Acid-base Electrolyte Research Articles

Electrophoretic impregnation of porous anodizing layer by synthesized TiO2 nanoparticles

This paper deals with the elaboration of a stable suspension of TiO2 nanoparticles and their incorporation by electrophoretic deposition into pores of an anodized 5754 aluminum alloy. The as-synthesized TiO2 nanopowder was characterized by the X-ray diffraction, scanning and transmission electron microscopy, energy dispersive X-ray spectroscopy and IR spectroscopy. During this work, both the transmission electron microscopy and particle analysis showed that the resulting particles had a narrow size distribution with a crystallite size of about 15 nm. The zeta potential and stability of TiO2 nanoparticles dispersed with poly(acrylic acid) in an aqueous solution were also measured. A porous anodic film was synthesized in the phosphoric acid-base electrolyte and then filled by 15 nm TiO2 particles via electrophoresis. In addition, the effect of poly(acrylic acid) and pH on the suspension stability has been investigated. It was also demonstrated that by adding glycine in buffered suspension gelating phenomenon can be avoided that inhibits the insertion of nanoparticles inside the pores of an anodic film. It was also noted that an applied electric field greatly influences the electrophoretic deposition process. The field emission gun-scanning electron microscopy observations showed that larger (125 nm in diameter) and linear (6 μm in length) pores are successfully filled in 5 min.

Study of Electrolyte Serum Disturbances and Acid-base Status in Patients with Oral-maxillofacial and Dental Sepsis

Septicaemia is an important public health issue and a clinical challenge with a major impact on healthcare expenditure and resources. The present retrospective study was conducted over 127 patients registered during 2006-2015 for the area of Moldavia, Romania. In our study we are concerned about the serum electrolyte disturbances and acid-base status in patients with oral-maxillofacial and dental septicaemia. We measured serum levels of sodium, potassium, chloride, alkali reserve and pH. The prevalence of electrolyte disturbances was: 15.85% for sodium, 69.15% for potassium and 55.50% for chloride. Early recognition of acid-base status and serum electrolytes disturbances proves to be of great importance for clinical management since it signalizes the gravity of the disease and the increase of fatality rate, and is imperative to save the lives of patients with dental and oral-maxillofacial septicaemia.

Surgical Complications of Simple and Complex Gastroschisis in Newborn

Objective:To determine early or late post surgical complications secondary to simple and complex gastroschisis.Methods:The association between early (acid-base disorders, electrolyte disturbances and presence of hypoalbuminemia), and late postnatal complications (respiratory, gastrointestinal, infectious) was investigated in newborn.Results:42 children, 54.8% male, 73.8% premature, average gestational age of 35.6±2.5 gestational weeks of age (GWA), weight 2147±537gr, they have a NICU stay of 192±14 days, PNT of 19.2±20 days, mortality of 26.2%. The frequent immediate postoperative complications were base-acid imbalance; the metabolic acidosis was associated to simple gastroschisis (p=0.049). The complex gastroschisis was associated to necrotizing enterocolitis (p=0.025), surgical closure type (p=0.003), reinterventions (p=0.025).Conclusion:Acid-Base alterations (76.1%), hypoalbuminemia (59.5%) as early complications and Late sepsis (40.4%), cholestasis (26.1%) as late complications are the most common in patients with Gasthoschisis.

The clinical data used for conventional indications of initiating renal replacement therapy and for predicting the prognosis of critically ill patients with acute kidney injury

Objective To investigate the value of clinical data used for conventional indications of initiating renal replacement therapy (RRT) such as serum creatinine (SCr) , blood urea nitrogen (BUN) and acute renal injury (AKI) stage and in estimating the prognosis of critically ill patients with AKI. Methods A retrospective analysis of 258 AKI adult inpatients treated with continuous renal replacement therapy (CRRT) in ICU from Jan. 2011 to Jan. 2015. According to the outcomes, all subjects were divided into survival group (n=104) and death group (n=154). The general condition, AKI causes, results of renal function (urine output, SCr, BUN and AKI stage), homeostasis (acid-base balance and electrolyte level) , severity of disease (APACHE Ⅱ score and SOFA score) and others were compared between two groups. Additionally, risk factors for the prognosis of critically ill patients with AKI were screened by the multivariate Cox's proportional hazard models and the receiver operating characteristic(ROC) curve. Results There were no significant differences in gender, age, primary disease, AKI causes, APACHE Ⅱscore, renal function (urine output, SCr, BUN and AKI stage), serum potassium level and phosphorus level between two groups before CRRT(P > 0.05), but more patients in death group had severe sepsis (31.17% vs. 19.23%, P=0.033), lower pH value [(7.27±0.34) vs. (7.41±0.34), P=0.024] and higher level of lactate[(3.97±2.87) vs. s (2.64±2.30), P=0.006]. After the analysis with multivariate Cox's proportional hazard models, it was found that the levels of serum phosphorus (P = 0.043) and lactate (P = 0.009) were the independent risk factors for prognosis of critically ill patients with AKI, and other conventional indications for initiating RRT such as SCr, BUN, AKI stage, urine output, pH, bicarbonate level or potassium level were not closely associated with the prognosis of patients (P > 0.05). Therefore, a composite of these six variables (pH, bicarbonate level, phosphorus level, potassium level, urine output and AKI stage) was analyzed. According to the analysis result of ROC curve, the diagnostic value of combined six different variables in predicting in-hospital mortality of AKI patients [area under the curve (AUC) 0.669, 95% CI: 0.577-0.762]was almost as high as that of lactate (AUC: 0.683, 95% CI:0.590-0.777) , and significantly higher than SCr (AUC: 0.460, 95% CI:0.358-0.562) , BUN (AUC: 0.469, 95% CI:0.366-0.571). Conclusions This composite of six different variables is more useful than any other conventional indications for initiating RRT in predicting post-AKI mortality. As a result, a composition of six different variables should be considered rather than any single variable alone for indication of initiating RRT in critically ill patients with AKI. Key words: Critically ill patients; Acute kidney injury; Renal replacement therapy; Optimal timing; Classical indications; Composition of parameters; Prognosis; Predictive value

The fatal booze!—triple acid-base disorder in a patient with alcohol intoxication

Patients of chronic alcohol abuse can present with a variety of acid-base disorders and electrolyte disturbances. Lactic acidosis (LA) along with alcoholic ketoacidosis is an infrequent and underappreciated cause of wide anion-gap metabolic acidosis in alcoholic patients. The likelihood of misdiagnosing the condition is high because of the lack of awareness and presence of nonspecific clinical signs and symptoms shared with other clinical abnormalities such as acute pancreatitis, methanol or ethylene glycol poisoning, and diabetic ketoacidosis, which exist in these patients. As this condition is reversible with early intervention, promptly recognizing the condition and initiating proper treatment by the physicians would go a long way in preventing the morbidity and mortality in these patients. The outcome for such patients is excellent with early intervention. We report a patient with history of chronic alcoholism and alcohol binge admitted to the emergency department with triple acid–base disorder, which included life-threatening high anion-gap metabolic acidosis owing to concomitant LA and alcohol-related ketoacidosis in which the primary element was LA along with metabolic and respiratory alkalosis.

Acid-Base Membranes Based on Poly(1-vinylimidazole) for Fuel Cell Applications

Novel acid-base electrolyte membranes have been developed using the acid-base blending of a basic polymer poly(1-vinylimidazole) (PVIm) and an acidic polymer poly(ethylene-co-acrylic acid) (PEAA). High non-aqueous ionic conductivities of the order of 10-2 – 10-3 S/cm were observed for acid-base blend electrolytes over the temperature range of 30-120 oC and are found to be stable over the temperature range measured. The highest ionic conductivity was observed for 2-8 composition and was postulated to be due to better interaction between the acid and base sites along with better morphology. The blend electrolytes developed are found to be stable up to temperatures in excess of 450oC, even reaching 500 oC for 5-5 compositions. Nano-composite acid-base blend membranes using the 2-8 composition were then developed with the subsequent addition of nano-tubular titania into the electrolyte matrix. The ionic conductivity has been found to be effected by the addition of nano-tubular phase and is higher than that obtained for the parent electrolyte. This increase in conductivity is attributed to the better morphology of the electrolytes with the addition of nano-tubular titania into the matrix as inferred from SEM studies. Nanocomposite membranes were also found to be more thermally stable than the parent membranes. The addition of acid-functionalized nanotubular titania was found to further increase the ionic conductivity of the acid- base blend membranes whilst maintaining good thermal stability.

The effects of bronchodilator drugs and antibiotics used for respiratory infection on human erythrocyte carbonic anhydrase I and II isozymes

Carbonic anhydrase (CA) is an enzyme which plays role/roles in various homeostatic mechanisms, such as the acid-base balance and electrolyte secretion in various tissues. This study aimed to determine and to compare possible alterations in activity of this enzyme caused by use of bronchodilator drugs and respiratory infection antibiotics. CA I and II were purified from human erythrocytes by a simple one step procedure using Sepharose 4B-L-tyrosine-sulfonamide affinity column. The iso-enzymes were purified 259.16-fold with a yield of 31.74%. CAI and II isozymes were treated with several drugs, then the inhibition or activation of the enzymes were determined. The results of this study show that itrapropium bromide is the most effective inhibitor for human erythrocytes carbonic anhydrase compared with the other bronchodilator drugs.

The effects of anti-epileptic drugs on human erythrocyte carbonic anhydrase I and II isozymes

Carbonic anhydrase (CA) is an enzyme which plays a role in various homeostatic mechanisms, such as acid-base balance and electrolyte secretion in a various tissues. This study was aimed at determining and comparing possible alterations in activity of this enzyme caused by the use of old (Carbamazepine, Phenytoin Sodium, Sodium Valproate) and new (Levetiracetam, Pregabalin, Gabapentin, Oxcarbazepine) anti-epileptic drugs. Blood samples were collected from the volunteers. The blood samples were centrifuged to separate plasma and erythrocyte package. Hemolysate was prepared from the red cells. CA I and II were purified from human erythrocytes by a simple one step procedure using Sepharose 4B-L-tyrosine-sulfonamide affinity column. CA I and II isozymes were treated with some anti-epileptic drugs, then the inhibition or activation of enzyme determined. The results of this study show that Levetiracetam is the most effective inhibitor for human erythrocytes carbonic anhydrase compared with the other anti-epileptic drugs.

Artifactually elevated serum bicarbonate results caused by elevated serum lactate dehydrogenase concentrations

An accurate estimation of serum bicarbonate concentration (HCO3(-)) is essential to the diagnosis and treatment of acid-base disorders and electrolyte disturbances. We noted significant discrepancies between HCO3(-) concentration measured by the Olympus AU2700 analyser and total serum carbon dioxide (TCO2) concentration derived from a Radiometer blood gas analyser on several patient samples. This was reported to the manufacturer which led to a recall of certain reagent lot numbers. We hypothesised the mechanism for this interference to be elevated levels of lactate dehyrogenase (LD). We investigated the effect of increasing LD concentration on HCO3(-) with the reagent lot that was recalled and compared this with a subsequent reagent lot that was known to be unaffected on an Olympus AU2700. The experimental data confirmed a positive interference in the Olympus AU2700 HCO3(-) assay using older reagent lot numbers. The false positive HCO3(-) interference was significant (>10% change) when the LD concentration exceeded 845 U/L. Very high levels of LD concentrations were the cause of interference in the Olympus AU2700 HCO3(-) enzymatic assay. Laboratorians should be aware that very high levels of LD may be a potential interference in some enzymatic HCO3(-) assays.

Maternal Nutritional Deficiencies and Interventions

Maternal Nutritional Deficiencies and Interventions

Self-Lubricating SiC/PTFE Composite Coating Formation on Surface of Aluminium Alloy

Anodized composite films containing n-SiC and PTFE particles are prepared on 2024 Al alloy by anodization in phosphoric acid-base electrolyte and ultrasonic impregnation and subsequent heat treatment. Results show that the oxide film microhardness increase with n-SiC content and ultrasonic impregnation time increase, the oxide film wear extent decrease with n-SiC and PTFE content increase basically. The composite films formed on optimum conditions have reduced friction coefficients and relatively high microhardness. The friction coefficient can be as small as 0.14, while the microhardness can reach as high as 429 HV, which is much better than that of an oxide film prepared under the same conditions but without adding any particles. This indicates that the synthesized composite films have good anti-wear and self-lubricating properties

Clinical study on the treatment of chronic renal failure of spleen and kidney yang deficiency and turbid toxic obstruction type with self-made Huazhuo Baoyuan decoction

Objective To observe the effect of treating chronic renal failure with self-made Huazhuo Baoyuan decoction. Methods 90 patients of chronic renal failure belonging to spleen and kidney yang deficiency and turbid toxic obstruction type diagnosed by TCM syndrome differentiation were randomly divided into a treatment group and a control group according to the date of reception. 40 cases in the control group were treated with conventional western medicine, which were low-salt high-quality low-protein diet; to correct acid-base balance and electrolyte imbalance; to correct anemia; adding amino acids; to control blood sugar in patients with history of diabetes; to control blood pressure in patients with hypertension. 50 patients in the treatment group were additionally treated with self-made Huazhuo Baoyuan decoction on the basis of the control group. Such indexes as symptom score, serum creatinine （Scr）, blood urea nitrogen （BUN）, endogenous creatinine clearance rate （Ccr）, hemoglobin （Hb）, liver function： aspartate aminotransferase （AST）, alanine aminotransferase （ALT） ; lipids： total cholesterol（TC）, triglyceride（TG）, high density lipoprotein cholesterol（HDL-C）, low-density lipoprotein cholesterol （LDL-C） were observed before and after the treatment. Results After treatment, total effective rate was 88.0% and 67.5% in the treatment group and the control group respectively, the difference was statistically significant （P= 0.012） . The value of Scr （292.95___ 85.95） μmol/L, BUN （22.69±9.84） mmol/L, Ccr （22.69±9.84） ml/min, CH （6.23 ±0.57） mmol/L, TG （1.70±0.22） mmol/L, HDL-C （1.45 ± 0.04） mmol/L, LDL-C （3.30 ± 0.60） mmol/L showed significant difference after the treatment than before in the treatment group （P〈0.05 or P〈 0.01）. Compared with the control group of after treatment[Scr（336.63 ± 90.77）μmol/L, BUN（10.47 ± 2.71） retool/L, Ccr（19.47 ±6.71） ml/min, CH （7.21 ± 0.62） retool/L, TG （2.30 ± 0.27） mmol/L, HDL-C （0.87 ±0.05） mmol/L, LDL-C （5.60±0.70） retool/L], the difference was statistically significant （P〈0.05）. Conclusion Self-made Huazhuo Baoyuan decoction was effective and safe to treat chronic renal failure. Key words: Traditional Chinese medicine; Renal failure; Chronic

Dyselectrolytemias and acid-base disorder in acute kidney injury

Acid-base disturbances are frequently seen in acute kidney injury patients, common being mild anion gap metabolic acidosis. Similarly, electrolyte disturbances like hyponatremia, hyperkalemia, hypocalcemia, and hyperphosphatemia are common in acute kidney injury. Acute kidney injury occurring in intensive, and critical care setting have more complex acid-base and electrolyte disturbances with multiple mechanism and etiology. It is difficult to separate the acid-base effects critical illness from that of acute renal failure and in such setting quantitative physicochemical methods like strong ion difference help to understand the nature of disturbance. This review focuses on nature of acid-base electrolytes disturbances seen in acute kidney injury patients along with its mechanism and etiology.

A novel isotonic‐balanced electrolyte solution with 1% glucose for perioperative fluid management in children‐ an animal experimental preauthorization study

The recommendations for perioperative maintenance fluid in children have been adapted from hypotonic to isotonic electrolyte solutions with lower glucose concentrations (1-2.5% instead of 5%) to avoid hyponatremia or hyperglycemia. The objective of this prospective animal study was to determine the margin of safety of a novel isotonic-balanced electrolyte solution with 1% glucose (BS-G1) in comparison with normal saline with 1% glucose (NS-G1) in the case of accidental hyperhydration with a focus on acid-base electrolyte balance, glucose concentration, osmolality and intracranial pressure in piglets. Ten piglets (bodyweight 11.8 +/- 1.8 kg) were randomly assigned to receive either 100 ml.kg(-1) of BS-G1 or NS-G1 within one hour. Before, during and after fluid administration, electrolytes, lactate, hemoglobin, hematocrit, glucose, osmolality and acid-base parameters were measured. Unlike BS-G1, administration of NS-G1 produced mild hyperchloremic acidosis (base excess BS-G1 vs NS-G1, baseline 1.9 +/- 1.7 vs 2.9 +/- 0.9 mmol.l(-1), study end 0.2 +/- 1.7 vs -2.7 +/- 0.5 mmol.l(-1), P < 0.05, chloride BS-G1 vs NS-G1 baseline 102.4 +/- 3.4 vs 102.0 +/- 0.7 mmol.l(-1), study end 103.4 +/- 1.8 vs 109.0 +/- 1.4 mmol.l(-1)P < 0.05). The addition of 1% glucose led to moderate hyperglycemia (P < 0.05) with a concomitant increase in serum osmolality in both groups (P < 0.05). Both solutions showed a wide margin of safety in the case of accidental hyperhydration with less acid-base electrolyte changes when using BS-G1. This novel solution could therefore enhance patient's safety within the scope of perioperative volume management.

The effects of saline or albumin resuscitation on acid-base status and serum electrolytes

The effects of saline or albumin resuscitation on acid-base status and serum electrolytes

Reference Intervals for Anion Gap and Strong Ion Difference in Pregnancy: A Pilot Study

Objective: Acid-base status and electrolyte levels change in normal pregnancy. We hypothesized that these physiological changes affect both anion gap and strong ion difference (SID). Methods: A cross-sectional study of normal pregnant women (6 in the first trimester, 47 in the second trimester, 59 in the third trimester, and 13 postpartum). Results: The anion gap in pregnancy (8.5 ± 2.9 mEq/L) was less, compared to postpartum values (10.7 ± 2.5 mEq/L), (p < 0.005). The SID, too, was lower (pregnancy, 38.3 ± 2.9 mEq/L, postpartum 43.5 ± 2.3 mEq/L, p < 0.001), reflecting the combined influence of changes in albumin, SID, and PCO2. Conclusion: Anion gap and SID both decrease in pregnancy, events which must be taken into account when managing acid-base disorders in gestation.

Intensive care treatment of severe mixed metabolic acidosis

We report a case of severe metabolic acidosis associated with acute renal failure and septicaemia following treatment with maximal therapeutic doses of metformin and diclofenac. On the second day of intensive care the patient deteriorated with respiratory insufficiency and abdominal pain during continuous renal replacement therapy. A laparoscopy revealed a perforated cholecystitis with abscess formation. The patient regained renal function and recovered. Intake of diclofenac 5 days before this episode could have been the main cause of renal insufficiency and metabolic acidosis in this patient and could also have delayed surgical treatment by masking early clinical signs of perforated cholecystitis. The renal failure may also have caused metformin and lactate to accumulate, contributing to the mixed pattern of metabolic acidosis. This case report describes a mixed organic and non-organic metabolic acidosis associated with acute renal failure, presumably resulting from a combination of drugs and diseases often found in the elderly - metformin for diabetes mellitus and a non-steroidal anti-inflammatory drug for cholecystolithiasis. Acid-base balance and electrolyte changes were rapidly normalized by continuous renal replacement therapy.

The Effect of Intense Passive Apnea in the Acid-Base Balance and Electrolytes

The aim of this study was to investigate the disturbances of the acid-base balance and electrolyte disorders in healthy individuals in the greatest passive apnea (prior to apnea and prior to first inhalation). The changes of the acid-base balance, the serum potassium and calcium levels as well as the disturbances of the cardiac rhythm were studied in a group of 15 healthy males aged 18 to 41 years old. Seven individuals part of the original group participated in a second trial. Following the initial apnea trial the individuals were allowed to 2–3 free inhalations and a second passive apnea effort was performed. The same parameters were measured in the second effort. In the primary effort the apnea duration was 170 ± 53 s (mean ± SD). The results received prior to the effort and immediately before the end of the apnea (paired t-test), showed no significant changes in the blood pH. The PaCO2 increased significantly, the PaO2 decreased significantly, blood bicarbonate increased significantly, the hemoglobin oxygen saturation decreased significantly. In addition the serum potassium and calcium levels decreased significantly. In the subgroup (7 individuals) the second effort of apnea lasted 50–70 s and showed no significant changes in the blood pH. The same changes concerning PaCO2 and blood bicarbonate were observed in the first and second effort of passive apnea. The serum potassium and calcium levels as well as the hemoglobin oxygen saturation showed no significant changes. During the initial effort of apnea all men presented bradycardia, which was followed by tachycardia immediately after the end of the effort. One individual, whose effort lasted 290 s suffered intense tachycardia, cyanosis, convulsions, and loss of consciousness. It is concluded that during an intense effort of passive apnea: (a) the blood PaCO2 is significantly increased, as well as the blood bicarbonates, (b) the PaO2, the hemoglobin oxygen saturation and the serum potassium and calcium levels are significantly decreased, (c) the cardiac rate is significantly decreased, and (d) the second effort of apnea, following immediately the initial one, is sorter in duration and produces similar or milder changes of the above parameters.

Acid-Base and Electrolyte Disturbances in Patients With Hypercalcemia

In the present study, we analyzed acid-base and electrolyte disturbances in hypercalcemic patients to determine the principal causes of hypercalcemia. We studied a total of 76 hypercalcemic patients and 91 healthy individuals. Acid-base and electrolyte parameters were determined before any therapeutic intervention. Hyperparathyroidism and neoplasias were the most common causes of hypercalcemia. Hypercalcemic patients had increased serum urea and creatinine levels, a higher urea/creatinine ratio, and a higher rate of acid-base disorders, but lower serum albumin, potassium, chloride, phosphorus, and magnesium concentrations than those found in the control subjects. Notably, significant differences in acid-base balance and electrolyte concentrations were evident between patients with hyperparathyroidism and patients with cancer. Primary hyperparathyroidism and neoplasia are the most common causes of hypercalcemia. A wide array of concurrent acid-base and electrolyte disorders may be evident in hypercalcemic patients. Differences in these laboratory parameters are helpful in diagnostic workup.

Electrolyte abnormalities in elderly patients admitted to a general medical ward.

Elderly patients are particularly sensitive to the development of various electrolyte abnormalities, since they commonly exhibit some derangements in the physiologic homeostasis of acid-base status and electrolyte balance. Our study was undertaken to assess the prevalence, as well as the pathophysiologic mechanisms involved in the development of electrolyte abnormalities in 248 elderly patients admitted to our clinic for a variety of causes. Fifty-five out of these patients (22.2%) had at least one electrolyte abnormality. In such cases a thorough laboratory investigation was performed in an attempt to delineate the pathophysiologic mechanisms involved in relation to age.