ABSTRACT
O objetivo deste estudo foi evidenciar e discutir as principais alterações hidroeletrolíticas em pessoas com cirrose. Trata-se de uma revisão integrativa, de natureza qualitativa. Os artigos foram selecionados por meio da plataforma Medical Literature Analysis and Retrievel System Online. Os principais achados identificados a partir dos artigos selecionados foram a ocorrência de hiponatremia, o mau prognóstico diante da presença de distúrbios hidroeletrolíticos em relação à sobrevida em pessoas com cirrose e a importância da albumina. Indivíduos com cirrose são suscetíveis ao desenvolvimento de distúrbios hidroeletrolíticos devido às mudanças fisiopatológicas da doença e às condições clínicas apresentadas. A hiponatremia e a hipocalemia são os mais recorrentes, destacando, porém, a necessidade de atenção aos demais distúrbios. (AU)
The objective of this study was to show and discuss the main hydroelectrolytic alterations in cirrhotic patients. This is an integrative review, a qualitative study, in which articles were selected at the Medical literature Analysis and Retrieval System Online. The main findings identified in the articles selected were the occurrence of hyponatremia, the poor prognostic, due to the presence of hydroelectrolytic disorders, regarding cirrhotic individuals survival and the importance of albumin. Individuals with cirrhosis are susceptible to the development of hydroelectrolytic disorders due to the pathophysiological alterations of the disease and because of the clinical status presented. Hyponatremia and hypokalemia are the most recurrent, but attention shall be given to the other disorders too. (AU)
Subject(s)
Humans , Water-Electrolyte Imbalance/metabolism , Liver Cirrhosis/metabolism , Prognosis , Acid-Base Imbalance/etiology , Water-Electrolyte Imbalance/complications , Water-Electrolyte Imbalance/etiology , Survival Analysis , Hypophosphatemia/etiology , Hypoalbuminemia/etiology , Qualitative Research , Albumins/therapeutic use , Liver Cirrhosis/complications , Liver Cirrhosis/physiopathology , Liver Cirrhosis/therapy , Magnesium Deficiency/etiologyABSTRACT
O objetivo deste artigo foi abordar as controvérsias científicas acerca dos distúrbios ácido-base nas doenças hepáticas. Nos estágios avançados da doença hepática, os distúrbios ácido-base atuam de forma complexa, comprometendo a qualidade de vida do paciente e desafiando o manejo clínico. A literatura apresenta a alcalose respiratória como uma das principais alterações, porém há uma longa discussão sobre o mecanismo fisiopatológico; em especial, citam-se a hipóxia, a hipocapnia e o nível de progesterona. Nas desordens metabólicas, com destaque para a acidose, os estudos apontam principalmente o lactato, os unmeasured ions ou íons não medidos e as alterações hidroeletrolíticas, mas cada componente desse sobressai-se dependendo da fase da doença estudada, compensada ou descompensada. As controvérsias dos distúrbios ácido-base nas doenças hepáticas devem-se ora à complexidade da fisiopatologia da própria doença, ora à necessidade de mais estudos esclarecedores.
The aim of this study is to address the scientific controversy about acid-base disorders in liver diseases. In the end stage of liver diseases, the acid-base disorder has a complex performance, impairing the patient's quality of life and challenging the clinic management. Although the literature shows respiratory alkalosis as one of the main alterations, there is a long discussion about the pathophysiological mechanism, specially regarding hypoxia, hypocapnia, and progesterone level. In metabolic disorders, especially acidosis, the studies mainly indicate the lactate, unmeasured ions, and hydroelectrolytic alterations, but, depending on the disease phase, either compensated or decompensated, each element has a particular action. The controversy about acid-base disorders in liver diseases is associated with the complexity of this condition, as well as with the necessity of more specialized research.
Subject(s)
Humans , Acid-Base Imbalance/etiology , Liver Diseases/complications , Water-Electrolyte Imbalance/physiopathology , Acidosis, Lactic/physiopathology , Alkalosis, Respiratory/physiopathology , Liver Diseases/physiopathology , Liver Diseases/metabolismABSTRACT
Malaria is re-emerging as the major infectious killer and it is the top priority tropical disease of the World Health Organization. Indian sub-continent harbours a global threat in the form of epicenter of multidrug resistant plasmodium falciparum. High prevalence of Complicated Falciparum Malaria in Costal Andhra Pradesh requiring ICU admission with high morbidity and mortality prompted this study. 60 cases of falciparum malaria in 3 sub groups, i.e, uncomplicated falciparum, severe falciparum with ARF, severe falciparum without ARF are taken. In Group-II, i.e, severe falciparum with ARF pts., mean serum potassium is 5.06 -hyperkalemia, mean PaO2 and PaCO2 are 80.33 and 32.75 respectively and mean bicarbonate value is 19.83, mean PH is 7.10, which reflects underlying metabolic acidosis and compensatory respiratory alkalosis, also mortality is 6 in Group-II out of total 9 deaths. Hence electrolytes and acid-base disturbance, especially hyperkalemia and acidosis are important cause of mortality in severe falciparum malaria. In acute renal failure setting, which is associated with both hyperkalemia and acidosis, prognosis is worsened. “Humanity has but three great enemies : fever, famine and war; of these by far the greatest, by far the most terrible, is fever(William Osler).
Subject(s)
Acid-Base Imbalance/etiology , Humans , Malaria, Falciparum/epidemiology , Malaria, Falciparum/mortality , Malaria, Falciparum/physiology , Morbidity , Mortality , Water-Electrolyte Imbalance/etiologyABSTRACT
The acid, base and electrolyte changes are usually observed in the perioperative settings. We report a case of prolonged laparoscopic repair of left-sided diaphragmatic hernia which involved a lot of tissue handling and fluid replacement leading to acid, base and electrolyte imbalance. A 42-year-old male underwent prolonged laparoscopic repair under general anesthesia. Intraoperatively, surgeon reported that contents of hernia includes bowel along with mesentery, spleen and lot of fatty tissue The blood loss was about 2 L which was replaced with 1 L of colloid and 7.5 L of lactated ringer. Near the end of surgery arterial blood gas analysis revealed metabolic acidosis, hyperkalemia, and hypocalcemia leading to delayed recovery. We conclude prolonged laparoscopic surgery involving lot of tissue handling including gut and fat should be monitored for acid, base, electrolyte imbalance and corrected timely to have uneventful rapid recovery
Subject(s)
Humans , Male , Laparoscopy , Acid-Base Imbalance/etiology , Water-Electrolyte Imbalance , Preoperative Period , Hypocalcemia/etiology , Hypokalemia/etiology , AcidosisABSTRACT
Apesar de o cloreto ser um exame amplamente disponível e solicitado em instituições de saúde, a maior pane dos médicos crê ser difícil interpretar seus resultados, estabelecer correlações com outros parâmetros laboratoriais associados e tomar decisões terapêuticas baseadas no mesmo. Devido à complexidade de sua homeostase e à intrincada correlação com o status hidroeletrolítico e ácido-básico, poucos médicos se sentem efetivamente aptos a aproveitar a valiosa informação clínica que ele pode revelar. Isto é agravado pela rarefeita bibliografia objetiva sobre o tema. Os autores desta revisão não foram capazes de encontrar nenhum capítulo especificamente dedicado ao cloreto nos principais livros-texto de Fisiologia, Clínica Médica e Nefrologia, disponíveis, à exceção de três revisões bibliográficas no Medline. Não obstante, tentamos organizar a informação tão claramente quanto possível, com o objetivo de tornar o cloreto uma ferramenta útil aos nossos colegas profissionais de saúde.
Even though chloride is a widely available and requested test in health institutions, most part of physicians find it difficult to interpret its results, establish correlations with other laboratory linked parameters and take therapeutic decisions based on it. Due to the complexity of its homeostatic balance and intrincated correlation to hydroelectrolytic and acid base status, few doctors feel actually able to fully profit from the valuable clinical information it can unfold. This is aggravated by the scarce objective bibliography on the issue. The authors of this review were not able to find any chapters specifically dedicated to chloride on major Physiology, Internal Medicine and Nephrology textbooks, but only three reviews on Medline. Nevertheless, we managed to organize the information as clearly as possible with the aim of making chloride test an useful tool to our fellow health professionals.
Subject(s)
Clinical Laboratory Techniques , Chlorides/physiology , Chlorides/blood , Acid-Base Imbalance/complications , Acid-Base Imbalance/diagnosis , Acid-Base Imbalance/etiology , Acid-Base Equilibrium/physiology , Acidosis/diagnosis , Acidosis/etiology , Alkalosis/diagnosis , Alkalosis/etiology , Bromides/adverse effects , Metabolism/physiologyABSTRACT
PURPOSE: To study the effects on the water, electrolyte, and acid-base balances in rabbits submitted to antegrade enema with different solutions through appendicostomy. METHODS: Forty male New Zealand rabbits were submitted to appendicostomy, and distributed in 4 groups, according to the antegrade enema solution: PEG group, polyethylene glycol electrolyte solution (n=10); ISS group, isotonic saline solution (n=10); GS group, glycerin solution (n=10); SPS group, sodium phosphate solution (n=10). After being weighed, arterial blood gas analysis, red blood count, creatinine and electrolytes were measured at 4 times: preoperatively (T1); day 6 postop, before enema (T2); 4h after enema (T3); and 24h after T3 (T4). RESULTS: In PEG group occurred Na retention after 4h, causing alkalemia, sustained for 24h with HCO3 retention. In ISS group occurred isotonic water retention and hyperchloremic acidosis after 4h, which was partially compensated in 24h. GS group showed metabolic acidosis after 4h, compensated in 24h. In SPS group occurred hypernatremic dehydration, metabolic acidosis in 4h, and hypokalemia, hypocalcemia, hypomagnesemia, and metabolic alkalosis with partially compensated dehydration in 24h. CONCLUSIONS: All solutions used in this study caused minor alterations on water, electrolyte or acid-base balances. The most intense ones were caused by hypertonic sodium phosphate solution (SPS) and isotonic saline solution (ISS) and the least by polyethyleneglycol electrolyte solution (PEG) and glycerin solution 12 percent (GS).
OBJETIVO: Estudar os efeitos no equilíbrio hídrico, eletrolítico e ácido-base, do enema anterógrado com diferentes soluções em coelhos através de apendicostomia. MÉTODOS: 40 coelhos Nova Zelândia, machos, submetidos a apendicostomia, distribuídos em quatro grupos segundo a solução de enema: grupo PEG (n = 10) solução de polietilenoglicol com eletrólitos; grupo SF (n = 10) solução fisiológica; grupo SG (n = 10) solução glicerinada; grupo FS (n = 10) solução de fosfato de sódio. Realizou-se pesagem, gasometria arterial, série vermelha, creatinina e ionograma, em quatro tempos: TI (pré-operatório); T2 (6o PO antes do enema); T3 (4h após enema); T4 (24h após T3). RESULTADOS: No PEG ocorreu retenção de Na em 4h, com alcalemia por retenção de HCO3, mantida por 24h. No SF ocorreu retenção hídrica isotônica e acidose hiperclorêmica em 4h, resolvidos parcialmente com 24h. No SG ocorreu acidose metabólica hiperclorêmica em 4h, compensada com 24h. No FS ocorreu desidratação hipenatrêmica, acidose metabólica com ânion gap elevado em 4h, hipopotassemia, hipocalcemia, hipomagnesemia e alcalose metabólica com recuperação parcial da desidratação em 24h. CONCLUSÕES: Todas as soluções empregadas neste estudo causam alterações de pouca intensidade no equilíbrio hídrico, eletrolítico ou ácido-base. As mais intensas foram causadas pela solução de fosfato de sódio e solução fisiológica, e as menos intensas pela solução de polietilenoglicol com eletrólitos e solução glicerinada.
Subject(s)
Animals , Male , Rabbits , Acid-Base Equilibrium/drug effects , Enema/methods , Glycerol/adverse effects , Phosphates/adverse effects , Polyethylene Glycols/adverse effects , Water-Electrolyte Balance/drug effects , Acid-Base Imbalance/blood , Acid-Base Imbalance/etiology , Appendix/surgery , Cathartics/administration & dosage , Cathartics/adverse effects , Enema/adverse effects , Glycerol/administration & dosage , Isotonic Solutions/administration & dosage , Isotonic Solutions/adverse effects , Models, Animal , Magnesium Deficiency/blood , Magnesium Deficiency/etiology , Phosphates/administration & dosage , Polyethylene Glycols/administration & dosage , Time Factors , Water-Electrolyte Imbalance/blood , Water-Electrolyte Imbalance/etiologyABSTRACT
Se presenta el caso clínico de una paciente diabética tipo 2 tratada con metformina que es internada por un accidente cerebrovascular isquémico. En el laboratorio se detectó una hiperlactacidemia de 4,8 mmol/l, con pH, bicarbonato y exceso de base normales. Sin embargo, el enfoque de Stewart permitió identificar la presencia de una acidosis metabólica por aniones no medidos y una alcalosis hipoclorémica. El anión gap estaba elevado y sus valores declinaron paralelamente a los del ácido láctico. Se revisa la acidosis láctica por mertformina y el enfoque diagnóstico de este trastorno metabólico ácido-base.
Subject(s)
Humans , Female , Aged , Acidosis, Lactic/ethnology , Hypoglycemic Agents , Metformin/adverse effects , Acid-Base Imbalance/etiologyABSTRACT
Este estudio se diseñó para determinar la frecuencia de las alteraciones ácido-base en una muestra de pacientes ingresados a una unidad de cuidados intensivos generales, mediante un estudio descriptivo y transversal. Se incluyeron 30 pacientes que ingresaron a la unidad de cuidados intensivos en quienes se revisó la determinación de gases arteriales y electrólitos séricos, así como la brecha aniónica. Mediante nomograma se identificaron los trastornos ácido-base mixtos. Los resultados mostraron, en todos los pacientes, desequilibrio ácido-base. El mayor porcentaje de casos fue en pacientes con alcalosis respiratoria crónica (46.6 por ciento), que invariablemente sucedió en quienes presentaban cardiopatía isquémica. La mortalidad fue mayor en pacientes con trastornos ácido-base mixtos
Subject(s)
Humans , Male , Female , Alkalosis, Respiratory/epidemiology , Blood Gas Analysis/statistics & numerical data , Acid-Base Imbalance/diagnosis , Acid-Base Imbalance/epidemiology , Acid-Base Imbalance/etiology , Electrolytes/analysis , Electrolytes/blood , Intensive Care UnitsABSTRACT
Hypocalcaemia, induced in cow calves by slow infusion of Na2EDTA for 6 hr, led to biphasic changes in acid-base status. Decrease in ionized plasma Ca2+ concentration upto 0.82 +/- 0.06 mmole 1(-1) was associated with metabolic alkalosis. Further decrease in ionized plasma Ca2+ concentration (0.61 +/- 0.09 mmole 1(-1)) led to metabolic acidosis, superimposed by a respiratory component. There was significant decrease in oxygen tension and saturation of arterial blood as well as impaired uptake of oxygen by peripheral tissues and pulmonary blood.
Subject(s)
Acid-Base Imbalance/etiology , Animals , Blood Gas Analysis , Cattle , Disease Progression , Hypocalcemia/blood , MaleSubject(s)
Humans , Acidosis, Respiratory/etiology , Acidosis, Respiratory/physiopathology , Alkalosis, Respiratory/diagnosis , Alkalosis, Respiratory/etiology , Acidosis, Lactic/diagnosis , Acidosis, Lactic/etiology , Acidosis, Lactic/physiopathology , Acid-Base Imbalance/complications , Acid-Base Imbalance/diagnosis , Acid-Base Imbalance/etiologyABSTRACT
As crises agudas de asma säo motivo freqüente de consultas em pediatria e internaçöes hospitalares. A avaliaçäo adequada de pacientes em insuficiência respiratória requer a determinaçäo do pH e gases arteriais. A análise retrospectiva de dados obtidos em 66 internaçöes por estado de mal-asmático revelou que a hipoxemia estava presente em todos os casos e relacionados as alteraçöes do nível de consciência. O distúrbio ácido-básico mais freqüente foi acidose metabólica, pura (35%) e mista (25%). A alcalose respiratória foi observada em 23% dos casos. Portanto, a acidose metabólica ocorre com maior freqüência na criança que no adulto. A hipoxemia deve ser corrigida para evitar-se complicaçöes mais graves do estado de mal-asmático