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1.
Kidney Int ; 99(1): 28-31, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33390237

RESUMO

Metabolic acidosis is an early and deleterious complication of chronic kidney disease. Because it is frequently eubicarbonatemic, diagnosis may be difficult. In this issue, Gianella et al. suggest that lower urinary citrate excretion, considered as an homeostatic response to metabolic acidosis, may be helpful for early diagnosis and monitoring of alkali treatment. This study should be an incentive for further assessment of the tubular handling of urinary citrate in CKD patients and determination of the performance of urinary citrate for the diagnosis of eubicarbonatemic metabolic acidosis and monitoring of alkali therapy.


Assuntos
Acidose , Insuficiência Renal Crônica , Acidose/diagnóstico , Acidose/etiologia , Citratos , Ácido Cítrico , Creatinina , Humanos , Insuficiência Renal Crônica/diagnóstico , Insuficiência Renal Crônica/terapia
2.
BMJ Case Rep ; 14(1)2021 Jan 08.
Artigo em Inglês | MEDLINE | ID: mdl-33419747

RESUMO

A 75-year-old woman was admitted to a regional hospital with an acute kidney injury (AKI) and nausea on a background of recent treatment for Staphylococcus aureus bacteraemia secondary to pneumonia. The treatment thereof resulted in a high anion gap metabolic acidosis (HAGMA). The pneumonia was initially treated with intravenous piperacillin and tazobactam and the patient transferred to a tertiary hospital. There, the diagnosis of S. aureus bacteraemia secondary to a pulmonary source was confirmed and treatment was changed to intravenous flucloxacillin and the patient was discharged to hospital in the home (HITH is a service that allows short-term healthcare at home to be provided to people who would otherwise need to be in hospital) to complete the antibiotic course. Five weeks after commencing flucloxacillin, the patient was referred back to hospital with nausea and worsening kidney function with an associated significant HAGMA. The patient has a background of chronic kidney disease and chronic back pain for which she was taking long-term paracetamol. The HAGMA was determined to be due to a pyroglutamic acidosis (PGA), deemed secondary to the combined use of paracetamol and flucloxacillin. This was subsequently confirmed with a plasma pyroglutamic acid concentration level of 7467 µmol/L (reference range 20-50 µmol/L) and a urinary level of 1700 mmol/mol creatinine (<110 mmol/mol creatinine). To our knowledge, this is the highest plasma and urinary levels published to date. Furthermore, considering the common use of paracetamol and penicillins, it is important to recognise HAGMA as a potential complication of co-administration of paracetamol and iso-oxylopenicillin. The HAGMA resolved after cessation of flucloxacillin despite the continuation of paracetamol and without administration of N-acetylcysteine. PGA-related HAGMA appears to be a unique potential side effect of iso-oxylopenicillin rather than other beta-lactams.


Assuntos
Acetaminofen/efeitos adversos , Acidose/induzido quimicamente , Antibacterianos/efeitos adversos , Antipiréticos/efeitos adversos , Floxacilina/efeitos adversos , Ácido Pirrolidonocarboxílico/metabolismo , Acidose/diagnóstico , Lesão Renal Aguda/complicações , Lesão Renal Aguda/metabolismo , Lesão Renal Aguda/terapia , Idoso , Bacteriemia/tratamento farmacológico , Feminino , Humanos , Infecções Estafilocócicas/tratamento farmacológico
4.
Ann Biol Clin (Paris) ; 78(4): 417-424, 2020 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-32753366

RESUMO

We present the case of a four-year-old girl, who was hospitalized in intensive care unit for a coma resulting from metabolic acidosis with increased anion gap. The patient was treated for short bowel syndrome, following necrotising enterocolitis, which occurred 51 days after birth. In our initial evaluation of the patient's metabolic acidosis, we were unable to identify the cause of the increased anion gap. Urinary organic acids chromatography identified a large peak of lactate (quantified at 15 mmol/mol of creatiniuria), as well as its metabolites. The discrepancy between normal blood lactate concentration assayed by enzymatic assay, and the large amount of lactate found by gas-chromatography/mass spectrometry (GC/MS) in urine highlights the limit of the stereospecificity of enzymatic assays. Indeed, most lactates assay use enzymatic assays that are specific for L-lactate, whereas organic acids chromatography, whose column is mostly achiral, can detect both stereoisomers, D- and L-lactate. Organic acids in urine analysis, in addition to the clinical context, suggested a diagnosis of D-lactic acidosis. Following a review of the physiopathology and treatment of short bowel syndrome, we will discuss the mechanism and diagnosis of the D-lactic acidosis in our patient. This case highlights the need to perform an organic acid profile in urine in the presence of any unexplained increased anion gap to determine its cause.


Assuntos
Equilíbrio Ácido-Base/fisiologia , Acidose Láctica/diagnóstico , Acidose/diagnóstico , Coma/diagnóstico , Síndrome do Intestino Curto/diagnóstico , Acidose/etiologia , Acidose/metabolismo , Acidose Láctica/etiologia , Acidose Láctica/metabolismo , Acidose Láctica/urina , Análise Química do Sangue/métodos , Pré-Escolar , Coma/sangue , Coma/etiologia , Coma/urina , Diagnóstico Diferencial , Feminino , Cromatografia Gasosa-Espectrometria de Massas , Humanos , Ácido Láctico/sangue , Ácido Láctico/urina , Síndrome do Intestino Curto/complicações , Síndrome do Intestino Curto/metabolismo , Urinálise
5.
Ann Biol Clin (Paris) ; 78(3): 323-328, 2020 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-32540819

RESUMO

Ketosis is a metabolic situation involving an increase in blood and urine concentrations of ketones that, when prolonged, leads to acidosis. Moderate ketosis usually appears after a fast of a few hours, but its prolongation exposes to hyperketosis. Observation: A 25-year-old woman presented to the emergency department for cohercitive vomiting. She was fasting for a long time in a spiritual setting and had a restricted diet limited to water and vitamin supplements. Clinical and biological assessment was in favour of fasting ketoacidosis. Evolution was favorable with intravenous hydration, poly-ionic and micronutrient supplementation and a gradual resumption of oral feeding. Conclusion: We report the case of a patient with fasting ketoacidosis. Besides consequences of this ketoacidosis, the challenge was also in resuming oral feeding in order to avoid a potentially fatal inappropriate renutrition syndrome.


Assuntos
Jejum/efeitos adversos , Cetose/etiologia , Inanição/complicações , Acidose/sangue , Acidose/diagnóstico , Acidose/etiologia , Acidose/terapia , Adulto , Jejum/sangue , Feminino , Hidratação , Humanos , Cetose/sangue , Cetose/diagnóstico , Cetose/terapia , Nutrição Parenteral , Inanição/sangue , Inanição/terapia , Fatores de Tempo
8.
Acta Obstet Gynecol Scand ; 99(10): 1411-1416, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32274792

RESUMO

INTRODUCTION: Cardiotocography (CTG) is currently the most commonly used method for intrapartum fetal monitoring during labor. However, a high false-positive rate of fetal acidosis indicated by CTG leads to an increase in obstetric interventions. We developed a microdialysis probe that is integrated into a fetal scalp electrode allowing continuous measurement of lactate subcutaneously, thus giving instant information about the oxygenation status of the fetus. Our aim was to establish proof of concept in an animal model using a microdialysis probe to monitor lactate subcutaneously. MATERIAL AND METHODS: We performed an in vivo study in adult male wild-type Wistar rats. We modified electrodes used for CTG monitoring in human fetuses to incorporate a microdialysis membrane. Optimum flow rates for microdialysis were determined in vitro. For the in vivo experiment, a microdialysis probe was inserted into the skin on the back of the animal. De-oxygenation and acidosis were induced by lowering the inspiratory oxygen pressure. Oxygenation and heart rate were monitored. A jugular vein cannula was inserted to draw blood samples for analysis of lactate, pH, pco2 , and saturation. Lactate levels in dialysate were compared with plasma lactate levels. RESULTS: Baseline blood lactate levels were around 1 mmol/L. Upon de-oxygenation, oxygen saturation fell to below 40% for 1 h and blood lactate levels increased 2.5-fold. Correlation of dialysate lactate levels with plasma lactate levels was 0.89 resulting in an R2 of .78 in the corresponding linear regression. CONCLUSIONS: In this animal model, lactate levels in subcutaneous fluid collected by microdialysis closely reflected blood lactate levels upon transient de-oxygenation, indicating that our device is suitable for subcutaneous measurement of lactate. Microdialysis probe technology allows the measurement of multiple compounds in the dialysate, such as glucose, albumin, or inflammatory mediators, so this technique may offer the unique possibility to shed light on fetal physiology during the intrapartum period.


Assuntos
Monitorização Fetal/instrumentação , Lactatos/análise , Membranas Artificiais , Microdiálise , Tela Subcutânea/química , Acidose/diagnóstico , Animais , Feminino , Doenças Fetais/diagnóstico , Monitorização Fetal/métodos , Modelos Animais , Oximetria , Gravidez , Ratos Wistar
9.
PLoS One ; 15(4): e0230708, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32271786

RESUMO

Neonatal calf diarrhea (NCD) is a major problem to calf health worldwide, in terms of both morbidity and mortality. A five-point ordinal scale clinical assessment scoring (CAS) chart was utilized to assess calves suffering from NCD-related clinical abnormalities (acidosis and dehydration) on commercial farms. The objective of this research was to determine the predictive capability of this CAS chart against gold standard blood gas parameters, designed to assist farmers in the accurate assessment of the clinical consequences of NCD. A total of 443 diarrheic and non-diarrheic calves were enrolled in the study. The CAS chart rated a calf's health from no clinical signs to varying degrees of clinical severity on a 0 (clinically normal) to 4 (grave) scale, based on clinical indicators including calf demeanour, ear position, mobility, suckle reflex, desire-to-feed, and enophthalmos. Blood gas analysis was conducted for individual calves, consisting of pH, base excess, Na+, K+, Ca2+, Cl-, glucose, total hemoglobin, bicarbonate, anion gap, and strong ion difference. Statistical evaluation was performed by comparison of the CAS score with blood gas profiles using ordinal logistic regression and a non-parametric estimation of the Receiver Operating Characteristics (ROC). The ROC analysis indicated that the CAS chart had acceptable specificity (>95%) with low sensitivity (<60%) in differentiating clinically normal from acidotic/dehydrated cases. Assessment of individual severity classes indicated that the chart can predict and differentiate both clinically normal and advanced cases from the other severity classes (peak estimations >80%) but had reduced accuracy in differentiating mild and moderate cases (peak estimations >50%). The chart, as presented, provides a simple tool to differentiate clinically normal from calves suffering the consequences of diarrhea, but fails to accurately differentiate severity for NCD related acidosis and dehydration. Further efforts are required to enhance the sensitivity and differential diagnostic value of this type of chart.


Assuntos
Animais Recém-Nascidos , Doenças dos Bovinos/diagnóstico , Técnicas e Procedimentos Diagnósticos/veterinária , Diarreia/diagnóstico , Design de Software , Acidose/sangue , Acidose/diagnóstico , Acidose/veterinária , Animais , Gasometria/normas , Gasometria/veterinária , Bovinos , Doenças dos Bovinos/sangue , Doenças dos Bovinos/patologia , Desidratação/sangue , Desidratação/diagnóstico , Desidratação/veterinária , Técnicas e Procedimentos Diagnósticos/normas , Diarreia/sangue , Diarreia/patologia , Diarreia/veterinária , Feminino , Masculino , Valor Preditivo dos Testes , Prognóstico , Projetos de Pesquisa , Índice de Gravidade de Doença
11.
Pediatr Hematol Oncol ; 37(3): 245-247, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31984843

RESUMO

Acute lymphoblastic leukemia maintenance chemotherapy includes mercaptopurine, a purine analog with uncommon side effects, that can be life-threatening. We describe a 7-year-old female patient with ALL that presented with altered state of consciousness after maintenance chemotherapy with methotrexate and 6-mercaptopurine, due to severe hypoglycemia with metabolic acidosis. She initiated metabolic corrections with rapid resolution of symptoms. Hypoglycemia secondary to 6-mercaptopurine is a rare and transient side effect. The cause effect relation is difficult to establish, leading to underdiagnosis. Hypoglycemia is preventable without compromising maintenance therapy efficacy.


Assuntos
Acidose , Hipoglicemia , Mercaptopurina , Leucemia-Linfoma Linfoblástico de Células Precursoras , Acidose/sangue , Acidose/induzido quimicamente , Acidose/diagnóstico , Criança , Feminino , Humanos , Hipoglicemia/sangue , Hipoglicemia/induzido quimicamente , Hipoglicemia/diagnóstico , Mercaptopurina/administração & dosagem , Mercaptopurina/efeitos adversos , Leucemia-Linfoma Linfoblástico de Células Precursoras/sangue , Leucemia-Linfoma Linfoblástico de Células Precursoras/tratamento farmacológico , Índice de Gravidade de Doença
12.
J Am Soc Nephrol ; 31(3): 469-482, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31988269

RESUMO

Retrospective analyses and single-center prospective studies identify chronic metabolic acidosis as an independent and modifiable risk factor for progression of CKD. In patients with CKD, untreated chronic metabolic acidosis often leads to an accelerated reduction in GFR. Mechanisms responsible for this reduction include adaptive responses that increase acid excretion but lead to a decline in kidney function. Metabolic acidosis in CKD stimulates production of intrakidney paracrine hormones including angiotensin II, aldosterone, and endothelin-1 (ET-1) that mediate the immediate benefit of increased kidney acid excretion, but their chronic upregulation promotes inflammation and fibrosis. Chronic metabolic acidosis also stimulates ammoniagenesis that increases acid excretion but also leads to ammonia-induced complement activation and deposition of C3 and C5b-9 that can cause tubule-interstitial damage, further worsening disease progression. These effects, along with acid accumulation in kidney tissue, combine to accelerate progression of kidney disease. Treatment of chronic metabolic acidosis attenuates these adaptive responses; reduces levels of angiotensin II, aldosterone, and ET-1; reduces ammoniagenesis; and diminishes inflammation and fibrosis that may lead to slowing of CKD progression.


Assuntos
Acidose/complicações , Aldosterona/metabolismo , Angiotensina II/metabolismo , Progressão da Doença , Endotelina-1/metabolismo , Insuficiência Renal Crônica/fisiopatologia , Equilíbrio Ácido-Base/efeitos dos fármacos , Equilíbrio Ácido-Base/fisiologia , Acidose/diagnóstico , Acidose/tratamento farmacológico , Adaptação Fisiológica/fisiologia , Biomarcadores/sangue , Feminino , Seguimentos , Taxa de Filtração Glomerular/fisiologia , Humanos , Falência Renal Crônica/etiologia , Falência Renal Crônica/fisiopatologia , Masculino , Estudos Prospectivos , Insuficiência Renal Crônica/etiologia , Estudos Retrospectivos , Medição de Risco , Índice de Gravidade de Doença , Fatores de Tempo , Resultado do Tratamento
13.
Spine Deform ; 8(2): 345-348, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-31925762

RESUMO

We report the case of a 12-year-old female, otherwise healthy patient, who underwent surgery for scoliosis correction in prone position under total intravenous general anesthesia, with CardioQ and sensory-motor-evoked potentials for hemodynamic and neurological monitoring. The patient showed severe intraoperative hypotension, lactic acidosis, and complete abolition of motor-evoked potentials during the positioning of posterior corrective bars. During the postoperative period, the increase in muscle and liver enzymes indicated an abdominal organ damage and confirmed hypoperfusion of the lower limbs. Both side effects were caused by the malposition of the patient on the operating table. The case resolved within the first postoperative week without sequelae.


Assuntos
Complicações Intraoperatórias/diagnóstico , Complicações Intraoperatórias/etiologia , Fígado/lesões , Músculo Esquelético/lesões , Posicionamento do Paciente/efeitos adversos , Decúbito Ventral , Escoliose/cirurgia , Fusão Vertebral/efeitos adversos , Acidose/diagnóstico , Acidose/etiologia , Criança , Potencial Evocado Motor , Feminino , Humanos , Hipotensão/diagnóstico , Hipotensão/etiologia , Doença Iatrogênica , Monitorização Neurofisiológica Intraoperatória , Ácido Láctico , Fusão Vertebral/métodos
14.
Am J Perinatol ; 37(7): 762-768, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-31121633

RESUMO

OBJECTIVE: Electronic fetal monitoring (EFM) is intended to assess fetal well-being during labor. Our objective was to test the hypothesis that findings of a category I tracing at any time in the 60 minutes prior to delivery would rule out neonatal acidemia. STUDY DESIGN: This was a planned secondary analysis of a single-center prospective cohort study of 8,580 singleton pregnancies undergoing labor with nonanomalous infants at term. Monitoring was reviewed by obstetric research nurses at 10-minute intervals in the 60 minutes prior to delivery. The primary outcome was acidemia, defined as an umbilical cord arterial pH of 7.10 or less. RESULTS: Of the 4,274 patients included, 42 (0.98%) infants had acidemia at birth. Of the 42 infants with acidemia, 13 (31%) had category I tracings in the 30 minutes prior to delivery. Three (7%) infants had neonatal acidemia despite category I tracing for >40 minutes in the 60 minutes prior to delivery. CONCLUSION: Even in the presence of category I tracing in the 60 minutes prior to delivery, neonatal acidemia can still occur. Periods of category I should be interpreted within the clinical context of a priori risk for acidemia, knowing that it does not completely rule out acidemia.


Assuntos
Acidose/diagnóstico , Cardiotocografia , Sangue Fetal/química , Recém-Nascido/sangue , Feminino , Frequência Cardíaca Fetal , Humanos , Trabalho de Parto , Gravidez , Estudos Prospectivos
15.
J Matern Fetal Neonatal Med ; 33(3): 404-409, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-29945485

RESUMO

Introduction: The intrapartum cardiotocography (CTG) classification system by FIGO in 2015 (FIGO2015) was introduced to simplify CTG interpretation, but it is not harmonized with the fetal ECG ST analysis (STAN) algorithm from 2007 (STAN2007), which is based on the FIGO CTG system from 1987. The study aimed to determine time courses and sensitivity between the systems in classifying CTG + ST events to indicate metabolic acidosis at birth.Material and methods: Forty-four cases with umbilical cord artery metabolic acidosis were retrieved from a European multicenter database. CTG patterns and timing of the first occurring significant ST events were evaluated post hoc in consensus by an expert panel and sensitivity statistics were performed. Wilcoxon's matched-pairs signed-ranks test and McNemar's test were used with a two-tailed p < .05 regarded significant.Results: STAN2007 had a higher sensitivity (73 versus 43%, p = .0002) and alarmed for metabolic acidosis in mean 34 min earlier than the FIGO2015 system did (p = .002). In every fourth case, the time difference was ≥20 min.Conclusions: In this simulation study, surveillance with STAN2007 combined with fetal ECG ST analysis had a significantly higher sensitivity and would have alarmed for metabolic acidosis significantly earlier than the new FIGO system would have.


Assuntos
Acidose/diagnóstico , Cardiotocografia , Acidose/sangue , Eletrocardiografia , Feminino , Sangue Fetal/química , Humanos , Recém-Nascido , Masculino
16.
Theriogenology ; 142: 303-309, 2020 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-31711710

RESUMO

During stage II of parturition, the bovine fetus is at risk of oxygen deficiency caused by insufficient gas exchange between the dam and the fetus. The early detection of this critical condition, followed by assistance at calving, can help to improve the vitality of the newborn calf, or even prevent it from being born dead. By using pulse oximetry, the arterial oxygen saturation, as well as the pulse rate, can be continuously and non-invasively measured. The aim of our study was to identify critical thresholds for the parameters 'arterial oxygen saturation (FSpO2)' and 'pulse rate (PR)' that indicate a severe postnatal risk for calves to suffer from acidosis. FSpO2 and PR from 40 bovine fetuses were recorded during the last 25 min of calving with a commercially available pulse oximeter (Radius-7, Masimo Corporation, Irvine, USA). The calves were tested immediately after birth for acidosis by analyzing their blood with a portable blood gas analyzer (VetScan iStat1, Abaxis Inc., Union City, USA). Retrospectively, the pulsoximetric data were scanned for predefined patterns. The validity of these patterns to predict acidosis in newborn calves was analyzed by using receiver operating characteristics (ROC) curve analyses. In general, PR was a stronger predictive parameter for acidosis than FSpO2, with the greatest area under the curve (AUC) for the PR criteria 'Pulse rate > 120 beats per minute (bpm) for at least 2 min', with an AUC of 0.764, in contrast to an AUC of 0.613 for the best FSpO2 criteria 'FSpO2 < 40% for at least 50% of the measurement'. Further studies should investigate whether vitality after calving can be improved and fetal death rate can be reduced when obstetric assistance is performed as soon as one of these criteria apply to the bovine fetus. For more practical implementation in the field, improvement of the device's hardware would be necessary.


Assuntos
Acidose/diagnóstico , Artérias/química , Doenças Fetais/diagnóstico , Monitorização Fetal , Frequência Cardíaca Fetal , Oximetria , Oxigênio/sangue , Acidose/veterinária , Animais , Animais Recém-Nascidos , Bovinos , Doenças dos Bovinos/diagnóstico , Feminino , Doenças Fetais/veterinária , Monitorização Fetal/métodos , Monitorização Fetal/veterinária , Trabalho de Parto/fisiologia , Masculino , Oximetria/métodos , Oximetria/veterinária , Oxigênio/análise , Valor Preditivo dos Testes , Gravidez , Prognóstico , Troca Gasosa Pulmonar/fisiologia , Reprodutibilidade dos Testes , Estudos Retrospectivos
17.
Arch Pediatr ; 27(1): 6-11, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31776075

RESUMO

INTRODUCTION: The best biomarker for neonatal metabolic acidosis (NMA) and its related complications is still a matter of debate. Umbilical artery (Ua) cord pH is not sufficiently specific, as is lactatemia, while base deficit is considered to offer no added value. From a physiological point of view, the calculated neonatal eucapnic pH is a more specific marker for neonatal metabolic acidosis and may be a better predictor of birth complications of hypoxic origin, because complications related to asphyxia are always preceded by neonatal depression leading to a transfer to a neonatal intensive care unit (NICU) for close monitoring. OBJECTIVE: This study aimed to test the hypothesis that in a group of neonates with significant acidemia, neonatal eucapnic pH (pH euc-n) predicts NICU admission better than the Ua cord pH does. METHODS: From a cohort of 5,392 infants all born at ≥35 weeks' gestation, we identified a group of 30 cases with Ua cord pH <7.0. We calculated the area under the curve (AUC) for pH euc-n and Ua cord pH using the receiver-operating characteristic (ROC) curve and compared the performance of these biological markers in predicting transfer to the NICU. Cut-off points were determined by selecting the best value of the positive likelihood ratio that maximizes the accuracy of prediction. RESULTS: From the 30 newborns diagnosed with significant acidemia, four infants were transferred to the NICU. No case of neonatal encephalopathy was observed. In these infants, the pH euc-n AUC (0.66) was significantly higher than the Ua cord pH AUC (0.44) (P<0.005), with the best pH euc-n cut-off value at 7.11. CONCLUSION: Despite the study limitations, our results suggest that pH euc-n is a better marker than Ua pH for predicting admission to the NICU in newborns with acidemia at birth. These are preliminary results and further investigations are mandatory in larger population samples to confirm these findings and to determine the optimal cut-off value for pH euc-n for the most accurate prediction of a complicated transition to extrauterine life and, potentially, neonatal hypoxic-ischemic encephalopathy.


Assuntos
Acidose/diagnóstico , Sangue Fetal/fisiologia , Biomarcadores/sangue , Dióxido de Carbono/sangue , Estudos de Coortes , Feminino , Humanos , Concentração de Íons de Hidrogênio , Hipóxia-Isquemia Encefálica/sangue , Recém-Nascido , Doenças do Recém-Nascido , Unidades de Terapia Intensiva Neonatal , Masculino , Curva ROC
18.
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
19.
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
20.
Med Klin Intensivmed Notfmed ; 115(4): 275-280, 2020 May.
Artigo em Alemão | MEDLINE | ID: mdl-30725274

RESUMO

Acid-base disorders and in particular metabolic acidosis are very common in critically ill patients and contribute significantly to morbidity and mortality. We shed light on the most common causes, the pathophysiology and treatments. Particular attention will be paid to the common practice of substituting sodium bicarbonate in the light of recent study results.


Assuntos
Acidose/diagnóstico , Acidose/terapia , Bicarbonatos , Equilíbrio Ácido-Base , Estado Terminal , Humanos
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