosphate buffer. Rising LDH and GOT liberation rates during preservation and reoxygenation were observed with HEPES and TRIS buffer. The enzyme release induced by these three buffer systems correlated with their pKa values. Higher pH of the preservation solution resulted in higher enzyme leakage from the cells. In contrast, the Histidine/HCl buffer system with low pH led to striking cell damage during preservation as well as during reoxygenation. MOPS, a weak acid with the lowest pH in solution, led to the lowest enzyme release during the preservation period, but to high enzyme release after reoxygenation with standard medium. Incubation of the cultures with MOPS after UW preservation resulted in lower enzyme levels in comparison to the controls. In summary, PBS had the best results in our study.

Six healthy adult cats were fed a basal minced beef meat and rice diet with varying amounts or combinations of acidifying and alkalizing additives (ammonium chloride, calcium and sodium carbonate). The base excess in the food (mmol/kg dry matter) was calculated (data on food compounds in g/kg dry matter) as follows: base excess = 49.9*Ca + 82.3*Mg + 43.5*Na + 25.6*K - 64.6*P - 13.4*Met-16.6*Cystine -28.2*Cl. It amounted to between +305 and -1079 mmol/kg dry matter. Urine and blood pH as well as balance of minerals and water were determined in the cats. The mean urine pH ranged between 6.1 and 7.8. There was a highly significant correlation between the base excess in the food and the mean urine pH. The regression line was linear down to a base excess in the diet of about -400 to -500 mmol/kg dry matter and a pH in the urine of 6.2. The postprandial increase of urine pH was suppressed either by large amounts of ammonium chloride (> 780 mmol/kg dry matter) alone or in combination with calcium carbonate, but not in combination with sodium carbonate. The relationship between the decrease of the blood pH and the amount of ammonium chloride added to the diet was more marked than the relationship between blood pH and base excess in the food. In order to avoid health risks by long term application of acidifying diets it is recommended to formulate struvite diets with low base excess in such a way, that they contain as few alkalizing compounds as possible, which must be neutralized by acidifiers.

Prostaglandin E2 is often used for induction of labour. A procedure appropriate for obstetrical condition of the cervix uteri is recommended. 1,472 births with a medical indication were induced in a multicenter-study. With a bishopscore < 5 prostaglandin E2 gel intracervical and with a score between 5 and 8 vaginal tablets were used for induction. Appropriate for the condition of cervix it was allowed to continue the induction. With a bishopscore > 8 an infusion of oxytocin was given. The fetal outcome was evaluated appropriate for the condition of cervix before and during induction of labour. The APGAR-score one minute post partum was < 8 in 10.8 per cent of all neonates. This part was near the same in the gel- and in the tablet group (p > 5%). By continuation of induction, the part with pathological findings was at all times not in relation to the different groups of cervical condition. It's the same by APGAR-scores 5 and 10 minutes after delivery. The acidotic morbidity at all was 10.7%. Also in this connection it was only an unimportant (p > 5%) increasing to observe then the induction was continued. There is no relation between the different groups of cervical condition and the acidotic morbidity. Under observation of mother and child the to cervical condition appropriated used method of induction of labour does not expect a bad neonatal outcome. The longer the cervix is unripen, the higher is the rate of delivery by caesarean section. The exploitation of the possibilities of induction by drugs can be recommended.

40 not selected elderly patients (average age 79.3 years were investigated with a oesophago-gastro-duodenoscopy (OGD). For premedication the patients got 5 mg Diazemuls R and 20 mg Buscopan R i.v. With 30 patients there was taken a blood-gas-analysis before premedication and before fiberendoscopy. ECG-registration was performed before OGD und during OGD with all patients. The premedication led to a reduction of the p02 on an average of 8.9%. The average pO2 did not decrease below the age-related value. In some cases there was a great difference. With a 86-year old woman the pO2 decreased about 25% after premedication and led to a severe hypoxaemiae. Only patients (12.5%) showed a few ventricular extrasystoles, there was no serious arrhythmia. After premedication the heart-rate rose over 100 heart-beats per minute up to maximal 137 beats/minute in 9 patients. If a low dose of Diazemuls R is used, there is no need to do the OGD in elderly patients without premedication. However, there should be the possibility to give a patient oxygen via nasal insufflation to prevent severe hypoxaemia which can occur in some cases. In general, monitoring is only necessary for patients with a higher risk.

Illicit drug abuse, as well as smoking, are known risk factors in the development of intrauterine growth retardation. In an attempt to clarify the influence of these two aetiological factors, a retrospective analysis was carried out. 35 drug- and nicotine-addicted pregnant women were compared to 104 smokers and 101 non-smoking controls with regard to foetal outcome. Relative risk estimates for intrauterine growth retardation of the drug and nicotine group were 3.14 (95% confidence limits 1.88-5.25; p = 0.0001) whereas the smoking group had 1.39 (95% confidence limits 0.96-2.02; p = 0.0482) compared to non-smoking controls. The foetal outcome was best in the latter group: children of drug-addicted mothers had a considerably higher morbidity and mortality rate. This study shows an almost threefold risk for intrauterine growth retardation in drug-addicts who smoke, compared to nicotine abuse alone.

The side effects of anthraquinones, diphenylmethane derivatives (e.g. bisacodyl, sodium picosulphate), saline laxatives, lactulose, and cisapride are discussed. When taken in recommended doses, no relevant side effects have been observed, except for hypermagnesemia following magnesium containing cathartics in renal insufficiency. This holds also true for the time of pregnancy and lactation. (Pseudo-)melanosis coli is characterized by pigment loaded macrophages without apparent functional consequences. It occurs mainly after anthraquinones, but to a lesser degree also after diphenylmethane derivatives. Clinically relevant side effects of the above laxatives have been published exclusively after excessive dosing. They consist in electrolyte disturbances (mainly hypokalemia), metabolic alkalosis, renal tubular dysfunction, and other less frequent side effects. Cases of "cathartic colon" have not been published during the last decades. It was probably due to laxatives which are no longer used.

Long-term administration of ciclosporin has been complicated by side-effects, the predominant being nephrotoxicity. We performed renal function studies on 20 patients treated with ciclosporin (group 1) and on 12 patients serving as controls (group 2). Only patients with serum creatinine less than 1.3 mg/dl entered the study. The renal function studies consisted of: Inulin clearance, PAH clearance, sodium sulphate loading, sodium bicarbonate loading. Plasma renin activity (PRA), inactive renin (IR) and aldosterone (ALDO) were measured basally and after stimulation with 40 mg furosemide i.v. Serum creatinine was not significantly impaired under ciclosporin with 1.1 +/- 0.1 mg/dl vs 0.9 +/- 0.1 mg/dl in the control group (ns). Glomerular filtration rates as measured by creatinine and inulin clearance were significantly impaired in group 1 as compared to group 2. Inulin clearance was impaired by ciclosporin with 93.5 +/- 4.4 ml/min/1.73 m2 as compared to 121 +/- 6.6 ml/min/1.73 m2 (p less than 0.05) in patients of group 2. The PAH clearance in ciclosporin treated patients was impaired, with 379 +/- 22.1 ml/min/1.73 m2 in group 1 as compared to 605 +/- 39 ml/min/1.73 m2 (p less than 0.001) in group 2. Mean arterial pressure and renovascular resistance were significantly increased in ciclosporin treated patients. We demonstrated, by means of sodium sulphate and bicarbonate loading, incomplete distal tubular acidosis in 3 patients from group 1 but in none of group 2. There was no difference in basal plasma renin activity (PRA), but during volume contraction induced by furosemide there was only blunted response by PRA in patients receiving ciclosporin with 2.7 +/- 0.3 ng/ml/h as compared to 7.7 +/- 0.5 ng/ml/h in controls.(ABSTRACT TRUNCATED AT 250 WORDS)

Two patients aged 37 and 44 years developed life-threatening lactic acidosis following abdominal surgery and a period of about 3 weeks of total parenteral nutrition. Septicaemia and hypoxia were excluded as possible causes. Conventional treatment including high doses of buffer agents was unsuccessful. Thiamine (vitamin B1) depletion was suspected as the cause of the metabolic acidosis, and two doses of 400 mg thiamine were given. In both patients, the lactic acidosis improved immediately, and it disappeared following the second dose of thiamine. Both patients were subsequently discharged as symptom-free. As part of the pyruvate-dehydrogenase (PDH) complex, thiamine was capable of improving the life-threatening situation.

A changed exocrine pancreatic secretion could be a pathogenetic factor of an acute pancreatitis after administration of angiotensin-converting enzyme (ace) inhibitors. In six conscious dogs with gastric and duodenal Thomas fistulas we studied the effect of an intravenous (iv.) bolus injection of 10 mg enalaprilat, an intraduodenal (id.) bolus injection of 20 and 40 mg enalapril (e.), and 0.15 M NaCl (20 ml iv., resp., id.) on pancreatic bicarbonate- and protein output in response to secretin (20.5 pmol/kg bw/h and caerulein (29.6 pmol/kg bw/h). Arterial blood pressure and heart rate we also measured. The iv. and id. injection of enalapril(at) significantly increased heart rate by 28% after 10 mg of e. iv. [peak 101 +/- 11 beats/min, N = 6, X +/- SEM] and by 13 resp. 37% after 20 resp. 40 mg e. id. [peak 89 +/- 4, resp., 108 +/- 7 beats/min] as compared to control [peak 79 +/- 5 beats/min]. Systolic blood pressure was significantly decreased by 6% after 10 mg e. iv. [lowest value 121 +/- 2 mm Hg] and by 8% and 9% after 20 and 40 mg e. id., respectively, [lowest value 119 +/- 2, resp., 118 +/- 1 mm Hg] as compared to control [lowest value 129 +/- 1 mm Hg]. The applied enalapril(at) doses had no significant effect on hormonal stimulated pancreatic bicarbonate- and protein output. The results confirmed the well known effects of enalapril(at) on heart rate and on arterial blood pressure. Beyond that the results exposed that therapeutical doses of enalapril(at) had no significant effect on exocrine pancreatic secretion. Conclusion of this study is that a pathogenetic role of pancreatic exocrine secretion in the ace-inhibitors and the acute pancreatitis induced by ace-inhibitors is unlikely.

To investigate the effect of partial correction of anemia in patients maintained by chronic intermittent hemodialysis on exercise capacity, patients underwent a bicycle acido-ergometry before and after treatment with recombinant human erythropoietin. The results demonstrate a (subjective) improvement of exercise capacity without any evidence for that in the pH values.

The substitution fluids applied in continuous haemofiltration contain 40 mmol/l of lactate. This is unphysiological, since administration of large amounts of lactate lowers the phosphorylation potential and increases catabolism. With bicarbonate-buffered fluid three problems may arise: 1. Precipitation of calcium carbonate and magnesium carbonate; 2. pH is usually 8.4; 3. evaporation of CO2 increases pH. To solve these problems we applied a two-component system consisting of a glass bottle with 160 ml sodium bicarbonate 8.4% and a bag with 4.5 l of acidic solution. Prior to use, the bicarbonate was infused into the bag. The values of Ca++, Mg++, bicarbonate, and pH in this final substitution solution were constant during a 24 hr period after mixing. Precipitation of Ca++ and Mg++ carbonate was prevented by 3 mmol/l of lactic acid in the solution. The pH was 7.37. Evaporation of CO2 was prevented by bags made of special plastic sheeting. The solution was then applied in 7 intensive-care patients suffering from acute renal failure treated by continuous arteriovenous haemofiltration. No side effects of the solution were observed during six days of treatment. The values of Ca++, bicarbonate, pH, and pCO2 remained constant under clinical routine conditions. Hence, bicarbonate-buffered substitution solution is recommended for continuous haemofiltration. Continuous haemofiltration is now also available for patients with impaired liver function and increased lactate levels.

Acid-base balanced in cows were but slightly affected by butyric acid exposure experiment over three weeks. Applications of sodium butyrate over the same period of time, on the other hand, was associated with buildup of alkalosis in the second half of the experimental period, with alternation of loading, compensation, and reloading being recordable. Nitrogen metabolism in cows was but slightly affected under the given experimental conditions. However, clearly noticeable impairment of nitrogen metabolism was exhibited by one cow that had fallen ill, in the course of experimentation.

The opioid Fentanyl was used in a dosage of 0.15 mg via a peridural catheter for birth analgesia (PDA) in a high risk collective of 40 female patients. A prolonged analgesia with good acceptance could be achieved with low dosage. The advantages of the mobilisation could be fully used because of telemetric monitoring and missing influence of the sympathetic nerve and undisturbed motoric activity. If a caesarean section was necessary we continued the peridural analgesia using 0.5 percent Marcain. Postnatal assessment of the condition of the newborn was not disturbed. Short-term irregularities in CTG--a decrease of the rate of acceleration, a silent oscillation pattern--are interpreted in the sense of a sleeping pattern, without harmful influence on the fetus. At present PDA is the most effective method in birth analgesia. It represents a valuable contribution to the care in the field of psychomotoric preparation of patients to birth. Considering the contraindications PDA with Fentanyl can be recommended in obstetrics.

43 patients in 31-42 weeks of gestation showed fetal distress confirmed by fetal scalp blood measurements and/or cardiotocography. In addition to conventional treatment of intrapartum fetal distress a beta-adrenergic receptor stimulator, fenoterol was given, 1. as iv. bolus of 25 micrograms in two min. 2. iv. bolus of 25 micrograms + iv. infusion of 3-4 micrograms/min or 3. iv. infusion of 3-4 micrograms/min. The suppression of labor was sufficient in 88 per cent and the improvement of fetal condition allowed the avoidance of an emergency operation in 84 per cent. The diagnosis was confirmed in addition to CTG, by fetal scalp blood pH measurements in 65 per cent of cases. The fetal blood pH was 7,20 and BE - 8,77 before therapy, after tocolytic therapy pH 7,23 and BE - 7,53 and in umbilical cord arterial blood pH 7,21 and BE - 12,12. Apgar scores at 1' and 5' averaged 8,0 and 9,1.

The goal of any anaesthesiologist delivering anaesthesia to patients with pre-existing lung disease has to be the prevention of intra- and postoperative complications. Changes in gas exchange imposed by anaesthesia and surgery can cause dangerous disturbances in oxygen transport and in acid-base balance. Uptake and elimination of volatile and gaseous anaesthetics depend upon normal respiratory function. Any marked impairment can considerably modify the kinetics of these processes.

This report presents 100 epidural analgesias using a catheter in a high risk group. Two groups are compared, one with intermittent manual injections, the other with constant infusion rate (CIR) by means of a syringe with bupivacaine solution 0,5% and a pump. The analgetic effect was stable, without fluctuations and was adequate during the first and the second stage of labour in the group with CIR. The CIR avoids plasma peaks with transient hypoxemia of the fetus. The high blood pressure in patients with severe pregnancy induced hypertension is more decreased with this technique. In comparison to deliveries without epidural analgesia the instrumental delivery rate was higher, the fetal outcome was equal. Severe complications are not seen. The indicated use of the epidural analgesia with CIR is recommended.

Intravenous infusion of glucose in high dosage was given to 42 tumor patients, attaining a hyperglycemia of about 40 mg/100 ml over a period of 24 hours. This hyperglycemia is a part of the so-called "cancer-multistep-therapie". During the period of glucose-infusion a water-turnover of about 6,000 ml can be registered which is connected with a requirement of glucose of about 2,000 g. Only 1/3 of this amount is loosing by renal excretion, but 2/3 are metabolised to correspond with a glucose-uptake of 0,94 g and a glucosuria of 0,32 g per kg bodyweight and hour. Requirement of glucose and glucose uptake are in inverse proportion to the age of the patients and to the duration of hyperglycemia. Further a "glucose-potassium-equivalent" existed: about 10 mval potassium per 100 g infused glucose, whereas the netto uptake of potassium is 0,049 mval per g of metabolised glucose. Acid-base-equilibrium and red blood-picture did not show any relevant variations while typical deviations of some other parameters (cardiac-frequency, body-temperature), white blood-picture) are can be associated with the so-called "general adaptation syndrom". The findings are discussed in view of their general importance for the parenteral application of glucose.

Therapy of chronic renal failure requires individual management in diet and vigorous treatment of disorders of fluid and electrolyte metabolism and renal acidosis. Concomitant diseases such as renal hypertension, arrhythmia, cardiac insufficiency, pulmonary complications, gastrointestinal disorders, renal anaemia, affection of central nervous system, disturbance in glucose, uric acid and lipid metabolism and infections, demand careful medication Selection of drugs and doses related to impaired renal functions, is indicated.

A well known complication following surgical intervention is metabolic alkalosis. In general this acid-base disturbance is treated in our intensive care units by application of arginine-hydrochloride. In an experimental study on rats in vivo we determined the influence of this substance on the acid-base status of the extra- and intracellular body compartment. It was found that the extracellular bicarbonate decreases but there is nearly no influence on intracellular buffering. The "mean whole body pHi", an overall estimate of the intracellular pH as complementary to the in vivo determined extracellular plasma pH, was determined with DMO (5,5-dimethyl-2,4-oxazolidinedione) and shown to increase significantly after application of arginine-HCl. From this result it is concluded that arginine-hydrochloride should no longer be used for clinical therapy of metabolic alkalosis.

The authors' experience with Ketalar anaesthesia applied in 483 cases has been described. The effect of the narcotic on the cardiovascular system, respiration and acid-base household is analysed in details. As stated by the authors, the narcotic is well applicable in obstetrical and gynecological small operations. By appropriate preparation the occurence of side effects can be reduced. With Shirodkar operations increase of the uterine tonus can be prevented by protective premedication. Ketalar is not recommended for the introduction of anaesthesia in cases of Caesarean section as it may increase the incidence of neonatal asphyxia.

For the estimation of the haemodynamic and metabolic effect of 1 mg/kg phenoxybenzamine in a kidney donor with craniocerebral trauma model experiments were performed on dogs with hypovolaemic hypotension. The results show that phenoxybenzamine leads to vasodilatation in a constant aortic pressure of 80 mm Hg in the systemic circulation as well as in the renal circulation with different speed of reaction. Thus the arterial and venous O2 and CO2 partial pressure normalizes and the diuresis increases. On the other hand, the hypotension-conditioned metabolic acidosis and the symptoms of an acute renal failure may not be influenced.

9 normal pregnant women in the active phase of labor were treated with 500 ml low molecular dextrane with a pH of 4,5 under standardised external conditions. Before and after this infusion simultaneous estimations of the maternal and fetal acid-base status were made. There was neither a maternal nor a fetal acidosis.