Acid-base Disorders Research Articles

Demonstrating the Analytical Potential of a Wearable Microneedle-Based Device for Intradermal CO2 Detection.

Monitoring of carbon dioxide (CO2) body levels is crucial under several clinical conditions (e.g., human intensive care and acid-base disorders). To date, painful and risky arterial blood punctures have been performed to obtain discrete CO2 measurements needed in clinical setups. Although noninvasive alternatives have been proposed to assess CO2, these are currently limited to benchtop devices, requiring trained personnel, being tedious, and providing punctual information, among other disadvantages. To the best of our knowledge, the literature and market lack a wearable device for real-time, on-body monitoring of CO2. Accordingly, we have developed a microneedle (MN)-based sensor array, labeled as CO2-MN, comprising a combination of potentiometric pH- and carbonate (CO32-)-selective electrodes together with the reference electrode. The CO2-MN is built on an epidermal patch that allows it to reach the stratum corneum of the skin, measuring pH and CO32- concentrations directly into the interstitial fluid (ISF). The levels for the pH-CO32- tandem are then used to estimate the PCO2 in the ISF. Assessing the response of each individual MN, we found adequate response time (t95 < 5s), sensitivity (50.4 and -24.6 mV dec-1 for pH and CO32-, respectively), and stability (1.6 mV h-1 for pH and 2.1 mV h-1 for CO32-). We validated the intradermal measurements of CO2 at the ex vivo level, using pieces of rat skin, and then, with in vivo assays in anesthetized rats, showing the suitability of the CO2-MN wearable device for on-body measurements. A good correlation between ISF and blood CO2 concentrations was observed, demonstrating the high potential of the developed MN sensing technology as an alternative to blood-based analysis in the near future. Moreover, these results open new horizons in the noninvasive, real-time monitoring of CO2 as well as other clinically relevant gases.

Application of Compensation Rules in the Four-quadrant Graphical Tool for Arterial Blood Gas Interpretation: A Cross-sectional Study

Introduction: Arterial Blood Gas (ABG) interpretation plays an indispensable role in emergency medicine and the care of intensive care patients, yet it remains a challenging task. Although several graphical methods exist for ABG interpretation, they are not commonly used at the bedside. The existing graphs are complicated, difficult to understand, and unable to diagnose many disorders. In previous research articles, the current author developed and published a four-quadrant graphical tool for ABG interpretation. The tool incorporates compensation rules, which are crucial for identifying changes resulting from compensations or the presence of a second primary acid-base disorder. Aim: To develop a method for applying compensation rules in a four-quadrant graphical tool to interpret ABG reports for complex acid-base disorders in clinical practice. Materials and Methods: This cross-sectional study was conducted at Shri Sathya Sai Medical College and Research Institute, Chennai, Tamil Nadu, India, from November 2022 to April 2023. A total of 232 ABG samples were utilised, and the values of pH, pCO2, HCO3, Standard HCO3, and Standard Base Excess (SBE) were recorded. These values were classified according to different acid-base disorders. Three derived ratios were calculated using the values of pCO2, bicarbonate, and standard bicarbonate, as these ratios change in various acid-base disorders and provide clues for differentiating between different acid-base disturbances. A four-quadrant graph method was constructed using the values of SBE, pCO2, and these ratios. Subsequently, compensation rules were applied to this graph method. Results: The four-quadrant method facilitated the easy identification of different acid-base disorders, and the application of compensation rules further simplified the identification of mixed or compensatory acid-base disorders. Conclusion: The application of compensation rules in this four- quadrant graphical tool for ABG interpretation distinguishes this tool as a unique method among existing approaches. This tool offers an optimal and simplified approach for interpreting ABG results for complex acid-base disturbances, making it highly suitable for clinical practice at the bedside.

Efficacy of cardiopulmonary rehabilitation nursing in enhancing pulmonary function, sleep quality, and living ability in COVID-19 patients.

The purpose of this study was to elucidate the impact of cardiopulmonary rehabilitation nursing on the pulmonary function, sleep quality, and living ability of patients afflicted with Coronavirus Disease 2019 (COVID-19). A total of 98 patients with COVID-19 treated at The People's Hospital of Guang'an between September 2021 and January 2023 were retrospectively collected as the research subjects. Among them, 48 patients who received standard nursing care from September 2021 to September 2022 were set as the control group, and 50 patients who underwent cardiopulmonary rehabilitation nursing from October 2022 to January 2023 were set as the research group. The pulmonary function indicators [including Forced Expiratory Volume in 1 second (FEV1) and Left Ventricular Ejection Fraction (LVEF)], sleep quality [evaluated using the Pittsburgh Sleep Quality Index (PSQI)], and living ability [assessed by the 36-Item Short Form Survey (SF-36) scale] pre- and post-intervention were compared between the two groups. Pre-intervention, FEV1, LVEF, PSQI scores, inflammatory factor levels [C-reactive protein (CRP), procalcitonin (PCT)], and SF-36 scores showed no significant differences between the two groups (P>0.05). Post-intervention, the research group exhibited notably enhanced FEV1 and LVEF, lower PSQI scores, lower CRP and PCT, and higher SF-36 scores compared with the control group, with statistical significance (P<0.05). Multifactorial logistic regression analysis showed that non-receipt of cardiopulmonary rehabilitation, age ≥60 years, concurrent respiratory failure, coexistent heart failure, and acid-base imbalance were independent risk factors of adverse outcomes in COVID-19 patients (P<0.05). Application of cardiopulmonary rehabilitation nursing in COVID-19 patients can significantly improve pulmonary function, sleep quality, and overall quality of life, and relieve the inflammatory state of the patients, thereby enhancing prognosis. This approach has certain value of popularization and application.

Parahydrogen-enhanced pH measurements using [1-13C]bicarbonate derived from non-enzymatic decarboxylation of [1-13C]pyruvate-d3.

Alterations in pH are a hallmark in several pathologies including cancer, ischemia, and inflammation. Non-invasive magnetic resonance methods to measure pH offer a new approach for early diagnosis of diseases characterized by acid-base imbalances. The hyperpolarization with parahydrogen-induced polarization (PHIP) enhances inherently low signals in magnetic resonance experiments by several orders of magnitude and offers a suitable platform to obtain biocompatible markers in less than one minute. Here, we present an optimized preparation of an hyperpolarized H13CO3-/13CO2 pH sensor via non-enzymatic decarboxylation with H2O2 of [1-13C]pyruvate-d3 obtained by PHIP at 7 T. An improved 13C polarization of purified [1-13C]pyruvate-d3 in water with 36.65 ± 0.06% polarization was obtained starting from 50 mM precursor. Subsequent decarboxylation, H13CO3-/13CO2 exhibited 12.46 ± 0.01% of polarization at physiological pH, 45 seconds after the reaction start. Considering the dilution factor that [1-13C]pyruvate-d3 exhibits in vivo, we optimized our methodology to test the accuracy of the pH sensor at single digit millimolar concentration. In vitro pH estimations on phantoms and cell culture media demonstrated accurate pH calculations with uncertainties of less than 0.08 units. These promising results highlight the efficiency of a pH sensor generated via PHIP in less than one minute, with remarkable polarization, and biocompatibility suitable for future in vivo studies.

Acid-base disorders and their correction in victims with severe burn trauma

Acid-base disorders and their correction in victims with severe burn trauma

Conn´s syndrome after kidney transplantation.

Conn's syndrome, defined as unilateral aldosterone-producing adenoma, accounts for 35-40% of cases of primary hyperaldosteronism. Primary hyperaldosteronism typically occurs in younger patients with poorly controlled arterial hypertension due to extracellular fluid retention, in whom at least atriple combination of antihypertensives, including adiuretic, is needed to maintain normotension. The clinical picture of arterial hypertension may be complemented by symptoms associated with hypokalaemia, such as weakness, fatigue, palpitations, convulsions, polydipsia, or polyuria. In addition to arterial hypertension and hypokalaemia, the diagnosis of Conn's syndrome relies on examination of serum renin and aldosterone concentrations, plasma renin activity, exercise or furosemide stimulation tests, and imaging studies, preferably computed tomography. The method of treatment of Conn's syndrome is adrenalectomy. In patients with primary hyperaldosteronism with underlying bilateral adrenal cortical hyperplasia or patients contraindicated for surgery, mineralocorticoid receptor antagonists are administered in combination with antihypertensives targeted for optimal blood pressure control.In the group of patients after kidney transplantation, the exact incidence of primary hyperaldosteronism is unknown. Based on across-sectional study performed in 2020, it is estimated to be approximately 15% in the group of patients with unsatisfactorily compensated arterial hypertension; in the cohort of normotensive recipients, the incidence of primary hyperaldosteronism is not documented. Diagnosis of Conn's syndrome in patients in the early period after kidney transplantation is problematic, as the prevalence of arterial hypertension in transplanted patients is high (70-90%) according to the literature. Mineral abnormalities, including hypokalaemia, are also common in the early post-transplant period, mainly due to factors such as duration of cold ischaemia, onset of graft function, donor parameters, post-transplant tubulopathy, and diuretics, the effects of immunosuppressive drugs (especially calcineurin inhibitors and corticosteroids), and possibly potassium-restricted dietary habits that the patient brings from the pre-transplant period, which may mask the effect of hyperaldosteronism on potassium.We present the case of apatient who was diagnosed with Conn's syndrome 7 months after primary kidney transplantation from adeceased donor based on persistent hypokalaemia unresponsive to replacement therapy. At the time of the first manifestation of severe hypokalaemia, the patient was treated with adual combination of antihypertensives (amlodipine at adaily dose of 5 mg and carvedilol at adaily dose of 50 mg), without the need for adiuretics.We consider the case interesting because the spectrum of mineral and acid-base abnormalities in advanced renal failure and in the early post-transplant period, as well as acid-base and mineral imbalances, including hypokalaemia, and the high prevalence of arterial hypertension in the post-transplant period, may mask the picture of Conn's syndrome (Fig. 3, Ref. 19). Text in PDF www.elis.sk Keywords: kidney transplantation, primary hyperaldosteronism, hypokalaemia, metabolic alkalosis, secondary arterial hypertension.

Гіперсенситивний пневмоніт. Клінічний випадок

Abstract. Hypersensitivity pneumonitis (HP), or exogenous allergic alveolitis, is a complex and heterogeneous immune-mediated inflammatory and/or fibrotic disease of the lung parenchyma, small airways and interstitium that occurs in people with congenital or acquired hypersensitivity/ susceptibility to certain inhaled antigens. The disease can occur in acute/inflammatory form (duration of the disease is less than 6 months) or chronic form (duration of the disease is more than 6 months). According to the latter classification, HP is divided into fibrotic and non-fibrotic forms: non-fibrotic HP is a mild form of HP compared to fibrotic HP. However, non-fibrotic HP often progresses to fibrosis, i.e. it can be recurrent. The article describes a clinical case of acute HP induced by poultry antigens in the occupational environment. The clinical case study shows that the anamnesis data, namely the identification of a direct link between the occupational environment and the onset of symptoms of dyspnoea, cough, weakness, and headache, made it possible to suspect poultry antigen-induced HP. The characteristic picture of HP observed on computed tomography images, as well as auscultation and radiological findings, made it possible to confirm the diagnosis. The results of the respiratory function assessment showed the presence of pulmonary insufficiency, and the laboratory examination data showed the presence of inflammation, immunological imbalance, acid-base (alkaline) disorders and hypoxia.

Specifičnosti poremećaja acidobazne ravnoteže kod dece

The balance between the production and elimination of acids and bases is essential for the homeostasis of the organism. Disturbances of this balance (metabolic and respiratory acidosis and alkalosis and mixed disorders) are secondary, arising from other diseases and injuries, so their treatment is primarily etiological. In the diagnosis of acid-base imbalance, gas analyses of arterial blood play a key role, which is also a guide in therapy, but the anamnesis, physical examination, and other diagnostic methods should not be neglected either. Although the basic elements of the diagnosis and treatment of acid-base disorders, as well as the etiology and pathogenesis are very similar in children and adults, there are still numerous specificities related to children's age, which are listed in this paper.

Alteration of Biochemical Parameters in Patients with Respiratory Acidosis and Alkalosis: A Hospital Based CrossSectional Study

Biochemical parameters like pH, pO2, pCO2, HCO3-, TCO2 and SO2 are frequently measured in critically ill patients with respiratory acidosis and alkalosis. These parameters have utmost importance in the assessment of ventilation, oxygenation and acid base status of these patients. The present study was undertaken to determine alteration of different biochemical parameters in patients with respiratory acidosis and alkalosis. This is a hospital based cross-sectional study conducted from May to December 2023, in the Department of Biochemistry, CMCTH. Arterial blood was collected and biochemical parameters like pH, pO2, pCO2, HCO3-, TCO2 and SO2 were measured using automated blood gas analyzer. Statistical analysis was done with SPSS version 21. This study showed that majority of the patients with respiratory acid-base disorder were females (58.1%) and elderly (41.8%). Respiratory acidosis and alkalosis were more common in elderly patients under age group 61- 70 years followed by &gt;70 years category. Respiratory acidosis was accompanied by alteration of various ABG parameters like low pH, low pO2, high pCO2, high HCO3-, normal TCO2 and normal SO2 levels while respiratory alkalosis was accompanied by high pH, low pCO2, low HCO3-, low TCO2, normal sO2 and normal pO2 levels. Respiratory acid-base disorders are common in hospital settings with ailing respiratory diseases like COPD, Pneumonia, TB and Sepsis with higher incidences among elderly patients. Respiratory acidosis and alkalosis should be treated promptly giving highest consideration to various biochemical parameters in order to reduce comorbidities and mortalities associated with these conditions.

A small-scale test of whether alkalizing diets can reduce the risk of disease as predicted by the Warburg Hypothesis

Diet and so-called dietary acid load have a significant effect on what have traditionally been called acid-base disorders and various disease states, including cancer. However, the effect has been poorly investigated, and standards of care in medical treatments for cancer patients generally do not consider monitoring acid-base disorders and resolving them using dietary interventions.This paper begins by explaining the Warburg Hypothesis, focusing on dietary interventions thought to help maintain acid-base balance and reduce inflammation at the cellular level, as reflected in certain venous blood parameters. By integrating traditional and modern nutritional sciences for preventing and managing cancer, potential dietary interventions are identified that may help maintain nutritional status.In addition, data on the efficacy of these nutritional interventions are presented, where the effect of following an alkalizing diet for 1-3 months is measured through venous blood gas parameters. Of 30 volunteers, 10 followed the prescribed diet for an entire month and their venous blood gas parameters before and after the diet were compared.There appeared to be a significant impact of the diet on these parameters. Thus, we speculate that the prescribed alkalizing diet may be an effective practice to eliminate acid-base disorders and reduce its impact on cancer and other diseases. Further research should examine on a larger sample over a longer period of time, using additional parameters, whether such a diet could have an impact on the incidence or development of the cellular acid-base balance, levels of inflammation, and eventually various diseases, including cancer.

The Effect of High Ambient Temperature on Acid-Base Balance and ‎Electrolyte Parameters in Rats

Exposure to high environmental temperature could lead to different heat-related illness as well as worsening some disease conditions. Thirty rats were used to determine the nature of the disturbances of the acid-base balance and electrolytes of blood serum after exposure to high ambient temperature. Twenty rats which formed the experimental group were exposed to sun for 30 minutes daily for two weeks, while the remaining rats served as the unexposed control group. The serum pH, serum HCO3- and electrolytes of both the groups in the first week and the second week were obtained using pH meter, back titration, flame photometry, mercurite titrimetric and spectro-photometry. Histopathology of the lungs and kidneys of rats from each group was carried out using basic histological technique. Results show decreased level of serum HCO3- and increased level of serum pH in the experimental group. In the second week there is significant difference in HCO3- levels (p&lt;0.05). The serum pH in 1st and 2nd week did not show any significant difference in regard to change in the temperature. The findings also showed that high ambient temperature have significant effect on serum sodium (Na+), serum chloride (Cl-) and serum potassium levels (K) (p&lt;0.05); but did not affect serum calcium (Ca+) level (p&gt;0.05). There is glomerular degeneration, interstitial haemorrhage and tubular distension due to fluid retention in the kidney as revealed by the photomicrograph of the exposed rat kidneys. In the lungs of the exposed rat, there is mild interstitial haemorrhage and peribronchoilar epithelial shading. In conclusion, this study indicates that serum calcium is not significantly affected like in the case of serum sodium, chloride and potassium during heat stress and respiratory alkalosis is the predominant acid-base disorder in rats exposed to sun due the occurrence of hyperventilation in heat stress. This research provided some references of acid-base and electrolytes disorder in rats exposed to high ambient temperature.

Changes in the gas composition of umbilical cord blood of newborns after cesarean section using various protocols of general anesthesia in dogs

Cesarean section, being one of the most common operations in veterinary surgery, requires a special anesthetic protocol that provides adequate anesthesia for the mother and has minimal effect on puppies. The aim of the study was to evaluate the effect of various non-inhalation and inhaled anesthetics on newborn puppies during cesarean section, based on the analysis of cord blood gases. 3 groups of experimental animals were formed, which used one of the studied anesthetic protocols. In the first experimental group, propofol at a dose of 4-6 mg/kg was used to maintain general anesthesia. Inhaled halogen-containing anesthetics were used in the second and third experimental groups. Isoflurane 0.5 – 2.0 vol% was used in the second group, and sevoflurane 1.0 – 2.0 vol% was used in the third group. When using all the studied anesthetics, an acidbase imbalance in the form of moderate acidosis was detected in the puppies after delivery, however, acidosis was less pronounced in the groups where halogen-containing anesthetics were used. The use of inhaled halogen-containing anesthetics had a lesser effect on puppies compared to non-inhalation ones. There were no significant differences in the effect of isoflurane and sevoflurane from inhaled anesthetics.

Evaluation of the Acid-Base Status in Patients Admitted to the ICU Due to Severe COVID-19: Physicochemical versus Traditional Approaches.

Stewart's approach is known to have better diagnostic accuracy for the identification of metabolic acid-base disturbances compared to traditional methods based either on plasma bicarbonate concentration ([HCO3-]) and anion gap (AG) or on base excess/deficit (BE). This study aimed to identify metabolic acid-base disorders using either Stewart's or traditional approaches in critically ill COVID-19 patients admitted to the ICU, to recognize potential hidden acid-base metabolic abnormalities and to assess the prognostic value of these abnormalities for patient outcome. This was a single-center retrospective study, in which we collected data from patients with severe COVID-19 admitted to the ICU. Electronical files were used to retrieve data for arterial blood gases, serum electrolytes, and proteins and to derive [HCO3-], BE, anion gap (AG), AG adjusted for albumin (AGadj), strong ion difference, strong ion gap (SIG), and SIG corrected for water excess/deficit (SIGcorr). The acid-base status was evaluated in each patient using the BE, [HCO3-], and physicochemical approaches. We included 185 patients. The physicochemical approach detected more individuals with metabolic acid-base abnormalities than the BE and [HCO3-] approaches (p < 0.001), and at least one acid-base disorder was recognized in most patients. According to the physicochemical method, 170/185 patients (91.4%) had at least one disorder, as opposed to the number of patients identified using the BE 90/186 (48%) and HCO3 62/186 (33%) methods. Regarding the derived acid-base status variables, non-survivors had greater AGadj, (p = 0.013) and SIGcorr (p = 0.035) compared to survivors. The identification of hidden acid-base disturbances may provide a detailed understanding of the underlying conditions in patients and of the possible pathophysiological mechanisms implicated. The association of these acid-base abnormalities with mortality provides the opportunity to recognize patients at increased risk of death and support them accordingly.

Isotonic balanced fluid versus 0.9% saline in patients with moderate to severe traumatic brain injury: A double-blinded randomised controlled trial

Background and importanceTraumatic brain injury (TBI) is a global health concern with significant economic impact. Optimal fluid therapy aims to restore intravascular volume, maintain cerebral perfusion pressure and blood flow, thus preventing secondary brain injury. While 0.9% saline (NS) is commonly used, concerns about acid-base and electrolyte imbalance and development of acute kidney injury (AKI) lead to consideration of balanced fluids as an alternative. ObjectivesThis study aimed to compare the outcomes of patients with moderate to severe TBI treated with Sterofundin (SF) versus NS. Design, settings and participantsA double-blinded randomised controlled trial of patients aged 18 to 65 years with TBI was conducted at the University Malaya Medical Centre from February 2017 to November 2019. Intervention or exposurePatients were randomly assigned to receive either NS or SF. The study fluids were administered for 72 h as continuous infusions or boluses. Participants, investigators, and staff were blinded to the fluid type. Outcomes measure and analysisThe primary outcome was in-hospital mortality. Relative risk (RR) with 95% confidence interval (CI) was calculated. Main resultsA total of 70 patients were included in the analysis, with 38 in the NS group and 32 in the SF group. The in-hospital mortality rate were 3 (7.9%) in the NS group vs. 4 (12.5%) in the SF group, RR = 1.29 (95% CI, 0.64 to 2.59; p = 0.695). No patients developed AKI and required renal replacement therapy. ICP on day 3 was significantly higher in the SF group (18.60 ± 9.26) compared to 12.77 ± 3.63 in the NS group, (95% CI, −11.46 to 0.20; p = 0.037). There were no significant differences in 3-day biochemical parameters and cerebral perfusion pressure, ventilator-free days, length of ICU stay, or Glasgow Outcome Scale-Extended (GOS-E) score at 6 months. ConclusionsIn patients with moderate to severe TBI, the use of SF was not associated with reduced in-hospital mortality, development of AKI, or improved 6-month GOS-E when compared to NS.

Renal calcification in children with renal tubular acidosis: What a paediatrician ‎should ‎know‎.

Renal tubular acidosis (RTA) can lead to renal calcification in children, which can cause various complications and impair renal function. This review provides pediatricians with a comprehensive understanding of the relationship between RTA and renal calcification, highlighting essential aspects for clinical management. The article analyzed relevant studies to explore the prevalence, risk factors, underlying mechanisms, and clinical implications of renal calcification in children with RTA. Results show that distal RTA (type 1) is particularly associated with nephrocalcinosis, which presents a higher risk of renal calcification. However, there are limitations to the existing literature, including a small number of studies, heterogeneity in methodologies, and potential publication bias. Longitudinal data and control groups are also lacking, which limits our understanding of long-term outcomes and optimal management strategies for children with RTA and renal calcification. Pediatricians play a crucial role in the early diagnosis and management of RTA to mitigate the risk of renal calcification and associated complications. In addition, alkaline therapy remains a cornerstone in the treatment of RTA, aimed at correcting the acid-base imbalance and reducing the formation of kidney stones. Therefore, early diagnosis and appropriate therapeutic interventions are paramount in preventing and managing renal calcification to preserve renal function and improve long-term outcomes for affected children. Further research with larger sample sizes and rigorous methodologies is needed to optimize the clinical approach to renal calcification in the context of RTA in the pediatric population.

Effect of different hypoxic and hypobaric interventions on blood gas and erythrocyte-related indicators in rats.

To explore the effects of hypoxic and hypobaric conditions on blood gas and erythrocyte-related indicators in rats. SD male rats were exposed to low-pressure hypoxic conditions simulating an altitude of 6500 m in a small or a large experimental cabin. Abdominal aortic blood samples were collected and blood gas indicators, red blood cells (RBCs) count, and hemoglobin (Hb) content were measured. The effects of exposure to different hypoxia times, different hypoxia modes, normal oxygen recovery after hypoxia, and re-hypoxia after hypoxia preconditioning on blood gas indicators, RBCs count and Hb content were investigated. The effect of blood gas indicators was correlated with the length of exposure time of hypoxia and the reoxygenation after leaving the cabin. Hypoxia caused acid-base imbalance and its severity was associated with the duration of hypoxia; hypoxia also led to an increase in RBCs count and Hb content, and the increase was also related to the time exposed to hypoxia. The effects of reoxygenation on acid-base imbalance in rats caged in a small animal cabin were more severe that those in a large experimental cabin. Acetazolamide alleviated the effects of reoxygenation after leaving the cabin. Different hypoxia modes and administration of acetazolamide had little effect on RBCs count and Hb content. Normal oxygen recovery can alleviate the reoxygenation and acid-base imbalance of hypoxic rats after leaving the cabin and improve the increase in red blood cell and hemoglobin content caused by hypoxia. The improvement of hypoxia preconditioning on post hypoxia reoxygenation is not significant, but it can alleviate the acid-base imbalance caused by hypoxia in rats and to some extent improve the increase in red blood cell and hemoglobin content caused by hypoxia. Due to excessive ventilation and elevated RBCs count and Hb content after hypoxia reoxygenation, oxygen partial pressure and other oxygenation indicators in hypoxic rats are prone to become abnormal, while blood gas acid-base balance indicators are relatively stable, which are more suitable for evaluating the degree of hypoxia injury and related pharmacological effects in rats.

A Prospective Observational Study of Acid Base Disorders in Organophosphorous Poisoning in a Tertiary Care Centre

A Prospective Observational Study of Acid Base Disorders in Organophosphorous Poisoning in a Tertiary Care Centre

2559. Antibiotic-induced Bartter-like syndrome - A Systematic Review

Abstract Background Bartter syndrome encompasses salt-losing tubulopathies characterized by hypokalemia, hypochloremic metabolic alkalosis, and hyperreninemic hyperaldosteronism with normal blood pressure. Acquired Bartter or Bartter-like syndrome (BLS) is commonly associated with the use of diuretics and antibiotics such as capreomycin, netilmicin, colistin, and amphotericin B. This systematic review was done to understand the time of occurrence of Bartter syndrome post-inciting drug and gain knowledge regarding its progression and management. Methods We searched PubMed, Google Scholar, Embase, medRxiv, and bioRxiv databases for articles published from 1986 to March 2022 using the keywords "Antibiotic," "Bartter Syndrome," "Pseudobartter Syndrome," and "Bartter-like." Studies that reported cases of BLS in adults or children with confirmation of the inciting drug were included. We excluded studies that did not provide sufficient details of the clinical presentation and outcome. Results We identified 31 studies, comprising 43 cases of BLS. The mean age of the patients was 41.1 years (range: 25–57 years), and 65.1% were female. The most common antimicrobial class associated with BLS was aminoglycosides (65.1%), followed by the polymyxin group. The most common antimicrobial was Gentamicin (41.8%), followed by Colistin (32.5%), Streptomycin, and Capreomycin (6.9% each). Hypokalemia(100%), metabolic alkalosis(97.2%), hypocalcemia(92.5%), and hypomagnesemia(100%) were reported in almost all patients. The median time of onset after exposure to the inciting agent was 10 days (range 7–18 days), and the median time for resolution after stopping the drug was 14 days (range 7–31 days). There was a complete resolution of the symptoms following discontinuation in all cases. Demographic and baseline characteristics of the patients Prevalence of electrolyte, acid-base disorder, and urinary electrolyte abnormalities Laboratory parameters among the reported cases Conclusion BLS is a rare but potentially reversible complication of various antimicrobials, most commonly aminoglycosides. The diagnosis requires a high index of suspicion and a careful review of the drug history. The prognosis is favorable, with a complete reversal of the state after drug discontinuation. Disclosures All Authors: No reported disclosures

Base excess as a predictor of neonatal mortality in neonatal sepsis

Background: Neonatal sepsis is responsible for approximately 15% of all neonatal deaths in the world. Despite of availability in advanced medical healthcare facilities for mother and neonates, incidence of mortality secondary to sepsis especially in developing countries like India is more common. Metabolic acidosis is the most common form of acid base imbalance in neonatal sepsis which can be analyzed with increased levels of base excess. Hence early diagnosis of neonatal sepsis can be done by determining base excess. Methods: This is a prospective observational study conducted in NICU at Cheluvamba Hospital, Mysore. 73 term neonates with suspected sepsis were enrolled in the study who were on regular follow-up and treatment till death/discharged from NICU. Base excess value is obtained from the arterial blood gas analysis from each subject and it was compared with survivor and non-survivor group along with other study parameter Results: Out of 73 subjects, incidence of non survivors group with severe increase in base excess is 75%. To predict the mortality, we compared it with standard base excess which showed the prediction of more than 60%, with significant AOC (0.827) of very near to one in ROC curve, with statistically significant (p&lt;0.001) sensitivity of 92.59%, specificity of 63.04%, positive predictive value of 59.5%, negative predictive value of 93.5%. Conclusions: In present study we have proved that base excess is an important parameter for the early diagnosis and for early intervention in neonatal sepsis.

Prognostic value of serum bicarbonate in patients hospitalized for acute heart failure

Abstract Background Acute heart failure (AHF) requiring hospitalization is associated with significant morbidity and mortality. Acid-base disorders are very common in patients with AHF due to pulmonary oedema and low tissue perfusion. However, its long-term prognostic significance remains to be clarified. We aimed to determine the relationships between serum bicarbonate (HCO3) levels, which reflect acid–base homeostasis, with long-term outcomes. Methods This cohort study included all patients admitted for AHF from June 2021 to August 2022 in a single center. We excluded patients who did not have available gasometric values at admission. All patients had received a primary diagnosis of acute decompensated heart failure, including signs and symptoms of fluid overload and a concentration of N-terminal pro-B-type natriuretic peptide (NT-ProBNP) of 300 pg/mL at least. Clinical and demographic characteristics of all patients were collected during hospitalization. Normal range of HCO33 were defined as 22 to 26 mmol/L. The primary objective was a composite outcome of cardiovascular death and AHF readmission. Results Total of 153 patients were enrolled. Median age was 75,4 ± 10,8 years and 66 (43%) patients were female. 62 (38%) patients had diabetes and 67(41%) had chronic kidney disease. The median [IQR] of NT-ProBNP at admission was 4525 (IQR 25-75: 2010-7148), 58 (38%) patients had left ventricular ejection fraction (LVEF) ≤ 40%, 90 (56%) patients had atrial fibrillation and 49 (32%) patients had coronary artery disease. Regarding acid-base disorders, 38 (24,8%) patients had high serum HCO3 level, and 53 (34,6%) patients had low serum HCO3 level. During a median follow-up period of 10 months, there were 24 deaths (15%), and 60 patients were readmitted for heart failure. High serum HCO3 level (≥26 mmol/L) was significantly associated with higher incidence of the composite outcome (24/38, 63,2% vs 48/115, 41,7%; OR 2.39, 95% CI: 1.12-5.09, p = 0,017) compared with normal and low HCO3 level. In contrast, low serum HCO3 level had lower incidence of the composite outcome (19/53, 36% vs 53/100, 53%; OR 0.5, 95% CI: 0,25-0,98, p = 0,032) compared with normal and high serum HCO3 level. Moreover, we did not find differences between groups stratified by acidaemia (OR 0.82, 95% CI: 0,32-2,08, p = 0,43), alkalaemia (OR 2,8, 95% CI: 0,69-11,26, p = 0,12) and hyperlactatemia (OR 0,72, 95% CI: 0,34-1,52, p = 0,45). Conclusions High serum HCO3 level, but not low serum HCO3 level, on admission was associated with composite outcome cardiovascular death or AHF readmission in patients with acute heart failure. HCO3 level seems to be a useful tool to identify acid-base disorders for stratifying the risk of adverse outcomes in patients with acute heart failure.