Sodium Bicarbonate Tablets Research Articles

7815 Pembrolizumab-Induced Autoimmune Hypophysitis with “Isolated” ACTH Deficiency: Need for Heightened Awareness and Action Among Medical Fraternity

Abstract Disclosure: S. Shankar: None. S.S. Sundar: None. M.S. Vaishnav: None. L. Lekkala: None. K. Thummala: None. S. Srikanta: None. T. Deepak: None. R.B. Vijay: None. K. Muniraj: None. V. Nath: None. C. Siddlingappa: None. P. Ravikumar: None. M.D. Chitra: None. Introduction: Autoimmune hypophysitis caused by immune checkpoint inhibitors [ICIs; anti-CTLA-4 (Ipilimumab alone 7.9%), anti-PD-1 (Pembrolizumab alone 1.7%; nivolumab alone 0%)] are being increasingly documented, with anterior hypopituitarism affecting corticotrophs more commonly than thyrotrophs and gonadotrophs (large time span of onset; different recovery patterns). Clinical Case 2021 Sep Age 65 years (type 2 diabetes, hypertension). Renal Cell Carcinoma S/P radical nephrectomy. 2023 Jul PET-CT= Metastatic pleuropulmonary nodules. Four admissions to Specialist Oncology Hospital [Four 2 weekly cycles of Inj Pembrolizumab 200 mg (with Tab Axitinib 10 mg/day)]. After first cycle: progressive fatigue, body aches, drowsiness. S Sodium= Pre-pembrolizumab= 137 mEq/L (135-145); Post-pembrolizumab= 124, 134, 132, 124; T3= 1.63 to 0.60 to 1.24 to 1.35 ng/mL (0.97-1.69); T4= 6.83 to 4.93 to 10.44 to 11.44 mcg/dL (5.53-11); TSH= 10.46 to 6.28 to 5.39 to 9.48 mIU/mL (0.46-4.68); S Cortisol 8 am= 1.54 mcg/dL (5-25); S Potassium= 4.59 mEq/dL (3.5-5.1)]. One episode of loss of consciousness; EEG= abnormal; MRI Brain= normal. During every hospital admission, oncology, medical, endocrinology and nephrology teams attributed the same to “illness” (no specific diagnosis) and provided symptomatic treatment (IV 3% saline, tolvaptan and sodium bicarbonate tablets).2023 Nov Medicine: Very severe nausea, anorexia, generalised weakness, myalgia, hiccoughs, and inability to walk. Frustrated family members sought admission in “new” General Hospital. S Sodium= 119, 120; S Potassium= 4.8; S Creatinine= 1.67 mg/dL (0.7-1.3); S Uric acid= 4.5 mg/dL (4.40-7.60); Urine spot Sodium= 84 mmol/L; ESR= 144 mm. Endocrinology: S Cortisol 8 am= 0.09 mcg/dL;S Cortisol post 250 mcg Inj Synacthen= 3.76 (>20);Plasma ACTH= 5.4 pg/ml (9-52). S T3= 1.35; S T4= 11.44; S TSH= 9.48; LH= 3.61mIU/mL (1.5-9.3); FSH= 1.4mIU/mL (1.4-18.1); PRL= 30.1 (2.6-13.3); Testosterone total= 314 ng/dL (241-827); TPO antibodies negative. MRI-Pituitary: Partial empty sella; infundibulum neurohypophysis normal; mild asymmetric enhancement (5.5 mm) left cavernous sinus. Treatment: Tab Hydrocortisone 25 mg/day, with complete clinical and biochemical response [Suggestion of gonadotroph dysfunction and partial recovery of thyrotrope dysfunction/ injury. Hence, not on thyroxine replacement]. Clinical Lessons: Mechanisms for differential cellular vulnerability for ICI induced autoimmune pathologies [thyroid (destructive versus stimulatory), islet beta cells, adrenal cortical cells, various anterior pituitary cells (corticotrophs vs thyrotrophs and gonadotrophs] need elucidation. Specific molecular and cellular immunopathogenic pathways in different autoimmune endocrinopathies appear distinct and disparate. Presentation: 6/2/2024

Effects of Oral Sodium Bicarbonate Supplementation on Protein Metabolism and Inflammation in Iraqi Hemodialysis Patients: An Open-Label Randomized Controlled Trial.

The effect of correcting metabolic acidosis on protein metabolism in hemodialysis patients is controversial. To study the effects of oral sodium bicarbonate on protein metabolism and markers of inflammation in acidotic hemodialysis patients. Patients and Methods. An open-label randomized controlled trial was conducted at a single center. Sixty-six clinically stable adult hemodialysis patients were recruited with an average predialysis serum bicarbonate level of <22 mmol/l and a dialysate bicarbonate concentration of 35 mmol/l. Forty-nine participants have completed the study. Oral sodium bicarbonate tablets of 500 mg were given daily in the intervention group (n = 25) for 12 weeks versus the standard of care in the control group (n = 24). Outcomes compared intervention versus nonintervention in both groups at equivalent time points (0 and 3 months). The clinical data, anthropometry, dialysis adequacy, albumin, normalized protein catabolism rate, blood gas analysis, and bicarbonate were recorded at 0 and 3 months. In addition, muscle mass and handgrip strength were measured. Finally, IL-6 as a marker of inflammation was measured at randomization and three months. Serum bicarbonate and pH increased significantly from 17.57 ± 3.34 mmol/L to 20.69 ± 2.54 mmol/L and from 7.26 ± 0.06 to 7.34 ± 0.04, respectively (p < 0.0001). Serum albumin was significantly higher in the intervention group at three months than in the control group, 4.11 ± 0.45 vs. 3.79 ± 0.47 (p value 0.011). Serum potassium significantly decreased in the intervention group at three months compared to the control group, 5.00 ± 0.43 mEq/l vs. 5.33 ± 0.63 mEq/l (p value 0.03). Muscle strength expressed as handgrip has improved significantly in the intervention group at three months compared to the control group, 45.01 ± 19.19 vs. 33.93 ± 15.06 (p value 0.03). The IL-6 values were less in the intervention group at 3 months with a p value of 0.01. The interdialytic weight of the intervention group at three months was 2.42 ± 0.64 compared to the 2.20 ± 1.14 control group, but this did not reach statistical significance (p value of 0.4). The composite of (albumin + nPCR) at three months was achieved in 59.18% of the intervention group compared to 14.28% with a p value of 0.01. Correcting metabolic acidosis in hemodialysis patients improved serum albumin and nPCR without hypokalemia or significant interdialytic weight gain. This was particularly evident in patients with minimal inflammation with low IL-6 values.

Comparison of sodium bicarbonate capsules and gastro-resistant sodium bicarbonate tablets in patients with stage 4 CKD

Comparison of sodium bicarbonate capsules and gastro-resistant sodium bicarbonate tablets in patients with stage 4 CKD

The Effect of Denture Cleansing Solutions on the Retention of Precision Attachments: An In Vitro Study.

This study aimed to investigate the effect of different cleansing solutions on the retention of precision attachments. A precision attachment patrix was embedded into acrylic resin and the matrix was placed onto the patrix. The red (high retention, 8 N), yellow (regular retention, 6 N), and green (reduced retention, 4 N) plastic matrixes of the attachments (n = 32) were soaked in three different denture cleansing solutions (sodium laureth sulfate, sodium bicarbonate-sodium perborate, sodium bicarbonate) for a duration simulating 6 months of clinical use. The control group was soaked in tap water. A universal testing machine was used to measure the retention values of attachments after they were soaked in denture cleansers. The retention values were compared among the groups with repeated-measures analysis of variance followed by the Tukey HSD test (p = 0.05). Yellow attachments were affected by sodium laureth sulfate, sodium bicarbonate-sodium perborate, and water (p = 0.012). Green attachments’ retention increased after immersion in sodium laureth sulfate (p = 0.04) and water (p = 0.02). Red attachments’ retention increased after immersion in sodium laureth sulfate or sodium bicarbonate-sodium perborate (p = 0.045). Water did not affect the retention of red attachments. Because sodium bicarbonate tablets did not affect the retention of attachments, clinicians may recommend their use as a cleanser. Clinicians also may inform patients using fixed and removable partial prostheses with precision attachments of a possible increase in retention after the use of sodium laureth sulfate or when using sodium bicarbonate-sodium perborate with yellow and red attachments.

Acute gouty arthritis attacks induced by a great toe injury: a case report and literature review

Introduction: Gouty arthritis usually occurs in patients with hyperuricemia and can be induced by a variety of factors. Here, we describe a case of acute gouty arthritis attacks induced by a great toe injury and was successfully treated by benzbromarone and ibuprofen. Patient concerns: A 27-year-old Asian man with hyperuricemia informed us his first metatarsophalangeal joint of left foot began to redness and swelling, accompanied by severe pain presented 8 days after the toenail injury. Diagnoses: Laboratory tests confirmed as gouty arthritis with no signs of infection, but serum uric acid was significantly higher than normal at 523 μmol/L. Interventions: Drug treatment was adopted, including benzbromarone 100 mg daily, ibuprofen pills 75mg twice a day, and sodium bicarbonate tablets 0.5g three times a day. Outcomes: All of his symptoms of acute gouty arthritis attacks gradually disappear after drug treatment for a week and blood uric acid had dropped to 87 μmol/L two weeks later. Conclusion: When patients with a broken great toe present with symptoms of first metatarsophalangeal joint began to redness and swelling, accompanied by severe pain, acute gouty arthritis attacks should also be considered, and the drug treatment is effective. Abbreviation: GA = Gouty arthritis, MSU = Monosodium urate, ESRD = End-stage renal disease.

Oral sodium bicarbonate in people on haemodialysis: a randomised controlled trial

BackgroundAdverse events and mortality tend to cluster around dialysis sessions, potentially due to the impact of the saw-toothed profile of uraemic toxins such as potassium, peaking pre-dialysis and rapidly dropping during dialysis. Acidosis could be contributing to this harm by exacerbating a rise in potassium. The objectives of this study were to investigate the effects of oral bicarbonate treatment on reducing inter-dialytic potassium gain as well as other clinical consequences of preserving muscle mass and function and reducing intradialytic arrhythmia risk in people on haemodialysis.MethodsOpen-label randomised controlled trial in a single-centre (London, UK). Forty-three clinically stable adults on haemodialysis were recruited, with a 6 month average pre-dialysis serum bicarbonate level < 22 mmol/l and potassium > 4 mmol/l. Thirty-three participants completed the study. Oral sodium bicarbonate tablets titrated up to a maximum of 3 g bd (6 g total) in intervention group for 12 weeks versus no treatment in the control group. Outcomes compared intervention versus non-intervention phases in the treated group and equivalent time points in the control group: pre- and post-dialysis serum potassium; nutritional assessments: muscle mass and handgrip strength and electrocardiograms (ECGs) pre and post dialysis.ResultsParticipants took an average of 3.7 ± 0.5 g sodium bicarbonate a day. In the intervention group, inter-dialytic potassium gain was reduced from 1.90 ± 0.60 to 1.69 ± 0.49 mmol/l (p = 0.032) and pre-dialysis potassium was reduced from 4.96 ± 0.62 to 4.79 ± 0.49 mmol/l without dietary change. Pre-dialysis bicarbonate increased from 18.15 ± 1.35 to 20.27 ± 1.88 mmol/l, however with an increase in blood pressure. Nutritionally, lean tissue mass was reduced in the controls suggesting less catabolism in the intervention group. There was no change in ECGs. Limitations are small sample size and unblinded study design lacking a placebo, with several participants failing to achieve the target of 22 mmol/l serum bicarbonate levels due mainly to tablet burden.ConclusionOral sodium bicarbonate reduced bicarbonate loss and potassium gain in the inter-dialytic period, and may also preserve lean tissue mass.Trial registrationThe study was registered prospectively on 06/08/2015 with EU Clinical Trials Register EudraCT number 2015-001439-20.

SUN-196 Persistent Hyperkalemia After Unilateral Adrenalectomy for Aldosteronoma

IntroductionFollowing unilateral adrenalectomy, some patients experience persistent hyperkalemia. This has been attributed to hypoaldosteronism due to severe suppression of aldosterone synthesis in the contralateral adrenal gland. Additionally, excess aldosterone leads to glomerular hyperfiltration masking kidney dysfunction, which can then manifest after cure with CKD-related hyperkalemia.Case PresentationWe report a case of 51-year-old male who was diagnosed with hypertension in his late 30s. He required a beta-blocker and calcium channel blocker (CCB) for 10 years, and eventually developed hypertensive nephropathy. With worsening lower extremity edema, he was switched from a CCB to an angiotensin receptor blocker. Soon afterwards, he presented with hypertensive emergency and was discovered to have significant hypokalemia (K 2.1 mmol/L), prompting work up for primary aldosteronism.Biochemical evaluation revealed an elevated aldosterone to renin ratio of 38 [(ng/dL)/(ng/mL/hr)] and adrenal protocol CT scan revealed a 1.9 cm left adrenal nodule with benign characteristics. Adrenal vein sampling showed marked lateralization of excess aldosterone to the left adrenal gland, with proper catheter placement demonstrated in each adrenal veins (5-fold cortisol gradient bilaterally). He was started on spironolactone and 6 weeks later, underwent an uncomplicated laparoscopic left adrenalectomy. Spironolactone was discontinuedSerum K level was normal at 4.8 mmol/L immediately postoperatively. Ten hours later, his K went up to 6.6 mmol/L which was confirmed by repeat blood work, accompanied by worsened renal function (Cr 2.5 mg/dL up from a of baseline 2.0). His hyperkalemia persisted in the 5.0 – 6.0 range despite IV Calcium Gluconate, Insulin and D50. Oral potassium binders were avoided due to concerns about ileus. Upon recognition of the possibility of hypoaldosteronism, we recommended a NaHCO3 gtt, with subsequent normalization of serum K. We avoided initiating fludrocortisone in the short term, due to uncertainty about duration of hypoaldosteronism, & because he was still requiring two antihypertensive agents. Plasma aldosterone 2 wks after surgery was fully suppressed, confirming suspicion of hypoaldosteronism. He has been managed successfully with oral sodium bicarbonate tablets, remaining normokalemic at 3 weeks post-surgery.Conclusion:Here we present a case of persistent hyperkalemia following resection of a signficantly biochemically active and long-standing aldosteronoma, which was successfully managed with sodium bicarbonate. We attribute the post-operative hyperkalemia in this patient to a combination of hypoaldosteronism due to deep suppression of the mineralocorticoid production of the contralateral adrenal, as well as unmasking of more severe kidney dysfunction than was he previously thought to have once aldosterone excess was withdrawn.

Oral Methods of Urinary Alkalinization for High-dose Methotrexate Administration: Alternatives to Intravenous Sodium Bicarbonate During a Critical Drug Shortage.

A nationwide shortage of intravenous (IV) sodium bicarbonate required institutions to explore alternative options for urinary alkalinization for high-dose methotrexate (HDMTX). Children's Hospital Colorado implemented a protocol utilizing oral alkalinizing agents as alternatives to intravenous sodium bicarbonate during the shortage. The purpose of this study was to determine the safety and efficacy of oral alkalinization strategies for HDMTX administration. This retrospective study was conducted at a pediatric institution and evaluated cycles of HDMTX administered with at least one dose of oral sodium bicarbonate tablets or sodium citrate-citric acid oral solution. The time to achieve urine pH of ≥7 was 3.48 hours from the start of alkalinization. A median dose of 66.4 mEq/m/day of oral sodium bicarbonate was administered to maintain a urine pH of ≥7 until methotrexate was cleared. Gastrointestinal side effects occurred with 43% of HDMTX cycles and patients switched to IV sodium acetate in 25.5% of HDMTX cycles, primarily due to inadequate alkalinization or intolerance. During a shortage of IV sodium bicarbonate, oral alkalinization is an effective strategy for most patients to allow for administration of HDMTX.

Progressive osseous heteroplasia: three case reports

Objective To investigate clinicopathological features, diagnosis and treatment of progressive osseous heteroplasia (POH) . Methods Clinicopathological data were collected from 3 cases of POH, and analyzed retrospectively. Related literature was also reviewed. Results All the 3 patients were female, and developed POH within a few days to months after birth. POH clinically manifested as light pink or skin-colored indurated papules, nodules or plaques scattered over the scalp, trunk and extremities without subjective symptoms. Histopathological examination showed that there were flaky bone or bone-like tissues in the middle and lower dermis. Serum levels of calcium, phosphate and parathyroid hormone were normal in the 3 children. Case 1 was treated with oral sodium bicarbonate tablets and surgical resection of skin lesions on the right lower abdomen. During the follow-up for about 7 months, the skin lesions on the right lower abdomen did not recur, while other skin lesions became more bulging, larger and harder, and new skin lesions occurred. Case 2 was treated with topical adapalene gel, and these skin lesions did not increase in number, but became larger and harder. Case 3 received no treatment, and was lost to follow-up. Conclusion POH clinically manifests as indurated maculopapules and plaques progressively affecting deeper skin tissues, and there are no effective therapies or prevention approaches at present. Key words: Bone diseases, developmental; Skin manifestations; Pathologic processes; Diagnosis; Therapy; Progressive osseous heteroplasia

Chinese herbal medicine for constipation: zheng-based associations among herbs, formulae, proprietary medicines, and herb-drug interactions.

BackgroundAs current symptomatic treatments of constipation are still unsatisfactory, an increasing number of patients seek help from Chinese medicine (CM), particularly Chinese herbal medicine (CHM). This study aimed to review the most frequently used CHM herbs and formulae, proprietary CHMs, and herb–drug interactions for functional constipation using zheng (syndrome)-based differentiation, and to determine the current practice of zheng-based CHM treatments for functional constipation.MethodsWe developed a search strategy to include all the related clinical studies of CHM for constipation and set inclusion and exclusion criteria as studies on subjects with constipation of all ages and both sexes, using objective measures from laboratory or imaging techniques. The interventions included single herbs, CM classical formulae, CM new formulae, and Chinese herb-derived products and combination products. The clinical study types included were quasi- or randomized controlled trials, observational clinical studies, case series or case reports, and other types of appropriate research methods. The data concerning study design, sample size, mode of recruitment, sampling and diagnostic procedure, inclusion and exclusion criteria, and participants’ characteristics (including age, sex, and duration of constipation). CM patterns, CM treatment principles, treatment regimen, and CM treatment outcomes were recorded.ResultsA total of 29,832 relevant records were found, of which 8541 were duplicate records and 20,639 were excluded for reasons of irrelevance. The full text of 965 articles was retrieved for detailed assessment, following which 480 articles were excluded for various reasons. From the included articles, we retrieved 190 different CM zheng diagnoses from 485 individual studies. The most common zheng was dual deficiency of qi and blood (N = 48), which was diagnosed in 948 out of 15,740 subjects. The most frequently used classical formula was Ma-Zi-Ren-Wan (MZRW) (N = 75) and the most frequently used proprietary CHM was Run-Chang-Wan (N = 87). The most frequently used combined medication was Da Huang with sodium bicarbonate tablets (frequency across all studies, n = 23), followed by Fan Xie Ye with lactulose oral solution (n = 8), Ma-Ren-Ruan-Jiao-Nang with lactulose oral solution (n = 6) and Liu-Wei-An-Xiao-Jiao-Nang (n = 6) with mosapride citrate tablets.ConclusionThis study examined the use of CHM for constipation and summarized the herbs, formulae, proprietary medicines, and herb–drug interactions application. These data indicated there were limited information about herb-drug interactions and adverse effects of CHM and further randomized controlled trials with strict design are necessary.Electronic supplementary materialThe online version of this article (doi:10.1186/s13020-016-0099-4) contains supplementary material, which is available to authorized users.

The efficacy of hemodialysis in interventional therapy in coronary artery disease patients with chronic renal insufficiency

The aim of this study was to explore the efficacy and safety of hemodialysis in interventional therapy for patients with coronary artery disease combined with chronic renal insufficiency. With the aging and social development, the number of coronary artery disease patients with chronic renal insufficiency gradually increased. Total 58 coronary heart disease patients with chronic renal dysfunction were selected. These patients were characterized with typical angina symptoms and typical electrocardiogram (ECG) changes of onset angina. Continuous oral administration of sodium bicarbonate tablets 1 g 3/day × 3 days and slow intravenous input sodium chloride 1000 ∼1500 mL 3–12 h before operation were given. By this way, all patients were treated by hydration and alkalization. After percutaneous coronary intervention (PCI) treatment, patients were immediately transferred to undergo 4 h of dialysis treatment without removing indwelling of femoral artery puncture sheath tube to protect renal function. Changes in renal function including serum creatinine, glomerular filtration rate, and urine were observed and recorded. All patients were successfully underwent PCI treatment. Within one month after PCI, there were no obvious complication and no stent thrombosis occurred. Among of 58 patients, 56 cases showed no significant increase in serum creatinine levels compared with those before operation. However, serum creatinine level of one patient increased to 251 umol/L and one patient still required permanent dialysis. Using hemodialysis in interventional therapy in coronary artery disease patients with chronic renal insufficiency could significantly improve the prognosis of the patients.

Efficacy of urine alkalinization by oral administration of sodium bicarbonate: a prospective open-label trial

BackgroundUrine alkalinization is indicated for various medical conditions. Alkalinization is usually achieved by intravenous administration of alkali substances titrated by repeated urinalyses.Some situations such as mass casualty events might require urine alkalinization by the oral route. We evaluated the efficacy of oral sodium bicarbonate administration for urine alkalinization. MethodsIn a prospective open-label trial, 4 g of sodium bicarbonate was administered orally 3 times daily to 9 healthy volunteers for 24 hours. Serial blood and urine samples were collected, and urine pH was evaluated. Plasma electrolytes and pH were also measured for safety purposes. ResultsAll participants had a urine pH of at least 7 after 10 hours. At 20 hours, all participants had a urine pH of at least 8.No adverse effects or abnormal blood results were documented during the 24-hour follow-up. ConclusionsOral administration of a standard dose of sodium bicarbonate tablets resulted in effective urine alkalinization. Further research is needed to investigate the natural course of urine pH after cessation of our protocol and the efficacy of longer periods of treatment.

Formulation Development and Evaluation of Sodium Bicarbonate Tablets by Direct Compression Method

Acidity is a worldwide problem caused by an imbalance between the acid secreting mechanisms of stomach and proximal intestine. It creates great trouble in the life of many people. An antacid neutralizes excess acidity and provide relief. Sodium bicarbonate is prescribed as an antacid to treat heartburn and acid indigestion condition. The main objective of the current work was to prepare sodium bicarbonate antacid tablets by direct compression method and to evaluate trial formulation with those available in the local market by pharmacopeial and nonpharmacopeial methods. Besides sodium bicarbonate, the excipients used were lactose, microcrystalline cellulose (Avicel) and magnesium stearate. The tablet weight set for compression was 318mg (±5%). After sieving through a 20 mesh screen, the powder was blended for five minutes and evaluated for its flow properties before compression on a single punch machine. The results revealed that the blend possessed good flow property, compressed easily and the resulting tablets complied all the standards and showed a close resemblance with sodium bicarbonate tablets which are available in the local market.

Correcting metabolic acidosis leads to an increase in dietary protein intake in patients with established chronic kidney disease

Background: Metabolic acidosis is a feature of chronic kidney disease (CKD) due to the reduced capacity of the kidney to synthesize ammonia and excrete hydrogen ions. It is identified by low plasma bicarbonate levels on routine blood testing. The literature suggests that correction of metabolic acidosis using sodium bicarbonate tablets can reduce protein degradation, reduce amino acid oxidation, reduce inflammation and increase albumin synthesis (Brady & Hasbargen, 1998). The evidence of the benefits and the risks of correcting metabolic acidosis are limited with no randomized controlled trials (RCTs) in pre-dialysis patients (Roderick et al., 2007). Metabolic acidosis has been associated with protein-energy malnutrition and it has been questioned if acidosis plays a part in reducing appetite leading to a reduction in energy and protein intake. The aim of the project was to determine the effects of the correction of chronic metabolic acidosis on energy and protein and kilocalorie intake in patients with established CKD. Method: The project was an observational, prospective study involving seven pre-dialysis subjects recruited from nephrology review clinics. Participants were invited to take part in the project on identification of acidosis with a bicarbonate level of <22 mM during a 6 months recruitment period. A power calculation was not deemed necessary for this initial pilot study. No medical conditions were excluded from the project. Three participants failed to return their diaries and were withdrawn from the project. Sodium bicarbonate tablets were given to correct acidosis at the clinic. A 5 day food diary was issued at the first nephrology review along with five questions on appetite. Participants self reported their appetite status using a scale of 1–4 (very good, good, fair and poor respectively). A further diary was given at their subsequent review appointment. Blood biochemistry, anthropometric measurements, blood pressures and diary analysis were completed at each review. Energy and protein intakes were assessed using DietPlan6; dietary analysis software package. Any difference between the energy and protein intake means were determined using SPSS statistical software package and scores for appetite were assessed. Difference in energy and protein intake was assessed using t-tests, statistical significant assessed at P < 0.05. Ethical approval was obtained from the Lancashire and Cumbria Ethical Committee. Results: Results of the paired t-test statistical testing for the variables using 95% confidence. Variable Mean Difference SD Difference t Significance 2-tailed *No changes seen in appetite scores. Weight (Kg) 1.48 1.93 1.88 0.119 eGFR (mls per min per sa) -0.86 2.91 -0.78 0.466 Dialystolic BP (mmHg) 9.71 11.03 2.09 0.081 Systolic BP (mmHg) -4.29 12.58 -0.90 0.402 Energy (kilocalories) 175 236 1.96 0.098 Protein (g) 7.3 7.07 2.73 0.034 Discussion: The project supports earlier studies which suggest that bicarbonate supplementation can increase protein intake, which in turn can have beneficial effects on the nutritional status of people with CKD. The study looked at a very small group of individuals therefore strong conclusions cannot be made due to the limiting amount of data retrieved. Plasma bicarbonate levels increased in all seven participants indicating compliance with the medication. Using a scoring system for appetite changes is difficult to detect small changes and no treatment blinding was possible in this project. Further research on the health effects of chronic metabolic acidosis are needed to determine the level of bicarbonate needed for optimal health. Conclusion: The results of the project suggest that correcting metabolic acidosis can improve dietary protein intake and nutritional parameters in CKD without causing any detrimental effects to health.

Autoimmune hemolytic anemia associated with a formulation of traditional Chinese medicines

A case of autoimmune hemolytic anemia (AIHA) after treatment with a Chinese herbal preparation is reported. A 29-year-old woman was admitted to the hospital with the primary complaints of jaundice, tea-colored urine, and fatigue lasting 10 days. Thirteen days prior, she went to a local private clinic seeking treatment for mild stomach pain and general malaise and was given weidean tablets. She took four tablets of weidean, a Chinese herbal preparation, orally three times daily for 2 days. After 2 days, she experienced fatigue, dizziness, and chest distress and subsequently discontinued treatment. Upon examination, she exhibited mild scleral and mucosal icterus. Her conjunctivas were pale, and her skin was slightly jaundiced. Preliminary laboratory tests found a low hemoglobin level and an elevated reticulocyte count. Biochemical tests showed an elevated total serum bilirubin concentration with indirect hyperbilirubinemia. Coombs' test results were positive for immunoglobulin G but negative for C3. All other test results were normal. The patient was diagnosed with AIHA secondary to weidean use, and she was treated promptly with oral prednisone, i.v. cimetidine, and oral sodium bicarbonate tablets. Seven days later, she showed clinical improvement. Her hemoglobin level rapidly increased to above 100 g/L, with a corresponding decrease in her reticulocyte count and serum bilirubin value over the next 8 days. She was discharged 15 days after admission and was asymptomatic at a three-week follow-up visit. Weidean, a formulation of Chinese medicinal herbs and other constituents, was associated with AIHA in a woman taking the remedy for gastritis.

A 42-Year-Old Woman With Flaccid Paralysis

A 42-Year-Old Woman With Flaccid Paralysis

Effect of Oral Sodium Bicarbonate Supplementation on Interdialytic Weight Gain, Plasma Sodium Concentrations and Predialysis Blood Pressure in Hemodialysis Patients

Background: Correction of metabolic acidosis in dialysis patients should be considered of paramount importance. However, consuming sodium bicarbonate tablets during the interdialytic interval to reach predialysis bicarbonate levels of 23–24 mmol/l is not widespread due to the fear of greater interdialytic weight gain and fluid overload. For this reason we investigated in a cross-sectional and in an interventional study the effect of oral sodium bicarbonate supplementation on body weight gain, plasma sodium concentrations and predialysis blood pressure in a group of stable uremic patients on regular hemodialysis (HD) treatment. Study Design: 110 patients (67 men, 43 women), mean age 67 ± 15 (range 22–89) years, on regular chronic HD treatment for 6–372 (median 48) months were studied. 70 patients were on regular oral bicarbonate supplementation for at least 4 weeks (group A), 40 patients were not on oral bicarbonate supplementation (group B). The following parameters were recorded: dry body weight (DBW), interdialytic weight gain (IWG), body mass index (BMI), plasma sodium (Na), serum pH, serum bicarbonate (sBic), K_t/V, normalized protein catabolic rate (PCRn), predialysis systolic (SBP) and diastolic (DBP) blood pressure, and bicarbonate therapy (g/day). 18 patients not on oral bicarbonate supplementation with sBic levels ≤20 mmol/l were started on oral bicarbonate therapy and were prospectively followed in the context of an interventional study of correction of chronic metabolic acidosis. The same parameters were recorded before (pre) and after (post) 4 months of oral bicarbonate supplementation. Results:Serum pH and sBic concentrations were significantly higher in patients in group A compared to patients in group B (pH 7.37 ± 0.02 group A vs. 7.33 ± 0.02 group B: p <0.001: sBic 23.8 ± 1.4 group A vs. 20.9 ± 1.4 group B: p < 0.0001). Age, DBW, BMI, IWG, SBP, DBP, Na, K_t/V and PCRn did not differ between groups. The mean daily dose of oral sodium bicarbonate administered to patients in group A was 1.9 ± 0.9 (range 1–5, median 2) g/day. Also in the 18 patients who started bicarbonate treatment, a significant increase in serum pH and sBic concentrations and a significant reduction in PCRn were observed. No significant change in DBW, IWG, SBP, DBP and Na concentrations after 4 months of treatment was found. Conclusions: Our data show that in stable uremic patients on regular HD treatment, oral daily administration of sodium bicarbonate is effective in correcting mild-moderate chronic metabolic acidosis, and does not cause increased interdialytic body weight gain, different plasma sodium concentrations and different systolic-diastolic blood pressure levels compared to patients not on oral sodium bicarbonate supplementation.

Evaluation of Critical Binder Properties Affecting the Compactibility of Binary Mixtures

The aim of this study was to identify essential physical and mechanical properties of various binders and to investigate their influence on the tensile strength and porosity of tablets made from binary mixtures with sodium bicarbonate. The binders were characterized according to axial and radial tensile strength after compression into tablets, yield pressure and minimum porosity during compression, and elastic recovery after compression. The addition of a binder generally resulted in an increase in the tensile strength and a decrease in the porosity of the sodium bicarbonate tablets. The location of the binder in the voids between the sodium bicarbonate particles thus decreasing the porosity of the tablet seemed to be an important consideration. Consequently, the addition of binders with a low yield pressure value and a relatively small elastic recovery value (e.g., polyethylene glycol 3000 and polyvinylpyrrolidone) resulted in tablets of low porosity and high tensile strength, especially in the axial direction. The tensile strength of the pure binder also seemed to be important, especially for binders with a lower degree of deformability (e.g., microcrystalline cellulose and pregelatinised starch). The results also indicated the value of using both axial and radial tensile strength measurements in assessing the effect of a dry binder and showed that the importance of different binder properties varied according to the direction of the tablet strength measurements. The results demonstrated that the applied characteristics of the binders used in this study may serve as a useful tool in evaluating the effectiveness of binders.

Evaluation of the effect of addition of polyethylene glycols of differing molecular weights on the mechanical strength of sodium chloride and sodium bicarbonate tablets

The effects of the addition of polyethylene glycols (PEGs) of differing molecular weights on the tensile strength of tablets made of sodium chloride or sodium bicarbonate were studied. The results indicated that fractures occurring during tablet strength testing tended to propagate around rather than through the sodium chloride and sodium bicarbonate particles. The addition of PEG to sodium chloride or sodium bicarbonate generally increased the tablet strength. In some cases, a synergistic effect was seen, i.e. the strength of the tablets made from the mixtures was higher than the strengths of the tablets made of the individual components. This was thought to be the result of an increased fracture surface area. When a PEG was added to a compound that had a high capacity for volume reduction (sodium chloride), the tensile strength of the compact reflected the ductility of the PEG but, when a compound with a lower capacity for volume reduction (sodium bicarbonate) was used, the tensile strength of the tablets reflected the tensile strength of the corresponding pure PEG tablet. The results also indicated that the bonding mechanisms of the compounds are likely to affect the tensile strength of the tablet obtained.

The Physical Stability of Tablets Coated using an Aqueous Dispersion of Ethylcellulose

AbstractFilms formed from an aqueous dispersion of ethylcellulose mixed with hydroxypropylmethylcellulose were deposited onto sodium bicarbonate, microcrystalline cellulose, and acetylsalicylic acid (ASA) tablets. Upon storage at elevated temperatures and relative humidity, no changes in disintegration times were observed with the sodium bicarbonate tablets or with tablets containing microcrystalline cellulose. Marked increases were observed in disintegration times with the ASA tablets, these increases being dependent on both temperature and relative humidity. Examination of films by scanning electron microscopy indicated that coalescence of particles within the films had occurred in those samples where increases in disintegration times were observed.