Blood Bicarbonate Research Articles

Registry on extracorporeal multiple organ support with the advanced organ support (ADVOS) system: 2-year interim analysis.

The objective of this registry is to collect data on real-life treatment conditions for patients for whom multiple organ dialysis with Advanced Organ Support (ADVOS) albumin hemodialysis is indicated.This registry was performed under routine conditions and without any study-specific intervention, diagnostic procedures, or assessments. Data on clinical laboratory tests, health status, liver function, vital signs, and examinations were collected (DRKS-ID: DRKS00017068). Mortality rates 28 and 90 days after the first ADVOS treatment, adverse events and ADVOS treatment parameters, including treatment abortions, were documented.This analysis was performed 2 years after the first patient was included on January 18, 2017. As of February 20, 2019, 4 clinical sites in Germany participated and enrolled 118 patients with a median age of 60 (IQR: 45, 69) of whom 70 were male (59.3%). Patients had a median SOFA Score of 14 (IQR: 11, 16) and a predicted mortality of 80%. The median number of failing organs was 3 (IQR: 2, 4).Four hundred twenty nine ADVOS treatments sessions were performed with a median duration of 17 hours (IQR: 6, 23). A 5.8% of the ADVOS sessions (25 of 429) were aborted due to device related errors, while 14.5% (62 of 429) were stopped for other reasons. Seventy nine adverse events were documented, 13 of them device related (all clotting, and all recovered without sequels).A significant reduction in serum creatinine (1.5 vs 1.2 mg/dl), blood urea nitrogen (24 vs 17 mg/dl) and bilirubin (6.9 vs 6.5 mg/dl) was observed following the first ADVOS treatment session. Blood pH, bicarbonate (HCO3-) and base excess returned to the physiological range, while partial pressure of carbon dioxide (pCO2) remained unchanged. At the time of the analysis, 28- and 90-day mortality were 60% and 65%, respectively, compared to an expected ICU-mortality rate of 80%. SOFA score was an independent predictor for outcome in a multivariable logistic regression analysis.The reported data show a high quality and completion of all participating centers. Data interpretation must be cautious due to the small number of patients, and the nature of the registry, without a control group. However, the data presented here show an improvement of expected mortality rates. Minor clotting events similar to other dialysis therapies occurred during the treatments.

Capsule Size Alters the Timing of Metabolic Alkalosis Following Sodium Bicarbonate Supplementation.

Introduction: Sodium bicarbonate (NaHCO3) is a well-established nutritional ergogenic aid that is typically ingested as a beverage or consumed in gelatine capsules. While capsules may delay the release of NaHCO3 and reduce gastrointestinal (GI) side effects compared with a beverage, it is currently unclear whether the capsule size may influence acid–base responses and GI symptoms following supplementation.Aim: This study aims to determine the effects of NaHCO3 supplementation, administered in capsules of different sizes, on acid–base responses, GI symptoms, and palatability.Methods: Ten healthy male subjects (mean ± SD: age 20 ± 2 years; height 1.80 ± 0.09 m; weight 78.0 ± 11.9 kg) underwent three testing sessions whereby 0.3 g NaHCO3/kg of body mass was consumed in either small (size 3), medium (size 0), or large (size 000) capsules. Capillary blood samples were procured pre-ingestion and every 10 min post-ingestion for 180 min. Blood samples were analyzed using a radiometer (Radiometer ABL800, Denmark) to determine blood bicarbonate concentration ([]) and potential hydrogen (pH). GI symptoms were measured using a questionnaire at the same timepoints, whereas palatability was recorded pre-consumption.Results: Capsule size had a significant effect on lag time (the time [] changed, Tlag) and the timing of peak blood [] (Tmax). Bicarbonate Tlag was significantly higher in the large-sized (28 ± 4 min) compared with the small-sized (13 ± 2 min) capsules (P = 0.009). Similarly, Tmax was significantly lower in the small capsule (94 ± 24 min) compared with both the medium-sized (141 ± 27 min; P < 0.001) and the large-sized (121 ± 29 min; P < 0.001) capsules. The GI symptom scores were similar for small-sized (3 ± 3 AU), medium-sized (5 ± 3 AU), and large-sized (3 ± 3 AU) capsules, with no significant difference between symptom scores (F = 1.3, P = 0.310). Similarly, capsule size had no effect on palatability (F = 0.8, P = 0.409), with similar scores between different capsule sizes.Conclusion: Small capsule sizes led to quicker Tlag and Tmax of blood [] concentration compared to medium and large capsules, suggesting that individuals could supplement NaHCO3 in smaller capsules if they aim to increase extracellular buffering capacity more quickly.

The Impact of COVID-19 Pandemic on Prevalence of Diabetic Ketoacidosis at Diagnosis of Type 1 Diabetes: A Single-Centre Study in Central Pennsylvania.

ObjectiveWe conducted this study to investigate whether the COVID‐19 pandemic impacted the rate of DKA and previously identified risk factors in children presenting with T1D.MethodsWe performed an extension of a retrospective analysis of all paediatric patients (age ≤ 18) newly diagnosed with T1D within a tertiary care referral centre between 01/01/2017 and 09/14/2020. Demographics, insurance coverage and clinical documents 30 days before their T1D diagnosis were abstracted to assess for symptoms at diagnosis, laboratory values (blood glucose, HbA1c, venous pH and bicarbonate) and any healthcare encounters within 30 days of their diagnosis of T1D.Results412 patients with T1D [171 F:241 M; 370 pre‐COVID era:42 post‐COVID era] were included. The percentages of DKA diagnoses at admission were very similar between the pre‐COVID and post‐COVID groups (47% vs. 48%), as were the severity (13% vs. 14% mild DKA; 33% vs. 31% moderate or severe DKA).ConclusionThere were no fluctuations in the rate of DKA among paediatric patients newly diagnosed with T1D throughout the coronavirus pandemic in central Pennsylvania.

Machine learning algorithms to predict seizure due to acute tramadol poisoning.

This study was designed to develop and evaluate machine learning algorithms for predicting seizure due to acute tramadol poisoning, identifying high-risk patients and facilitating appropriate clinical decision-making. Several characteristics of acute tramadol poisoning cases were collected in the Emergency Department (ED) (2013-2019). After selecting important variables in random forest method, prediction models were developed using the Support Vector Machine (SVM), Naïve Bayes (NB), Artificial Neural Network (ANN) and K-Nearest Neighbor (K-NN) algorithms. Area Under the Curve (AUC) and other diagnostic criteria were used to assess performance of models. In 909 patients, 544 (59.8%) experienced seizures. The important predictors of seizure were sex, pulse rate, arterial blood oxygen pressure, blood bicarbonate level and pH. SVM (AUC = 0.68), NB (AUC = 0.71) and ANN (AUC = 0.70) models outperformed k-NN model (AUC = 0.58). NB model had a higher sensitivity and negative predictive value and k-NN model had higher specificity and positive predictive values than other models. A perfect prediction model may help improve clinicians' decision-making and clinical care at EDs in hospitals and medical settings. SVM, ANN and NB models had no significant differences in the performance and accuracy; however, validated logistic regression (LR) was the superior model for predicting seizure due to acute tramadol poisoning.

Investigating the Outcomes of Aluminum Phosphide Poisoning in Khorshid Referral Hospital, Isfahan, Iran: A Retrospective Study.

Objective:Aluminum phosphide (ALP) (rice-tablet) is a common cause of adult poisoning in Iran, including Isfahan. So far, no effective treatment has been identified for this poisoning. We aimed to investigate the outcome of ALP poisoned patients admitted to the clinical toxicology ward of Khorshid Hospital in Isfahan from 2017 to 2019.Methods:This chart-review study was performed on the population of ALP poisoned patients admitted to the clinical toxicology ward of Khorshid University Hospital from 2017 to 2019 treated with the hospital’s new treatment protocol, using the complete enumeration approach. The outcomes were determined by reviewing and abstracting medical charts of ALP poisoned patients from the hospital archive.Findings:The most common complaints at admission were depressed consciousness (41.9%) and vomiting (32.2%). There was no significant change in blood sugar, pH, base excess (BE), and venous blood bicarbonate throughout their hospitalization (P > 0.05). Treatment outcomes had a significant relationship with blood pH 2 h and 6 h after admission and the BE 6 h after admission (P < 0.05). There was also a significant relationship between the outcome and the length of stay, initial ejection fraction (EF), and EF in predischarge echocardiography (P < 0.05). Out of 31 patients, 24 (77.4%) died within 72 h, 5 (16.1%) recovered without any complication, and 2 (6.5%) recovered with some complications.Conclusion:The mortality rate of ALP poisoned patients was reasonably high and can be attributed to the poor efficacy of the new treatment protocol or the long time it takes for patients to reach the hospital and start receiving treatments.

Predicting 90 day acute heart failure readmission and death using machine learning-supported decision analysis.

Readmission or death soon after heart failure (HF) admission is a significant problem. Traditional analyses for predicting such events often fail to consider the gamut of characteristics that may contribute– tending to focus on 30‐day outcomes even though the window of increased vulnerability may last up to 90 days. Risk assessments incorporating machine learning (ML) methods may be better suited than traditional statistical analyses alone to sort through multitude of data in the electronic health record (EHR) and identify patients at higher risk.HypothesisML‐based decision analysis may better identify patients at increased risk for 90‐day acute HF readmission or death after incident HF admission.Methods and ResultsAmong 3189 patients who underwent index HF hospitalization, 15.2% experienced primary or acute HF readmission and 11.5% died within 90 days. For risk assessment models, 98 variables were considered across nine data categories. ML techniques were used to help select variables for a final logistic regression (LR) model. The final model's AUC was 0.760 (95% CI 0.752 to 0.767), with sensitivity of 83%. This proved superior to an LR model alone [AUC 0.744 (95% CI 0.732 to 0.755)]. Eighteen variables were identified as risk factors including dilated inferior vena cava, elevated blood pressure, elevated BUN, reduced albumin, abnormal sodium or bicarbonate, and NT pro‐BNP elevation. A risk prediction ML‐based model developed from comprehensive characteristics within the EHR can efficiently identify patients at elevated risk of 90‐day acute HF readmission or death for whom closer follow‐up or further interventions may be considered.

Development and validation of a prognostic nomogram for myocardial infarction patients in intensive care units: a retrospective cohort study

ObjectivesWe aimed to develop and validate a prognostic nomogram and evaluate the discrimination of the nomogram model in order to improve the prediction of 30-day survival of critically ill myocardial...

Effect of Isotonic and Hypotonic Fluid Therapy on Serum Sodium: A Randomized Controlled Trial

There is little consensus about the type of maintenance fluid therapy and it’s the effect on serum sodium in adults. Thus, this study was conducted to assess the effect of maintenance fluid therapy on serum sodium of hospitalized patients in the intensive care unit. This randomized clinical trial was carried out on 64 patients aged 18-90 years hospitalized in the intensive care unit (ICU) of Imam Sadjad and Shahid Beheshti hospitals, Yasuj, Iran, in 2017. These patients were randomly allocated to take 2500-3000 milliliters of intravenous maintenance isotonic (0.9% saline) or hypotonic (0.45% saline) fluids daily. Blood and urine samples were taken to measure biochemical parameters before and 48 hours after the intervention. Data analyses were done by using SPSS 16 software via descriptive and analytic statistics. Twenty-eight patients in the 0.9% saline group (19 male and 9 female) and 32 patients in 0.45% saline (20 male and 12 female) completed the study. There was no significant difference between two groups in sodium (P=0.94), potassium (P=0.21), sugar (P=0.91), creatinine (P=0.21), Blood Urea Nitrogen (P=0.99), systolic (P=0.81) and diastolic (P=0.73) blood pressure, PH (P=0.27), bicarbonate (P=0.8), and urine specific gravity (P=0.73). Based on the results of this study, it was shown that the administration of maintenance hypotonic fluids has been appropriate for the patients and will not face them with the risk of hyponatremia.

The Impact of a New Best Practice Advisory on the Management of Diabetic Ketoacidosis.

According to the Center for Disease Control and Prevention, diabetic ketoacidosis (DKA) hospitalization rates have been steadily increasing. Due to the increasing incidence and the economic impact associated with its morbidity and treatment, effective management is key. We aimed to streamline the management of DKA in our intensive care units (ICU) by implementing a Best-Practice Advisory (BPA) that notifies providers when DKA has resolved. A BPA was implemented on 9/15/2018. We conducted a retrospective review of patients admitted to the ICU with DKA a year before and after 9/15/2018. Adults (≥18 age) meeting DKA criteria on admission and treated with continuous insulin infusion (CII) were included. Pre-intervention group included patients admitted before BPA implementation and post-intervention group included patients admitted after. Summary and univariate analyses were performed. A total of 282 patients were included; 162 (57%) pre-intervention and 120 (43%) post-intervention. Mean (±SD) age of the patients was 44 (±17) years. There was no significant difference in baseline characteristics such as age, sex, race, BMI, HbA1c, initial blood glucose, anion gap or bicarbonate concentration between both the groups (p>0.05). Mean (±SD) total time on CII in hours was significantly lower in the post-intervention group {14.8 (±7.7) vs. 17.5 (±14.3) p=0.041, 95% CI: 0.11-5.3}. The incidence of hypoglycemia was lower in the post-intervention group {n=4 (3%) vs. 17 (10%), p=0.024}. There was no significant difference in hypokalemia, mortality, LOS or ICU stay between both the groups (p>0.05). The BPA introduced in our DKA management algorithm successfully reduced the total time on insulin and the incidence of hypoglycemia.

Clinical Symptoms and Para-Clinical Findings among the Deceased Patients Due to Aluminum Phosphide Poisoning in Ardabil, Iran, From 2009 To 2017

Introduction: Aluminum phosphide or rice tablet is one of the most common pesticides and insecticides used in agriculture to protect crops, cereals, and rice. Recently, this substance has been increasingly used as a method for committing suicide among people in society. This study aimed to evaluate the clinical symptoms and para-clinical findings of deceased patients due to Aluminum phosphide poisoning in Ardabil province, Iran. Materials and Methods: This descriptive cross-sectional study was conducted on 97 hospitalized patients who died due to Aluminum phosphide poisoning in Ardabil province, Iran, from 2009 to 2017. The data were collected using a checklist and then analyzed in SPSS software (version 19) through descriptive and analytical statistics Results: The mean age of all patients was 34.3±15.8 years, and the majority of the cases (77.3%) were female. The most important symptoms were nausea and vomiting in males (92%) and females (100%). Moreover, the patients had a mean recovery time of 5.89 h. Of all the deceased patients, 22 and 75 cases took two and one tablets, respectively. Furthermore, 92.7% of the patients had taken the rice tablets orally. The amount of Glasgow Coma Scale (P=0.001), systolic blood pressure (P=0.001), PH (P=0.001), heart rate (P=0.001), respiratory rate (P=0.001), bicarbonate (P=0.001) and white blood cell (P=0.009) in died patients in more than 24 hour significantly difference with died patients in less than 24 hour. The females obtained a significantly lower systolic blood pressure (P=0.01) and lower pH (p=0.045), but the higher partial pressure of oxygen (P=0.01), compared to males. Conclusion: The results of this study showed that the frequency of deaths due to rice pill poisoning was much higher in males than females; moreover, this value was higher in middle-aged groups, compared to other age groups.

The treating dogs for enteropathy with PLE

One of the most common and poorly understood diseases in dogs and cats is enteropathy with PLE. The disease occurs, according to studies, in dogs of 2-6 years old breeds: Yorkshire terrier, German shepherd, and Golden Retriever. The disease in most cases is manifested by anorexia, polydipsia, diarrhea, fever up to 39.7 °C, tachycardia (145–170 bpm), and abdominal pain. In sick dogs, leucocytosis (21.0 ± 0.50 g/l), thrombocytosis (480.0 ± 10.13 g/l), oligocythaemia (4.8 ± 0.12 T/l), oligochromemia (109.0 ± 5.06 g/l), decrease in haematocrit value (29.0 ± 1.21 % in healthy people 42.3 ± 0.65 %). In a biochemical study of blood in dogs with enteropathy with PLE, hypoproteinaemia (38.2 ± 0.65 g/l), hypoalbuminemia (9.6 ± 0.61 g/l); hyperazotemia (8.6 ± 0.37 mmol/l), hypercholesterolemia (8.0 ± 0.23 mmol/l), hyperenzymemia of LF (ALP) and ALT (alanine aminotransferase), hyponatremia, hypokalaemia, hypochloraemia, decreased blood pH values (7.26 ± 0.013), HCO3- (15.3 ± 0.71 mmol/L) and AG (2.85 ± 0.084 mmol/L, in healthy people 14.3 ± 1.17 mmol/L). The diagnosis of enteropathy with PLE was confirmed by studies in feces of α1-antitrypsin, which in sick dogs with PLE was more than 22 mg/dL (in clinically healthy dogs up to 18 mg/dL). A treatment regimen with trometamol, Xylat, Disparkol, Voluven, Reopoliglukin, Maropitant, prednisolone, α-lysine escinat, albumin, Presorb and feed additives Vivonex Ten Elemental and Royal Canin Recoveri promotes the recovery of dogs, prevents their death. Under the action of drugs, erythro- and leuсocytopoiesis, protein-synthesizing (the content of total protein and albumin increased by 34.3 and 246.9 %, respectively) and urea-forming functions of hepatocytes improves. We have developed and tested a treatment scheme that restores the acid-base balance of the body, as indicated by the physiological values of blood pH, bicarbonates, anion gap (AG), Na+, K+, Cl- and Mg+.

Bicarbonate Unlocks the Ergogenic Action of Ketone Monoester Intake in Endurance Exercise.

ABSTRACTPurposeWe recently reported that oral ketone ester (KE) intake before and during the initial 30 min of a 3 h 15 min simulated cycling race (RACE) transiently decreased blood pH and bicarbonate without affecting maximal performance in the final quarter of the event. We hypothesized that acid–base disturbances due to KE overrules the ergogenic potential of exogenous ketosis in endurance exercise.MethodsNine well-trained male cyclists participated in a similar RACE consisting of 3 h submaximal intermittent cycling (IMT180′) followed by a 15-min time trial (TT15′) preceding an all-out sprint at 175% of lactate threshold (SPRINT). In a randomized crossover design, participants received (i) 65 g KE, (ii) 300 mg·kg−1 body weight NaHCO3 (BIC), (iii) KE + BIC, or (iv) a control drink (CON), together with consistent 60 g·h−1 carbohydrate intake.ResultsKE ingestion transiently elevated blood D-ß-hydroxybutyrate to ~2–3 mM during the initial 2 h of RACE (P < 0.001 vs CON). In KE, blood pH concomitantly dropped from 7.43 to 7.36 whereas bicarbonate decreased from 25.5 to 20.5 mM (both P < 0.001 vs CON). Additional BIC resulted in 0.5 to 0.8 mM higher blood D-ß-hydroxybutyrate during the first half of IMT180′ (P < 0.05 vs KE) and increased blood bicarbonate to 31.1 ± 1.8 mM and blood pH to 7.51 ± 0.03 by the end of IMT180′ (P < 0.001 vs KE). Mean power output during TT15′ was similar between KE, BIC, and CON at ~255 W but was 5% higher in KE + BIC (P = 0.02 vs CON). Time to exhaustion in the sprint was similar between all conditions at ~60 s (P = 0.88). Gastrointestinal symptoms were similar between groups.DiscussionThe coingestion of oral bicarbonate and KE enhances high-intensity performance at the end of an endurance exercise event without causing gastrointestinal distress.

The Perfect Timing For Sodium Bicarbonate Supplementation: Greater Possibilities With Probabilities

PURPOSE: To describe the reliability of blood bicarbonate pharmacokinetics to sodium bicarbonate (SB) supplementation and, based on those data, to estimate probabilities of SB ingestion timing before exercise using currently accepted thresholds. METHODS: Thirteen males (age 27±5 y; body mass (BM) 77.4±10.5 kg; height 1.75±0.06 m) ingested 0.3 g·kg-1BM SB in capsules on 3 occasions (SB1, SB2 and SB3). Blood was obtained at baseline and every 10 min following SB ingestion for 3h, then every 20 min for a further hour to determine bicarbonate concentration. Time-to-peak (Tmax), absolute peak (Cmax), absolute peak change (ΔCmax) and area under the curve (AUC) were determined and analysed using mixed models, as was the intraclass correlation coefficient (ICC), coefficient of variation (CV) and typical error (TE). Individual variation in pharmacokinetic responses was assessed using a Bayesian simulation approach using multilevel models with random intercepts. RESULTS: No significant differences between sessions were shown for blood bicarbonate regarding Cmax, ΔCmax or AUC (all p>0.05), although Tmax occurred significantly earlier in SB2 (127±36 min) than in SB1 (169±54 min, p=0.0088) and SB3 (159±42 min, p=0.05). ICC, CV and TE showed moderate to poor reliability for these variables. Bayesian modelling estimated that over 80% of individuals from the population experience elevated blood bicarbonate levels greater than +5 mmol·L-1 between 75-240 min after ingestion, and between 90-225 min for elevations greater than +6 mmol·L-1 (Table 1). CONCLUSIONS: Assessing SB supplementation using discrete values showed only moderate reliability at the group level, and poor reliability at the individual level, while Tmax was not reproducible. However, when analysed as modelled curves, a 0.3 g·kg-1BM dose was shown to create a long-lasting window of ergogenic potential, which has practical utility for athletes and suggests that individually tailored timings are not required.

Effect of β-Alanine Supplementation on Repeated Sprint Ability and Responses of Blood Lactate and Bicarbonate in Male Soccer Players

Effect of β-Alanine Supplementation on Repeated Sprint Ability and Responses of Blood Lactate and Bicarbonate in Male Soccer Players

The influence of progressive-chronic and acute sodium bicarbonate supplementation on anaerobic power and specific performance in team sports: a randomized, double-blind, placebo-controlled crossover study

BackgroundThe aims of this study were to verify the effect of progressive-chronic and acute sodium bicarbonate (SB) supplementation on the anaerobic capacity, blood acid-base balance, and discipline-specific performance in team sports disciplines.MethodsTwenty-four trained male field hockey players completed a randomized, placebo-controlled, crossover trial of either progressive-chronic (increments from 0.05 up to 0.2 g/kg) or an acute one-off dose (0.2 g/kg) supplementation protocol. Before and after treatments, athletes completed an exercise protocol that comprised of a discipline-specific field performance test conducted between two separate Wingate anaerobic tests (WAnTs).ResultsProgressive-chronic SB supplementation improved anaerobic capacity in the first bout of WAnTs, as observed based on an increase in mean power (MP: 575 ± 71 vs. 602 ± 67 W, p = 0.005, ~ + 4.7%), peak power (PP: 749 ± 94 vs. 777 ± 96 W, p = 0.002, ~ + 3.7%), power carry threshold (PCT) at 97%PP (727 ± 91 vs. 753 ± 93 W, p = 0.002, ~ + 3.6%) and average power over PCT (739 ± 94 vs. 765 ± 95 W, p = 0.001, ~ + 3.5%). Acute SB supplementation had no effect on anaerobic capacity. However, an improvement in time during discipline-specific field performance test was observed after progressive-chronic (919 ± 42 vs. 912 ± 27 s, p = 0.05; ~ − 0.8%) and acute (939 ± 26 vs. 914 ± 22 s, p = 0.006, ~ 2.7%) SB supplementation. Acute SB supplementation also improved post-exercise parameters of acid-base balance (based on blood pH, bicarbonate concentration and base excess) compared to no supplementation or placebo.ConclusionsOur study indicates that both chronic and acute SB supplementation positively supports discipline-specific performance among field hockey athletes. Moreover, the chronic protocol supported anaerobic power indices before the inset of exercise-induced fatigue but had no significant impact afterwards. However, only the acute protocol significantly affected the buffering capacity, which can be used to determine athlete’s performance during high-intensity sporting events. This study design therefore highlighted that future studies focusing on sodium bicarbonate supplementation in team sports should concentrate on the efficiency of chronic and acute supplementation in varying time frames.

Resting time before slaughter restores homeostasis, increases rigor mortis time and fillet quality of surubim Pseudoplatystoma spp.

This study assesses the respiratory dynamics related to stress parameters and resting time before slaughter, in the quality of surubim (Pseudopatystoma spp.) fillets. A completely randomized design was conducted using five treatments: resting time before slaughter of 0, 2, 4, 8 and 24 hours, with 15 fish sampled per treatment. Time 0 corresponded to the treatment without resting time, where the fish were slaughtered immediately after arriving at the processing plant. The resting time did not affect the electrolyte balance, hemoglobin, plasma, hepatic glycogen, myofibrillar fragmentation index (MFI) and water holding capacity (WHC) of surubins. However, with increased resting time, there was a significant decrease in muscle glycogen and an increase in blood pH and blood bicarbonate levels. Additionally, respiratory parameters showed an increase in pO2 and, consequently, in O2 saturation and a decrease in pCO2.The hematocrit and MCV values of the surubins after 24 hours of resting decreased significantly. In the first hours of resting, the highest values of erythrocytes and CHCM were observed. The lowest level of stress was observed for fish having 24 hours of resting. Fish having longer resting periods (8 and 24 hours) presented fillets with a higher pH (P <0.05) and the rigor mortis establishment time was shorter for the first 2 hours and 24 hours of resting time. There was a linear decrease in fillet lightness and an increase in the intensity of red (CIE a*) color up to 24 hours when resting was increased. In CIE b*, a linear decrease (P <0.05) of the yellow intensity of the fillets was observed as the surubim resting time increased. A resting time of 4 to 8 hours before slaughter is effective in reestablishing homeostasis after transporting surubim, providing fillets with higher quality and a greater length of the pre-rigor mortis period.

Seizure Prediction Model in Acute Tramadol Poisoning; a Derivation and Validation study.

Seizure is a common complication of tramadol poisoning and predicting it will help clinicians in preventing seizure and better management of patients. This study aimed to develop and validate a prediction model to assess the risk of seizure in acute tramadol poisoning. This retrospective observational study was conducted on 909 patients with acute tramadol poisoning in Baharloo Hospital, Tehran, Iran, (2015-2019). Several available demographic, clinical, and para-clinical characteristics were considered as potential predictors of seizure and extracted from clinical records. The data were split into derivation and validation sets (70/30 split) via random sampling. Derivation set was used to develop a multivariable logistic regression model. The model was tested on the validation set and its performance was assessed with receiver operating characteristic (ROC) curve. The mean (standard deviation (SD)) of patients' age was 23.75 (7.47) years and 683 (75.1%) of them were male. Seizures occurred in 541 (60%) patients. Univariate analysis indicated that sex, pulse rate (PR), arterial blood Carbone dioxide pressure (PCO2), Glasgow Coma Scale (GCS), blood bicarbonate level, pH, and serum sodium level could predict the chance of seizure in acute tramadol poisoning. The final model in derivation set consisted of sex, PR, GCS, pH, and blood bicarbonate level. The model showed good accuracy on the validation set with an area under the ROC curve of 0.77 (95% CI: 0.67-0.87). Representation of this model as a decision tree could help clinicians to identify high-risk patients with tramadol poisoning-induced seizure and in decision-making at triage of emergency departments in hospitals.

Dialysis timing may be deferred toward very late initiation: An observational study.

The optimal timing to initiate dialysis among patients with an estimated glomerular filtration rate (eGFR) of <5 mL/min/1.73 m2 is unknown. We hypothesized that dialysis initiation time can be deferred in this population even with high uremic burden. A case-crossover study with case (0–30 days before dialysis initiation [DI]) and control (90–120 days before DI) periods was conducted in 1,079 hemodialysis patients aged 18–90 years at China Medical University Hospital between 2006 and 2015. The uremic burden was quantified based on 7 uremic indicators that reached the predefined threshold in case period, namely hemoglobin, serum albumin, blood urea nitrogen, serum creatinine, potassium, phosphorus, and bicarbonate. Dialysis timing was classified as standard (met 0–2 uremic indicators), late (3–5 indicators), and very late (6–7 indicators). Median eGFR-DI of the 1,079 patients was 3.4 mL/min/1.73 m2 and was 2.7 mL/min/1.73 m2 in patients with very late initiation. The median follow-up duration was 2.42 years. Antibiotics, diuretics, antihypertensive medications, and non-steroidal anti-inflammatory drugs (NSAIDs) were more prevalently used during the case period. The fully adjusted hazards ratios of all-cause mortality for the late and very late groups were 0.97 (95% confidence interval 0.76–1.24) and 0.83 (0.61–1.15) compared with the standard group. It is safe to defer dialysis initiation among patients with chronic kidney disease (CKD) having an eGFR of <5 mL/min/1.73 m2 even when patients having multiple biochemical uremic burdens. Coordinated efforts in acute infection prevention, optimal fluid management, and prevention of accidental exposure to NSAIDs are crucial to prolong the dialysis-free survival.

Enteric-coated sodium bicarbonate supplementation improves high-intensity cycling performance in trained cyclists

PurposeEnteric-coated sodium bicarbonate (NaHCO3) can attenuate gastrointestinal (GI) symptoms following acute bicarbonate loading, although the subsequent effects on exercise performance have not been investigated. The purpose of this study was to examine the effects of enteric-coated NaHCO3 supplementation on high-intensity exercise performance and GI symptoms.MethodsEleven trained male cyclists completed three 4 km time trials after consuming; a placebo or 0.3 g∙kg–1 body mass NaHCO3 in enteric-coated or gelatin capsules. Exercise trials were timed with individual peak blood bicarbonate ion concentration ([HCO3–]). Blood acid–base balance was measured pre-ingestion, pre-exercise, and post-exercise, whereas GI symptoms were recorded pre-ingestion and immediately pre-exercise.ResultsPre-exercise blood [HCO3−] and potential hydrogen (pH) were greater for both NaHCO3 conditions (P < 0.0005) when compared to placebo. Performance time was faster with enteric-coated (− 8.5 ± 9.6 s, P = 0.044) and gelatin (− 9.6 ± 7.2 s, P = 0.004) NaHCO3 compared to placebo, with no significant difference between conditions (mean difference = 1.1 ± 5.3 s, P = 1.000). Physiological responses were similar between conditions, although blood lactate ion concentration was higher with gelatin NaHCO3 (2.4 ± 1.7 mmol∙L–1, P = 0.003) compared with placebo. Furthermore, fewer participants experienced GI symptoms with enteric-coated (n = 3) compared to gelatin (n = 7) NaHCO3.DiscussionAcute enteric-coated NaHCO3 consumption mitigates GI symptoms at the onset of exercise and improves subsequent 4 km cycling TT performance. Athletes who experience GI side-effects after acute bicarbonate loading may, therefore, benefit from enteric-coated NaHCO3 supplementation prior to exercise performance.

The Effect of Sodium Bicarbonate Supplementation on the Decline in Gross Efficiency During a 2000-m Cycling Time Trial

Gross efficiency (GE) declines during high-intensity exercise. Increasing extracellular buffer capacity might diminish the decline in GE and thereby improve performance. To examine if sodium bicarbonate (NaHCO3) supplementation diminishes the decline in GE during a 2000-m cycling time trial. Sixteen male cyclists and 16 female cyclists completed 4 testing sessions including a maximal incremental test, a familiarization trial, and two 2000-m GE tests. The 2000-m GE tests were performed after ingestion of either NaHCO3 supplements (0.3g/kg body mass) or placebo supplements (amylum solani, magnesium stearate, and sunflower oil capsules). The GE tests were conducted using a double-blind, randomized, crossover design. Power output, gas exchange, and time to complete the 2000-m time trials were recorded. Capillary blood samples were analyzed for blood bicarbonate, pH, and lactate concentration. Data were analyzed using magnitude-based inference. The decrement in GE found after the 2000-m time trial was possibly smaller in the male and female groups after NaHCO3 than with placebo ingestion, with the effect in both groups combined being unclear. The effect on performance was likely trivial for males (placebo 164.2 [5.0]s, NaHCO3 164.3 [5.0]s; Δ0.1; ±0.6%), unclear for females (placebo 178.6 [4.8]s, NaHCO3 178.0 [4.3]s; Δ-0.3; ±0.5%), and very likely trivial when effects were combined. Blood bicarbonate, pH, and lactate concentration were substantially elevated from rest to pretest after NaHCO3 ingestion. NaHCO3 supplementation results in an unclear effect on the decrease in GE during high-intensity exercise and in a very likely trivial effect on performance.