383 results on '"Hyperchloremic acidosis"'
Search Results
2. Deferasirox-induced hyperammonemia and Fanconi syndrome: a case report
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Houfu Zhou, Daoxue Xiong, Yan Feng, and Jianyu Jiang
- Subjects
hyperchloremic acidosis ,deferasirox hyperchloremic ,metabolic acidosis ,hyperammonemia ,Fanconi syndrome ,Pediatrics ,RJ1-570 - Abstract
BackgroundThe exact mechanism of hyperammonemia is thought to be multifactorial, but is not yet fully understood. No studies have yet reported hyperammonemia combined with Fanconi syndrome caused by deferasirox.Case presentationA 10-year-old girl was admitted for vomiting and altered consciousness. Blood testing revealed hyperammonemia and normal liver and coagulation functions. During hospitalization, the patient also exhibited hyperchloremic metabolic acidosis, hypokalemia, hyponatremia, and hypophosphatemia. Additionally, urinalysis revealed glucose and protein levels clinically consistent with Fanconi syndrome. The patient had a history of severe beta-thalassemia and had received intermittent blood transfusions for approximately ten years. The patient had been administered oral deferasirox at a 400 mg/day dose at the age of four, which had been gradually increased to the current 750 mg/day dosage. Upon admission, deferasirox was discontinued and treatment including mechanical ventilation, continuous blood purification therapy for ammonia reduction and acidosis, and electrolyte imbalance corrections was administered. Subsequently, serological markers returned to normal, urine test findings improved. To the best of our knowledge, this is the first report of a case of hyperammonemia with Fanconi syndrome owing to deferasirox.ConclusionsFor effective management and long-term follow-up of chronic diseases in children, pediatricians must master standardized treatments and the adverse reactions of various drugs. When symptoms are difficult to explain clinically, we must trace the source and adjust the treatment plan to maximize improving the patient's prognosis.
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- 2024
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3. Patogeneze euglykemické ketoacidózy asociované se SGLT2 inhibitory.
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M., Šitina and V., Šrámek
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Euglycemic ketoacidosis associated with SGLT2 inhibitors, also referred to as gliflozins, is a rare but potentially fatal clinical entity characterized by metabolic acidosis with normal or only mildly elevated glycemia, predominantly in patients with type 2 diabetes mellitus. In addition to ketoacidosis, hyperchloremic acidosis may also contribute significantly to metabolic acidosis. Relative hypoglycemia induced by gliflozins and concomitant stress condition lead to decreased insulin level and increased glucagon, cortisol, and catecholamines, which stimulates ketogenesis. At the same time, gliflozins induce com‑ plex renal metabolic dysfunction, in particular impaired renal elimination of acids and renal ammoniogenesis, resulting in hyperchloremic acidosis. In patients treated with gliflozins, acid-base balance and ketonemia should be checked in a timely manner when their condition worsens. Treatment of acidosis consists of discontinuation of gliflozin and administration of insulin at a dose sufficient to suppress ketogenesis. Because of the risk of acidosis, gliflozins should be discontinued at least 3 days before elective surgery and resumed only after stabilization and reliable restoration of oral intake. Similarly, gliflozins should be discontinued in most hospitalized nonsurgical patients with risk factors for the development of acidosis, such as in patients with acute infection, acute heart disease, stroke, fasting before examination, or alcohol abuse. [ABSTRACT FROM AUTHOR]
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- 2024
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4. Euglykemická ketoacidóza asociovaná se SGLT2 inhibitory a DPP4 inhibitory – rozbor kazuistik.
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M., Šitina and V., Šrámek
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Euglycemic ketoacidosis is a rare but potentially fatal complication of treatment with SGLT2 inhibitors (gliflozins). However, similar euglycemic ketoacidosis may rarely occur with other antidiabetic drugs or conditions such as pregnancy or alcohol abuse. We describe 3 cases of our patients with euglycemic ketoacidosis associated with gliflozins and 1 case associated with the DPP4 inhibitor sitagliptin and discuss in detail the acid-base disturbances present and the distinction of euglycemic ketoacidosis from classical ketoacidosis in type 1 diabetes. [ABSTRACT FROM AUTHOR]
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- 2024
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5. Empagliflozin-associated postoperative mixed metabolic acidosis. Case report and review of pathogenesis
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Michal Sitina, Marek Lukes, and Vladimir Sramek
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Empagliflozin ,SGLT2 inhibitor ,Euglycemic ketoacidosis ,Hyperchloremic acidosis ,Case report ,Diseases of the endocrine glands. Clinical endocrinology ,RC648-665 - Abstract
Abstract Background Euglycemic diabetic ketoacidosis associated with SGLT2 inhibitors is a rare, relatively new and potentially fatal clinical entity, characterized by metabolic acidosis with normal or only moderately elevated glycemia. The mechanisms are not fully understood but involve increased ketogenesis and complex renal metabolic dysfunction, resulting in both ketoacidosis and hyperchloremic acidosis. We report a rare case of fatal empagliflozin-associated acidosis with profound hyperchloremia and review its pathogenesis. Case presentation A patient with type 2 diabetes mellitus treated with empagliflozin underwent an elective hip replacement surgery. Since day 4 after surgery, he felt generally unwell, leading to cardiac arrest on the day 5. Empagliflozin-associated euglycemic diabetic ketoacidosis with severe hyperchloremic acidosis was identified as the cause of the cardiac arrest. Conclusions This unique case documents the possibility of severe SGLT2 inhibitor-associated mixed metabolic acidosis with a predominant hyperchloremic component. Awareness of this possibility and a high index of suspicion are crucial for correct and early diagnosis.
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- 2023
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6. Empagliflozin-associated postoperative mixed metabolic acidosis. Case report and review of pathogenesis.
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Sitina, Michal, Lukes, Marek, and Sramek, Vladimir
- Subjects
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ELECTIVE surgery , *EMPAGLIFLOZIN , *SURGICAL complications , *METABOLIC disorders , *TYPE 2 diabetes , *SEVERITY of illness index , *POSTOPERATIVE period , *CARDIAC arrest , *SODIUM-glucose cotransporter 2 inhibitors , *ACIDOSIS , *DIABETIC acidosis , *DISEASE risk factors , *DISEASE complications - Abstract
Background: Euglycemic diabetic ketoacidosis associated with SGLT2 inhibitors is a rare, relatively new and potentially fatal clinical entity, characterized by metabolic acidosis with normal or only moderately elevated glycemia. The mechanisms are not fully understood but involve increased ketogenesis and complex renal metabolic dysfunction, resulting in both ketoacidosis and hyperchloremic acidosis. We report a rare case of fatal empagliflozin-associated acidosis with profound hyperchloremia and review its pathogenesis. Case presentation: A patient with type 2 diabetes mellitus treated with empagliflozin underwent an elective hip replacement surgery. Since day 4 after surgery, he felt generally unwell, leading to cardiac arrest on the day 5. Empagliflozin-associated euglycemic diabetic ketoacidosis with severe hyperchloremic acidosis was identified as the cause of the cardiac arrest. Conclusions: This unique case documents the possibility of severe SGLT2 inhibitor-associated mixed metabolic acidosis with a predominant hyperchloremic component. Awareness of this possibility and a high index of suspicion are crucial for correct and early diagnosis. [ABSTRACT FROM AUTHOR]
- Published
- 2023
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7. Flüssigkeitsmanagement auf der Intensivstation: Kochsalz- vs. balancierte Lösung.
- Author
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Doevelaar, Adrian and Westhoff, Timm H.
- Abstract
Copyright of Die Nephrologie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
- Published
- 2023
- Full Text
- View/download PDF
8. Deferasirox-induced hyperammonemia and Fanconi syndrome: a case report.
- Author
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Zhou H, Xiong D, Feng Y, and Jiang J
- Abstract
Background: The exact mechanism of hyperammonemia is thought to be multifactorial, but is not yet fully understood. No studies have yet reported hyperammonemia combined with Fanconi syndrome caused by deferasirox., Case Presentation: A 10-year-old girl was admitted for vomiting and altered consciousness. Blood testing revealed hyperammonemia and normal liver and coagulation functions. During hospitalization, the patient also exhibited hyperchloremic metabolic acidosis, hypokalemia, hyponatremia, and hypophosphatemia. Additionally, urinalysis revealed glucose and protein levels clinically consistent with Fanconi syndrome. The patient had a history of severe beta-thalassemia and had received intermittent blood transfusions for approximately ten years. The patient had been administered oral deferasirox at a 400 mg/day dose at the age of four, which had been gradually increased to the current 750 mg/day dosage. Upon admission, deferasirox was discontinued and treatment including mechanical ventilation, continuous blood purification therapy for ammonia reduction and acidosis, and electrolyte imbalance corrections was administered. Subsequently, serological markers returned to normal, urine test findings improved. To the best of our knowledge, this is the first report of a case of hyperammonemia with Fanconi syndrome owing to deferasirox., Conclusions: For effective management and long-term follow-up of chronic diseases in children, pediatricians must master standardized treatments and the adverse reactions of various drugs. When symptoms are difficult to explain clinically, we must trace the source and adjust the treatment plan to maximize improving the patient's prognosis., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2024 Zhou, Xiong, Feng and Jiang.)
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- 2024
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9. Perioperative Fluid Management in Pediatric Patients
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Chhabada, Surendrasingh, Licina, Lauren, Gupta, Namita, Farag, Ehab, editor, Kurz, Andrea, editor, and Troianos, Christopher, editor
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- 2020
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10. Effect of 0.9% NaCl compared to plasma-lyte on biomarkers of kidney injury, sodium excretion and tubular transport proteins in patients undergoing primary uncemented hip replacement – a randomized trial
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A. M. Østergaard, A. N. Jørgensen, S. Bøvling, N. P. Ekeløf, F. H. Mose, and J. N. Bech
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Isotonic saline ,Hyperchloremic acidosis ,Acute kidney injury ,NGAL ,KIM-1 ,Diseases of the genitourinary system. Urology ,RC870-923 - Abstract
Abstract Background Isotonic saline (IS) is widely used to secure perioperative cardiovascular stability. However, the high amount of chloride in IS can induce hyperchloremic acidosis. Therefore, IS is suspected to increase the risk of acute kidney injury (AKI). Biomarkers may have potential as indicators. Methods In a double-blinded, placebo-controlled study, 38 patients undergoing primary uncemented hip replacement were randomized to IS or PlasmaLyte (PL). Infusion was given during surgery as 15 ml/kg the first hour and 5 ml/kg the following two hours. Urinary samples were collected upon admission and the day after surgery. As surgery was initiated, urine was collected over the course of 4 h. Hereafter, another urine collection proceeded until the morning. Urine was analyzed for markers of AKI neutrophil gelatinase-associated lipocalin (NGAL) and kidney injury molecule-1 (KIM-1). Arterious and venous blood samples for measurements of pH and plasma electrolytes including chloride (p-Cl) were collected as surgery was initiated, at the end of surgery and the following morning. Results IS induced an increase in p-Cl (111 ± 2 mmol/L after IS and 108 ± 3 after PL, p = 0.004) and a decrease in pH (7.39 ± 0.02 after IS and 7.43 ± 0.03 after PL, p = 0.001). Urinary NGAL excretion increased in both groups (ΔNGAL: 5.5 [4.1; 11.7] μg/mmol creatinine p = 0.004 after IS vs. 5.5 [2.1;9.4] μg/mmol creatinine after PL, p
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- 2021
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11. Prepartum anionic diet induces hyperchloremic acidosis in high-producing dairy cows without preventing subclinical hypocalcemia
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Keli D.C.L. Ramella, Luis G. Cucunubo Santos, Thais H.C. Patelli, Karina K.M.C. Flaiban, and Júlio A.N. Lisbôa
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Hyperchloremic acidosis ,hypocalcemia ,transition period ,serum electrolytes ,ammonium chloride ,calcium metabolism ,dietary cation-anion difference ,dairy cattle ,prepartum diet ,cattle ,Veterinary medicine ,SF600-1100 - Abstract
ABSTRACT: In this study we evaluated the effects of the prepartum anionic diet on the electrolyte balance and calcemia of high producing dairy cows in the first days of lactation, and investigated the impact on the frequency of subclinical hypocalcemia (SCH). Sixty healthy Holstein cows, producing 30 kg of milk/day, handled in intensive system (compost barn), were distributed in groups (n=15) according to lactation order: first, second, third, and fourth to sixth. In the last three weeks before calving they received a diet with negative DCAD (-6mEq/100g DM) and high chloride content. After calving, they received a diet with positive DCAD (18mEq/100g DM). Urine pH was measured before calving. Serum Na+, Cl-, K+, and total Ca concentrations, and the strong ion difference (SID3) were determined in samples taken soon after calving (0h), 24, 48, 72 and 96h after. The frequencies of SCH were determined considering the critical value of 2.125mmol/L (8.5mg/dL). Two-way repeated measures ANOVA and chi-square test were used for comparisons. The cows eliminated acidic urine before calving. Na+, K+, Cl-, and SID3 values did not differ between groups. Na+ and K+ did not vary between days; Cl- was elevated at calving and decreased until 72h; and SID3 was reduced at calving and increased up to 48h. The Ca levels were reduced until 24h and increased up to 72h. Cows of third and fourth to sixth lactations presented lower values up to 24h. SCH was observed in almost half of the cows (43.3% to 55%) until 48h. The maintenance of hypocalcemia for three or more consecutive days occurred in 53.3% of third and fourth to sixth lactations cows. Ingestion of a high chloride prepartum anionic diet led to hyperchloremic acidosis and this imbalance was reversed on the second postpartum day. The induced effects on electrolyte and acid-base balances were not able to prevent the occurrence of SCH in the first days of lactation.
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- 2021
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12. Normal Anion-Gap Metabolic Acidosis in an Extremely Preterm Neonate.
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Murugesan, Ambalakkuthan and CS, Sandesh
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Extremely preterm neonates (< 28 wk) are at risk of metabolic complications like hypocalcemia, hypophosphatemia, hyponatremia, and metabolic acidosis. Many of these complications are often the result of prematurity per se, while some of them may be the result of prolonged parenteral nutrition. Most of the complications occur in the initial few weeks of hospital stay, but hyponatremia, hypocalcemia, and hypophosphatemia may persist for longer periods of time. Optimizing enteral nutrition along with fortification helps in promoting optimal growth and overcoming the aforementioned problems. The authors report one such extremely preterm neonate with hyperchloremic metabolic acidosis, the cause of which is uncommon and not reported previously in the literature. [ABSTRACT FROM AUTHOR]
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- 2023
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13. Komplikationen von 0,9 %iger NaCl-Spüllösungen bei der Thuliumlaserenukleation der Prostata.
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Graß, Katja, Ghitulescu, Adrian, Geldner, Götz, and Jurczok, Andreas
- Abstract
Copyright of Der Urologe A is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
- Published
- 2022
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- View/download PDF
14. Acid-Base Balance and Blood Gas Analysis
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Agrò, Felice Eugenio, Vennari, Marialuisa, Benedetto, Maria, Dabbagh, Ali, editor, Esmailian, Fardad, editor, and Aranki, Sary, editor
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- 2018
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15. Cloro, el ion olvidado y su relación con el suero fisiológico
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Esteban Hume V.
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Chloride ,normal saline ,Hyperchloremic acidosis ,Medicine ,Anesthesiology ,RD78.3-87.3 - Published
- 2019
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16. Effect of 3% saline and furosemide on biomarkers of kidney injury and renal tubular function and GFR in healthy subjects – a randomized controlled trial
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F. H. Mose, A. N. Jörgensen, M. H. Vrist, N. P. Ekelöf, E. B. Pedersen, and J. N. Bech
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Hypertonic saline ,3% saline ,Hyperchloremic acidosis ,NGAL ,KIM-1 ,Fractional excretion of sodium ,Diseases of the genitourinary system. Urology ,RC870-923 - Abstract
Abstract Background Chloride is speculated to have nephrotoxic properties. In healthy subjects we tested the hypothesis that acute chloride loading with 3% saline would induce kidney injury, which could be prevented with the loop-diuretic furosemide. Methods The study was designed as a randomized, placebo-controlled, crossover study. Subjects were given 3% saline accompanied by either placebo or furosemide. Before, during and after infusion of 3% saline we measured glomerular filtration rate (GFR), fractional excretion of sodium (FENa), urinary chloride excretion (u-Cl), urinary excretions of aquaporin-2 (u-AQP2) and epithelial sodium channels (u-ENaCγ), neutrophil gelatinase-associated lipocalin (u-NGAL) and kidney injury molecule-1 (u-KIM-1) as marker of kidney injury and vasoactive hormones: renin (PRC), angiotensin II (p-AngII), aldosterone (p-Aldo) and arginine vasopressin (p-AVP). Four days prior to each of the two examinations subjects were given a standardized fluid and diet intake. Results After 3% saline infusion u-NGAL and KIM-1 excretion increased slightly (u-NGAL: 17 ± 24 during placebo vs. -7 ± 23 ng/min during furosemide, p = 0.039, u-KIM-1: 0.21 ± 0.23 vs − 0.06 ± 0.14 ng/ml, p
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- 2019
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17. Effect of 0.9% NaCl compared to plasma-lyte on biomarkers of kidney injury, sodium excretion and tubular transport proteins in patients undergoing primary uncemented hip replacement - a randomized trial.
- Author
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Østergaard, A. M., Jørgensen, A. N., Bøvling, S., Ekeløf, N. P., Mose, F. H., and Bech, J. N.
- Subjects
TOTAL hip replacement ,CARRIER proteins ,ACUTE kidney failure ,PROTEIN transport ,KIDNEY injuries ,URINE collection & preservation - Abstract
Background: Isotonic saline (IS) is widely used to secure perioperative cardiovascular stability. However, the high amount of chloride in IS can induce hyperchloremic acidosis. Therefore, IS is suspected to increase the risk of acute kidney injury (AKI). Biomarkers may have potential as indicators.Methods: In a double-blinded, placebo-controlled study, 38 patients undergoing primary uncemented hip replacement were randomized to IS or PlasmaLyte (PL). Infusion was given during surgery as 15 ml/kg the first hour and 5 ml/kg the following two hours. Urinary samples were collected upon admission and the day after surgery. As surgery was initiated, urine was collected over the course of 4 h. Hereafter, another urine collection proceeded until the morning. Urine was analyzed for markers of AKI neutrophil gelatinase-associated lipocalin (NGAL) and kidney injury molecule-1 (KIM-1). Arterious and venous blood samples for measurements of pH and plasma electrolytes including chloride (p-Cl) were collected as surgery was initiated, at the end of surgery and the following morning.Results: IS induced an increase in p-Cl (111 ± 2 mmol/L after IS and 108 ± 3 after PL, p = 0.004) and a decrease in pH (7.39 ± 0.02 after IS and 7.43 ± 0.03 after PL, p = 0.001). Urinary NGAL excretion increased in both groups (ΔNGAL: 5.5 [4.1; 11.7] μg/mmol creatinine p = 0.004 after IS vs. 5.5 [2.1;9.4] μg/mmol creatinine after PL, p < 0.001). No difference was found between the groups (p = 0.839). Similarly, urinary KIM-1 excretion increased in both groups (ΔKIM-1: IS 115.8 [74.1; 156.2] ng/mmol creatinine, p < 0.001 vs. PL 152.4 [120.1; 307.9] ng/mmol creatinine, p < 0.001). No difference between the groups (p = 0.064). FENa increased (1.08 ± 0.52% after IS and 1.66 ± 1.15% after PL, p = 0.032). ENaC excretion was different within groups (p = 0.019).Conclusion: A significantly higher plasma chloride and a lower pH was present in the group receiving isotonic saline. However, u-NGAL and u-KIM-1 increased significantly in both groups after surgery despite absence of changes in creatinine. These results indicate that surgery induced subclinical kidney injury. Also, the IS group had a delayed sodium excretion as compared to the PL group which may indicate that IS affects renal sodium excretion differently from PL.Trial Registration: ClinicalTrials.gov Identifier: NCT02528448 , 19/08/2015. [ABSTRACT FROM AUTHOR]- Published
- 2021
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18. A prospective, randomized, comparison study on effect of perioperative use of chloride liberal intravenous fluids versus chloride restricted intravenous fluids on postoperative acute kidney injury in patients undergoing off-pump coronary artery bypass grafting surgeries
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K Bhaskaran, Ganapathy Arumugam, and P V Vinay Kumar
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Acute kidney injury ,hyperchloremic acidosis ,off-pump coronary bypass grafting ,Anesthesiology ,RD78.3-87.3 ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Context and Aims: Off-pump coronary artery bypass graft (OPCABG) is a form of CABG surgery. It is performed without the use of cardiopulmonary bypass machine as a surgical treatment for coronary heart disease. Acute kidney injury (AKI) is one of the common postoperative complications of OPCABG. Previous studies suggest important differences related to intravenous fluid (IVF) chloride content and renal function. We hypothesize that perioperative use of chloride restricted IVFs may decrease incidence and severity of postoperative AKI in patients undergoing OPCABG. Methods: Six hundred patients were randomly divided into two groups of 300 each. In Group A (n = 300), chloride liberal IVFs, namely, hydroxyethyl starch (130/0.4) in 0.9% normal saline (Voluven), 0.9% normal saline, and Ringer's lactate were used for perioperative fluid management. In Group B (n = 300), chloride-restricted IVFs, namely, hydroxyethyl starch (130/0.4) in balanced colloid solution (Volulyte) and balanced salt crystalloid solution (PlasmaLyte A), were used for perioperative fluid management. Serum creatinine values were taken preoperatively, postoperatively at 24 h and at 48 h. Postoperative AKI was determined by AKI network (AKIN) criteria. Results: In Group A, 9.2% patients and in Group B 4.6% patients developed Stage-I AKI determined by AKIN criteria which was statistically significant (P < 0.05). Conclusion: Perioperative use of chloride restricted IVF was found to decrease incidence of postoperative AKI. The use of chloride liberal IVF was associated with hyperchloremic metabolic acidosis.
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- 2018
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19. Hyperchloremic acidosis develops at the stage G4 and shifts to high anion gap acidosis at the stage G5 in chronic kidney disease.
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Tanemoto, Masayuki, Kamachi, Ryohei, Kimura, Takahide, Yamada, Seiki, Yokoyama, Takeshi, and Okazaki, Yukio
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- *
CHRONIC kidney failure , *ACIDOSIS , *GLOMERULAR filtration rate , *MEDICAL records , *ANIONS - Abstract
Background: Amelioration of hyperchloremic acidosis (Cl-Ac), a common complication in chronic kidney disease (CKD), could preserve renal function in chronic kidney disease (CKD). However, the development of Cl-Ac in CKD has not been clarified yet. Methods: The degree of Cl-Ac, which is indicated as the bicarbonate concentration decrease with serum chloride concentration increase (∆[HCO3–]Cl), was compared with the estimated glomerular filtration rate (eGFR) by using CKD patient records. Results: In 307 records with metabolic acidosis, a spline curve obtained from the plot comparing ∆[HCO3–]Cl with eGFR showed that ∆[HCO3–]Cl did not change, increased, and decreased during eGFR decrease until 27, from 27 to 17.5, and from 17.5 mL/min/1.73 m2, respectively. Conclusion: By CKD progression, Cl-Ac progressed and regressed at the CKD stages G4 and G5, respectively. The regression would have reflected the shift of Cl-Ac to high anion gap acidosis. [ABSTRACT FROM AUTHOR]
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- 2020
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20. Association of Familial Hyperkalemia and Hypertension with Proximal Renal Tubular Acidosis and Epileptic Seizures.
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Shirin N, Rabinowitz G, Blatt I, Karlish SJD, Farfel Z, and Mayan H
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- Child, Mice, Animals, Humans, Ammonia, Protein Serine-Threonine Kinases genetics, Seizures, Hyperkalemia complications, Hyperkalemia genetics, Acidosis, Renal Tubular complications, Acidosis, Renal Tubular genetics, Hypertension complications, Hypertension genetics, Pseudohypoaldosteronism genetics, Epilepsy complications, Epilepsy genetics, Ammonium Compounds
- Abstract
Introduction: Familial hyperkalemic hypertension (FHHt) is an inherited disease characterized by hyperkalemia, hypertension, and hyperchloremic acidosis (HCA). The primary defect is a hyperactive sodium chloride co-transporter, expressed in the renal distal tubule. FHHt is caused by mutation in either WNK1, WNK4, KLHL3, or Cul3. The mechanism of HCA is not completely understood., Methods: Clinical and genetic data were collected from the largest family with FHHt described in the literature. Urine ammonia was measured in 26 family members. Epilepsy was diagnosed clinically., Results: Of the 85 family members, 44 are affected by the Q565E WNK4 mutation, and 28 are newly described. In genetically engineered mice, urinary ammonium was decreased. In our study, urine ammonium did not change. In 11 unaffected subjects, urine ammonia per creatinine was 8.013 ± 3.620 m
m /mm, and in 15 subjects affected by FHHt, it was 8.990 ± 4.300 mm /mm (p = 0.546, not significant). Due to the large family size and prolonged follow-up, rare conditions can be identified. Indeed, two children have genetic generalized epilepsy and one child has migraine. The prevalence of epilepsy is 4.545% (2/44) much higher than in the general population (0.681%). This difference is statistically significant (χ2 with Yates correction = 5.127, p = 0.023)., Conclusions: We provide further evidence that the origin of HCA in FHHt lies in the proximal renal tubule. The association of FHHt with epilepsy leads us to speculate that the raised serum K in susceptible subjects may cause a rise in CSF K, and extracellular cerebral K, leading to epilepsy., (© 2023 The Author(s). Published by S. Karger AG, Basel.)- Published
- 2024
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21. Hypotonic versus isotonic maintenance fluid administration in the pediatric surgical patient.
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Abdessalam, Shahab
- Abstract
Intravenous fluid administration has been occurring for well over one hundred years for a variety of pediatric disease processes. Surprisingly, clinicians have yet to agree upon a standardized intravenous solution. There is ongoing debate regarding the administration of isotonic versus hypotonic fluids as maintenance solutions. In this article, we will review what is known about different maintenance solutions, discuss the potential complications with their use, and summarize the available evidence to help guide clinicians in their choice of maintenance fluids for their patients. [ABSTRACT FROM AUTHOR]
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- 2019
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22. Вплив альтерації гомеостазу глюкози на водно-електролітний баланс та кислотно-основний стан у пацієнтів із цукровим діабетом
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O.V. Ivaniushko
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medicine.medical_specialty ,Type 1 diabetes ,Diabetic ketoacidosis ,business.industry ,Anion gap ,Metabolic acidosis ,medicine.disease ,Ketoacidosis ,Endocrinology ,Internal medicine ,Diabetes mellitus ,Hyperchloremic acidosis ,medicine ,Ketone bodies ,business - Abstract
Despite the success of the treatment of diabetes mellitus, the incidence of diabetic ketoacidosis in recent years has not decreased. Its clinical manifestations Dreshfeld first described in 1886. Insulin began to be used in 1922. Mortality of this complication was 100 %. Widespread implementation of insulin therapy into the clinical practice reduced mortality by 30 %, and with improvement of treatment, including infusion therapy, there was a further reduction. The level of mortality of patients with diabetic ketoacidosis remains high (about 5 % in specialized centers). Prediction of the disease much worsens with age, in the development of coma and hypotension. The prevalence of diabetes mellitus is growing rapidly and currently ranges from 20 to 50 % of new-onset disease in young people. Violations of electrolytes are frequent in patients with this disease and may be the result of altered distribution of electrolytes associated with hyperglycemia-induced osmotic fluid shifts or general shortages caused by osmotic diuresis. Complications from damage to the target organs and therapies used in the treatment of diabetes can also contribute to electrolyte disturbances. We highlight the ways, in which specific electrolytes may be influenced by dysregulation in glucose homeostasis. High or normal plasma sodium concentration in the presence of hyperglycemia indicates a clinically significant deficit of the total body fluid. Sodium correction in patients with glycemia helps to evaluate shortage of sodium and water, and ensure adequate assessment required for tonicity during the course of rehydration therapy. Because children with diabetic ketoacidosis are at particularly high risk of such terrible complications, as swelling of the brain, then to some extent hypernatremia is acceptable during treatment to minimize this complication. Insulin deficiency, which often occurs in type 1 diabetes mellitus, is an important factor of potassium output from the cells. Changes in potassium level, caused by metabolic acidosis, are more significant in mineral acidosis (hyperchloremic, non-anion gap acidosis) than in the organic acidosis (large anion gap acidosis), which is present in diabetic ketoacidosis. In diabetic patients receiving non-selective β-blockers, increased adrenergic activity can exacerbate hyperkalemia, because unopposed α-receptor stimulation, promotes the release of potassium from the cells. Ketoacidosis occurs when the rate, at which hepatic ketoacid is generated, exceeds peripheral utilization and the concentration of ketoacid in the blood increases. Normalization of acid-base balance is made within a few days, as the correction of bicarbonate deficit occurs through its regeneration by kidneys. Patients with primary kidney diabetic ketoacidosis are not involved (with their normal function). Kidney compensate by higher ammonia discharge. Urinary osmolarity gap is measured in order to find out whether there is a corresponding increase in the excretion of ammonia, which leads to violations in acid-base status. Low urinary osmolarity gap in patients with persistent hyperchloremic acidosis provides leads to tubular dysfunction. Despite recent advances that allowed direct assessment of the levels of β-hydroxybutyrate, determining the concentration of ketone bodies often can not fully explain the increase in anion gap and in many patients may contribute to hyperlactatemia. Lactate level may be increased in response to increased adrenergic activity, even in the absence of tissue hypoperfusion. Chronic hyperglycemia leads to the development of «carbonyl stress» and accumulation of toxic dicarbonyl compounds, such as methyl glyoxal, etc. Epidemiological studies suggest that low magnesium intake is associated with increased risk of diabetes, while higher magnesium intake is associated with lower risk of developing diabetes. In patients with diabetic ketoacidosis, osmotic diuresis due to poor glycemic control leads to renal loss of magnesium. Hypomagnesemia can cause hypocalcemia, because magnesium deficiency may lead to lower parathyroid hormone release. Randomized studies of phosphate therapy in patients with diabetic ketoacidosis did not establish that this therapy provides clinical benefit. The dysregulation of glucose homeostasis leads to many direct and indirect effects on electrolyte and acid-base balance. Since the high prevalence of diabetes ensures that clinicians of every medical specialty will interact with these patients, familiarity with related electrolyte abnormalities is important.
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- 2022
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23. Базові основи та принципи керованої інфузійної терапії у хворих із невідкладною хірургічною патологією органів черевної порожнини
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E.N. Klygunenko and O.V. Kravets
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Pathology ,medicine.medical_specialty ,Alkalosis ,business.industry ,Balanced Crystalloid Solution ,Metabolic alkalosis ,Metabolic acidosis ,Acid–base homeostasis ,medicine.disease ,Lactic acidosis ,Hyperchloremic acidosis ,medicine ,medicine.symptom ,business ,Acidosis - Abstract
Over the past fifteen years, the number of urgent laparotomy is 36–58 % and is characterized by a mortality of 30–80 %. One of the main causes of this is hypovolemia, which causes hemodynamic disorders, tissue hypoxia and the development of multiple organ failure. The main method of its treatment is to fill the circulating blood volume deficiency, where the first choice drugs are crystalloids. It is easy to predict the effects of crystalloid solutions using the physico-chemical model of Stewart’s acid-alkaline equilibrium. Physiologically, all substances in the body are in a dissolved state. Enhancement or weakening of the dissociation of biological aqueous solutions regulate the dependent (H+, HCO3–) and independent (partial pressure of carbon dioxide (pCO2), strong ion difference (SID), total weak acid concentration (Atot)) variables. The regulation of the body’s aqueous media is subject to the three laws of electroneutrality, the equilibrium of dissociation and mass conservation. Based on the Stewart model, electrolyte disturbances can lead to a change in SID and Atot, which forms metabolic acidosis and alkalosis. The composition of cations in a balanced crystalloid solution should correspond to their physiological concentration in the plasma. In this case, the preservation of the physiological concentration of such a strong anion as Cl– in a crystalloid solution is possible only with an increase in the concentration of organic ions. Organic ions are lactate (lactic acid); acetate (acetic acid); malate (malic acid); gluconate (glucuronic acid); citrate (citric acid).These organic ions are moderately strong organic acids and belong to strong electrolytes. In the literature, organic ions are called donors of reserve alkalinity HCO3–. To date, evidence-based studies do not recommend the use of lactate because of: an increase in oxygen consumption during metabolism in the liver, which aggravates tissue hypoxia in conditions of initial oxygen deficiency; threat of intestinal cerebral edema and coagulopathy with excessive concentration of lactate; contraindications to use in shock, accompanied by lactic acidosis and liver failure. Acetate: rapidly stabilizes acid-alkaline disorders due to its rapid metabolism; can be used for violations of the liver; provides minimum oxygen consumption in the process of correction of metabolic acidosis; is an antihypoxant (representing the energy substrate of the Krebs cycle). Malate — can be used for violations of the liver; an antihypoxant (representing the energy substrate of the Krebs cycle); has a detoxification and antioxidant effect. For safe clinical use of crystalloid solutions in patients with urgent abdominal cavity pathology, it is necessary to know: intravenous infusion of solutions causes a “mixing phenomenon” of two different fluids — infusion solution and plasma, which differ from each other in the values of SID and Atot. The main characteristic of the infusion solution is its SIDinf. Before starting the infusion, it is necessary to clearly understand the SID and Atot of the solution used. The total infusion volume changes the SID and Atot of the plasma, with the subsequent effect on the plasma pH. During the infusion therapy, the plasma values of SID and Atot will tend to subjugate SIDinf and Atot of the injected fluid. Crystalloid solutions do not contain albumins or phosphates, therefore, Atot of any crystalloid solution is 0. The characteristics of a balanced crystalloid solution are: SIDinf = 24 mEqL–1; compliance of the electrolyte content with their plasma concentration; the presence in the composition of organic ions, preventing an increase in the concentration of Cl– in the infusion solution and being donors of reserve alkalinity. According to the criteria for the balance of crystalloid solutions, we distinguish: unbalanced crystalloid solutions (0.9% NaCl solution); partially balanced crystalloid solutions (Ringer’s lactate and Hartmann’s solutions); fully balanced solutions (plasmalyte, plasmalyte A, sterofundin, sterofundin ISO). The use of unbalanced solutions (0.9% NaCl solution) is dangerous due to the development of hyperchloremic acidosis. The use of partially balanced crystalloid solutions (Ringer’s lactate and Hartmann’s solutions) can form or aggravate lactate acidosis in conditions of tissue hypoxia and/or liver dysfunction. Infusion of balanced solutions — plasmalyte, plasmalyte A, sterofundin allows you to quickly adjust metabolic acidosis, but requires mandatory laboratory monitoring of the parameters of acid-base balance because of the threat of metabolic alkalosis. Introduction of a balanced solution sterofundin ISO has the highest safety profile, it enables to clinically apply the solution “blindly”.
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- 2022
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24. How to Maintain and Restore Fluid Balance: Crystalloids
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Nuevo, Florian R., Vennari, Marialuisa, Agrò, Felice Eugenio, and Agrò, Felice Eugenio, editor
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- 2013
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25. Distal Renal Tubular Acidosis (TYPE I, DRTA)
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Sanjad, Sami A., Elzouki, Abdelaziz Y., editor, Harfi, Harb A., editor, Nazer, Hisham M., editor, Stapleton, F. Bruder, editor, Oh, William, editor, and Whitley, Richard J., editor
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- 2012
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26. Komplikationen von 0,9 %iger NaCl-Spüllösungen bei der Thuliumlaserenukleation der Prostata
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Adrian Ghitulescu, Götz Geldner, Andreas Jurczok, and Katja Graß
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Nephrology ,medicine.medical_specialty ,business.industry ,Urology ,medicine.medical_treatment ,Enucleation ,medicine.disease ,Thulium laser ,medicine.anatomical_structure ,Prostate ,Intensive care ,Internal medicine ,Hyperchloremic acidosis ,medicine ,Hypervolemia ,business ,Saline - Abstract
Systemic fluid absorption frequently occurs during endoscopic prostatic surgery. The introduction of lasers allowed the use of normal saline (0.9% sodium chloride). We report 2 patients who developed hyperchloremic metabolic acidosis and isotonic hypervolemia during thulium laser enucleation of the prostate (ThuLEP) and required prolonged ventilation time, catecholamines, intensive care and prolonged hospitalization. A change to balanced electrolyte solutions in urology-as is already established in infusion and volume therapy-would be desirable, especially to avoid hyperchloremic metabolic acidosis.
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- 2021
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27. A prospective, randomized, comparison study on effect of perioperative use of chloride liberal intravenous fluids versus chloride restricted intravenous fluids on postoperative acute kidney injury in patients undergoing off-pump coronary artery bypass grafting surgeries.
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Bhaskaran, K, Arumugam, Ganapathy, Vinay Kumar, P, and Vinay Kumar, P V
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ACUTE kidney failure , *CORONARY artery bypass , *CARDIAC surgery , *KIDNEY injuries , *PERIOPERATIVE care , *POSTOPERATIVE care - Abstract
Context and Aims: Off-pump coronary artery bypass graft (OPCABG) is a form of CABG surgery. It is performed without the use of cardiopulmonary bypass machine as a surgical treatment for coronary heart disease. Acute kidney injury (AKI) is one of the common postoperative complications of OPCABG. Previous studies suggest important differences related to intravenous fluid (IVF) chloride content and renal function. We hypothesize that perioperative use of chloride restricted IVFs may decrease incidence and severity of postoperative AKI in patients undergoing OPCABG.Methods: Six hundred patients were randomly divided into two groups of 300 each. In Group A (n = 300), chloride liberal IVFs, namely, hydroxyethyl starch (130/0.4) in 0.9% normal saline (Voluven), 0.9% normal saline, and Ringer's lactate were used for perioperative fluid management. In Group B (n = 300), chloride-restricted IVFs, namely, hydroxyethyl starch (130/0.4) in balanced colloid solution (Volulyte) and balanced salt crystalloid solution (PlasmaLyte A), were used for perioperative fluid management. Serum creatinine values were taken preoperatively, postoperatively at 24 h and at 48 h. Postoperative AKI was determined by AKI network (AKIN) criteria.Results: In Group A, 9.2% patients and in Group B 4.6% patients developed Stage-I AKI determined by AKIN criteria which was statistically significant (P < 0.05).Conclusion: Perioperative use of chloride restricted IVF was found to decrease incidence of postoperative AKI. The use of chloride liberal IVF was associated with hyperchloremic metabolic acidosis. [ABSTRACT FROM AUTHOR]- Published
- 2018
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28. Comparison of normal saline solution with low-chloride solutions in renal transplants: a meta-analysis
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Jahangir, Abdullah, Sahra, Syeda, Niazi, Muhammad Rafay Khan, Siddiqui, Fasih Sami, Anwar, Muhammad Yasir, Jahangir, Ahmad, and El-Charabaty, Elie J.
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medicine.medical_specialty ,Hyperkalemia ,medicine.medical_treatment ,sodium bicarbonate ,Urology ,kidney transplantation ,Specialties of internal medicine ,saline solution ,chemistry.chemical_compound ,delayed graft function ,ringer’s lactate ,Hyperchloremic acidosis ,medicine ,Clinical significance ,dialysis solutions ,Saline ,Internal medicine ,Creatinine ,business.industry ,General Medicine ,medicine.disease ,RC31-1245 ,Confidence interval ,Transplantation ,chemistry ,RC581-951 ,Original Article ,medicine.symptom ,business ,Cohort study - Abstract
Background Normal saline solution (NSS) has been the fluid of choice for renal transplant patients, but it can lead to hyperchloremic acidosis and hyperkalemia. This study was performed to compare the safety profile of low-chloride solutions with that of NSS in renal transplant patients. Methods We conducted a systemic review search on PubMed, Embase, and the Central Cochrane Registry. Randomized clinical trials (RCTs) and matched cohort studies involving NSS as the control arm and low-chloride solutions as an intervention arm were chosen. The standardized mean difference for continuous variables, the odds ratio (OR) for discrete variables, and a 95% confidence interval (CI) for effect sizes were used. A p-value of
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- 2021
29. Management of acute metabolic acidosis in the ICU: sodium bicarbonate and renal replacement therapy
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Tomoko Fujii and Kosuke Yagi
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Sodium bicarbonate ,Diabetic ketoacidosis ,business.industry ,RC86-88.9 ,Acute kidney injury ,Metabolic acidosis ,Medical emergencies. Critical care. Intensive care. First aid ,Review ,Buffers ,Critical Care and Intensive Care Medicine ,medicine.disease ,Renal Replacement Therapy ,Intensive Care Units ,chemistry.chemical_compound ,Sodium Bicarbonate ,Intravenous sodium bicarbonate ,chemistry ,Lactic acidosis ,Anesthesia ,Hyperchloremic acidosis ,medicine ,Humans ,Base excess ,Acidosis ,business - Abstract
Metabolic acidosis is a process caused by a decrease in strong ion difference (SID) or an increase in weak acids. Acute metabolic acidosis is well-recognized in the intensive care unit (ICU). A recent epidemiological study revealed that the hospital mortality of patients with moderate or severe metabolic acidosis (pH < 7.3 and base excess
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- 2021
30. Effects of Fluid Rehydration Strategy on Correction of Acidosis and Electrolyte Abnormalities in Children With Diabetic Ketoacidosis
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T. Charles Casper, Aris Garro, Nicole Glaser, Simona Ghetti, Kimberly S. Quayle, Maria Y. Kwok, Lise E. Nigrovic, Jennifer L. Trainor, Kathleen M. Brown, Nathan Kuppermann, Jeff E. Schunk, Julie K. McManemy, Michael J. Stoner, Jonathan E. Bennett, Cody S. Olsen, Leah Tzimenatos, Arleta Rewers, and Sage R. Myers
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Adolescent ,Diabetic ketoacidosis ,Endocrinology, Diabetes and Metabolism ,medicine.medical_treatment ,Anion gap ,pCO2 ,Diabetic Ketoacidosis ,Electrolytes ,Diabetes mellitus ,Hyperchloremic acidosis ,Internal Medicine ,medicine ,Humans ,Child ,Saline ,Acidosis ,Advanced and Specialized Nursing ,Emerging Therapies: Drugs and Regimens ,business.industry ,Sodium ,medicine.disease ,Anesthesia ,Fluid Therapy ,medicine.symptom ,business ,Fluid replacement - Abstract
OBJECTIVE Fluid replacement to correct dehydration, acidosis, and electrolyte abnormalities is the cornerstone of treatment for diabetic ketoacidosis (DKA), but little is known about optimal fluid infusion rates and electrolyte content. The objective of this study was to evaluate whether different fluid protocols affect the rate of normalization of biochemical derangements during DKA treatment. RESEARCH DESIGN AND METHODS The current analysis involved moderate or severe DKA episodes (n = 714) in children age RESULTS The rate of change of pH did not differ by treatment arm, but Pco2 increased more rapidly in the fast versus slow fluid infusion arms during the initial 4 h of treatment. The anion gap also decreased more rapidly in the fast versus slow infusion arms during the initial 4 and 8 h. Glucose-corrected sodium levels remained stable in patients assigned to 0.90% saline but decreased in those assigned to 0.45% saline at 4 and 8 h. Potassium levels decreased, while chloride levels increased more rapidly with 0.90% versus 0.45% saline. Hyperchloremic acidosis occurred more frequently in patients in the fast arms (46.1%) versus the slow arms (35.2%). CONCLUSIONS In children treated for DKA, faster fluid administration rates led to a more rapid normalization of anion gap and Pco2 than slower fluid infusion rates but were associated with an increased frequency of hyperchloremic acidosis.
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- 2021
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31. Вплив негазового ацидозу i алкалозу на стан необмеженого протеолізу крові та тканин
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I.M. Trofimova, V. A. Mikhnev, M.V. Krishtal, and Yu.V. Perepelytsia
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medicine.medical_specialty ,Kidney ,Alkalosis ,Lysis ,Hypoxia (medical) ,medicine.disease ,Sepsis ,chemistry.chemical_compound ,medicine.anatomical_structure ,Endocrinology ,chemistry ,Internal medicine ,Hyperchloremic acidosis ,Sodium citrate ,medicine ,medicine.symptom ,Earth-Surface Processes ,Acidosis - Abstract
Many clinical conditions, such as diabetes, hypoxia, chronic renal failure, cancer, severe trauma, and sepsis are accompanied by acidosis. The aim of the study was to study the changes in proteolytic activity of blood and tissues under conditions of chronic experimental non-gaseous acidosis and alkalosis, and comparison of them with the previously obtained indicators of the pituitary-adrenal system in chronic non-gaseous acidosis and alkalosis. Material and methods. The experiments were carried out on 60 intact white outbred male rats weighing 120-180 g, which were kept on a balanced diet of vivarium.Chronic non-gaseous hyperchloremic acidosis was simulated by daily intragastric administration with a probe for 30 days 20 mmol/kg NH4CL, and chronic non-gaseous alkalosis — 30 mmol/kg NaHCO3. The control animals were injected with the same amount of tap water. Euthanasia of animals was performed under light ether anesthesia by decapitation. Stabilization of blood was carried out with 3.8% sodium citrate solution. Results. Lysis of azoalbumin (breakdown of low molecular weight proteins), lysis of azocasein (breakdown of high molecular weight proteins) and lysis of azocol (lysis of collagen) in chronic non-gaseous alkalosis are almost no different from normal in the serum. However, in chronic non-gaseous acidosis, the lysis of azoalbumin increases in 3.6 times (control — 1.635±0.717 E440/h/ml, experiment — 5.985±0.812 E440/h/ml, p
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- 2021
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32. Stewart (physicochemical) approach versus conventional anion gap approach for resolution of metabolic acidosis in diabetic ketoacidosis
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Rama Walia, Jyotdeep Kaur, Susheel Kumar, Rakesh Sharma, Ashok Kumar Pannu, and Navneet Sharma
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APACHE II ,Diabetic ketoacidosis ,business.industry ,Endocrinology, Diabetes and Metabolism ,Insulin ,medicine.medical_treatment ,Anion gap ,030209 endocrinology & metabolism ,Metabolic acidosis ,medicine.disease ,03 medical and health sciences ,0302 clinical medicine ,Diabetes mellitus ,Anesthesia ,Hyperchloremic acidosis ,Internal Medicine ,Medicine ,030212 general & internal medicine ,medicine.symptom ,business ,Acidosis - Abstract
Diabetic ketoacidosis (DKA) frequently requires emergency admission. The anion gap approach is conventionally used for the diagnosis and documenting the resolution of acidosis during treatment. However, it fails to detect hyperchloremic acidosis during the resolution and may result in the prolongation of treatment. To determine the role of the Stewart approach of acid-base disorder during DKA management for the prediction of an earlier resolution. A prospective comparative study was conducted between January 2017 and December 2017 at a single academic hospital in north India. Patients aged above 12 years with a diagnosis of DKA were randomly divided into two groups—the conventional group and the Stewart group, according to the approach used for DKA resolution. The primary outcome was the time duration required for resolution. The secondary outcomes were the therapeutic requirement of intravenous fluid, insulin, and potassium, Acute Physiology and Chronic Health Evaluation II (APACHE II) score at the time of resolution, and hospital stay. Forty-four DKA patients were equally distributed in the two groups with comparable baseline parameters. The Stewart group had early resolution of DKA (mean, 32.4±17.5 h versus 41.7±19.6 h; p value
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- 2021
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33. Dieta aniônica pré-parto provoca acidose hiperclorêmica em vacas leiteiras de alta produção mas não evita a hipocalcemia subclínica
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Keli D.C.L. Ramella, Júlio Augusto Naylor Lisbôa, Luis G. Cucunubo Santos, Karina Keller Marques da Costa Flaiban, and Thais Helena Constantino Patelli
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040301 veterinary sciences ,dietary cation-anion difference ,Veterinary medicine ,Ice calving ,hipocalcemia ,Urine ,calcium metabolism ,hypocalcemia ,Acidose hiperclorêmica ,diferença entre cátions e ânions na dieta ,0403 veterinary science ,Animal science ,dieta pré-parto ,Lactation ,Hyperchloremic acidosis ,SF600-1100 ,medicine ,Ingestion ,período de transição ,transition period ,Dairy cattle ,Subclinical infection ,Calcium metabolism ,General Veterinary ,serum electrolytes ,Chemistry ,0402 animal and dairy science ,metabolismo do cálcio ,dairy cattle ,04 agricultural and veterinary sciences ,medicine.disease ,ammonium chloride ,040201 dairy & animal science ,eletrólitos séricos ,medicine.anatomical_structure ,bovinos leiteiros ,cattle ,prepartum diet ,cloreto de amônio - Abstract
In this study we evaluated the effects of the prepartum anionic diet on the electrolyte balance and calcemia of high producing dairy cows in the first days of lactation, and investigated the impact on the frequency of subclinical hypocalcemia (SCH). Sixty healthy Holstein cows, producing 30 kg of milk/day, handled in intensive system (compost barn), were distributed in groups (n=15) according to lactation order: first, second, third, and fourth to sixth. In the last three weeks before calving they received a diet with negative DCAD (-6mEq/100g DM) and high chloride content. After calving, they received a diet with positive DCAD (18mEq/100g DM). Urine pH was measured before calving. Serum Na+, Cl-, K+, and total Ca concentrations, and the strong ion difference (SID3) were determined in samples taken soon after calving (0h), 24, 48, 72 and 96h after. The frequencies of SCH were determined considering the critical value of 2.125mmol/L (8.5mg/dL). Two-way repeated measures ANOVA and chi-square test were used for comparisons. The cows eliminated acidic urine before calving. Na+, K+, Cl-, and SID3 values did not differ between groups. Na+ and K+ did not vary between days; Cl- was elevated at calving and decreased until 72h; and SID3 was reduced at calving and increased up to 48h. The Ca levels were reduced until 24h and increased up to 72h. Cows of third and fourth to sixth lactations presented lower values up to 24h. SCH was observed in almost half of the cows (43.3% to 55%) until 48h. The maintenance of hypocalcemia for three or more consecutive days occurred in 53.3% of third and fourth to sixth lactations cows. Ingestion of a high chloride prepartum anionic diet led to hyperchloremic acidosis and this imbalance was reversed on the second postpartum day. The induced effects on electrolyte and acid-base balances were not able to prevent the occurrence of SCH in the first days of lactation. RESUMO: Os objetivos do estudo foram avaliar os efeitos que a dieta aniônica pré-parto provoca sobre o equilíbrio eletrolítico e sobre a calcemia de vacas leiteiras de alta produção nos primeiros dias de lactação, e verificar o impacto sobre a frequência da hipocalcemia subclínica (HSC). Sessenta fêmeas hígidas HPB, com produção de 30 kg de leite/dia, manejadas em sistema intensivo (compost barn), foram distribuídas por grupos (n=15) de acordo com a ordem de lactação: primeira, segunda, terceira e quarta a sexta. Nas três semanas pré-parto receberam dieta com DCAD negativa (-6mEq/100g MS) e teor de cloreto elevado. Após o parto receberam dieta com DCAD positiva (18mEq/100g MS). O pH da urina foi mensurado antes do parto. As concentrações séricas de Na+, Cl-, K+ e Ca total e a diferença de íons fortes (SID3) foram determinadas em amostras colhidas ao parto (0h), 24, 48, 72 e 96h após. As frequências de HSC foram determinadas considerando-se o valor crítico de 2,125mmol/L (8,5mg/dL). ANOVA de medidas repetidas e teste de qui-quadrado foram empregados para as comparações. As vacas eliminavam urina ácida antes do parto. Os valores de Na+, K+, Cl- e SID3 não diferiram entre os grupos. Na+ e K+ não variaram entre os dias; Cl- era elevado ao parto e diminuiu até 72h; e SID3 era reduzida ao parto e aumentou até 48h. A calcemia era reduzida até 24h e se elevou até 72h. Vacas de terceira e de quarta a sexta lactações apresentaram valores mais baixos até 24h. A HSC foi observada em quase metade das vacas (43,3% a 55%) até 48h. A manutenção de hipocalcemia por três ou mais dias seguidos ocorreu em 53,3% das vacas de terceira e de quarta a sexta lactações. A ingestão de dieta aniônica pré-parto com alto teor de cloreto provocou acidose hiperclorêmica e este desequilíbrio se reverteu no segundo dia pós-parto. Os efeitos induzidos sobre os equilíbrios eletrolítico e ácido base não foram capazes de prevenir a ocorrência de HSC nos primeiros dias da lactação.
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- 2021
34. Hyperchloremic acidosis is associated with acute kidney injury after abdominal surgery.
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Toyonaga, Yosuke and Kikura, Mutsuhito
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- *
PERCHLORIC acid , *ABDOMINAL surgery , *ACUTE kidney failure , *ACIDOSIS , *CHRONIC kidney failure , *CHLORIDE ions , *LOGISTIC regression analysis - Abstract
Aim Hyperchloremic acidosis may have an important role as a precursor of acute kidney injury (AKI) in the hyperchloremic environment induced by chloride-rich fluids, but this remains unclear. We tested the hypothesis that hyperchloremic acidosis assessed by the Stewart approach is associated with postoperative AKI. Methods A historical cohort study was conducted in adult patients who had normal renal function preoperatively and required admission to the intensive care unit after elective abdominal surgery. The Risk, Injury, Failure, Loss of kidney function, End stage kidney disease (RIFLE) classification was used for definition of AKI. Results Of 206 patients (144 male, 69.9%) included in the study, 42 (20.4%) had postoperative AKI (AKI group) and 164 (79.6%) did not (non-AKI group). Base excess-chloride (BE-Cl) and strong ion difference (SID, approximated as Na-Cl) decreased, and the chloride level on postoperative day 1 increased compared with preoperative values in both groups ( P < 0.05). In the AKI group, BE-Cl and SID were lower, and chloride was higher than in the non-AKI group ( P < 0.05). The intraoperative load of chloride ions in fluids increased the risk of postoperative AKI ( P < 0.01). In multivariate logistic regression analysis, postoperative BE-Cl < −7 mEq/L (i.e. SID <31 mEq/L) was an independent risk factor for AKI (odds ratio; 2.8, 95% CI; 1.2-6.4, P = 0.01). In the AKI group, stays in the intensive care unit and in hospital were longer than those in the non-AKI group ( P < 0.05). Conclusion Hyperchloremic acidosis is associated with postoperative AKI, and this may be attenuated by reducing the intraoperative chloride load. [ABSTRACT FROM AUTHOR]
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- 2017
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35. Minding the Gap: Utility of the Anion Gap in the Differential Diagnosis of Metabolic Acidosis.
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Givens Bell, Susan
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ACID-base equilibrium ,ACIDOSIS ,DIFFERENTIAL diagnosis ,GASTROINTESTINAL diseases ,NEONATAL diseases ,KIDNEY diseases ,INBORN errors of metabolism ,KIDNEY failure ,CONTINUING education units ,LABORATORY test panels ,DIAGNOSIS - Abstract
The anion gap, in conjunction with other laboratory results, can be a useful clue in the differential diagnosis of metabolic acidosis. There are three primary causes of metabolic acidosis: loss of base, decreased renal excretion of acid, and increased acid production. Depending on the cause of metabolic acidosis, the anion gap may be elevated or normal. [ABSTRACT FROM AUTHOR]
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- 2017
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36. The effect of balanced electrolyte solution versus normal saline in the prevention of hyperchloremic metabolic acidosis in diabetic ketoacidosis patients: a randomized controlled trial.
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Aditianingsih, Dita, Djaja, Anne S., and George, Yohanes W. H.
- Abstract
Background: In resuscitation, normal saline could cause hyperchloremic metabolic acidosis, while balanced electrolyte solution is a crystalloid fluid resembling blood plasma with lower chloride content. This study compared the effect of normal saline and balanced electrolyte solution Ringerfundin (BES) as the resuscitation fluid in diabetic ketoacidosis (DKA) patients. Parameters applied in this study were standard base excess (SBE) as resuscitation's result indicator and strong ion difference (SID) to measure chloride's influence in developing hyperchloremic acidosis. Methods: A prospective, randomized, single blind controlled trial was conducted at the Emergency Department of Cipto Mangunkusumo Hospital. Thirty subjects with blood sugar >250 mg/dl, arterial pH <7.35 mg/dl, and positive blood ketone were randomly allocated to receive either normal saline (NS) or RingerfundinO (BES) as the standardized resuscitation protocol. Data analysis was performed using the unpaired T-test and the Mann Whitney test to compare the SBE and the SID means between both groups. Additional parameters were the level of consciousness, blood sugar level, vital signs, blood gas analysis, lactate, electrolyte, and blood ketone. Results: The mean SID in the BES group was significantly greater than the NS group of all measurements (p<0.05). The BES group had significantly higher mean SBE compared to the NS group at 18 hours (-4.88±5.69 vs -9.68±5.64; p=0.009), 24 hours (-3.99±4.27 vs -8.7±5.35; p=0.023), and 48 hours (-4.06±4.11 vs -7.01±5.46; p=0.009). BES resulted in non¬significant higher delta SBE and sId than NS. Additional parameters were not different between both groups. Conclusion: This study showed that fluid resuscitation of DKA patients with BES resulted in slightly but not significantly higher mean actual SBE and SID than NS. suggesting that BES as an alternative fluid resuscitation to prevent hyperchloremic acidosis in diabetic ketoacidosis patients was not superior to NS. [ABSTRACT FROM AUTHOR]
- Published
- 2017
- Full Text
- View/download PDF
37. The effects of balanced versus saline based colloid and crystalloid solutions on acid-base and electrolyte balance in gastrointestinal surgery.
- Author
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Brahma, Subir Kumar, Mukherjee, Maitreyee, Chandra, Debalpana, Bhattacharya, Dipasri, Bhattacharya, Santi, and Chowdhury, Goutam
- Subjects
- *
SALINE solutions , *ACIDOSIS , *ACID-base imbalances , *SALT , *STOMACH surgery - Abstract
Background and Objectives: Large-volume administration of 0.9% saline are known to causes hyperchloremic metabolic acidosis (HMA) due to its high chloride load. Balanced or physiological fluids with inorganic ions are not associated with the same disturbance. The purpose of this study was to see whether balanced crystalloid and colloid solutions cause less disturbances in postoperative acid base status than sodium chloride based solutions in patients undergoing elective open gastrointestinal surgery. Methodology: Study subjects were patients aged between 30-60 years, ASA grades I and II, undergoing elective open gastrointestinal surgery, were selected as per proposed sampling design and were allotted into two groups, by the help of simple randomization process. Patients in the Group B received Hartmann's solution and 6% hetastarch in balanced electrolyte and glucose solution and patients in the Group N received 0.9% sodium chloride solution and 6% hetastarch in 0.9% sodium chloride solution. Arterial blood samples were taken from both the groups of patients just prior to and 30 min after surgery. Baseline and final acid base status, heart rate, mean blood pressure, peripheral temperature, as well as urine output before, during and after surgery were recorded up to 48 hours. Prevalence of development of HMA was determined by appropriate statistical technique. Results: The mean chloride level of normal saline group postoperatively was 118.66 ± 5.75 mmol/L (Normal range: 98-106 mmol/L) whereas in balanced saline group it was 103.27 ± 2.29 mmol/L, arterial pH was 7.31 ± 0.29 and 7.4 ± 0.02 respectively. Hence the changes in chloride level as well as arterial pH were significant in normal saline group versus balanced fluid group. Conclusion: Normal saline based fluids cause significant alteration in arterial chloride and pH levels against the use of balanced fluids in gastrointestinal surgery. [ABSTRACT FROM AUTHOR]
- Published
- 2017
38. Hyperchloremic acidosis develops at the stage G4 and shifts to high anion gap acidosis at the stage G5 in chronic kidney disease
- Author
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Masayuki Tanemoto, Ryohei Kamachi, Takeshi Yokoyama, Yukio Okazaki, Seiki Yamada, and Takahide Kimura
- Subjects
Adult ,Male ,Nephrology ,medicine.medical_specialty ,Physiology ,Bicarbonate ,030232 urology & nephrology ,Urology ,Renal function ,030204 cardiovascular system & hematology ,Kidney ,urologic and male genital diseases ,03 medical and health sciences ,chemistry.chemical_compound ,0302 clinical medicine ,Chlorides ,Physiology (medical) ,Internal medicine ,Hyperchloremic acidosis ,medicine ,Humans ,Serum chloride ,Renal Insufficiency, Chronic ,Aged ,Retrospective Studies ,Acid-Base Equilibrium ,Aged, 80 and over ,business.industry ,Metabolic acidosis ,Middle Aged ,medicine.disease ,female genital diseases and pregnancy complications ,Bicarbonates ,chemistry ,Disease Progression ,Female ,Acidosis ,Complication ,business ,Biomarkers ,Glomerular Filtration Rate ,Kidney disease - Abstract
Amelioration of hyperchloremic acidosis (Cl-Ac), a common complication in chronic kidney disease (CKD), could preserve renal function in chronic kidney disease (CKD). However, the development of Cl-Ac in CKD has not been clarified yet. The degree of Cl-Ac, which is indicated as the bicarbonate concentration decrease with serum chloride concentration increase (∆[HCO3–]Cl), was compared with the estimated glomerular filtration rate (eGFR) by using CKD patient records. In 307 records with metabolic acidosis, a spline curve obtained from the plot comparing ∆[HCO3–]Cl with eGFR showed that ∆[HCO3–]Cl did not change, increased, and decreased during eGFR decrease until 27, from 27 to 17.5, and from 17.5 mL/min/1.73 m2, respectively. By CKD progression, Cl-Ac progressed and regressed at the CKD stages G4 and G5, respectively. The regression would have reflected the shift of Cl-Ac to high anion gap acidosis.
- Published
- 2020
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39. Spironolactone-furosemide combination therapy and acid-base disorders in liver cirrhosis patients
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Milena Čáslavská, Julius Spicak, Miroslava Horáčková, Halima Gottfriedová, Věra Lánská, Antonín Jabor, and Otto Schück
- Subjects
Liver Cirrhosis ,medicine.medical_specialty ,Cirrhosis ,medicine.medical_treatment ,Anion gap ,Acid-Base Imbalance ,Spironolactone ,Gastroenterology ,Urine sodium ,chemistry.chemical_compound ,Furosemide ,Internal medicine ,Hyperchloremic acidosis ,medicine ,Humans ,Pharmacology (medical) ,Diuretics ,Pharmacology ,business.industry ,Metabolic acidosis ,medicine.disease ,chemistry ,Drug Therapy, Combination ,Diuretic ,business ,medicine.drug - Abstract
OBJECTIVE Respiratory alkalosis (RA) and dilutional hyperchloremic acidosis (DHA) are the most common acid-base balance (ABB) disorders in patients with liver cirrhosis. The aims of this study were to clarify whether RA develops in relation to DHA via respiratory compensation of metabolic acidosis and whether spironolactone in combination with low-dose furosemide - diuretics known to ameliorate DHA - positively affects RA in liver cirrhosis patients. MATERIALS AND METHODS 59 patients with advanced cirrhosis were divided into two groups. Group D consisted of individuals (urine sodium concentration (UNa+) > 20 mmol/L) who responded to combination therapy consisting of spironolactone and low-dose furosemide. The non-D group consisted of individuals (UNa+ ≤ 20 mmol/L) who either did not respond to the treatment or who were not administered it. In both groups, we examined serum and urine concentrations of electrolytes and ABB parameters, including SNa+-SCl- and SNa+/SCl- values. RESULTS In group D, we found a statistically significant relationship between pCO2 and SHCO3-: r = 0.756 (p < 0.001) and between pCO2 and SNa+-SCl-: r = 0.522 (p = 0.001). Neither Salb nor the corrected anion gap were associated with changes in SHCO3- or pCO2 values. Although SHCO3- values were normal, abnormal pCO2 values were observed in one third of group D patients. Based on multivariable analysis, SHCO3- proved to be a statistically significant influencing factor on pCO2 values. CONCLUSION DHA contributes to the development of RA in individuals with liver cirrhosis. Reducing DHA by means of effective diuretic therapy comprising spironolactone and furosemide has a beneficial effect on RA in such patients.
- Published
- 2020
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40. Saline versus Lactated Ringer’s Solution
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Alparslan Turan, Natalya Makarova, Carlos A. Higuera-Rueda, Alan G Kuhel, Michael Ritchey, Edward J. Mascha, Chao Ma, Hani Essber, Iman Suleiman, Kamal Maheshwari, Kurt Ruetzler, Sabri Barsoum, Gausan Ratna Bajracharya, Tatyana Kopyeva, Wael Ali Sakr Esa, Barak Cohen, Daniel I. Sessler, Andrea Kurz, Luca Stocchi, and David Chelnick
- Subjects
medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Acute kidney injury ,030208 emergency & critical care medicine ,030204 cardiovascular system & hematology ,medicine.disease ,Colorectal surgery ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Anesthesiology and Pain Medicine ,Randomized controlled trial ,law ,Anesthesia ,Relative risk ,Orthopedic surgery ,Hyperchloremic acidosis ,Medicine ,Ringer's solution ,business ,Saline - Abstract
Background Both saline and lactated Ringer’s solutions are commonly given to surgical patients. However, hyperchloremic acidosis consequent to saline administration may provoke complications. The authors therefore tested the primary hypothesis that a composite of in-hospital mortality and major postoperative complications is less common in patients given lactated Ringer’s solution than normal saline. Methods The authors conducted an alternating cohort controlled trial in which adults having colorectal and orthopedic surgery were given either lactated Ringer’s solution or normal saline in 2-week blocks between September 2015 and August 2018. The primary outcome was a composite of in-hospital mortality and major postoperative renal, respiratory, infectious, and hemorrhagic complications. The secondary outcome was postoperative acute kidney injury. Results Among 8,616 qualifying patients, 4,187 (49%) were assigned to lactated Ringer’s solution, and 4,429 (51%) were assigned to saline. Each group received a median 1.9 l of fluid. The primary composite of major complications was observed in 5.8% of lactated Ringer’s versus 6.1% of normal saline patients, with estimated average relative risk across the components of the composite of 1.16 (95% CI, 0.89 to 1.52; P = 0.261). The secondary outcome, postoperative acute kidney injury, Acute Kidney Injury Network stage I–III versus 0, occurred in 6.6% of lactated Ringer’s patients versus 6.2% of normal saline patients, with an estimated relative risk of 1.18 (99.3% CI, 0.99 to 1.41; P = 0.009, significance criterion of 0.007). Absolute differences between the treatment groups for each outcome were less than 0.5%, an amount that is not clinically meaningful. Conclusions In elective orthopedic and colorectal surgery patients, there was no clinically meaningful difference in postoperative complications with lactated Ringer’s or saline volume replacement. Clinicians can reasonably use either solution intraoperatively. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New
- Published
- 2020
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41. Severe Metabolic Acidosis and Hyperammonemia Induced by the Concomitant Use of Acetazolamide and Aspirin in a Patient With Impaired Renal Function
- Author
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Shao-Ying Liu and Tien-En Chen
- Subjects
Male ,medicine.medical_treatment ,Kidney ,Renal Dialysis ,Hyperchloremic acidosis ,medicine ,Humans ,Hyperammonemia ,Dialysis ,Acidosis ,Aspirin ,business.industry ,Metabolic acidosis ,Middle Aged ,medicine.disease ,Acetazolamide ,Anesthesia ,Emergency Medicine ,medicine.symptom ,business ,Kidney disease ,medicine.drug - Abstract
Background Acetazolamide is contraindicated in patients undergoing dialysis and should be used with caution in patients with chronic kidney disease (CKD). Here, we evaluate the effect of the concomitant use of aspirin by patient with CKD using acetazolamide. Case Report A 63-year-old man with CKD and multimorbidity presented at our Emergency Department (ED) with general weakness and dyspnea for 4 days. Work-up at the ED revealed severe metabolic acidosis and hyperammonemia, which were initially considered signs of sepsis due to an elevated C-reactive protein level and pyuria. However, subsequent blood work indicated hyperchloremic acidosis with low lactate levels. After reviewing his medical history, we suspected the concomitant use of acetazolamide and aspirin as the etiology. Weakness, acidosis, and hyperammonemia were resolved after the patient discontinued acetazolamide. Why Should an Emergency Physician Be Aware of This? Severe acidosis can be life threatening. Acetazolamide is known for causing mild metabolic acidosis, except in patients with severely impaired renal function. Here, we present a patient with mildly impaired renal function and concomitant aspirin use who developed severe metabolic acidosis and hyperammonemia after being prescribed acetazolamide. Regardless of the severity of the disease, patients with CKD should avoid taking acetazolamide concomitantly with aspirin.
- Published
- 2021
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42. A Consequence of Fluid Therapy Algorithm of Diabetic Ketoacidosis: Iatrogenic Hyperchloremic Acidosis.
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Sarıkaya, Zeynep Tuğçe, Güçyetmez, Bülent, Özdemir, Duran, Ören, Behiye, and Telci, Lütfi
- Subjects
- *
DIABETIC acidosis , *FLUID therapy , *ACIDOSIS , *INTENSIVE care units , *IATROGENIC diseases , *LACTATES - Abstract
Introduction: Since the aim of fluid therapy in diabetic ketoacidosis (DKA) is to remove ß-hydroxybutyrate with Na from the kidneys, the first recommended fluid is 0.9% NaCl. BECl (Na-Cl-32) is the best chloride evaluation. Administering fluids with BECl <32 in DKA may cause hyperchloremic acidosis. This study investigates the effect of the administered fluids with BECl <32 and BECl ≥32 on metabolic acid-base status in the first 6 hours of DKA. Materials and Methods: Patients with DKA admitted to intensive care units (ICU) in the last 15 years were retrospectively evaluated. Demographic data, blood gas samples, and strong ion gap (SIG) were recorded at the ICU admission and the 6th hour. According to BECl values of administered fluids in the first 6 hours, patients were separated into two groups: Group I (Fluids with BECl<32) and group II (fluids with BECl ≥32). SPSS Version 28 was used for statistical analysis. Results: DKA was detected in forty-seven (0.2%) of 15,364 patients. Thirty-two (GI=26; GII=6) patients with DKA were included in the study. Demographics and blood gas parameters at the ICU admission and SIG, Na, K, lactate, and glucose levels at the 6th hour were similar in groups. At the 6th hour, pH, PaCO2, HCO3, SBE, and Na-Cl difference in GI were significantly lower (p<0.001, p=0.016, p=0.011, p=0.022 and p<0.001, respectively), whereas Cl was significantly higher than GII (p=0.023). Conclusion: Although SIG is decreased by administering fluids with BECl <32 in DKA, the reason for the lack of expected increase in HCO3 and SBE and continued hypocapnia at the 6th hour is the iatrogenic hyperchloremia. Hence, the usage of fluids with BECl <32 in DKA should be avoided, and the fluid therapy algorithm of DKA should be reconsidered. [ABSTRACT FROM AUTHOR]
- Published
- 2023
43. Chloride content of solutions used for regional citrate anticoagulation might be responsible for blunting correction of metabolic acidosis during continuous veno-venous hemofiltration.
- Author
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Jacobs, Rita, Honore, Patrick M., Diltoer, Marc, and Spapen, Herbert D.
- Subjects
PHYSIOLOGICAL effects of chlorides ,CITRATES ,ANTICOAGULANTS ,ACIDOSIS ,CONTINUOUS arteriovenous hemofiltration ,BLOOD filtration ,THERAPEUTICS ,TREATMENT of acute kidney failure ,BICARBONATE ions ,CHLORIDES analysis ,ACID-base equilibrium ,BUFFER solutions ,RETROSPECTIVE studies - Abstract
Background: Citrate, the currently preferred anticoagulant for continuous veno-venous hemofiltration (CVVH), may influence acid-base equilibrium.Methods: The effect of 2 different citrate solutions on acid-base status was assessed according to the Stewart-Figge approach in two consecutive cohorts of critically ill adult patients. The first group received Prismocitrate 10/2 (PC10/2; 10 mmol citrate/L). The next group was treated with Prismocitrate 18/0 (PC18; 18 mmol citrate/L). Both groups received bicarbonate-buffered fluids in post-dilution.Results: At similar citrate flow, the metabolic acidosis present at baseline in both groups was significantly attenuated in PC18 patients but persisted in PC10/2 patients after 24 h of treatment (median pH 7,42 vs 7,28; p = 0.0001). Acidosis in the PC10/2 group was associated with a decreased strong ion difference and an increased strong ion gap (respectively 43 vs. 51 mmol/L and 17 vs. 12 mmol/L, PC10/2 vs. PC18; both p = 0.001). Chloride flow was higher in PC10/2 than in PC18 subjects (25.9 vs 14.3 mmol/L blood; p < 0.05).Conclusion: Correction of acidosis was blunted in patients who received 10 mmol citrate/L as regional anticoagulation during CVVH. This could be explained by differences in chloride flow between the applied citrate solutions inducing hyperchloremic acidosis. [ABSTRACT FROM AUTHOR]- Published
- 2016
- Full Text
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44. Solutés balancés en réanimation.
- Author
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Besnier, E., Grange, S., and Tamion, F.
- Abstract
Copyright of Reanimation is the property of Lavoisier and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
- Published
- 2016
- Full Text
- View/download PDF
45. Etiological factors and clinical value of metabolic acidosis after cardiac surgery with cardiopulmonary bypass
- Subjects
medicine.medical_specialty ,business.industry ,Extracorporeal circulation ,General Engineering ,Hemodynamics ,030208 emergency & critical care medicine ,Metabolic acidosis ,medicine.disease ,law.invention ,Cardiac surgery ,03 medical and health sciences ,0302 clinical medicine ,030202 anesthesiology ,law ,Anesthesia ,Vasoplegia ,Hyperchloremic acidosis ,medicine ,Cardiopulmonary bypass ,medicine.symptom ,business ,Acidosis - Abstract
Aim – determine a forms of metabolic acidosis (MetAc) after cardiac surgery with cardiopulmonary bypass (CPB). Estimate significance of MetAc in an early postoperative period.Material and methods. We included the 129 adult cardiac surgery patients. We studied the indicators of acid-base blood status, markers of systemic inflammation, an oxygen delivery and consumption, the hemodynamic parameters, the clinical course of the postoperative period.Results. The acid-base disorders were found in 73.6 % of cases. The metabolic acidosis was in 51.2 % of cases: the lactate acidosis was in 92.4 % and the hyperchloremic acidosis was in 7.6 %. The metabolic lactate acidosis was represented by two forms: 1. the acid-base disorders due to a low cardiac output syndrome with a decrease in oxygen delivery and contractility (14.7 %); 2. the lactate acidosis due to a systemic inflammatory response syndrome (49.2 % of cases). It is associated with a high delivery and a low oxygen extraction, increased cardiac output and a vasoplegia. Patients with these disorders had a higher level of leukocytosis after 24 hours of the end the operation, had a longer duration of respiratory support and a long ICU stay and hospital stay.Conclusion. The lactate acidosis is represented by two forms: the lactate acidosis associated with the low cardiac output syndrome and lactate acidosis associated with the systemic inflammatory response. The lactate acidosis is a predictor of adverse outcome after cardiac surgery with CPB and associated with a postoperative complications and a mortality.
- Published
- 2019
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46. Intravenous sodium and chloride: not too much, not too quick, and only to healthy kidneys!
- Author
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Zaccaria Ricci and Stefano Romagnoli
- Subjects
Pulmonary and Respiratory Medicine ,business.industry ,Sodium ,medicine.medical_treatment ,chemistry.chemical_element ,030204 cardiovascular system & hematology ,medicine.disease ,Chloride ,Cholera ,Clinical Practice ,Clinical study ,03 medical and health sciences ,0302 clinical medicine ,chemistry ,Anesthesia ,Volume expansion ,Hyperchloremic acidosis ,medicine ,030212 general & internal medicine ,business ,Saline ,medicine.drug - Abstract
Although the first clinical use of a fluid therapy based on sodium chloride dates back to the European cholera pandemic in 1831 (1), the first clinical study focused on the acid-base equilibrium in patients receiving NaCl 0.9% (or saline or normal saline) for volume expansion was published in 1999 and was entitled “Rapid Saline Infusion Produces Hyperchloremic Acidosis in Patients Undergoing Gynecologic Surgery” (2). This landmark study aimed at evaluating the effects of the administration of saline, a high chloride concentration crystalloid, in clinical practice.
- Published
- 2019
- Full Text
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47. Comprehensive clinical approach to renal tubular acidosis.
- Author
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Sharma, Sonia, Gupta, Ankur, and Saxena, Sanjiv
- Subjects
- *
RESPIRATORY acidosis , *ACID-base imbalances , *ACIDOSIS , *NEPHROLOGY , *CLINICAL trials - Abstract
Renal tubular acidosis (RTA) is essentially characterized by normal anion gap and hyperchloremic metabolic acidosis. It is important to understand that despite knowing the disease for 60-70 years, complexities in the laboratory tests and their interpretation still make clinicians cautious to diagnose and label types of tubular disorder. Hence, we are writing this mini-review to emphasize on the step wise approach to RTA with some understanding on its basic etiopathogenesis. This will definitely help to have an accurate interpretation of urine and blood reports in correlation with the clinical condition. RTA can be a primary or secondary defect and results either due to abnormality in bicarbonate ion absorption or hydrogen ion secretion. Primary defects are common in children due to gene mutation or idiopathic nature while secondary forms are more common in adults. We are focusing and explaining here in this review all the clinical and laboratory parameters which are essential for making the diagnosis of RTA and excluding the extrarenal causes of hyperchloremic, normal anion gap metabolic acidosis. [ABSTRACT FROM AUTHOR]
- Published
- 2015
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48. Treatment of acute non-anion gap metabolic acidosis.
- Author
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Kraut, Jeffrey A. and Kurtz, Ira
- Subjects
- *
ACIDOSIS , *ACID-base imbalances , *CELL contraction , *CHLORIDE channels , *HYPERTENSION , *DIARRHEA - Abstract
Acute non-anion gap metabolic acidosis, also termed hyperchloremic acidosis, is frequently detected in seriously ill patients. The most common mechanisms leading to this acid-base disorder include loss of large quantities of base secondary to diarrhea and administration of large quantities of chloride-containing solutions in the treatment of hypovolemia and various shock states. The resultant acidic milieu can cause cellular dysfunction and contribute to poor clinical outcomes. The associated change in the chloride concentration in the distal tubule lumen might also play a role in reducing the glomerular filtration rate. Administration of base is often recommended for the treatment of acute non-anion gap acidosis. Importantly, the blood pH and/or serum bicarbonate concentration to guide the initiation of treatment has not been established for this type of metabolic acidosis; and most clinicians use guidelines derived from studies of high anion gap metabolic acidosis. Therapeutic complications resulting from base administration such as volume overload, exacerbation of hypertension and reduction in ionized calcium are likely to be as common as with high anion gap metabolic acidosis. On the other hand, exacerbation of intracellular acidosis due to the excessive generation of carbon dioxide might be less frequent than in high anion gap metabolic acidosis because of better tissue perfusion and the ability to eliminate carbon dioxide. Further basic and clinical research is needed to facilitate development of evidencebased guidelines for therapy of this important and increasingly common acid-base disorder. [ABSTRACT FROM AUTHOR]
- Published
- 2015
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49. Severe Hypokalemia Secondary to Transient Distal Renal Tubular Acidosis in a Previously Healthy Woman
- Author
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Efthymia Kallistrou, Soubhik K Pal, Samson O Oyibo, and Nalini Narayanan Architha
- Subjects
metabolic acidosis ,Urinary system ,distal renal tubular acidosis ,Anion gap ,hypobicarbonatemia ,030204 cardiovascular system & hematology ,03 medical and health sciences ,transient ,0302 clinical medicine ,Hyperchloremia ,Distal renal tubular acidosis ,hyperchloremia ,Hyperchloremic acidosis ,hypokalemia ,medicine ,urinary potassium ,muscle weakness ,non-gap ,Past medical history ,business.industry ,General Engineering ,urinary ph ,Metabolic acidosis ,medicine.disease ,Hypokalemia ,Nephrology ,Anesthesia ,Emergency Medicine ,medicine.symptom ,business ,030217 neurology & neurosurgery - Abstract
Normal anion gap (non-gap) hyperchloremic acidosis with hypokalemia is a medical emergency. There are several causes of this metabolic phenomenon, of which distal renal tubular acidosis is among the very rare causes. In this report, we present an unusual case of a previously healthy woman who was admitted to the intensive care unit with a short history of severe muscle weakness. She had no significant past medical history and was not taking any regular medication. There was also no history of recent drug or herb ingestion. Investigations demonstrated a combination of severe hypokalemia, hyperchloremia, hypobicarbonatemia (non-gap metabolic acidosis), and relatively raised urinary potassium and urinary pH in the presence of severe hypokalemia and metabolic acidosis. Results suggested a diagnosis of distal renal tubular acidosis. The patient responded rapidly to a short course of electrolyte replacement therapy and the condition resolved spontaneously thereafter. This case highlights the fact that distal renal tubular acidosis can occur as a transient phenomenon in previously healthy individuals.
- Published
- 2021
- Full Text
- View/download PDF
50. Postoperative outcomes based on crystalloid administration in pediatric patients with necrotizing enterocolitis undergoing laparotomy
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Xin Xie, Chunbao Guo, Siyuan Guo, and Chun Deng
- Subjects
Male ,Blood transfusion ,crystalloid administration ,medicine.medical_treatment ,Blood Loss, Surgical ,Observational Study ,estimated blood loss ,03 medical and health sciences ,0302 clinical medicine ,Enterocolitis, Necrotizing ,Laparotomy ,Hyperchloremic acidosis ,Medicine ,Humans ,030212 general & internal medicine ,Retrospective Studies ,business.industry ,Incidence (epidemiology) ,Infant, Newborn ,Infant ,Metabolic acidosis ,Retrospective cohort study ,General Medicine ,Crystalloid Solutions ,Length of Stay ,medicine.disease ,abdominal surgery ,Treatment Outcome ,030220 oncology & carcinogenesis ,Anesthesia ,Necrotizing enterocolitis ,Cohort ,Fluid Therapy ,Administration, Intravenous ,Female ,length of hospital stay ,business ,Research Article - Abstract
Intravenous fluid prescription is an essential part of postoperative care and may play a causal role in postoperative complications. The objective of the present study was to evaluate the relationship between intraoperative fluid administration and postoperative outcomes in a large cohort of pediatric patients. This analysis included a retrospective review of 172 patients who underwent gastroenterological surgery from January 2012 to September 2018 at an academic tertiary care hospital. Patients were evaluated based on the median amount of corrected crystalloids and subsequently dichotomized as low (25.89 mL/kg h). The primary outcome measure was the postoperative length of hospital stay (pLOS). Secondary outcome measures included the postoperative time to restore gastroenterological functions and postoperative complications. Patients who received larger amounts of crystalloids were more likely to have a lower intraoperative level of hemoglobin (P = .78) and an intraoperative blood transfusion (P = .27). There were trends toward lower incidence rates of hyperchloremic acidosis (P = .375) and metabolic acidosis (P = .54) in the high crystalloid administration cohort. The incidence of postoperative complications increased as the amount of administered fluid decreased (P = .046). The total length of hospital stay was shorter in patients who received high volumes of crystalloid fluid (19.5 [15.75–32.25] days) than in patients who received low volumes (22 [16–29.5] days, P = .283). Significant and multifaceted variability in crystalloid administration was noted among pediatric patients undergoing major surgery. High fluid administration was associated with favorable postoperative outcomes; these findings could be applied to improve patient safety and facilitate better quality of care.
- Published
- 2020
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