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2.
J Cardiothorac Surg ; 14(1): 163, 2019 Sep 10.
Artigo em Inglês | MEDLINE | ID: mdl-31500645

RESUMO

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


Assuntos
Acidose/terapia , Bicarbonatos/provisão & distribução , Ponte Cardiopulmonar/efeitos adversos , Soluções para Diálise/provisão & distribução , Complicações Pós-Operatórias/terapia , Ultrafiltração/métodos , Bicarbonatos/farmacologia , Soluções para Diálise/farmacologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Estados Unidos
4.
J Med Case Rep ; 13(1): 203, 2019 Jul 03.
Artigo em Inglês | MEDLINE | ID: mdl-31266532

RESUMO

BACKGROUND: Brake oil is an automobile transmission fluid composed of a mixture of toxic alcohols such as ethylene glycols and glycol ethers. Both accidental and intentional ingestion cases have been reported and they can present with multisystem involvement. Life-threatening complications evolve from deleterious effects on cardiopulmonary and renal systems. Effects on neurological and gastrointestinal systems give rise to a multitude of complications although non-fatal in nature. The biochemical panel consists of a high concentration of ethylene glycol with severe metabolic acidosis, high anion gap, high osmolar gap, oxaluria, and hypocalcemia. The mainstay of treatment is enhanced elimination of ethylene glycol and its metabolites by hemodialysis, together with general supportive care, gastric decontamination, and vitamins such as thiamine and pyridoxine to minimize the adverse effects of intoxication. CASE PRESENTATION: A 26-year-old Sinhalese woman presented with reduced urine output, shortness of breath, reduced level of consciousness, abdominal pain, and vomiting with mild degree fever of 2 days' duration. She had bilateral lower limb edema, crepitations over bilateral lower lung fields, and right-sided lower motor type facial nerve palsy. Investigations showed severe metabolic acidosis with high anion gap and high osmolar gap. With regular hemodialysis she made a complete recovery after 3 months. CONCLUSION: Even without a clear history of poisoning, the presence of a high anion, high osmolar gap metabolic acidosis should prompt one to search for ethylene glycol ingestion. Uncommon manifestations like cranial neuropathies need to be examined and considered. Timely aggressive treatment leads to a better prognosis.


Assuntos
Acidose/induzido quimicamente , Etilenoglicol/envenenamento , Doenças do Nervo Facial/induzido quimicamente , Equilíbrio Ácido-Base , Acidose/fisiopatologia , Acidose/terapia , Adulto , Feminino , Humanos , Diálise Renal , Tentativa de Suicídio
5.
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
6.
Ir Med J ; 112(4): 918, 2019 04 11.
Artigo em Inglês | MEDLINE | ID: mdl-31243947

RESUMO

Case Pyroglutamic acidosis is an uncommonly diagnosed but important cause of a high anion gap metabolic acidosis. Our case report concerns an elderly male admitted to the Intensive Care Unit (ICU) following the acute onset of coma which developed during treatment of a prosthetic joint infection. A diagnosis of pyroglutamic acidosis was ultimately made and later confirmed with laboratory testing. Blood gas analysis revealed a profound high anion gap metabolic acidosis. Treatment Treatment included withdrawal of the precipitating medications, N-acetylcysteine and sodium bicarbonate. Discussion This case highlights an unusual cause of severe metabolic acidosis caused by commonly used medications and readily reversible if recognised. This is of particular relevance in elderly, frail patients as incorrect alternate diagnoses may result in decisions which incorrectly limit critical care therapies.


Assuntos
Acetaminofen/efeitos adversos , Acidose/induzido quimicamente , Antibacterianos/efeitos adversos , Antipiréticos/efeitos adversos , Floxacilina/efeitos adversos , Infecções Relacionadas à Prótese/tratamento farmacológico , Infecções Estafilocócicas/tratamento farmacológico , Infecção da Ferida Cirúrgica/tratamento farmacológico , Acetilcisteína/uso terapêutico , Acidose/terapia , Idoso de 80 Anos ou mais , Artroplastia de Quadril , Gasometria , Interações de Medicamentos , Prótese de Quadril , Humanos , Doença Iatrogênica , Masculino , Ácido Pirrolidonocarboxílico/metabolismo , Insuficiência Renal Crônica/complicações , Terapia de Substituição Renal , Índice de Gravidade de Doença , Bicarbonato de Sódio/uso terapêutico
8.
Artif Organs ; 43(8): 719-727, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30706485

RESUMO

Low flow extracorporeal veno-venous CO2 removal (ECCO2 R) therapy is used to remove CO2 while reducing ventilation intensity. However, the use of this technique is limited because efficiency of CO2 removal and potential beneficial effects on pulmonary hemodynamics are not precisely established. Moreover, this technique requires anticoagulation that may induce severe complications in critically ill patients. Therefore, our study aimed at determining precise efficiency of CO2 extraction and its effects on right ventricular (RV) afterload, and comparing regional anticoagulation with citrate to systemic heparin anticoagulation during ECCO2 R. This study was performed in an experimental model of severe hypercapnic acidosis performed in two groups of three pigs. In the first group (heparin group), pigs were anticoagulated with a standard protocol of unfractionated heparin while citrate was used for ECCO2 R device anticoagulation in the second group (citrate group). After sedation, analgesia and endotracheal intubation, pigs were connected to a volume-cycled ventilator. Severe hypercapnic acidosis was obtained by reducing tidal volume by 60%. ECCO2 R was started in both groups when arterial pH was lower than 7.2. Pump Assisted Lung Protection (PALP, Maquet, Rastatt, Germany) system was used to remove CO2 . CO2 extraction, arterial pH, PaCO2 as well as systemic and pulmonary hemodynamic were continuously followed. Mean arterial pH was normalized to 7.37 ± 1.4 at an extracorporeal blood flow of 400 mL/min, coming from 7.11 ± 1.3. RV end-systolic pressure increased by over 30% during acute hypercapnic acidosis and was normalized in parallel with CO2 removal. CO2 extraction was not significantly increased in citrate group as compared to heparin group. Mean ionized calcium and MAP were significantly lower in the citrate group than in the heparin group during ECCO2 R (1.03 ± 0.20 vs. 1.33 ± 0.19 and 57 ± 14 vs. 68 ± 15 mm Hg, respectively). ECCO2 R was highly efficient to normalize pH and PaCO2 and to reduce RV afterload resulting from hypercapnic acidosis. Regional anticoagulation with citrate solution was as effective as standard heparin anticoagulation but did not improve CO2 removal and lead to more hypocalcemia and hypotension.


Assuntos
Acidose/terapia , Anticoagulantes/uso terapêutico , Dióxido de Carbono/isolamento & purificação , Citratos/uso terapêutico , Oxigenação por Membrana Extracorpórea/métodos , Hipercapnia/terapia , Acidose/etiologia , Animais , Feminino , Heparina/uso terapêutico , Hipercapnia/complicações , Masculino , Respiração Artificial/métodos , Suínos
9.
BMJ Case Rep ; 12(2)2019 Feb 09.
Artigo em Inglês | MEDLINE | ID: mdl-30739090

RESUMO

We report a case of 50-year-old male patient from tribal area in South Indian state of Telangana, who ingested the liquid extract from crushed leaves of the plant, cleistanthus collinius with the intention of self-harm. Immediate gastric lavage and activated charcoal administration was done and the patient was subsequently admitted into an acute medical care unit. During first 24 hours of monitoring, the patient was clinically stable. There was mild normal anion gap metabolic acidosis and hypokalaemia on arterial blood gas (ABG) and was corrected accordingly. On second day of admission he developed acute onset shortness of breath. Chest auscultation revealed extensive bilateral coarse crackles. Chest X-ray was suggestive of acute respiratory distress syndrome (ARDS). The patient had to be intubated. Continuous renal replacement therapy (CRRT) was initiated in view of worsening metabolic acidosis and unstable haemodynamics. In spite of appropriate intensive care measures, the patient succumbed to illness. Immediate gastric lavage and activated charcoal administration was done and the patient was subsequently admitted into an acute medical care unit. During first 24 hours of monitoring, the patient was clinically stable. There was mild normal anion gap metabolic acidosis and hypokalaemia on ABG and was corrected accordingly. On second day of admission, he developed acute onset shortness of breath. Chest auscultation revealed extensive bilateral coarse crackles. Chest X-ray was suggestive of ARDS. The patient had to be intubated on day 2. CRRT was initiated in view of worsening metabolic acidosis and unstable haemodynamics. In spite of appropriate intensive care measures, the patient gradually deteriorated, had cardiac arrest and passed away on day 5 of his hospital stay.


Assuntos
Antídotos/uso terapêutico , Carvão Vegetal/uso terapêutico , Lavagem Gástrica/métodos , Malpighiales , Extratos Vegetais/envenenamento , Envenenamento/terapia , Suicídio , Acidose/induzido quimicamente , Acidose/terapia , Evolução Fatal , Humanos , Masculino , Pessoa de Meia-Idade , Envenenamento/etiologia , Terapia de Substituição Renal , Síndrome do Desconforto Respiratório do Adulto/induzido quimicamente , Síndrome do Desconforto Respiratório do Adulto/terapia
11.
Wiad Lek ; 71(7): 1316-1319, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30448803

RESUMO

OBJECTIVE: Introduction: The problem of the influence of infusion solutions on the correction of acid alkaline balance disorders in acute ischemic stroke (AIS) remains unclear. The aim: Compare the dynamics of changes acid alkaline balance (AAB) in the application of isosmolar 0.9% NaCl solution and hyperosmolar solution of mannitol in patients with acute ischemic stroke. PATIENTS AND METHODS: Materials and methods: The study included 50 patients with AIS. As the investigated solutions were used: hyperosmolar mannitol 15% and isosmolar 0.9% NaCl. The control group received only 0.9% NaCl, compared with main group of 0.9% NaCl+mannitol. The research was carried out at 1, 4 and 7 day, a number of indicators were determined: рН, РаО2, РаСО2, АВ, SB, ВВ, ВЕ. RESULTS: Results: The conducted research showed that in all observation groups, on 1st day, manifestations of mixed acidosis were observed. On the 7th day of observation the group of 0.9% NaCl showed results close to the norm of the studied parameters, indicating the leveling of acidosis developed in this group on the 1st day of stroke. Somewhat worse correction of metabolic acidosis was in the group of mannitol, on the 7th day of observation the manifestations of acidosis were not significantly different from the 1st day and were respectively: pH = 7.33 (7.24; 7.36); pO2 = 36 (33; 39); AB = 23 (15; 26); BE = -3.4 (-13.5, 0.2), SB = 22.9 (18.0, 25.4). CONCLUSION: Conclusions: Analysis of changes in the parameters of AAB in the application of different circuits of infusion therapy in patients with acute ischemic stroke showed that all the observation groups had manifestations of metabolic acidosis on the first day of AIS. The ability to normalize the disturbances of acid alkaline balance did not differ significantly (p>0.05) for patients of group 0.9% NaCl solution and mannitol.


Assuntos
Equilíbrio Ácido-Base , Acidose/terapia , Isquemia Encefálica/complicações , Manitol/uso terapêutico , Acidente Vascular Cerebral/complicações , Acidose/complicações , Humanos , Infusões Intravenosas
12.
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
13.
Praxis (Bern 1994) ; 107(20): 1097-1106, 2018.
Artigo em Alemão | MEDLINE | ID: mdl-30278847

RESUMO

CME: Ethylene Glycol Intoxication Abstract. Ethylene glycol is a sweet-tasting alcohol used in common antifreeze and other industrial solutions. Without appropriate therapy, intoxication with ethylene glycol can result in severe metabolic acidosis, acute renal failure, and in death. After gastrointestinal resorption, hepatic metabolism starts with oxidation by alcohol dehydrogenase and results in severe anion gap metabolic acidosis. Other metabolic products are calcium oxalate crystals, which can deposit in several tissues like the kidneys and lead to acute tubular necrosis with reversible renal failure. The crucial therapeutic step is rapid inhibition of alcohol dehydrogenase with fomepizole or ethanol to avoid the formation of toxic metabolites. Additionally, haemodialysis is the most effective way to eliminate ethylene glycol as well as its toxic metabolites. If therapy is initiated rapidly, prognosis is favorable.


Assuntos
Acidose/induzido quimicamente , Lesão Renal Aguda/induzido quimicamente , Etilenoglicol/envenenamento , Equilíbrio Ácido-Base , Acidose/mortalidade , Acidose/terapia , Lesão Renal Aguda/mortalidade , Lesão Renal Aguda/terapia , Adulto , Terapia Combinada , Cuidados Críticos/métodos , Diagnóstico Diferencial , Diagnóstico Precoce , Intervenção Médica Precoce , Serviço Hospitalar de Emergência , Etilenoglicol/farmacocinética , Humanos , Necrose do Córtex Renal/induzido quimicamente , Necrose do Córtex Renal/mortalidade , Necrose do Córtex Renal/terapia , Masculino , Diálise Renal , Tentativa de Suicídio
14.
Intensive Care Med ; 44(11): 1888-1895, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30255318

RESUMO

OBJECTIVE: Although sodium bicarbonate (SB) solution has been widely used in clinical practice, its effect on mortality when administered to a large population of patients with acidosis is not known. The study aimed to investigate the effectiveness of SB infusion in septic patients with metabolic acidosis. METHODS: Septic patients with metabolic acidosis were identified from the Medical Information Mart for Intensive Care (MIMIC)-III database. Propensity score (PS) was used to account for the baseline differences in the probability to receive SB or not. The marginal structural Cox model (MSCM) was employed to adjust for both baseline and time-varying confounding factors. MAIN RESULTS: A total of 1718 septic patients with metabolic acidosis were enrolled in the study, including 500 in the SB group and 1218 in the non-SB group. Both pH [7.16 (standard deviation (SD): 0.10) vs. 7.22 (SD: 0.07); p < 0.001] and bicarbonate concentration (BC) [11.84 (SD: 3.63) vs. 14.88 (SD: 3.36) mmol/l; p < 0.001] were significantly lower in the SB than that in the non-SB group. While there was no significant mortality effect in the overall population [hazard ratio (HR): 1.04; 95% CI 0.86-1.26; p = 0.67], SB was observed to be beneficial in patients with acute kidney injury (AKI) stage 2 or 3 and pH < 7.2 (HR 0.74; 95% CI 0.51-0.86; p = 0.021). Similar results were replicated with the MSCM. CONCLUSION: Our study observed that SB infusion was not associated with improved outcome in septic patients with metabolic acidosis, but it was associated with improved survival in septic patients with AKI stage 2 or 3 and severe acidosis. The results need to be verified in randomized controlled trials.


Assuntos
Acidose/complicações , Acidose/terapia , Cuidados Críticos , Sepse/mortalidade , Bicarbonato de Sódio/uso terapêutico , Acidose/mortalidade , Idoso , Feminino , Mortalidade Hospitalar , Humanos , Masculino , Pessoa de Meia-Idade , Pontuação de Propensão , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Sepse/complicações , Sepse/terapia , Taxa de Sobrevida
15.
S Afr Med J ; 108(8): 636-639, 2018 Jul 25.
Artigo em Inglês | MEDLINE | ID: mdl-30182878

RESUMO

Starvation ketoacidosis (SKA) constitutes an important consideration in the pregnant patient who presents with profound metabolic acidosis. Pregnancy-related changes predispose the patient to develop SKA following relatively short periods (12 - 14 hours) of 'starvation'. Patients also typically look clinically well in relation to the significant metabolic derangements that accompany the condition. Prompt recognition and early institution of appropriate therapy is therefore extremely important in terms of optimising maternal and fetal outcome. We describe a pregnant patient with SKA who presented with profound euglycaemic ketoacidosis that resolved rapidly following the early initiation of appropriate therapy. Furthermore, appropriate therapy resulted in our patient avoiding the need for an emergency caesarean section, which is often reported in this scenario. The ensuing discussion addresses SKA in pregnancy, the unique features of our patient, and management considerations from a maternal and fetal perspective. We also discuss the various causes of ketoacidosis such as diabetic ketoacidosis (DKA), euglycaemic DKA, alcohol-induced euglycaemic ketoacidosis and SKA in pregnant patients.


Assuntos
Acidose , Cetose , Complicações na Gravidez , Equilíbrio Ácido-Base , Acidose/diagnóstico , Acidose/metabolismo , Acidose/terapia , Glicemia , Diagnóstico Precoce , Intervenção Médica Precoce , Feminino , Humanos , Cetose/diagnóstico , Cetose/metabolismo , Cetose/terapia , Gravidez , Complicações na Gravidez/diagnóstico , Complicações na Gravidez/metabolismo , Complicações na Gravidez/terapia , Adulto Jovem
16.
Anaesthesist ; 67(9): 674-678, 2018 09.
Artigo em Alemão | MEDLINE | ID: mdl-30178118

RESUMO

We present the case of a 31-year old male with ingestion of fire extinguisher powder in an attempted suicide. After consulting several poison information centres, the intoxication was initially classified as harmless; nevertheless, the patient was admitted to our intensive care unit for cardiopulmonary monitoring. Subsequently, due to the ingestion of ammonium sulphate and ammonium dihydrogen phosphate containing powder the patient developed severe metabolic acidosis with distinct electrolyte imbalance that required temporary haemodialysis.


Assuntos
Acidose/induzido quimicamente , Fosfatos/envenenamento , Acidose/terapia , Adulto , Humanos , Masculino , Diálise Renal , Tentativa de Suicídio
17.
Int J Artif Organs ; 41(8): 431-436, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-29976124

RESUMO

BACKGROUND/AIMS: Severe metabolic acidosis during cardiopulmonary resuscitation is an important and yet unresolved issue. The potential use of hemodialysis for severe metabolic acidosis during cardiopulmonary resuscitation was investigated. METHODS: Acute hemodialyses between January 2012 and April 2017 were reviewed for patients with concomitant hemodialysis and cardiopulmonary resuscitation. In addition, MEDLINE was searched for similar reports. Data were extracted from hospital records. RESULTS: Two patients (36M, 70F) were found to study, without similar reports in MEDLINE. Cardiac arrests (in-hospital) occurred due to severe metabolic acidosis in both patients (due to ethylene glycol and metformin intoxications, respectively). Return of spontaneous circulation could not be obtained within the first 28 and 30 min of cardiopulmonary resuscitation only, whereas both patients had return of spontaneous circulation following at least 45 min of concomitant hemodialysis and cardiopulmonary resuscitation. One patient (70F) was discharged with good neurological outcome, but the other died. CONCLUSION: The addition of high-efficiency hemodialysis during cardiopulmonary resuscitation may contribute to the return of spontaneous circulation in patients with severe metabolic acidosis due to intoxication.


Assuntos
Acidose/terapia , Reanimação Cardiopulmonar , Parada Cardíaca/terapia , Diálise Renal , Acidose/complicações , Adulto , Idoso , Terapia Combinada , Feminino , Parada Cardíaca/complicações , Humanos , Masculino , Resultado do Tratamento
18.
Clin Nephrol ; 90(2): 148-154, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-29932410

RESUMO

INTRODUCTION: Methanol intoxication is an infrequent cause of poisoning in the United Sates. It can present with prominent stroke-like features and acute kidney injury. Despite the life-threatening nature of this condition, it is poorly identified by clinicians. We aim to present a case of rapidly progressive mental decline and renal involvement, discuss a diagnostic work-up and provide a critical review on therapeutic strategies. CASE PRESENTATION: A 24-year-old patient presented to the emergency department with acute encephalopathy and diffuse muscular rigidity. His studies were relevant for severe anion gap metabolic acidosis, extensive brain infarction, and acute kidney injury. After excluding infections, drug intoxication, and environmental exposure, his serum methanol levels were found to be high. The patient was effectively treated with renal replacement therapy and survived with residual neurological sequelae. CONCLUSIONS: Methanol intoxication should be in the differential diagnosis of patients with brain infarction and high anion gap metabolic acidosis. Early use of renal replacement therapy may be life-saving and should be tailored on an individual basis.
.


Assuntos
Acidose/induzido quimicamente , Lesão Renal Aguda/induzido quimicamente , Infarto Encefálico/induzido quimicamente , Metanol/envenenamento , Diálise Renal , Acidose/terapia , Lesão Renal Aguda/terapia , Infarto Encefálico/terapia , Humanos , Masculino , Resultado do Tratamento , Adulto Jovem
19.
Arch. argent. pediatr ; 116(3): 365-370, jun. 2018. tab
Artigo em Inglês, Espanhol | LILACS, BINACIS | ID: biblio-950013

RESUMO

Introducción. La cetoacidosis diabética (CAD) se caracteriza por acidosis metabólica (AM) con anión restante (AR) elevado, aunque, ocasionalmente, puede presentar hipercloremia. Se postuló que la presencia de hipercloremia inicial podría reflejar un mejor estado de hidratación; sin embargo, su prevalencia y su impacto en el tratamiento de la CAD se desconoce. Objetivos. Determinar la prevalencia de AM con componente hiperclorémico previo al inicio del tratamiento y evaluar si su presencia se asocia con mejor estado de hidratación y con menor tiempo de salida de la CAD, en comparación con los pacientes con AR elevado exclusivo. Pacientes y métodos. Se agruparon los pacientes internados con CAD (período entre enero de 2014 y junio de 2016) según presentaran, al ingresar, AM con AR elevado exclusivo o con hipercloremia y se compararon sus variables clínicas, de laboratorio y la respuesta al tratamiento. Resultados. Se incluyeron 40 pacientes -amp;#91;17 varones, mediana de edad: 14,5 años (2,4-18)-amp;#93;, 22 con AM con componente hiperclorémico (prevalencia de 55%) y 18 con AR elevado exclusivo. La presencia de hipercloremia no se asoció con mejor estado de hidratación (porcentaje de déficit de peso en ambos grupos: 4,9%; p= 0,81) ni con una respuesta terapéutica más rápida (con componente hiperclorémico: 9,5 horas; con AR elevado exclusivo: 11 horas; p= 0,64). Conclusiones. En niños con CAD, la prevalencia de AM con componente hiperclorémico fue del 55% y no se asoció con un mejor estado de hidratación ni con una salida más temprana de la descompensación metabólica.


Introduction. Diabetic ketoacidosis (DKA) is characterized by metabolic acidosis (MA) with a high anion gap (AG), although, occasionally, it can present with hyperchloremia. It has been postulated that the early presence of hyperchloremia could reflect a better hydration status; however, its prevalence and impact on DKA treatment remain unknown. Objectives. To determine the prevalence of the hyperchloremic component in MA prior to treatment and to assess whether it is associated with a better hydration status and a shorter recovery time from DKA compared to patients with high AG only. Patients and Methods. Patients hospitalized with DKA (between January 2014 and June 2016) were grouped according to whether they were admitted with MA with high AG only. or with hyperchloremia, and clinical and laboratory outcome measures and response to treatment were compared. Results. Forty patients (17 males, median age: 14.5 years -amp;#91;2.4-18-amp;#93;) were included; 22 with hyperchloremic metabolic acidosis (prevalence of 55%) and 18 with metabolic acidosis with high AG only. The presence of hyperchloremia was not associated with a better hydration status (weight loss percentage in both groups: 4.9%; p= 0.81) nor with a faster treatment response (MA with a hyperchloremic component: 9.5 hours; MA with high AG only: 11 hours; p= 0.64). Conclusions. The prevalence of MA with a hyperchloremic component among children with DKA was 55% and was not associated with a better hydration status nor with a faster recovery from the metabolic decompensation.


Assuntos
Humanos , Masculino , Feminino , Lactente , Pré-Escolar , Criança , Adolescente , Equilíbrio Ácido-Base/fisiologia , Acidose/terapia , Cloretos/sangue , Cetoacidose Diabética/terapia , Acidose/fisiopatologia , Desequilíbrio Hidroeletrolítico , Prevalência , Estudos Transversais , Cetoacidose Diabética/fisiopatologia , Estado de Hidratação do Organismo/fisiologia
20.
Ital J Pediatr ; 44(1): 52, 2018 May 10.
Artigo em Inglês | MEDLINE | ID: mdl-29747671

RESUMO

BACKGROUND: FPIES (Food Protein Induced Eneterolitis Syndrome) is a rare non IgE- mediated food allergy, usually affecting infants and children after first months of life. Clinical presentation is heterogeneous, usually characterised by repetitive vomiting and diarrhoea, lethargy, failure to thrive until to dehydration with hypotension and shock. The diagnosis is based on clinical criteria, after excludind other hypothetical conditions. Early recognition of FPIES is essential to set a correct dietatay management that is resolving for the patient. CASE REPORT: We present the case of a 12 days old child who was admitted to the hospital for poor feeding, failure to thrive and severe metabolic acidosis. CONCLUSIONS: The early onset of this case is peculiar and rember us to consider FPIES in differential diagnosis of newborn metabolica acidosis.


Assuntos
Acidose/etiologia , Enterocolite/diagnóstico , Enterocolite/etiologia , Hipersensibilidade a Leite/complicações , Hipersensibilidade a Leite/diagnóstico , Proteínas do Leite/efeitos adversos , Acidose/diagnóstico , Acidose/terapia , Enterocolite/terapia , Humanos , Recém-Nascido , Masculino
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