Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 1.606
Filtrar
1.
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
3.
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
4.
Clin Nephrol ; 92(5): 258-262, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31347495

RESUMO

BACKGROUND: Falsely low or even unmeasurable serum bicarbonate has been described in patients with severe hypertriglyceridemia or paraproteinemia. This phenomenon, known as pseudo-hypobicarbonatemia, is believed to be due to interference by these components when the commonly used enzymatic assay is utilized for serum bicarbonate measurement. The calculated bicarbonate derived from blood gas machines is not affected. This can lead to a misdiagnosis of a severe anion gap metabolic acidosis along with an extensive and expensive work-up. CASE PRESENTATIONS: We review a series of 5 patients with severe hypertriglyceridemia who presented with pseudo-hypobicarbonatemia and an elevated anion gap metabolic acidosis. Membrane-based therapeutic plasma exchange was utilized. RESULTS: Following aggressive lowering of the triglycerides, there was an immediate resolution of the pseudo-hypobicarbonatemia and anion gap metabolic acidosis. CONCLUSION: Recognition of lipemic serum in the setting of an otherwise unexplained anion gap metabolic acidosis should prompt the clinician to obtain a blood gas sample for true determination of the acid-base status. Doing so may avoid an extensive and expensive metabolic work-up.


Assuntos
Acidose , Hipertrigliceridemia/complicações , Troca Plasmática , Equilíbrio Ácido-Base/fisiologia , Acidose/sangue , Acidose/diagnóstico , Acidose/etiologia , Acidose/terapia , Análise Química do Sangue/normas , Erros de Diagnóstico , Humanos , Hipertrigliceridemia/sangue
5.
Clin Exp Nephrol ; 23(8): 1045-1049, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31062197

RESUMO

BACKGROUND: Gap acidosis, a type of metabolic acidosis caused by titratable acid accumulation, participates in CKD progression. It was found at all the stages of chronic kidney disease (CKD), whereas the kidney was believed to preserve its ability to excrete titratable acid until renal function is impaired severely. METHODS: Serum concentrations of lactate (Lac) and the other usually unmeasured anions (OUA) were separately examined using 420 records of blood gas analysis performed simultaneously with serum chemistry at a general hospital. RESULTS: Between the records grouped by the CKD stage, Lac was generally higher in the early stages than the late stages (2.2 ± 1.1, 1.9 ± 1.7, 1.5 ± 1.3, and 1.2 ± 0.6 mmol/L in G1-2, G3, G4, and G5, respectively). While OUA was not significantly different between G1-2, G3, and G4 (1.3 ± 2.0, 2.5 ± 2.7, and 2.6 ± 2.2 mEq/L, respectively), it was higher in G5 (4.7 ± 2.3 mEq/L) than in G1-4 (P < 0.001). In G5, OUA generally increased as eGFR decreased, and OUA was 6.6 ± 1.9, 4.7 ± 2.1 and 3.6 ± 2.0 mEq/L in subgroups of eGFR < 5, 5-10, and 10-15 mL/min/1.73 m2, respectively (P ≤ 0.001). CONCLUSIONS: Gap acidosis except lactic acidosis developed and progressed during the CKD stage G5, while lactic acidosis developed in the CKD stages G1-4. Prevention of lactic acidosis by preserving peripheral perfusion in the early CKD stages could slow CKD progression.


Assuntos
Equilíbrio Ácido-Base , Acidose/fisiopatologia , Rim/fisiopatologia , Insuficiência Renal Crônica/fisiopatologia , Acidose/sangue , Acidose/diagnóstico , Acidose Láctica/fisiopatologia , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/sangue , Progressão da Doença , Feminino , Humanos , Ácido Láctico/sangue , Masculino , Pessoa de Meia-Idade , Insuficiência Renal Crônica/sangue , Insuficiência Renal Crônica/diagnóstico , Estudos Retrospectivos , Fatores de Risco
7.
J Pediatr Endocrinol Metab ; 32(4): 335-340, 2019 Apr 24.
Artigo em Inglês | MEDLINE | ID: mdl-30862760

RESUMO

Background Thiamine deficiency is commonly reported in patients with diabetes especially during diabetic ketoacidosis (DKA) that could attribute to myocardial dysfunction in those patients. However, there is limited data regarding its relation to myocardial function among those patients. This study aimed to explore the association between myocardial function and serum thiamine levels in children with type 1 diabetes mellitus (DM). Methods This cross-sectional comparative study included 25 patients with DKA. Clinical data assessment, echocardiographic examination and measurement of serum high-sensitive troponin T (hs-cTnT) and thiamine levels were done. We also assessed the association between troponin levels, echocardiographic ventricular systolic and diastolic function and serum thiamine. Results Twenty-four percent of children with DKA had thiamine deficiency. DKA children with thiamine deficiency had significant acidosis and higher serum troponin levels and significant impairment of diastolic function than those without thiamine deficiency. The serum thiamine level had a significant positive correlation with the echocardiographic indices of diastolic function but negative correlation with troponin levels. Conclusions Thiamine deficiency is a common finding during the treatment of children with DKA, and this deficiency may be associated with myocardial dysfunction.


Assuntos
Acidose/etiologia , Biomarcadores/sangue , Cardiomiopatias/sangue , Cardiomiopatias/etiologia , Cetoacidose Diabética/fisiopatologia , Deficiência de Tiamina/complicações , Tiamina/sangue , Acidose/sangue , Acidose/patologia , Adolescente , Cardiomiopatias/patologia , Criança , Pré-Escolar , Estudos Transversais , Feminino , Seguimentos , Humanos , Masculino , Prognóstico , Deficiência de Tiamina/epidemiologia
8.
J Matern Fetal Neonatal Med ; 32(22): 3778-3783, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-29724142

RESUMO

Introduction: To examine interobserver agreement in intrapartum cardiotocography (CTG) classification in women undergoing trial of labor after a cesarean section (TOLAC) at term with or without complete uterine rupture. Materials and methods: Nineteen blinded and independent Danish obstetricians assessed CTG tracings from 47 women (174 individual pages) with a complete uterine rupture during TOLAC and 37 women (133 individual pages) with no uterine rupture during TOLAC. Individual pages with CTG tracings lasting at least 20 min were evaluated by three different assessors and counted as an individual case. The tracings were analyzed according to the modified version of the Federation of Gynaecology and Obstetrics (FIGO) guidelines elaborated for the use of STAN (ST-analysis). Occurrence of defined abnormalities was recorded and the tracings were classified as normal, suspicious, pathological, or preterminal. The interobserver agreement was evaluated using Fleiss' kappa. Results: Agreement on classification of a preterminal CTG was almost perfect. The interobserver agreement on normal, suspicious or pathological CTG was moderate to substantial. Regarding the presence of severe variable decelerations, the agreement was moderate. No statistical difference was found in the interobserver agreement between classification of tracings from women undergoing TOLAC with and without complete uterine rupture. Conclusions: The interobserver agreement on classification of CTG tracings from high-risk deliveries during TOLAC is best for assessment of a preterminal CTG and the poorest for the identification of severe variable decelerations.


Assuntos
Cardiotocografia/estatística & dados numéricos , Sofrimento Fetal/diagnóstico , Monitorização Fetal/estatística & dados numéricos , Frequência Cardíaca Fetal/fisiologia , Prova de Trabalho de Parto , Nascimento Vaginal Após Cesárea , Acidose/sangue , Acidose/diagnóstico , Acidose/epidemiologia , Adulto , Estudos de Casos e Controles , Feminino , Sofrimento Fetal/sangue , Sofrimento Fetal/epidemiologia , Monitorização Fetal/métodos , Humanos , Variações Dependentes do Observador , Valor Preditivo dos Testes , Gravidez , Estudos Retrospectivos , Sensibilidade e Especificidade , Nascimento Vaginal Após Cesárea/efeitos adversos , Nascimento Vaginal Após Cesárea/métodos , Nascimento Vaginal Após Cesárea/estatística & dados numéricos
10.
Am J Obstet Gynecol ; 220(4): 348-353, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30529344

RESUMO

Obstetricians and gynecologists belong to 1 of the medical specialties with the highest rate of litigation claims. Among birth injury cases, those cases with cerebral palsy outcomes account for litigation settlements or judgments often in the millions of dollars. In cases of potential perinatal asphyxia, a threshold level of metabolic acidosis (base deficit ≥12 mmol/L) is necessary to attribute neonatal encephalopathy to an intrapartum hypoxic event. With increasing duration or severity of a hypoxic stress resulting in metabolic acidosis, newborn infant umbilical artery base deficit increases. It may be alleged that, as base deficit levels increase beyond 12 mmol/L, there is an increased likelihood and severity of cerebral palsy. As a corollary, it may be claimed that an earlier delivery (by minutes) would reduce the base deficit and prevent or reduce the severity of cerebral palsy. This issue is of relevance to obstetricians as defendants, because retrospective "expert" analysis of cases may suggest that optimal management decisions would have resulted in an earlier delivery. In addressing the association of metabolic acidosis and cerebral palsy, base deficit should be measured as the extracellular component (base deficitextracellular fluid) rather than the commonly used base deficitblood. Studies suggest that, beyond the base deficit threshold of 12 mmol/L, the incidence and severity of cerebral palsy does not significantly increase (until ≥20 mmol/L), although the risk of neonatal death rises markedly. Thus, among most infants with hypoxia-associated neonatal encephalopathy, the occurrence of cerebral palsy is unlikely to be impacted by delivery time variation of few minutes, and this argument should not serve as the basis for medical legal claims.


Assuntos
Acidose/sangue , Traumatismos do Nascimento/sangue , Paralisia Cerebral/sangue , Hipóxia Encefálica/sangue , Jurisprudência , Acidose/epidemiologia , Traumatismos do Nascimento/epidemiologia , Paralisia Cerebral/epidemiologia , Feminino , Sangue Fetal , Humanos , Hipóxia Encefálica/epidemiologia , Incidência , Recém-Nascido , Doenças do Recém-Nascido , Responsabilidade Legal , Obstetrícia , Gravidez , Artérias Umbilicais
11.
Nephrology (Carlton) ; 24(1): 81-87, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-29064128

RESUMO

AIM: Correction of metabolic acidosis in patients with chronic kidney disease has been associated with improvement in thyroid function. We examined whether changes in bicarbonate were associated with changes in thyroid function in patients with end-stage renal disease receiving conventional or more frequent haemodialysis. METHODS: In the Frequent Hemodialysis Network Trials, the relationship between changes in serum bicarbonate, free triiodothyronine (FT3) and free thyroxine (FT4) was examined among 147 and 48 patients with endogenous thyroid function who received conventional (3×/week) or more frequent (6×/week) haemodialysis (Daily Trial) or who received conventional or more frequent nocturnal haemodialysis (Nocturnal Trial). Equilibrated normalized protein catabolic rate (enPCR) was examined to account for nutritional factors affecting both acid load and thyroid function. RESULTS: Increasing dialysis frequency was associated with increased bicarbonate level. Baseline bicarbonate level was not associated with baseline FT3 and FT4. Change in bicarbonate level was not associated with changes in FT3 and FT4 in the Daily Trial nor for FT4 in the Nocturnal Trial (r ≤ 0.14, P > 0.21). While, a significant correlation between change in serum bicarbonate and change in FT3 (r = 0.44, P = 0.02) was observed in the Nocturnal Trial; findings were no longer significant after adjusting for change in enPCR (r = 0.37, P = 0.08). For participants with baseline bicarbonate <23 mmol/L, no association between change in bicarbonate and change in thyroid indices were seen in the Daily Trial; for the Nocturnal Trial, findings were also not significant for change in FT3 and the association between change in bicarbonate and change in FT4 (r = 0.54, P = 0.03) was no longer significant after adjusting for enPCR (r = 0.45, P = 0.11). CONCLUSION: Changes in bicarbonate were not associated with changes in thyroid hormone levels after adjusting for enPCR, as a marker of nutritional status. Future studies should examine whether improvement in acid base status improves thyroid function in haemodialysis patients with evidence of thyroid hypofunction.


Assuntos
Equilíbrio Ácido-Base , Bicarbonatos/sangue , Hemodiálise no Domicílio/métodos , Falência Renal Crônica/terapia , Diálise Renal/métodos , Glândula Tireoide/metabolismo , Tiroxina/sangue , Tri-Iodotironina/sangue , Acidose/sangue , Acidose/fisiopatologia , Adulto , Idoso , Biomarcadores/sangue , Feminino , Hemodiálise no Domicílio/efeitos adversos , Humanos , Falência Renal Crônica/sangue , Falência Renal Crônica/diagnóstico , Falência Renal Crônica/fisiopatologia , Masculino , Pessoa de Meia-Idade , Estado Nutricional , Estudos Prospectivos , Desnutrição Proteico-Calórica/sangue , Desnutrição Proteico-Calórica/fisiopatologia , Diálise Renal/efeitos adversos , Glândula Tireoide/fisiopatologia , Fatores de Tempo , Resultado do Tratamento
12.
Clin Exp Nephrol ; 23(2): 215-222, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30168046

RESUMO

BACKGROUND: Metabolic acidosis, which reduces serum bicarbonate levels, contributes to the progression of chronic kidney disease (CKD). The difference between sodium and chloride (Na-Cl) may theoretically predict serum bicarbonate levels. This study aimed to evaluate serum Na-Cl level as a risk factor for renal function decline among patients who participated in the chronic kidney disease Japan cohort (CKD-JAC) study. METHODS: The association between low Na-Cl concentration (< 34 mmol/L) and composite renal function decline events (any initiation of renal replacement therapy or 50% decline in estimated glomerular filtration rate) was evaluated among 2143 patients with CKD stage G3a-4. Using Cox regression analysis, hazard ratios (HRs) were estimated after adjusting for the following covariates: age, sex, diabetes mellitus, diabetic nephropathy, cardiovascular disease, anemia, angiotensin-converting enzyme inhibitors and angiotensin II receptor antagonists, loop diuretics, cigarette smoking, body mass index, serum albumin, systolic blood pressure, urine albumin-to-creatinine ratio, and CKD stage. RESULTS: Composite renal function decline events were observed in 405 patients (18.9%) over the 4-year follow-up period. Low serum Na-Cl level (< 34 mmol/L) was independently associated with a greater risk for composite renal function decline events (HR 1.384; 95% confidence interval [CI], 1.116-1.717). Subgroup analyses identified that the association between low Na-Cl level and composite renal function decline events was stronger among patients with CKD stage G4 and those with anemia. CONCLUSIONS: Our investigation suggests that Na-Cl is an independent predictor of CKD progression, especially among patients with CKD stage G4 and those with anemia.


Assuntos
Taxa de Filtração Glomerular , Rim/fisiopatologia , Insuficiência Renal Crônica/sangue , Insuficiência Renal Crônica/fisiopatologia , Cloreto de Sódio/sangue , Acidose/sangue , Acidose/fisiopatologia , Idoso , Anemia/sangue , Anemia/fisiopatologia , Bicarbonatos/sangue , Biomarcadores/sangue , Progressão da Doença , Regulação para Baixo , Feminino , Hemoglobinas/metabolismo , Humanos , Japão , Masculino , Pessoa de Meia-Idade , Insuficiência Renal Crônica/diagnóstico , Insuficiência Renal Crônica/terapia , Terapia de Substituição Renal , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo
13.
J Matern Fetal Neonatal Med ; 32(19): 3288-3293, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-29621906

RESUMO

Introduction: Recent developments have produced new CTG classification systems and the question is to what extent these may affect the model of FHR + ST interpretation? The two new systems (FIGO2015 and SSOG2017) classify FHR + ST events differently from the current CTG classification system used in the STAN interpretation algorithm (STAN2007). Aim: Identify the predominant FHR patterns in connection with ST events in cases of cord artery metabolic acidosis missed by the different CTG classification systems. Indicate to what extent STAN clinical guidelines could be modified enhancing the sensitivity. Provide a pathophysiological rationale. Material and methods: Forty-four cases with umbilical cord artery metabolic acidosis were retrieved from a European multicenter database. Significant FHR + ST events were evaluated post hoc in consensus by an expert panel. Results: Eighteen cases were not identified as in need of intervention and regarded as negative in the sensitivity analysis. In 12 cases, ST changes occurred but the CTG was regarded as reassuring. Visual analysis of the FHR + ST tracings revealed specific FHR patterns: Conclusion: These findings indicate FHR + ST analysis may be undertaken regardless of CTG classification system provided there is a more physiologically oriented approach to FHR assessment in connection with an ST event.


Assuntos
Acidose/diagnóstico , Cardiotocografia , Frequência Cardíaca Fetal/fisiologia , Parto/fisiologia , Acidose/sangue , Acidose/fisiopatologia , Adulto , Algoritmos , Bases de Dados Factuais , Eletrocardiografia/métodos , Europa (Continente) , Feminino , Sangue Fetal/química , Sangue Fetal/metabolismo , Monitorização Fetal/métodos , Humanos , Concentração de Íons de Hidrogênio , Recém-Nascido , Valor Preditivo dos Testes , Gravidez , Prognóstico , Sensibilidade e Especificidade
14.
J Anim Physiol Anim Nutr (Berl) ; 103(2): 416-426, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30588673

RESUMO

Two consecutive experiments were carried out to determine efficacy of Megasphaera elsdenii inoculation in alleviation of subacute ruminal acidosis (SARA). In the first experiment, SARA was induced by feeding corn- and wheat-based diets (20%, 40%, 60% and 80% of TMR, DM basis) in six ruminally cannulated heifers. Continuous pH was obtained using data loggers embedded in rumen. In corn (80%)- and wheat (60%)-based diets ruminal pH ranged from 5.2 to 5.6 for 7.77 and 5.93 hr. In the second experiment (5 day), M. elsdenii (200 ml; 2.4 x 1010 cfu/ml) was inoculated during the first two days. During the SARA induction period, M. elsdenii and S. bovis in rumen liquor were more abundant in wheat-based feeding (7.97 and 8.77) than in corn-based feeding (7.06 and 7.95 per ml, log basis; p < 0.0001 for both). M. elsdenii inoculation increased total volatile fatty acids (VFA) concentration when corn-based diet was fed, whereas it decreased total VFA concentration when wheat-based diet was fed (p < 0.004). There was a decrease in the propionic acid proportion (24.04%-19.08%; p < 0.002), whereas no alteration in lactate and ammonia concentrations was observed. M. elsdenii inoculation increased protozoa count (from 5.39 to 5.55 per ml, log basis; p < 0.009) and decreased S. bovis count (from 9.18 to 7.95 per ml, log basis; p < 0.0001). The results suggest that M. elsdenii inoculation may help prevent SARA depending on dietary grain through altering rumen flora as reflected by a decrease in S. bovis count and an increase in protozoa count.


Assuntos
Acidose/veterinária , Doenças dos Bovinos/prevenção & controle , Megasphaera elsdenii , Rúmen/microbiologia , Gastropatias/veterinária , Acidose/sangue , Acidose/microbiologia , Acidose/urina , Animais , Glicemia , Bovinos , Doenças dos Bovinos/sangue , Doenças dos Bovinos/microbiologia , Doenças dos Bovinos/urina , Hematócrito , Concentração de Íons de Hidrogênio , Gastropatias/sangue , Gastropatias/microbiologia , Gastropatias/urina
15.
Eur J Obstet Gynecol Reprod Biol ; 231: 25-29, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30317141

RESUMO

INTRODUCTION: Umbilical artery blood analysis is assumed to give a picture of the acid-base balance of the infant at birth and is considered the gold standard to diagnose neonatal acidemia at birth. The evaluation of umbilical vein pH has been suggested as an adjunct in order to optimize the understanding of the pathophysiology of the hypoxic events in labor. The objective of this study was to assess the correlation between the Delta pH (vein-to-artery) on the umbilical cord and the intrapartum cardiotocography (CTG) patterns in a selected cohort of acidemic neonates. METHODS: Retrospective analysis of all CTG traces from non-anomalous term neonates consecutively born with acidemia (pH < 7.05 on the arterial cord) at four European tertiary Maternity Units. Intrapartum CTG traces were collected and their characteristics were reviewed in consensus by three senior Obstetricians. Each case was assigned to one of these four types of intrapartum hypoxia according to the CTG features: acute hypoxia, subacute hypoxia, slowly evolving hypoxia, and chronic hypoxia. The relationship between the different categories of intrapartum hypoxia and the Delta pH on the umbilical cord were evaluated. RESULTS: Overall, 83 acidemic neonates were included. Acute hypoxia, subacute hypoxia, slowly evolving hypoxia, and chronic hypoxia accounted for 19 (22.9%), 24 (28.9%), 24 (28.9%) and 16 (19.3%) cases, respectively. No difference of the Delta pH (p 0.61) was noted across the CTG subclasses, while significantly lower birthweight among cases with chronic hypoxia was found (p 0.03). The mean Delta pH did not vary at comparison between the cases with rapid onset hypoxia (acute + subacute hypoxia) and those with long lasting hypoxia (chronic + slowly evolving) (p 0.59). CONCLUSIONS: Within a selected cohort of acidemic neonates, our data do not demonstrate an association between the different CTG patterns of intrapartum hypoxia and the artery-to-vein Delta pH on the umbilical cord.


Assuntos
Acidose/sangue , Cardiotocografia , Sangue Fetal/química , Hipóxia/diagnóstico , Artérias Umbilicais , Veias Umbilicais , Feminino , Humanos , Concentração de Íons de Hidrogênio , Recém-Nascido , Gravidez , Estudos Retrospectivos
16.
J Med Case Rep ; 12(1): 290, 2018 Oct 10.
Artigo em Inglês | MEDLINE | ID: mdl-30301468

RESUMO

BACKGROUND: Transformer oil is used in oil-filled transformers for its insulating as well as coolant properties. Transformer oil ingestion for attempted suicide is seldom heard of. Our patient's case presented us with a major diagnostic as well as treatment challenge because we encountered such a case for the first time and were totally unaware of the fact that methanol might make up the main component of an aged transformer oil. CASE PRESENTATION: A 19-year-old Pakistani/Asian man was brought to our hospital with altered sensorium. He was found to have elevated anion gap acidosis, increased osmolal gap, and acute kidney injury. He had no evidence of rhabdomyolysis or hemolysis. Computed tomography of his head showed cerebral edema. He was resuscitated with intravenous fluids and bicarbonate. Three days later, he confessed taking transformer oil with suicidal intention. His clinical picture mimicked acute methanol intoxication. With an initial improvement in his neurological status, he started complaining of constant headache with episodes of agitation and delirium. His renal function continued worsening despite an adequate urine output. He showed a remarkable improvement in his neurological state after just one session of hemodialysis. CONCLUSIONS: There is evidence that aged transformer oil contains methanol, and a patient who consumes it can present with features mimicking acute methanol intoxication.


Assuntos
Acidose , Lesão Renal Aguda , Hidratação/métodos , Óleos Industriais , Metanol/toxicidade , Diálise Renal/métodos , Bicarbonato de Sódio/administração & dosagem , Equilíbrio Ácido-Base/efeitos dos fármacos , Acidose/sangue , Acidose/induzido quimicamente , Acidose/diagnóstico , Acidose/terapia , Lesão Renal Aguda/induzido quimicamente , Lesão Renal Aguda/diagnóstico , Lesão Renal Aguda/metabolismo , Lesão Renal Aguda/terapia , Edema Encefálico/diagnóstico por imagem , Edema Encefálico/etiologia , Tampões (Química) , Humanos , Óleos Industriais/análise , Óleos Industriais/toxicidade , Masculino , Tentativa de Suicídio , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento , Adulto Jovem
17.
Medicine (Baltimore) ; 97(36): e12221, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30200141

RESUMO

Metabolic acid-base disorders, especially metabolic acidosis, are common in critically ill patients who require renal replacement therapy. Continuous veno-venous hemodiafiltration (CVVHDF) achieves profound changes in acid-base status, but metabolic acidosis can remain unchanged or even deteriorate in some patients. The objective of this study is to understand the changes of acid-base variables in critically ill patients with septic associated acute kidney injury (SA-AKI) during CVVHDF and to determine how they relate to clinical outcome.Observational study of 200 subjects with SA-AKI treated with CVVHDF for at least 72 hours. Arterial blood gases and electrolytes and other relevant acid-base variables were analyzed using quantitative acid-base chemistry.Survivors and nonsurvivors had similar demographic characteristics and acid-base variables on day one of CVVHDF. However, during the next 48 hours, the resolution of acidosis was significantly different between the 2 groups, with an area under the ROC curve for standard base excess (SBE) and mortality of 0.62 (0.54-0.70), this was better than APACHE II score prediction power. Quantitative physicochemical analysis revealed that the majority of the change in SBE was due to changes in Cl and Na concentrations.Survivors of SA-AKI treated with CVVHDF recover hyperchloremic metabolic acidosis more rapidly than nonsurvivors. Further study is needed to determine if survival can be improved by measures to correct acidosis more rapidly.


Assuntos
Acidose/sangue , Lesão Renal Aguda/sangue , Análise Química do Sangue , Hemodiafiltração , Sepse/sangue , APACHE , Acidose/complicações , Acidose/mortalidade , Lesão Renal Aguda/complicações , Lesão Renal Aguda/mortalidade , Lesão Renal Aguda/terapia , Anticoagulantes/uso terapêutico , Área Sob a Curva , Cuidados Críticos , Estado Terminal , Humanos , Concentração de Íons de Hidrogênio , Prognóstico , Curva ROC , Estudos Retrospectivos , Sepse/complicações , Sepse/mortalidade , Sepse/terapia
18.
J Pregnancy ; 2018: 2195965, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30245882

RESUMO

Background: Despite major advances in perinatal medicine, intrapartum asphyxia remains a leading and potentially preventable cause of perinatal mortality and long-term morbidity. The umbilical cord pH is considered an essential criteria for the diagnosis of acute intrapartum hypoxic events. The purpose of this study was to evaluate whether obstetric risk factors are associated with fetal acidaemia at delivery. Methodology: In a case-control study, 294 women with term singleton pregnancies complicated by an umbilical artery cord pH < 7.20 at birth were individually matched by controls with umbilical artery cord pH > 7.20. Groups were compared for differences in maternal, obstetric, and fetal characteristics using logistic regression models presented as odds ratio (OR) with 95% confidence intervals (CI). Results: The study showed pregestational diabetes (PGDM) [OR: 5.31, 95% CI: 1.15- 24.58, P = 0.018], urinary tract infection (UTI) [OR: 3.21, 95% CI: 1.61- 6.43, P < 0.001], and low Apgar scores to be significantly associated with acidaemia, whereas low maternal BMI [OR: 0.19, 95% CI: 0.04-0.87, P = 0.032], pyrexia in labour [OR 0.23; 95% CI 0.12-0.53; P < 0.001], electronic fetal monitoring (EFM) [OR 0.65; 95% CI 0.43-0.99; P = 0.042), and emergency caesarean section [OR 0.42; 95% CI 0.26-0.66; P < 0.001] were found to be protective of acidaemia. Conclusion: Certain obstetric risk factors before and during labour can identify newborns at risk of developing acidaemia. Further research is needed to gain quantitative insight into the predictive capacity of these risks that can inform obstetric clinical management for improved outcomes.


Assuntos
Acidose/sangue , Acidose/etiologia , Sangue Fetal/química , Complicações na Gravidez/epidemiologia , Resultado da Gravidez , Acidose/epidemiologia , Adulto , Índice de Apgar , Estudos de Casos e Controles , Distribuição de Qui-Quadrado , Parto Obstétrico/estatística & dados numéricos , Feminino , Humanos , Recém-Nascido , Modelos Logísticos , Gravidez , Resultado da Gravidez/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Adulto Jovem
19.
Exp Clin Transplant ; 16(6): 754-756, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30119620

RESUMO

An interaction between regained renal function in a transplanted kidney and hyperventilation syndrome may interfere with correct diagnosis of acid-base status in patients with preoperative nongap acidosis. Here, we present a patient with glomerular nephritis and hyperchloremia who underwent kidney transplant. Progressively increasing bicarbonate reabsorption by the renal graft, which thereby changed the arterial carbon dioxide tension-to-bicarbonate ratio, resulted in a time-sequence swing of an acid-base interpretation despite persistent mixed respiratory alkalosis due to hyperventilation syndrome and nongap metabolic acidosis due to preexisting hyperchloremia. Specifically, the sequence was mixed primary metabolic acidosis and primary respiratory acidosis immediately after surgery, primary metabolic acidosis and secondary respiratory alkalosis on postoperative days 1 and 2, mixed primary hyperchloremic metabolic acidosis and primary respiratory alkalosis on postoperative day 3, and finally primary respiratory alkalosis and secondary hyperchloremic metabolic acidosis on postoperative day 7. This swing in the acid-base interpretation indicates that the acid-base imbalance described here does not fit the empirical relationship for calculating the expected bicarbonate or carbon dioxide tension value, suggesting that "correct" interpretation of acid-base status may not lead to "correct" diagnosis of acid-base status. It should be remembered that not every acid-base imbalance fits the empirical relationship.


Assuntos
Equilíbrio Ácido-Base , Acidose/fisiopatologia , Alcalose Respiratória/fisiopatologia , Cloretos/sangue , Hiperventilação/fisiopatologia , Transplante de Rim/efeitos adversos , Rim/fisiopatologia , Rim/cirurgia , Acidose/sangue , Acidose/diagnóstico , Acidose/etiologia , Adulto , Alcalose Respiratória/sangue , Alcalose Respiratória/diagnóstico , Alcalose Respiratória/etiologia , Bicarbonatos/sangue , Biomarcadores/sangue , Humanos , Hiperventilação/sangue , Hiperventilação/diagnóstico , Hiperventilação/etiologia , Masculino , Valor Preditivo dos Testes , Recuperação de Função Fisiológica , Reprodutibilidade dos Testes , Síndrome , Fatores de Tempo , Resultado do Tratamento
20.
J Perinatol ; 38(9): 1144-1150, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-29915374

RESUMO

OBJECTIVE: To investigate whether maternal overweight and obesity increased the risk of fetal acidosis measured in umbilical cord arterial blood after delivery. STUDY DESIGN: Population-based cohort study of 84,785 term (≥37 weeks) infants. Logistic regression was used to estimate risks of fetal acidosis in umbilical cord arterial blood. Fetal acidosis was defined as pH <7.10 or as pH <1st percentile on a normal reference curve. RESULT: Risks of fetal acidosis increased, regardless of definition, with maternal overweight and obesity severity. Compared to normal weight (BMI 18.5-<25), the odds ratios (95% confidence interval) for pH <7.10 were 1.35 (1.23-1.47) for overweight (BMI 25-<30), 1.46 (1.27-1.69) for mild obesity (BMI 30-<35), and 1.75 (1.42-2.15) for severe obesity (BMI ≥35). The association for obesity was attenuated in analyses restricted to non-instrumental vaginal deliveries. CONCLUSION: Maternal overweight and obesity increased the risk of fetal acidosis. More complicated deliveries in obese women may partially explain this association.


Assuntos
Acidose/epidemiologia , Trabalho de Parto , Obesidade Mórbida/complicações , Sobrepeso/complicações , Complicações na Gravidez/epidemiologia , Acidose/sangue , Adolescente , Adulto , Índice de Massa Corporal , Estudos de Coortes , Feminino , Sangue Fetal/química , Idade Gestacional , Humanos , Concentração de Íons de Hidrogênio , Recém-Nascido , Modelos Logísticos , Masculino , Gravidez , Complicações na Gravidez/sangue , Fatores de Risco , Suécia/epidemiologia , Adulto Jovem
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA