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2.
Osteoporos Int ; 30(2): 431-439, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30255228

RESUMO

Potassium bicarbonate was administrated to an already alkaline diet in seven male subjects during a 21-day bed rest study and was able to decrease bed rest induced increased calcium excretion but failed to prevent bed rest-induced bone resorption. INTRODUCTION: Supplementation with alkali salts appears to positively influence calcium and bone metabolism and, thus, could be a countermeasure for population groups with an increased risk for bone loss. However, the extent to which alkalization counteracts acid-induced bone resorption or whether it merely has a calcium and bone maintenance effect is still not completely understood. In the present study, we hypothesized that additional alkalization to an already alkaline diet can further counteract bed rest-induced bone loss. METHODS: Seven healthy male subjects completed two parts of a crossover designed 21-day bed rest study: bed rest only (control) and bed rest supplemented with 90 mmol potassium bicarbonate (KHCO3) daily. RESULTS: KHCO3supplementation during bed rest resulted in a more alkaline status compared to the control intervention, demonstrated by the increase in pH and buffer capacity level (pH p = 0.023, HCO3p = 0.02, ABE p = 0.03). Urinary calcium excretion was decreased during KHCO3 supplementation (control 6.05 ± 2.74 mmol/24 h; KHCO3 4.87 ± 2.21 mmol/24 h, p = 0.03); whereas, bone formation was not affected by additional alkalization (bAP p = 0.58; PINP p = 0.60). Bone resorption marker UCTX tended to be lower during alkaline supplementation (UCTX p = 0.16). CONCLUSIONS: The more alkaline acid-base status, achieved by KHCO3 supplementation, reduced renal calcium excretion during bed rest, but was not able to prevent immobilization-induced bone resorption. However, advantages of alkaline salts on bone metabolism may occur under acidic metabolic conditions or with respect to the positive effect of reduced calcium excretion within a longer time frame. TRIAL REGISTRATION: Trial number: NCT01509456.


Assuntos
Repouso em Cama/efeitos adversos , Bicarbonatos/uso terapêutico , Reabsorção Óssea/prevenção & controle , Suplementos Nutricionais , Compostos de Potássio/uso terapêutico , Adulto , Bicarbonatos/farmacologia , Biomarcadores/metabolismo , Reabsorção Óssea/etiologia , Reabsorção Óssea/metabolismo , Cálcio/urina , Estudos Cross-Over , Humanos , Concentração de Íons de Hidrogênio/efeitos dos fármacos , Imobilização/efeitos adversos , Imobilização/fisiologia , Masculino , Osteogênese/efeitos dos fármacos , Compostos de Potássio/farmacologia , Suporte de Carga/fisiologia , Adulto Jovem
3.
Crit Care Med ; 47(2): 194-200, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30407950

RESUMO

OBJECTIVES: Clinical providers have access to a number of pharmacologic agents during in-hospital cardiac arrest. Few studies have explored medication administration patterns during in-hospital cardiac arrest. Herein, we examine trends in use of pharmacologic interventions during in-hospital cardiac arrest both over time and with respect to the American Heart Association Advanced Cardiac Life Support guideline updates. DESIGN: Observational cohort study. SETTING: Hospitals contributing data to the American Heart Association Get With The Guidelines-Resuscitation database between 2001 and 2016. PATIENTS: Adult in-hospital cardiac arrest patients. INTERVENTIONS: The percentage of patients receiving epinephrine, vasopressin, amiodarone, lidocaine, atropine, bicarbonate, calcium, magnesium, and dextrose each year were calculated in patients with shockable and nonshockable initial rhythms. Hierarchical multivariable logistic regression was used to determine the annual adjusted odds of medication administration. An interrupted time series analysis was performed to assess change in atropine use after the 2010 American Heart Association guideline update. MEASUREMENTS AND MAIN RESULTS: A total of 268,031 index in-hospital cardiac arrests were included. As compared to 2001, the adjusted odds ratio of receiving each medication in 2016 were epinephrine (adjusted odds ratio, 1.5; 95% CI, 1.3-1.8), vasopressin (adjusted odds ratio, 1.5; 95% CI, 1.1-2.1), amiodarone (adjusted odds ratio, 3.4; 95% CI, 2.9-4.0), lidocaine (adjusted odds ratio, 0.2; 95% CI, 0.2-0.2), atropine (adjusted odds ratio, 0.07; 95% CI, 0.06-0.08), bicarbonate (adjusted odds ratio, 2.0; 95% CI, 1.8-2.3), calcium (adjusted odds ratio, 2.0; 95% CI, 1.7-2.3), magnesium (adjusted odds ratio, 2.2; 95% CI, 1.9-2.7; p < 0.0001), and dextrose (adjusted odds ratio, 2.8; 95% CI, 2.3-3.4). Following the 2010 American Heart Association guideline update, there was a downward step change in the intercept and slope change in atropine use (p < 0.0001). CONCLUSIONS: Prescribing patterns during in-hospital cardiac arrest have changed significantly over time. Changes to American Heart Association Advanced Cardiac Life Support guidelines have had a rapid and substantial effect on the use of a number of commonly used in-hospital cardiac arrest medications.


Assuntos
Antiarrítmicos/uso terapêutico , Parada Cardíaca/tratamento farmacológico , Vasoconstritores/uso terapêutico , Idoso , Amiodarona/uso terapêutico , Atropina/uso terapêutico , Bicarbonatos/uso terapêutico , Cálcio/uso terapêutico , Epinefrina/uso terapêutico , Feminino , Glucose/uso terapêutico , Fidelidade a Diretrizes/estatística & dados numéricos , Hospitalização , Humanos , Lidocaína/uso terapêutico , Modelos Logísticos , Magnésio/uso terapêutico , Masculino , Pessoa de Meia-Idade , Razão de Chances , Guias de Prática Clínica como Assunto , Padrões de Prática Médica/estatística & dados numéricos , Vasopressinas/uso terapêutico
4.
Acta Biomed ; 89(9-S): 76-80, 2018 12 17.
Artigo em Inglês | MEDLINE | ID: mdl-30561398

RESUMO

BACKGROUND AND AIM OF THE WORK: Historical studies have demonstrated that the prevalence of symptomatic nephrolithiasis is higher in patients with inflammatory bowel disease (IBD), compared to general population. The aim of the review was to analyze literature data in order to identify the main risk conditions described in literature and the proposed treatment. METHODS: A research on the databases PubMed, Medline, Embase and Google Scholar was performed by using the keywords "renal calculi/lithiasis/stones" and "inflammatory bowel diseases". A research on textbooks of reference for Pediatric Nephrology was also performed, with focus on secondary forms of nephrolithiasis. RESULTS: Historical studies have demonstrated that the prevalence of symptomatic nephrolithiasis is higher in patients with inflammatory bowel disease (IBD), compared to general population, typically in patients who underwent extensive small bowel resection or in those with persistent severe small bowel inflammation. In IBD, kidney stones may arise from chronic inflammation, changes in intestinal absorption due to inflammation, surgery or intestinal malabsorption. Kidney stones are more closely associated with Crohn's Disease (CD) than Ulcerative Colitis (UC) in adult patients for multiple reasons: mainly for malabsorption, but in UC intestinal resection may be an additional risk. Nephrolithiasis is often under-diagnosed and might be a rare but noticeable extra-intestinal presentation of pediatric IBD. Secondary enteric hyperoxaluria the main risk factor of UL in IBD, this has been mainly studied in CD, whether in UC has not been completely explained. In the long course of CD recurrent urolithiasis and calcium-oxalate deposition may cause severe chronic interstitial nephritis and, as a consequence, chronic kidney disease. ESRD and systemic oxalosis often develop early, especially in those patients with multiple bowel resections. Even if we consider that many additional factors are present in IBD as hypomagnesuria, acidosis, hypocitraturia, and others, the secondary hyperoxaluria seems to finally have a central role. Some medications as parenteral vitamin D, long-term and high dose steroid treatment, sulfasalazine are reported as additional risk factors. Hydration status may also play an important role in this process. Intestinal surgery is a widely described independent risk factor. Patients with ileostomy post bowel resection may have relative dehydration from liquid stool, which, added to the acidic pH from bicarbonate loss, is responsible for this process. In this acidic pH, the urinary citrate level excretion reduces. The stones most commonly seen in these patients contain uric acid or are mixed. In addition, the risk of calcium containing stones also increases with ileostomy. The treatment of UL in IBD involves correction of the basic gastrointestinal tract inflammation, restricted dietary oxalate intake, and, at times, increased calcium intake. Citrate therapy that increases both urine pH and urinary citrate could also provide an additional therapeutic benefit. Finally, patients with IBD in a pediatric study had less urologic intervention for their calculosis compared with pediatric patients without IBD.


Assuntos
Doenças Inflamatórias Intestinais/complicações , Urolitíase/etiologia , Bicarbonatos/uso terapêutico , Criança , Citratos/uso terapêutico , Desidratação/complicações , Suscetibilidade a Doenças , Humanos , Inflamação , Doenças Inflamatórias Intestinais/fisiopatologia , Doenças Inflamatórias Intestinais/cirurgia , Síndromes de Malabsorção/etiologia , Síndromes de Malabsorção/fisiopatologia , Oxalatos/metabolismo , Risco , Urolitíase/tratamento farmacológico , Urolitíase/prevenção & controle
5.
Cochrane Database Syst Rev ; 10: CD007554, 2018 10 26.
Artigo em Inglês | MEDLINE | ID: mdl-30362116

RESUMO

BACKGROUND: Biocompatible peritoneal dialysis (PD) solutions, including neutral pH, low glucose degradation product (GDP) solutions and icodextrin, have previously been shown to favourably influence some patient-level outcomes, albeit based on generally sub-optimal quality studies. Several additional randomised controlled trials (RCT) evaluating biocompatible solutions in PD patients have been published recently. This is an update of a review first published in 2014. OBJECTIVES: This review aimed to look at the benefits and harms of biocompatible PD solutions in comparison to standard PD solutions in patients receiving PD. SEARCH METHODS: The Cochrane Kidney and Transplant Specialised Register was searched up to 12 February 2018 through contact with the Information Specialist using search terms relevant to this review. Studies in the Specialised Register are identified through searches of CENTRAL, MEDLINE, and EMBASE, conference proceedings, the International Clinical Trials Register Search Portal and ClinicalTrials.gov. SELECTION CRITERIA: All RCTs and quasi-RCTs in adults and children comparing the effects of biocompatible PD solutions (neutral pH, lactate-buffered, low GDP; neutral pH, bicarbonate(± lactate)-buffered, low GDP; glucose polymer (icodextrin)) in PD were included. Studies of amino acid-based solutions were excluded. DATA COLLECTION AND ANALYSIS: Two authors extracted data on study quality and outcomes. Summary effect estimates were obtained using a random-effects model, and results were expressed as risk ratios and 95% confidence intervals (CI) for categorical variables, and mean differences (MD) or standardised mean differences (SMD) and 95% CI for continuous variables. MAIN RESULTS: This review update included 42 eligible studies (3262 participants), including six new studies (543 participants). Overall, 29 studies (1971 participants) compared neutral pH, low GDP PD solution with conventional PD solution, and 13 studies (1291 participants) compared icodextrin with conventional PD solution. Risk of bias was assessed as high for sequence generation in three studies, allocation concealment in three studies, attrition bias in 21 studies, and selective outcome reporting bias in 16 studies.Neutral pH, low GDP versus conventional glucose PD solutionUse of neutral pH, low GDP PD solutions improved residual renal function (RRF) preservation (15 studies, 835 participants: SMD 0.19, 95% CI 0.05 to 0.33; high certainty evidence). This approximated to a mean difference in glomerular filtration rate of 0.54 mL/min/1.73 m2 (95% CI 0.14 to 0.93). Better preservation of RRF was evident at all follow-up durations with progressively greater preservation observed with increasing follow up duration. Neutral pH, low GDP PD solution use also improved residual urine volume preservation (11 studies, 791 participants: MD 114.37 mL/day, 95% CI 47.09 to 181.65; high certainty evidence). In low certainty evidence, neutral pH, low GDP solutions may make little or no difference to 4-hour peritoneal ultrafiltration (9 studies, 414 participants: SMD -0.42, 95% CI -0.74 to -0.10) which approximated to a mean difference in peritoneal ultrafiltration of 69.72 mL (16.60 to 122.00 mL) lower, and may increase dialysate:plasma creatinine ratio (10 studies, 746 participants: MD 0.01, 95% CI 0.00 to 0.03), technique failure or death compared with conventional PD solutions. It is uncertain whether neutral pH, low GDP PD solution use led to any differences in peritonitis occurrence, hospitalisation, adverse events (6 studies, 519 participants) or inflow pain (1 study, 58 participants: RR 0.51, 95% CI 0.24 to 1.08).Glucose polymer (icodextrin) versus conventional glucose PD solutionIn moderate certainty evidence, icodextrin probably reduced episodes of uncontrolled fluid overload (2 studies, 100 participants: RR 0.30, 95% CI 0.15 to 0.59) and augmented peritoneal ultrafiltration (4 studies, 102 participants: MD 448.54 mL/d, 95% CI 289.28 to 607.80) without compromising RRF (4 studies, 114 participants: SMD 0.12, 95% CI -0.26 to 0.49; low certainty evidence) which approximated to a mean creatinine clearance of 0.30 mL/min/1.73m2 higher (0.65 lower to 1.23 higher) or urine output (3 studies, 69 participants: MD -88.88 mL/d, 95% CI -356.88 to 179.12; low certainty evidence). It is uncertain whether icodextrin use led to any differences in adverse events (5 studies, 816 participants) technique failure or death. AUTHORS' CONCLUSIONS: This updated review strengthens evidence that neutral pH, low GDP PD solution improves RRF and urine volume preservation with high certainty. These effects may be related to increased peritoneal solute transport and reduced peritoneal ultrafiltration, although the evidence for these outcomes is of low certainty due to significant heterogeneity and suboptimal methodological quality. Icodextrin prescription increased peritoneal ultrafiltration and mitigated uncontrolled fluid overload with moderate certainty. The effects of either neutral pH, low GDP solution or icodextrin on peritonitis, technique survival and patient survival remain uncertain and require further high quality, adequately powered RCTs.


Assuntos
Soluções para Diálise/química , Diálise Peritoneal/métodos , Peritônio , Adulto , Bicarbonatos/química , Bicarbonatos/uso terapêutico , Criança , Soluções para Diálise/efeitos adversos , Glucose/metabolismo , Glucose/uso terapêutico , Humanos , Concentração de Íons de Hidrogênio , Icodextrina/uso terapêutico , Rim/fisiologia , Peritônio/efeitos dos fármacos , Peritônio/lesões , Soluções Farmacêuticas/química , Soluções Farmacêuticas/uso terapêutico , Ensaios Clínicos Controlados Aleatórios como Assunto , Urina
6.
Kidney Blood Press Res ; 43(3): 959-969, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29895022

RESUMO

Metabolic acidosis is commonly found in patients with chronic kidney disease (CKD), and its causes are: impaired ammonia excretion, reduced tubular bicarbonate reabsorption and insufficient renal bicarbonate production in relation to the amount of acids synthesised by the body and ingested with food. As the consequence, numerous metabolic abnormalities develop, which may lead to dysfunction of several organs. In observational studies, it has been found that CKD patients with metabolic acidosis are characterised by faster progression of kidney disease towards end stage kidney failure, and by increased mortality. Results of interventional studies suggest that alkali therapy in CKD patients slows progression of kidney disease. In view of these facts, the members of "The Working Group of the Polish Society of Nephrology on Metabolic and Endocrine Abnormalities in Kidney Diseases" have prepared the following statement and guidelines for the diagnosis and treatment of metabolic acidosis in CKD patients. Measurement of bicarbonate concentration in venous plasma or venous blood to check for metabolic acidosis should be performed in all CKD patients and metabolic acidosis in these patients should be diagnosed when the venous plasma or venous blood bicarbonate concentration is lower than 22 mmol/l. In patients with metabolic acidosis and CKD, oral sodium bicarbonate administration is recommended. The goal of such a treatment is to achieve a plasma or blood bicarbonate concentration equal to or greater than 22 mmol/l.


Assuntos
Acidose/diagnóstico , Acidose/tratamento farmacológico , Insuficiência Renal Crônica/complicações , Bicarbonatos/sangue , Bicarbonatos/uso terapêutico , Progressão da Doença , Humanos , Nefrologia/métodos , Polônia
7.
Nephrol Dial Transplant ; 33(11): 2043-2051, 2018 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-29860419

RESUMO

Background: A novel in vitro test (T50 test) assesses ex vivo serum calcification propensity and predicts mortality in chronic kidney disease and haemodialysis (HD) patients. For the latter, a time-dependent decline of T50 was shown to relate to mortality. Here we assessed whether a 3-month switch to acetate-free, citrate-acidified, standard bicarbonate HD (CiaHD) sustainably improves calcification propensity. Methods: T50 values were assessed in paired midweek pre-dialysis sera collected before and 3 months after CiaHD in 78 prevalent European HD patients. In all, 44 were then switched back to acetate. Partial correlation was used to study associations of changing T50 and changing covariates. Linear mixed effect models were built to assess the association of CiaHD and covariates with changing T50. Results: A significant intra-individual increase of serum calcification resilience was found after 3 months on CiaHD (206 ± 56 to 242 ± 56 min; P < 0.001), but not after switching back to acetate (252 ± 63 to 243 ± 64 min; n = 44; P = 0.29). CiaHD, Δ serum phosphate and Δ albumin but not Δ ionized calcium and magnesium were the strongest determinants of changing T50. Beneath T50, only serum albumin but not phosphate changed significantly during 3 months of CiaHD. Conclusion: CiaHD dialysis favourably affected calcification propensity as measured by the T50 test. Whether this treatment, beyond established phosphate-directed treatments, has the potential to sustainably tip the balance towards a more anti-calcific serum milieu needs to be further investigated.


Assuntos
Calcinose/sangue , Diálise Renal/métodos , Insuficiência Renal Crônica/sangue , Adulto , Idoso , Idoso de 80 Anos ou mais , Bicarbonatos/uso terapêutico , Ácido Cítrico/uso terapêutico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fosfatos/sangue , Estudos Prospectivos , Insuficiência Renal Crônica/mortalidade , Albumina Sérica/análise
8.
Medicine (Baltimore) ; 97(26): e11281, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29953009

RESUMO

RATIONALE: Rhabdomyolysis owing to status epilepticus (SE) can be life-threating, with acute kidney injury (AKI) the most serious complication; therefore, early recognition of the risk factors is important. Hyperuricemia after epileptic seizures has been reported, and severe hyperuricemia can lead to acute renal function damage. PATIENT CONCERNS: We present the case of a 21-year-old man hospitalized for SE, who had especially high level of blood uric acid (UA) at initial presentation. DIAGNOSIS: The patient was diagnosed with rhabdomyolysis due to SE. INTERVENTIONS: The patient was treated with hydration and bicarbonate therapy. But he developed acute kidney failure (AKF) and hemodialysis was performed. OUTCOMES: After hemodialysis, his symptoms disappeared and laboratory data returned to normal. LESSONS: Hyperuricemia after SE might indicate severe muscle damage or reduced clearance of metabolites, and could be a risk factor for kidney dysfunction, especially with rhabdomyolysis. To our knowledge, this is the first report of rhabdomyolysis following SE with hyperuricemia.


Assuntos
Lesão Renal Aguda/etiologia , Hiperuricemia/etiologia , Rabdomiólise/etiologia , Estado Epiléptico/complicações , Lesão Renal Aguda/terapia , Bicarbonatos/uso terapêutico , Humanos , Masculino , Diálise Renal , Fatores de Risco , Adulto Jovem
9.
Int J Biometeorol ; 62(5): 897-905, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-29322254

RESUMO

The aim of this study was to investigate the effects of balneotherapy on chronic low back pain. This is a minimized, follow-up study evaluated according to the analysis of intention to treat. The subjects included in the study were 105 patients suffering from chronic low back pain. The control group (n = 53) received the traditional musculoskeletal pain killer treatment, while the target group (n = 52) attended thermal mineral water treatment for 3 weeks for 15 occasions on top of the usual musculoskeletal pain killer treatment. The following parameters were measured before, right after, and 9 weeks after the 3-week therapy: the level of low back pain in rest and the level during activity are tested using the Visual Analog Scale (VAS); specific questionnaire on the back pain (Oswestry); and a questionnaire on quality of life (EuroQual-5D). All of the investigated parameters improved significantly (p < 0.001) in the target group by the end of the treatment compared to the base period, and this improvement was persistent during the follow-up period. There were no significant changes in the measured parameters in the control group. Based on our results, balneotherapy might have favorable impact on the clinical parameters and quality of life of patients suffering from chronic low back pain.


Assuntos
Balneologia , Bicarbonatos/uso terapêutico , Dor Lombar/terapia , Magnésio/uso terapêutico , Águas Minerais/uso terapêutico , Bicarbonato de Sódio/uso terapêutico , Idoso , Bicarbonatos/análise , Doença Crônica , Feminino , Humanos , Magnésio/análise , Masculino , Pessoa de Meia-Idade , Águas Minerais/análise , Medição da Dor , Qualidade de Vida , Método Simples-Cego , Bicarbonato de Sódio/análise
10.
J Matern Fetal Neonatal Med ; 31(17): 2237-2244, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-28587493

RESUMO

OBJECTIVE: Labor dystocia is an intransigent, high-profile issue in obstetric care. Amniotic fluid lactate (AFL) reflects the uterine metabolic status. High levels associate with subsequent need for operative intervention due to dystocia. In sports medicine, it is known that lactic acid can affect muscular performance and can be decreased by bicarbonate given orally before physical activity. MATERIAL AND METHODS: Two hundred dystocic deliveries were included. At the confirmation of dystocia, the AFL-level was analyzed. Deliveries were randomized to an intake of bicarbonate or not. In the "non-bicarbonate-group", stimulation with oxytocin was started immediately. In the "bicarbonate-group", bicarbonate was given; and oxytocin was started 1 hour after the intake. New sampling of AF was performed after 1 hour in both groups. OUTCOME MEASURED: if an oral intake of bicarbonate changes the AFL levels and enhances delivery outcome in dystocic deliveries. RESULTS: Bicarbonate decreases the AFL levels (p < .001). The spontaneous vaginal delivery rate after treatment with bicarbonate was increased (p = .007), without affecting the fetal outcome. CONCLUSIONS: An increase of spontaneous vaginal deliveries resulted from bicarbonate ingestion by dystocic women. A decreased level of AFL-level was shown. This simple, low cost treatment has the potential to improve maternal morbidity and satisfaction worldwide.


Assuntos
Bicarbonatos/uso terapêutico , Parto Obstétrico/métodos , Distocia/tratamento farmacológico , Adulto , Cesárea/estatística & dados numéricos , Feminino , Humanos , Ocitócicos/administração & dosagem , Ocitocina/administração & dosagem , Gravidez , Resultado da Gravidez/epidemiologia , Resultado do Tratamento , Adulto Jovem
11.
Rev Esp Anestesiol Reanim ; 65(3): 154-159, 2018 Mar.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-28754400

RESUMO

Isolated limb perfusion is the treatment of stage III melanoma with in-transit metastasis. This technique allows the administration of cytostatics at an effective concentration and temperature, which could not be administered systemically because of their toxicity. The toxicity due to leakage of the chemotherapy agent from the limb into the systemic circulation is the most serious short-term complication, and is manifested by a systemic inflammatory response syndrome in the immediate post-intervention period. Early detection of this complication and its peri-operative management requires a multidisciplinary approach, in which the anaesthesiologist plays a key role. A case of isolated lower limb perfusion is reported in which the procedure had to be interrupted due to the passage of tumour necrosis factor into the systemic circulation, with severe intra-operative haemodynamic repercussions.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Quimioterapia do Câncer por Perfusão Regional/efeitos adversos , Extravasamento de Materiais Terapêuticos e Diagnósticos , Hipotensão/induzido quimicamente , Complicações Intraoperatórias/induzido quimicamente , Melanoma/secundário , Taquicardia/induzido quimicamente , Fator de Necrose Tumoral alfa/efeitos adversos , Desequilíbrio Ácido-Base/induzido quimicamente , Idoso , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Bicarbonatos/uso terapêutico , Cálcio/uso terapêutico , Epinefrina/uso terapêutico , Feminino , Humanos , Hipertermia Induzida , Hipotensão/tratamento farmacológico , Complicações Intraoperatórias/tratamento farmacológico , Perna (Membro) , Excisão de Linfonodo , Metástase Linfática , Melanoma/tratamento farmacológico , Melanoma/cirurgia , Melfalan/administração & dosagem , Azul de Metileno/uso terapêutico , Norepinefrina/uso terapêutico , Neoplasias Cutâneas/cirurgia , Taquicardia/tratamento farmacológico , Fator de Necrose Tumoral alfa/administração & dosagem
12.
J Clin Endocrinol Metab ; 103(2): 452-459, 2018 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-29211866

RESUMO

Context: Elevated urine net acid excretion (NAE), indicative of subclinical metabolic acidosis, has been associated with higher bone turnover. Urine citrate, which is a common clinical measure, changes in response to acid-base status but its association with bone turnover is uncertain. Objective: We evaluated the association between change in urine citrate and change in bone turnover and calcium excretion. Design, Intervention, and Participants: A total of 233 healthy men and women ≥60 years old were randomly assigned to 1.0 mmol/kg/d potassium bicarbonate (KHCO3), 1.5 mmol/kg/d KHCO3, or placebo for 84 days. Outcome Measures: Urine citrate, NAE, N-telopeptide of collagen type-I (NTX), calcium excretion, and serum amino-terminal propeptide of type 1 procollagen (P1NP) were measured before and after intervention. Results: Urine citrate increased dose dependently after KHCO3 supplementation (P trend < 0.001). The urine citrate change was significantly inversely associated with P1NP change (P = 0.021) but not with change in NTX (P = 0.051) or calcium excretion (P = 0.652). The NAE change was positively associated with change in NTX and calcium excretion (P ≤ 0.003) but not with change in P1NP (P = 0.051). When the urine citrate change and NAE change were included in the same model, the urine citrate change was not associated with change in NTX, calcium excretion, or serum P1NP (P ≥ 0.086), whereas change in NAE remained associated with change in NTX and calcium excretion (P ≤ 0.003). Conclusion: Urine citrate may not be a suitable alternative to NAE when assessing acid-base status in relation to bone turnover in older adults.


Assuntos
Equilíbrio Ácido-Base/fisiologia , Envelhecimento/urina , Reabsorção Óssea/diagnóstico , Reabsorção Óssea/urina , Cálcio/urina , Ácido Cítrico/urina , Equilíbrio Ácido-Base/efeitos dos fármacos , Idoso , Idoso de 80 Anos ou mais , Envelhecimento/metabolismo , Bicarbonatos/farmacologia , Bicarbonatos/uso terapêutico , Remodelação Óssea/efeitos dos fármacos , Reabsorção Óssea/tratamento farmacológico , Reabsorção Óssea/metabolismo , Método Duplo-Cego , Feminino , Humanos , Concentração de Íons de Hidrogênio/efeitos dos fármacos , Masculino , Pessoa de Meia-Idade , Compostos de Potássio/farmacologia , Compostos de Potássio/uso terapêutico , Prognóstico , Resultado do Tratamento
13.
Nephrol Ther ; 14(1): 13-23, 2018 Feb.
Artigo em Francês | MEDLINE | ID: mdl-29150416

RESUMO

Acid-base regulation is essential to maintain homeostasis in humans. Carbonic acid/bicarbonate (H2CO3/HCO3-) couple is the most predominant extracellular buffer to keep plasma pH within a physiological range. The ability to (re)generate such a buffer is a key milestone that necessitates to understand a precise physiology of both renal tubule and digestive tract. Here, we first reviewed renal and digestive cycles of bicarbonate in physiology. We also reviewed pathological findings where acid-base disequilibrium is involved and nutritional and/or alkali therapy could be necessary. Secondly, data from clinical trials were synthesized. Alkali therapy, oral and parenteral, from mineral-based water, masterful preparations or pharmaceutics drugs, is regularly used in a wide range of clinical findings, even if supporting data are (often) of a low level of evidence. Bicarbonate is primarily used during contrast-induced nephropathy, metabolic acidosis in chronic kidney disease or nephrolithiasis in which alkaline urine is necessary. Cast nephropathy, rhabdomyolysis and tumor lysis syndrome make usually physicians prescribe alkali therapy even if this prescription is only supported by physiopathological data without any proven clinical results. Finally, bicarbonate is essential in the composition of dialysate in both hemodialysis and peritoneal dialysis.


Assuntos
Equilíbrio Ácido-Base/fisiologia , Bicarbonatos/metabolismo , Insuficiência Renal Crônica/terapia , Desequilíbrio Ácido-Base/terapia , Bicarbonatos/uso terapêutico , Soluções para Diálise , Humanos , Rim/fisiopatologia , Diálise Renal/métodos
14.
Rev Med Chil ; 145(8): 1072-1075, 2017 Aug.
Artigo em Espanhol | MEDLINE | ID: mdl-29189867

RESUMO

Metformin-associated lactic acidosis is a severe and infrequent adverse event. Early diagnosis is essential to start an early treatment, which often has favorable results. We report a 56 years old non-insulin-requiring type 2 diabetic female who developed a severe metabolic acidosis associated with metformin in relation to an acute renal failure secondary to infectious diarrhea. Early treatment with bicarbonate and continuous hemofiltration allowed a quick improvement of the patient. Metformin-associated lactic acidosis has an elevated mortality (50-80%) and has a specific and effective treatment. Therefore, the condition must be born in mind.


Assuntos
Acidose Láctica/induzido quimicamente , Hipoglicemiantes/efeitos adversos , Metformina/efeitos adversos , Acidose Láctica/terapia , Bicarbonatos/uso terapêutico , Diabetes Mellitus Tipo 2/tratamento farmacológico , Feminino , Hemofiltração/métodos , Humanos , Pessoa de Meia-Idade
15.
BMC Pediatr ; 17(1): 209, 2017 Dec 19.
Artigo em Inglês | MEDLINE | ID: mdl-29258472

RESUMO

BACKGROUND: This study is to explore the clinical characteristics, laboratory diagnosis, and treatment outcomes in pediatric patients with non-diabetic ketoacidosis. METHODS: Retrospective patient chart review was performed between March 2009 to March 2015. Cases were included if they met the selection criteria for non-diabetic ketoacidosis, which were: 1) Age ≤ 18 years; 2) urine ketone positive ++ or >8.0 mmol/L; 3) blood ketone >3.1 mmol/L; 4) acidosis (pH < 7.3) and/or HCO3 < 15 mmol/L; 5) random blood glucose level < 11.1 mmol/L. Patients who met the criteria 1, 4, 5, plus either 2 or 3, were defined as non-diabetic ketoacidosis and were included in the report. RESULTS: Five patients with 7 episodes of non-diabetic ketoacidosis were identified. They all presented with dehydration, poor appetite, and Kussmaul breathing. Patients treated with insulin plus glucose supplementation had a quicker recovery from acidosis, in comparison to those treated with bicarbonate infusion and continuous renal replacement therapy. Two patients treated with bicarbonate infusion developed transient coma and seizures during the treatment. CONCLUSION: Despite normal or low blood glucose levels, patients with non-diabetic ketoacidosis should receive insulin administration with glucose supplementation to correct ketoacidosis.


Assuntos
Cetose/diagnóstico , Cetose/terapia , Adolescente , Bicarbonatos/uso terapêutico , Criança , Pré-Escolar , Terapia Combinada , Feminino , Glucose/uso terapêutico , Humanos , Hipoglicemiantes/uso terapêutico , Lactente , Recém-Nascido , Insulina/uso terapêutico , Masculino , Terapia de Substituição Renal , Estudos Retrospectivos , Resultado do Tratamento
17.
Asian Cardiovasc Thorac Ann ; 25(7-8): 495-501, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28975821

RESUMO

Objective Blood cardioplegia, the gold-standard cardioprotective strategy, requires frequent dosing, resulting in hyperkalemia-induced myocardial edema. The aim of our study was to compare the efficacy and safety of a long-acting blood-based cardioplegia with physiological potassium levels versus the well-established cold blood St. Thomas' Hospital no. 1 cardioplegia solution in multivalve surgeries. Methods One hundred patients undergoing simultaneous elective aortic and mitral valve replacement ± tricuspid valve repair were randomized in two groups. In group 1, adenosine 12 mg was given via the aortic root after crossclamping, followed by a single dose of long-acting solution at 14℃ (30 mLckg-1); in group 2, an initial 30 mLckg-1 of St. Thomas' cardioplegia at 14℃ was administered, followed by 15 mLckg-1 every 20 min. Duration of cardiopulmonary bypass, inotropic score, arrhythmias, ventilation time, and the levels of interleukin-6, creatinine kinase-MB, and troponin I were compared. Results Mean cardiopulmonary bypass and crossclamp times were 134.04 ± 36.12 vs. 154.34 ± 34.26 ( p = 0.004) and 110.37 ± 24.80 vs. 132.48 ± 31.68 min ( p = 0.002), respectively, in the long-acting and St. Thomas' groups. Cardiac index, creatinine kinase-MB and troponin I levels were comparable. Interleukin-6 levels post-bypass were 61.72 ± 15.33 and 75.44 ± 31.78 pgcmL-1 ( p = 0.007) in the long-acting and St. Thomas' cardioplegia groups, respectively. Conclusions Single-dose long-acting cardioplegia gives a cardioprotective effect comparable to repeated doses of the well-established St. Thomas' Hospital no. 1 cold blood cardioplegia.


Assuntos
Soluções Cardioplégicas/uso terapêutico , Parada Cardíaca Induzida/métodos , Doenças das Valvas Cardíacas/cirurgia , Implante de Prótese de Valva Cardíaca , Valvas Cardíacas/cirurgia , Adulto , Bicarbonatos/efeitos adversos , Bicarbonatos/química , Bicarbonatos/uso terapêutico , Cloreto de Cálcio/efeitos adversos , Cloreto de Cálcio/química , Cloreto de Cálcio/uso terapêutico , Soluções Cardioplégicas/efeitos adversos , Soluções Cardioplégicas/química , Ponte Cardiopulmonar , Cardiotônicos/administração & dosagem , Feminino , Parada Cardíaca Induzida/efeitos adversos , Doenças das Valvas Cardíacas/fisiopatologia , Implante de Prótese de Valva Cardíaca/efeitos adversos , Valvas Cardíacas/fisiopatologia , Humanos , Hiperpotassemia/sangue , Hiperpotassemia/induzido quimicamente , Índia , Magnésio/efeitos adversos , Magnésio/química , Magnésio/uso terapêutico , Masculino , Pessoa de Meia-Idade , Potássio/sangue , Cloreto de Potássio/efeitos adversos , Cloreto de Potássio/química , Cloreto de Potássio/uso terapêutico , Estudos Prospectivos , Respiração Artificial , Fatores de Risco , Cloreto de Sódio/efeitos adversos , Cloreto de Sódio/química , Cloreto de Sódio/uso terapêutico , Fatores de Tempo , Resultado do Tratamento
18.
Artigo em Inglês | MEDLINE | ID: mdl-29073302

RESUMO

INTRODUCTION: Diabetic ketoacidosis (DKA) is a life-threatening complication of diabetes mellitus (DM) that requires appropriate treatment with insulin and intravenous fluids. Both one-bag and two-bag systems of fluid management are used to treat pediatric diabetic ketoacidosis. AIM OF THE STUDY: We compare the one-bag and two-bag systems of fluid managementwith regard to incidence of hypoglycemia, serum bicarbonate correction, pH correction and discharge from the pediatric intensive care unit (PICU). METHOD: This was a retrospective study of 61 patients less than 21 years old admitted to the PICU with a diagnosis of DKA. Of the 61 patients, 38 were treated with the one-bag system and 23 treated with the two-bag system. RESULTS: The two-bag system had significantly (p=0.03) lower incidence of hypoglycemia (n=2, 8.7%) compared to the one-bag system (n=13, 34.2%). The two-bag system had significantly (p=0.001) fewer hours of PICU stay (M=29.6, SD=15.23) than the one-bag system (M=47.9, SD=22.32). However, there were no significant differences between the bag systems for hours for pH and bicarbonate correction. CONCLUSION: The two-bag system is associated with lower incidence of hypoglycemia and faster discharge from the PICU. We recommend that clinicians consider using the two-bag system for fluid management in pediatric patients with diabetic ketoacidosis.


Assuntos
Bicarbonatos/uso terapêutico , Complicações do Diabetes/tratamento farmacológico , Cetoacidose Diabética/tratamento farmacológico , Cetoacidose Diabética/etiologia , Hidratação/métodos , Hipoglicemia/tratamento farmacológico , Insulina/uso terapêutico , Adolescente , Bicarbonatos/sangue , Criança , Feminino , Humanos , Infusões Intravenosas/instrumentação , Unidades de Terapia Intensiva Pediátrica , Masculino , Estudos Retrospectivos
19.
Trans R Soc Trop Med Hyg ; 111(5): 204-210, 2017 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-28957470

RESUMO

Background: Severe cholera is a life-threatening illness of hypovolemic shock and metabolic acidosis due to rapid and profuse diarrheal fluid loss. Emergency life-saving therapy is i.v. saline, optionally supplemented with potassium and alkali to correct the fluid deficit, potassium losses and acidosis. After this initial rehydration, for the next 2 days ongoing stool losses are replaced with oral rehydration solution (ORS), which contains sodium chloride, potassium and alkali together with glucose or rice powder as a source of glucose to serve as a carrier for sodium. Results: In actual field trials, antibiotics are given to reduce fluid requirements, but large volumes averaging about 7 liters of i.v. fluid followed by about 14 liters of ORS have been given to adult patients. Disturbing trends during therapy have included overhydration, hyponatremia and polyuria. Conclusions: It is suggested that stool output and fluid requirements could be reduced, if borne out in future research, by avoiding overhydration by restricting ORS intake to match stool output and promoting intestinal reabsorption of luminal fluid by early introduction of glucose without salts into the intestine, more gradual correction of dehydration, giving mineralocorticoid and vasopressin, and infusing glucose or short-chain fatty acids into the proximal colon.


Assuntos
Antidiarreicos/uso terapêutico , Cólera/complicações , Defecação , Desidratação/terapia , Diarreia/terapia , Hidratação/métodos , Antidiarreicos/administração & dosagem , Antidiarreicos/farmacologia , Bicarbonatos/administração & dosagem , Bicarbonatos/química , Bicarbonatos/uso terapêutico , Cólera/terapia , Defecação/efeitos dos fármacos , Desidratação/etiologia , Diarreia/tratamento farmacológico , Diarreia/etiologia , Diarreia/prevenção & controle , Fezes , Hidratação/efeitos adversos , Glucose/administração & dosagem , Glucose/química , Glucose/uso terapêutico , Humanos , Hiponatremia/etiologia , Hiponatremia/prevenção & controle , Poliúria/etiologia , Poliúria/prevenção & controle , Cloreto de Potássio/administração & dosagem , Cloreto de Potássio/química , Cloreto de Potássio/uso terapêutico , Cloreto de Sódio/administração & dosagem , Cloreto de Sódio/química , Cloreto de Sódio/uso terapêutico
20.
FP Essent ; 459: 35-38, 2017 08.
Artigo em Inglês | MEDLINE | ID: mdl-28806049

RESUMO

Oral electrolyte solutions are used widely for rehydration in diarrheal illness and to maintain hydration during vigorous exercise. In diarrheal illness, an oral rehydration solution (ORS) typically is preferred over intravenous fluids except for patients with severe dehydration. The preferred ORS is one similar to the glucose-containing reduced osmolarity World Health Organization ORS. There also are polymer-based solutions that use rice or wheat as the source of carbohydrates but these are not widely recommended. Use of other liquids, such as sport drinks, juice, soft drinks, and chicken broth is not recommended, though these can be considered for patients with no or mild dehydration. For maintaining hydration during exercise, particularly vigorous high-intensity exercise, recommendations are to consume fluids (ie, 5 to 7 mL/kg) and a sodium-containing snack at least 4 hours before. During exercise, individuals require 200 to 800 mL/hour of liquid that should contain 20 to 30 mEq/L of sodium. Carbohydrate intake is recommended during high-intensity exercise. Intake of excessive sodium-free fluids should be avoided to prevent exercise-induced hyponatremia. Additional fluids (ie, 1.5 L/kg of weight lost) can be consumed after exercise to restore hydration. Vitamin and mineral supplements are not recommended routinely for athletes unless known deficiencies exist.


Assuntos
Desidratação/terapia , Exercício , Hidratação/métodos , Soluções para Reidratação/uso terapêutico , Desequilíbrio Hidroeletrolítico/terapia , Bicarbonatos/uso terapêutico , Desidratação/etiologia , Diarreia/complicações , Glucose/uso terapêutico , Humanos , Cloreto de Potássio/uso terapêutico , Cloreto de Sódio/uso terapêutico , Desequilíbrio Hidroeletrolítico/etiologia
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