Association of prehospital lactate levels with base excess in various emergencies - a retrospective study.

OBJECTIVES: Blood gas analysis, including parameters like lactate and base excess (BE), is crucial in emergency medicine but less commonly utilized prehospital. This study aims to elucidate the relationship between lactate and BE in various emergencies in a prehospital setting and their prognostic implications. METHODS: We conducted a retrospective analysis of prehospital emergency patients in Graz, Austria, from October 2015 to November 2020. Our primary aim was to assess the association between BE and lactate. This was assessed using Spearman's rank correlation and fitting a multiple linear regression model with lactate as the outcome, BE as the primary covariate of interest and age, sex, and medical emergency type as confounders. RESULTS: In our analysis population (n=312), lactate and BE levels were inversely correlated (Spearman's ρ, -0.75; p<0.001). From the adjusted multiple linear regression model (n=302), we estimated that a 1 mEq/L increase in BE levels was associated with an average change of -0.35 (95 % CI: -0.39, -0.30; p<0.001) mmol/L in lactate levels. Lactate levels were moderately useful for predicting mortality with notable variations across different emergency types. CONCLUSIONS: Our study highlights a significant inverse association between lactate levels and BE in the prehospital setting, underscoring their importance in early assessment and prognosis in emergency care. Additionally, the findings from our secondary aims emphasize the value of lactate in diagnosing acid-base disorders and predicting patient outcomes. Recognizing the nuances in lactate physiology is essential for effective prehospital care in various emergency scenarios.

Prognostic Significance of the Strong Ion Gap in Patients in Medical and Surgical Intensive Care Units.

Background This study aimed to analyze acid-base imbalance by assessing the arterial blood gas (ABG) samples of the medical and surgical intensive care unit (ICU) patients by the Stewart approach and demonstrate the advantages of this method in delineating the acid-base status in cases where Henderson-Hasselbalch, anion gap, and base excess cannot optimally depict the imbalance and create recognition in the clinicians in this regard.  Methodology Adult (i.e., age > 18 years) patients admitted to the ICU of our institution during a one-year study period were included in this study. The patients were divided into two groups based on the indication of admission to the ICU as medical or surgical. The ABG, sodium, potassium, calcium, magnesium, phosphate, chloride, albumin, lactate, hemoglobin, hematocrit, leukocyte, blood urea nitrogen, and creatinine values determined during the first 24-hour period were used for calculating the Acute Physiologic Assessment and Chronic Health Evaluation (APACHE II), strong ion difference apparent (SIDa), and SID effective (SIDe) scores, which were subsequently compared between the groups.  Results Overall, 220 (110 medical and 110 surgical) patients were included. The mean patient age was 63.56 ± 18.08 years. The mean APACHE II scores were 21.99 and 19.63 in the medical and surgical groups, respectively. Overall, 110 patients died, while 110 were referred to the regular patient floor. The mean APACHE II score of the patients who died was 28.3, and the latter group had a mean APACHE II score of 13.57. There was a significant difference between the surgical and medical patient groups regarding mean values of APACHE II, SIDa, and SIDe scores. Also, the differences were significant between the patients who died and were discharged. There was a significant difference between the patients who died and were discharged regarding the strong ion gap (SIG); however, the medical and surgical patient groups were not different concerning the SIG values.  Conclusions We conclude that SIDa, SIDe, and SIG can be used in medical and surgical ICU patients to predict prognosis.

Caffeine Administration in Piglets with Low Birthweight and Low Vitality Scores, and Its Effect on Physiological Blood Profile, Acid-Base Balance, Gas Exchange, and Infrared Thermal Response.

Intrapartum asphyxia, fetal hypoxia, and their consequences (e.g., acidosis, hypercapnia, hypoglycemia, and hypothermia) are the main factors related to physio-metabolic imbalances that increase neonatal mortality in piglets, particularly in piglets with low birthweight and low vitality scores. This study aimed to evaluate the effect of three different doses of caffeine (10, 20, and 30 mg/kg) administered orally to 480 newborn piglets with low birthweight and low vitality scores. Blood gas parameters (pH, pO2, pCO2, and HCO3-), physio-metabolic profile (Ca++, glucose, and lactate), and the thermal response assessed through infrared thermography in four thermal windows (ocular, auricular, snout, and hindlimb) and rectal temperature were evaluated during the first 24 h of life. Doses of 30 mg/kg resulted in significant differences at 24 h for all evaluated parameters, suggesting that caffeine administration improved the cardiorespiratory function and metabolic activity of piglets by reducing acidosis, restoring glycemia, and increasing surface and rectal temperature. In conclusion, caffeine at 30 mg/kg could be suggested as an appropriate dose to use in piglets with low birthweight and low vitality scores. Future research might need to study the presentation of adverse effects due to higher caffeine concentrations.

Perioperative considerations of pyruvate dehydrogenase complex deficiency: a case report of two consecutive anesthesia.

BACKGROUND: Pyruvate dehydrogenase complex (PDHC) deficiency is a rare mitochondrial disorder caused by a genetic mutation affecting the activity of the PDHC enzyme, which plays a major role in the tricarboxylic cycle. Few cases of surgery or anesthesia have been reported. Moreover, there is no recommended anesthetic method. CASE: A 24-month-old child with a PDHC deficiency presented to the emergency room with respiratory failure, mental decline, systemic cyanosis, and lactic acidosis. During hospitalization period, the patient presented with pneumothorax, pneumoperitoneum, and multiple air pockets in the heart. Two surgeries were performed under general anesthesia using an inhalational anesthetic agent. The patient was discharged with home ventilation. CONCLUSIONS: Anesthesiologists should be wary of multiple factors when administering anesthesia to patients with PDHC deficiency, including airway abnormalities, acid-base imbalance, intraoperative fluid management, selection of appropriate anesthetics, and monitoring of lactic acid levels.

Cerebrospinal fluid and arterial acid-base equilibria in spontaneously breathing third-trimester pregnant women.

BACKGROUND: Acid-base status in full-term pregnant women is characterised by hypocapnic alkalosis. Whether this respiratory alkalosis is primary or consequent to changes in CSF electrolytes is not clear. METHODS: We enrolled third-trimester pregnant women (pregnant group) and healthy, non-pregnant women of childbearing age (controls) undergoing spinal anaesthesia for Caesarean delivery and elective surgery, respectively. Electrolytes, strong ion difference (SID), partial pressure of carbon dioxide ( [Formula: see text] ), and pH were measured in simultaneously collected CSF and arterial blood samples. RESULTS: All pregnant women (20) were hypocapnic, whilst only four (30%) of the controls (13) had an arterial [Formula: see text] <4.7 kPa (P<0.001). The incidence of hypocapnic alkalosis was higher in the pregnant group (65% vs 8%; P=0.001). The CSF-to-plasma Pco2 difference was significantly higher in pregnant women (1.5 [0.3] vs 1.0 [0.4] kPa; P<0.001), mainly because of a decrease in arterial Pco2 (3.9 [0.3] vs 4.9 [0.5] kPa; P<0.001). Similarly, the CSF-to-plasma difference in SID was less negative in pregnant women (-7.8 [1.4] vs -11.4 [2.3] mM; P<0.001), mainly because of a decreased arterial SID (31.5 [1.2] vs 36.1 [1.9] mM; P<0.001). The major determinant of the reduced plasma SID of pregnant women was a relative increase in plasma chloride compared with sodium. CONCLUSIONS: Primary hypocapnic alkalosis characterises third-trimester pregnant women leading to chronic acid-base adaptations of CSF and plasma. The compensatory SID reduction, mainly sustained by an increase in chloride concentration, is more pronounced in plasma than in CSF, as the decrease in Pco2 is more marked in this compartment. CLINICAL TRIAL REGISTRATION: NCT03496311.

Study of Arterial Blood Gas Analysis in Moderate-to-Severe COVID-19 Patients.

Background The high prevalence of pneumonia and renal involvement in coronavirus disease 2019 (COVID-19) leads to frequent acid-base abnormalities in serious patients and affects prognosis. In this study, we aimed to assess the arterial blood gas (ABG) and acid-base patterns in COVID-19 patients admitted to a tertiary care hospital. Methodology A retrospective observational study was conducted in a designated COVID-19 hospital involving 267 reverse transcription-polymerasechain reaction-positive COVID-19 patients. Demographic and laboratory data including ABG data within the first day after admission and in patients with multiple ABG analyses, only the first measurement was collected and analyzed statistically, including its association with comorbidities. Results The most common age group of the patients was 51-60 years (30.8%), with a male predominance (male:female = 2.7:1). The most common comorbidities were hypertension, diabetes mellitus, and chronic obstructive pulmonary disease found in 147 (55%) COVID-19 patients. Alkalosis and acidosis were observed in 145 (54.3%) and 50 (18.7%) patients, respectively. The most common ABG abnormality observed was primary respiratory alkalosis with secondary metabolic acidosis in 67 (25.1%) patients, followed by primary respiratory alkalosis with secondary metabolic alkalosis in 54 (20.2%) patients. Statistically significant negative correlation was found with PaCO2 and pH (r = -0.530, p < 0.0001), statistically significant positive correlation was found between pH and base (r = 0.533, p < 0.0001), pH and TCO2 (r = 0.260, p < 0.0001), and pH and HCO3 (r = 0.354, p < 0.0001). Conclusions Acid-base abnormalities are commonly encountered in COVID-19 patients. Respiratory alkalosis as a part of a single or mixed pattern on ABG was the most common pattern found in critically ill COVID-19 patients. ABG on admission in moderate-to-severe COVID-19 patients can help in the early correction of metabolic abnormalities leading to improved patient outcomes.

Natural high ambient temperature-induced respiratory hypocapnia without activation of the hypothalamic-pituitary-adrenal axis in lactating goats.

Background and Aim: Activation of breathing, the hypothalamic-pituitary-adrenal (HPA) axis, and plasma antioxidant defense are adaptive mechanisms in lactating dairy goats fed during the summer season. However, an excess of these responses can interfere with the gas exchange. This study aimed to investigate the effect of natural high ambient temperature (HTa) on blood gas parameters and their relation to the HPA axis and antioxidant defense. Materials and Methods: Six mid-lactating goats were included in this study and were fed in individual pens for 2 weeks. The data on ambient conditions, physiological responses, and blood chemistry were measured for two sampling days (D7 and D14), 1 week apart during the late summer season. On this two-sampling day, the main physiological responses to HTa, including respiration rate (RR), rectal temperature (Tr), blood gas, and blood chemistry, were measured in the morning and afternoon. Results: Goats from both D7 and D14 increased RR and Tr significantly according to morning and afternoon periods. In addition, goats were at the hypocapnia stage during afternoon panting without a change in blood pH and bicarbonate levels. Interestingly, HTa-induced hypocapnia was not accompanied by an increase in plasma cortisol levels. Finally, ΔTa was negatively correlated with changes in glutathione peroxidase activity. Conclusion: The natural HTa (ΔTa; 5-8°C) in this study activated evaporative heat dissipation and was high enough to induce respiratory hypocapnia. Importantly, this ΔTa did not activate the HPA axis but was correlated with a change in antioxidant defense. Therefore, under natural HTa in tropical conditions, respiratory hypocapnia is the first line of physiological response in goats within a specific range of natural ΔTa (5-8°C).

Design and application of arterial blood gas analysis assisted by electronic computation: analysis of two cases attached / 中国小儿急救医学

Objective:To make Excel spreadsheet of arterial blood gas analysis to judge the types of acid-base imbalance quickly and accurately, and guide the clinical treatment of acid-base disorders.Methods:According to the Henderson-Hasselbalch equation, the compensation formula of acid-base imbalance prediction, the theory of acid-base balance and the related research progress, the analysis process of acid-base balance disorder was settled, and the IF function in Microsoft Office Excel 2003 was used to edit the formula to make Excel spreadsheet for arterial blood gas analysis.Once the pH value, artery blood carbon dioxide pressure (PaCO 2), actual bicarbonate (HCO 3-), sodiumion (Na + ), chlorineion (Cl -) and compensatory time-limited parameters were input, the types of acid-base imbalance can be shown.Arterial blood gas analysis of 185 cases from intensive care unit at Xuzhou Central Hospital was determined by Excel spreadsheet group and manual group respectively, the results and time of judging the type of acid-base imbalance were compared between two groups for statistical analysis. Results:The results of acid-base imbalance between two groups were compared, and 42 cases were normal and simple acid-base and the consistent rate was 100%, double acid-base imbalances of 107 cases with the consistent rate of 97.20%, triple acid-base imbalances of 36 cases with the consistent rate of 91.67%.After Kappa consistency test (Kappa value=0.944) and Pair chi-square Test (McNemar-Bowker Test)( P=0.223), the results of two groups were consistent.It took less time to judge the results of normal or simple acid-base imbalance[(32.32±4.26)s vs.(75.88±19.22)s], double acid-base imbalance[(31.28±5.31)s vs.(137.56±37.64)s] and triple acid-base imbalance[(32.98±4.23)s vs.(315.09±89.37)s] by the Excel spreadsheet group compared with the manual group, and the differences were statistically significant ( P<0.01). Conclusion:The automatic judging of Excel spreadsheet for arterial blood gas analysis can quickly and accurately determine the types of acid-base imbalance in arterial blood gas analysis and has more advantages for triple acid and base imbalance especially with simple interface and simple operation.And it can avoid the missing judgment of acid and base imbalance when pH is 7.35 to 7.45.

Carp Edema Virus Infection Is Associated With Severe Metabolic Disturbance in Fish.

Significant mortalities associated with emerging viral diseases are challenging the economy of common carp aquaculture. As such, there is an increased need to disentangle how infected fish cope with progressive disease pathology and lose the ability for homeostatic maintenance of key physiological parameters. A natural carp edema virus (CEV) infection outbreak at a carp fish farm provided an opportunity to examine diseased and healthy carp in the same storage pond, thereby contributing to our better understanding of CEV disease pathophysiology. The disease status of fish was determined using PCR-based virus identification combined with analysis of gill pathology. Compared with healthy control carp, the blood chemistry profile of CEV-infected fish revealed major disruptions in electrolyte and acid-base balance (i.e., hyponatraemia, hypochloraemia, hyperphosphatemia, elevated pH, base excess, and anion gap and decreased partial dissolved carbon dioxide). In addition, we recorded hyperproteinaemia, hyperalbuminaemia, hypotonic dehydration, endogenous hyperammonaemia, and decreased lactate along with increased creatinine, alkaline phosphatase, alanine aminotransferase, and aspartate aminotransferase. Red blood cell associated hematology variables were also elevated. The multivariate pattern of responses for blood chemistry variables (driven by sodium, pH, partial dissolved carbon dioxide, ammonia, and albumin in the principal component analysis) clearly discriminated between CEV-infected and control carp. To conclude, we show that CEV infection in carp exerts complex adverse effects and results in severe metabolic disturbance due to the impaired gill respiratory and excretory functioning.

An Audit and Comparison of pH, Measured Concentration, and Particulate Matter in Mannitol and Hypertonic Saline Solutions.

Background: The preferred hyperosmolar therapy remains controversial. Differences in physical properties such as pH and osmolality may be important considerations in hyperosmolar agent selection. We aimed to characterize important physical properties of commercially available hyperosmolar solutions. Methods: We measured pH and concentration in 37 commonly-used hyperosmolar solutions, including 20 and 25% mannitol and 3, 5, 14.6, and 23.4% hypertonic saline. pH was determined digitally and with litmus paper. Concentration was determined by freezing point and vapor pressure osmometry. Salinity/specific gravity was measured with portable refractometry. Particulate matter was analyzed with filtration and light microscopy and with dynamic light scattering nephelometry. Results: pH of all solutions was below physiological range (measured range 4.13-6.80); there was no correlation between pH and solution concentration (R 2 = 0.005, p = 0.60). Mannitol (mean 5.65, sd 0.94) was less acidic than hypertonic saline (5.16, 0.60). 14/59 (24%) pH measurements and 85/111 concentration measurements were outside manufacturer standards. All 36/36 mannitol concentration measurements were outside standards vs. 48/72 (67%) hypertonic saline (p < 0.0001). All solutions examined on light microscopy contained crystalline and/or non-crystalline particulate matter up to several hundred microns in diameter. From nephelometry, particulate matter was detected in 20/22 (91%) solutions. Conclusion: We present a novel characterization of mannitol and hypertonic saline. Further research should be undertaken, including research examining development of acidosis following hyperosmolar therapy, the relevance of our findings for dose-response, and the clinical relevance of particulate matter in solution.

[Metabolic acidosis in neobladder patients : Risk factors and treatment options]. / Metabolische Azidose bei Neoblasepatienten : Risikofaktoren und Therapiemöglichkeiten.

BACKGROUND: In cystectomy patients who underwent neobladder creation, the intestinal mucosa of the neobladder is in constant contact with urine, which may result in chronic metabolic acidosis (CMA) due to specific absorption capabilities of the intestinal mucosa. Despite being a prevalent comorbidity, the risk factors for CMA and its diagnostic parameters are poorly understood. OBJECTIVES: This review examines the risk factors associated with the development of CMA and their prevalence in patients with a neobladder. MATERIALS AND METHODS: We conducted a systematic literature search using the PubMed database to detect studies about the topics CMA and neobladder that were published between 2000 and 2020. The prevalence and risk factors for CMA in neobladder patients were assessed by reviewing 23 studies. RESULTS: Acidosis is most prevalent during the first year after surgery (25-70%). Risk factors are renal failure, high continence, old age and diabetes mellitus. CONCLUSIONS: The prevalence of CMA is at its highest during the early postoperative period for neobladder patients, so for this time period, weekly diagnostic investigations are recommended according to the German S3-guidelines for the "Früherkennung, Diagnose, Therapie und Nachsorge des Harnblasenkarzinomsent für Neoblasepatienten". Blood gas tests should not only be used to analyze the pH value but also to detect and counteract acid-base imbalance issues in time. The recommended normalization of serum bicarbonate levels with oral bicarbonate follows patient-specific therapy strategies.

Use of intravenous sodium bicarbonate in neonatal intensive care units in Italy: a nationwide survey.

BACKGROUND: Metabolic Acidosis (MA) is a disturbance of the acid-base balance that can occur in preterm and critically ill term neonates due to different etiologies. Intravenous sodium bicarbonate (SB) has been traditionally used to correct such unbalance, despite the lack of evidence about its safety and efficacy. In literature, reported undesirable effects of treatment with SB in neonates include worsening of intracellular acidosis, impairment of myocardial function, cerebral blood flow fluctuations and intracranial hemorrhage. A national survey was conducted by the Neonatal Pharmacotherapy Study Group of the Italian Society of Neonatology with the aim to assess and describe attitudes and practices concerning the use of SB, particularly for the treatment of MA in Italian NICUs. METHODS: A questionnaire regarding treatment of MA and SB prescription habits was sent to the directors of 120 Italian NICUs from June 2017 to March 2018. RESULTS: The survey response rate was 97.5% (117/120 centers). Findings showed that in 55% of the surveyed NICUs (64/117 units) it is common practice to correct MA with intravenous SB. On the other hand, the remaining 45% of the units try to solve the metabolic disturbances adopting different approaches (improving perfusion, adjusting ventilation parameters or increasing blood volume). Moreover, to prevent the occurrence of MA, 37.6% of the NICUs (44/117) include buffer salts (lactate, acetate or both) in parenteral nutrition prescriptions. SB is also used as a treatment for other conditions, mainly pathologies with bicarbonate loss and tubular acidosis (respectively in 53.8 and 32.5% of the NICUs). CONCLUSION: This survey showed how SB is a commonly used treatment for MA in more than half of Italian NICUs, with indications and prescription criteria that significantly vary across centers. Based on current knowledge, it is reasonable to suggest that the management of neonatal MA should be firstly directed to identify the underlying disorders. Thus, the use of SB should be reserved only for selected cases, also considering the severity of SB adverse effects and the lack of evidence about its efficacy. Guidance for the management of MA is required to harmonize practices and reduce the use of potentially inappropriate and unsafe treatments.

Congenital chloride diarrhea in patient with SLC26A2 mutation - analysis of the clinical phenotype and differential diagnosis.

INTRODUCTION: To analyze the clinical features and SLC26A3 mutation of one patient in our hospital who had congenital loss of chlorine diarrhea (CLD), and to investigate the treatment of the disease and the prognosis. MATERIAL AND METHODS: By reviewing the literature, analyzing the clinical features and differential diagnosis and investigating the treatment and prognosis, the patient was diagnosed as CLD. RESULTS: Excessive accumulation of amniotic fluid was observed during pregnancy. The patient was born prematurely with normal body weight. The patient was a 4-month old boy admitted for anorexia, watery diarrhea, electrolyte disorders (hyponatremia, hypokalemia and hypochloremia) and metabolic alkalosis. The patient was also considered to be affected by Batter syndrome. After treating with spironolactone, indomethacin and potassium chloride sustained release tablet, the symptom of watery diarrhea was alleviated, the ingested amount of milk increased gradually and the amount of urine became normal; however, electrolyte imbalance persisted and the frequency of bowel movements remained high. Genetic analysis demonstrated that the patient had a SLC26A3 c.269_270dupAA homozygous mutation in exon 3, leading to a frameshift from 91st amino acid Gly and alteration of the SLC26A3 transmembrane protein sequence, thus resulting in a Cl-/HCO3- exchange barrier. The parents of the patient had normal phenotypes and were all heterozygous carriers of the mutation. Moreover, the patient was diagnosed as CLD. Sodium chloride and potassium chloride rather than spironolactone and indomenthacin were given to the patient to correct the dehydration, so the symptom of watery diarrhea alleviated and the blood gas and electrolyte levels returned to the normal range. In addition, the patients morale was good and the ingested amount of milk was moderate. CONCLUSIONS: Persistent diarrhea and electrolyte disorder in pediatrics are easy to misdiagnose as CLD. Furthermore, it is difficult to identify Batter syndrome, Gitelman syndrome, renal tubular acidosis and CLD. Blood and stool electrolyte detection and SLC26A3 genetic tests are helpful for diagnosis, and sodium chloride and potassium chloride replacement therapy are critical for the patient prognosis.

Euglycemic diabetic ketoacidosis associated with SGLT2i use: Case series.

INTRODUCTION: Euglycemic diabetic ketoacidosis (EuDKA) associated with Sodium-Glucose Cotransporter-2 inhibitor (SGLT2i) use has been described but remains poorly understood. Data on Emergency Department (ED) presentation, resource utilization, and safety outcomes for these patients are lacking. We report a case series of patients diagnosed with EuDKA in the ED. METHODS: An electronic medical record search identified adult patients presenting to a large tertiary ED with EuDKA. They were screened for concurrent use of SGLT2i. Clinical presentation, resource utilization, safety, and disposition data were collected and described. RESULTS: Five patients were included for analysis. Median age [range] was 57 [43-73] years. Presenting symptoms included nausea, vomiting, fatigue, and altered mental status. Initial results included: serum glucose 191 mg/dL [176-215], venous pH 7.01 [6.95-7.30], serum HCO3 8 mEq/L [6-13], anion gap 27 [26-31], serum beta-hydroxybutyrate 9.9 mmol/L [9.2-12.3], and urine ketones 150 [150-150]. Patients remained on an insulin infusion for 18.77 h [11.25-56.48]. There were zero episodes of hypoglycemia and one episode of hypokalemia while on insulin infusion. Time to resolution of metabolic acidosis was 23.82 h [15.45-24.77]. DISCUSSION: We report a case series of ED patients with EuDKA associated with SGLT2i use, and describe presentation characteristics, resource utilization, and safety outcomes. Emergency physicians should be aware of the association between SGLT2i use and EuDKA. An appropriate work-up should be pursued for patients taking an SGLT2i who present with symptoms suggestive of DKA, including nausea, vomiting, malaise, and altered mental status, or are noted to have an unexplained elevated anion gap metabolic acidosis.

Impact of Acid-Base Status on Mortality in Patients with Acute Pesticide Poisoning.

We investigated clinical impacts of various acid-base approaches (physiologic, base excess (BE)-based, and physicochemical) on mortality in patients with acute pesticide intoxication and mutual intercorrelated effects using principal component analysis (PCA). This retrospective study included patients admitted from January 2015 to December 2019 because of pesticide intoxication. We compared parameters assessing the acid-base status between two groups, survivors and non-survivors. Associations between parameters and 30-days mortality were investigated. A total of 797 patients were analyzed. In non-survivors, pH, bicarbonate concentration (HCO3-), total concentration of carbon dioxide (tCO2), BE, and effective strong ion difference (SIDe) were lower and apparent strong ion difference (SIDa), strong ion gap (SIG), total concentration of weak acids, and corrected anion gap (corAG) were higher than in survivors. In the multivariable logistic analysis, BE, corAG, SIDa, and SIDe were associated with mortality. PCA identified four principal components related to mortality. SIDe, HCO3-, tCO2, BE, SIG, and corAG were loaded to principal component 1 (PC1), referred as total buffer bases to receive and handle generated acids. PC1 was an important factor in predicting mortality irrespective of the pesticide category. PC3, loaded mainly with pCO2, suggested respiratory components of the acid-base system. PC3 was associated with 30-days mortality, especially in organophosphate or carbamate poisoning. Our study showed that acid-base abnormalities were associated with mortality in patients with acute pesticide poisoning. We reduced these variables into four PCs, resembling the physicochemical approach, revealed that PCs representing total buffer bases and respiratory components played an important role in acute pesticide poisoning.

Acid-base imbalance: a review with proposed unified diagnostic algorithm / Desequilibrio ácido-base: una revisión con el algoritmo de diagnóstico unificado propuesto

Abstract Introduction: Alterations in the acid-base balance are studied in all medical specialties. Although most cases derive from a preexisting pathology, they can also manifest themselves in a primary context. The proper identification of the acid-base disorder allows the pathological process to be characterized. The correct interpretation of the blood gasometry as a technique for monitoring the ventilatory status, oxygenation and acid-base balance of a patient requires the integration of various physicochemical approaches in order to specify a diagnosis, quantify a therapeutic response, and monitor the severity or the progression of a pathological process. Methodology: A literature review was conducted in the PubMed, Scopus and Science Direct databases. The articles were selected according to the title and the abstract and sorted by topics relevant by pathophysiology, divergences, clinical approach, diagnosis, and management. Results: A guide the clinical correlation of the critical patient with the blood gasometry parameters to characterize the acid-base disorder through the proposition of a diagnostic algorithm. Conclusion: The incorporation of the three theories in a diagnostic algorithm facilitates a greater understanding of the pathophysiological mechanisms and allows us to identify a more precise therapeutic objective to correct the underlying disorder in the different clinical contexts of the patient.

Resumen Introducción: las alteraciones del equilibrio ácido-base se estudian en todas las especialidades médicas. Aunque la mayoría de los casos derivan de una patología preexistente, también pueden manifestarse en un contexto primario, por lo que la identificación adecuada del trastorno ácido-base permite caracterizar su proceso patológico. La correcta interpretación de la gasometría sanguínea como técnica para monitorizar el estado ventilatorio, la oxigenación y el equilibrio ácido-base de un paciente requiere la integración de varios enfoques fisicoquímicos para precisar un diagnóstico, cuantificar una respuesta terapéutica y monitorizar la gravedad o la progresión de un proceso patológico. Materiales y métodos: se realizó una revisión de la literatura en las bases de datos PubMed, Scopus y ScienceDirect. Los artículos fueron seleccionados según el título y el resumen, y ordenados por tópicos relevantes por fisiopatología, divergencias, abordaje clínico, diagnóstico y manejo. Resultados: en la literatura consultada se evidenció que el uso de un enfoque lógico y sistemático es necesario para interpretar adecuadamente los parámetros de la gasometría sanguínea e identificar oportunamente el trastorno ácido-base. Conclusión: la incorporación de las tres teorías en un algoritmo diagnóstico facilita una mayor comprensión de los mecanismos fisiopatológicos y permite identificar un objetivo terapéutico más preciso para corregir el trastorno de base en los diferentes contextos clínicos del paciente.

Congenital chloride diarrhea in patient with SLC26A2 mutation - analysis of the clinical phenotype and differential diagnosis.

INTRODUCTION: To analyze the clinical features and SLC26A3 mutation of one patient in our hospital who had congenital loss of chlorine diarrhea (CLD), and to investigate the treatment of the disease and the prognosis. MATERIAL AND METHODS: By reviewing the literature, analyzing the clinical features and differential diagnosis and investigating the treatment and prognosis, the patient was diagnosed as CLD. RESULTS: Excessive accumulation of amniotic fluid was observed during pregnancy. The patient was born prematurely with normal body weight. The patient was a 4-month old boy admitted for anorexia, watery diarrhea, electrolyte disorders (hyponatremia, hypokalemia and hypochloremia) and metabolic alkalosis. The patient was also considered to be affected by Batter syndrome. After treating with spironolactone, indomethacin and potassium chloride sustained release tablet, the symptom of watery diarrhea was alleviated, the ingested amount of milk increased gradually and the amount of urine became normal; however, electrolyte imbalance persisted and the frequency of bowel movements remained high. Genetic analysis demonstrated that the patient had a SLC26A3 c.269_270dupAA homozygous mutation in exon 3, leading to a frameshift from 91st amino acid Gly and alteration of the SLC26A3 transmembrane protein sequence, thus resulting in a Cl-/HCO3- exchange barrier. The parents of the patient had normal phenotypes and were all heterozygous carriers of the mutation. Moreover, the patient was diagnosed as CLD. Sodium chloride and potassium chloride rather than spironolactone and indomenthacin were given to the patient to correct the dehydration, so the symptom of watery diarrhea alleviated and the blood gas and electrolyte levels returned to the normal range. In addition, the patients morale was good and the ingested amount of milk was moderate. CONCLUSIONS: Persistent diarrhea and electrolyte disorder in pediatrics are easy to misdiagnose as CLD. Furthermore, it is difficult to identify Batter syndrome, Gitelman syndrome, renal tubular acidosis and CLD. Blood and stool electrolyte detection and SLC26A3 genetic tests are helpful for diagnosis, and sodium chloride and potassium chloride replacement therapy are critical for the patient prognosis.