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1.
Acta Vet Scand ; 63(1): 43, 2021 Nov 14.
Artigo em Inglês | MEDLINE | ID: mdl-34775972

RESUMO

BACKGROUND: The physiology of sheep as small ruminants is remarkably different from monogastric animals especially regarding the forestomach system. Using sheep for surgical procedures during scientific research thereby presents an exceptional setting for the anaesthetist. Long-term anaesthesia generally demands deprivation of food to reduce the risk of bloat in sheep. This might influence the energy and electrolyte balance. In horses and companion animals, close monitoring of mean arterial blood pressure, capnography and blood gas analysis are common procedures during long-term surgery. However, few data are available on reference ranges for blood gas in sheep and these cover only short periods of anaesthesia. To the authors' knowledge, there is no study available that includes the monitoring of electrolytes and pH in ruminal fluid and kidney function tests in sheep undergoing long term anaesthesia. Thereby, the aim of the present study was to gather data on blood parameters, and data on ruminal fluid and kidney function during long-term anaesthesia in sheep. Data were obtained from eight sheep undergoing the invasive surgical procedure of left pneumonectomy and auto-transplantation or isolated left lung perfusion. After a 19-h fasting period, the animals were administered xylazine and ketamine and then intubated and maintained in general anaesthesia under artificial ventilation using isoflurane in oxygen. Blood samples were evaluated during 9 h of anaesthesia; ruminal fluid and kidney function tests were evaluated during 7 h of anaesthesia. RESULTS: Blood parameters such as electrolytes and partial pressure of carbon dioxide revealed few changes, yet blood glucose decreased and beta-hydroxybutyric acid increased significantly. All animals showed an elevated arterial pH and bicarbonate concentration despite artificial ventilation. In ruminal fluid, the pH significantly decreased and no significant changes in electrolytes occurred. Kidney function tests revealed no significant changes in any of the animals. However, fractional excretion of water and phosphate was slightly increased. One animal showed severe complications due to hypokalaemia. CONCLUSION: Invasive surgery under long-term anaesthesia in sheep is possible without great imbalances of arterial pH and electrolytes. Nevertheless, potassium concentrations should be monitored carefully, as a deficiency can lead to life-threatening complications. The operated sheep tended not to develop metabolic acidosis and the mean kidney function could be maintained within the physiological range throughout anaesthesia. However, slight elevations in renal fractional water and phosphate excretion could suggest an early tubular reabsorption dysfunction. In ruminal fluid, acidification occurred, though no significant changes were observed in L- and D-lactate levels or in electrolyte concentrations. To our knowledge, the role of the rumen in storing fluids and balancing electrolytes in the blood has not yet been documented during anaesthesia. However, the importance of the rumen for fluid equilibrium in sheep indicates the necessity for routine monitoring and further research.


Assuntos
Acidose , Ovinos , Acidose/etiologia , Acidose/veterinária , Animais , Eletrólitos , Concentração de Íons de Hidrogênio , Testes de Função Renal , Rúmen , Ovinos/cirurgia
2.
JAAPA ; 34(12): 31-33, 2021 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-34813533

RESUMO

ABSTRACT: This article describes a rare case of lactation ketoacidosis in a patient who started a ketogenic diet while nursing an infant and toddler. The patient presented to the ED with a history of nausea, vomiting, and postural dizziness, and was found to have a significant metabolic acidosis and elevated lipase level. The metabolic changes induced in this patient could occur in anyone with high metabolic demands who also is on a strict ketogenic diet. The case highlights the importance of a dietary history in patients with unexplained metabolic derangements.


Assuntos
Acidose , Dieta Cetogênica , Cetose , Acidose/etiologia , Dieta Cetogênica/efeitos adversos , Feminino , Humanos , Lactente , Cetose/etiologia , Lactação , Vômito
3.
Ugeskr Laeger ; 183(33)2021 08 16.
Artigo em Dinamarquês | MEDLINE | ID: mdl-34477100

RESUMO

It is a common but flawed presumption that blood lactate reflects the lactic acid production in the body's tissues. Lactate is formed directly from pyruvate and functions to dampen reductions in intracellular pH through lactate-H+ cotransport to the extracellular space. Though this may give rise to elevated blood lactate, increased lactate production is not the cause of metabolic acidosis in such instances. "Lactic acidosis" is thus an inappropriate term as it indicates causality and in this review, we suggest that in the future, the term "hyperlactataemia-associated metabolic acidosis" should be used instead.


Assuntos
Acidose Láctica , Acidose , Acidose/diagnóstico , Acidose/etiologia , Acidose Láctica/diagnóstico , Acidose Láctica/etiologia , Humanos , Ácido Láctico
4.
Nutrients ; 13(8)2021 Jul 24.
Artigo em Inglês | MEDLINE | ID: mdl-34444694

RESUMO

Metabolic acidosis is a severe complication of chronic kidney disease (CKD) which is associated with nefarious impairments such as bone demineralization, muscle wasting, and hormonal alterations, for example, insulin resistance. Whilst it is possible to control this condition with alkali treatment, consisting in the oral administration of sodium citrate or sodium bicarbonate, this type of intervention is not free from side effects. On the contrary, opting for the implementation of a targeted dietetic-nutritional treatment for the control of CKD metabolic acidosis also comes with a range of additional benefits such as lipid profile control, increased vitamins, and antioxidants intake. In our review, we evaluated the main dietary-nutritional regimens useful to counteract metabolic acidosis, such as the Mediterranean diet, the alkaline diet, the low-protein diet, and the vegan low-protein diet, analyzing the potentialities and limits of every dietary-nutritional treatment. Literature data suggest that the Mediterranean and alkaline diets represent a valid nutritional approach in the prevention and correction of metabolic acidosis in CKD early stages, while the low-protein diet and the vegan low-protein diet are more effective in CKD advanced stages. In conclusion, we propose that tailored nutritional approaches should represent a valid therapeutic alternative to counteract metabolic acidosis.


Assuntos
Acidose/dietoterapia , Dieta/métodos , Terapia Nutricional/métodos , Insuficiência Renal Crônica/dietoterapia , Equilíbrio Ácido-Base , Acidose/etiologia , Acidose/prevenção & controle , Dieta Mediterrânea , Dieta com Restrição de Proteínas , Dieta Vegana , Humanos , Insuficiência Renal Crônica/complicações
5.
Cells ; 10(7)2021 07 06.
Artigo em Inglês | MEDLINE | ID: mdl-34359883

RESUMO

While sudden loss of perfusion is responsible for ischemia, failure to supply the required amount of oxygen to the tissues is defined as hypoxia. Among several pathological conditions that can impair brain perfusion and oxygenation, cardiocirculatory arrest is characterized by a complete loss of perfusion to the brain, determining a whole brain ischemic-anoxic injury. Differently from other threatening situations of reduced cerebral perfusion, i.e., caused by increased intracranial pressure or circulatory shock, resuscitated patients after a cardiac arrest experience a sudden restoration of cerebral blood flow and are exposed to a massive reperfusion injury, which could significantly alter cellular metabolism. Current evidence suggests that cell populations in the central nervous system might use alternative metabolic pathways to glucose and that neurons may rely on a lactate-centered metabolism. Indeed, lactate does not require adenosine triphosphate (ATP) to be oxidated and it could therefore serve as an alternative substrate in condition of depleted energy reserves, i.e., reperfusion injury, even in presence of adequate tissue oxygen delivery. Lactate enriched solutions were studied in recent years in healthy subjects, acute heart failure, and severe traumatic brain injured patients, showing possible benefits that extend beyond the role as alternative energetic substrates. In this manuscript, we addressed some key aspects of the cellular metabolic derangements occurring after cerebral ischemia-reperfusion injury and examined the possible rationale for the administration of lactate enriched solutions in resuscitated patients after cardiac arrest.


Assuntos
Acidose/prevenção & controle , Lesões Encefálicas Traumáticas/prevenção & controle , Parada Cardíaca/complicações , Hipóxia-Isquemia Encefálica/prevenção & controle , Ácido Láctico/uso terapêutico , Fármacos Neuroprotetores/uso terapêutico , Traumatismo por Reperfusão/prevenção & controle , Acidose/etiologia , Acidose/patologia , Animais , Lesões Encefálicas Traumáticas/etiologia , Lesões Encefálicas Traumáticas/patologia , Morte Celular/efeitos dos fármacos , Circulação Cerebrovascular/efeitos dos fármacos , Metabolismo Energético/efeitos dos fármacos , Parada Cardíaca/patologia , Parada Cardíaca/terapia , Humanos , Soluções Hipertônicas , Hipóxia-Isquemia Encefálica/etiologia , Hipóxia-Isquemia Encefálica/patologia , Neurônios/efeitos dos fármacos , Neurônios/metabolismo , Neurônios/patologia , Estresse Oxidativo/efeitos dos fármacos , Traumatismo por Reperfusão/etiologia , Traumatismo por Reperfusão/patologia , Ressuscitação/métodos
6.
Nutrients ; 13(7)2021 Jun 22.
Artigo em Inglês | MEDLINE | ID: mdl-34206629

RESUMO

A perinatal high-salt (HS) diet was reported to elevate plasma triglycerides. This study aimed to investigate the hypothesis that a perinatal HS diet predisposed offspring to non-alcoholic fatty liver disease (NAFLD), the hepatic manifestation of abnormal lipid metabolism, and the possible mechanism. Female C57BL/6 mice were fed a control diet (0.5% NaCl) or HS diet (4% NaCl) during pregnancy and lactation and their offspring were sacrificed at weaning. The perinatal HS diet induced greater variation in fecal microbial beta-diversity (ß-diversity) and increased bacteria abundance of Proteobacteria and Bacteroides. The gut microbiota dysbiosis promoted bile acid homeostasis disbalance, characterized by the accumulation of lithocholic acid (LCA) and deoxycholic acid (DCA) in feces. These alterations disturbed gut barrier by increasing the expression of tight junction protein (Tjp) and occludin (Ocln), and increased systemic lipopolysaccharide (LPS) levels and hepatic inflammatory cytokine secretion (TNF-α and IL-6) in the liver. The perinatal HS diet also inhibited hepatic expression of hepatic FXR signaling (CYP7A1 and FXR), thus triggering increased hepatic expression of pro-inflammatory cytokines (TNF-α and IL-6) and hepatic lipid metabolism-associated genes (SREBP-1c, FAS, ACC), leading to unique characteristics of NAFLD. In conclusion, a perinatal HS diet induced NAFLD in weanling mice offspring; the possible mechanism was related to increased bacteria abundance of Proteobacteria and Bacteroides, increased levels of LCA and DCA in feces, and increased expressions of hepatic FXR signaling.


Assuntos
Dieta/efeitos adversos , Fenômenos Fisiológicos da Nutrição Materna , Efeitos Tardios da Exposição Pré-Natal/etiologia , Sódio na Dieta/efeitos adversos , Acidose/etiologia , Animais , Animais Recém-Nascidos , Ácidos e Sais Biliares/metabolismo , Dieta/métodos , Disbiose/etiologia , Feminino , Microbioma Gastrointestinal/fisiologia , Homeostase/fisiologia , Lactação/metabolismo , Metabolismo dos Lipídeos , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Hepatopatia Gordurosa não Alcoólica/etiologia , Gravidez , Transdução de Sinais/fisiologia , Triglicerídeos/sangue , Desmame
7.
Nephrol Dial Transplant ; 36(10): 1806-1820, 2021 09 27.
Artigo em Inglês | MEDLINE | ID: mdl-34240183

RESUMO

BACKGROUND: Metabolic acidosis occurs frequently in patients with kidney transplant and is associated with a higher risk for and accelerated loss of graft function. To date, it is not known whether alkali therapy in these patients improves kidney function and whether acidosis and its therapy are associated with altered expression of proteins involved in renal acid-base metabolism. METHODS: We retrospectively collected kidney biopsies from 22 patients. Of these patients, nine had no acidosis, nine had metabolic acidosis [plasma bicarbonate (HCO3- <22 mmol/L) and four had acidosis and received alkali therapy. We performed transcriptome analysis and immunohistochemistry for proteins involved in renal acid-base handling. RESULTS: We found that the expression of 40 transcripts significantly changed between kidneys from non-acidotic and acidotic patients. These genes are mostly involved in proximal tubule (PT) amino acid and lipid metabolism and energy homoeostasis. Three transcripts were fully recovered by alkali therapy: the Kir4.2 potassium channel, an important regulator of PT HCO3- metabolism and transport, acyl-CoA dehydrogenase short/branched chain and serine hydroxymethyltransferase 1, genes involved in beta oxidation and methionine metabolism. Immunohistochemistry showed reduced staining for the PT NBCe1 HCO3- transporter in kidneys from acidotic patients who recovered with alkali therapy. In addition, the HCO3- exchanger pendrin was affected by acidosis and alkali therapy. CONCLUSIONS: Metabolic acidosis in kidney transplant recipients is associated with alterations in the renal transcriptome that are partly restored by alkali therapy. Acid-base transport proteins mostly from PT were also affected by acidosis and alkali therapy, suggesting that the downregulation of critical players contributes to metabolic acidosis in these patients.


Assuntos
Acidose , Transplante de Rim , Equilíbrio Ácido-Base , Acidose/etiologia , Álcalis , Humanos , Transplante de Rim/efeitos adversos , Estudos Retrospectivos
8.
J Int Med Res ; 49(6): 3000605211024480, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34162258

RESUMO

Compared with monopolar transurethral resection of the prostate (TURP), which requires electrolyte-free irrigation fluid, normal saline can be used as the irrigation solution in bipolar and laser TURP. The risk of TURP syndrome and severe electrolyte disturbance is minimized when normal saline is used as the irrigation fluid. However, the use of isotonic saline also causes acid-base imbalance and electrolyte disturbance. We experienced two patients who developed hyperchloremic metabolic acidosis during bipolar TURP. After proper intervention, hemodynamic instability resolved, and laboratory test results normalized. Anesthesiologists must pay attention to acid-base and electrolyte status when rapid absorption of excessive isotonic solution is suspected, even during bipolar and laser TURP, which use normal saline as the irrigation fluid.


Assuntos
Acidose , Hiperplasia Prostática , Ressecção Transuretral da Próstata , Acidose/etiologia , Humanos , Masculino , Próstata , Hiperplasia Prostática/cirurgia , Ressecção Transuretral da Próstata/efeitos adversos , Resultado do Tratamento , Procedimentos Cirúrgicos Urológicos
9.
Diabetes Care ; 44(9): 2061-2068, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34187840

RESUMO

OBJECTIVE: Fluid replacement to correct dehydration, acidosis, and electrolyte abnormalities is the cornerstone of treatment for diabetic ketoacidosis (DKA), but little is known about optimal fluid infusion rates and electrolyte content. The objective of this study was to evaluate whether different fluid protocols affect the rate of normalization of biochemical derangements during DKA treatment. RESEARCH DESIGN AND METHODS: The current analysis involved moderate or severe DKA episodes (n = 714) in children age <18 years enrolled in the Fluid Therapies Under Investigation in DKA (FLUID) Trial. Children were assigned to one of four treatment groups using a 2 × 2 factorial design (0.90% or 0.45% saline and fast or slow rate of administration). RESULTS: The rate of change of pH did not differ by treatment arm, but Pco2 increased more rapidly in the fast versus slow fluid infusion arms during the initial 4 h of treatment. The anion gap also decreased more rapidly in the fast versus slow infusion arms during the initial 4 and 8 h. Glucose-corrected sodium levels remained stable in patients assigned to 0.90% saline but decreased in those assigned to 0.45% saline at 4 and 8 h. Potassium levels decreased, while chloride levels increased more rapidly with 0.90% versus 0.45% saline. Hyperchloremic acidosis occurred more frequently in patients in the fast arms (46.1%) versus the slow arms (35.2%). CONCLUSIONS: In children treated for DKA, faster fluid administration rates led to a more rapid normalization of anion gap and Pco2 than slower fluid infusion rates but were associated with an increased frequency of hyperchloremic acidosis.


Assuntos
Acidose , Cetoacidose Diabética , Acidose/etiologia , Acidose/terapia , Adolescente , Criança , Cetoacidose Diabética/tratamento farmacológico , Cetoacidose Diabética/terapia , Eletrólitos , Hidratação , Humanos , Sódio
10.
Undersea Hyperb Med ; 48(2): 157-168, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33975406

RESUMO

Introduction: Safe administration of critical care hyperbaric medicine requires specialized equipment and advanced training. Equipment must be tested in order to evaluate function in the hyperbaric environment. High-frequency percussive ventilation (HFPV) has been used in intensive care settings effectively, but it has never been tested in a hyperbaric chamber. Methods: Following a modified U.S. Navy testing protocol used to evaluate hyperbaric ventilators, we evaluated an HFPV transport ventilator in a multiplace hyperbaric chamber at 1.0, 1.9, and 2.8 atmospheres absolute (ATA). We used a test lung with analytical software for data collection. The ventilator uses simultaneous cyclic pressure-controlled ventilation at a pulsatile flow rate (PFR)/oscillatory continuous positive airway pressure (oCPAP) ratio of 30/10 with a high-frequency oscillation percussive rate of 500 beats per minute. Inspiratory and expiratory times were maintained at two seconds throughout each breathing cycle. Results: During manned studies, the PFR/oCPAP ratios were 26/6, 22/7, and 22.5/8 at an airway resistance of 20cm H2O/L/second and 18/9, 15.2/8.5, and 13.6/7 at an airway resistance of 50 cm/H2O/L/second at 1, 1.9, and 2.8 ATA. The resulting release volumes were 800, 547, and 513 mL at airway resistance of 20 cm H2O/L/sec and 400, 253, and 180 mL at airway resistance of 50 cm/H2O/L/sec at 1, 1.9, and 2.8 ATA. Unmanned testing showed similar changes. The mean airway pressure (MAP) remained stable throughout all test conditions; theoretically, supporting adequate lung recruitment and gas exchange. A case where HFPV was used to treat a patient for CO poisoning was presented to illustrate that HFPV worked well under HBO2 conditions and no complications occurred during HBO2 treatment. Conclusion: The HFPV transport ventilator performed adequately under hyperbaric conditions and should be considered a viable option for hyperbaric critical care. This ventilator has atypical terminology and produces unique pulmonary physiology, thus requiring specialized training prior to use.


Assuntos
Ventilação de Alta Frequência/instrumentação , Oxigenação Hiperbárica/instrumentação , Lesão por Inalação de Fumaça/terapia , Ventiladores Mecânicos , Acidose/etiologia , Idoso , Resistência das Vias Respiratórias , Pressão Atmosférica , Intoxicação por Monóxido de Carbono/complicações , Feminino , Ventilação de Alta Frequência/métodos , Humanos , Oxigenação Hiperbárica/métodos , Pulmão/fisiologia , Respiração com Pressão Positiva/instrumentação , Respiração com Pressão Positiva/métodos , Troca Gasosa Pulmonar/fisiologia , Fluxo Pulsátil , Valores de Referência , Respiração
11.
Medicine (Baltimore) ; 100(17): e25724, 2021 Apr 30.
Artigo em Inglês | MEDLINE | ID: mdl-33907164

RESUMO

ABSTRACT: Metabolic acidosis is observed in 98% of patients with out-of-hospital cardiac arrest (OHCA). The longer the no-flow or low-flow duration, the more severe is the acidosis in these patients. This study explored whether blood pH in early stages of advanced life support (ALS) was an independent predictor of neurological prognosis in patients with OHCA.We retrospectively enrolled patients with OHCA from January 2012 to June 2018 in a single-medical tertiary hospital in Taiwan. Patients with OHCA whose blood gas analyses within 5 minutes after receiving ALS at the emergency department (ED) were enrolled. Patients younger than 20 years old, with cardiac arrest resulting from traumatic or circumstantial causes, with return of spontaneous circulation (ROSC) before ED arrival, lacking record of initial blood gas analysis, and with do-not-resuscitate orders were excluded. The primary outcome of this study was neurological status at hospital discharge.In total, 2034 patients with OHCA were enrolled. The majority were male (61.89%), and the average age was 67.8 ±â€Š17.0 years. Witnessed OHCA was noted in 571 cases, cardiopulmonary resuscitation was performed before paramedic arrival in 512 (25.2%) cases, and a shockable rhythm was observed in 269 (13.2%). Blood pH from initial blood gas analysis remained an independent predictor of neurological outcome after multivariate regression.Blood pH at early stages of ALS was an independent prognostic factor of post-OHCA neurological outcome. Blood gas analysis on arrival at the ED may provide additional information about the prognosis of patients with OHCA.


Assuntos
Acidose , Gasometria , Reanimação Cardiopulmonar/métodos , Serviços Médicos de Emergência , Doenças do Sistema Nervoso , Parada Cardíaca Extra-Hospitalar , Acidose/diagnóstico , Acidose/etiologia , Idoso , Gasometria/métodos , Gasometria/estatística & dados numéricos , Reanimação Cardiopulmonar/normas , Serviços Médicos de Emergência/métodos , Serviços Médicos de Emergência/estatística & dados numéricos , Feminino , Humanos , Concentração de Íons de Hidrogênio , Masculino , Doenças do Sistema Nervoso/diagnóstico , Doenças do Sistema Nervoso/epidemiologia , Doenças do Sistema Nervoso/etiologia , Exame Neurológico/métodos , Exame Neurológico/estatística & dados numéricos , Parada Cardíaca Extra-Hospitalar/sangue , Parada Cardíaca Extra-Hospitalar/complicações , Parada Cardíaca Extra-Hospitalar/epidemiologia , Parada Cardíaca Extra-Hospitalar/terapia , Avaliação de Processos e Resultados em Cuidados de Saúde , Prognóstico , Taiwan/epidemiologia , Centros de Atenção Terciária , Tempo para o Tratamento/estatística & dados numéricos
12.
Urologe A ; 60(5): 617-623, 2021 May.
Artigo em Alemão | MEDLINE | ID: mdl-33884463

RESUMO

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.


Assuntos
Acidose , Neoplasias da Bexiga Urinária , Derivação Urinária , Acidose/diagnóstico , Acidose/epidemiologia , Acidose/etiologia , Bicarbonatos , Cistectomia , Humanos , Fatores de Risco , Neoplasias da Bexiga Urinária/cirurgia , Derivação Urinária/efeitos adversos
13.
Am J Med Genet A ; 185(6): 1854-1857, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-33686767

RESUMO

The COVID-19 pandemic has affected the health and healthcare of individuals of all ages worldwide. There have been multiple reports and reviews documenting a milder effect and decreased morbidity and mortality in the pediatric population, but there have only been a small number of reports discussing the SARS-CoV-2 infection in the setting of an inborn error of metabolism (IEM). Here, we report two patients with underlying metabolic disorders, propionic acidemia and glutaric aciduria type 1, and discuss their clinical presentation, as well as their infectious and metabolic management. Our report demonstrates that individuals with an underlying IEM are at risk of metabolic decompensation in the setting of a COVID-19 infection. The SARS-CoV-2 virus does not appear to cause a more severe metabolic deterioration than is typical.


Assuntos
Erros Inatos do Metabolismo dos Aminoácidos/complicações , Encefalopatias Metabólicas/complicações , COVID-19/complicações , Glutaril-CoA Desidrogenase/deficiência , Acidemia Propiônica/complicações , SARS-CoV-2 , Acidose/etiologia , Acidose/terapia , Acidose Láctica/etiologia , Transfusão de Componentes Sanguíneos , COVID-19/diagnóstico , Teste de Ácido Nucleico para COVID-19 , Terapia Combinada , Proteínas na Dieta/administração & dosagem , Gerenciamento Clínico , Suscetibilidade a Doenças , Ingestão de Energia , Nutrição Enteral , Feminino , Hidratação , Glucose/administração & dosagem , Glucose/efeitos adversos , Humanos , Hiperamonemia/etiologia , Hiperamonemia/terapia , Hiperglicemia/induzido quimicamente , Hiperglicemia/tratamento farmacológico , Lactente , Insulina/uso terapêutico , Unidades de Terapia Intensiva Pediátrica , Oxigenoterapia , Pancitopenia/etiologia , Pancitopenia/terapia , Diálise Renal , Síndrome de Resposta Inflamatória Sistêmica/diagnóstico
14.
BMJ Case Rep ; 14(3)2021 Mar 25.
Artigo em Inglês | MEDLINE | ID: mdl-33766972

RESUMO

Sodium is an essential nutrient and inadequate sodium intake and/or excessive sodium losses can result in suboptimal growth. Infants with ileostomies are at significant risk of developing growth failure as a result of excessive sodium loss in their ileostomy effluent. Chronic sodium depletion can also limit the kidney's ability to excrete hydrogen and potassium ions, mimicking electrolyte abnormalities found in type 4 renal tubular acidosis. This report describes an infant with an ileostomy with severe growth failure, hyperkalaemia and metabolic acidosis-all of which promptly resolved with sodium supplementation.


Assuntos
Acidose Tubular Renal , Acidose , Hiponatremia , Acidose/etiologia , Insuficiência de Crescimento , Humanos , Ileostomia , Lactente , Sódio
15.
J Am Soc Nephrol ; 32(5): 1025-1028, 2021 05 03.
Artigo em Inglês | MEDLINE | ID: mdl-33769949

RESUMO

Two papers, one in 1986 and another one in 1988, reported a strong inverse correlation between urinary anion gap (UAG) and urine ammonia excretion (UNH4) in patients with metabolic acidosis and postulated that UAG could be used as an indirect measure of UNH4 This postulation has persisted until now and is widely accepted. In this review, we discuss factors regulating UAG and examine published evidence to uncover errors in the postulate and the design of the original studies. The essential fact is that, in the steady state, UAG reflects intake of Na, K, and Cl. Discrepancy between intake and urinary output of these electrolytes (i.e, UAG) indicates selective extrarenal loss of these electrolytes or nonsteady state. UNH4 excretion, which depends, in the absence of renal dysfunction, mainly on the daily acid load, has no consistent relationship to UAG either theoretically or in reality. Any correlation between UAG and UNH4, when observed, was a fortuitous correlation and cannot be extrapolated to other situations. Furthermore, the normal value of UAG has greatly increased over the past few decades, mainly due to increases in dietary intake of potassium and widespread use of sodium salts with anions other than chloride as food additives. The higher normal values of UAG must be taken into consideration in interpreting UAG.


Assuntos
Equilíbrio Ácido-Base/fisiologia , Acidose/diagnóstico , Acidose/metabolismo , Acidose/etiologia , Amônia/urina , Humanos
16.
BMC Cardiovasc Disord ; 21(1): 120, 2021 03 02.
Artigo em Inglês | MEDLINE | ID: mdl-33653281

RESUMO

BACKGROUND: Organ malperfusion is a lethal complication in acute type B aortic dissection (ATBAD). The aim of present study is to develop a nomogram integrated with metabolic acidosis to predict in-hospital mortality and organ malperfusion in patients with ATBAD undergoing thoracic endovascular aortic repair (TEVAR). METHODS: The nomogram was derived from a retrospectively study of 286 ATBAD patients who underwent TEVAR from 2010 to 2017 at a single medical center. Model performance was evaluated from discrimination and calibration capacities, as well as clinical effectiveness. The results were validated using a prospective study on 77 patients from 2018 to 2019 at the same center. RESULTS: In the multivariate analysis of the derivation cohort, the independent predictors of in-hospital mortality and organ malperfusion identified were base excess, maximum aortic diameter ≥ 5.5 cm, renal dysfunction, D-dimer level ≥ 5.44 µg/mL and albumin amount ≤ 30 g/L. The penalized model was internally validated by bootstrapping and showed excellent discriminatory (bias-corrected c-statistic, 0.85) and calibration capacities (Hosmer-Lemeshow P value, 0.471; Brier Score, 0.072; Calibration intercept, - 0.02; Slope, 0.98). After being applied to the external validation cohort, the model yielded a c-statistic of 0.86 and Brier Score of 0.097. The model had high negative predictive values (0.93-0.94) and moderate positive predictive values (0.60-0.71) for in-hospital mortality and organ malperfusion in both cohorts. CONCLUSIONS: A predictive nomogram combined with base excess has been established that can be used to identify high risk ATBAD patients of developing in-hospital mortality or organ malperfusion when undergoing TEVAR.


Assuntos
Acidose/mortalidade , Aneurisma Dissecante/cirurgia , Aneurisma da Aorta Torácica/cirurgia , Implante de Prótese Vascular/mortalidade , Técnicas de Apoio para a Decisão , Procedimentos Endovasculares/mortalidade , Mortalidade Hospitalar , Nomogramas , Acidose/diagnóstico , Acidose/etiologia , Doença Aguda , Adulto , Idoso , Aneurisma Dissecante/diagnóstico por imagem , Aneurisma Dissecante/mortalidade , Aneurisma Dissecante/fisiopatologia , Aneurisma da Aorta Torácica/diagnóstico por imagem , Aneurisma da Aorta Torácica/mortalidade , Aneurisma da Aorta Torácica/fisiopatologia , Implante de Prótese Vascular/efeitos adversos , Procedimentos Endovasculares/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Prospectivos , Reprodutibilidade dos Testes , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
17.
J Coll Physicians Surg Pak ; 31(1): 95-97, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33546543

RESUMO

Multiple carboxylase deficiency organic Acidemia is a rare inherited metabolic disorder. It is autosomal recessive disorder of two types: Holocarboxylase deficiency and Biotinidase deficiency. It is the metabolic disorder resulting from deficiency of biotin as a co-enzyme or reduced activity of biotin-dependent carboxylases (propionyl CoA carboxylase, and 3-methylcrotonyl CoA carboxylase and pyruvate carboxylase). A case of two months' female child is reported, who presented with recurrent infantile seizures and skin rash since birth; and biochemically with metabolic acidosis, hyper-ammonemia (on and off) since birth with multiple hospitalization. She had past history of jaundice. One sibling's death at 2nd day of life due to similar complaints. Initial presentation of raised ammonia and lactate levels were the first indication to this organic academia, which was later proven by increased peak levels of various organic acids on urine organic acid analysis by gas chromatography-mass spectrometry. Key Words: Multiple carboxylase deficiency, Holocarboxylase synthetase deficiency, Biotinidase deficiency.


Assuntos
Acidose , Deficiência de Holocarboxilase Sintetase , Deficiência Múltipla de Carboxilase , Acidose/etiologia , Biotina , Criança , Feminino , Deficiência de Holocarboxilase Sintetase/genética , Humanos , Convulsões/etiologia
18.
Am J Forensic Med Pathol ; 42(2): 174-177, 2021 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-33590987

RESUMO

ABSTRACT: Acute myeloid leukemia can rarely cause sudden, unexpected death in children. Presentation may be non-specific and death may occur in children with no prior medical history. Herein we present the case of a previously healthy 2-year and 2 month-old White girl, who on autopsy, was found to have acute myeloid leukemia with KMT2A rearrangement extensively involving all major thoracic and abdominal organs. This case is presented to the forensic community to discuss the presentation and findings in sudden death caused by acute leukemia. The case highlights when acute leukemia should enter the differential as a potential cause of death, as well as potential resources available in the postmortem workup of acute leukemias.


Assuntos
Morte Súbita/etiologia , Leucemia Mieloide Aguda/diagnóstico , Acidose/etiologia , Anemia/etiologia , Pré-Escolar , Feminino , Rearranjo Gênico , Histona-Lisina N-Metiltransferase/genética , Humanos , Hiperpotassemia/etiologia , Hipoglicemia/etiologia , Ácido Láctico/sangue , Leucemia Mieloide Aguda/complicações , Leucocitose/etiologia , Proteína de Leucina Linfoide-Mieloide/genética , Trombocitopenia/etiologia
19.
BMJ Case Rep ; 14(2)2021 Feb 23.
Artigo em Inglês | MEDLINE | ID: mdl-33622736

RESUMO

Diabetic ketoacidosis (DKA) is one of the most serious acute metabolic complications of diabetes mellitus. It is characterised by the biochemical triad of hyperglycaemia, ketonemia/ketonuria, and an increased anion gap metabolic acidosis. In this case, a 40-year-old male patient presented to the emergency department, with vomiting, nausea, polydipsia, polyuria and weight loss. He was found to have an elevated plasma glucose, despite having no known history of diabetes mellitus. His medical history was significant for spina bifida and ileal neobladder reconstruction. The plasma glucose level was 38 mmol/L. Blood gas analysis showed normal anion gap metabolic acidosis with high chloride and low bicarbonate. His plasma ketone level was 4.5 mmol/L. No significant reason for hyperchloraemia was identified. On initiation of DKA regimen, his condition improved and serum ketones normalised. Due to persistent hyperchloraemic metabolic acidosis, bicarbonate infusion was administered and his metabolic acidosis resolved.


Assuntos
Acidose , Cetoacidose Diabética , Desequilíbrio Hidroeletrolítico , Acidose/etiologia , Adulto , Bicarbonatos , Cloretos , Cetoacidose Diabética/etiologia , Humanos , Masculino
20.
J Am Soc Nephrol ; 32(2): 342-356, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33478973

RESUMO

BACKGROUND: The kidney plays an important role in maintaining normal blood pH. Metabolic acidosis (MA) upregulates the pathway that mitochondria in the proximal tubule (PT) use to produce ammonia and bicarbonate from glutamine, and is associated with AKI. However, the extent to which MA causes AKI, and thus whether treating MA would be beneficial, is unclear. METHODS: Gavage with ammonium chloride induced acute MA. Multiphoton imaging of mitochondria (NADH/membrane potential) and transport function (dextran/albumin uptake), oxygen consumption rate (OCR) measurements in isolated tubules, histologic analysis, and electron microscopy in fixed tissue, and urinary biomarkers (KIM-1/clara cell 16) assessed tubular cell structure and function in mouse kidney cortex. RESULTS: MA induces an acute change in NAD redox state (toward oxidation) in PT mitochondria, without changing the mitochondrial energization state. This change is associated with a switch toward complex I activity and decreased maximal OCR, and a major alteration in normal lipid metabolism, resulting in marked lipid accumulation in PTs and the formation of large multilamellar bodies. These changes, in turn, lead to acute tubular damage and a severe defect in solute uptake. Increasing blood pH with intravenous bicarbonate substantially improves tubular function, whereas preinjection with the NAD precursor nicotinamide (NAM) is highly protective. CONCLUSIONS: MA induces AKI via changes in PT NAD and lipid metabolism, which can be reversed or prevented by treatment strategies that are viable in humans. These findings might also help to explain why MA accelerates decline in function in CKD.


Assuntos
Acidose/etiologia , Injúria Renal Aguda/etiologia , Túbulos Renais/metabolismo , Túbulos Renais/patologia , Metabolismo dos Lipídeos/fisiologia , NAD/metabolismo , Acidose/metabolismo , Acidose/patologia , Injúria Renal Aguda/metabolismo , Injúria Renal Aguda/patologia , Animais , Modelos Animais de Doenças , Córtex Renal/metabolismo , Córtex Renal/patologia , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Mitocôndrias/metabolismo , Mitocôndrias/patologia , Consumo de Oxigênio/fisiologia
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