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1.
J Zoo Wildl Med ; 50(4): 1026-1030, 2020 Jan 09.
Artigo em Inglês | MEDLINE | ID: mdl-31926542

RESUMO

The Galápagos shearwater, Puffinus subalaris, is a seabird endemic to the Galápagos archipelago. Hematology, blood chemistry, and general health parameters have not been published for this species. Analyses were run on blood samples drawn from 20 clinically healthy Galápagos shearwaters captured by hand at their nests at Islote Pitt on San Cristóbal Island in July 2016. A portable blood analyzer (iSTAT) was used to obtain near immediate field results for pH, pO2, pCO2, TCO2, HCO3 -, hematocrit, hemoglobin, sodium, potassium, chloride, ionized calcium, creatinine, urea nitrogen, anion gap, and glucose. Blood lactate was measured using a portable Lactate Plus analyzer. The reported results provide baseline data that can be used for comparisons among populations and in detecting changes in health status among Galápagos shearwaters.


Assuntos
Bicarbonatos/sangue , Aves/sangue , Dióxido de Carbono/sangue , Hematócrito/veterinária , Oxigênio/sangue , Equilíbrio Ácido-Base , Animais , Glicemia , Cálcio/sangue , Cloretos/sangue , Creatinina/sangue , Hemoglobinas , Concentração de Íons de Hidrogênio , Lactatos/sangue , Potássio/sangue , Sódio/sangue
2.
Biol Pharm Bull ; 42(10): 1707-1712, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31582658

RESUMO

Recent clinical studies indicate that sodium-glucose cotransporter 2 (SGLT2) inhibitors exhibit a renoprotective effect. While studies at the single nephron level suggest that direct effects of SGLT2 inhibitors on renal hemodynamics may be a possible mechanism underlying their renoprotective effect, few studies have focused on such direct effects at the whole-kidney level. In the present study, we investigated the acute and direct effect of SGLT2 inhibition on creatinine clearance, an index of whole-kidney glomerular filtration rate (GFR), in a rat model of type 2 diabetes. Twelve to fifteen-week-old male Spontaneously Diabetic Torii (SDT) fatty rats and Sprague-Dawley rats were used as diabetic animals and non-diabetic controls, respectively. Under general anesthesia, baseline urine samples were collected from the left and right ureters for 1 h. The selective SGLT2 inhibitor ipragliflozin or vehicle was subsequently administered intravenously and post-drug urine was collected for 1 h. Baseline and post-drug blood samples were collected immediately before baseline urine collection and immediately after post-drug urine collection, respectively. Plasma glucose, urine volume, urinary glucose and albumin excretion were measured, and creatinine clearance was calculated. Blood pressure and heart rate were monitored continuously throughout the experiment. A single intravenous injection of ipragliflozin increased both urine output and glucose excretion, but reduced creatinine clearance without affecting systemic blood pressure. These results suggest that SGLT2 inhibition directly reduced whole-kidney GFR, most likely due to a reduction in intraglomerular pressure, by altering local renal hemodynamics, which may contribute to the renoprotective effects demonstrated in clinical studies.


Assuntos
Diabetes Mellitus Experimental/tratamento farmacológico , Taxa de Filtração Glomerular/efeitos dos fármacos , Glucosídeos/uso terapêutico , Inibidores do Transportador 2 de Sódio-Glicose/uso terapêutico , Tiofenos/uso terapêutico , Animais , Glicemia/efeitos dos fármacos , Pressão Sanguínea/efeitos dos fármacos , Cloretos/sangue , Creatinina/sangue , Diabetes Mellitus Experimental/sangue , Diabetes Mellitus Experimental/fisiopatologia , Nefropatias Diabéticas/prevenção & controle , Glucosídeos/farmacologia , Frequência Cardíaca/efeitos dos fármacos , Masculino , Ratos Sprague-Dawley , Sódio/sangue , Transportador 2 de Glucose-Sódio , Inibidores do Transportador 2 de Sódio-Glicose/farmacologia , Tiofenos/farmacologia
3.
Aquat Toxicol ; 216: 105315, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31561138

RESUMO

Blooms of cyanobacteria, a common event in eutrophic environments, result in the release of potentially toxic substances into the water. The cyanobacterium Radiocystis fernandoi produces microcystin (MC) and other peptides that may disturb homeostasis. This study evaluated the effect of intraperitoneal injections containing the crude extract (CE) of R. fernandoi strain R28 on the gills and kidneys of neotropical fish, Piaractus mesopotamicus, 3, 6 and 24 h post-injection. CE contained MC-RR, MC-YR and minor other oligopeptides. Plasma ions and the activities of the enzymes PP1 and PP2A, Na+/K+-ATPase (NKA), H+-ATPase (HA) and carbonic anhydrase (CA) were determined and morphological changes in both the gills and kidneys were characterized. Compared to controls, the concentration of Na+ within the plasma of P. mesopotamicus decreased after treatment with CE 3 h post treatment and increased after 24 h; the concentration of K+ decreased after 6 h. The activity of the endogenous PP1 and PP2A was unchanged in the gills and was inhibited in the kidneys 6 h after i.p. injection. In the gills, NKA activity increased after 3 h and decreased 6 h post i.p. exposure. Further, NKA activity did not differ from the controls 24-h post injection. In the kidneys, NKA, HA and CA activities were unaffected by treatment. The mitochondria-rich cell (MRC) density in the gills decreased after 3 h in the filament and 3 and 6 h in the lamellae and was restored to the control levels 24 h post-exposure. Filament epithelial hyperplasia and hypertrophy, lamellar atrophy and rupture of the lamellar epithelium were the most common effects of treatment in the gills. No histopathological changes occurred in the kidneys. This study demonstrates that a single dose of toxic CE from R. fernandoi can cause a transitory ion imbalance in P. mesopotamicus which is related to the changes in MRC levels and NKA activity. Ionic balance was recovered 24 h post i.p. injection, however, morphological changes that occurred in the gills took a longer amount of time to return to normal. To conclude, the effects of components contained within the CE of R. fernandoi may be harmful to P. mesopotamicus. In particular, the recovery of ionic regulation depends on MRC responses and histopathological changes produced by CE may affect gas exchange and other gill functions.


Assuntos
Caraciformes/fisiologia , Misturas Complexas/toxicidade , Cianobactérias/metabolismo , Exposição Ambiental , Osmorregulação , Animais , Caraciformes/sangue , Cloretos/sangue , Creatinina/sangue , Brânquias/efeitos dos fármacos , Brânquias/enzimologia , Brânquias/patologia , Íons/sangue , Rim/efeitos dos fármacos , Rim/enzimologia , Rim/patologia , Mitocôndrias/efeitos dos fármacos , Mitocôndrias/metabolismo , Osmorregulação/efeitos dos fármacos , Potássio/sangue , ATPases Translocadoras de Prótons/metabolismo , Sódio/sangue , ATPase Trocadora de Sódio-Potássio/metabolismo , Poluentes Químicos da Água/toxicidade
4.
Clin Lab ; 65(8)2019 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-31414738

RESUMO

BACKGROUND: Accurate chloride measurement is important in critically ill patients. METHODS: Chloride concentration measured simultaneously between the central laboratory (indirect ion-selective electrode) and blood gas analysis (direct ion-selective electrode) were compared. RESULTS: We report a discrepancy with chloride measurement between the central laboratory and blood gas analysis at low bicarbonate levels. CONCLUSIONS: Caution should be applied while interpreting the chloride concentration when indirect ion-selective electrode methodology is used, especially in the setting of low serum bicarbonate levels.


Assuntos
Bicarbonatos/análise , Gasometria/métodos , Cloretos/análise , Estado Terminal , Bicarbonatos/sangue , Gasometria/instrumentação , Cloretos/sangue , Eletrodos , Humanos , Concentração de Íons de Hidrogênio , Potássio/análise , Potássio/sangue , Sódio/análise , Sódio/sangue
5.
Analyst ; 144(17): 5223-5231, 2019 Aug 16.
Artigo em Inglês | MEDLINE | ID: mdl-31360940

RESUMO

Reagent sensors in diagnostic assays are used in medical laboratories to obtain patient results. However, interference during the analysis of blood samples is a constant problem with reagent sensors and leads to inaccurate results. Interference in blood analysis is frequently caused by hemolysis and icterus. This study analyzed the effects of interferents on reagent sensors and devised a method to improve the measurement accuracy using an interference index detection (IID) system to minimize the interference effect. The IID system can be easily applied using only two wells and an optical component for sample measurement. After applying the IID system, the interference rates from bilirubin and hemoglobin improved dramatically. A comparison of results obtained for clinical samples showed that the IID system had a positive effect on the accuracy.


Assuntos
Técnicas Biossensoriais/métodos , Análise Química do Sangue/métodos , Confiabilidade dos Dados , Hemólise , Icterícia , Bilirrubina/sangue , Bilirrubina/química , Técnicas Biossensoriais/instrumentação , Técnicas Biossensoriais/estatística & dados numéricos , Análise Química do Sangue/instrumentação , Análise Química do Sangue/estatística & dados numéricos , Nitrogênio da Ureia Sanguínea , Cloretos/sangue , Hemoglobinas/análise , Hemoglobinas/química , Humanos , Análise de Regressão , gama-Glutamiltransferase/sangue
6.
Biomed Environ Sci ; 32(4): 250-259, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31217061

RESUMO

OBJECTIVE: Identification of new risk factors is needed to improve prediction of adverse outcomes in patients with three-vessel disease (TVD). The present study aimed to evaluate the prognostic values of serum chloride and sodium levels in patients with TVD. METHODS: We used data from a prospective cohort of consecutive patients with angiographically confirmed TVD. The primary endpoint was all-cause death. Cox proportional hazard regression was used to analyze the relationship of serum chloride and sodium levels with long-term outcomes of TVD patients. RESULTS: A total of 8,318 participants with available serum chloride and sodium data were included in this analysis. At baseline, patients in the low tertiles group of serum chloride level (⪕ 102.0 mmol/L) or serum sodium level (⪕ 139.0 mmol/L) had more severe disease conditions. During a median follow-up of 7.5-year, both low serum chloride level and low serum sodium level were found to be associated with an increased risk for mortality in univariate analysis. However, when both parameters were incorporated into a multivariate model, only low serum sodium level remained to be an independent predictor of all-cause death (hazard ratio: 1.16, 95% confidence interval: 1.01-1.34, P = 0.041). Modest but significant improvement of discrimination was observed after incorporating serum sodium level into the Synergy between percutaneous coronary intervention (PCI) with Taxus and Cardiac Surgery score. CONCLUSION: Serum sodium level is more strongly associated with long-term outcomes of TVD patients compared with serum chloride level. Low serum sodium level is an independent risk factor for mortality, but only provides modest prognostic information beyond an established risk model.


Assuntos
Cloretos/sangue , Doença da Artéria Coronariana/sangue , Sódio/sangue , Idoso , China/epidemiologia , Doença da Artéria Coronariana/diagnóstico , Doença da Artéria Coronariana/mortalidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Prospectivos
7.
J Vet Emerg Crit Care (San Antonio) ; 29(4): 399-406, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31225690

RESUMO

OBJECTIVE: To compare intravenous and intraosseous blood aspirates using point-of-care diagnostic equipment available in veterinary hospitals. DESIGN: Prospective study. SETTING: Private referral hospital. ANIMALS: Dogs undergoing a tibial plateau leveling osteotomy or extracapsular anterior cruciate ligament stabilization procedure were enrolled. METHODS: Under general anesthesia, simultaneous 0.5 mL intravenous and intraosseous blood samples were collected from the jugular vein and proximal tibia, respectively. Samples were evaluated in duplicate within 10 minutes of collection and averaged for each of the following parameters: blood urea nitrogen (BUN), glucose, packed cell volume, total plasma protein (TPP), plasma lactate, sodium, potassium, chloride, urea, glucose, pH, anion gap, pO2, and pCO2 . Normalcy was tested with Kolmogorov-Smirnov test. A Student's t-test and Bland-Altman plot were used to compare intravenous and intraosseous samples. RESULTS: Twelve dogs were recruited into the study. There were statistically significant differences between intravenous and intraosseous samples for sodium (P = 0.0216), chloride (P = 0.0225), BUN (P = 0.014), and potassium (P < 0.0001), respectively. No significant differences were detected for the other parameters evaluated. DISCUSSION: The intraosseous space provides an easily accessible, noncollapsible alternative for assessing blood parameters. Omitting potassium, the statistically significant differences noted between sites was not felt to be clinically significant. Although statistically insignificant, the large difference in hematocrit values indicates that the samples should not be used interchangeably. CONCLUSION: Intraosseous aspirates, excluding potassium and hematocrit, appear to be a reliable alternative for assessing most point-of-care analytes in healthy dogs, although a larger sample size should be investigated. The application of these data in shock patients is unknown.


Assuntos
Medula Óssea/fisiologia , Cães/sangue , Emergências/veterinária , Testes Imediatos , Equilíbrio Ácido-Base , Animais , Gasometria , Nitrogênio da Ureia Sanguínea , Cloretos/sangue , Hematócrito/veterinária , Infusões Intraósseas/métodos , Veias Jugulares , Ácido Láctico/sangue , Projetos Piloto , Potássio/sangue , Estudos Prospectivos
8.
Ann R Coll Surg Engl ; 101(6): e131-e132, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31155884

RESUMO

A 52-year-old man was admitted with diarrhoea and faecaluria and referred recurrent urinary tract infections for over 20 years. He also reported a two-week hospital admission more than 20 years ago for right iliac fossa pain, which was managed conservatively. Computed tomography showed a fistulous tract extending from the bladder with an unclear connection to the bowel. Cystoscopy confirmed the presence of a vesical fistula and biopsy of the tract confirmed colonic mucosa. Flexible sigmoidoscopy was negative. A cystogram was requested as an outpatient procedure and the patient was discharged after antibiotic treatment. A few days after discharge the patient was readmitted as an emergency to critical care for severe hyperchloraemic hypokalaemic acidosis and a Glasgow Coma Score of 6/15. He was intubated and ventilated and his metabolic derangement was treated. As soon as his conditions improved, he underwent emergency laparotomy, which revealed the presence of a fistula between the caecal fundus and the bladder. The fistula was repaired and the patient recovered swiftly and completely and was discharged on postoperative day 5. At 12-month follow up the patient was completely symptoms-free, his bowel habits were normal and he has not had any urinary infection. Appendicovesical fistula is a rare and potentially lethal condition due to its metabolic consequences. Past history of right iliac fossa pain treated conservatively, diarrhoea and recurrent urinary tract infection must raise suspicion.


Assuntos
Acidose/diagnóstico , Apêndice , Fístula Intestinal/diagnóstico , Fístula da Bexiga Urinária/diagnóstico , Acidose/etiologia , Apêndice/diagnóstico por imagem , Cloretos/sangue , Humanos , Hipopotassemia/etiologia , Fístula Intestinal/complicações , Fístula Intestinal/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X , Fístula da Bexiga Urinária/complicações , Fístula da Bexiga Urinária/diagnóstico por imagem
9.
Heart Vessels ; 34(12): 1952-1960, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31114959

RESUMO

According to the "chloride theory" for heart failure (HF) pathophysiology, manipulation of the serum chloride concentration is an important therapeutic target. This study determined the short- and long-term effects of acetazolamide (Diamox), a potential chloride-regaining diuretic, on peripheral blood, serum electrolytes, and renal function. Effects of low-dose Diamox (250-500 mg/day) were evaluated in 30 HF patients for whom Diamox was added as de-novo/add-on decongestion therapy for acutely worsening HF (n = 18) or as modification therapy for serum hypochloremia in stable HF ( < 100 mEq/L; n = 12). Peripheral hematologic tests were performed at baseline, and at short- ( ≤ 10 days) and long-term ( ~ 60 days) time-points. In all 30 study patients of both groups, the serum chloride concentration increased in the short-term and even further over the long-term. The serum potassium concentration constantly decreased throughout the study period. Both the blood urea nitrogen and serum creatinine concentrations increased in the short-term, but returned to baseline levels over the long-term. Responders to Diamox (n = 13; defined by HF resolution and body weight loss ≥ 1 kg) in the decongestion group exhibited reduced serum b-type natriuretic peptide levels and a markedly increased serum chloride concentration, but the hemoglobin/hematocrit and serum creatinine concentrations did not change after treatment. In conclusion, acetazolamide is a potent candidate "chloride-regaining diuretic" for treating HF patients under the "chloride theory". Its effect to enhance the serum chloride concentration occurred within 10 days and persisted for at least ~ 60 days. Plasma volume and renal function were preserved under adequate diuretic treatment with acetazolamide.


Assuntos
Acetazolamida/administração & dosagem , Cloretos/sangue , Insuficiência Cardíaca/tratamento farmacológico , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/sangue , Nitrogênio da Ureia Sanguínea , Creatinina/sangue , Diuréticos/administração & dosagem , Relação Dose-Resposta a Droga , Feminino , Seguimentos , Insuficiência Cardíaca/sangue , Insuficiência Cardíaca/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Volume Sistólico/fisiologia , Fatores de Tempo , Resultado do Tratamento
10.
BMC Anesthesiol ; 19(1): 79, 2019 05 17.
Artigo em Inglês | MEDLINE | ID: mdl-31101086

RESUMO

BACKGROUND: This study investigated the associations of fluctuations in serum chloride (Cl-) levels with 30-day mortality after intensive care unit (ICU) admission among critically ill patients. METHODS: We retrospectively analyzed the medical records of adult patients (≥18 years old) admitted to the ICU between January 2012 and December 2017. Positive and negative fluctuations in Cl- were defined as the differences between the Cl- upon ICU admission (baseline Cl-) and the maximum and minimum Cl- levels, respectively, measured within 72 h after ICU admission. RESULTS: The final analysis included 18,825 adult patients. In multivariable Cox regression analyses, the risk of 30-day mortality increased by 8% per 1-mmol L- 1 positive fluctuation in Cl- within 72 h (hazard ratio = 1.08, 95% confidence interval: 1.04-1.11, P < 0.001). In subgroup analyses, a positive fluctuation in Cl- was associated with increased 30-day mortality among patients with a severe positive cumulative fluid balance (FB, > 10%), normochloremia (97-110 mmol L- 1) or hyperchloremia (> 110 mmol L- 1) upon ICU admission. Furthermore, a negative fluctuation in the Cl- level during the first 72 h of an ICU stay was associated with a negative cumulative FB (< 0%) or hypochloremia (< 97 mmol L- 1) upon ICU admission. CONCLUSIONS: A fluctuation in the Cl- level during the first 72 h of an ICU stay was found to associate independently with increased 30-day mortality among critically ill adult patients. However, the nature of this association differed according to the cumulative FB status or dyschloremia status upon ICU admission.


Assuntos
Cloretos/sangue , Estado Terminal/epidemiologia , Mortalidade Hospitalar/tendências , Unidades de Terapia Intensiva/tendências , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/sangue , Estudos de Coortes , Estado Terminal/terapia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Tempo , Equilíbrio Hidroeletrolítico/fisiologia
11.
PLoS One ; 14(5): e0216993, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31120941

RESUMO

Hand, foot and mouth disease (HFMD) is an infectious disease that affects mostly children. The children with HFMD also have other immune and metabolic disorders. However, the association of these disorders with the severity of HFMD has not yet been determined. In this study, we used a case-control study design to examine the correlation of immune and metabolic disorders with HFMD development in children. 406 mild and severe patients were recruited and divided into different subgroups based on the number of days from the initial onset time to hospitalization (1, 2, 3, 4, and ≥5 days). Logistic regression model was used to define the predictors of severe HFMD. We found that the patients from rural area (OR = 1.76, 95% CI [1.19~2.63], P = 0.005) or with body temperature of >39°C (OR = 2.14, 95% CI [1.12~4.12], P = 0.022) exhibited higher risk for severe symptoms. In addition, the risk increased with the rise of body temperature by using a Chis-quare trend test (P = 0.01). We also found that a decreased number of eosinophils was an predictor of severe HFMD at 1, 2, 3,and 4 days post infection (dpi). Decreased levels of Na+, Cl-, and creatine kinase were also predictors at 1 and ≥5 dpi. On the other hand, elevated level of globulin was a predictor for severe HFMD at 4 dpi and ≥5 dpi, and the increased number of neutrophils or increased level of alkaline phosphatase posed risk for severe HFMD at 3 and ≥5 dpi. Our results suggested that rural living, hyperpyrexia, changes in the immune system that include the numbers of eosinophils and neutrophils and the levels of IgG and globulin, and metabolic alterations, such as the levels of alkaline phosphatase, Na+, Cl-, and creatine kinase in peripheral blood are predictors of severe HFMD.


Assuntos
Doença de Mão, Pé e Boca/diagnóstico , Doença de Mão, Pé e Boca/imunologia , Adolescente , Adulto , Fosfatase Alcalina/sangue , Biomarcadores/sangue , Temperatura Corporal , Estudos de Casos e Controles , Criança , China , Cloretos/sangue , Eosinófilos/metabolismo , Feminino , Globulinas/análise , Doença de Mão, Pé e Boca/sangue , Hospitalização , Humanos , Sistema Imunitário , Imunoglobulina G/sangue , Inflamação/sangue , Masculino , Análise Multivariada , Análise de Regressão , Fatores de Risco , População Rural , Sódio/sangue , Adulto Jovem
12.
J Vet Intern Med ; 33(4): 1822-1832, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31059164

RESUMO

BACKGROUND: The plasma ionized calcium concentration (cCa2+ ) represents the biologically active form of calcium and is the preferred method for evaluating calcium status in animals. Different pH-corrective equations have been developed for human plasma, but the validity of the equations for bovine plasma is unknown. HYPOTHESIS: We hypothesized that pH-corrective equations for bovine plasma would be similar to those used for human plasma; cCa2+ was dependent on the plasma concentrations of total calcium (cTCa), chloride (cCl), L-lactate (cLactate), and albumin (cAlbumin); and the in vitro and in vivo cCa2+ -pH relationships would differ. ANIMALS: Ten healthy calves (in vitro study), 1426 critically ill calves. METHODS: The in vitro plasma log10 (cCa2+ )-pH relationship was determined by CO2 tonometry of 465 plasma samples. Plasma cCl was altered by equivolume dilution of plasma with 3 electrolyte solutions of different cCl. The in vivo plasma cCa2+ -pH relationship was investigated and validated using clinicopathologic data extracted from the medical records of 950 (model development) and 476 (model validation) critically ill calves. RESULTS: pH-corrective equations for bovine plasma were similar to those used for human plasma. Plasma cCa2+ increased in vitro with increases in plasma cCl. Plasma cCa2+ in critically ill calves was associated with plasma cTCa, blood pH, plasma cCl, serum cMg, and cL-lactate (R2 = 0.69) but not plasma cAlbumin. CONCLUSIONS AND CLINICAL IMPORTANCE: Calculation of cCa2+ from cTCa in calf plasma or serum requires adjustment for at least pH and cCl when 1 or both are outside the reference range.


Assuntos
Cálcio/sangue , Doenças dos Bovinos/sangue , Concentração de Íons de Hidrogênio , Animais , Dióxido de Carbono/sangue , Bovinos , Cloretos/sangue , Estado Terminal , Feminino , Ácido Láctico/sangue , Magnésio/sangue , Masculino , Albumina Sérica/análise
13.
J Vet Emerg Crit Care (San Antonio) ; 29(3): 309-313, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31066159

RESUMO

OBJECTIVE: To evaluate changes in serum creatinine and chloride concentrations in anesthetized dogs that received 6% hydroxyethyl starch (HES) 670/0.7. DESIGN: Retrospective case series, 2002-2015. SETTING: University veterinary teaching hospital. ANIMALS: Two hundred forty-four client-owned dogs undergoing general anesthesia that received an HES solution. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Medical records of dogs that received an HES solution (6%, 670/0.7) while under general anesthesia during the study period were reviewed. Information obtained from the medical record included patient signalment, reason for anesthesia or diagnosis, body weight, amount of HES solution administered, pre- and postanesthesia creatinine value, pre- and postanesthesia chloride value, and day interval between measurements. Corrected chloride values were used for all statistical analysis. Dogs received a median dose of 6.3 mL/kg hetastarch during anesthesia. Median preanesthesia creatinine and corrected chloride values were 79.5 µmol/L (0.9 mg/dL) (range 8.8-689.5 µmol/L [0.1-7.8 mg/dL]) and 111 mmol/L (111 mEq/L) (range 80-123 mmol/L [80-123 mg/dL]), respectively. Median postanesthesia creatinine was 57.4 µmol/L (0.65 mg/dL) (8.8-716 µmol/L [0.1-8.1 mg/dL]). Median postanesthesia corrected chloride was 115 mmol/L (115 mEq/L) (range 87.5-129.6 mmol/L [87.5-129.6 mEq/L]). Mann-Whitney test analysis revealed a significant decrease in creatinine (Δ Cr 17.7 µmol/L [0.2 mg/dL], P < 0.01) and a significant increase in corrected chloride (Δ Cl 4.1 mmol/L [4.1mEq/L], P < 0.01) between pre- and postanesthesia values. CONCLUSIONS: In a mixed population of hospitalized dogs undergoing general anesthesia that received a median dose of 6 mL/kg of HES, creatinine was lower and chloride was higher in the postanesthetic than in the preanesthetic period. The clinical significance of these changes and the role that HES administration played in them relative to concurrent therapies is unknown.


Assuntos
Cloretos/sangue , Creatinina/sangue , Cães/fisiologia , Derivados de Hidroxietil Amido/administração & dosagem , Substitutos do Plasma/administração & dosagem , Lesão Renal Aguda/induzido quimicamente , Lesão Renal Aguda/veterinária , Anestesia Geral/veterinária , Animais , Cães/sangue , Feminino , Derivados de Hidroxietil Amido/efeitos adversos , Masculino , Substitutos do Plasma/efeitos adversos , Registros/veterinária , Estudos Retrospectivos
14.
PLoS One ; 14(4): e0213057, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31034525

RESUMO

INTRODUCTION: Balanced fluid replacement solutions can possibly reduce the risks for electrolyte imbalances, for acid-base imbalances, and thus for renal failure. To assess the intraoperative change of base excess (BE) and chloride in serum after treatment with either a balanced gelatine/electrolyte solution or a non-balanced gelatine/electrolyte solution, a prospective, controlled, randomized, double-blind, dual centre phase III study was conducted in two tertiary care university hospitals in Germany. MATERIAL AND METHODS: 40 patients of both sexes, aged 18 to 90 years, who were scheduled to undergo elective abdominal surgery with assumed intraoperative volume requirement of at least 15 mL/kg body weight gelatine solution were included. Administration of study drug was performed intravenously according to patients need. The trigger for volume replacement was a central venous pressure (CVP) minus positive end-expiratory pressure (PEEP) <10 mmHg (CVP <10 mmHg). The crystalloid:colloid ratio was 1:1 intra- and postoperatively. The targets for volume replacement were a CVP between 10 and 14 mmHg minus PEEP after treatment with vasoactive agent and mean arterial pressure (MAP) > 65 mmHg. RESULTS: The primary endpoints, intraoperative changes of base excess -2.59 ± 2.25 (median: -2.65) mmol/L (balanced group) and -4.79 ± 2.38 (median: -4.70) mmol/L (non-balanced group)) or serum chloride 2.4 ± 1.9 (median: 3.0) mmol/L and 5.2 ± 3.1 (median: 5.0) mmol/L were significantly different (p = 0.0117 and p = 0.0045, respectively). In both groups (each n = 20) the investigational product administration in terms of volume and infusion rate was comparable throughout the course of the study, i.e. before, during and after surgery. DISCUSSION: Balanced gelatine solution 4% combined with a balanced electrolyte solution demonstrated significant smaller impact on blood gas analytic parameters in the primary endpoints BE and serum chloride when compared to a non-balanced gelatine solution 4% combined with NaCl 0.9%. No marked treatment differences were observed with respect to haemodynamics, coagulation and renal function. TRIAL REGISTRATION: ClinicalTrials.gov (NCT01515397) and clinicaltrialsregister.eu, EudraCT number 2010-018524-58.


Assuntos
Abdome/cirurgia , Desequilíbrio Ácido-Base/tratamento farmacológico , Assistência Perioperatória , Desequilíbrio Hidroeletrolítico/tratamento farmacológico , Abdome/fisiopatologia , Desequilíbrio Ácido-Base/fisiopatologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Cloretos/sangue , Eletrólitos/administração & dosagem , Feminino , Hidratação , Gelatina/administração & dosagem , Alemanha , Humanos , Concentração de Íons de Hidrogênio , Derivados de Hidroxietil Amido/administração & dosagem , Masculino , Pessoa de Meia-Idade , Substitutos do Plasma/administração & dosagem , Equilíbrio Hidroeletrolítico/efeitos dos fármacos , Desequilíbrio Hidroeletrolítico/fisiopatologia , Adulto Jovem
15.
J Wildl Dis ; 55(4): 857-861, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-30896363

RESUMO

Biochemical and trace element analyses of blood from wild Whooping Cranes (Grus americana) were performed to assess the health of the only self-sustaining, migratory population in North America. Juvenile cranes (n=31) approximately 49-70 d-old were sampled at Wood Buffalo National Park, Northwest Territories, Canada, in midsummer from 2010 to 2012. Archived serum (n=24) and whole blood (n=31) samples from captive juvenile cranes were selected as age-matched controls. Reference values were calculated for serum biochemical analytes and trace elements in whole blood from the captive juvenile Whooping Cranes reared under controlled conditions and with known health histories. Several statistical differences among blood biochemical and trace element values of the wild and captive juveniles were identified and were likely attributable to dietary differences between the populations.


Assuntos
Envelhecimento , Aves/sangue , Oligoelementos/sangue , Equilíbrio Ácido-Base , Fosfatase Alcalina/sangue , Animais , Animais Selvagens , Aspartato Aminotransferases/sangue , Bicarbonatos/sangue , Glicemia , Proteínas Sanguíneas , Cálcio/sangue , Cloretos/sangue , Colesterol/sangue , Creatina Quinase/sangue , L-Lactato Desidrogenase/sangue , Fósforo/sangue , Sódio/sangue , Ácido Úrico/sangue
16.
Aquat Toxicol ; 211: 1-10, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30901626

RESUMO

Flowback and produced water (FPW) is a complex, often brackish, solution formed during the process of hydraulic fracturing. Despite recent findings on the short-term toxicity of FPW on aquatic biota, longer-term impacts of FPW on fish have not yet been investigated and the mechanisms of chronic effects remain unknown. The aim of the present study was to observe the effect of a diluted FPW on ionoregulatory endpoints in the rainbow trout Oncorhynchus mykiss, following a 28-d sub-chronic exposure. A salinity-matched control solution (SW), recreating the salt content of the FPW, was used to differentiate the specific effect of the salts from the effects of the other FPW components (i.e. organics and metals). Overall, fish ionoregulation was not impacted by the chronic exposure. An accumulation of strontium (Sr) and bromide (Br) occurred in the plasma of the FPW-exposed fish only, however no change of plasma ions (Na, K, Cl, Ca, Mg) was observed in SW- or FPW-exposed fish. Similarly, exposures did not alter branchial activity of the osmoregulatory enzymes sodium/potassium ATPase and proton ATPase. Finally, FPW exposure resulted in modifications of gill morphology over time, with fish exposed to the fluid displaying shorter lamellae and increased interlamellar-cell mass. However, these effects were not distinct from morphological changes that also occurred in the gills of control groups.


Assuntos
Monitoramento Ambiental/métodos , Brânquias/efeitos dos fármacos , Fraturamento Hidráulico , Oncorhynchus mykiss/metabolismo , Poluentes Químicos da Água/toxicidade , Animais , Cloretos/sangue , Brânquias/enzimologia , Brânquias/patologia , Modelos Teóricos , Oncorhynchus mykiss/sangue , Osmose , Sódio/sangue , ATPase Trocadora de Sódio-Potássio/metabolismo , Testes de Toxicidade Aguda , Testes de Toxicidade Subcrônica
17.
PLoS One ; 14(2): e0211104, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30768603

RESUMO

Portable blood gas analyzers are used to facilitate diagnosis and treatment of disorders related to disturbances of acid-base and electrolyte balance in the ambulatory care of equine patients. The aim of this study was to determine whether 2 portable analyzers produce results in agreement with a stationary analyzer. Blood samples from 23 horses hospitalized for various medical reasons were included in this prospective study. Blood gas analysis and electrolyte concentrations measured by the portable analyzers VetStat and epoc were compared to those produced by the cobas b 123 analyzer via concordance analysis, Passing-Bablok regression and Bland-Altman analysis. Limits of agreement indicated relevant bias between the VetStat and cobas b 123 for partial pressure of oxygen (pO2; 27.5-33.8 mmHg), sodium ([Na+]; 4.3-21.6 mmol/L) and chloride concentration ([Cl-]; 0.3-7.9 mmol/L) and between the epoc and cobas b 123 for pH (0.070-0.022), partial pressure of carbon dioxide (pCO2; 3.6-7.3 mmHg), pO2 (36.2-32.7 mmHg) and [Na+] (0.38.1 mmol/L). The VetStat analyzer yielded results that were in agreement with the cobas b 123 analyzer for determination of pH, pCO2, bicarbonate ([HCO3-]) and potassium concentration [K+], while the epoc analyzer achieved acceptable agreement for [HCO3-] and [K+]. The VetStat analyzer may be useful in performing blood gas analysis in equine samples but analysis of [Na+], [Cl-] and pO2 should be interpreted with caution. The epoc delivered reliable results for [HCO3-] and [K+], while results for pH, pCO2, pO2 and [Na+] should be interpreted with caution.


Assuntos
Gasometria/instrumentação , Eletrólitos/sangue , Cavalos/sangue , Animais , Bicarbonatos/sangue , Gasometria/estatística & dados numéricos , Dióxido de Carbono/sangue , Cloretos/sangue , Feminino , Concentração de Íons de Hidrogênio , Masculino , Oxigênio/sangue , Pressão Parcial , Sistemas Automatizados de Assistência Junto ao Leito , Potássio/sangue , Estudos Prospectivos , Reprodutibilidade dos Testes , Sódio/sangue
18.
Diabetes Metab Syndr ; 13(1): 216-221, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30641700

RESUMO

AIMS: Although diabetic ketoacidosis (DKA) commonly presents as a pure diabetic ketoacidosis (PDKA), up to 30% of cases may be associated with a mixed hypochloremic metabolic alkalosis (HMA). It is unknown whether there is a difference in treatment outcomes between these two entities. We evaluated an insulin infusion protocol (IIP), previously validated for hyperglycemia management in ICU's, for the management of PDKA and HMA. MATERIALS AND METHODS: A retrospective case series/cohort study of 41 DKA admissions was further characterized as having PDKA or HMA. HMA was defined in those having an elevated delta-delta gradient (ΔAG-ΔHCO3) ≥ 5 mmol/L and base excess chloride (BECl) > 2.7 mmol/L. The main outcome measures were times to recovery of glucose levels to ≤250 mg/dL and of anion gap to ≤12 mmol/L. RESULTS: The initial serum glucose was 553 ±â€¯265 mg/dL, serum bicarbonate of 8.8 ±â€¯5.1 mmol/L, and venous pH 7.13 ±â€¯0.2). Recovery of glucose occurred in 5 h: 25 min (±3 h:39min), and for anion gap in 11 h:25 min (±6 h:56min). HMA compared with PDKA had a delayed recovery of serum glucose (7 h: 23min ±â€¯3 h: 35min vs. 4 h: 31min ±â€¯3:h:21min, p = 0.017), which was due to the higher initial level of glucose (p = 0.02) rather than level of BECl (p = 0.17). There was no difference in time to anion gap closure between the PDKA and HMA. CONCLUSIONS: Correction of hyperglycemia and acidosis in PDKA as well as in HMA was managed through the IIP. The simultaneous fluid and electrolyte management corrected the hypochloremic alkalosis.


Assuntos
Alcalose/tratamento farmacológico , Cloretos/sangue , Cetoacidose Diabética/tratamento farmacológico , Hiperglicemia/prevenção & controle , Hipoglicemiantes/administração & dosagem , Insulina/administração & dosagem , Adulto , Alcalose/sangue , Alcalose/complicações , Alcalose/patologia , Cetoacidose Diabética/sangue , Cetoacidose Diabética/complicações , Cetoacidose Diabética/patologia , Feminino , Seguimentos , Humanos , Hiperglicemia/etiologia , Masculino , Pessoa de Meia-Idade , Prognóstico
19.
Acta Clin Belg ; 74(1): 2-6, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-29757121

RESUMO

Introduction: For the last few decades, electrolyte determinations in plasma or serum are carried out by reliable potentiometric methods. In recent years, a marked technical evolution has taken place, where the clinical analysis of common analytes (e.g. electrolytes) is partly moving from centralised clinical core laboratories to near-patient point-of-care testing. Methods: As the measuring principle used by point-of-care testing markedly differs from the one used in core laboratories, sodium results are not always interchangeable in critically ill patients due to the different sensitivity of the analytical methods for the electrolyte exclusion effect. Results: This effect mainly occurs in patients with decreased plasma protein values. The observed differences in generated test results might significantly affect the judgment and the treatment of electrolyte disturbances. As technical solutions are not likely to occur in the near future, clinicians and laboratorians should be well aware of this growing problem. Mathematical correction of the sodium results for plasma protein concentration may resolve the problem to a certain extent. Discussion: Although electrolyte determinations are generally very reliable, analytical interferences can occur for sodium rarely, mainly due to contamination by surfactants, benzalkonium in particular. For potassium, the major problem is hemolysis. To a lesser extent, leukocyte lysis and thrombocytopenia may also interfere. For chloride determination, the selectivity of the electrodes used is not ideal. Occasionally, false positive signals can be observed in presence of interfering ions (e.g. bromide).


Assuntos
Desequilíbrio Hidroeletrolítico/sangue , Desequilíbrio Hidroeletrolítico/diagnóstico , Cloretos/sangue , Erros de Diagnóstico , Humanos , Potássio/sangue , Sódio/sangue
20.
J Neurosurg Anesthesiol ; 31(3): 311-317, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-29794571

RESUMO

BACKGROUND: Hyperchloremia is known to influence postoperative outcomes and may result in postoperative acute kidney injury (AKI). This study sought to investigate whether hyperchloremia was associated with postoperative AKI in patients who underwent surgery for primary brain tumor resection. MATERIALS AND METHODS: This is a retrospective, observational study of patients who underwent craniotomy for primary brain tumor resection at a single tertiary care hospital between January 2005 and October 2017. Maximum levels of serum chloride (mmol/L) measured on postoperative days (PODs) 0 to 3 and increase in serum chloride (mmol/L), (maximum serum chloride-baseline serum chloride before surgery) were measured. We examined whether perioperative hyperchloremia was associated with postoperative AKI during PODs 0 to 3. Univariate and multivariate logistic regression analyses were used in this study. RESULTS: A total of 726 patients were included in the analysis; of these, 39 (5.4%) were diagnosed with postoperative AKI during PODs 0 to 3. The risk of postoperative AKI was associated with maximum chloride levels (odds ratio, 1.10; 95% confidence interval, 1.02-1.19; P=0.015) and with an increase in serum chloride levels during PODs 0 to 3 (odds ratio, 1.11; 95% confidence interval, 1.04-1.19; P=0.004). CONCLUSIONS: Our study shows that perioperative hyperchloremia during PODs 0 to 3 was associated with an increased risk of postoperative AKI during this period after craniotomy for primary brain tumor resection.


Assuntos
Lesão Renal Aguda/sangue , Neoplasias Encefálicas/cirurgia , Cloretos/sangue , Craniotomia/efeitos adversos , Complicações Pós-Operatórias/sangue , Desequilíbrio Hidroeletrolítico/complicações , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento
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