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1.
Hum Cell ; 34(6): 1744-1754, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34558034

RESUMO

Positive retests of COVID-19 represent a public health concern because of the increased risk of transmission. This study explored whether factors other than the nucleic acid amplification test (NAAT) contribute to positive retest results. Patients with COVID-19 admitted to the Guanggu district of the Hubei Maternal and Child Health Hospital between February 17 and March 28, 2020, were retrospectively included. The patients were grouped into the negative (n = 133) and positive (n = 51) retest groups. The results showed that the proportion of patients presenting with cough was higher (P < 0.001) and the proportion of patients with dyspnea was lower (P = 0.018) in the positive than in the negative retest group. The positive retest group showed shorter durations between symptom onset and hospitalization (P < 0.001) and symptom onset and the first positive NAAT (P = 0.033). The positive retest group had higher basophil counts (P = 0.023) and direct bilirubin (P = 0.032) and chlorine concentrations (P = 0.023) but lower potassium concentrations (P = 0.001) than the negative retest group. Multivariable regression analysis showed that coughing (OR = 7.59, 95% CI 2.28-25.32, P = 0.001) and serum chloride concentrations (OR = 1.38, 95% CI 1.08-1.77, P = 0.010) were independently associated with a positive retest result. Coughing and serum chloride concentrations were independent risk factors for positive NAAT retest results. Patients with a hospital stay of < 2 weeks or a short incubation period should stay in isolation and be monitored to reduce transmission. These results could help identify patients who require closer surveillance.


Assuntos
Teste de Ácido Nucleico para COVID-19/métodos , COVID-19/diagnóstico , Adulto , Idoso , COVID-19/prevenção & controle , Cloretos/sangue , Tosse , Reações Falso-Positivas , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Sensibilidade e Especificidade
2.
Pediatrics ; 148(3)2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34373322

RESUMO

OBJECTIVES: Diabetic ketoacidosis (DKA) is typically characterized by low or low-normal serum sodium concentrations, which rise as hyperglycemia resolves. In retrospective studies, researchers found associations between declines in sodium concentrations during DKA and cerebral injury. We prospectively investigated determinants of sodium concentration changes and associations with mental status alterations during DKA. METHODS: Using data from the Pediatric Emergency Care Applied Research Network Fluid Therapies Under Investigation in Diabetic Ketoacidosis Trial, we compared children who had declines in glucose-corrected sodium concentrations with those who had rising or stable concentrations. Children were randomly assigned to 1 of 4 intravenous fluid protocols that differed in infusion rate and sodium content. Data from the first 4, 8, and 12 hours of treatment were analyzed for 1251, 1086, and 877 episodes, respectively. RESULTS: In multivariable analyses, declines in glucose-corrected sodium concentrations were associated with higher sodium and chloride concentrations at presentation and with previously diagnosed diabetes. Treatment with 0.45% (vs 0.9%) sodium chloride fluids was also associated with declines in sodium concentration; however, higher rates of fluid infusion were associated with declines in sodium concentration only at 12 hours. Frequencies of abnormal Glasgow Coma Scale scores and clinical diagnoses of cerebral injury were similar in patients with and without declines in glucose-corrected sodium concentrations. CONCLUSIONS: Changes in glucose-corrected sodium concentrations during DKA treatment are influenced by the balance of free-water loss versus sodium loss at presentation and the sodium content of intravenous fluids. Declines in glucose-corrected sodium concentrations are not associated with mental status changes during treatment.


Assuntos
Cetoacidose Diabética/terapia , Escala de Coma de Glasgow , Sódio/sangue , Criança , Cloretos/sangue , Cetoacidose Diabética/sangue , Feminino , Hidratação/métodos , Humanos , Masculino , Estudos Prospectivos , Cloreto de Sódio/administração & dosagem
3.
Biomed Res Int ; 2021: 6632128, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34258274

RESUMO

Titanium dioxide nanoparticles (TiO2) were used in various fields such as food industry, cosmetics, medicine, and agriculture. Despite the many advantages of nanotechnology, the adverse effects of nanoparticles are inevitable. The present study was conducted to evaluate the protective effect of bee bread on titanium dioxide (TiO2) nanoparticle toxicity. Male rats were randomly divided into four groups: Group 1 received daily by gavage (10 mL/kg bw) of distilled water, Group 2 received bee bread ethanolic extract (100 mg/kg bw), Group 3 received TiO2 (100 mg/kg bw) and distilled water (10 mL/kg bw), and Group 4 received TiO2 (100 mg/kg bw) and bee bread ethanolic extract (100 mg/kg bw). All treatments were given daily by gavage during 30 days. At the end of the experiment period, blood samples were collected to analyze fasting blood glucose, lipid profile (TC, TG, LDL-C, HDL-C, and VLDL-C), liver enzymes (AST, ALT, and LDH), total protein, urea, albumin, creatinine, sodium, potassium, and chloride ions. In addition, histological examinations of the kidneys, liver, and brain were investigated. The results showed that the subacute administration of TiO2 alone (100 mg/kg bw) had induced hyperglycemia (309 ± 5 mg/dL) and elevation of hepatic enzyme levels, accompanied by a change in both lipid profile and renal biomarkers as well as induced congestion and dilatation in the hepatic central vein and congestion in kidney and brain tissues. However, the cotreatment with bee bread extract restored these biochemical parameters and attenuated the deleterious effects of titanium nanoparticles on brain, liver, and kidney functions which could be due to its rich content on functional molecules. The findings of this paper could make an important contribution to the field of using bee bread as a detoxifying agent against titanium dioxide nanoparticles and other xenobiotics.


Assuntos
Encéfalo/patologia , Rim/patologia , Fígado/patologia , Nanopartículas/toxicidade , Própole/farmacologia , Titânio/toxicidade , Albuminas/análise , Animais , Glicemia/metabolismo , Encéfalo/efeitos dos fármacos , Cloretos/sangue , Creatinina/sangue , Rim/efeitos dos fármacos , Lipídeos/análise , Fígado/efeitos dos fármacos , Marrocos , Potássio/sangue , Ratos Wistar , Sódio/sangue , Ureia/sangue
4.
PLoS One ; 16(6): e0247542, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34181644

RESUMO

Intravenous magnesium sulfate (MgSO4) is used in equine practice to treat hypomagnesemia, dysrhythmias, neurological disorders, and calcium dysregulation. MgSO4 is also used as a calming agent in equestrian events. Hypercalcemia affects calcium-regulating hormones, as well as plasma and urinary electrolytes; however, the effect of hypermagnesemia on these variables is unknown. The goal of this study was to investigate the effect of hypermagnesemia on blood parathyroid hormone (PTH), calcitonin (CT), ionized calcium (Ca2+), ionized magnesium (Mg2+), sodium (Na+), potassium (K+), chloride (Cl-) and their urinary fractional excretion (F) after intravenous administration of MgSO4 in healthy horses. Twelve healthy female horses of 4-18 years of age and 432-600 kg of body weight received a single intravenous dose of MgSO4 (60 mg/kg) over 5 minutes, and blood and urine samples were collected at different time points over 360 minutes. Plasma Mg2+ concentrations increased 3.7-fold over baseline values at 5 minutes and remained elevated for 120 minutes (P < 0.05), Ca2+ concentrations decreased from 30-60 minutes (P < 0.05), but Na+, K+ and Cl- concentrations did not change. Serum PTH concentrations dropped initially to rebound and remain elevated from 30 to 60 minutes, while CT concentrations increased at 5 minutes to return to baseline by 10 minutes (P < 0.05). The FMg, FCa, FNa, FK, and FCl increased, while urine osmolality decreased from 30-60 minutes compared baseline (P < 0.05). Short-term experimental hypermagnesemia alters calcium-regulating hormones (PTH, CT), reduces plasma Ca2+ concentrations, and increases the urinary excretion of Mg2+, Ca2+, K+, Na+ and Cl- in healthy horses. This information has clinical implications for the short-term effects of hypermagnesemia on calcium-regulation, electrolytes, and neuromuscular activity, in particular with increasing use of Mg salts to treat horses with various acute and chronic conditions as well as a calming agent in equestrian events.


Assuntos
Cálcio/metabolismo , Eletrólitos/metabolismo , Sulfato de Magnésio/farmacologia , Administração Intravenosa/métodos , Animais , Calcitonina/sangue , Calcitonina/urina , Cálcio/sangue , Hormônios e Agentes Reguladores de Cálcio/metabolismo , Cloretos/sangue , Cloretos/urina , Eletrólitos/sangue , Eletrólitos/urina , Feminino , Doenças dos Cavalos/sangue , Cavalos/metabolismo , Magnésio/sangue , Magnésio/metabolismo , Sulfato de Magnésio/administração & dosagem , Hormônio Paratireóideo/sangue , Hormônio Paratireóideo/urina , Potássio/sangue , Potássio/urina , Sódio/sangue , Sódio/urina
5.
Am J Med ; 134(9): 1170-1174, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-33864761

RESUMO

BACKGROUND: Pseudohyperchloremia results in a very low or negative anion gap. Historically, the most common cause of this artifact was bromide poisoning. Bromide salts have been removed from most medications and bromism has become very uncommon. More recently, the introduction of chloride ion selective sensing electrodes (Cl-ISE) has generated a new cause of pseudohyperchloremia-salicylate poisoning. We describe 5 such patients and quantitate the error generated by this measurement artifact. METHODS: The magnitude of artifactual hyperchloremia generated by high salicylate levels was quantified in 5 patients by measuring chloride concentration with several Cl-ISEs from different manufacturers and with Cl-ISEs of different "ages," and comparing these results to measurements with a chloridometer (coulometric titration), which is free of the salicylate artifact. RESULTS: Cl-ISEs from different manufacturers generated a wide range of artifactual chloride concentration elevation. Furthermore, the same Cl-ISE generated increasingly severe pseudohyperchloremia as it was repeatedly reused over time and "aged." CONCLUSIONS: Salicylate interferes with measurement of the blood chloride concentration when a Cl-ISE is used. The severity of this artifact is related to the salicylate level, the specific Cl-ISE, and the "age" of the electrode. Toxic blood salicylate levels can generate marked pseudohyperchloremia, and consequently, an artifactual very small or negative anion gap. The large anion gap metabolic acidosis typical of salicylate poisoning is masked by this artifact. Salicylate has become the most common cause of pseudohyperchloremia, and physicians should immediately consider salicylate poisoning whenever the combination of hyperchloremia and a very small or negative anion gap is reported by the laboratory.


Assuntos
Acidose , Aspirina/envenenamento , Cloretos , Eletrodos Íon-Seletivos/normas , Salicilatos , Equilíbrio Ácido-Base , Desequilíbrio Ácido-Base/induzido quimicamente , Desequilíbrio Ácido-Base/diagnóstico , Desequilíbrio Ácido-Base/terapia , Acidose/sangue , Acidose/induzido quimicamente , Acidose/diagnóstico , Acidose/terapia , Artefatos , Cloretos/análise , Cloretos/sangue , Análise de Falha de Equipamento , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Assistência ao Paciente/métodos , Salicilatos/sangue , Salicilatos/envenenamento , Tentativa de Suicídio
6.
PLoS One ; 16(4): e0250292, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33901227

RESUMO

PURPOSE: We sought to describe the association between serum chloride levels and mortality among unselected cardiac intensive care unit (CICU) patients. MATERIALS AND METHODS: We retrospectively reviewed adult patients admitted to our CICU from 2007 to 2015. The association of dyschloremia and hospital mortality was assessed in a multiple variable model including additional confounders, and the association of dyschloremia and post-discharge mortality were assessed using Cox proportional-hazards analysis. RESULTS: 9,426 patients with a mean age of 67±15 years (37% females) were included. Admission hypochloremia was present in 1,384 (15%) patients, and hyperchloremia was present in 1,606 (17%) patients. There was a U-shaped relationship between admission chloride and unadjusted hospital mortality, with increased hospital mortality among patients with hypochloremia (unadjusted OR 3.0, 95% CI 2.5-3.6, p<0.001) or hyperchloremia (unadjusted OR 1.9, 95% CI 1.6-2.3, p<0.001). After multivariate adjustment, hypochloremia remained associated with higher hospital mortality (adjusted OR 2.1, 95% CI 1.6-2.9, p <0.001). Post-discharge mortality among hospital survivors was higher among patients with admission hypochloremia (adjusted HR 1.3, 95% CI 1.1-1.6; p<0.001). CONCLUSION: Abnormal serum chloride on admission to the CICU is associated with increased short- and long-term mortality, with hypochloremia being a strong independent predictor.


Assuntos
Doenças Cardiovasculares/sangue , Doenças Cardiovasculares/mortalidade , Cloretos/sangue , Unidades de Cuidados Coronarianos , Mortalidade Hospitalar , Idoso , Idoso de 80 Anos ou mais , Doenças Cardiovasculares/terapia , Cuidados Críticos/métodos , Estado Terminal , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Admissão do Paciente , Alta do Paciente , Prognóstico , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Resultado do Tratamento
7.
PLoS One ; 16(4): e0250274, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33914794

RESUMO

To practically determine the effect of chloride (Cl) on the acid-base status, four approaches are currently used: accepted ranges of serum Cl values; Cl corrections; the serum Cl/Na ratio; and the serum Na-Cl difference. However, these approaches are governed by different concepts. Our aim is to investigate which approach to the evaluation of the effect of Cl is the best. In this retrospective cohort study, 2529 critically ill patients who were admitted to the tertiary care unit between 2011 and 2018 were retrospectively evaluated. The effects of Cl on the acid-base status according to each evaluative approach were validated by the standard base excess (SBE) and apparent strong ion difference (SIDa). To clearly demonstrate only the effects of Cl on the acid-base status, a subgroup that included patients with normal lactate, albumin and SIG values was created. To compare approaches, kappa and a linear regression model for all patients and Bland-Altman test for a subgroup were used. In both the entire cohort and the subgroup, correlations among BECl, SIDa and SBE were stronger than those for other approaches (r = 0.94 r = 0.98 and r = 0.96 respectively). Only BECl had acceptable limits of agreement with SBE in the subgroup (bias: 0.5 mmol L-1) In the linear regression model, only BECl in all the Cl evaluation approaches was significantly related to the SBE. For the evaluation of the effect of chloride on the acid-base status, BECl is a better approach than accepted ranges of serum Cl values, Cl corrections and the Cl/Na ratio.


Assuntos
Equilíbrio Ácido-Base/fisiologia , Desequilíbrio Ácido-Base/sangue , Cloretos/sangue , Sódio/sangue , APACHE , Desequilíbrio Ácido-Base/diagnóstico , Desequilíbrio Ácido-Base/fisiopatologia , Idoso , Estado Terminal , Feminino , Humanos , Concentração de Íons de Hidrogênio , Unidades de Terapia Intensiva , Ácido Láctico/sangue , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Albumina Sérica Humana/metabolismo , Centros de Atenção Terciária
8.
J Int Soc Sports Nutr ; 18(1): 22, 2021 Mar 15.
Artigo em Inglês | MEDLINE | ID: mdl-33722257

RESUMO

BACKGROUND: Muscle cramp is a painful, involuntary muscle contraction, and that occurs during or following exercise is referred to as exercise-associated muscle cramp (EAMC). The causes of EAMC are likely to be multifactorial, but dehydration and electrolytes deficits are considered to be factors. This study tested the hypothesis that post-exercise muscle cramp susceptibility would be increased with spring water ingestion, but reduced with oral rehydration solution (ORS) ingestion during exercise. METHODS: Ten men performed downhill running (DHR) in the heat (35-36 °C) for 40-60 min to reduce 1.5-2% of their body mass in two conditions (spring water vs ORS) in a cross-over design. The body mass was measured at 20 min and every 10 min thereafter during DHR, and 30 min post-DHR. The participants ingested either spring water or ORS for the body mass loss in each period. The two conditions were counter-balanced among the participants and separated by a week. Calf muscle cramp susceptibility was assessed by a threshold frequency (TF) of an electrical train stimulation to induce cramp before, immediately after, 30 and 65 min post-DHR. Blood samples were taken before, immediately after and 65 min after DHR to measure serum sodium, potassium, magnesium and chroride concentrations, hematocrit (Hct), hemoglobin (Hb), and serum osmolarity. Changes in these varaibles over time were compared between conditions by two-way repeated measures of analysis of variance. RESULTS: The average (±SD) baseline TF (25.6 ± 0.7 Hz) was the same between conditions. TF decreased 3.8 ± 2.7 to 4.5 ± 1.7 Hz from the baseline value immediately to 65 min post-DHR for the spring water condition, but increased 6.5 ± 4.9 to 13.6 ± 6.0 Hz in the same time period for the ORS condition (P < 0.05). Hct and Hb did not change significantly (P > 0.05) for both conditions, but osmolarity decreased (P < 0.05) only for the spring water condition. Serum sodium and chloride concentrations decreased (< 2%) at immediately post-DHR for the spring water condition only (P < 0.05). CONCLUSIONS: These results suggest that ORS intake during exercise decreased muscle cramp susceptibility. It was concluded that ingesting ORS appeared to be effective for preventing EAMC.


Assuntos
Água Potável , Exercício Físico/fisiologia , Temperatura Alta , Águas Minerais/efeitos adversos , Cãibra Muscular/etiologia , Soluções para Reidratação/administração & dosagem , Adulto , Índice de Massa Corporal , Cloretos/sangue , Estudos Cross-Over , Suscetibilidade a Doenças , Ingestão de Líquidos , Hematócrito , Hemoglobina A/análise , Humanos , Magnésio/sangue , Masculino , Águas Minerais/administração & dosagem , Cãibra Muscular/sangue , Cãibra Muscular/prevenção & controle , Concentração Osmolar , Potássio/sangue , Corrida/fisiologia , Sódio/sangue , Fatores de Tempo , Adulto Jovem
9.
J Wildl Dis ; 57(1): 178-183, 2021 01 06.
Artigo em Inglês | MEDLINE | ID: mdl-33635992

RESUMO

Hematology and serum biochemistry reference intervals were estimated for the Iberian hare (Lepus granatensis). Most parameters differed significantly between hunted and livetrapped Iberian hares. Significant differences were found for sex (red blood cell count, mean corpuscular volume, total protein, albumin, uric acid, triglycerides, cholesterol, chloride) and age classes (red blood cell count, hematocrit, mean corpuscular hemoglobin, glucose, calcium, and sodium). Sex- and age-specific reference intervals were estimated for these parameters. Red blood cell count, hemoglobin concentration, mean corpuscular hemoglobin, urea, and potassium show seasonal variations, with the lowest values in summer and the highest in winter. Creatinine, calcium, sodium, and phosphorus achieve their highest values in summer and stable baseline values throughout the rest of the year. These reference intervals can be used as baseline to monitor health, physiology, ecology, and nutrition of Iberian hare populations.


Assuntos
Envelhecimento/sangue , Lebres/fisiologia , Animais , Glicemia , Proteínas Sanguíneas , Cálcio/sangue , Cloretos/sangue , Colesterol/sangue , Contagem de Eritrócitos , Índices de Eritrócitos , Feminino , Lebres/sangue , Hematócrito/veterinária , Masculino , Potássio/sangue , Valores de Referência , Estações do Ano , Albumina Sérica , Sódio/sangue , Triglicerídeos/sangue , Ureia/sangue , Ácido Úrico/sangue
10.
Am J Emerg Med ; 43: 69-76, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33529852

RESUMO

OBJECTIVE: Chloride is an important electrolyte in the body. In this study, we aimed to evaluate the associations between chloride levels on emergency department (ED) admission and neurologic outcomes by stratifying patients undergoing targeted temperature management (TTM) after out-of-hospital cardiac arrest (OHCA) into three groups (hyper/normo/hypochloremia); we also assessed the effect of changes in chloride levels from baseline over time on outcomes. METHODS: This retrospective, observational cohort study of 346 patients was conducted between 2011 and 2019. The chloride levels were categorized as hypochloremia, normochloremia, and hyperchloremia by predetermined definitions. The primary endpoint was poor neurologic outcomes after hospital discharge. We evaluated the associations between chloride levels on ED admission and neurologic outcomes and assess the effect of changes in chloride levels over time on clinical outcomes. RESULTS: On ED admission, compared with normochloremia, hypochloremia was significantly associated with unfavorable neurologic outcomes (OR, 2.668; 95% CI, 1.217-5.850, P = 0.014). Over time, unfavorable neurologic outcomes were significantly associated with increases in chloride levels in the hyperchloremia and normochloremia groups after ED admission. The rates of poor neurologic outcomes in the hyperchloremia and normochloremia groups were increased by 14.2% at Time-12, 20.1% at Time-24, and 9.3% at Time-48 with a 1-mEq/L increase in chloride levels. CONCLUSION: In clinical practice, chloride levels can be routinely and serially measured cost-effectively. Thus, baseline chloride levels may be a promising tool for rapid risk stratification of patients after OHCA. For fluid resuscitation after cardiac arrest, a chloride-restricted solution may be an early therapeutic strategy.


Assuntos
Cloretos/sangue , Hidratação/métodos , Parada Cardíaca Extra-Hospitalar/terapia , Idoso , Biomarcadores/sangue , Reanimação Cardiopulmonar/estatística & dados numéricos , Feminino , Humanos , Hipotermia Induzida/métodos , Masculino , Pessoa de Meia-Idade , Parada Cardíaca Extra-Hospitalar/mortalidade , Estudos Retrospectivos
11.
J Zoo Wildl Med ; 51(4): 933-947, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33480574

RESUMO

The blue iguana (Cyclura lewisi) is an endangered rock iguana species native to Grand Cayman, in the Cayman Islands. Health assessments were conducted on captive and free-roaming iguanas in 2001 and 2003-2014 and were performed in the summer wet season (June-July) of 2003-2004 and 2010-2014 and in the winter dry season (November-December) of 2001 and 2005-2009. Morphometric data were recorded from iguanas when blood samples were collected: 903 samples were collected and data from 890 samples from 775 iguanas were included. Samples were analyzed for hematology, plasma biochemistry, protein electrophoresis, mineral panels, 25-hydroxyvitamin D, and testosterone. Reference intervals were created for captive subadults, captive adults, and free-roaming adults when data were sufficient. Significant differences among these groups were described, as were differences on the basis of sex, season, and origin (captive vs free-roaming). In captive iguanas, most analytes were significantly different between subadults and adults, mature heterophils and copper were significantly higher in the dry season, zinc levels were significantly higher in the wet season, and cholesterol and triglycerides were significantly higher in adult females than adult males. Testosterone in adult males was significantly higher in the dry season. These results will aid in future health assessments and disease investigations in wild and captive populations of blue iguanas and are of comparative value for other Cyclura species that are free-roaming, captive, and, especially, in similar conservation release programs.


Assuntos
Proteínas Sanguíneas/química , Eletroforese/veterinária , Contagem de Eritrócitos/veterinária , Hematócrito/veterinária , Iguanas/sangue , Contagem de Leucócitos/veterinária , Amilases/sangue , Animais , Aspartato Aminotransferases/sangue , Glicemia , Nitrogênio da Ureia Sanguínea , Cloretos/sangue , Colesterol/sangue , Creatina Quinase/sangue , Creatinina/sangue , Eletrólitos/sangue , L-Lactato Desidrogenase/sangue , Minerais/sangue , Valores de Referência , Índias Ocidentais
12.
BMJ Case Rep ; 14(1)2021 Jan 25.
Artigo em Inglês | MEDLINE | ID: mdl-33495177

RESUMO

Pheochromocytoma occasionally engenders catecholamine-induced hypertension crisis. Pheochromocytoma is clinically identified in 0.1%-5.7% of patients with neurofibromatosis type 1 (NF1), which is 10 times more frequently than in healthy individuals. This report describes a case of newly diagnosed NF1 presenting with pheochromocytoma crisis, with severe electrolyte depletion and deteriorating recurrent ventricular tachycardia storm. Characteristic skin lesions such as café-au-lait macules and neurofibromas contributed to the diagnosis of NF1 and pheochromocytoma. No recurrence of electrolyte depletion was found after the adrenalectomy. Primary care physicians must distinguish the characteristic skin lesions of NF1, such as café-au-lait macules and neurofibromas and recognise the risk for pheochromocytoma.


Assuntos
Neurofibromatose 1/diagnóstico , Feocromocitoma/diagnóstico , Taquicardia Ventricular/terapia , Desequilíbrio Hidroeletrolítico/terapia , 3-Iodobenzilguanidina , Adrenalectomia , Alcoolismo/complicações , Catecolaminas/urina , Cloretos/sangue , Humanos , Hipopotassemia/etiologia , Hipopotassemia/metabolismo , Hipopotassemia/terapia , Hiponatremia/etiologia , Hiponatremia/metabolismo , Hiponatremia/terapia , Hipofosfatemia/etiologia , Hipofosfatemia/metabolismo , Hipofosfatemia/terapia , Masculino , Metanefrina/urina , Pessoa de Meia-Idade , Feocromocitoma/complicações , Feocromocitoma/metabolismo , Feocromocitoma/cirurgia , Cintilografia , Compostos Radiofarmacêuticos , Taquicardia Ventricular/etiologia , Desequilíbrio Hidroeletrolítico/etiologia , Desequilíbrio Hidroeletrolítico/metabolismo
13.
Otolaryngol Head Neck Surg ; 164(2): 308-314, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-32746759

RESUMO

OBJECTIVE: To determine the significance and impact of additional chloride testing as part of a diagnostic laboratory test battery for borderline primary hyperparathyroidism (pHPT). STUDY DESIGN: Retrospective database review of parathyroidectomy patients. SETTING: A tertiary care, academic health sciences center. SUBJECTS AND METHODS: Patients referred to a head and neck endocrine clinic for evaluation and treatment for pHPT. RESULTS: After exclusions, there were a total of 226 patients who underwent parathyroidectomy for primary hyperparathyroidism with the requisite preoperative and postoperative labs. Seventy-seven additional patients who had a thyroid operation for a nonmalignant cause were included as controls. Of the 303 total patients, 166 had normal calcium levels (<10.4 mg/dL), and 54 (32.5%) also exhibited hyperchloremia (>106 mmol/L). Of the 47 patients with normal calcium and parathyroid hormone (PTH) levels (<88 pg/mL), 6 (12.8%) had hyperchloremia, and of the 118 patients with normocalcemic pHPT, 48 (40.7%) were hyperchloremic. The area under the curve for the Cl:PO4 was 0.712. When using a cutoff of 33, the reported sensitivity and specificity of the curve were 58.4% and 28.6%, respectively. CONCLUSION: The Cl:PO4 ratio was a moderately sensitive test for the diagnosis of the borderline variants of primary hyperparathyroidism. The Ca:PO4 ratio was superior to the Cl:PO4 ratio. Our data also showed the superiority of preoperative calcium and ionized calcium over PTH when predicting the presence of pHPT.


Assuntos
Cálcio/sangue , Cloretos/sangue , Hiperparatireoidismo Primário/sangue , Hormônio Paratireóideo/sangue , Paratireoidectomia , Biomarcadores/sangue , Feminino , Humanos , Hiperparatireoidismo Primário/cirurgia , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Estudos Retrospectivos
14.
BJU Int ; 127(5): 538-543, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-32967050

RESUMO

OBJECTIVES: To determine the clinical utility of blood tests as a screening tool for metabolic abnormalities in patients with kidney stone disease. SUBJECTS AND METHODS: Clinical and biochemical data from 709 patients attending the Oxford University Hospitals NHS Foundation Trust for assessment and treatment of kidney stones were prospectively collected between April 2011 and February 2017. Data were analysed to determine the utility of serum calcium, parathyroid hormone (PTH), urate, chloride, bicarbonate, potassium and phosphate assays in screening for primary hyperparathyroidism, normocalcaemic hyperparathyroidism, hyperuricosuria, distal renal tubular acidosis (dRTA) and hypercalciuria. RESULTS: An elevated serum calcium level was detected in 2.3% of patients. Further investigations prompted by this finding resulted in a diagnosis of primary hyperparathyroidism in 0.2% of men and 4.6% of women for whom serum calcium was recorded. An elevated serum PTH level in the absence of hypercalcaemia was detected in 15.1% of patients. Of these patients, 74.6% were vitamin D-insufficient; no patients were diagnosed with normocalcaemic hyperparathyroidism. Hyperuricosuria was present in 21.6% of patients and hypercalciuria in 47.1%. Hyperuricaemia was not associated with hyperuricosuria, nor was hypophosphataemia associated with hypercalciuria. No patient was highlighted as being at risk of dRTA using serum chloride and bicarbonate as screening tests. CONCLUSION: This study indicates that individuals presenting with renal calculi should undergo metabolic screening with a serum calcium measurement alone. Use of additional blood tests to screen for metabolic disorders is not cost-effective and may provide false reassurance that metabolic abnormalities are not present. A full metabolic assessment with 24-h urine collection should be undertaken in recurrent stone formers and in those at high risk of future stone disease to identify potentially treatable metabolic abnormalities.


Assuntos
Acidose Tubular Renal/diagnóstico , Hipercalciúria/diagnóstico , Hiperparatireoidismo/diagnóstico , Cálculos Renais/sangue , Doenças Metabólicas/sangue , Doenças Metabólicas/diagnóstico , Acidose Tubular Renal/sangue , Adulto , Idoso , Idoso de 80 Anos ou mais , Bicarbonatos/sangue , Cálcio/sangue , Cálcio/urina , Cloretos/sangue , Feminino , Testes Hematológicos , Humanos , Hipercalciúria/sangue , Hiperparatireoidismo/sangue , Hipofosfatemia/sangue , Hipofosfatemia/diagnóstico , Cálculos Renais/etiologia , Masculino , Doenças Metabólicas/complicações , Pessoa de Meia-Idade , Hormônio Paratireóideo/sangue , Fosfatos/sangue , Potássio/sangue , Ácido Úrico/sangue , Ácido Úrico/urina , Adulto Jovem
15.
Emerg Med J ; 38(6): 423-429, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32883752

RESUMO

OBJECTIVES: Hyperchloraemia is associated with poor clinical outcomes in sepsis patients; however, this association is not well studied for hypochloraemia. We investigated the prevalence of chloride imbalance and the association between hypochloraemia and 28-day mortality in ED patients with septic shock. METHODS: A retrospective analysis of data from 11 multicentre EDs in the Republic of Korea prospectively collected from October 2015 to April 2018 was performed. Initial chloride levels were categorised as hypochloraemia, normochloraemia and hyperchloraemia, according to sodium chloride difference adjusted criteria. The primary outcome was 28-day mortality. A multivariate logistic regression model adjusting for age, sex, comorbidities, acid-base state, sepsis-related organ failure assessment (SOFA) score, lactate and albumin level was used to test the association between the three chloride categories and 28-day mortality. RESULTS: Among 2037 enrolled patients, 394 (19.3%), 1582 (77.7%) and 61 (3.0%) patients had hypochloraemia, normochloraemia and hyperchloraemia, respectively. The unadjusted 28-day mortality rate in patients with hypochloraemia was 27.4% (95% CI, 23.1% to 32.1%), which was higher than in patients with normochloraemia (19.7%; 95% CI, 17.8% to 21.8%). Hypochloraemia was associated with an increase in the risk of 28-day mortality (adjusted OR (aOR), 1.36, 95% CI, 1.00 to 1.83) after adjusting for confounders. However, hyperchloraemia was not associated with 28-day mortality (aOR 1.35, 95% CI, 0.82 to 2.24). CONCLUSION: Hypochloraemia was more frequently observed than hyperchloraemia in ED patients with septic shock and it was associated with 28-day mortality.


Assuntos
Cloretos/sangue , Serviço Hospitalar de Emergência , Choque Séptico/mortalidade , Idoso , Albuminas/metabolismo , Biomarcadores/sangue , Feminino , Humanos , Lactatos/sangue , Masculino , Pessoa de Meia-Idade , Escores de Disfunção Orgânica , Sistema de Registros , República da Coreia/epidemiologia , Estudos Retrospectivos
16.
Med Sci Sports Exerc ; 53(5): 1068-1078, 2021 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-33196605

RESUMO

PURPOSE: We recently demonstrated that coingestion of NaHCO3 to counteract ketoacidosis resulting from oral ketone ester (KE) intake improves mean power output during a 15-min time trial (TT) at the end of a 3-h cycling race by ~5%. This ergogenic effect occurred at a time when blood ketone levels were low, as ketosis was only induced during the initial ~2 h of the race. Therefore, in the current study, we investigated whether performance also increases if blood ketone levels are increased in the absence of ketoacidosis during high-intensity exercise. METHODS: In a double-blind crossover design, 14 well-trained male cyclists completed a 30-min TT (TT30') followed by an all-out sprint at 175% of lactate threshold (SPRINT). Subjects were randomized to receive (i) 50 g KE, (ii) 180 mg·kg-1 body weight NaHCO3 (BIC), (iii) KE + BIC, or (iv) a control drink (CON). RESULTS: KE ingestion increased blood d-ß-hydroxybutyrate to ~3-4 mM during the TT30' and SPRINT (P < 0.001 vs CON). In KE, blood pH and bicarbonate concomitantly dropped, causing 0.05 units lower pH and 2.6 mM lower bicarbonate in KE compared with CON during the TT30' and SPRINT (P < 0.001 vs CON). BIC coingestion resulted in 0.9 mM higher blood d-ß-hydroxybutyrate (P < 0.001 vs KE) and completely counteracted ketoacidosis during exercise (P > 0.05 vs CON). Mean power output during TT30' was similar between CON and BIC at 281 W, but was 1.5% lower in the KE conditions (main effect of KE: P = 0.03). Time to exhaustion in the SPRINT was ~64 s in CON and KE and increased by ~8% in the BIC conditions (main effect of BIC: P < 0.01). DISCUSSION: Neutralization of acid-base disturbance by BIC coingestion is insufficient to counteract the slightly negative effect of KE intake during high-intensity exercise.


Assuntos
Desempenho Atlético/fisiologia , Ciclismo/fisiologia , Cetonas/sangue , Cetose/fisiopatologia , Bicarbonato de Sódio/administração & dosagem , Equilíbrio Ácido-Base , Adulto , Análise de Variância , Cálcio/sangue , Cloretos/sangue , Estudos Cross-Over , Dieta da Carga de Carboidratos , Carboidratos da Dieta/administração & dosagem , Método Duplo-Cego , Ésteres/administração & dosagem , Humanos , Concentração de Íons de Hidrogênio , Hidroxibutiratos/sangue , Cetonas/administração & dosagem , Cetonas/urina , Cetose/induzido quimicamente , Cetose/prevenção & controle , Ácido Láctico/sangue , Masculino , Substâncias para Melhoria do Desempenho , Placebos/administração & dosagem , Fatores de Tempo
17.
Eur J Appl Physiol ; 121(3): 803-816, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33355715

RESUMO

PURPOSE: To reduce the need for invasive and expensive measures of human biomarkers, sweat is becoming increasingly popular in use as an alternative to blood. Therefore, the (in)dependency of blood and sweat composition has to be explored. METHODS: In an environmental chamber (33 °C, 65% relative humidity; RH), 12 participants completed three subsequent 20-min cycling stages to elicit three different local sweat rates (LSR) while aiming to limit changes in blood composition: at 60% of their maximum heart rate (HRmax), 70% HRmax and 80% HRmax, with 5 min of seated-rest in between. Sweat was collected from the arm and back during each stage and post-exercise. Blood was drawn from a superficial antecubital vein in the middle of each stage. Concentrations of sodium, chloride, potassium, ammonia, lactate and glucose were determined in blood plasma and sweat. RESULTS: With increasing exercise intensity, LSR, sweat sodium, chloride and glucose concentrations increased (P ≤ 0.026), while simultaneously limited changes in blood composition were elicited for these components (P ≥ 0.093). Sweat potassium, lactate and ammonia concentrations decreased (P ≤ 0.006), while blood potassium decreased (P = 0.003), and blood ammonia and lactate concentrations increased with higher exercise intensities (P = 0.005; P = 0.007, respectively). The vast majority of correlations between blood and sweat parameters were non-significant (P > 0.05), with few exceptions. CONCLUSION: The data suggest that sweat composition is at least partly independent of blood composition. This has important consequences when targeting sweat as non-invasive alternative for blood measurements.


Assuntos
Amônia/metabolismo , Cloretos/metabolismo , Exercício Físico/fisiologia , Glucose/metabolismo , Ácido Láctico/metabolismo , Potássio/metabolismo , Sódio/metabolismo , Suor/metabolismo , Adulto , Amônia/sangue , Cloretos/sangue , Feminino , Humanos , Ácido Láctico/sangue , Masculino , Potássio/sangue , Sódio/sangue
18.
Physiol Rep ; 8(23): e14593, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-33278069

RESUMO

A system for sorbent-assisted peritoneal dialysis (SAPD) has been developed that continuously recirculates dialysate via a tidal mode using a single-lumen peritoneal catheter with the regeneration of spent dialysate by means of sorbents. SAPD treatment may improve plasma clearance by the maintenance of a high plasma-to-dialysate concentration gradient and by increasing the mass transfer area coefficient (MTAC) of solutes. The system is designed for daily 8-hr treatment (12 kg, nighttime system). A wearable system (2.3 kg, daytime system) may further enhance the clearance of phosphate and organic waste solutes during the day. Uremic pigs (n = 3) were treated with the day- (n = 3) and nighttime system (n = 15) for 4-8 hr per treatment. Plasma clearance (Cl), MTAC, and total mass transport (MT) of urea, creatinine, phosphate, and potassium were compared with a static dwell (n = 28). Cl, MTAC, and MT of urea, creatinine, phosphate, and potassium were low in the pig as compared to humans due to the pig's low peritoneal transport status and could be enhanced only to a limited extent by SAPD treatment compared with a static dwell (nighttime system: Cl urea: ×1.5 (p = .029), Cl creatinine: ×1.7 (p = .054), Cl phosphate: ×1.5 (p = .158), Cl potassium: ×1.6 (p = .011); daytime system: Cl creatinine: ×2.7 (p = .040), Cl phosphate: ×2.2 (p = .039)). Sorbent-assisted peritoneal dialysis treatment in a uremic pig model is safe and enhances small solute clearance as compared to a static dwell. Future studies in humans or animal species with higher peritoneal transport should elucidate whether our SAPD system enhances clearance to a clinically relevant extent as compared to conventional PD.


Assuntos
Diálise Peritoneal/métodos , Uremia/terapia , Animais , Resinas de Troca Aniônica/química , Resinas de Troca Aniônica/normas , Cateteres/normas , Cloretos/sangue , Cloretos/urina , Creatinina/urina , Feminino , Diálise Peritoneal/instrumentação , Fosfatos/sangue , Fosfatos/urina , Potássio/sangue , Potássio/urina , Suínos , Ureia/sangue , Ureia/urina
19.
Sci Rep ; 10(1): 19623, 2020 11 12.
Artigo em Inglês | MEDLINE | ID: mdl-33184400

RESUMO

Dyschloremia is common in critically ill patients. However, little is known about the effects of dyschloremia on renal function in patients with acute kidney injury (AKI) requiring continuous renal replacement therapy (CRRT). A total of 483 patients who received CRRT for AKI were selected and divided into three groups according to their serum chloride concentrations at the time of CRRT initiation. At 90 days after initiating CRRT, renal outcome, i.e., non-complete renal recovery, or renal failure, was assessed in the three groups. The hypochloremia group (serum chloride concentrations < 96 mEq/L, n = 60), the normochloremia group (serum chloride concentrations, 96-111 mEq/L, n = 345), and the hyperchloremia group (serum chloride concentrations > 111 mEq/L, n = 78) were classified. The simplified acute physiology score III was higher in the hyperchloremia and hypochloremia groups than in the normochloremia group. Multivariate logistic regression analyses showed that hypochloremia (odds ratio, 5.12; 95% confidence interval [CI], 2.56-10.23; P < 0.001) and hyperchloremia (odds ratio, 2.53; 95% CI, 1.25-5.13; P = 0.01) were significantly associated with non-complete renal recovery. Similar trends were observed for renal failure. This study showed that dyschloremia was independently associated with failure in restoring renal function following AKI.


Assuntos
Injúria Renal Aguda/sangue , Injúria Renal Aguda/terapia , Cloretos/sangue , Terapia de Substituição Renal Contínua , Recuperação de Função Fisiológica , Injúria Renal Aguda/fisiopatologia , Idoso , Estado Terminal , Feminino , Humanos , Testes de Função Renal , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Índice de Gravidade de Doença
20.
Physiol Rep ; 8(22): e14647, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-33230967

RESUMO

Bikram yoga is practiced in a room heated to 105°F with 40% humidity for 90 min. During the class a large volume of water and electrolytes are lost in the sweat, specifically, sodium is lost, the main cation of the extracellular fluid. There is little known about the volume of sweat and the amount of sodium lost in sweat during Bikram yoga or the optimum quantity of fluid required to replace these losses. The participants who took part in this small feasibility study were five females with a mean age of 47.4 ± 4.7 years and 2.6 ± 1.6 years of experience at Bikram yoga. The total body weight, water consumed, serum sodium concentration, serum osmolality, and serum aldosterone levels were all measured before and after a Bikram yoga practice. Sweat sodium chloride concentration and osmolality were measured at the end of the practice. The mean estimated sweat loss was 1.54 ± 0.65 L, while the amount of water consumed during Bikram yoga was 0.38 ± 0.22 L. Even though only 25% of the sweat loss was replenished with water intake during the Bikram yoga class, we did not observe a change in serum sodium levels or serum osmolality. The sweat contained 82 ± 16 mmol/L of sodium chloride for an estimated total of 6.8 ± 2.1 g of sodium chloride lost in the sweat. The serum aldosterone increased 3.5-fold from before to after Bikram yoga. There was a decrease in the extracellular body fluid compartment of 9.7%. Sweat loss in Bikram yoga predominately produced a volume depletion rather than the dehydration of body fluids. The sweating-stimulated rise in serum aldosterone levels will lead to increased sodium reabsorption from the kidney tubules and restore the extracellular fluid volume over the next 24 hr.


Assuntos
Sudorese , Equilíbrio Hidroeletrolítico , Ioga , Adulto , Idoso , Aldosterona/sangue , Cloretos/sangue , Cloretos/metabolismo , Feminino , Humanos , Pessoa de Meia-Idade , Sódio/sangue , Sódio/metabolismo , Suor/metabolismo
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