Bicarbonate Levels Research Articles

Increasing the Anaerobic Capacity Resulting from the Improvement of Buffering and Hypoxia Indicators in Healthy Men

Background: Increasing anaerobic capacity is a crucial factor in enhancing performance in strength sports. Objectives: This study investigated the effect of 10 weeks of weightlifting training with increased respiratory dead space on buffering capacity and anaerobic capacity in healthy men. Methods: Eighteen male weightlifters (mean age: 28.2 ± 3.02 years, BMI: 24.27 ± 1.34 kg/m²) were selected through convenience sampling and randomly assigned to two training groups: With and without masks. Both groups performed selected weightlifting exercises three times per week for 10 weeks at 80% of their one-repetition maximum. The mask group trained using a mask and tube to increase respiratory dead space throughout the training period. The Borg scale was used to measure perceived effort, and the Wingate test assessed anaerobic power and Fatigue Index (FI). Blood samples were taken to measure lactate, CO₂, and hypoxia-inducible factor 1-alpha (HIF-1α) levels. Data analysis was conducted using ANOVA with repeated measures (P ≤ 0.05). Results: Ten weeks of weightlifting training with a mask led to a significant increase in bicarbonate levels (P = 0.029), lactate (P ≤ 0.001), FI (P ≤ 0.001), and rating of perceived exertion (RPE) (P = 0.041) compared to the group without a mask. There was no significant difference between the groups in HIF-1α levels (P = 0.079) or anaerobic power (P = 0.534). However, the percentage changes were greater in the mask group (anaerobic power = 5.9%, HIF-1α = 1.97%) compared to the group without a mask (anaerobic power = -0.9%, HIF-1α = 1.07%). Conclusions: Using the strategy of increasing respiratory dead space during weightlifting training has proven beneficial for enhancing buffering capacity and anaerobic power.

Risk factors for prolonged hospitalization as a marker for difficult-to-manage exacerbations of chronic obstructive lung disease (COPD): the DiMECO Study

BackgroundExacerbation is an independent risk factor for chronic obstructive pulmonary disease (COPD)-related morbidity and mortality. Despite optimal care, there may be risk factors that lead to difficulties in managing exacerbations that may be associated with prolongation of length of hospital stay (LOS).MethodsThis is a multicenter prospective observational study of COPD patients hospitalized with exacerbations. Prolonged LOS was calculated according to the 50th percentile and defined as ≥ 9 days. Potentially predicting factors of LOS were stratified into 4 pillars as patient-related, disease and exacerbation-related, treatment-related and, hospital utility-related. These categories were systematically documented throughout the duration of the hospitalization.ResultsA total of 434 patients, 361 males and 73 females, with a mean age of 69.2 ± 9.3 years, were included in the study. Variables of each pillar were tested with univariate analysis to identify potential risk factors for prolonged LOS. Subsequently significant factors excluding factors associated with hospital utility were tested with multivariate logistic regression analysis for detecting potential associated factors for difficult-to-manage COPD exacerbation. Biomass exposure, past history of non-invasive mechanical ventilation (NIMV), low bicarbonate levels at admission, antibiotic switching, need for theophylline, increasing oxygen requirement, need for in-hospital non-invasive mechanical ventilation, nutritional support and physiotherapy were found as defining factors.ConclusionsThe DiMECO study can help to identify COPD exacerbators who are at risk for prolonged hospitalizations that may associate with difficult-to-manage COPD exacerbations. Difficult to manage COPD exacerbation may serve as a provocative framework, underscoring the necessity for a better understanding of the multifaceted approaches to the management of COPD exacerbations. This conceptualization warrants further investigation across diverse clinical settings to validate its applicability and efficacy.

CO2 protects cells from iron-Fenton oxidative DNA damage in Escherichia coli and humans

While hydroxyl radical is commonly named as the Fenton product responsible for DNA and RNA damage in cells, here we demonstrate that the cellular reaction generates carbonate radical anion due to physiological bicarbonate levels. In human and Escherichia coli models, their transcriptomes were analyzed by RNA direct nanopore sequencing of ribosomal RNA and chromatography coupled to electrochemical detection to quantify oxidation products in order to follow the bicarbonate dependency in H2O2-induced oxidation. These transcriptomic studies identified physiologically relevant levels of bicarbonate focused oxidation on the guanine base favorably yielding 8-oxo-7,8-dihydroguanine (OG). In human cells, the bicarbonate-dependent oxidation was further analyzed in the metabolome by mass spectrometry, and a glycosylase-dependent qPCR assay to quantify oxidation sites in telomeres. These analyses further identify guanine as the site of oxidation when bicarbonate is present upon H2O2 exposure. Labile iron as the catalyst for forming carbonate radical anion was demonstrated by repeating the bicarbonate-dependent oxidations in cells experiencing ferroptosis, which had a >fivefold increase in redox-active iron, to find enhanced overall guanine-specific oxidation when bicarbonate was present. The complete profiling of nucleic acid oxidation in the genome, transcriptome, and metabolome supports the conclusion that a cellular Fe(II)-carbonate complex redirects the Fenton reaction to yield carbonate radical anion. Focusing H2O2-induced oxidative modification on one pathway is consistent with the highly evolved base excision repair suite of enzymes to locate G-oxidation sites for repair and gene regulation in response to oxidative stress.

The effect of sevelamer on serum calcification propensity in patients with chronic kidney disease: the results of a multicentre, double-blind, placebo-controlled, randomized clinical trial

Abstract Background The serum calcification propensity test (or T50 test) might become a standard tool for the assessment of vascular calcification risk, and T50 might be a valuable biomarker in clinical trials of treatments intended to slow the progression of vascular calcification. Literature data suggest that non-calcium-containing phosphate binders can influence T50 in chronic dialyzed patients. However, it is not clear whether similar interventions are effective in patients at earlier stages of chronic kidney disease (CKD). Methods The “FGF23 Reduction efficacy of a new Phosphate Binder in CKD” (FRENCH) trial was a multi-centre, double-blind, placebo-controlled, randomized trial of sevelamer carbonate in participants with stage 3b/4 CKD. In this subanalysis of the FRENCH data, T50 and other laboratory variables (including fetuin A, and ionized and total magnesium) were measured centrally at baseline and after 12 weeks of treatment. Results A total of 96 patients were screened; 78 (55 men and 23 women) met the inclusion criteria and were randomized to receive placebo (n=39) or sevelamer carbonate (n=39). The median [interquartile range] patient age was 66 [56-72], the median eGFR was 25 [21-30] mL/min/1.73m², and the mean T50 was 335 (82) minutes. In a linear regression model, T50 was independently associated with serum ionized magnesium, fetuin-A and bicarbonate levels; and inversely associated with phosphate concentration. The within-group changes in the mean [95% confidence interval] T50 between week 0 and week 12 were not significant in the sevelamer group or the placebo group (4.6 [-13.6; 22.8] minutes (p=0.61) and 7.8 [-16.4; 32.1] minutes (p=0.51), respectively). Furthermore, we did not observe significant changes in fetuin-A and magnesium levels. Conclusion A 12-week course of the non-calcium-containing phosphate binder sevelamer carbonate was not associated with a significant change in T50 in patients with stage 3b/4 CKD. Phosphate binders might not be an effective strategy for modifying serum calcification propensity in non-dialysis-dependent patients with CKD.

What is confirmed in the treatment of metabolic acidosis in chronic kidney disease?

Precise regulation of the acid-base balance is essential for the functioning of various organs and physiological processes. Acid retention and metabolic acidosis (MA) are frequent complications of chronic kidney disease (CKD) and can also occur following kidney transplantation. In addition to dietary modifications, pharmacological interventions, most notably sodium bicarbonate, are employed to correct MA. While several studies have reported abeneficial effect of MA correction on the progression of CKD, the results remain inconsistent and the magnitude of the treatment effect may be limited. Importantly, no beneficial effect on graft function has been demonstrated after kidney transplantation. The MA is associated with impaired bone quality and although alkali treatment has generally shown positive effects on markers of bone metabolism, consistent changes in bone density have not been observed. Additionally, MA is linked to an increased incidence of cardiovascular events but so far there is alack of interventional studies with definitive cardiovascular endpoints. Sodium bicarbonate may lead to sodium retention, potentially increasing blood pressure, although the data on this are inconclusive. One interventional study with notable limitations reported apositive effect of alkali treatment on mortality. Correction of MA has been suggested to positively impact protein and muscle catabolism, although no improvement in physical performance was observed in ageriatric population. Limited studies exist on the endocrinological effects of alkali treatment but these indicate afavorable impact on glucose metabolism and potential benefits for thyroid function in predialysis CKD patients. Given the overall low to moderate level of evidence supporting the benefits of alkali treatment, the current guidelines from Kidney Disease: Improving Global Outcomes (KDIGO) propose alkali treatment to prevent serum bicarbonate levels < 18 mmol/l (prior < 22 mmol/l) in adults and the resulting complications.

An investigation into the contributing factors to survival of ARDS patients supported by veno-venous ECMO.

This study aimed to identify characteristics associated with survival during and post Extra Corporeal Membrane Oxygenation (ECMO) therapy, in patients with acute respiratory distress syndrome (ARDS) during the COVID-19 pandemic. A retrospective observational study on 94 consecutive patients with confirmed COVID-19 induced ARDS supported by ECMO was carried out 49/94 (52.7%) patients survived to hospital discharge. Non-survivors were found to have significantly (p < .05) higher: Pre-ECMO International normalized ratios (INR), carbon dioxide partial pressure (pCO2), Acute Kidney Injury (AKI) scores and blood urea levels. Also, lower pre-ECMO peak inspiratory pressures (PIP), mean arterial pressure, saturation of arterial oxygen (SaO2), blood bicarbonate levels (HCO3), blood Ph and fewer trials off ECMO with shorter combined trial off times. Patients that did not survive were more likely to have renal impairment and have received peri-ECMO haemofiltration. Poor prognosis was significantly associated with: receiving pre-ECMO nitric oxide (HR = 3.047, CI = 1.247-7.447, p = .015), renal impairment (HR = 3.023, CI = 1.586-5.763, p < .001), AKI of 2 (HR = 3.611, CI = 1.382-9.441, p = .009) or 3 (HR = 3.275, CI = 1.235-8.685, p = .017), peri-ECMO haemofiltration (HR = 2.412, CI = 1.310-4.442, p = .005) and the ABO blood group B (HR = 3.103, CI = 1.335-7.212, p = .008). pre-ECMO high CO2 (HR = 1.134, CI = 1.031-1.248, p = .010), blood lactate (HR = 1.350, CI = 1.156-1.576, p < .001), INR (HR = 2.571, CI = 1.438-4.598, p=<0.001) and lower blood Ph (HR = 0.023, CI = 0.002-0.210, p < .001). Commonly used mortality scores may not be of use in a COVID-19 cohort of ECMO patients. The initiation of ECMO needs to be implemented prior to metabolic derangements, renal and fulminant respiratory failure.

A predictive model based on serum bicarbonate for cardiovascular events after initiation of peritoneal dialysis

Background The risk of cardiovascular events (CVEs) in peritoneal dialysis (PD) patients is high, but varies widely among individuals. Metabolic acidosis is prevalent in PD patients and may be involved in the development of CVEs. The aim of the study was to evaluate serum bicarbonate as a risk factor and derive a model of new CVE. Methods A predictive model was established by performing an observational study in 187 PD patients obtained from the First Affiliated Hospital of Anhui Medical University. The variables were extracted using least absolute shrinkage and selection operator (LASSO) regression, and the modeling was developed using multivariable Cox regression. Results Left ventricular hypertrophy (HR = 1.965, 95%CI 1.086–3.557) and history of CVEs (HR = 2.435, 95%CI 1.342–4.49) were risk parameters for a new CVE. Serum albumin (HR = 0.924, 95%CI 0.864–0.989) and bicarbonate levels (HR = 0.817, 95%CI 0.689–0.969) were protective parameters, in which the risk of CVEs was reduced by 7.6% and 18.3% for each 1-unit increase in serum albumin (g/L) and bicarbonate (mmol/L) levels, respectively. A nomogram based on the above predictive indicators was proposed with a C-statistic of 0.806, indicating good discrimination. Moreover, it successfully stratified patients into low-, intermediate-, and high-risk groups. Conclusions: We performed a risk prediction model for the development of CVEs in patients with PD, which may help physicians to evaluate the risk of new CVEs and provide a scientific basis for further interventions. Further studies are needed to externally validate current risk models before clinical application.

Factors affecting distribution and ecological risk assessment of volatile organic compounds (VOCs) in groundwater of the Huazhou district in northwestern China

Volatile organic compounds (VOCs) pollution in groundwater is a significant global concern. In this study, 26 groundwater samples were collected from the unconfined aquifers in Huazhou District, northwestern China, to assess their distribution characteristics, influencing factors, and ecological risks across various geomorphological settings. The findings revealed 35 VOCs in collected groundwater samples, with aromatic hydrocarbons having the highest detection rate (100%), and the VOCs distribution exhibited significant spatial variations, with the highest VOCs concentration near a chemical plant on the inclined pluvial plain. The lithology and groundwater flow influenced the vertical and lateral transport of VOCs, with concentrations decreasing as the aquifer permeability decreases along the groundwater flow from the inclined pluvial plain to the river. The Mantel test was used to analyze the correlation between VOCs and environmental factors, geochemical analyses indicated that nitrate (NO3−) and sulfate (SO42−) served as electron acceptors in the anaerobic biodegradation of organic pollutants, with bicarbonate (HCO3−) levels increasing as a result of this biodegradation. Additionally, the curved streamline searchlight shaped model (CS-SLM) was applied to identify the primary land use types affecting VOCs content, construction land and cropland were primary land use types affecting VOCs distribution. Finally, the ecological risk assessment indicated the highest risk quotient (RQ) for styrene (0.21), suggesting a manageable risk level. The study emphasizes the complexity of VOCs contamination in groundwater, providing a foundation for targeted mitigation strategies.

The investigation of the relationship between vitamin D level and severity of diabetic ketoacidosis in new cases of type 1 diabetes in children referred to Hazrat-E- Ali-Asghar Hospital in 2021

ABSTRACT Background and Purpose: According to the role of 25-hydroxyvitamin D (25OHD) in glucose homeostasis and immune modulation, vitamin D deficiency may be associated with type 1 diabetes and diabetic ketoacidosis (DKA). Therefore, this study was conducted with the aim of investigation of the relationship between the vitamin D level and severity of diabetic ketoacidosis in new cases of type 1 diabetes in children referred to Hazrat-E-Ali-Asghar Hospital in 2021. Methods: The present study is based on a cross-sectional study. The population studied in this research includes new cases of children with type 1 diabetes referred to Ali Asghar Children’s Hospital in Tehran in 2021. The data analysis was performed using SPSS version 23 software and a significance level of less than 0.05 was considered. Results: In total, 112 people were included in the study. The difference between the three groups of severity of ketoacidosis in blood pH and bicarbonate level was significant (P &lt; 0.001). The comparison of serum vitamin D levels in different severity of ketoacidosis showed a significant difference between the three groups (P = 0.013), which seems to be caused by the significant difference between the severe and mild ketoacidosis groups. There was observed no significant difference between the gender subgroups and different serum vitamin D levels and also different severity of ketoacidosis (P = 0.801) and (P = 0.25). Conclusion: Based on the findings of our study, there is a significant relationship between vitamin D and the severity of diabetic ketoacidosis in children with type 2 diabetes. We suggest that routine evaluation of vitamin D levels in diabetic patients and prescribing vitamin D supplements to patients with vitamin D deficiency to prevent the risk of diabetic ketoacidosis.

31 Impact of the amount of intravenous glucose administration on hospitalization for acute gastroenteritis in a paediatric emergency department

Abstract Background In case of failure of oral rehydration, children with acute gastroenteritis can be hydrated using intravenous (IV) solution. The choice of the intravenous solution itself (solutions containing dextrose versus crystalloids alone) and the glucose quantities to administer are not well established. Objectives The main objective of this study was to evaluate the impact of the amount of intravenous glucose provided to children treated for acute gastroenteritis on hospitalizations. Other objectives were to evaluate practice variation regarding the amount of glucose and liquid provided for IV rehydration in a paediatric emergency department (ED). Design/Methods We conducted a retrospective cohort study from 2019-2022 in a Canadian paediatric ED. We included children with acute gastroenteritis undergoing IV rehydration. Patient with hypoglycemia, metabolic disease or diabetes were excluded. The IV glucose administered during the initial four hours of rehydration was quantified. The primary outcome was hospitalization and return visit in the following seven days was a secondary outcome. 10% of the charts were evaluated in duplicate to assess inter-rater reliability. We examined glucose distribution at one and four hours, and utilized multiple logistic regression to relate glucose amounts with hospitalization and second visit, accounting for age, weight, bicarbonate levels, ondansetron use, and amount of liquid infused. It was estimated that the evaluation of 250 cases would have at least 50 admissions. Results Among 6,939 children evaluated for potential acute gastroenteritis, 250 met our inclusion/exclusion criteria. All variables included in the analysis had excellent inter-rater reliability. Notable variations existed in glucose quantities provided, both at one hour (first quartile: 87 mg/Kg; third quartile: 294 mg/Kg) and four hours (first quartile: 681 mg/Kg; third quartile: 1174 mg/kg) of rehydration. Multiple logistic regression showed a greater hospitalization risk with smaller amount of glucose administered during the initial hour (OR for each 100mg/kg increment: 0.60; 95%CI: 0.42-0.84) and four hours (OR: 0.76; 95%CI: 0.63-0.91) of rehydration. Moreover, children who received more dextrose during the first hour of rehydration were at lower risk of return visit (OR for each 100mg/kg increment: 0.52; 95%CI: 0.35-0.78), as well as during the first four hours (OR for each 100 mg/kg increment: 0.83; 95%CI: 0.73-0.94). Conclusion There was a wide practice variation in intravenous glucose provided to children with acute gastroenteritis. In this population, higher intravenous glucose amount was associated to a lower risk of hospitalization and lower risk of return visit.

A Comparison of Sodium Citrate and Sodium Bicarbonate's Safety and Effectiveness in Treating Metabolic Acidosis in Patients with Chronic Renal Disease

Background: Metabolic acidosis is a common complication in patients with chronic kidney disease (CKD) that accelerates disease progression and worsens overall health outcomes. Objective: This study compares the safety and effectiveness of sodium citrate and sodium bicarbonate in treating metabolic acidosis in CKD patients to determine the optimal therapeutic approach. Method: A prospective randomized clinical trial was conducted at the Department of Anesthesiology and ICU, Shaheed Monsur Ali Medical College and Hospital, Dhaka, Bangladesh, from October 2023 to September 2024. A total of 132 CKD patients with metabolic acidosis were randomly assigned to two groups: Group A (66 patients) received sodium citrate, and Group B (66 patients) received sodium bicarbonate. Safety, efficacy, and acid-base balance were monitored over 12 months. Results: Both sodium citrate and sodium bicarbonate significantly improved serum bicarbonate levels and reduced blood acidity. In Group A, 85% of patients showed a 50% reduction in acidemia, compared to 78% in Group B. However, Group A demonstrated superior gastrointestinal tolerance (10% side effects) compared to Group B (25% side effects). Sodium citrate also improved bone health markers, with a 15% improvement in calcium levels, while sodium bicarbonate patients had a 10% increase. However, sodium bicarbonate was more cost-effective. Conclusions: Sodium citrate appears to be more effective and better tolerated than sodium bicarbonate in treating metabolic acidosis in CKD patients, though cost considerations may influence therapeutic choices.

Kidney toxicology of a novel compound Lithium Bis(trifluoromethanesulfonyl)imide (LiTFSI, ie. HQ-115) used in energy applications: An epigenetic perspective

Exposure to emerging energy-based environmental contaminants such as lithium bis(trifluoromethanesulfonyl)imide (LiTFSI, trade name HQ-115), poses a significant threat to human health, yet its impact on kidney function and epigenetic regulation remains poorly understood. Here, we investigated the effects of LiTFSI exposure on kidney-related biochemical indicators, renal injuries, and epigenetic alterations in male CD-1 mice under both 14-day and 30-day exposure durations. Our study revealed that LiTFSI exposure led to changes in kidney-related markers, notably affecting serum bicarbonate levels, while relative kidney weight remained unaffected. Histological analysis revealed tubule dilation, inflammation, and loss of kidney structure in LiTFSI-exposed mice, alongside dysregulated expression of genes associated with inflammation, renal function, and uric acid metabolism. Epigenetic analysis further identified widespread DNA methylation changes in the two exposure regimes. Functional analysis revealed that differentially methylated regions are implicated in cell apoptosis and cancer-related pathways and are enriched with development-related transcription factor binding motifs, suggesting a potential mechanism of action underlying exposure induced kidney damage. These findings underscore the intricate interplay between environmental exposures, epigenetic modulation, and kidney health, emphasizing the need for additional research to unravel precise mechanisms and develop targeted interventions to mitigate the adverse effects of LiTFSI and exposure of similar clean energy compounds on human health.

High altitude impact on serum bicarbonate in healthy Mexican children: concerning the overdiagnosis of renal tubular acidosis

BackgroundAltitude influences bicarbonate levels, it is a variable that is hardly considered in diagnosing Renal Tubular Acidosis (RTA), so it should be a factor to consider when diagnosing this pathology, especially at 2250 mts over the sea level as it is the case of Mexico City. RTA is most often misdiagnosed. Regarding of this, the present study established reference limits for bicarbonate levels in healthy children without pathologies associated with alterations in the acid-base balance in Mexico City and it´s metropolitan area.MethodsA total of 267 healthy pediatric patients were included, within normal estimated glomerular filtration rate (eGFR), and without any associated pathology of any alteration in the acid-base balance.ResultsCompared to older children, children younger than two years of age showed statistically higher levels of calcemia and cystatin C. On the other hand, this same group showed lower values of creatininemia, pCO2, and HCO3-. Percentile 50 of bicarbonate in children under two years of age were 19.9 mEq/L and 21.9 mEq/L in those over that age. A correlation was identified between HCO3- levels and pCO2 (r = 0.68; p < 0.001).ConclusionsIn the study population, an effect of altitude on blood levels of pCO2 and HCO3- was observed.

Community-acquired sepsis in the medical intensive care unit: An experience from a lower-middle-income country.

To determine microbiological pathogens and in-hospital mortality in patients admitted with communityacquired sepsis to the intensive care unit in a tertiary-care setting in a low- and middle-income country. The retrospective, observational study was conducted at the medical intensive care unit of a large tertiary care hospital in Karachi, and comprised data from January 1 to December 31, 2019 of patients with community-acquired sepsis who were assessed using the Sepsis-3 criteria. Data was compared between survivors and non-survivors, and independent factors associated with in-hospital mortality were identified. Data was analysed using SPSS 23. Of the 135 patients with mean age 49.8±18.0 years, 91(67.4%) were males and 44(32.6%) were females. The most common primary site of infection was the respiratory tract 63(46.7%). Multi-drug-resistant organisms were isolated in 39 (28.9%) patients. In-hospital mortality was noted in 52(38.5%) cases, while there were 83(61.5%) survivors. Serum levels of lactate and bicarbonate as well as urine output, fungal pathogens, septic shock and sequential organ failure assessment score were significantly associated with mortality (p<0.05). Clinical and microbiological spectrum of community-acquired sepsis in a low- and middle-income country was found to be different from other regions of the world. Clinicians should keep these differences in mind while managing these critically ill patients.

Severe metabolic alkalosis with fludrocortisone therapy—a case report

Abstract Background We present an atypical case of severe metabolic alkalosis, not reported in the literature to date. Case Presentation Owing to concerns of apneas and desaturation, a 75-year-old man presented to the emergency department with significantly deranged physiology: bicarbonate level of 63.6 mmol/L, a base excess of 40.6, and a potassium concentration of 1.9 mmol/L. Primary diagnoses included metabolic alkalosis secondary to fludrocortisone therapy with respiratory compensation, hypokalemia, and hypochloremia. He initially received potassium replacement with cardiac monitoring, followed by permissive hypercapnia in the intensive care unit. He received acetazolamide to further improve his acid-base status. The patient had a good outcome with gradual return of his pH and bicarbonate levels to baseline. He was then discharged. Conclusion Iatrogenic mineralocorticoid excess should be considered when the patient presents with significantly raised bicarbonate levels. When starting fludrocortisone, renal function needs to be diligently monitored due to risk of hypokalemia metabolic alkalosis.

The Effect of Extreme Alkalemia upon Presentation to the Emergency Department on Patient Outcomes

Background/Objectives: The prognostic significance of alkalemia found in an initial emergency department (ED) evaluation has not been described thus far. Methods: We retrospectively reviewed the records of all patients aged 18 years or older evaluated in the ED of one large academic referral center during 2000–2023. Included patients were those with at least one measurement of pH ≥ 7.55 upon initial ED presentation. Alkalemia was deemed primarily metabolic (PM) if PCO2 was ≥35 mmHg and primarily respiratory (PR) if bicarbonate levels were ≤24 mEq/L. The primary outcome was survival 30 days from ED presentation. Results: Of 2440 patients included, 199 (8.1%) had PM and 1494 (61.2%) had PR. Alkalemia severity was not correlated with prognosis. Survival at 30 days was significantly (p &lt; 0.001) lower in the PM group (78.9%) compared with that of either the PR (95.3%) or the combined etiology (92.2%) groups. Multivariate survival analysis after balancing potential observed confounders using propensity score matching revealed the type of alkalemia (PM vs. PR) to be a significant predictor of 30-day mortality (aHR 1.73; 95% C.I. = [1.07 to 2.82]; p = 0.026), irrespective of age, other laboratory values obtained on ED evaluation (including pH), past medical history, or vital signs on presentation. Conclusions: In patients presenting to the ED with significant alkalemia, the mechanism of alkalemia, i.e., primarily metabolic versus primarily respiratory, rather than the absolute degree of alkalemia, is associated with increased mortality.

Study of indications, associated comorbid condi-tions and outcome of patients requiring Bilevel type of Non Inva-sive Positive Pressure Ventilation in a tertiary care hospital

BiLevel non-invasive positive pressure ventilation (BiPAP) is the most utilised supportive treatment in the world of medicine for respiratory failure. COPD is the most common indication for its use. We in-vestigated the indications and effects of comorbidities on BiPAP outcomes because there have been few studies on it. It is a descriptive, observational, cross-sectional study conducted over period of 12 months, wherein 60 patients fulfilling the inclusion criteria for the requirement of BiPAP were includ-ed in the study and evaluated. The indications, associated comorbid conditions and the outcomes of NIV therapy were studied. COPD exacerbation with Type II Respiratory failure was the most common indication (71.4%), followed by asthma [near fatal/severe] (21.4%). Success with BiPAP in COPD was 67.6% . In COPD patients with co-morbidities, success came down to 47.4%. Pneumonia, ILD &amp; Cardiogenic Pulmonary Edema (CPE) had success rates of 0%, 16.7% and 66.7% respectively with BiPAP therapy,with higher mortality rates for pneumonia and ILD. Comorbidities were present in 51.7% of patients and Hypertension (35%) and Diabetes Mellitus (21.7%) were the most common. In patients who had co-morbidities, the mean hospital stay was 12 days, which was higher than the mean hospital stay of 9.3 days in patient with no co-morbidities. The presence of co-morbidities was associated with higher failures with BiPAP (51.6%) comapred to ones with no co-morbidities (13.8%) (p value &lt;0.05). Higher respiratory rate (&gt;28/min), lower ABG pO2, pCO2 and bicarbonate levels and higher blood glucose and total leucocyte counts were associated with higher BiPAP failures and mortality. The conclusion was that the most common indication of BiPAP was a COPD exacerbation with type II respiratory failure and presence of comorbidities led to a poorer outcome with prolonged hospital stay. ABG parameters, blood glucose levels and total leucocyte counts has an effect on NIV outcome and mortality.

Pattern Of Renal Analytes Following Renal Function Assessment Of Infants In A Tertiary Health Facility In Southern Nigeria

Background/Objectives Electrolyte imbalance is a common finding in infants, and the story is so in the tropical countries, where most patients are usually victims of fluid losses from various etiologies. This study is aimed at assessing the profile and pattern of electrolytes imbalance and other parameters of renal function assessmentamong infants (0-12 months) in our environment. Methods/Subjects This cross-sectional study was carried out over a 6-month period on infants who wereadmitted into University of Calabar Teaching Hospital (UCTH) and investigated forelectrolyte, urea and creatine, after a hospitalstay of ≥24 hours. Blood samples were taken from such patients, analyzed and values obtained were compared with the reference intervals to ascertain the level of deviation from the expected normal for age. Results The total number of children that participated on the study was 200, made up of 106(53.0%)males and 94(47.0%) females. The children were classified based on their different ages from 0 to 12 months. Children aged 0-1month made up the bulk of the study population (57.0%). Low level of bicarbonate occurred in 65.5% of all the children. Hyponatremia (37.7%) and Hyperkalemia (28.9%), occurred in 0 -1month age group. These derangements have been known to contribute negatively to the outcome of the admitted infant if not corrected. Most of the infants had normal values of the individual electrolytes. Conclusion In view of the fact that infants are more vulnerable to electrolyte imbalance, prevention of electrolyte imbalances is preferable to treatment.

Predictors of Mortality in Ruptured Abdominal Aortic Aneurysms.

Introduction The outcome of a ruptured abdominal aortic aneurysm (AAA) without any interventions is close to uniformly fatal. The Society for Vascular Surgery suggests a door-to-intervention time of less than 90 minutes in a patient with a ruptured AAA. Admission factorsassociated with poor outcomes in ruptured AAAs include hypotension, renal insufficiency, severe anemia, advanced age, and cardiac arrest. Patients who are particularly at high risk for open AAA repair may be candidates for endovascular repair, which may decrease mortality. This study aimed to assess the relationship between systolic blood pressure (SBP) and serum bicarbonate levels in predicting mortality in patients with ruptured AAAs. Methods This retrospective study was performed using the United States Collaborative Network of 57 academic medical centers/healthcare organizations in the TriNetX database. A total of 4,226 patients with ruptured AAAs were identified. Patients were categorized based on SBP of ≤90 mmHg, any SBP, or >90 mmHgand further stratified by bicarbonate levels. Rounded cutoffs of the bicarbonate ranges (<10, 10.01-15; 15.01-20, >20.01) were chosen for interpretative purposes. Mortality outcome was assessed within 90 days after presentation for the ruptured AAA. Results After exclusions, 4,174 patients presented with ruptured AAA between September 30, 2003, and September 30, 2023, in the database. Overall, 90-day mortality in any SPB cohort was 28%. Patients who presented with a ruptured AAA with an SBP ≤ 90 had a 46.3% mortality. Those who presented with a SBP > 90 had a 20.1% mortality. Additionally, as bicarbonate levels decreased, mortality increased within each SBP group. Conclusions Early recognition and intervention are critical for survival in patients with ruptured AAAs. Metabolic acidosis is an important marker of the severity of hemorrhage in these patients. In this large cohort study of ruptured AAAs, mortality increases significantly with hypotension and metabolic acidosis, represented by lower bicarbonate levels. Abnormalities in the serum bicarbonate may be seen before severe changes invital signs in hemorrhaging patients. Early recognition of metabolic acidosis may lead to earlier life-saving interventions in patients with ruptured AAAs.

8226 A Diagnostic Challenge: Factitious Hypobicarbonatemia in Severe Hypertriglyceridemia

Abstract Disclosure: U. Rafat: None. S. Azmat: None. M. Siddiqui: None. R. Alshantti: None. D. Kircheva: None. V. Trendafilova: None. Background: Serum CO2 levels measured by a chemistry analyzer usually correlate with calculated bicarbonate levels on an ABG. There are some instances however, when this is not the case. Severe hypertriglyceridemia can cause serum bicarbonate levels to appear falsely low on metabolic panel. Clinical Case: A 48-year-old man was referred to Endocrinology Clinic for evaluation of hypogonadism and severe hypertriglyceridemia. Routine labs revealed a plasma CO2 of 11 mmol/L (20-31). Na was 133 mmol/L (136-145), K was 4.4 mmol/L (3.5-4.7), Chloride was 101 mmol/L (98-109) and anion gap was 25 (8-20) measured using a Siemens Vista enzymatic chemistry analyzer. His triglycerides were &amp;gt; 1100 mg/dL (0-150), above upper detection limits of the analyzer. The patient reported fatigue and mild abdominal pain. He was admitted to the hospital for further evaluation. His lipase was 41 U/L (12-73), lactic acid 1.2 mmol/L (0.50-2.20). ABG showed pH of 7.41, HCO3 of 26.6 mmol/L (22-29), and anion gap of 7 (10-20). The patient was well-appearing with normal vital signs and normal physical exam. He was made NPO and started on pravastatin, fenofibrate and fish oil. Once his triglycerides were &amp;lt; 1000 mg/dL, he was started on a very low-fat, low-carbohydrate diet. The CO2 level on BMP normalized on day 3 of hospitalization, when triglycerides measured 1010 mg/dL. No other treatment was given for the low CO2 levels. It does not appear that other lab indices were significantly affected by the hypertriglyceridemia. Review of Literature: A BMP measures serum total carbon dioxide using a chemistry analyzer using either an enzymatic/spectro-photometric method, or an electrode-based method; an ABG sample calculates plasma bicarbonate with the Henderson-Hasselbach equation, using the pH and partial pressure of pCO2 in the sample. Enzymatic analyzers measure CO2 using spectrophotometry and decrease in light absorbance is proportional to the sample’s CO2 levels. It is postulated that severely high triglycerides can interfere with this reaction and cause spuriously low CO2 levels, a phenomenon called pseudohypobicarbonatemia. One proposed mechanism for interference with the enzymatic assay method is turbidity causing a falsely low measured CO2 level. Verghese et al found that the severity of the CO2 measurement error positively correlates with the severity of triglyceride elevation. Conclusion: Awareness of the phenomenon of hypertriglyceridemia-induced pseudohypobicarbonatemia can prevent misdiagnosis or delays in diagnosis, as well as unwarranted testing and treatment. Presentation: 6/3/2024