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1.
Medicine (Baltimore) ; 99(31): e21351, 2020 Jul 31.
Artigo em Inglês | MEDLINE | ID: mdl-32756123

RESUMO

Paraquat (PQ) poisoning is associated with high mortality rate. Therefore, an accurate method for predicting the survival of patients with PQ poisoning is required. This study evaluated the value of serum anion gap (AG) at admission in predicting the survival of such patients.Cases of patients with PQ poisoning admitted to Cangzhou Central Hospital between May 2012 and March 2019 were retrospectively analyzed. The patients were classified into survival and nonsurvival groups on the basis of their 90-day prognosis. Correlation analysis, Cox regression analysis, and receiver operating characteristic and Kaplan-Meier curve analyses were performed to assess the value of AG in predicting the 90-day survival of patients with PQ poisoning.Only 44 of the 108 patients with PQ poisoning survived; thus, the 90-day survival was 40.74%. AG levels at admission were significantly higher in nonsurvivors (26.53 ±â€Š4.93 mmol/L) than in survivors (20.88 ±â€Š2.74 mmol/L) (P < .001) and negatively correlated with 90-day survival (r = -0.557; P < .001). Cox regression analysis revealed that AG at admission is an independent prognostic marker of the 90-day survival of patients with PQ poisoning. AG level at admission had an area under the receiver operating characteristic curve of 0.836 (95% confidence interval: 0.763-0.909) and an optimal cut-off value of 25.5 mmol/L (59.4% sensitivity and 95.5% specificity).AG level at admission may serve as a candidate marker for predicting the survival of patients with PQ poisoning.


Assuntos
Desequilíbrio Ácido-Base/sangue , Herbicidas/envenenamento , Paraquat/envenenamento , Envenenamento/mortalidade , Adulto , Biomarcadores/sangue , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Envenenamento/diagnóstico , Valor Preditivo dos Testes , Modelos de Riscos Proporcionais , Estudos Retrospectivos
2.
Ren Fail ; 42(1): 234-243, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32138574

RESUMO

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


Assuntos
Desequilíbrio Ácido-Base/etiologia , Custos Hospitalares/estatística & dados numéricos , Mortalidade Hospitalar , Tempo de Internação/estatística & dados numéricos , Neoplasias/complicações , Desequilíbrio Hidroeletrolítico/etiologia , Desequilíbrio Ácido-Base/sangue , Acidose/sangue , Acidose/etiologia , Idoso , Alcalose/sangue , Alcalose/etiologia , China , Feminino , Humanos , Hiperpotassemia/etiologia , Hipernatremia/etiologia , Hipocalcemia/etiologia , Hipopotassemia/etiologia , Hiponatremia/etiologia , Hipofosfatemia/etiologia , Masculino , Pessoa de Meia-Idade , Neoplasias/sangue , Estudos Retrospectivos , Fatores de Risco , Análise de Sobrevida , Desequilíbrio Hidroeletrolítico/sangue
3.
Rev. esp. anestesiol. reanim ; 67(1): 20-34, ene. 2020. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-197126

RESUMO

Las anomalías en el equilibrio ácido-base son problemas clínicos comunes, y pueden tener efectos perjudiciales en la función celular y ser el indicio de varios trastornos. Por lo tanto, es importante para el clínico, el hacer un diagnóstico preciso de los trastornos ácido-base presentes para un tratamiento adecuado. Se han propuesto 3 enfoques para evaluar los trastornos ácido-base: un enfoque centrado en el bicarbonato, el enfoque de Stewart y el enfoque de exceso de base. Aunque los 2 últimos tienen muchos adeptos, solo discutiremos el enfoque centrado en el bicarbonato. Este enfoque es más fácil de utilizar desde el punto de vista clínico, tiene una evaluación fisiológica del trastorno ácido-base, presenta una lógica fácilmente comprensible para evaluar la gravedad y proporciona, además, una base más sólida para el desarrollo de terapias efectivas. Por lo tanto, nuestro trabajo se limitará a un examen en profundidad de esta teoría. En esta revisión, primero se introducirán nuevos conceptos importantes; sus beneficios y discusión de sus limitaciones; y luego se mostrará su utilización para analizar casos reales. Se ha generado un algoritmo para abordar de forma sistemática el análisis que incorpora estos nuevos conceptos


Abnormalities in the acid-base balance are common clinical problems and can have deleterious effects on cellular function and be a clue to various disorders. Therefore, it is important for the clinician to make a precise diagnosis of the acid-base disorder(s) present for a proper treatment. Three approaches have been proposed to evaluate acid-base disorders: a bicarbonate-centric approach; the Stewart approach, and the base excess approach. Although the latter two have many adherents, we will only discuss the bicarbonate-centric approach. This approach is simpler to utilize at the bedside, has a physiological evaluation of the acid-base disorder, presents an easily understandable approach to assess severity, and provides a more solid foundation for the development of effective therapies. Therefore, the following discussion will be limited to an examination of this approach. In this case-centric review, important new concepts will be introduced first; their benefits and limitations discussed; and then their utilization to analyze actual cases will be shown. A systematic approach algorithm that incorporates these new concepts has been generated and will be highlighted


Assuntos
Humanos , Gasometria , Algoritmos , Desequilíbrio Ácido-Base/diagnóstico , Bicarbonatos/análise , Fenômenos Fisiológicos Celulares , Desequilíbrio Ácido-Base/classificação , Desequilíbrio Ácido-Base/sangue
4.
Am J Physiol Renal Physiol ; 318(2): F363-F374, 2020 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-31790303

RESUMO

In stone formers (SFs) with idiopathic hypercalciuria, urine pH governs the mineral phase of stones. Calcium phosphate (CaP) SFs have higher urine pH than calcium oxalate (CaOx) SFs. Normal women have higher urine pH than men on fixed diets, accompanied by greater absorption of food alkali. Female CaP and male CaOx SFs have similar urine pH as same sex normal individuals, but male CaP and female CaOx SFs may have abnormal acid-base handling. We studied 25 normal individuals (13 men and 12 women), 17 CaOx SFs (11 men and 6 women), and 15 CaP SFs (8 men and 7 women) on fixed diets. Urine and blood samples were collected under fasting and fed conditions. Female CaOx SFs had lower urine pH and lower alkali absorption, fed, compared with normal women; their urine NH4 was higher and urine citrate excretion lower than in normal women, consistent with their higher net acid excretion. Male CaOx SFs had higher urine citrate excretion and higher serum ultrafilterable citrate levels than normal men. Both male and female CaP SFs had higher urine pH fasting than same sex normal individuals, but only men were higher in the fed period, and there were no differences from normal in gut alkali absorption. CaP SFs of both sexes had higher urine NH4 and lower urine citrate than same sex normal individuals. The lower urine pH of female CaOx SFs seems related to decreased gut alkali absorption, while the higher pH of CaP SFs, accompanied by higher urine NH4 and lower urine citrate, suggests a proximal tubule disorder.


Assuntos
Equilíbrio Ácido-Base , Desequilíbrio Ácido-Base/urina , Oxalato de Cálcio/urina , Fosfatos de Cálcio/urina , Hipercalciúria/urina , Cálculos Renais/urina , Túbulos Renais Proximais/metabolismo , Desequilíbrio Ácido-Base/sangue , Desequilíbrio Ácido-Base/diagnóstico , Desequilíbrio Ácido-Base/fisiopatologia , Adulto , Compostos de Amônio/urina , Biomarcadores/sangue , Biomarcadores/urina , Estudos de Casos e Controles , Ácido Cítrico/urina , Cristalização , Dieta/efeitos adversos , Feminino , Absorção Gastrointestinal , Humanos , Concentração de Íons de Hidrogênio , Hipercalciúria/sangue , Hipercalciúria/diagnóstico , Hipercalciúria/fisiopatologia , Cálculos Renais/sangue , Cálculos Renais/diagnóstico , Cálculos Renais/fisiopatologia , Túbulos Renais Proximais/fisiopatologia , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Fatores Sexuais , Adulto Jovem
5.
Med. intensiva (Madr., Ed. impr.) ; 43(9): 521-527, dic. 2019. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-185898

RESUMO

Objetivo: Evaluar las diferencias observadas en la determinación de los iones y del anión GAP obtenidos por gasometría (POC) y por bioquímica de laboratorio, y analizar los posibles errores en función de los límites de normalidad. Material y métodos: Estudio descriptivo transversal retrospectivo para valorar la concordancia entre dos pruebas diagnósticas de los pacientes ingresados en la Unidad de Reanimación del Complexo Hospitalario Universitario de Ourense, entre julio y noviembre de 2015, con al menos una determinación coincidente de bioquímica y POC. Se excluyeron pacientes menores de 18años. Resultados: Se analizaron 1.073 muestras. Coeficientes de correlación de concordancia de Lin en sodio, potasio y cloro de 0,87, 0,84 y 0,72, respectivamente. Concordancia kappa de los límites de normalidad para sodio, potasio y cloro de 0,63, 0,74 y 0,32. Pobre correlación del anión GAP y nula concordancia entre el POC y el calculado por la bioquímica, incluido el corregido por albúmina. Conclusiones: Concordancia pobre entre los iones de la bioquímica y la gasometría, por lo que no son intercambiables. Concordancia kappa con los límites de normalidad buena para el sodio y potasio, y débil para el cloro. Posible validez para una orientación en la clasificación dentro de los límites de los iones, excepto para el cloro. Nula concordancia para el anión GAP, incluso el corregido por albúmina


Objective: To evaluate the differences observed in ion and GAP anion determinations obtained by point-of-care (POC) blood gas versus laboratory biochemical testing, and to analyze the possible errors according to the limits of normality. Material and methods: A descriptive, cross-sectional retrospective study was made to assess concordance between two diagnostic tests in patients admitted to the Critical Care Unit of Ourense University Hospital Complex (Spain), between July and November 2015, involving at least one coinciding biochemical test and POC determination. Patients under 18years of age were excluded. Results: A total of 1,073 samples were analyzed. Lin's concordance correlation coefficients for sodium, potassium and chlorine were 0.87, 0.84 and 0.72, respectively. Kappa concordance of the normality limits for sodium, potassium and chlorine was 0.63, 0.74 and 0.32. The results indicated poor correlation of the anion GAP and null concordance between POC and biochemical testing, including the value corrected for albumin. Conclusions: Poor concordance was observed between the ion values as determined by biochemistry and blood gases; the two methods are therefore not interchangeable. Kappa agreement with normality limits was good for sodium and potassium, and weak for chlorine. Possible validity was noted in orienting the classification within the ion limits, with the exception of chlorine. No agreement was recorded in relation to the anion GAP, even that corrected for albumin


Assuntos
Humanos , Equilíbrio Ácido-Base , Gasometria/métodos , Cuidados Críticos , Desequilíbrio Ácido-Base/sangue , Íons/análise , Sistemas Automatizados de Assistência Junto ao Leito , Estudos Transversais , Estudos Retrospectivos , Manejo de Espécimes/estatística & dados numéricos , Sódio/análise
7.
Med Klin Intensivmed Notfmed ; 114(8): 765-776, 2019 Nov.
Artigo em Alemão | MEDLINE | ID: mdl-31641791

RESUMO

Keeping blood pH levels stable within narrow limits is prerequisite for maintaining normal body function. Disruptions of this equilibrium can occur for a variety of reasons and may result in life-threatening conditions. Therefore, the identification and the interpretation of acid-base disorders are of great importance in emergency medicine. The same applies to intensive care as well as to almost all areas of internal medicine. In this article, we provide a practical overview of all relevant acid-base disorders that are due to both metabolic and respiratory disturbances. In addition, it shows how they can be diagnosed in everyday clinical practice by applying the simplified Stewart Approach.


Assuntos
Equilíbrio Ácido-Base/fisiologia , Desequilíbrio Ácido-Base , Gasometria , Cuidados Críticos/métodos , Desequilíbrio Ácido-Base/sangue , Desequilíbrio Ácido-Base/diagnóstico , Acidose , Humanos
9.
Air Med J ; 38(4): 276-280, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31248537

RESUMO

Improved prehospital methods for assessing the need for lifesaving interventions (LSIs) are needed to gain critical lead time in the care of the injured. We hypothesized that threshold values using prehospital handheld tissue oximetry would detect occult shock and predict LSI requirements. This was a prospective observational study of adult trauma patients emergently transported by helicopter. Patients were monitored with a handheld tissue oximeter (InSpectra Spot Check; Hutchinson Technology Inc, Hutchinson, MN), continuous vital signs, and 21 laboratory measurements obtained both in the field with a portable analyzer and at the time of admission. Shock was defined as base excess ≥ 4 or lactate > 3 mmol/L. Eighty-eight patients were enrolled with a median Injury Severity Score of 16 (interquartile range, 5-29). The median hemoglobin saturation in the capillaries, venules, and arterioles (StO2) value for all patients was 82% (interquartile range, 76%-87%; range, 42%-98%). StO2 was abnormal (< 75%) in 18 patients (20%). Eight were hypotensive (9%) and had laboratory-confirmed evidence of occult shock. StO2 correlated poorly with shock threshold laboratory values (r = -0.17; 95% confidence interval, -0.33 to 1.0; P = .94). The area under the receiver operating curve was 0.51 (95% confidence interval, 0.39-0.63) for StO2 < 75% and laboratory-confirmed shock. StO2 was not associated with LSI need on admission when adjusted for multiple covariates, nor was it independently associated with death. Handheld tissue oximetry was not sensitive or specific for identifying patients with prehospital occult shock. These results do not support prehospital StO2 monitoring despite its inclusion in several published guidelines.


Assuntos
Oximetria/instrumentação , Oxigênio/sangue , Choque/diagnóstico , Desequilíbrio Ácido-Base/sangue , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Área Sob a Curva , Serviços Médicos de Emergência , Feminino , Hemoglobinas/metabolismo , Humanos , Ácido Láctico/sangue , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Curva ROC , Choque/etiologia , Ferimentos e Lesões/sangue , Ferimentos e Lesões/complicações , Adulto Jovem
10.
Crit Rev Clin Lab Sci ; 56(3): 147-169, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30917291

RESUMO

Acid-base homeostasis is fundamental for life. The body is exceptionally sensitive to changes in pH, and as a result, potent mechanisms exist to regulate the body's acid-base balance to maintain it in a very narrow range. Accurate and timely interpretation of an acid-base disorder can be lifesaving but establishing a correct diagnosis may be challenging. The underlying cause of the acid-base disorder is generally responsible for a patient's signs and symptoms, but laboratory results and their integration into the clinical picture is crucial. Important acid-base parameters are often available within minutes in the acute hospital care setting, and with basic knowledge it should be easy to establish the diagnosis with a stepwise approach. Unfortunately, many caveats exist, beginning in the pre-analytical phase. In the post-analytical phase, studies on the arterial reference pH are scarce and therefore many different reference values are used in the literature without any solid evidence. The prediction models that are currently used to assess the acid-base status are approximations that are mostly based on older studies with several limitations. The two most commonly used methods are the physiological method and the base excess method, both easy to use. The secondary response equations in the base excess method are the most convenient. Evaluation of acid-base disorders should always include the assessment of electrolytes and the anion gap. A major limitation of the current acid-base laboratory tests available is the lack of rapid point-of-care laboratory tests to diagnose intoxications with toxic alcohols. These intoxications can be fatal if not recognized and treated within minutes to hours. The surrogate use of the osmolal gap is often an inadequate substitute in this respect. This article reviews the role of the clinical laboratory to evaluate acid-base disorders.


Assuntos
Desequilíbrio Ácido-Base , Análise Química do Sangue , Equilíbrio Ácido-Base , Desequilíbrio Ácido-Base/sangue , Desequilíbrio Ácido-Base/diagnóstico , Desequilíbrio Ácido-Base/fisiopatologia , Desequilíbrio Ácido-Base/urina , Adulto , Idoso , Eletrólitos/sangue , Feminino , Humanos , Concentração de Íons de Hidrogênio , Masculino , Pessoa de Meia-Idade , Adulto Jovem
11.
Am J Kidney Dis ; 73(1): 131-133, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-29960797

RESUMO

Four patients were recently seen at our institution presenting with severe hypobicarbonatemia and elevated anion gap on serum specimens processed by an autoanalyzer using enzymatic reactions. Arterial blood gas values in each case revealed no significant acid-base disturbance and a marked discordance between arterial blood gas calculated bicarbonate levels and those reported on the basic metabolic panel. All patients had profound hyperlipidemia (triglycerides > 3,500mg/L), and ultracentrifugation of one patient's serum corrected the discordance. Lipid interference with the photometric measurement of light absorbance after enzymatic reaction in the autoanalyzer is thought to be responsible for the low reported bicarbonate values. Use of an indirect ion-specific electrode method for total carbon dioxide analysis would avoid this pitfall. Caution is advised when enzymatic autoanalyzer-calculated laboratory values are used to diagnose acid-base disturbances in patients with severe hyperlipidemia. Physicians involved in the diagnosis of acid-base disorders in hospitalized patients should always be aware of the method used by their chemistry laboratories to determine total carbon dioxide values.


Assuntos
Desequilíbrio Ácido-Base/sangue , Desequilíbrio Ácido-Base/complicações , Bicarbonatos/sangue , Hiperlipidemias/sangue , Hiperlipidemias/complicações , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
12.
Braz J Med Biol Res ; 52(1): e7974, 2018 Dec 10.
Artigo em Inglês | MEDLINE | ID: mdl-30539970

RESUMO

Details about the acid-base changes in hemodialysis are scarce in the literature but are potentially relevant to adequate management of patients. We addressed the acid-base kinetics during hemodialysis and throughout the interdialytic period in a cross-sectional study of adults undergoing conventional hemodialysis. Samples for blood gas analysis were obtained from the arterial limb of the arteriovenous fistula before the first session of the week (HD1), immediately at the end of HD1, and on sequential collections at 15, 30, 45, 60, and 120 min post-HD1. Additional blood samples were collected after ∼20 h following the end of the first dialysis and immediately prior to the initiation of the second dialysis of the week. Thirty adult patients were analyzed (55±15 years, 50% men, 23% diabetic; dialysis vintage 69±53 months). Mean serum bicarbonate levels increased at the end of HD1 (22.3±2.7 mEq/L vs 17.5±2.3 mEq/L, P<0.001) and remained stable until 20 h after the end of the session. The mean values of pCO2 before HD1 were below reference and at 60 and 120 min post-HD1 were significantly lower than at the start (31.3±2.7 mmHg and 30.9±3.7 mmHg vs 34.3±4.1 mmHg, P=0.041 and P=0.010, respectively). The only point of collection in which mean values of pCO2 were above 35 mmHg was 20 h post-dialysis. Serum bicarbonate levels remained stable for at least 20 h after the dialysis sessions, a finding that may have therapeutic implications. During dialysis, the respiratory response for correction of metabolic acidosis (i.e., pCO2 elevation) was impaired.


Assuntos
Equilíbrio Ácido-Base/fisiologia , Desequilíbrio Ácido-Base/sangue , Falência Renal Crônica/metabolismo , Diálise Renal , Desequilíbrio Ácido-Base/metabolismo , Gasometria , Estudos Transversais , Feminino , Humanos , Falência Renal Crônica/sangue , Falência Renal Crônica/terapia , Masculino , Pessoa de Meia-Idade , Fatores de Tempo
13.
Semin Nephrol ; 38(6): 570-581, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30413252

RESUMO

In the United States, end-stage renal disease patients receiving hemodialysis have an exceedingly high risk of sudden cardiac death (SCD), accounting for 29% of death events, likely relating to their uremic milieu, recurring exposure to fluid and electrolyte fluxes, and underlying cardiovascular pathology. Furthermore, epidemiologic studies have shown that SCD events, as well as mortality and hospitalizations, occur most frequently on the first dialysis day after the long interdialytic gap, suggesting that abrupt fluctuations in the accumulation and removal of electrolytes, fluid, and uremic toxins over the dialysis cycle may be contributory. Some population-based observational studies have suggested that lower dialysate potassium concentrations appear to be associated with a heightened risk of postdialysis cardiac arrest in hemodialysis patients, although the optimal serum-to-dialysate potassium gradient remains unclear. Some observational studies have suggested that low dialysate calcium concentrations and high serum-to-dialysate calcium gradients may predispose patients to SCD. There is ongoing controversy about an association between higher dialysate bicarbonate concentrations and higher risk of cardiac arrest, likely owing to confounding by indication. Some observational studies also have shown that large interdialytic weight gains, fluid retention, and high ultrafiltration rates are linked with higher risk of SCD and mortality. However, there remains considerable controversy regarding the pros and cons of designating a specific upper ultrafiltration limit with extended treatment times as a clinical practice measure, and further studies are needed to define the optimal tools, metrics, targets, and implementation measures for volume control in the hemodialysis population. In this review, we highlight the epidemiology and pathophysiology of how specific aspects of the hemodialysis procedure may relate to the risk of SCD, as well as preventative strategies and future research directions that can address this risk.


Assuntos
Morte Súbita Cardíaca/epidemiologia , Soluções para Hemodiálise/química , Falência Renal Crônica/terapia , Potássio/sangue , Diálise Renal/efeitos adversos , Desequilíbrio Ácido-Base/sangue , Bicarbonatos/administração & dosagem , Bicarbonatos/análise , Cálcio/administração & dosagem , Cálcio/análise , Morte Súbita Cardíaca/prevenção & controle , Soluções para Hemodiálise/administração & dosagem , Humanos , Magnésio/administração & dosagem , Magnésio/análise , Potássio/administração & dosagem , Potássio/análise , Diálise Renal/métodos , Fatores de Tempo , Equilíbrio Hidroeletrolítico
15.
Am J Nephrol ; 48(1): 15-20, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29990967

RESUMO

The initial assessment of acid-base status is usually based on the measurement of total CO2 concentration ([TCO2]) in venous blood, a surrogate for [HCO3-]. Previously, we posited that the reference limits of serum [TCO2] in current use are too wide. Based on studies on the acid-base composition of normal subjects, we suggested that the reference limits of serum [TCO2] at sea level be set at 23-30 mEq/L. To validate this proposal, we queried the University of California at Los Angeles (UCLA's) Integrated Clinical and Research Data Repository, a database containing information on 4.5 million patients seen at UCLA from 2006 to the present. Criteria for inclusion included adults (18-40 years of age), who were free of disorders that could affect acid-base balance, were not taking medications that could affect acid-base balance, and were seen for a routine medical examination or immunization in the outpatient setting. The number of individuals who met the inclusion criteria (52% female and 48% male) was 28,480, with a mean age of 28.9 ± 5.1 years. The mean serum [TCO2] level was slightly higher in males than females, 26.6 ± 2.16 mEq/L vs. 25.0 ± 2.11 mEq/L (p < 0.05). Ninety-one percent of patient values were within the proposed 23-30 mEq/L range and 61.7% were within the 24-27 mEq/L range. These findings validate our proposal that the reference range of serum [TCO2] in venous blood at sea level be narrowed to 23-30 mEq/L. Subjects with serum [TCO2] outside this range might require assessment with a venous blood gas to exclude the presence of clinically important acid-base disorders.


Assuntos
Equilíbrio Ácido-Base/fisiologia , Desequilíbrio Ácido-Base/diagnóstico , Dióxido de Carbono/sangue , Desequilíbrio Ácido-Base/sangue , Adolescente , Adulto , Bicarbonatos/sangue , Gasometria/métodos , Bases de Dados Factuais/estatística & dados numéricos , Feminino , Humanos , Masculino , Valores de Referência , Fatores Sexuais , Veias , Adulto Jovem
16.
Respir Care ; 63(8): 943-949, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-29615483

RESUMO

BACKGROUND: Permissive hypercapnia is a lung-protection strategy. We sought to review our current clinical practice for the range of permissive hypercapnia and identify the relationship between PaCO2 and pH and adverse outcomes. METHODS: A secondary analysis of a delayed cord-clamping clinical trial was performed on all arterial blood gas tests in the first 72 h in infants < 32 weeks gestational age. All arterial blood gas values were categorized into a clinical range to determine the percent likelihood of occurring in the total sample. The univariate and multivariate relationships of severe adverse events and the time-weighted PaCO2 , fluctuation of PaCO2 , maximal and minimal PaCO2 , base excess, and pH were assessed. RESULTS: 147 infants with birthweight of 1,206 ± 395 g and gestational age of 28 ± 2 weeks were included. Of the 1,316 total samples, < 2% had hypocapnia (PaCO2 <30 mm Hg), 47% were normocapnic (PaCO2 35-45 mm Hg), 26.5% had mild hypercapnia (PaCO2 45-55 mm Hg), 13% had moderate hypercapnia (PaCO2 55-65 mm Hg), and 6.5% had severe hypercapnia (PaCO2 ≥ 65 mm Hg). There were no adverse events associated with hypocapnia. Subjects with death/severe intraventricular hemorrhage had a higher mean PaCO2 of 52.3 versus 44.7 (odds ratio [OR] 1.16, 95% CI 1.04-1.29, P = .006), higher variability of PaCO2 with a standard deviation of 12.6 versus 7.8 (OR 1.15, 95% CI 1.03-1.27, P = .01), and a lower minimum pH of 7.03 versus 7.23 (OR 0, 95% CI 0-0.06, P = .003). There was no significant difference in any variables in subjects who developed other adverse events. CONCLUSION: The routine targeting of higher than normal PaCO2 goals may lead to a low incidence of hypocapnia and associated adverse events. Hypercapnia is common, and moderate hypercapnia may increase the risk of neurologic injury and provide little pulmonary benefit.


Assuntos
Acidose/sangue , Hemorragia Cerebral Intraventricular/sangue , Hipercapnia/sangue , Hipocapnia/sangue , Respiração Artificial/métodos , Desequilíbrio Ácido-Base/sangue , Acidose/complicações , Gasometria , Dióxido de Carbono , Feminino , Humanos , Concentração de Íons de Hidrogênio , Hipercapnia/complicações , Hipocapnia/complicações , Incidência , Lactente , Morte do Lactente , Recém-Nascido , Recém-Nascido Prematuro/sangue , Masculino , Pressão Parcial , Ensaios Clínicos Controlados Aleatórios como Assunto , Respiração Artificial/efeitos adversos
17.
Nephron ; 139(4): 293-298, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29649820

RESUMO

BACKGROUND: Acid-base disturbances are frequent in critically ill patients. Arterial blood gas (ABG) is the gold standard in the diagnosis of these disturbances, but it is invasive with potential hazards. For patients with a central venous catheter, venous blood gas (VBG) sampling may be an alternative, less-invasive diagnostic tool. However, the accuracy of a central VBG-based acid-base disorder diagnosis compared to an ABG is unknown. The primary objective of this study was to assess the accuracy of a central VBG-based acid-base disorder diagnosis compared to the "gold standard" ABG in critically ill patients. METHODS: This was a study of adult patients in a medical intensive care unit that had simultaneously drawn ABG and central VBG samples. Expert acid-base diagnosticians, all nephrologists, diagnosed the acid-base disorder(s) in each blood gas sample. The central VBG diagnostic accuracy was assessed with percent agreement, sensitivity, and specificity compared to the ABG-based diagnosis. RESULTS: The study involved 23 participants. Overall, the central VBG had 100% sensitivity for metabolic acidosis, metabolic alkalosis, and respiratory acidosis, and lower sensitivity (71%) for respiratory alkalosis, and high percent agreement, ranging from 75 to 94%. VBG-based diagnoses in vasopressor-dependent patients (n = 13, 56.5%) performed similarly to the entire sample. CONCLUSIONS: In critically ill adult patients, central VBG may be used to detect and diagnose acid-base disturbances with reasonable diagnostic accuracy, even in shock states, compared to the ABG. This study supports the use of central VBG for diagnosis of acid-base disturbances in critically ill patients.


Assuntos
Equilíbrio Ácido-Base , Desequilíbrio Ácido-Base/diagnóstico , Gasometria/métodos , Cuidados Críticos/métodos , Desequilíbrio Ácido-Base/sangue , Acidose/diagnóstico , Adulto , Idoso , Alcalose/diagnóstico , Cateterismo Venoso Central , Estado Terminal , Estudos Transversais , Feminino , Humanos , Unidades de Terapia Intensiva , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Sensibilidade e Especificidade
19.
Anaesthesia ; 73(7): 839-846, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-29520867

RESUMO

Treatment of post-spinal hypotension during caesarean section assumes special concern in pre-eclamptic patients due to a compromised fetoplacental circulation and increased risk of placental hypoperfusion. Phenylephrine and ephedrine are the most commonly used vasopressors, although the best choice is still not clear. We studied 80 pre-eclamptic women with a singleton pregnancy who underwent caesarean section with spinal anaesthesia, and who developed hypotension defined as a decrease in systolic arterial pressure ≥ 20% from baseline or absolute value < 100 mmHg. Women were randomly allocated to receive phenylephrine 50 µg or ephedrine 4 mg boluses for treatment of hypotension. Blood pressure changes following vasopressor administration were similar in both groups, but heart rate remained higher after ephedrine at all time-points. The primary outcome measure of umbilical artery pH was 7.26 (0.11) in the phenylephrine group and 7.25 (0.09) in the ephedrine group (p = 0.86). The incidence of neonatal acidosis (umbilical artery pH < 7.20) was 9 (22.5%) in the phenylephrine group and 11 (27.5%) in the ephedrine group (p = 0.80). Other secondary outcome measures were comparable. In conclusion, phenylephrine 50 µg and ephedrine 4 mg, administered as intravenous boluses to treat post-spinal hypotension during caesarean section in pre-eclamptic patients, resulted in similar fetal acid-base values, were equally effective in treating hypotension and were associated with good maternal and neonatal outcome.


Assuntos
Cesárea/métodos , Efedrina/administração & dosagem , Efedrina/uso terapêutico , Hipotensão/tratamento farmacológico , Fenilefrina/administração & dosagem , Fenilefrina/uso terapêutico , Pré-Eclâmpsia/tratamento farmacológico , Vasoconstritores/administração & dosagem , Vasoconstritores/uso terapêutico , Desequilíbrio Ácido-Base/sangue , Desequilíbrio Ácido-Base/induzido quimicamente , Acidose/sangue , Acidose/induzido quimicamente , Adulto , Anestesia Obstétrica , Raquianestesia , Pressão Sanguínea/efeitos dos fármacos , Método Duplo-Cego , Feminino , Frequência Cardíaca/efeitos dos fármacos , Humanos , Recém-Nascido , Gravidez , Resultado do Tratamento
20.
J Clin Pathol ; 71(7): 648-652, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-29559519

RESUMO

Overhydrated stomatocytosis is a rare autosomal dominant disorder known to cause variably severe haemolytic anaemia due to heterozygous mutations in the RHAG gene. We report a 26-year-old man with recurring jaundice, splenohepatomegaly and mild chronic haemolytic anaemia with significant stomatocytosis. Extensive haemolytic work-up including flow cytometry for eosin-5'-maleimide and CD47 expression levels was carried out. Targeted resequencing revealed two probably causative heterozygous mutations in RHAG (Leu336Ser and Ile149Met) and one heterozygous mutation in ANK1 (Glu1046Lys). RHAG involvement was confirmed by decreased RhAG macrocomplex component indicated by the reduced CD47 expression on erythrocytes. In silico analysis concordantly flagged RHAG:Leu336Ser and ANK1:Glu1046Lys as likely deleterious mutation, whereas RHAG:Ile149Met was reported as likely neutral by PROVEAN. Family screening by Sanger sequencing revealed RHAG:Leu336Ser in a mother and ANK1:Glu1046Lys in a father who were both asymptomatic, excluding them as causative dominant events, thus establishing RHAG:Ile149Met, novel de novo mutation as probably causative. This case illustrates the importance of family screening in interpreting next-generation sequencing (NGS) data, as in silico analysis alone can be misleading. Erudite generation of diagnostic possibilities based on a thorough baseline clinical and laboratory work-up remains as important as ever, even as NGS brings about a paradigm shift in the diagnostic work-up of rare haemolytic anaemias.


Assuntos
Desequilíbrio Ácido-Base/genética , Anemia Hemolítica Congênita/genética , Proteínas Sanguíneas/genética , Glicoproteínas de Membrana/genética , Erros Inatos do Metabolismo/genética , Mutação , Desequilíbrio Ácido-Base/sangue , Desequilíbrio Ácido-Base/diagnóstico , Adulto , Anemia Hemolítica Congênita/sangue , Anemia Hemolítica Congênita/diagnóstico , Análise Mutacional de DNA/métodos , Contagem de Eritrócitos , Eritrócitos Anormais , Feminino , Predisposição Genética para Doença , Hereditariedade , Heterozigoto , Sequenciamento de Nucleotídeos em Larga Escala , Humanos , Masculino , Erros Inatos do Metabolismo/sangue , Erros Inatos do Metabolismo/diagnóstico , Linhagem , Fenótipo
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