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1.
BMJ Case Rep ; 14(1)2021 Jan 25.
Artigo em Inglês | MEDLINE | ID: mdl-33495193

RESUMO

Conn's syndrome is an important endocrine cause for secondary hypertension. Hypokalaemia paralysis and rhabdomyolysis with accelerated hypertension may be the presenting symptoms of Conn's syndrome. Here, we present one such case of a 38-year-old woman presenting with accelerated hypertension and acute onset quadriplegia. On biochemical evaluation, she was found to have severe hypokalaemia, metabolic alkalosis and elevated creatinine phosphokinase. Further evaluation revealed an elevated aldosterone renin ratio suggestive of primary hyperaldosteronism which was localised to left adrenal adenoma on contrast-enhanced CT. Patient's blood pressure and serum potassium levels normalised after resection of the adrenal adenoma.


Assuntos
Neoplasias do Córtex Suprarrenal/complicações , Adenoma Adrenocortical/complicações , Hiperaldosteronismo/etiologia , Hipopotassemia/etiologia , Quadriplegia/etiologia , Rabdomiólise/etiologia , Neoplasias do Córtex Suprarrenal/diagnóstico por imagem , Neoplasias do Córtex Suprarrenal/cirurgia , Adenoma Adrenocortical/diagnóstico por imagem , Adenoma Adrenocortical/cirurgia , Adulto , Alcalose/etiologia , Creatina Quinase , Feminino , Humanos , Hiperaldosteronismo/diagnóstico , Hiperaldosteronismo/fisiopatologia , Hiperaldosteronismo/cirurgia , Hipertensão/etiologia , Tomografia Computadorizada por Raios X
2.
Medicine (Baltimore) ; 99(29): e20826, 2020 Jul 17.
Artigo em Inglês | MEDLINE | ID: mdl-32702825

RESUMO

RATIONALE: The typical clinical presentations of patients with primary aldosteronism (PA) include generalized weakness, fatigue, high blood pressure, and potassium deficiency. However, normotensive PA is rare. Therefore, an atypical presentation of normal blood pressure is a challenge for the diagnosis and treatment of PA. PATIENT CONCERNS: A 43-year-old, thin, and tall woman (body mass index, 18.6 kg/m) with generalized weakness for 1 day presented to our emergency department, where hypokalemia was a significant finding. The initial diagnosis was anorexia nervosa with the evidence of renal potassium wasting with low urinary sodium and chloride levels, metabolic alkalosis, normal blood pressure, and low body mass index. However, neither vomiting features nor other specific induced vomiting features were noted. DIAGNOSES: The laboratory examination revealed high plasma aldosterone level, low plasma renin activity, and extremely high aldosterone-to-renin ratio indicating the diagnosis of PA, confirmed via adrenal computed tomography. INTERVENTIONS: Surgical adrenalectomy was performed. Pathological diagnosis was a benign cortical adenoma. OUTCOMES: Patient's serum potassium level and hormonal status became normalized after surgical removal of adrenal adenoma. She fully recovered without any further sequelae. LESSONS: It is too early to rule out PA based on the presence of normal blood pressure in a patient with metabolic alkalosis and renal wasting hypokalemia. Moreover, PA should be considered in a normotensive patient with an unknown hypokalemic etiology to avoid delayed diagnosis and treatment.


Assuntos
Anorexia Nervosa/diagnóstico , Hiperaldosteronismo/diagnóstico por imagem , Hipopotassemia/diagnóstico , Adenoma/cirurgia , Adrenalectomia/métodos , Adulto , Aldosterona/sangue , Alcalose/etiologia , Anorexia Nervosa/psicologia , Pressão Sanguínea/fisiologia , Diagnóstico Diferencial , Serviço Hospitalar de Emergência , Feminino , Humanos , Hiperaldosteronismo/sangue , Hiperaldosteronismo/patologia , Hiperaldosteronismo/cirurgia , Hipopotassemia/etiologia , Debilidade Muscular/etiologia , Renina/sangue , Sódio/urina , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento
3.
Am J Physiol Renal Physiol ; 318(6): F1418-F1429, 2020 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-32308019

RESUMO

The use of high dialysate bicarbonate for hemodialysis in end-stage renal disease is associated with increased mortality, but potential physiological mediators are poorly understood. Alkalinization due to high dialysate bicarbonate may stimulate organic acid generation, which could lead to poor outcomes. Using measurements of ß-hydroxybutyrate (BHB) and lactate, we quantified organic anion (OA) balance in two single-arm studies comparing high and low bicarbonate prescriptions. In study 1 (n = 10), patients became alkalemic using 37 meq/L dialysate bicarbonate; in contrast, with the use of 27 meq/L dialysate, net bicarbonate loss occurred and blood bicarbonate decreased. Total OA losses were not higher with 37 meq/L dialysate bicarbonate (50.9 vs. 49.1 meq using 27 meq/L, P = 0.66); serum BHB increased in both treatments similarly (P = 0.27); and blood lactate was only slightly higher with the use of 37 meq/L dialysate (P = 0.048), differing by 0.2 meq/L at the end of hemodialysis. In study 2 (n = 7), patients achieved steady state on two bicarbonate prescriptions: they were significantly more acidemic when dialyzed against a 30 meq/L bicarbonate dialysate compared with 35 meq/L and, as in study 1, became alkalemic when dialyzed against the higher bicarbonate dialysate. OA losses were similar to those in study 1 and again did not differ between treatments (38.9 vs. 43.5 meq, P = 0.42). Finally, free fatty acid levels increased throughout hemodialysis and correlated with the change in serum BHB (r = 0.81, P < 0.001), implicating upregulation of lipolysis as the mechanism for increased ketone production. In conclusion, lowering dialysate bicarbonate does not meaningfully reduce organic acid generation during hemodialysis or modify organic anion losses into dialysate.


Assuntos
Ácido 3-Hidroxibutírico/sangue , Equilíbrio Ácido-Base , Alcalose/sangue , Bicarbonatos/administração & dosagem , Soluções para Hemodiálise/administração & dosagem , Falência Renal Crônica/terapia , Ácido Láctico/sangue , Diálise Renal , Adulto , Idoso , Idoso de 80 Anos ou mais , Alcalose/diagnóstico , Alcalose/etiologia , Alcalose/fisiopatologia , Bicarbonatos/efeitos adversos , Bicarbonatos/metabolismo , Biomarcadores/sangue , Ácidos Graxos não Esterificados/sangue , Feminino , Soluções para Hemodiálise/efeitos adversos , Soluções para Hemodiálise/metabolismo , Humanos , Concentração de Íons de Hidrogênio , Falência Renal Crônica/sangue , Falência Renal Crônica/diagnóstico , Falência Renal Crônica/fisiopatologia , Lipólise , Masculino , Pessoa de Meia-Idade , Diálise Renal/efeitos adversos , Fatores de Tempo , Resultado do Tratamento
4.
Ren Fail ; 42(1): 234-243, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32138574

RESUMO

Background: This study aims to delineate the incidence of electrolyte and acid-base disorders (EAD) in cancer patients, to figure out the risk factors of EAD, then to assess the impact of EAD on patients' in-hospital clinical outcomes.Methods: Patients with the diagnosis of malignancies hospitalized during 1 October 2014 and 30 September 2015 were recruited in Zhongshan Hospital, Fudan University in Shanghai of China. Demographic characteristics, comorbidities, and clinical data, including survival, length of stay and hospital cost, were extracted from the electronic medical record system. Electrolyte and acid-base data were acquired from the hospital laboratory database.Results: Of 25,881 cancer patients with electrolyte data, 15,000 (58.0%) cases had at least one electrolyte and acid-base abnormity. Hypocalcemia (27.8%) was the most common electrolyte disorder, followed by hypophosphatemia (26.7%), hypochloremia (24.5%) and hyponatremia (22.5%). The incidence of simple metabolic acidosis (MAC) and metabolic alkalosis (MAL) was 12.8% and 22.1% respectively. Patients with mixed metabolic acid-base disorders (MAC + MAL) accounted for 30.2%. Lower BMI score, preexisting hypertension and diabetes, renal dysfunction, receiving surgery/chemotherapy, anemia and hypoalbuminemia were screened out as the major risk factors of EAD. In-hospital mortality in patients with EAD was 2.1% as compared to those with normal electrolytes (0.3%). The risk of death significantly increased among patients with severe EAD. Similarly, the length of stay and hospital cost also tripled as the number and grade of EAD increased.Conclusion: EAD is commonly encountered in cancer patients and associated with an ominous prognosis. Patients with comorbidities, renal/liver dysfunction, and anti-tumor therapy have a higher risk of EAD. Regular monitoring of electrolytes, optimum regimen for intravenous infusion, timely correction of modifiable factors and appropriate management of EAD should not be neglected during anti-tumor treatment.


Assuntos
Desequilíbrio Ácido-Base/etiologia , Custos Hospitalares/estatística & dados numéricos , Mortalidade Hospitalar , Tempo de Internação/estatística & dados numéricos , Neoplasias/complicações , Desequilíbrio Hidroeletrolítico/etiologia , Desequilíbrio Ácido-Base/sangue , Acidose/sangue , Acidose/etiologia , Idoso , Alcalose/sangue , Alcalose/etiologia , China , Feminino , Humanos , Hiperpotassemia/etiologia , Hipernatremia/etiologia , Hipocalcemia/etiologia , Hipopotassemia/etiologia , Hiponatremia/etiologia , Hipofosfatemia/etiologia , Masculino , Pessoa de Meia-Idade , Neoplasias/sangue , Estudos Retrospectivos , Fatores de Risco , Análise de Sobrevida , Desequilíbrio Hidroeletrolítico/sangue
7.
Acta Biomed ; 90(2): 348-352, 2019 05 23.
Artigo em Inglês | MEDLINE | ID: mdl-31125018

RESUMO

INTRODUCTION: Distal renal tubular acidosis is a rare genetic disease, characterised by deficit in renal tubular transport. Clinical features are metabolic acidosis with hypercloraemia and hypokalemia, and inability in urine acidification. Hypercalciuria may also be present, often treated with the use of a diuretic therapy with thiazides. CASE PRESENTATION: We present a severe disease onset in a neonate with consanguineous parents, both autosomal-recessive for an ATP6VOA4 gene mutation, and a nevertheless severe episode of metabolic alkalosis, occurred in the same patient after few months, during the diuretic therapy. CONCLUSION: Biochemical results lead us to hypothesize a susceptibility to the treatment that need further investigations.


Assuntos
Acidose Tubular Renal/tratamento farmacológico , Alcalose/etiologia , Diuréticos/efeitos adversos , ATPases Mitocondriais Próton-Translocadoras/genética , Tiazidas/efeitos adversos , Acidose Tubular Renal/diagnóstico , Alcalose/fisiopatologia , Análise Química do Sangue , Consanguinidade , Diuréticos/uso terapêutico , Serviço Hospitalar de Emergência , Seguimentos , Disgenesia Gonadal 46 XY , Humanos , Recém-Nascido , Mutação , Doenças Raras , Índice de Gravidade de Doença , Tiazidas/uso terapêutico , Urinálise/métodos , Perda de Peso
8.
BMJ Case Rep ; 12(4)2019 Apr 15.
Artigo em Inglês | MEDLINE | ID: mdl-30992286

RESUMO

Nephrotic range proteinuria and metabolic alkalosis are unusual findings in large vessel vasculitis. In this case, renovascular hypertension with unilateral renal artery stenosis in Takayasu arteritis was complicated by nephrotic range proteinuria. Symptoms resolved after angioplasty, although non-nephrotic proteinuria persisted. The renal pathology of Takayasu arteritis included focal glomerulosclerosis.


Assuntos
Alcalose/etiologia , Glomerulosclerose Segmentar e Focal/etiologia , Hipertensão Renovascular/complicações , Arterite de Takayasu/complicações , Adolescente , Anlodipino/administração & dosagem , Anti-Hipertensivos/administração & dosagem , Feminino , Cefaleia/etiologia , Humanos , Hipertensão Renovascular/diagnóstico , Hipertensão Renovascular/tratamento farmacológico , Nicardipino/administração & dosagem , Proteinúria/etiologia
11.
Acta Clin Belg ; 74(1): 34-40, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30369299

RESUMO

Metabolic alkalosis defined by the increase of both plasma HCO3- level (>26 mmol/L) and blood arterial pH (>7.43) is quite frequent and usually accompanied by hypokalemia. Its pathogenesis requires both the generation of alkalosis and its maintenance. Generation may be due to excessive hydrogen ion loss by the gastrointestinal tract (e.g. vomiting) or by the kidney (e.g. use of loop diuretics) or may be due to exogenous base gain. Maintenance reflects the inability of the kidney to excrete the excess of bicarbonate because of hypovolemia, chloride depletion, hypokalemia, hyperaldosteronism, renal failure or a combination of these factors. The evaluation of volemic status and measurement of urinary Cl- and plasma levels of renin and aldosterone are crucial to identify the cause(s) of metabolic alkalosis. The cornerstone of treatment is the correction of existing depletions and the prevention of further losses. In vomiting-induced chloride depletion alkalosis, infusion of potassium chloride restores the excretion of bicarbonate by the kidney.


Assuntos
Alcalose/etiologia , Idoso de 80 Anos ou mais , Alcalose/diagnóstico , Alcalose/terapia , Diagnóstico Diferencial , Feminino , Humanos
12.
Nutrition ; 60: 94-99, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30551121

RESUMO

OBJECTIVES: It is well established that ingestion of sodium bicarbonate (NaHCO3) causes metabolic alkalosis. However, there is no consensus in terms of optimal NaHCO3 doses leading to enhanced performance. This study aimed to determine the effects of different NaHCO3 doses on performance and lactate clearance in non-professional cyclists. METHODS: Twenty-one cyclists performed the following three double-blind trials: 1) ingestion of 0.3 g · kg-1 body weight (BW) of placebo; 2) ingestion of 0.1 g · kg-1 BW NaHCO3 plus 0.2 g · kg-1 BW placebo (0.1 BC); and 3) ingestion of 0.3 g · kg-1 BW NaHCO3 (0.3 BC). Performance was evaluated after warm-up on the bike followed by a performance test until exhaustion. Lactate levels were monitored in blood samples before and immediately after performance tests. RESULTS: Lactate levels in the blood were significantly higher after exercise in 0.3 BC and 0.1 BC (15.12 ± 0.92 versus 10.3 ± 1.22 and 13.24 ± 0.87 versus 10.3 ± 1.22 mmol/L; P < 0.05) compared with control. Significant improvements in performance were only identified in 0.3 BC group (76.42 ± 2.14; P = 0.01). CONCLUSIONS: The present study found that 0.3 g · kg-1 BW NaHCO3 is effective in improving performance and improving blood lactate levels in cyclists compared with control and 0.1 g · kg-1 BW NaHCO3.


Assuntos
Desempenho Atlético/fisiologia , Ciclismo/fisiologia , Tolerância ao Exercício/efeitos dos fármacos , Ácido Láctico/sangue , Bicarbonato de Sódio/administração & dosagem , Alcalose/sangue , Alcalose/etiologia , Estudos Cross-Over , Relação Dose-Resposta a Droga , Método Duplo-Cego , Humanos , Masculino , Adulto Jovem
13.
Nephrol Dial Transplant ; 34(1): 38-39, 2019 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-29982819

RESUMO

Hypokalaemia with alkalosis can suggest excess aldosterone. Aldosterone stimulates the collecting duct mineralocorticoid receptor (MR) to upregulate the epithelial sodium channel (ENaC) and stimulate electrogenic sodium reabsorption, with secretion of potassium and protons. Gitelman, Bartter and Liddle syndrome, and liquorice ingestion all cause hypokalaemic alkalosis. This mini-review outlines the pathophysiology of these conditions as well as how to differentiate them.


Assuntos
Alcalose/diagnóstico , Síndrome de Bartter/diagnóstico , Biomarcadores/metabolismo , Glycyrrhiza/efeitos adversos , Hipopotassemia/diagnóstico , Aldosterona/metabolismo , Alcalose/etiologia , Alcalose/metabolismo , Síndrome de Bartter/complicações , Síndrome de Bartter/metabolismo , Diagnóstico Diferencial , Canais Epiteliais de Sódio/metabolismo , Humanos , Hipopotassemia/etiologia , Hipopotassemia/metabolismo , Túbulos Renais/metabolismo , Potássio/metabolismo , Sódio/metabolismo
14.
CEN Case Rep ; 7(2): 195-197, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-29568987

RESUMO

Furosemide is one of the most common drug used to treat anasarca in childhood nephrotic syndrome. It has minimal side effects on short-term usage, but prolonged use can result in polyuria, hypokalemia and metabolic alkalosis. This pseudo-bartter complication can be treated by discontinuation of the drug with adequate potassium replacement. We report a child who was given furosemide for 20 days elsewhere to treat the edema due to nephrotic syndrome and then presented to us with bartter-like syndrome. Furosemide was discontinued and potassium replacement was initiated. However, the child continued to have polyuria leading to repeated episodes of hypotensive shock. In view of severe symptoms, she was given a short course of oral indomethacin for 6 days, to which she responded. This case highlights the fact that indomethacin can provide symptomatic improvement in furosemide induced pseudo-bartter.


Assuntos
Síndrome de Bartter/diagnóstico , Furosemida/efeitos adversos , Síndrome Nefrótica/tratamento farmacológico , Alcalose/induzido quimicamente , Alcalose/etiologia , Síndrome de Bartter/etiologia , Pré-Escolar , Inibidores de Ciclo-Oxigenase/uso terapêutico , Diuréticos/efeitos adversos , Diuréticos/uso terapêutico , Feminino , Furosemida/uso terapêutico , Humanos , Hipopotassemia/complicações , Hipotensão/etiologia , Indometacina/administração & dosagem , Indometacina/uso terapêutico , Rim/efeitos dos fármacos , Rim/fisiopatologia , Túbulos Renais/efeitos dos fármacos , Túbulos Renais/fisiopatologia , Síndrome Nefrótica/sangue , Síndrome Nefrótica/complicações , Síndrome Nefrótica/diagnóstico , Poliúria/induzido quimicamente , Poliúria/diagnóstico , Poliúria/etiologia , Antagonistas de Prostaglandina/uso terapêutico , Resultado do Tratamento
15.
J Obstet Gynaecol ; 38(4): 573-575, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-29385934

RESUMO

Hyperemesis gravidarum is defined as a condition emerging during pregnancy, is prominent with severe nausea and vomiting, a water-electrolyte imbalance and liver-kidney function disorder and causes more than 5% loss of body weight. In cases of severe hyperemesis gravidarum, maternal morbidities such as water-electrolyte imbalance, hepatorenal failure, Wernicke's encephalopathy, splenic avulsion, oesophageal rupture, pneumothorax have been reported. We present a case of hyperemesis gravidarum, which continued until the third trimester and developed secondary hepatorenal failure, a water-electrolyte imbalance, intrauterine growth restriction, anhydramnios, foetal distress and neonatal mortality.


Assuntos
Alcalose/etiologia , Retardo do Crescimento Fetal/etiologia , Síndrome Hepatorrenal/etiologia , Hiperêmese Gravídica/complicações , Feminino , Sofrimento Fetal , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Masculino , Morte Perinatal , Gravidez , Adulto Jovem
16.
Ugeskr Laeger ; 180(7)2018 Feb 12.
Artigo em Dinamarquês | MEDLINE | ID: mdl-29465034

RESUMO

This case report is about an 87-year-old woman with Alzheimer's disease and the milk-alkali syndrome, who took calcium carbonate as osteoporosis prophylaxis. We describe, how the milk-alkali syndrome can result in a triad of hypercalcaemia, metabolic alkalosis, and renal insufficiency. The syndrome is now the third most common cause of hypercalcaemia because of the use of calcium carbonate in osteoporosis prophylaxis and treatment, and the syndrome should be considered in patients with hypercalcaemia, as it may result in permanent renal impairment.


Assuntos
Hipercalcemia/etiologia , Idoso de 80 Anos ou mais , Alcalose/etiologia , Alcalose/terapia , Carbonato de Cálcio/efeitos adversos , Carbonato de Cálcio/uso terapêutico , Evolução Fatal , Feminino , Humanos , Hipercalcemia/terapia , Osteoporose/prevenção & controle , Insuficiência Renal/etiologia , Insuficiência Renal/terapia
17.
Iran J Kidney Dis ; 12(1): 61-63, 2018 01.
Artigo em Inglês | MEDLINE | ID: mdl-29421779

RESUMO

Cystinosis is a rare autosomal recessive disorder resulting from defective lysosomal transport of cystine due to mutations in the cystinosin lysosomal cystine transporter (CTNS) gene. The clinical phenotype of nephropathic cystinosis is characterized by renal tubular Fanconi syndrome and development of end-stage renal disease during the first decade. Although metabolic acidosis is the classically prominent finding of the disease, a few cases may present with hypokalemic metabolic alkalosis mimicking Bartter syndrome. Bartter-like presentation may lead to delay in diagnosis and initiation of specific treatment for cystinosis. We report a case of a 6-year-old girl initially presenting with the features of Bartter syndrome that was diagnosed 2 years later with nephropathic cystinosis and a novel CTNS mutation.


Assuntos
Sistemas de Transporte de Aminoácidos Neutros/genética , Síndrome de Bartter/diagnóstico , Cistinose/diagnóstico , Cistinose/genética , Mutação , Alcalose/etiologia , Criança , Cistinose/complicações , Cistinose/terapia , Análise Mutacional de DNA , Diagnóstico Diferencial , Progressão da Doença , Feminino , Predisposição Genética para Doença , Humanos , Hipopotassemia/etiologia , Falência Renal Crônica/etiologia , Diálise Peritoneal , Fenótipo , Valor Preditivo dos Testes
19.
Int Urol Nephrol ; 50(1): 81-89, 2018 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-28608260

RESUMO

Chronic hepatic patients, and particularly those suffering from cirrhosis, are predisposed to different sort of water, electrolyte, acid-base, and trace elements disorders due to their altered liver function, and also to their exposition to infectious, inflammatory, oncologic, and pharmacologic variables whose combination undermines their homeostatic capability. Hyponatremia, hypokalemia, hyperkalemia, hypocalcemia, metabolic acidosis, respiratory, and metabolic alkalosis are the main internal milieu alterations in this group.


Assuntos
Hiperpotassemia/etiologia , Hiponatremia/etiologia , Cirrose Hepática/sangue , Cirrose Hepática/complicações , Desequilíbrio Ácido-Base/etiologia , Acidose/sangue , Acidose/etiologia , Alcalose/sangue , Alcalose/etiologia , Humanos , Hiperpotassemia/sangue , Hipernatremia/sangue , Hipernatremia/etiologia , Hipopotassemia/sangue , Hipopotassemia/etiologia , Hiponatremia/sangue , Magnésio/metabolismo , Sódio/metabolismo , Oligoelementos/sangue , Desequilíbrio Hidroeletrolítico/etiologia
20.
J Surg Res ; 212: 229-237, 2017 05 15.
Artigo em Inglês | MEDLINE | ID: mdl-28550912

RESUMO

BACKGROUND: This pilot study focuses on regional tissue oxygenation (rSO2) in patients with infantile hypertrophic pyloric stenosis in a perioperative setting. To investigate the influence of enhanced metabolic alkalosis (MA) on cerebral (c-rSO2) and renal (r-rSO2) tissue oxygenation, two-site near-infrared spectroscopy (NIRS) technology was applied. MATERIALS AND METHODS: Perioperative c-rSO2, r-rSO2, capillary blood gases, and electrolytes from 12 infants were retrospectively compared before and after correction of MA at admission (T1), before surgery (T2), and after surgery (T3). RESULTS: Correction of MA was associated with an alteration of cerebral oxygenation without affecting renal oxygenation. When compared to T1, 5-min mean (± standard deviation) c-rSO2 increased after correction of MA at T2 (72.74 ± 4.60% versus 77.89 ± 5.84%; P = 0.058), reaching significance at T3 (80.79 ± 5.29%; P = 0.003). Furthermore, relative 30-min c-rSO2 values at first 3 h of metabolic compensation were significantly lowered compared with postsurgical states at 16 and 24 h. Cerebral oxygenation was positively correlated with levels of sodium (r = 0.37; P = 0.03) and inversely correlated with levels of bicarbonate (r = -0.34; P = 0.05) and base excess (r = -0.36; P = 0.04). Analysis of preoperative and postoperative cerebral and renal hypoxic burden yielded no differences. However, a negative correlation (r = -0.40; P = 0.03) regarding hematocrite and mean r-rSO2, indirectly indicative of an increased renal blood flow under hemodilution, was obtained. CONCLUSIONS: NIRS seems suitable for the detection of a transiently impaired cerebral oxygenation under state of pronounced MA in infants with infantile hypertrophic pyloric stenosis. Correction of MA led to normalization of c-rSO2. NIRS technology constitutes a promising tool for optimizing perioperative management, especially in the context of a possible diminished neurodevelopmental outcome after pyloromyotomy.


Assuntos
Alcalose/metabolismo , Encéfalo/metabolismo , Rim/metabolismo , Oxigênio/metabolismo , Estenose Pilórica Hipertrófica/fisiopatologia , Alcalose/etiologia , Alcalose/terapia , Biomarcadores/metabolismo , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Período Perioperatório , Projetos Piloto , Estenose Pilórica Hipertrófica/cirurgia , Estudos Retrospectivos , Espectroscopia de Luz Próxima ao Infravermelho
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