Acid-base Balance Disorders Research Articles

Regional Citrate Anticoagulation for Postdilution Continuous Venovenous Hemofiltration: An Easy Five-Step Prescribing Approach

Regional citrate anticoagulation (RCA) is the preferred anticoagulation method of continuous renal replacement therapy (CRRT) which is recommended by international guidelines, but the use of citrate anticoagulation is relatively complicated. If correct prescription and timely adjustment of RCA are not performed, disorders of fluid electrolyte and acid-base balance are prone to occur, especially hypocalcemia, which is a fatal complication. This article introduces the use of RCA with calcium-containing replacement fluid for postdilution continuous veno-venous hemofiltration, which provides a simple and easy CRRT anticoagulation protocol for clinical practice.

Evaluation and replacement of renal function: history, advancement, and challenges

<p indent=0mm>The kidneys are important for the excretion of metabolic and toxic waste from the body, the production of erythropoietin, 1,25-OH-vitamin D, and renin, and the maintenance of the body’s water, salt, and acid-base balance. Various primary or secondary kidney diseases can result in a decreased number of nephrons, resulting in the retention of metabolites in the body, abnormal renal endocrine functions, water, electrolyte, and acid-base balance disorders, and even in the progression to end-stage kidney disease (ESKD) with an irreversible decline in renal function. Complete renal function evaluation includes evaluation of the glomerular function, renal tubular function, and endocrine function, which can be used in the early diagnosis of kidney disease, the determination of the stage of kidney diseases, and monitoring of treatment responses. Renal replacement therapy is essential for maintaining life and improving the quality of life in patients with ESKD. This article will briefly review the history and current status of renal function evaluation and replacement therapy.

THE EFFECT OF STRUCTURED TEACHING PROGRAM ON KNOWLEDGE ABOUT ARTERIAL BLOOD GAS ANALYSIS AMONG THE STAFF NURSES WORKING IN CRITICAL CARE UNIT

Statement:A STUDY TO ASSESS THE EFFECT OF STRUCTURED TEACHING PROGRAM ON KNOWLEDGE ABOUT ARTERIAL BLOOD GAS ANALYSIS AMONG THE STAFF NURSES WORKING IN CRITICAL CARE UNIT OF SELECTED HOSPITAL, LUCKNOW Introduction: Arterial blood gas analysis is a basic and useful laboratory test for the critically ill patients. It is an essential investigation for assessing ventilation, oxygenation and acid base status among critically ill patients. These three are closely interrelated physiological parameters which maintain pH homeostasis. Measurement of arterial blood gas involves analysis of components: pH, partial pressure (PP), Base excess (BE), Bicarbonate (HCO3), Electrolytes, Haemoglobin (Hb) and Glucose.Interpreting an arterial blood gas (ABG) is a crucial skill for physicians, nurses, respiratory therapists, and other health care personnel. Any deviation from a normal value will indicate that the client is experiencing an acid base imbalance. Disorders of acid-base balance can lead to severe complications and occasionally the abnormality may be so severe that it can lead to life threatening condition. Objectives Of The Study: 1. Assess the level of knowledge about Arterial Blood Gas analysis among the staff nurses working in the Critical Care Unit at selected Hospital. 2. Evaluate the effect of Structure Teaching Programme on level of knowledge about Arterial Blood Gas Analysis among the staff nurses working in the Critical Care Unit at selected Hospital. 3. Association between level of knowledge about Arterial Blood Gas analysis among the staff nurses working in the Critical Care Unit with selected demographic variables. Research Methodology:This study was conducted using Quantitative approach at Integral Hospital, Lucknow. Pre-experimental one group pre-test-post-test design was used in the study. The conceptual framework used in this study was Modified Kings Goal Attainment theory. The total sample size was 30 selected by convenience sampling technique. The data was collected by administering Structured Knowledge Questionnaire followed by Structured Teaching Programme about Arterial Blood Gas analysis. After 7 days, post-test was done to assess the effectiveness of STP. Reults:The data obtained are tabulated and analysed using descriptive and inferential statistics. The statistical analysis of the data shows that 86.7% of the staff nurses had moderate knowledge and 13.3% of the staff nurses had inadequate knowledge. The mean pretest knowledge score regarding Arterial Blood Gas analysis was 13.96 with a standard deviation of 3.39. After giving STP the mean score was increased to 23.00 with a standard deviation of 2.36. The Structured Teaching Programme was effective in improving the knowledge as the t value is -12.54 which was highly significant with the degree of freedom 29 p&lt; 0.05. Conclusion: The findings revealed that there was a significant improvement in knowledge of staff nurses in post-test after structured teaching programme. It also showed that there was an association with pre-test knowledge and selected demographic variables like age and association of post-test knowledge and selected demographic variable like qualification.

Phenome-wide association of 1809 phenotypes and COVID-19 disease progression in the Veterans Health Administration Million Veteran Program.

BackgroundThe risk factors associated with the stages of Coronavirus Disease-2019 (COVID-19) disease progression are not well known. We aim to identify risk factors specific to each state of COVID-19 progression from SARS-CoV-2 infection through death.Methods and resultsWe included 648,202 participants from the Veteran Affairs Million Veteran Program (2011-). We identified characteristics and 1,809 ICD code-based phenotypes from the electronic health record. We used logistic regression to examine the association of age, sex, body mass index (BMI), race, and prevalent phenotypes to the stages of COVID-19 disease progression: infection, hospitalization, intensive care unit (ICU) admission, and 30-day mortality (separate models for each). Models were adjusted for age, sex, race, ethnicity, number of visit months and ICD codes, state infection rate and controlled for multiple testing using false discovery rate (≤0.1). As of August 10, 2020, 5,929 individuals were SARS-CoV-2 positive and among those, 1,463 (25%) were hospitalized, 579 (10%) were in ICU, and 398 (7%) died. We observed a lower risk in women vs. men for ICU and mortality (Odds Ratio (95% CI): 0.48 (0.30–0.76) and 0.59 (0.31–1.15), respectively) and a higher risk in Black vs. Other race patients for hospitalization and ICU (OR (95%CI): 1.53 (1.32–1.77) and 1.63 (1.32–2.02), respectively). We observed an increased risk of all COVID-19 disease states with older age and BMI ≥35 vs. 20–24 kg/m2. Renal failure, respiratory failure, morbid obesity, acid-base balance disorder, white blood cell diseases, hydronephrosis and bacterial infections were associated with an increased risk of ICU admissions; sepsis, chronic skin ulcers, acid-base balance disorder and acidosis were associated with mortality.ConclusionsOlder age, higher BMI, males and patients with a history of respiratory, kidney, bacterial or metabolic comorbidities experienced greater COVID-19 severity. Future studies to investigate the underlying mechanisms associated with these phenotype clusters and COVID-19 are warranted.

Acute liver damage in Hyperemesis gravidarum — case report

Hyperemesis gravidarum (HG) involves severe, persistent, intractable nausea and vomiting, which subsequently leads to weight loss&gt;5% of weight until pregnancy, in the absence of other causes, accompanied by dehydration, nutritional deficiency with ketosis, abnormalities electrolyte and/or acid-base balance disorders. in the paper we present the case of a 26-year-old woman, G2N1, in week 10 of gestation, who developed in the context of HG severe abnormalities, namely acute liver damage, with hepatopriv syndrome (Prothrombin after Quick 53%, INR -1, 42, total protein 46.91 /l, cholestatic syndrome (total bilirubin 39 mcmol/l) and cytolytic syndrome (ALT — 140.25 IU / L and AST -125.42 IU / L); alkalemia (arterial pH 7.51) , hyponatremia (serum sodium 132 mmol/l), hypokalemia (serum potassium 2.72 mmol/l). The diagnosis of HG, complicated by acute liver failure, has been confirmed. All laboratory symptoms and abnormalities were resolved by targeted administration of intravenous fluids, antiemetic treatment, and prophylactic antithrombotic treatment.

ACID-BASE BALANCE IN HYPERTENSIVE PATIENTS WITH CHRONIC KIDNEY DISEASE: INFLUENCE OF DIABETES

Objective: Metabolic acidosis is a common complication of advanced CKD and it has been associated with an increased risk of death and faster renal function decline. Diabetes mellitus is one of the most crucial cause of CKD. The dysregulation of glucose homeostasis may lead to many acid–base balance disorders. Our study was aimed to compare the acid-base status in diabetic patients with severe CKD with non diabetic CKD subjects. Design and method: Study population included 143 consecutive CKD hypertensive subjects attending our Nephrology unit with advanced renal failure. To be included on the study, patients were required to have an estimated eGFR of less than 30 mL/min, no intake of alkali within the previous 30 days, and the absence of pulmonary diseases and other clinical conditions at the time of the study that could explain an acute imbalance of the acid-base status, such as heart failure, hemorrhage, or sepsis. Patients were divided into two groups on the basis of the presence (n = 73) or the absence of Type 2 diabetes mellitus (n = 70) Arterial blood samples were drawn in all the subjects. Results: Age, sex distribution, serum creatinine, eGFR and proteinuria were not different in the two groups. Blood pH [7.406 (7.35–7.43) vs 7.384 (7.32–7.41), p = 0.02], bicarbonate levels [22 (19.1–23.7) vs 20.5 (17.4–23.1); p = 0.05] were higher and the prevalence of metabolic alkalosis (16.8 vs 8.4 %) was greater in diabetic patients as compared to non diabetic ones. The positive associations between diabetes and pH values (beta: 0.186; p = 0.02) and between diabetes and metabolic alkalosis (odds ratio 2.68; p &lt; 0.05), were confirmed respectively in linear multiple regression analyses and in logistic multivariate models even after adjustment for potential confounders. Conclusions: Our results, in agreement with those obtained in a previous study (Caracava F et al, Am J Kidney Dis 1999), seem to suggest that metabolic alkalosis is more common than metabolic acidosis in diabetic patients with severe CKD. Further studies are needed in order to provide the pathophysiological explanations of these findings.

Design and development of analysis software for acid-base balance disorder based on Visual Basic.NET

To develop a diagnostic analysis software for determining the type of acid-base balance disorder. Mathematical models were built based on Henderson-Hasselbalch equations and compensation formulas, to determine the important parameters of acid-base balance disorder, and to develope acid-base balance disorder analysis process. The software was compiled using the Visual Basic.NET programming language, and the installation package was generated after debugging. Acid-base balance disorder cases were searched by PubMed, Wanfang and CNKI databases from 1980 to 2015, and the blood gas parameters [pH, arterial partial pressure of carbon dioxide (PaCO2), HCO3- and anion gap (AG)] and the types of acid-base imbalance (literature results) were recorded. All cases were reanalyzed by software and the type of acid-base balance disorder was determined (software diagnostic type). Kappa-test and McNemar-test were performed for the two diagnostic results. The "four parameters-four steps" analysis method was used as the analysis process to judge the types of acid-base balance disorder. "Four parameters" included pH, PaCO2, HCO3- and AG. "Four steps" were outlined by following aspects: (1) according to the pH, combined with PaCO2 and HCO3-, the primary types of acid-base balance disorder was determined; (2) according to the compensation situation, double mixed acid-base balance disorder (DABD) was determined; (3) according to AG value, three mixed acid-base disorders (TABD) were determined; (4) the ratio of ΔAG ↑ /ΔHCO3- ↓ was also calculated to determine whether there was normal AG metabolic acidosis or metabolic alkalosis. The software had the characteristics of simple interface, convenient operation, rapid judgment, and comprehensive analysis. It could judge all acid-base balance disorder types excepted "AG normal metabolic acidosis combined metabolic alkalosis". The software was used to reanalyze 112 cases of acid-base balance disorder reported in the literature, with a consistent rate of 87.50% and better consistency of the diagnostic results (Kappa test: κ = 0.84, P < 0.01; McNemar test: χ2 = 0.87, P = 0.65). The software can be used as an important tool to judge the type of acid-base balance disorder, and provide clinicians with diagnostic reference, which have practical value and application prospect.

Hospital incidence, in-hospital mortality and medical costs of pneumococcal disease in Spain (2008–2017): a retrospective multicentre study

Objective The aim of this study was to analyze the characteristics of the patients attended with a pneumococcal disease in Spanish hospitals, to evaluate trends in hospital incidence and in-hospital mortality and to quantify patients’ use of resources and medical costs. Methods Medical admission records of patients admitted due to pneumococcal disease between 1 January 2008 and 31 December 2017 were obtained from a Spanish hospital discharge database. Records were identified with the International Statistical Classification of Diseases and Related Health Problems, 9th and 10th version codes corresponding to pneumococcal pneumonia, bacteraemia, pyogenic arthritis, endocarditis, meningitis, peritonitis and unspecified pneumococcal infections. Results Admissions of 168,074 patients were analyzed, with a mean age of 63.5 years (median = 72; interquartile range = 28). Pneumococcal pneumonia was responsible for 64.1% of all admissions, with a hospital incidence of 31.1 per 10,000 patients that decreased significantly over the study period (p = .002). Hospital incidence of meningitis also displayed a decreasing trend over the study period (p = .003), whereas incidence of bacteraemia and pyogenic arthritis increased significantly (p = .001; p = .004). Mean Charlson Comorbidity Index was 3.3 (standard deviation = 2.2). In-hospital mortality was 7.0% over the study period, being the highest in patients admitted with endocarditis (17.2%). Sepsis, acute renal failure, disorders of fluid electrolyte and acid-base balance, heart failure and acute respiratory failure were strongly associated with in-hospital mortality. Mean length of hospital stay was of 11.1 days (median = 22; interquartile range = 26) and there was a majority of urgent admissions (95.0%); the most extended stays were registered in patients with endocarditis, meningitis and pyogenic arthritis. The mean hospital admission cost was €5676, €104.2 million annually for all registered patients; 50.3% of all costs were associated with pneumonia, whereas the highest admission costs were registered in patients with endocarditis (€15,991) and meningitis (€11,934). Mean admission costs increased significantly over the study period for pneumonia and bacteraemia and decreased for endocarditis. Conclusions The incidence of pneumococcal pneumonia and meningitis decreased over the study period after the introduction of vaccination in Spain. The advanced age of patients and presence of chronic comorbid conditions that are associated to in-hospital mortality must be taken into account when improving care protocols and upcoming vaccination plans.

Intoxication syndrome in the practice of internist

Background. Intoxication syndrome (IS) is one of the most common syndromes in the medical practice, but its exact scientific outline has not yet been established. This is due to a variety of toxic factors, a large polymorphism of symptoms, and complex interactions between the processes of toxin production and detoxification.&#x0D; Objective. To describe the main features of IS and its treatment.&#x0D; Materials and methods. Analysis of literature sources on this issue.&#x0D; Results and discussion. The morphological basis of IS is the subcellular interaction between the toxin and the receptor. IS develops if the toxins’ entry or formation outweigh their elimination. Intoxications are divided into exogenous and endogenous. The diagnostic criteria for exogenous intoxications are the contact of the patient with the substance that caused the intoxication and the corresponding damage to the organs. Exogenous intoxications have a clear clinical picture, and the introduction of specific antidotes or antitoxins is the best treatment. In turn, endogenous IS is mediated by the accumulation of bacterial endotoxins, excess amounts of physiological metabolic products, biologically active substances and mediators. Natural ways of detoxification include metabolism, excretion and immune mechanisms. Infusion detoxification (IDT) with a significant load by crystalloids and multicomponent drugs is a mandatory treatment for both exogenous and endogenous IP. In most cases, the volume of infusion should be 25-35 ml/kg body weight. Requirements for the ideal drug for detoxification include hypervolemia, improving microcirculation and rheological properties of blood, correction of electrolyte disorders and disorders of acid-base balance, increase of diuresis and peristalsis. All these effects are typical for Reosorbilact (“Yuria-Pharm”). In general, the IDT program may include classical and balanced crystalloids (800-1500 ml), Reosorbilact (600-800 ml), specialized solutions (100-200 ml), and symptomatic drugs. The optimal duration of treatment with Reosorbilact is 7 days.&#x0D; Conclusions. 1. Exact scientific characteristics of IS are still missing. 2. IDT is the mandatory method of treatment of exogenous and endogenous IS. 3. Reosorbilact is the main component of IDT in any IP, as it affects the main links of the pathogenesis of the latter.

Effects of Yue-Bi-Tang on water metabolism in severe acute pancreatitis rats with acute lung-kidney injury.

BACKGROUNDThe complications acute lung injury and acute kidney injury caused by severe inflammation are the main reasons of high mortality of severe acute pancreatitis (SAP). These two complications can both lead to water metabolism and acid-base balance disorders, which could act as additional critical factors affecting the disease trend. Aquaporins (AQPs), which can regulate the transmembrane water transport, have been proved to participate in the pathophysiological process of SAP and the associated complications, such as acute lung injury and acute kidney injury. Thus, exploring herbs that can effectively regulate the expression of AQP in SAP could benefit the prognosis of this disease.AIMTo determine whether Yue-Bi-Tang (YBT) can regulate the water metabolism in rats with severe acute pancreatitis via regulating the expression of aquaporins.METHODSSprague-Dawley rats were randomly divided into three groups, sham operation group (SOG), model group (MG), and treatment group (TG). SAP was induced with 3.5% sodium taurocholate in the MG and TG. Rats in the TG were administered with YBT while SOG and MG rats were given the same volume of saline. Blood and tissue samples were harvested to detect serum inflammatory cytokines, histopathological changes, malondialdehyde and superoxide dismutase in the lung, and protein and mRNA expression of kidney injury molecule-1, α-smooth muscle actin, and vimentin in the kidney, and AQP1 and 4 in the lung, pancreas, and kidney.RESULTSThe serum interleukin-10, tumor necrosis factor α, and creatinine levels were higher in the MG than in the SOG. Tumor necrosis factor α level in the TG was lower than that in the MG. Malondialdehyde level in lung tissues was higher than in the SOG. The pathological scores and edema scores of the pancreas, lung, and kidney tissues in the MG were all higher than those in the SOG and TG. The protein expression of AQP4 in lung tissues and AQP1 in kidney tissues in the MG were higher than those in the SOG and TG. The expression of vimentin was significantly higher in the MG than in the SOG. The expression of AQP1 mRNA in the lung and kidney, and AQP4 mRNA in the kidney was up-regulated in the MG compared to the SOG.CONCLUSIONYBT might regulate water metabolism to reduce lung and kidney edema of SAP rats via decreasing AQP expression, and alleviate the tissue inflammatory injury.

Hypocalcemia in the Critically Ill Pediatric Patients: A Review

Hypocalcemia is common in the critically ill pediatric patients. However, the diagnosis of hypocalcemia in this population is complicated by interpretation of the total plasma calcium concentration. These limitations are principally the result of the effects of hypoalbuminemia and disorders of acid-base balance on the total calcium concentration. Thus, measurement of ionized calcium can be critical in determining an individual’s true serum calcium status. In this review, we first described the regulation of normal calcium metabolism and then focus on the various etiologies of hypocalcemia, which are encountered in the pediatric critical care settings. The approach to the treatment of hypocalcemia and the current consensus on treatment of hypocalcemia in the critically ill pediatric patient is also presented.&#x0D; DS (Child) H J 2019; 35(2) : 156-161

Clinical characteristics of hospitalized patients with 2019 novel coronavirus disease indicate potential proximal tubular dysfunction.

Clinical characteristics of hospitalized patients with 2019 novel coronavirus disease indicate potential proximal tubular dysfunction.

Clinical application of Excel spreadsheet with blood gas analysis in automatic judging the type of acid-base balance disorder

To judge the type of acid-base balance disorder automatically according to the results of arterial blood gas analysis by using the IF function editing formula in an Excel spreadsheet. The four-step analysis was used to carry out programmatically through establishing acid-base balance disorder analysis process: (1) the acid and base types were determined according to pH value and the primary or main type of acid-base balance disorder was determined according to the pH value combined with blood carbon dioxide pressure (PaCO2), HCO3- and their change rate; (2) the expected compensation formula was selected to determine whether there was mixed acid-base imbalance, according to the primary or main acid-base imbalance type; (3) the potential HCO3- should be calculated to replace the measured HCO3- when the primary acid-base imbalance was divided into two parts according to the prior two steps: respiratory acidosis or respiratory alkalosis accompanied with anion gap (AG) increased-metabolic acidosis and compared with the compensatory interval calculated by the predicted compensatory formula for acid or alkali to determine whether there were triple acid-base imbalance (TABD); (4) while the following two parts were judged: metabolic acidosis accompanied with AG increased-metabolic acidosis according to the prior two steps, ΔAG↑/ΔHCO3-↓ should be calculated to determine whether there was metabolic alkalosis or metabolic acidosis with normal AG. The results of arterial blood gas analysis were judged by using the editing formula of IF function in Excel 2003 spreadsheet. A total of 96 patients admitted to the department of intensive care unit (ICU) of Xuzhou Central Hospital were enrolled. According to the results of arterial blood gas analysis, the type of acid-base imbalance of patients was judged by both artificial judgment (artificial group) and Excel spreadsheet automatic judgment (Excel spreadsheet group). The artificial group was composed by 2 associate chief physicians from neonatal intensive care unit (NICU) and 1 attending respiratory physician. If the results were inconsistent, the decision should be made after discussion. In the Excel spreadsheet group, data were input by one NICU attending physician and checked by another. The differences in the results and the time spent in judging the type of acid-base imbalance between the two groups were compared. Forty-two types of acid-base imbalance were obtained by using the four-step analysis method and inputting relevant parameters such as pH, PaCO2, actual HCO3-, Na+, Cl- and compensation time limited into the Excel spreadsheet for blood gas analysis. Data analyses of 96 patients showed that the accuracy of using Excel spreadsheets to automatically determine the type of acid-base imbalance was higher than artificial group, but there was no statistically significant difference between the two groups [normal and simple acid-base imbalance: 100% (26/26) vs. 100% (26/26), mixed acid-base imbalance: 100% (51/51) vs. 96.08% (49/51), TABD: 100% (19/19) vs. 89.47% (17/19), all P > 0.05], and it took less time to judge the results of blood gas analysis by the Excel spreadsheet group compared with the artificial group (s: normal and simple acid-base imbalance: 31.13±4.70 vs. 74.20±16.53, mixed acid-base imbalance: 31.59±5.49 vs. 138.10±22.26, TABD: 30.98±5.40 vs. 308.40±78.12, all P < 0.01). The automatic judging Excel spreadsheet with blood gas analysis can quickly and accurately determine the type of acid-base imbalance in arterial blood gas analysis.

Diagnostic utility of different models used to assess the acid-base balance in cats with chronic kidney disease.

Metabolic acidosis is diagnosed based on the concentration of bicarbonate ions and partial pressure of carbon dioxide in arterial blood, although acid-base balance (ABB) disorders may also be diagnosed based on the serum ion concentrations in order to determine the values of strong ion difference (SID), anion gap (AG), corrected anion gap (AGcorr) and chloride/sodium ratio (Cl-/Na+). The aim of this study was to assess and compare the classic model, the value of the AG, AGcorr, and Cl-/Na+ in the diagnosis of ABB disorders in cats with chronic kidney disease (CKD). The study group consisted of 80 cats with CKD, divided into four groups based on the guidelines of the International Renal Interest Society (IRIS). The control group (C) included 20 healthy cats. Metabolic acidosis - diagnosed based on the classic model (Hendersson-Hasselbalch equation) - was found in IRIS group IV. AG, AGcorr, SID calculated for IRIS groups II, III and IV were lower than in group C, while the value of AGdiff and Cl-/Na+ in those groups was higher than in group C. We can conclude that ABB analysis using the classic model enabled the detection of ABB disorders in cats in stage IV CKD. However, the analysis of the AG, AGcorr and Cl-/Na+ values enabled the diagnosis of acid-base balance disorders in cats with IRIS stage II, III and IV CKD.

Study on Acid-Base Balance Disorders and the Relationship Between Its Parameters and Creatinine Clearance in Patients with Chronic Renal Failure

Objectives: We aimed to determine the parameters of acid-base balance in patients with chronic renal failure (CRF) and the relationship between the parameters evaluating acid-base balance and creatinine clearance. Methods: The current cross-sectional study was conducted on 300 patients with CRF (180 males and 120 females). Clinical examination and blood tests by taking an arterial blood sample for blood gas measurement as well as venous blood for biochemical tests to select study participants were performed. Results: Patients with CRF in the metabolic acidosis group accounted for 74%, other types of disorders were less common. The average pH, PCO₂, HCO₃, tCO₂ and BE of the patient group were 7.35 ± 0.09, 34.28 ± 6.92 mmHg, 20.18 ± 6.06 mmol/L, 21.47 ± 6.48 mmHg and -4.72 ± 6.61 mmol/L respectively. These parameters are lower than normal values and decrease by progressing chronic kidney disease (CKD) stage. These parameters correlated moderately with creatinine clearance. Conclusions: In patients with CRF, metabolic acidosis is predominant, and acid-base balance parameters are positively correlated with creatinine clearance.

Spironolactone-furosemide combination therapy and acid-base disorders in liver cirrhosis patients .

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. 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. 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. 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.

Acid-Base Balance Disorders During Kidney Preservation in Cold Ischemia

BackgroundAcid-base balance disorders are a crucial element of ischemia-reperfusion injury during organ transplantation. Hypoxia during organ procurement and storage cause cellular homeostasis imbalance with impact on further graft function. Acidosis in preserved kidney caused by lactate accumulation may have an important role as a common denominator of various pathways leading to cellular damage. MethodsOur trial sought to answer questions regarding a range of pH alterations in the kidney before the transplantation, their potential cause, and how this may affect further outcome of the kidney transplantation procedure. Perfusion fluid for pH analysis was obtained from perfusion pump (PP) or through kidney flushing at the end of preservation depending on the storage method. ResultsA total of 66 sample results were collated with the data from the transplant registry, hospitalization, and outpatient department. Statistical analysis was conducted linking pH results with factors related to donor, recipient, preservation, and outcome according to designed schematics. Mean perfusate pH was significantly lower in simple hypothermia (SH) vs the PP storage group (6.77 vs 7.11; P < .001). All samples of perfusate pH in the SH group were below physiological values (<7.35), and in 10% of samples in the SH group, pH >7.00. ConclusionsWe concluded that kidney storage in cold ischemia is associated with organ acidosis independent of preservation method and that SH is correlated with significantly bigger acidosis than storage in PP, which is an important procedure removing an excessive amount of hydrogen ions from kidney microcirculation, decreasing cell damage.

Arterial thromboembolism of non-cardiogenic origin in a domestic feline with ischemia and reperfusion syndrome – a case report

Arterial thromboembolism (ATE) is an acute and severe clinical condition resulting from the formation of a thrombus and its accommodation in an artery, impairing the perfusion of tissues irrigated by it. In felines, it is often related to hypertrophic cardiomyopathy, but there are reports of its association with neoplasms. Ischemia and reperfusion syndrome may occur secondary to ATE and result in difficult to correct electrolyte and acid-base imbalances. The aim of the present study is to describe a case of ATE, including its clinical and laboratory findings and electrolyte and acid-base changes compatible with ischemia and reperfusion syndrome. A 14-year-old crossbreed female feline with sudden pelvic limb paralysis was treated at the Feline Medicine Service of the Federal University of Rio Grande do Sul. Clinical and laboratory alterations included hypothermia, hypotension, bradycardia, azotemia, metabolic acidosis, and hyperkalemia. The electrocardiogram indicated sinoventricular rhythm, and echocardiogram evaluation showed no alterations. Thorax radiographic evaluation revealed areas of higher radiopacity in the pulmonary fields. We opted for abdominal aorta arteriotomy as an emergency treatment for thrombus removal. The feline died in the postoperative period, and histopathological examination of lungs, mediastinal lymph nodes, and heart were performed, being compatible with pulmonary adenocarcinoma with lymph node metastasis. This study deals with a case of ATE of possible neoplastic origin, which is uncommon in cats. In this case, the patient had difficult-to-manage hemodynamic impairment, as well as electrolyte and acid-base balance disorders severe and refractory to therapy, culminating in death. The time to start treatment from the presentation of clinical signs may be determinant in therapeutic success, reducing the possible effects of reperfusion syndrome.

Discussion on the treatment of heat stroke complicated with multiple organ dysfunction syndrome using circulating fluid replacement

Objective To investigate the nursing strategy and curative effect for two kinds of circulating fluid replacement in the treatment of heat stroke (HS) with multiple organ dysfunction (MODS). Methods The nursing data for 32 patients with HS were analyzed retrospectively. 17 patients of group A were treated with spend-and-tax of circulating fluid replacement. 15 patients of group B were treated with conventional fluid replacement. The rehydration fluid was 5% glucose (500ml) and Ringer′s solution (500ml). If necessary, the potassium should be supplemented. The last, to observe the effect of spend-and-tax on the outcome of comprehensive treatment of HS combined with MODS. Results 17 patients (group A) were all cured. During treatment, water, electrolyte and acid-base balance disorders did not occur. Comparing with the 15 cases (group B) treated for conventional fluid replacement at same time, the temperature (T), heart rate (HR) were significantly improved (t=-7.453-7.632, all P<0.05), the arterial blood pressures (ABP) were significantly increase (t=-7.896--3.326, all P<0.05). Conclusions Using the model of spend-and-tax fluid replacement can obviously improve the function of liver and kidney, reduce the injury of myocardium and skeletal muscle, improve prognosis, and decrease the mortality rate on patient suffered HS complicated MODS. It was an important content of nursing work that observing and nursing water、electrolytes for patients with HS and MODS. Key words: Heat stroke; Multiple organ dysfunction syndrome; Circulating fluid replacement; Nursing care

Exercise training session-induced metabolic acidosis in barrel racing horses

ABSTRACT: In horses, acid-base balance disorders are common after intense exercise, with metabolic acidosis being the most common after high intensity and short duration exercise. Understanding the processes that cause them is fundamental for procedures, which aimed to improve the physical fitness of horses for athletic purposes, with fewer changes in homeostasis. The present study assessed the effect of barrel racing on acid base balance in Quarter Horse, at the following times: T0 - immediately before training; T1 - immediately after the end of the second course; T2 - one hour after the end of the second course. In T1, there was decrease (P&lt;0.05) in the pH, HCO3 -, pCO2, cBase, tCO2 and strong ion difference concentrations, while the plasma lactate and anion gap increased (P&lt;0.05). It was concluded that barrel racing training caused transient metabolic acidosis in the horses, and hyperlactatemia was still present after an hour of rest.