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1.
Crit Care Resusc ; 22(1): 80-82, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32102646

RESUMO

BACKGROUND: Due to the lack of double-blind randomised controlled trials, the true effect of intravenous sodium bicarbonate therapy in ICU patients with metabolic acidosis remains unclear. METHODS: We diluted 100 mL 8.4% sodium bicarbonate in 150 mL 5% dextrose (D5W) within a 250 mL polyolefin bag after removing 100 mL. We asked ICU clinicians to inspect a 250 mL bag containing sodium bicarbonate or a 250 mL bag where 100 mL of D5W had been removed and then returned. The bags were attached to intravenous giving sets. We asked participants to identify the contents of the bags. RESULTS: Among 60 participants (39 nursing staff [65%], 20 medical staff [33.3%] and one pharmacist), 36 (60%) answered correctly. The Cohen κ for agreement between test bag content and participants' answers was 0.20 (95% CI, -0.05 to 0.45; P = 0.12), implying the answers were correct by chance. In the group of 28 participants who indicated they used a clue to help them decide their answer, 15 (53.6%) answered correctly, whereas in the remainder (n = 32), 21 (65.6%) answered correctly (P = 0.49). CONCLUSION: When 100 mL of 8.4% sodium bicarbonate were diluted in 150 mL of D5W within a 250 mL polyolefin bag, clinicians were unable to correctly identify the contents of the bags. Our findings imply that sodium bicarbonate therapy can be successfully blinded.


Assuntos
Acidose/tratamento farmacológico , Glucose/uso terapêutico , Bicarbonato de Sódio/uso terapêutico , Administração Intravenosa , Método Duplo-Cego , Eletrólitos , Glucose/administração & dosagem , Humanos , Injeções Intravenosas , Sódio/sangue , Bicarbonato de Sódio/administração & dosagem , Resultado do Tratamento
2.
Adv Exp Med Biol ; 1232: 277-282, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31893421

RESUMO

Acidification of the cellular microenvironment is found in different pathological states such as inflammation, ischemia and in solid tumors. It can affect cell function and phenotype, and by this aggravate the pathological process. Epithelial cells are a relevant functional part in several normal organs as well as in tumors and will thus be challenged by the acidic extracellular pH (acidosis). Therefore, the impact of acidosis on the expression of different inflammatory mediators (MCP-1, IL-6, osteopontin, iNOS, TNF-α, and COX-2), as well as the role of different signaling pathways regulating the expression, was studied in epithelial normal rat kidney cells (NRK-52E). Acidosis led to an increase in TNF-α expression but a down-regulation of MCP-1, iNOS and COX-2. Expression of IL-6 was only slightly modulated, while osteopontin was not regulated at all. Since acidosis activates ERK1/2 and p38 signaling in NRK-52E cells, the impact of MAP kinase signaling pathways on the expression of the inflammatory markers was analyzed. At normal pH, blocking ERK1/2 or p38 decreased the level of MCP-1, iNOS and partly TNF-α. However, the effect of acidosis on the expression of inflammatory mediators was not affected by inhibition of the MAP kinase pathways. In conclusion, our results show that an acidic microenvironment affects the transcriptional program of epithelial cells. Low pH mostly reduced the expression of pathological relevant genes and might thus repress inflammatory processes induced by epithelial cells.


Assuntos
Acidose , Células Epiteliais , Regulação da Expressão Gênica , Mediadores da Inflamação , Proteínas Quinases p38 Ativadas por Mitógeno , Acidose/metabolismo , Animais , Linhagem Celular , Quimiocina CCL2/genética , Ciclo-Oxigenase 2/genética , Células Epiteliais/metabolismo , Mediadores da Inflamação/metabolismo , Sistema de Sinalização das MAP Quinases/fisiologia , Óxido Nítrico Sintase Tipo II/genética , Ratos , Fator de Necrose Tumoral alfa/genética
3.
BJOG ; 127(3): 405-413, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31762140

RESUMO

OBJECTIVE: To determine variations in cord blood gas (CBG) parameters after 3-minute delayed cord clamping (DCC) in vaginal deliveries (VDs) and caesarean deliveries (CDs) at term without fetal distress. DESIGN: Prospective observational study. SETTING: University hospital. SAMPLE: CBG from 97 VDs and 124 CDs without fetal distress. METHODS: Comparison of paired arterial-venous CBG parameters drawn at birth from the unclamped cord and after 3-minutes DCC for VDs and CDs. MAIN OUTCOME MEASURES: Base excess, bicarbonate, haematocrit and haemoglobin from both arterial and venous cord blood, lactate, neonatal outcomes, partial pressure of oxygen (pO2 ), partial pressure of carbon dioxide (pCO2 ), pH, and postpartum haemorrhage. RESULTS: Arterial cord blood pH, bicarbonate ( HCO 3 - , mmol/l), and base excess (BE, mmol/l) decreased significantly after 3-minute DCC both in VDs (pH = 7.23 versus 7.27; P < 0.001; HCO 3 -  = 23.3 versus 24.3; P = 0.004; BE = -5.1 versus -2.9; P < 0.001) and CDs (pH = 7.28 versus 7.34; P < 0.001; HCO 3 -  = 26.2 versus 27.2; P < 0.001; BE = -1.5 versus 0.7; P < 0.001). After 3-minute DCC, pCO2 increased in CDs only (57 versus 51; P < 0.001), whereas lactate increased more in CDs compared with VDs (lactate, +1.1 [0.9, 1.45] versus +0.5 [-0.65, 2.35]; P = 0.01). Postpartum maternal haemorrhage, neonatal maximum bilirubin concentration, and need for phototherapy were similar between the two groups. Newborns born by CD more frequently required postnatal clinical monitoring or admission to a neonatal intensive care unit. CONCLUSIONS: After 3-minute DCC, the acid-base status shifted towards mixed acidosis in CDs and prevalent metabolic acidosis in VDs. CDs were associated with a more pronounced increase in arterial lactate, compared with VDs. TWEETABLE ABSTRACT: By 3-minute DCC, acid-base status shifts towards mixed and metabolic acidosis in caesarean and vaginal delivery, respectively.


Assuntos
Acidose , Cesárea , Parto Obstétrico , Sangue Fetal/metabolismo , Complicações do Trabalho de Parto , Cordão Umbilical/cirurgia , Acidose/sangue , Acidose/diagnóstico , Acidose/etiologia , Gasometria/métodos , Cesárea/efeitos adversos , Cesárea/métodos , Cesárea/estatística & dados numéricos , Constrição , Parto Obstétrico/efeitos adversos , Parto Obstétrico/métodos , Parto Obstétrico/estatística & dados numéricos , Feminino , Humanos , Recém-Nascido , Itália/epidemiologia , Masculino , Complicações do Trabalho de Parto/diagnóstico , Complicações do Trabalho de Parto/epidemiologia , Complicações do Trabalho de Parto/etiologia , Gravidez , Resultado da Gravidez/epidemiologia , Tempo para o Tratamento
4.
Dev Med Child Neurol ; 62(1): 57-61, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31745987

RESUMO

AIM: To investigate if potassium citrate, a mild alkaline compound, can prevent metabolic acidosis in children with epilepsy treated with the ketogenic diet without reducing antiepileptic efficacy. METHOD: In this prospective controlled study, we investigated the frequency of initial uncompensated metabolic acidosis in 51 participants. There were 22 participants with and 29 without potassium citrate supplementation. The ketogenic diet was used as add-on treatment to children with drug resistant epilepsy. We also estimated the proportion of participants with a greater than 50% seizure reduction after 7 months. RESULTS: None of the 22 participants (15 males, seven females; median age 1y 7mo, interquartile range [IQR] 3y 3mo) with, and 10 of 29 (12 males, 17 females; median age 6y 1mo, IQR 4y 8mo) without potassium citrate developed metabolic acidosis (odds ratio=0.04, 95% CI 0.00-0.75 [p<0.01]); median pH 7.32 vs 7.24; [p<0.001]), and median bicarbonate 19.7mmol/L vs 14.0mmol/L (p<0.001). The number of seizures was reduced by more than 50% in 9 of 22 with potassium citrate and 8 of 29 participants without potassium citrate, 7 months after introducing a ketogenic diet (p=0.4). INTERPRETATION: In the ketogenic diet, potassium citrate supplementation can prevent metabolic acidosis, without reducing antiepileptic efficacy. WHAT THIS PAPER ADDS: Citrate supplementation prevents metabolic acidosis in children treated with a ketogenic diet. Efficacy of the ketogenic diet is not affected by supplementation with citrate. Citrate supplementation does not affect beta-hydroxybuturate concentration. Potassium citrate reduces the time needed to reach an optimal ketogenic ratio. This article is commented on by Schoeler on page 8 of this issue.


Assuntos
Acidose/prevenção & controle , Dieta Cetogênica , Epilepsia Resistente a Medicamentos/dietoterapia , Citrato de Potássio/farmacologia , Criança , Pré-Escolar , Dieta Cetogênica/efeitos adversos , Suplementos Nutricionais , Feminino , Humanos , Lactente , Masculino , Citrato de Potássio/administração & dosagem
5.
Biochem Med (Zagreb) ; 30(1): 011001, 2020 Feb 15.
Artigo em Inglês | MEDLINE | ID: mdl-31839728

RESUMO

Introduction: D-lactic acidosis is an uncommon cause of high anion gap acidosis. Materials and methods: A 35-year old woman was admitted to the emergency room with somnolence, drowsiness, dizziness, incoherent speech and drunk appearance. Her past medical history included a Roux-en-Y bypass. Point-of-care venous blood analysis revealed a high anion gap acidosis. Based on the clinical presentation, routine laboratory results and negative toxicology screening, D-lactate and 5-oxoprolinuria were considered as the most likely causes of the high anion gap acidosis. Urine organic acid analysis revealed increased lactate, but no 5-oxoproline. Plasma D-lactate was < 1.0 mmol/L and could not confirm D-lactic acidosis. What happened: Further investigation revealed that the blood sample for D-lactate was drawn 12 hours after admission, which might explain the false-negative result. Data regarding the half-life of D-lactate are, however, scarce. During a second admission, one month later, D-lactic acidosis could be confirmed with an anion gap of 40.7 mmol/L and a D-lactate of 21.0 mmol/L measured in a sample collected at the time of admission. Main lesson: The time of blood collection is of utmost importance to establish the diagnosis of D-lactic acidosis due to the fast clearance of D-lactate in the human body.


Assuntos
Acidose/diagnóstico , Ácido Láctico/urina , Acidose Láctica/diagnóstico , Adulto , Reações Falso-Positivas , Feminino , Cromatografia Gasosa-Espectrometria de Massas , Humanos , Ácido Láctico/sangue , Fase Pré-Analítica
6.
J Dairy Sci ; 103(1): 750-767, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31704012

RESUMO

Adequate feeding of high-performance dairy cows is extremely important to avoid the digestive disorder subacute ruminal acidosis. Subacute ruminal acidosis is defined as a status with a below-average ruminal pH that does not cause direct clinical symptoms at the individual level but is relevant for animal welfare due to a higher risk of secondary health problems at the herd level. The main objective of this study was to apply meta-analytical methods in an exploratory approach to investigate the association between pH parameters of the ventral rumen with milk and diet parameters. Data from 32 studies using continuous pH measurement in the ventral rumen of lactating cows were included in the meta-analysis. Available information extracted from all studies was categorized into parameters associated with management, cow, diet, milk, and pH. The statistical analysis was divided into 4 sections. First, a multiple imputation procedure based on a principal component model was applied, since approximately 19% of the data set consisted of missing values due to heterogeneity in provided information between the studies included in the analysis. In a second step, all potential predictors for the pH parameters, including the daily mean pH, the time with a pH below 5.8, and the pH range, were examined for their prediction suitability using multi-level mixed effects meta-regression models. These analyses were performed on the raw and the imputed data. Because the results of both approaches were consistent, the imputing procedure was considered to be appropriate. Third, automated variable selection was applied to all 3 pH parameters separately for the predictor groups milk and diet using the imputed data set. Thereby, multi-model inference was used to estimate the relative importance of the selected variables. Finally, a functional relationship between the 3 pH parameters was established. The fat to protein ratio of milk, milk fat, and milk protein showed significant associations in meta-regression analysis for all 3 pH parameters when used as a single predictor. Out of the group of diet-specific variables, the acid detergent fiber, neutral detergent fiber, nonfiber carbohydrate, starch content, as well as the forage to concentrate ratio, showed the highest significance in the models. In particular, the multi-model inference showed that the protein, fat, and lactose content of the milk can best quantify the association to the daily mean pH and the time with a pH below 5.8 in a multiple regression model.


Assuntos
Acidose/veterinária , Doenças dos Bovinos/etiologia , Bovinos/fisiologia , Modelos Biológicos , Modelos Estatísticos , Rúmen/química , Acidose/etiologia , Ração Animal/análise , Animais , Dieta/veterinária , Feminino , Concentração de Íons de Hidrogênio , Lactação , Leite , Análise de Regressão , Fatores de Risco , Rúmen/metabolismo
8.
Pol J Vet Sci ; 22(4): 685-693, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31867921

RESUMO

The objective of this study was to determine the association between subclinical acidosis (SARA) and subclinical ketosis (SCK) with biomarkers from an automatic milking system (AMS) measuring in relation to rumination time (RT), milk yield (MY), bodyweight (BW), milk temperature, the milk fat-to-protein ratio, and the electrical conductivity of milk at the udder quarters-level which can be read in fresh dairy cows. During the course of the study, all of the fresh dairy cows (n=711) were examined according to a general clinical investigation plan. The cows were selected for 1-30 days of milk (DIM) and were milked using Lely Astronaut® A3 milking robots with free traffic. Rumination time shows a statistically significant positive correlation with milk yield (milk temperature) and is negatively correlated with the fat and protein ratio. Healthy cows demonstrated the highest level of rumination time and the lowest milk temperature. The average BW for these cows was 1.64% lower than for the SARA group and the BW kg was 2.10% higher than SCK cows. MY was 14.01% lower in comparison with SARA and 6.42% higher in comparison with SCK. According to these results, some biomarkers from the AMS have an association with SARA and SCK. However, further research with a higher number of cows is needed to confirm this conclusion.


Assuntos
Acidose/veterinária , Criação de Animais Domésticos/instrumentação , Doenças dos Bovinos/diagnóstico , Cetose/veterinária , Animais , Biomarcadores , Temperatura Corporal , Peso Corporal , Bovinos , Feminino , Lactação , Leite/química
10.
Medicine (Baltimore) ; 98(41): e17434, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31593098

RESUMO

RATIONALE: Preoperative prolonged fasting may cause starvation ketoacidosis. Herein, we report of a case of starvation ketoacidosis due to long-term fasting before surgery. PATIENT CONCERNS: We report of a case of metabolic acidosis due to prolonged fasting in a previously healthy 44-year-old woman during a total laparoscopic hysterectomy. Hyperventilation was observed to occur when the surgery was completed. Metabolic acidosis and hypoglycemia were demonstrated by blood gas analysis of the radial artery. DIAGNOSIS: Metabolic acidosis. INTERVENTIONS: The patient received sodium bicarbonate and 5% glucose fluid at the end of the surgery. OUTCOMES: The tracheal tube was successfully removed when the tidal volume of the patient returned to normal after the therapy. However, the patient suffered pulmonary edema when she was transferred to the intensive care unit (ICU). With treatments with furosemide and sodium bicarbonate, acidosis and pulmonary edema were completely corrected at 8 hours after the surgery. On the second day after the surgery, the patient suffered nausea and vomiting. Nausea and vomiting were not completely relieved on the sixth day after the operation; therefore, the patient was transferred to the Department of Gastroenterology for further therapy. LESSONS: This case suggests that although the concept of enhanced recovery after surgery (ERAS) has been adopted by most physicians because of its positive outcomes, the issue of prolonged fasting still exists, and such patients may be exposed to the risk of starvation ketoacidosis.


Assuntos
Acidose/etiologia , Jejum/efeitos adversos , Inanição/complicações , Adulto , Feminino , Humanos , Histerectomia , Período Pré-Operatório
11.
Med Klin Intensivmed Notfmed ; 114(8): 765-776, 2019 Nov.
Artigo em Alemão | MEDLINE | ID: mdl-31641791

RESUMO

Keeping blood pH levels stable within narrow limits is prerequisite for maintaining normal body function. Disruptions of this equilibrium can occur for a variety of reasons and may result in life-threatening conditions. Therefore, the identification and the interpretation of acid-base disorders are of great importance in emergency medicine. The same applies to intensive care as well as to almost all areas of internal medicine. In this article, we provide a practical overview of all relevant acid-base disorders that are due to both metabolic and respiratory disturbances. In addition, it shows how they can be diagnosed in everyday clinical practice by applying the simplified Stewart Approach.


Assuntos
Equilíbrio Ácido-Base/fisiologia , Desequilíbrio Ácido-Base , Gasometria , Cuidados Críticos/métodos , Desequilíbrio Ácido-Base/sangue , Desequilíbrio Ácido-Base/diagnóstico , Acidose , Humanos
12.
Med. U.P.B ; 38(2): 168-176, 17 de octubre de 2019.
Artigo em Espanhol | LILACS | ID: biblio-1023412

RESUMO

Aunque poco común, la intoxicación por cianuro acarrea una mortalidad alta, sobre todo, cuando no se administra el tratamiento oportuno. La exposición a este tóxico puede darse por inhalación o por ingestión oral. Lo que se ha descrito sobre el manejo de esta intoxicación está basado en reportes de casos y pequeñas series, dado que en la literatura no se encuentran estudios que den un sustento claro. Dentro de estos reportes, y según los aspectos fisiopatológicos, son especialmente relevantes: el nitrito de sodio, el nitrito de amilo, el tiosulfito de sodio y la hidroxicobalamina, como arsenal terapéutico de esta intoxicación.


Cyanide intoxication is a rare condition. Yet, it leads to a high mortality, especially when proper treatment is not available. The exposure to this substance may occur via inhalation or oral ingestion. The basis of this intoxication´s treatment is on little case series and reports; this is due to the fact that the literature to support it remains scant and unclear. Based on physiopathological aspects, within this evidence the following are particularly relevant: sodium nitrile, amile nitrile, sodium tiosulphite, and hidroxicobalamin, as part of this intoxication´s treatment.


Embora pouco comum, a intoxicação por cianeto provoca uma mortalidade alta, sobre tudo, quando não se administra o tratamento oportuno. A exposição a este tóxico pode dar-se por inalação ou por ingestão oral. O que se há descrito sobre o manejo desta intoxicação está baseado em reportes de casos e pequenas séries, dado que na literatura não se encontram estudos que deem um sustento claro. Dentro destes relatos, e segundo os aspectos fisiopatológicos, são especialmente relevantes: o nitrito de sódio, o nitrito de amilo, o tiossulfato de sódio e a hidroxicobalamina, como arsenal terapêutico desta intoxicação.


Assuntos
Envenenamento , Acidose , Cianetos , Antídotos
13.
BMJ Case Rep ; 12(9)2019 Sep 19.
Artigo em Inglês | MEDLINE | ID: mdl-31537605

RESUMO

A 26-year-old Caucasian man with no medical history, except years of oral and intravenous drug abuse, presented with fatigue, shortness of breath, epistaxis and uncontrolled hypertension. He was pale with skin ecchymosis over his thighs and was anaemic, with severe renal failure and metabolic acidosis. Following initial clinical stabilisation of the patient, a renal biopsy was obtained, which showed vascular and glomerular changes consistent with thrombotic microangiopathic injury and advanced glomerulosclerosis. He was treated with antihypertensives and required haemodialysis. He admitted using 'crystal meth' regularly for many years, which is likely responsible for his renal failure. We present the case to illustrate methamphetamine-induced renal disease leading to end-stage renal disease and to bring awareness among practising clinicians, ancillary healthcare workers and public health professionals of this often undervalued cause of renal failure, which can be prevented.


Assuntos
Falência Renal Crônica/induzido quimicamente , Falência Renal Crônica/patologia , Metanfetamina/efeitos adversos , Acidose/complicações , Adulto , Progressão da Doença , Humanos , Hipertensão/complicações , Masculino , Abuso de Substâncias por Via Intravenosa , Abuso Oral de Substâncias
14.
Res Vet Sci ; 126: 127-130, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31479828

RESUMO

The aim of the present study was to investigate whether abnormalities in plasma diamine oxidase (DAO) activity reflect the degree of intestinal mucosal disorder in calves with diarrhea. A total of 50 Holstein calves were enrolled. Thirty-six of the 50 calves presented diarrhea and were sub-classified by severity based on fecal status (0: firm, 1: pasty, 2: loose, and 3: watery) and blood pH (acidemia: blood pH <7.25) as follows: Seventeen calves exhibiting watery diarrhea and/or fall into acidemia were sub-categorized into the severe group. The other nineteen calves exhibiting pasty or loose diarrhea and not fall into acidemia were sub-categorized into the moderate group. The remaining 14 calves without diarrhea were assigned to the control group. The plasma DAO activity was significantly lower (p < .01) in the calves with severe or moderate diarrhea than in the control group. In addition, the plasma DAO activity was significantly lower (p < .05) in the severe group than in the moderate group. The relationship between plasma DAO activity and fecal score (r = -0.55, p < .01) in calves with diarrhea were found to have significantly and negatively correlated by Spearman's rank test in this study. Our results suggested that plasma DAO activity reflect the degree of intestinal mucosal disorder due to diarrhea.


Assuntos
Doenças dos Bovinos/sangue , D-Aminoácido Oxidase/sangue , Diarreia/veterinária , Mucosa Intestinal/patologia , Acidose , Animais , Biomarcadores/sangue , Bovinos , Diarreia/sangue , Diarreia/patologia , Fezes
15.
Vet Res Commun ; 43(4): 215-224, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31485844

RESUMO

The objective of this study was to evaluate blood levels of various hormones and compounds related to energy metabolism in cows with subacute ruminal acidosis (SARA). We investigated 11 lactating cows presumed to have SARA based on duration of ruminal pH <5.6 and reticulum pH <6.3 in 2015-2016. Kraft pulp (KP) was used to supplement feed of 7 of the cows studied in an effort to reduce SARA. We continuously monitored ruminal pH and measured blood concentrations of hormones and metabolites related to energy metabolism. Blood measurements included glucose (GLU), total cholesterol (TC), free fatty acid (FFA), insulin, adiponectin (ADN), malate dehydrogenase (MDH), and lactate dehydrogenase (LDH). Additionally, we analyzed milk data (milk yield, milk fat percentage, milk protein percentage, milk urea nitrogen, and protein fat ratio) and reproduction data. The results demonstrated that ADN levels at 4 weeks post-parturition correlated with the total amount of time that the ruminal or reticulum fluid pH was under the threshold during 1 week post-parturition, as well as the numbers of days the cows were diagnosed with SARA (SARA-positive days) up to 30 days post-parturition. SARA-positive days in 2016 were higher than those in 2015. In both years, numbers of SARA-positive days for cows supplemented with KP were lower than those for cows without KP. Increased ADN levels may be a compensatory reaction to frequent SARA which modulates the inflammatory response against high LPS levels and improves insulin resistance caused by LPS. ADN may serve as an estimative index for SARA.


Assuntos
Acidose/veterinária , Adiponectina/sangue , Biomarcadores/sangue , Doenças dos Bovinos/sangue , Técnicas de Diagnóstico do Sistema Digestório/veterinária , Gastropatias/veterinária , Acidose/sangue , Acidose/diagnóstico , Animais , Bovinos , Doenças dos Bovinos/diagnóstico , Técnicas de Diagnóstico do Sistema Digestório/normas , Feminino , Rúmen/patologia , Gastropatias/sangue , Gastropatias/diagnóstico
16.
J Cardiothorac Surg ; 14(1): 163, 2019 Sep 10.
Artigo em Inglês | MEDLINE | ID: mdl-31500645

RESUMO

BACKGROUND: Zero balance ultrafiltration (Z-BUF) utilizing injectable 8.4% sodium bicarbonate is utilized to treat hyperkalemia and metabolic acidosis associated with cardiopulmonary bypass (CPB). The nationwide shortage of injectable 8.4% sodium bicarbonate in 2017 created a predicament for the care of cardiac surgery patients. Given the uncertainty of availability of sodium bicarbonate solutions, our center pro-actively sought a solution to the sodium bicarbonate shortage by performing Z-BUF with dialysate (Z-BUF-D) replacement fluid for patients undergoing cardiopulmonary bypass. METHODS: Single-center, retrospective observational evaluation of the first 46 patients at an academic medical center who underwent Z-BUF using dialysate over a period of 150 days with comparison of these findings to a historical group of 39 patients who underwent Z-BUF with sodium chloride (Z-BUF-S) over the preceding 150 days. The primary outcome was the change in whole blood potassium levels pre- and post-Z-BUF-D. Secondary outcomes included changes in pre- and post-Z-BUF-D serum bicarbonate levels and the amount of serum bicarbonate used in each Z-BUF cohort (Z-BUF-D and Z-BUF-S). RESULTS: Z-BUF-D and Z-BUF-S both significantly reduced potassium levels during CPB. However, Z-BUF-D resulted in a significantly decreased need for supplemental 8.4% sodium bicarbonate administration during CPB (52 mEq ± 48 vs. 159 mEq ± 85, P < 0.01). There were no complications directly attributed to the Z-BUF procedure. CONCLUSION: Z-BUF with dialysate appears to be analternative to Z-BUF with sodium chloride with marked lower utilization of intravenous sodium bicarbonate.


Assuntos
Acidose/terapia , Bicarbonatos/provisão & distribução , Ponte Cardiopulmonar/efeitos adversos , Soluções para Diálise/provisão & distribução , Complicações Pós-Operatórias/terapia , Ultrafiltração/métodos , Bicarbonatos/farmacologia , Soluções para Diálise/farmacologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Estados Unidos
17.
PLoS Med ; 16(8): e1002858, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31442221

RESUMO

BACKGROUND: Severe falciparum malaria is a medical emergency characterised by potentially lethal vital organ dysfunction. Patient fatality rates even with parenteral artesunate treatment remain high. Despite considerable research into adjuvant therapies targeting organ and tissue dysfunction, none have shown efficacy apart from renal replacement therapy. Understanding the causal contributions of clinical and laboratory abnormalities to mortality is essential for the design and evaluation of novel therapeutic interventions. METHODS AND FINDINGS: We used a structural model causal inference approach to investigate causal relationships between epidemiological, laboratory, and clinical variables in patients with severe falciparum malaria enrolled in clinical trials and their in-hospital mortality. Under this causal model, we analysed records from 9,040 hospitalised children (0-12 years, n = 5,635) and adults (n = 3,405, 12-87 years) with severe falciparum malaria from 15 countries in Africa and Asia who were studied prospectively over the past 35 years. On admission, patient covariates associated with increased in-hospital mortality were severity of acidosis (odds ratio [OR] 2.10 for a 7-mEq/L increase in base deficit [95% CI 1.93-2.28]), renal impairment (OR 1.71 for a 2-fold increase in blood urea nitrogen [95% CI 1.58, 1.86]), coma (OR 3.59 [95% CI 3.07-4.21]), seizures (OR 1.40 [95% CI 1.16-1.68]), shock (OR 1.51 [95% CI 1.14-1.99]), and presumed pulmonary oedema (OR 1.58 [95% CI 1.04-2.39]). Lower in-hospital mortality was associated with moderate anaemia (OR 0.87 for a decrease of 10 percentage points in haematocrit [95% CI 0.80-0.95]). Circulating parasite density was not associated with mortality (OR 1.02 for a 6-fold increase [95% CI 0.94-1.11]), so the pathological effects of parasitaemia appear to be mediated entirely by the downstream effects of sequestration. Treatment with an artemisinin derivative decreased mortality compared with quinine (OR 0.64 [95% CI 0.56-0.74]). These estimates were consistent across children and adults (mainly representing African and Asian patients, respectively). Using inverse probability weighting, transfusion was not estimated to be beneficial in children with admission haematocrit values between 15% and 25% (OR 0.99 [95% CI 0.97-1.02]). Except for the effects of artemisinin treatment and transfusion, causal interpretations of these estimates could be biased by unmeasured confounding from severe bacterial sepsis, immunity, and duration of illness. CONCLUSION: These data suggest that moderate anaemia is associated with a reduced risk of death in severe falciparum malaria. This is possibly a direct causal association. The severe anaemia threshold criteria for a definition of severe falciparum malaria should be reconsidered.


Assuntos
Malária Falciparum/etiologia , Acidose/parasitologia , Doença Aguda , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Nitrogênio da Ureia Sanguínea , Criança , Pré-Escolar , Coma/etiologia , Feminino , Mortalidade Hospitalar , Humanos , Lactente , Recém-Nascido , Malária Falciparum/complicações , Malária Falciparum/mortalidade , Malária Falciparum/patologia , Masculino , Pessoa de Meia-Idade , Pontuação de Propensão , Edema Pulmonar/etiologia , Estudos Retrospectivos , Convulsões/etiologia , Choque/etiologia , Adulto Jovem
18.
Transplant Proc ; 51(7): 2262-2264, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31400980

RESUMO

INTRODUCTION: The ideal crystalloid solution to be used during the perioperative period in patients undergoing kidney transplantation remains unclear. Normal saline (NS), the intravenous fluid commonly using during the perioperative period, contains a high chloride content, which may be associated with hyperchloremic metabolic acidosis and acute kidney injury. Balanced crystalloid (BC) solutions have a lower chloride content. The purpose of the study was to determine if a BC solution prevents the incidence of hyperchloremia and hyperkalemia during renal transplantation. METHODS: NS and BC given during kidney transplantation are compared. The primary outcome was hyperchloremia and hyperkalemia within 24 hours after surgery. Secondary outcomes were levels of serum creatinine at preoperative and within 5 days after transplantation, the incidence of acute rejection episodes, graft failure, length of stay at hospital, and mortality. RESULTS: A total of 60 patients were included in the study (30 in the BC group and 30 in the NS group). The mean postoperative chloride was 103.0 mmol/L (95% CI, 101-105) in the NS group and 100 mmol/L (95% CI, 98-102) in the BC group (P < .05). There were no significant differences in demographic characteristics, serum creatinine values within 5 days, short-term outcomes, and graft survival rates at 28 days postoperatively between groups (P > .05). CONCLUSIONS: Our results suggest that a moderate volume (approximately 1500.0 mL) of NS infusion causes hyperchloremia rather than adverse clinical outcomes. A moderate amount of NS infusion can be used safely during uncomplicated living-donor kidney transplantations.


Assuntos
Acidose/epidemiologia , Lesão Renal Aguda/epidemiologia , Soluções Cristaloides/efeitos adversos , Hidratação/efeitos adversos , Hiperpotassemia/epidemiologia , Transplante de Rim , Solução Salina/efeitos adversos , Acidose/induzido quimicamente , Lesão Renal Aguda/induzido quimicamente , Adulto , Creatinina/sangue , Feminino , Hidratação/métodos , Humanos , Hiperpotassemia/induzido quimicamente , Masculino , Pessoa de Meia-Idade , Período Perioperatório
19.
BMC Vet Res ; 15(1): 298, 2019 Aug 19.
Artigo em Inglês | MEDLINE | ID: mdl-31426783

RESUMO

BACKGROUND: Dietary structure in ruminants is closely connected with the composition of gastrointestinal microbiota. Merging study has shown that dietary induced SARA causes the alteration of microbial community in the cecum leading to the local inflammation. However, the mechanisms of cecum inflammation elicited by the shift of microbial flora in ruminants are largely unknown, and whether the development of this inflammation is modified by epigenetic modifications. RESULTS: Ten multiparous lactating goats were randomly seperated into two groups and received either a low concentrate diet (LC, 40% concentrate, n = 5) or a high concentrate diet (HC, 60% concentrate) to induce subacute ruminal acidosis (SARA). Compared with LC, HC-induced SARA altered the predominant phyla and genera, thereby increasing the concentration of lipopolysaccharide (LPS) and short chain fatty acids (SCFAs). Meanwhile, HC-induced SARA enhanced the mRNA expression of cytokines and chemokines and the expression of mRNA and protein of GPR41, GPR43, p38 and ERK1/2, while HC-induced SARA had no effect on TLR4 and p65. Furthermore, HC-induced SARA decreased the percentage of chromatin compaction and DNA methylation at the area of the promoters of GPR41 and GPR43. CONCLUSION: This study indicated that HC diet induced SARA resulted in the alteration in the composition of cecal microbiota. This alteration increased the concentration of LPS, but failing to activate TLR4 signaling pathway due to the tolerance effect of intestinal epithelial cell to certain level of LPS, as well as elevated the concentration of SCFAs, thereby activating GPR41 and GPR43 signaling pathway to produce cytokines and chemokins and cause the cecal inflammation. And epigenetic mechanisms contributed to the development of this inflammation in the lactating goats suffering from SARA.


Assuntos
Acidose/veterinária , Microbioma Gastrointestinal/fisiologia , Doenças das Cabras/metabolismo , Inflamação/veterinária , Receptores Acoplados a Proteínas-G/metabolismo , Rúmen/química , Animais , Bactérias/classificação , Ceco/microbiologia , Feminino , Regulação da Expressão Gênica , Doenças das Cabras/patologia , Cabras , Concentração de Íons de Hidrogênio , Lactação , Leite/química , Membrana Mucosa/metabolismo , Membrana Mucosa/microbiologia , Gravidez , Receptores Acoplados a Proteínas-G/genética , Transdução de Sinais , Fatores de Tempo
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