Bicarbonate Levels Research Articles

The effect of serum biochemical parameters on clinical prognosis in children presenting with diabetic ketoacidosis.

The aim of this study was to determine whether diabetes mellitus has a high risk of diabetic ketoacidosis-related complications. Biochemical parameters affect the resolution time of diabetic ketoacidosis. The present study is based on a retrospective evaluation of the records of patients who presented to the Pediatrics Clinic of Adiyaman University Hospital between January 1, 2017, and October 1, 2022, with a diagnosis ofdiabetic ketoacidosis. The demographic characteristics, serum biochemical parameters, blood gas results, and time to transition to subcutaneous insulin therapy were all recorded. This study included 49 (49%) female and 51 (51%) male patients aged 1-17 years (mean age: 9.05±4.33 years). The average time to clinical improvement of the sample, that is, transition to subcutaneous insulin therapy, was 21.04±7.8 h. An evaluation of the presence of acute kidney injury based on serum urea and creatinine levels and eGFR values revealed no significant effect on the rate of clinical recovery (respective p-values: p=0.076, p=0.494, and p=0.884). A univariate analysis identified blood glucose (p=0.025), blood gas pH (p<0.001), and blood bicarbonate (p=0.004) values as prognostic factors, while a multivariate analysis revealed pH values had an independent and significant effect on the resolution time of diabetic ketoacidosis. Serum glucose, pH, and bicarbonate levels are the most important determinants of clinical prognosis in patients with diabetic ketoacidosis. These findings can serve as a guide for clinicians in the follow-up and treatment of such patients.

Factors associated with mortality of patients with COVID-19 on invasive mechanical ventilation: A retrospective cohort study in a university hospital in Northeastern Brazil.

The aim of this study is to identify the factors associated with mortality in patients with COVID-19 undergoing invasive mechanical ventilation at a university hospital in Northeastern Brazil. This is a retrospective cohort from April to August 2020 through an analysis of medical records, considering the demographic profile, comorbidities, complications, supports, respiratory and laboratory parameters. A total of 65 patients required invasive mechanical ventilation, of which 64.6% died in the ICU. They were older, had more comorbidities, shorter length of stay in the intensive care unit, received more support such as palliative care and two vasopressors simultaneously, showed lower levels of pH, hemoglobin and calcium, and higher levels of bicarbonate, lactate, prothrombin time, international normalized ratio, troponin and ferritin at the start of invasive mechanical ventilation. Furthermore, the time course of pH, arterial oxygen partial pressure to fractional inspired oxygen ratio, arterial carbon dioxide partial pressure, lactate, hemoglobin, platelets, lymphocytes, neutrophil-to-lymphocyte ratio, coagulation parameters, calcium, urea, aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase, ferritin, static compliance, airway resistance, tidal volume, and noradrenaline doses showed association with mortality. There was a high mortality rate in invasively mechanically ventilated COVID-19 patients, with some associated factors identified at the start of invasive mechanical ventilation and others identified over time.

Utility of Pyloric Length Measurement for Detecting Severe Metabolic Alkalosis in Infants with Hypertrophic Pyloric Stenosis.

Infantile hypertrophic pyloric stenosis (IHPS) is a common gastrointestinal disease in neonates and hypochloremia metabolic alkalosis is a typical laboratory finding in affected patients. This study aimed to analyze the clinical characteristics of infants with IHPS and evaluate the association of clinical and laboratory parameters with ultrasonographic findings. Infants diagnosed with IHPS between January 2017 and July 2022 were retrospectively evaluated. A total of 67 patients were included in the study. The mean age at diagnosis was 40.5±19.59 days, and the mean symptom duration was 11.97±9.91 days. The mean pyloric muscle thickness and pyloric canal length were 4.87±1.05 mm and 19.6±3.46 mm, respectively. Hyponatremia and metabolic alkalosis were observed in five (7.5%) and 36 (53.7%) patients, respectively. Serum sodium (p=0.011), potassium (p=0.023), and chloride levels (p=0.015) were significantly lower in patients with high bicarbonate levels (≥30 mmol/L). Furthermore, pyloric canal length was significantly higher in patients with high bicarbonate levels (p=0.015). To assess metabolic alkalosis in IHPS patients, the area under the receiver operating characteristic curve of pyloric canal length was 0.910 and the optimal cutoff value of the pyloric canal length was 23.5 mm. We found a close association between laboratory and ultrasonographic findings of IHPS. Clinicians should give special consideration to patients with pyloric lengths exceeding 23.5 mm and appropriate fluid rehydration should be given to these patients.

Obstructive sleep apnea as a risk factor for hypertension: a systematic review

Obstructive sleep apnea (OSA) is a progressively sleep-disordered breathing condition marked by bouts of upper airway obstruction during sleep. This systematic review aimed to comprehensively explore the lately available literature on OSA as an independent risk factor for developing hypertension (HTN). PubMed, SCOPUS, Web of Science, Science Direct, and Google Scholar were systematically searched for relevant literature. Rayyan QRCI was employed throughout this comprehensive process. This review included eight studies with a total of 12,473 parents, and 8,974 (71.9%) males. The total frequency of HTN in OSA cases was 5,643 (45.2%). The prevalence of HTN was rather high in OSA patients. Obesity and elevated bicarbonate levels were cofactors in the development of HTN in OSA patients. Children with OSA were three times more likely to develop HTN in the future. A growing number of OSA patients had or required HTN treatment. If treatment is not received, the patient becomes more vulnerable to cardiovascular and cerebrovascular diseases as a result of a self-perpetuating pathophysiological process. Even though there is a lot of research and strategies available for OSA cases who necessitate blood pressure decline, further choices are critically needed.

Factors associated with carbon dioxide transfer in an experimental model of severe acute kidney injury and hypoventilation during high bicarbonate continuous renal replacement therapy and oxygenation membrane support.

To investigate the factors influencing carbon dioxide transfer in a system that integrates an oxygenation membrane in series with high-bicarbonate continuous veno-venous hemodialysis in hypercapnic animals. In an experimental setting, we induced severe acute kidney injury and hypercapnia in five female Landrace pigs. Subsequently, we initiated high (40mEq/L) bicarbonate continuous veno-venous hemodialysis with an oxygenation membrane in series to maintain a pH above 7.25. At intervals of 1 hour, 6 hours, and 12 hours following the initiation of continuous veno-venous hemodialysis, we performed standardized sweep gas flow titration to quantify carbon dioxide transfer. We evaluated factors associated with carbon dioxide transfer through the membrane lung with a mixed linear model. A total of 20 sweep gas flow titration procedures were conducted, yielding 84 measurements of carbon dioxide transfer. Multivariate analysis revealed associations among the following (coefficients ± standard errors): core temperature (+7.8 ± 1.6 °C, p < 0.001), premembrane partial pressure of carbon dioxide (+0.2 ± 0.1/mmHg, p < 0.001), hemoglobin level (+3.5 ± 0.6/g/dL, p < 0.001), sweep gas flow (+6.2 ± 0.2/L/minute, p < 0.001), and arterial oxygen saturation (-0.5 ± 0.2%, p = 0.019). Among these variables, and within the physiological ranges evaluated, sweep gas flow was the primary modifiable factor influencing the efficacy of low-blood-flow carbon dioxide removal. Sweep gas flow is the main carbon dioxide removal-related variable during continuous veno-venous hemodialysis with a high bicarbonate level coupled with an oxygenator. Other carbon dioxide transfer modulating variables included the hemoglobin level, arterial oxygen saturation, partial pressure of carbon dioxide and core temperature. These results should be interpreted as exploratory to inform other well-designed experimental or clinical studies.

Pneumatosis Intestinalis and Pneumoperitoneum After Lung Transplantation: Single-Center Experience and Systematic Review.

Background: Pneumatosis intestinalis (PI) and pneumoperitoneum are some of the complications after lung transplantation (LT). But only limited reports are published. The purpose of this study is to review our experience and perform a systematic review to discuss the possible causes, risk factors, and management. Methods: We reviewed the characteristics, management, and outcome of the patients who developed PI or pneumoperitoneum after LT in our institution from 2013 to 2022. We also performed a systematic review to discuss the management and outcome. Results: PI and pneumoperitoneum were found in 15 out of 729 patients (2.06%) in our institution. We also found 50 patients in the systematic review. Tracheostomy was performed in 40% and gastrointestinal procedures were performed in 55.6%. Laparotomy was performed in 23.4%. A total of 44.6% of patients had benign physical exams or no symptoms. Rejection was seen in 42.9%. A total of 28.6% of patients died during follow-up periods. Conclusions: This report has the largest number of patients so far with PI and pneumoperitoneum after LT. These conditions have a high rejection and high mortality rate. Mechanical ventilation, tracheostomy, gastrointestinal procedure, CMV infection, Clostridium difficile (C. difficile) infection, and immunosuppression can be the risk factors, and the management includes laparotomy or conservative management. It is generally recommended to proceed with laparotomy if patients have portal venous gas, elevated white blood cell count, elevated lactic acid level, decreased bicarbonate level, elevated amylase level, metabolic acidosis, abdominal tenderness, or abdominal distension. Otherwise, most of the patients recover with conservative management with nil per os (NPO), metronidazole, ganciclovir, antibiotics, high-flow oxygen, and holding mycophenolate mofetil (MMF).

Кислотно-щелочное состояние крови у пациентов с мочекаменной болезнью. Исследование I: роль бикарбонатов.

Introduction. Kidneys play a leading role in maintaining acid-base balance. Kidney disorders lead to the acid-base balance violations. Data analysis showed that there are not enough attention to the problem of assessing blood acid-base balance in patients with urolithiasis. The aim of the first stage of this work was to determine the presence and severity of changes in one of the main indicators of acid-base balance - the level of blood bicarbonate in patients with urolithiasis. Materials and methods. We analyzed data from 83 patients: 39 men and 44 women aged 18 to 74 years. All patients were prescribed a biochemical blood test, a biochemical analysis of daily urine, blood acid-base balance and stone chemical composition. We studied the relationship of actual serum bicarbonate (actHCO3 - ) and standard bicarbonate (stdHCO3- ) in urolithiasis patients with level of other blood and urine parameters. Statistical analysis was performed using the methods of descriptive statistics, comparative statistical analysis, calculation of the t-test for independent groups, correlation analysis for two variables using the computer program Statistica 10.0 (StatSoft USA). Results. According to the statistical analysis performed using the calculation of Student's t-test, patients with actual serum bicarbonate [actHCO3- ] &lt;21.0 mmol/l and urine pH&gt;5.8 had lower serum total calcium levels (p&lt;0.05 ), higher serum [Cl-] (p&lt;0.05), higher serum creatinine (p&lt;0.05) and urea (p&lt;0.05), lower serum pH (p&lt;0, 05), serum pCO2 (p&lt;0.05), serum lactate concentration (p&lt;0.05), lower BE (p&lt;0.05) than patients with [actHCO3- ] blood &gt;28.0 mmol/l. Correlation analysis showed that there is a relationship between the level of [actHCO3- ] and indicators of total blood calcium (p &lt;0.05), blood chloride (p&lt;0.05), creatinine and blood urea (p &lt;0.05) and the concentration of calcium and magnesium in the daily urine (p&lt;0.05). There was no statistically confirmed relationship between the level of standard blood bicarbonate [stdHCO3- ] and the concentration of other indicators of blood and daily urine. Conclusion. Determination of the serum bicarbonate level is necessary to clarify the metabolic state in urolithiasis patients. It is necessary to determine the concentration of actual blood bicarbonate (actHCO3- ) in urolithiasis patients.

The association between serum chloride and mortality in ICU patients with heart failure: The impact of bicarbonate

ObjectiveTo assess whether serum chloride predicts risk of death in intensive care unit (ICU) patients with heart failure (HF) and the effect of bicarbonate on the efficacy of serum chloride in predicting risk of death in ICU patients. MethodsA total of 9364 HF patients hospitalized in the ICU were enrolled. Patients were divided into hypochloremia (< 96 mEq/L), normal chloride (96–108 mEq/L), and hyperchloremia (> 108 mEq/L) groups. Similarly, we divided the serum bicarbonate level into three groups: low bicarbonate (< 22 mEq/L), medium bicarbonate (22–26 mEq/L), and high bicarbonate (> 26 mEq/L). The outcome of this study was in-hospital mortality. Then, we analyzed the association between abnormal serum chloride and mortality according to the category of serum bicarbonate and assessed the interaction effect. Restricted cubic spline (RCS) was used to show possible nonlinear associations. ResultsIn the overall study population, hypochloremia was associated with a higher risk of in-hospital mortality than normal chloride (odds ratio [OR] 1.54, 95% confidence interval [CI] 1.26–1.86, P < 0.001), hyperchloremia was not significantly related to in-hospital mortality (OR 1.00, 95% CI 0.85–1.19, P = 0.962). However, a linear association between serum chloride and in-hospital mortality was found in the low and normal bicarbonate groups (all P for nonlinear >0.05). ConclusionsHypochloremia is associated with in-hospital mortality and longer hospital stay in critically ill patients with HF. In addition, risk of death in the low and medium serum bicarbonate groups decreased with increasing serum chloride level.

Relationship of Hospital Mortality with Metabolic Acidosis Severity in Critically Ill Patients

Background: Metabolic acidosis (MA) is a common pathologic process with fatal consequences in critically ill (CI) patients. The more the severity of acidosis the more mortality rate is expected. To evaluate the relationship of hospital mortality with MA severity in CI patients admitted to emergency department (ED).&#x0D; Methods: In this prospective cohort study, we enrolled CI patients (based on physician clinical assumption), most at level 1 or 2 emergency severity index triage system. Patients were followed and evaluated in 2 parallel groups, one with and the other without MA. The severity of acidosis, chief complaints, final diagnosis, demographic data, acute physiologic assessment and chronic health evaluation II (APACHE II) score, serum lactate and bicarbonate level, need for intubation and mechanical ventilation, admission ward, hospital length of stay and in hospital mortality were compared between the 2 groups.&#x0D; Results: A total of 1811 CI patients including 60.2% males and 39.8% females with and without MA were evaluated. The most common age range was 65-55 years old (31.7%) with the meanSD of 61.348.23. The most common complaints and diagnoses were weakness (40.5%) and pneumosepsis (35.1%), respectively. Patients with severe acidosis had higher lactate level and APACHE II score (p&lt;0.05). Mortality rate was 10.4%. Most of our cases had severe MA. Expired cases had higher lactate level and APACHE II score (p&lt;0.05).&#x0D; Conclusion: Lactate level, bicarbonate level and APACHE II score were all significant independent predictors of hospital mortality in CI patients.

Тубулоинтерстициальный нефрит с увеитом: серия клинических наблюдений

Tubulointerstitial nephritis and uveitis syndrome (TINU) is a rare autoimmune disease that develops predominantly in young people and is characterized by variable clinical manifestations and an uncertain prognosis. A single-center retrospective observational study included 3 pediatric patients (a girl and two boys) with clinically and morphologically confirmed TINU. Age of onset, clinical symptoms, gender-age-height-standardized blood pressure (BP), proteinuria (g/l), excretion level of β2-microglobulin, glucose, phosphorus in urine, blood pH and bicarbonate levels, Bedside Schwartz equation estimated glomerular filtration rate (eGFR, ml/min/1.73 m2, norm≥90 ml/min/1.73 m2), ophthalmoscopy data and the therapy were analyzed at the time of disease manifestation and during the follow-up. The duration of follow-up ranged from 3 to 7 years. The disease debuted at the age of 10 to 14 y/o with severe symptoms of intoxication, inflammatory activity, acute kidney damage (eGFR=22 to 35 ml/min/1.73 m2) and the development of Fanconi syndrome. Anterior uveitis had manifested in 1 to 5 months after the kidney disease. The TINU diagnosis was established after 6 to 9 months from the onset of the disease. All children received systemic steroid therapy coupled with the local treatment for uveitis. A significant decrease in blood creatinine levels and urine β2-microglobulin excretion with partial restoration of renal filtration function was noted by the sixth month of the therapy. All children developed chronic kidney disease (CKD) stages 2 to 3 over time. Stable remission of uveitis was achieved in 2 children after 3 to 10 months of treatment without complications; and in one patient a subacute uveitis led to the secondary changes in the cornea and decreased visual acuity. Conclusion: children with TINU have a high risk of developing CKD as a result of acute kidney disease; uveitis is characterized by a chronic course and, in the absence of remission, can lead to the development of ophthalmological complications.

Effect of Azadirachta indica Leaf Extract on Some Biochemical Parameters in Wistar Albino Mice Infected with Plasmodium berghei

The use of medicinal plants in combating many tropical diseases including malaria is gaining wide acceptance owing to their many bioactive compounds. Malaria, which is caused by a Plasmodium parasite, and transmitted by the bite of infected mosquitoes is endemic in developing countries especially in Africa where it pose serious health challenge to the populace. This study evaluates the effect of Azadirachta indica leaf extract on some biochemical parameters in Wistar Albino mice infected with Plasmodiumberghei. A total of ninety (90) mature male swiss albino mice (free from infection and weighing between 25-35g) were used for the study. The animals were grouped into six classes (A-F) of fifteen (15) mice per group, per cage. Groups A to C served as the control groups [normal (uninfected plus distilled water), standard (infected plus Lonart (4mg/kg) and negative (infected plus distilled water)] respectively while groups D, E and F served as the treatment groups and were orally administered 100 mg/kg, 200 mg/kg and 400 mg/kg doses of leaf extract of Azadirachta indica for five (5) days consecutively. Malaria parasites (Plasmodium berghei, Anka strain) were inoculated using standard methods. At the end of the experimental periods, the animals were sacrificed and blood collected through cardiac puncture for bioassay studies. Activities of ALT, AST, ALP were determined using standard assay kits and concentrations of bilirubin (total and direct) as well as urea, creatinine, sodium, potassium, chloride and bicarbonate levels were carried out using standard methods. Results showed a significant increase (p&lt;0.05) in serum activities of ALT and AST in extract treated animals when compared with the untreated control while there was significant decrease (p&gt;0.05) in the serum activities of ALP in extract treated animals when compared with the untreated control. Results further showed an increase in the bilirubin (total and direct) levels of the extract treated groups as compared with the untreated control. Similar trends were observed for the levels of urea, creatinine, sodium, potassium and chloride. It could therefore be concluded that administration of Azadirachta indica leaf extract, though potent in fighting against malarial infection, could pose a threat to the liver and other organs of the body if not properly monitored.

A Comparison Between Saline and Balanced Solutions in Kidney Transplants: A Randomized Clinical Trial.

Objective This study aimed to investigate the impact of different types of intravenous fluids -normal saline (NS), lactated Ringer's solution (LR), and PlasmaLyte (PL) - on the acid-base balance and electrolyte concentration following kidney transplant, a common procedure for patients with end-stage renal disease (ESRD). Methodology A randomized controlled trial design was employed, wherein the primary parameters analyzed were postoperative pH and serum potassium levels. Postoperative concentrations of serum bicarbonate, sodium, chloride, and creatinine, as well as graft functionality, were assessed as secondary outcomes. These measurements were performed at the start and end of surgery, as well as 24 and 72 hours postoperatively. Results A total of 53 patients were included in the study and randomized into three cohorts: NS, LR, and PL, each of which showed comparability in terms of demographic and transplantation specifics. Notably, patients in the NS group exhibited a more significant decrease in pH (NS group: 7.285 ±0.098, LR group: 7.324 ±0.075, PL group: 7.7338 ±0.059) and bicarbonate levels (17.0 ±4.2, 20.9 ±2.8, 20.0 ±4.5) post24 hours after the operation and displayed a similar patternimmediately after the surgery. However, there were no discernible differences in potassium (p=0.460), sodium (p=0.681), and chloride (p=0.321) levels across the groups. Furthermore, the study did not observe any significant differences in postoperative graft functionality. Conclusion The use of NS as the intraoperative fluid of choice led to lower pH and bicarbonate levels following kidney transplant, as compared to LR and PL. However, these results did not correlate with improvements in graft functionality.

Calcium carbide-ripened plantain induced alterations in plasma electrolytes concentration and kidney function in rats.

Artificial fruit ripening agents such as ethanol, ethylene, ethephon, and calcium carbide (CaC2) is usually employed in stimulating the fruit ripening process. Currently, there is a paucity of information regarding the effects of various artificial fruits ripening methods on the health status of consumers. In this study, the physiological effects and possible health hazards associated with the consumption of plantain ripened by CaC2 and other non-chemical methods on the kidneys were investigated. Artificially ripened plantain was mixed with rat feed and fed to Wistar albino rats for four weeks, and the levels of plasma electrolytes (Na+, HCO3-, K+, and Cl-), urea, creatinine, as well as histological changes in the kidneys were determined. Results indicated that rats fed with carbide-ripened plantain had a significantly high level of plasma bicarbonate (HCO3-) compared to control rats., but there was no difference in the level of plasma sodium (Na+). However, the levels of plasma potassium (K+) and chloride (Cl-) were significantly low in rats fed with CaC2-ripened plantain as compared to the control rats. Furthermore, the levels of urea and creatinine were significantly high in rats fed with CaC2-ripened plantain compared to the control animals. Histological analyses showed glomeruli atrophy and tubular necrosis in kidneys of rats fed with CaC2-ripened plantain, thereby further indicating toxicity to the kidneys. Histological evidence and alterations in the level of the plasma electrolytes, urea, and creatinine suggest that consumption of fruits ripened with calcium carbide may be harmful to the kidneys.

Methanol poisoning during the COVID-19 pandemic in Iran: A retrospective cross-sectional study of clinical, laboratory, and brain imaging characteristics and outcomes.

To evaluate the frequency and significance of brain imaging findings in methanol poisoning patients and to propose a criterion for prioritizing brain imaging. We retrospectively reviewed the data of 306 patients (286 men and 34 women, mean age 32.10 ± 9.9 years) with confirmed methanol poisoning who were admitted to two hospitals in Iran during the COVID-19 pandemic. We analyzed their demographic, clinical, laboratory, and brain imaging data. The main brain computed tomography(CT) scan findings were hypodensity in the putamen (11.1%), cerebellar nuclei (8.2%), diffuse cerebral edema (7.5%), and intracranial hemorrhage (ICH; 1.6%). These findings were associated with blood pH, Glasgow Coma Scale (GCS), renal failure, bicarbonate, oxygen, carbon dioxide, potassium, and glucose levels (p < 0.05). Poor prognosis was related to blindness, opium addiction, chronic alcohol use, hyperglycemia, and abnormal CT scans (p < 0.001 for all). The most predictive brain imaging findings for poor prognosis were hypodensity in the cerebellar nuclei, diffuse cerebral edema, and ICH. Brain imaging can provide valuable information for the diagnosis and management of methanol poisoning patients. We suggest that patients with severe acidosis, low GCS, low pH, low oxygen saturation, and high glucose levels should undergo brain CT scan as a priority.

Hyperaldosteronism Screening and Findings From a Large Diverse Population With Resistant Hypertension Within an Integrated Health System.

Hyperaldosteronism (HA) is a common cause of secondary hypertension and may contribute to resistant hypertension (RH). The authors sought to determine and characterize HA screening, positivity rates, and mineralocorticoid receptor antagonist (MRA) use among patients with RH. A cross-sectional study was performed within Kaiser Permanente Southern California (7/1/2012-6/30/2017). Using contemporary criteria, RH was defined as blood pressure uncontrolled (≥ 130/80) on ≥ 3 medications or requiring ≥ 4 antihypertensive medications. The primary outcome was screening rate for HA defined as any aldosterone and plasma renin activity measurement. Secondary outcomes were HA screen positive rates and MRA use among all patients with RH. Multivariable logistic regression analysis was used to estimate odds ratio (with 95% confidence intervals) for factors associated with HA screening and for patients that screened positive. Among 102,480 patients identified as RH, 1977 (1.9%) were screened for HA and 727 (36.8%) screened positive for HA. MRA use was 6.5% among all patients with RH (22.5% among screened, 31.2% among screened positive). Black race, potassium < 4, bicarbonate > 29, chronic kidney disease, obstructive sleep apnea, and systolic blood pressure were associated with HA screening, but only Black race (1.55 [1.20-2.01]), potassium (1.82 [1.48-2.24]), bicarbonate levels (1.39 [1.10-1.75]), and diastolic blood pressure (1.15 [1.03-1.29]) were associated with positive screenings. The authors' findings demonstrate low screening rates for HA among patients with difficult-to-control hypertension yet a high positivity rate among those screened. Factors associated with screening did not always correlate with screening positive. Screening and targeted use of MRA may lead to improved blood pressure control and outcomes among patients with RH.

Impact of different land use types on groundwater quality in Ibadan, Nigeria

Studies of comparative analysis of groundwater quality under different land use types are scarce, and such studies remain critical in achieving sustainable water resource management. This study used suitable multi-statistical techniques alongside the Water Quality Index (WQI) to assess and compare the effects of residential, industrial, and agricultural land use types on groundwater quality in a region of Ibadan, Nigeria, primarily underlain by banded gneisses. The study also established the appropriateness of the water samples for human consumption. Thirty water samples, consisting of 10 samples each from three different land use types, were randomly collected and subjected to established methods of analysis for nine physicochemical parameters. The results from the Kruskal-Wallis test and Dunn's test showed that average concentration levels of pH, total hardness, calcium, magnesium, chloride, bicarbonate, nitrate, and sulfate in the tested water samples were significantly different (p-value ≤ 0.05) among the three land use types investigated. The results also suggested that where poor environmental conditions are common, residential land use type could pose a greater risk to groundwater quality than either agricultural land use or industrial land use. At least, a three-factor model was suggested and explained 63.4 %, 70.2 %, and 91.6 % of the total groundwater quality variation under the residential, agricultural, and industrial land uses respectively using Kaiser's varimax rotation method. In addition, the WQI results showed that 100 % of the water samples from industrial and agricultural land uses were appropriate for drinking but only 20 % of the water samples from residential land use were. The findings indicated that differing land use types affect groundwater quality in different ways. It was thus recommended that an improved sanitation system should be provided by the authorities to help reduce groundwater pollution in the residential area. This can help toward achieving water security mentioned in the African Union's Agenda 2063.

High-flow nasal cannula may prolong the length of hospital stay in patients with hypercapnic acute COPD exacerbation

BackgroundHigh-flow nasal cannula (HFNC) is increasingly used in patients with acute exacerbation of COPD (AECOPD). We aimed to confirm whether the baseline bicarbonate is an independent predictor of outcomes in patients with hypercapnic AECOPD receiving HFNC. MethodsThis was a secondary analysis of a multicentre randomised trial that enrolled 330 patients with non-acidotic hypercapnic AECOPD supported by HFNC or conventional oxygen treatment (COT). We compared the length of stay (LOS) in hospital and the rate of non-invasive positive pressure ventilation (NPPV) use according to baseline bicarbonate levels using the log-rank test or Cox proportional hazard model. ResultsIn the high bicarbonate subgroup (n = 165, bicarbonate 35.0[33.3–37.9] mmol/L, partial pressure of arterial carbon dioxide [PaCO2] 56.8[52.0–62.8] mmHg), patients supported by HFNC had a remarkably prolonged LOS in hospital when compared to COT (HR 1.59[1.16–2.17], p = 0.004), whereas patients in the low bicarbonate subgroup (n = 165, bicarbonate 28.8[27.0–30.4] mmol/L, PaCO2 48.0[46.0–50.0] mmHg) had a comparable LOS in hospital regardless of respiratory support modalities. The rate of NPPV use in patients with high baseline bicarbonate level was significantly higher than that in patients with low baseline bicarbonate level (19.4 % vs. 3.0 %, p < 0.0001). Patients with high bicarbonate level in HFNC group had a lower rate of NPPV use compared to COT group (15.4 % vs. 23.0 %, p = 0.217). ConclusionsAmong patients with non-acidotic hypercapnic AECOPD with high baseline bicarbonate level, HFNC is significantly associated with a prolonged LOS in hospital, which may be due to the reduced escalation of NPPV treatment. Trial registrationclinicaltrials.gov (NCT 03003559)

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

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

Atrial fibrillation as a trigger for acute heart failure

Abstract Background Both atrial fibrillation (AF) and heart failure (HF) facilitate the occurrence and aggravate the prognosis of each other, and often coexist (1). Rapid AF is considered to be a trigger for HF decompensation. However, rapid AF can also be secondary to the increase sympathetic drive associated with HF decompensation. Few data are available regarding the hemodynamic and metabolic consequences of rapid AF in acute HF. Purpose To study the clinical impact of rapid AF in acute HF. Methods We studied 8,997 patients admitted with acutely decompensated heart failure (ADHF). Propensity-score matching was generated using 21 clinical variables. The primary endpoint was in-hospital mortality. Results Rapid AF (defined as ventricular rate ≥110) at admission was present in 339 patients (3.8%). Patient with rapid AF had higher prevalence of diabetes, ischemic heart disease chronic lung disease, and higher levels of BUN and white blood cells (All P&amp;lt;0.001). Systolic blood pressure was lower and diastolic blood pressure was higher with rapid AF (Table). Blood lactate levels were slightly higher with rapid AF but the O2 saturation, pH, bicarbonate and pCO2 levels were similar (Table). In a multivariable logistic regression model, adjusting for all available clinical variables, the odds ration (OR) for in hospital mortality was 1.07 (95% CI 0.77 to 1.49; P=0.69). Propensity score matching yielded 338 patient pairs. In-hospital mortality occurred in 16.3% of patients with rapid AF and in 12.7% of patients without rapid AF ( OR 1.34; 95% CI 0.87 to 2.08, P= 0.19). Conclusion Rapid AF at admission was not associated with a significant hemodynamic or metabolic compromise and carried a similar risk for in-hospital mortality as in patients without rapid AF.Hemodynamic and metabolic parameters

Abstract 12042: Elevated Levels of Bicarbonate Predict Adverse Outcomes in Patients With Chronic Heart Failure

Background: The bicarbonate (HCO3 - ) buffer system plays a crucial role in maintaining acid-base homeostasis, and HCO3 - levels are affected by multiple factors in heart failure. Recently, a sub-analysis of the ADVOR trial for acute heart failure revealed that patients with elevated serum HCO3 - levels experienced beneficial effects of decongestion by acetazolamide. However, the significance of HCO3 - levels in chronic heart failure has not been fully understood. Aim: We sought to clarify whether HCO3 - levels have clinical relevance or prognostic impact in patients with chronic heart failure. Methods and Results: We conducted a prospective study involving hospitalized patients with stage C/D heart failure and measured HCO3 - levels in arterial blood gas samples prior to discharge. We enrolled a total of 718 patients (mean 68.3 years old and 62.1% male), with neutral pH ranging from 7.35 to 7.45, and found that 132 (18.4%) had HCO3 - levels exceeding 26 mmol/L. Patients with HCO3 - &gt; 26 mmol/L were more likely to be male and to use loop diuretics, and had higher serum sodium, as well as lower potassium levels, compared to those with HCO3 - &lt; 26 mmol/L, whereas there were no differences in B-type natriuretic peptide levels or left ventricular ejection fraction between the two groups. In a Kaplan-Meier analysis, patients with HCO3 - &gt; 26 mmol/L had lower event-free survival rates from cardiac deaths and decompensated heart failure as well as the composite of the cardiac events over a median follow-up period of 1540 days ( Figure ). In a multivariable Cox proportional hazard model after adjusting confounding variables, the presence of HCO3 - &gt; 26 mmol/L was independently associated with increased risks of the composite of cardiac events (hazard ratio, 1.64; P &lt; 0.01). Conclusion: Elevated HCO3 - levels may indicate enhanced proximal nephron activation and resistance to loop diuretics, which predicted adverse outcomes in patients with chronic heart failure, even within a normal pH range.