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1.
Biol Trace Elem Res ; 200(1): 147-155, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33689144

RESUMO

Hypercapnia can increase the production of reactive oxygen species (ROS) by inducing oxidative stress in cells. Transient receptor potential melastatin 2 (TRPM2) channel activation that is realized by ROS plays a critical role in the cellular mechanism. It was shown that antioxidants such as zinc (Zn), selenium (Se), and glutathione (GSH) can partake in the structures of enzymes and create a protective effect against oxidative stress. This study revealed the relationship between TRPM2 channel and hypercapnia, and the interaction of zinc, selenium, and glutathione. In our study, normoxia, hypercapnia, hypercapnia + Zn, hypercapnia + Se, and hypercapnia + GSH were created, in transfected HEK293 cells. The cells were exposed to normoxia or hypercapnia gasses in two different times (30 min and 60 min), while Zn, Se, and GSH were applied to the cells in the other groups before being exposed to the gas mixtures. The statistical evaluation showed a significant increase in lipid peroxidation (LPO) level and lactate dehydrogenase (LDH)% in the hypercapnia 30 min and 60 min groups, compared to the normoxia 30 min and 60 min groups, and an increase in LPO level and LDH% in the hypercapnia groups that Zn, Se, and GSH were applied. It was determined that in comparison with the normoxia 30 min and 60 min groups, the amount of inward Ca+2 current across TRPM2 channels and mean current density increased in the groups that were exposed to hypercapnia for 30 min and 60 min, while the same values significantly decreased in the hypercapnia groups that Zn, Se, and GSH were applied. Also, it was shown that oxidative stress rose as the duration of hypercapnia exposure increased. It was concluded that hypercapnia increased oxidative stress and caused cellular membrane damage, while the addition of Zn, Se, and GSH could protect the cell membrane from these damaging effects.


Assuntos
Acidose , Selênio , Canais de Cátion TRPM , Glutationa/metabolismo , Células HEK293 , Humanos , Zinco
2.
Acta Vet Scand ; 63(1): 43, 2021 Nov 14.
Artigo em Inglês | MEDLINE | ID: mdl-34775972

RESUMO

BACKGROUND: The physiology of sheep as small ruminants is remarkably different from monogastric animals especially regarding the forestomach system. Using sheep for surgical procedures during scientific research thereby presents an exceptional setting for the anaesthetist. Long-term anaesthesia generally demands deprivation of food to reduce the risk of bloat in sheep. This might influence the energy and electrolyte balance. In horses and companion animals, close monitoring of mean arterial blood pressure, capnography and blood gas analysis are common procedures during long-term surgery. However, few data are available on reference ranges for blood gas in sheep and these cover only short periods of anaesthesia. To the authors' knowledge, there is no study available that includes the monitoring of electrolytes and pH in ruminal fluid and kidney function tests in sheep undergoing long term anaesthesia. Thereby, the aim of the present study was to gather data on blood parameters, and data on ruminal fluid and kidney function during long-term anaesthesia in sheep. Data were obtained from eight sheep undergoing the invasive surgical procedure of left pneumonectomy and auto-transplantation or isolated left lung perfusion. After a 19-h fasting period, the animals were administered xylazine and ketamine and then intubated and maintained in general anaesthesia under artificial ventilation using isoflurane in oxygen. Blood samples were evaluated during 9 h of anaesthesia; ruminal fluid and kidney function tests were evaluated during 7 h of anaesthesia. RESULTS: Blood parameters such as electrolytes and partial pressure of carbon dioxide revealed few changes, yet blood glucose decreased and beta-hydroxybutyric acid increased significantly. All animals showed an elevated arterial pH and bicarbonate concentration despite artificial ventilation. In ruminal fluid, the pH significantly decreased and no significant changes in electrolytes occurred. Kidney function tests revealed no significant changes in any of the animals. However, fractional excretion of water and phosphate was slightly increased. One animal showed severe complications due to hypokalaemia. CONCLUSION: Invasive surgery under long-term anaesthesia in sheep is possible without great imbalances of arterial pH and electrolytes. Nevertheless, potassium concentrations should be monitored carefully, as a deficiency can lead to life-threatening complications. The operated sheep tended not to develop metabolic acidosis and the mean kidney function could be maintained within the physiological range throughout anaesthesia. However, slight elevations in renal fractional water and phosphate excretion could suggest an early tubular reabsorption dysfunction. In ruminal fluid, acidification occurred, though no significant changes were observed in L- and D-lactate levels or in electrolyte concentrations. To our knowledge, the role of the rumen in storing fluids and balancing electrolytes in the blood has not yet been documented during anaesthesia. However, the importance of the rumen for fluid equilibrium in sheep indicates the necessity for routine monitoring and further research.


Assuntos
Acidose , Ovinos , Acidose/etiologia , Acidose/veterinária , Animais , Eletrólitos , Concentração de Íons de Hidrogênio , Testes de Função Renal , Rúmen , Ovinos/cirurgia
3.
JAAPA ; 34(12): 31-33, 2021 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-34813533

RESUMO

ABSTRACT: This article describes a rare case of lactation ketoacidosis in a patient who started a ketogenic diet while nursing an infant and toddler. The patient presented to the ED with a history of nausea, vomiting, and postural dizziness, and was found to have a significant metabolic acidosis and elevated lipase level. The metabolic changes induced in this patient could occur in anyone with high metabolic demands who also is on a strict ketogenic diet. The case highlights the importance of a dietary history in patients with unexplained metabolic derangements.


Assuntos
Acidose , Dieta Cetogênica , Cetose , Acidose/etiologia , Dieta Cetogênica/efeitos adversos , Feminino , Humanos , Lactente , Cetose/etiologia , Lactação , Vômito
4.
J Assoc Physicians India ; 69(11): 11-12, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34781612

RESUMO

INTRODUCTION: Winters' formula (pCO2 =1.5*HCO3 +8) is used worldwide to predict the ventilatory response to metabolic acidosis, namely to predict the pCO2 value complying with reduction of serum bicarbonate concentration (HCO3 ). This equation was obtained half a century ago in mostly pediatric subjects. Subsequently different and inconsistent rules have been suggested. The study was done to verify the reliability of Winters' formula in severely ill patients with respect of other modern and commonly used formulas. METHODS: We applied Winters' formula and some other formulas to a dataset of arterial gas analysis from 29 severely ill malaria patients (about half of them requiring ICU or hemodialysis). The expected pCO2 value was computed by each formula and the root mean square error (RMSE) was measured. Beyond predicting the expected pCO2 value, expected range of values was also computed (as expected value ± each own error) and agreement with the best fit equation (± its error) was assessed. RESULTS: In this dataset featured by metabolic acidosis of moderate degree (mean pH 7.2, mean HCO3 : 15.3 mmol/l) a strong positive linear relationship between pCO2 and HCO3 was found (R squared =0.97). The best fit linear equation was in form of pCO2 = 1.28*HCO3 +11.55. Winters' formula exhibits the lowest RMSE (1 mmHg) and shows the better agreement (Cohen's kappa=0.7) with the best fit equation Conclusions: Winters' formula can still profitably used to compute the expected pCO2 value and in turn to infer mixed (metabolic plus respiratory) acid-base disorders in severely ill patients.


Assuntos
Acidose , Bicarbonatos , Criança , Humanos , Concentração de Íons de Hidrogênio , Diálise Renal , Reprodutibilidade dos Testes
5.
J Am Vet Med Assoc ; 259(8): 899-908, 2021 10 15.
Artigo em Inglês | MEDLINE | ID: mdl-34609179

RESUMO

OBJECTIVE: To evaluate the reticulorumen pH of beef feedlot steers throughout the feeding period and to assess the association between the respective durations that the reticulorumen pH was ≤ 5.6 (subacute ruminal acidosis) and ≤ 5.2 (acute ruminal acidosis) and liver abscess severity. ANIMALS: 59 feedlot steers (mean body weight, 349.5 kg). PROCEDURES: On day 0, each steer was orally administered an electronic bolus that monitored the reticulorumen pH every 10 minutes for 150 days. Steers were transitioned from a starter to intermediate ration on day 8 (transition 1) and from the intermediate to finish ration on day 19 (transition 2). The ration carbohydrate and megacalorie contents increased with each transition. During each transition, the lower megacalorie ration was fed at the 8:00 am feeding and the higher megacalorie ration was fed at the 2:00 pm feeding for 3 days before the higher megacalorie ration was fed extensively. Steers were sent to slaughter after 182 days; each carcass was assessed for liver abscesses. RESULTS: The diurnal reticulorumen pH pattern was characterized by a peak at 7:00 am and nadir at 8:00 pm. The mean percentages of time that the reticulorumen pH was ≤ 5.6 and ≤ 5.2 were more than 10-fold greater during transition 1, compared with during transition 2, and were significantly greater for steers with extensive liver abscesses than for steers without extensive liver abscesses. CONCLUSIONS AND CLINICAL RELEVANCE: Efforts to minimize the duration that the reticulorumen pH is ≤ 5.6 might mitigate liver abscess formation in feedlot cattle.


Assuntos
Acidose , Doenças dos Bovinos , Abscesso Hepático , Acidose/veterinária , Ração Animal/análise , Animais , Bovinos , Dieta/veterinária , Concentração de Íons de Hidrogênio , Abscesso Hepático/veterinária
6.
Int J Mol Sci ; 22(19)2021 Oct 06.
Artigo em Inglês | MEDLINE | ID: mdl-34639130

RESUMO

Metabolic transformation of cancer cells leads to the accumulation of lactate and significant acidification in the tumor microenvironment. Both lactate and acidosis have a well-documented impact on cancer progression and negative patient prognosis. Here, we report that cancer cells adapted to acidosis are significantly more sensitive to oxidative damage induced by hydrogen peroxide, high-dose ascorbate, and photodynamic therapy. Higher lactate concentrations abrogate the sensitization. Mechanistically, acidosis leads to a drop in antioxidant capacity caused by a compromised supply of nicotinamide adenine dinucleotide phosphate (NADPH) derived from glucose metabolism. However, lactate metabolism in the Krebs cycle restores NADPH supply and antioxidant capacity. CPI-613 (devimistat), an anticancer drug candidate, selectively eradicates the cells adapted to acidosis through inhibition of the Krebs cycle and induction of oxidative stress while completely abrogating the protective effect of lactate. Simultaneous cell treatment with tetracycline, an inhibitor of the mitochondrial proteosynthesis, further enhances the cytotoxic effect of CPI-613 under acidosis and in tumor spheroids. While there have been numerous attempts to treat cancer by neutralizing the pH of the tumor microenvironment, we alternatively suggest considering tumor acidosis as the Achilles' heel of cancer as it enables selective therapeutic induction of lethal oxidative stress.


Assuntos
Acidose/fisiopatologia , Caprilatos/farmacologia , Ciclo do Ácido Cítrico/efeitos dos fármacos , Glucose/metabolismo , Mitocôndrias/efeitos dos fármacos , Neoplasias/tratamento farmacológico , Sulfetos/farmacologia , Microambiente Tumoral , Adaptação Fisiológica , Antineoplásicos/farmacologia , Metabolismo Energético , Glicólise , Humanos , Concentração de Íons de Hidrogênio , Ácido Láctico/metabolismo , Mitocôndrias/metabolismo , Mitocôndrias/patologia , Neoplasias/metabolismo , Neoplasias/patologia , Estresse Oxidativo , Células Tumorais Cultivadas
7.
Cir Cir ; 89(5): 583-587, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34665180

RESUMO

OBJECTIVE: We investigated the effect of carotid body ischemia-induced cerebrospinal fluid acidosis on spinal cord during subarachnoid hemorrhage (SAH). METHODS: Twenty-three hybrid rabbits were divided into three groups: control (n = 5), Sham (injected with 0.5 ml isotonic) (n = 6), and the SAH (n = 12) (injected with 0.5 ml autologous blood into the 4th ventricle) and then monitored for 3 weeks. Cerebrospinal fluid pH and degenerated ependymal cell density and volume of cervical central canal were analyzed. RESULTS: The mean cervical central canal volumes, degenerated ependymal cells densities, and cerebrospinal pH values were 1.056 ± 0.053 mm3-6 ± 2 per mm2-7.342 ± 0.034, 1.321 ± 0.12 mm3-35 ± 9 per mm2-7.314 ± 0.056, and 1.743 ± 0.245 mm3-159 ± 24 per mm2-7.257 ± 0.049 in the Control, Sham, and SAH groups, respectively. The more degenerated carotid body neuron density induced decreased cerebrospinal fluid pH values (p < 0.0001) could result in the more ependymal cells desquamation (p < 0.0005) and central canal dilatation (p < 0.00001). CONCLUSION: Increased neurodegeneration of carotid bodies can reduce cause cerebrospinal fluid pH-induced ependymal cell degeneration and central canal dilatation following SAH.


Assuntos
Acidose , Hemorragia Subaracnóidea , Animais , Modelos Animais de Doenças , Isquemia , Coelhos , Medula Espinal
8.
J Dairy Sci ; 104(12): 12520-12539, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34482977

RESUMO

The objectives of this study were to induce hindgut and metabolic acidosis via abomasal infusion of corn starch and ß-hydroxybutyrate (BHB), respectively, and to determine the effects of these physiological states in early-lactation dairy cows. In a 6 × 6 Latin square design, 6 rumen-fistulated Holstein-Friesian dairy cows (66 ± 18 d in milk) were subjected to 5 d of continuous abomasal infusion treatments followed by 2 d of rest. The abomasal infusion treatments followed a 3 × 2 factorial design, with 3 levels of corn starch and 2 levels of BHB. The infusions were water as control, 1.5 kg of corn starch/d, 3.0 kg of corn starch/d, 8.0 mol BHB/d, 1.5 kg of corn starch/d + 8.0 mol BHB/d, or 3.0 kg of corn starch/d + 8.0 mol BHB/d. A total mixed ration consisting of 35.0% grass silage, 37.4% corn silage, and 27.6% concentrate (on a dry matter basis) was fed at 90% of ad libitum intake of individual cows. The experiment was conducted in climate respiration chambers to facilitate determination of energy and N balance. Fecal pH decreased with each level of corn starch infused into the abomasum and was 6.49, 6.00, and 5.15 with 0.0, 1.5, and 3.0 kg of corn starch/d, respectively, suggesting that hindgut acidosis was induced with corn starch infusion. No systemic inflammatory response was observed and the permeability of the intestine or hindgut epithelium was not affected by the more acidic conditions. This induced hindgut acidosis was associated with decreased digestibility of nutrients, except for crude fat and NDF, which were not affected. Induced hindgut acidosis did not affect milk production and composition and energy balance, but increased milk N efficiency. Abomasal infusion of BHB resulted in a compensated metabolic acidosis, which was characterized by a clear disturbance of acid-base status (i.e., decreased blood total CO2, HCO3, and base excess, and a tendency for decreased urinary pH), whereas blood pH remained within a physiologically normal range. Abomasal infusion of BHB resulted in increased concentrations of BHB in milk and plasma, but both remained well below the critical threshold values for subclinical ketosis. Induced compensated metabolic acidosis, as a result of abomasally infused BHB, increased energy retained as body fat, did not affect milk production and composition or inflammatory response, but increased intestinal permeability.


Assuntos
Acidose , Doenças dos Bovinos , Ácido 3-Hidroxibutírico , Abomaso , Acidose/veterinária , Animais , Bovinos , Dieta/veterinária , Digestão , Lactação , Leite , Rúmen , Silagem/análise , Amido , Zea mays
9.
Clin J Am Soc Nephrol ; 16(9): 1306-1308, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34497106
10.
Animal ; 15(10): 100370, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34583314

RESUMO

Ruminant animals are generally fed with starch-rich grain as the main energy source, and the incidence of metabolic diseases such as subacute ruminal acidosis (SARA) is high due to the intensive farming. Thiamin has been reported to alleviate SARA caused by high-concentrate diets, but the exact mechanism is not well understood. The goal of this study was to examine the role of thiamine in intestinal inflammation and microbiota caused by high-concentrate diets. The SARA model was induced by low neutral detergent fibre/starch ration to study the effects of thiamine on intestinal tissue structure and microbiota. 18 mid-lactation (148 ± 3 d in milk; milk yield = 0.71 ± 0.0300 kg/d) Saanen goats (BW = 36.5 ± 1.99 kg; body condition score = 2.73 ± 0.16, where 1 = emaciated and 6 = obese) in parities 1 or 2 were selected. The goats were randomly divided into three groups with six replicates: (1) control diet (C; concentrate:forage 30:70), (2) high-concentrate diet (H; concentrate:forage 70:30), and (3) high-concentrate diet with 200 mg of thiamine/kg of DM intake (H + T;concentrate:forage 70:30). The experimental period was lasted for 56 d. The small and large intestine, expression of inflammatory factor genes, tight junction protein genes, total antioxidant capacity, and intestinal microbiota were measured. The results showed that SARA was observed in treatment H, whereas rumen fluid pH was improved in treatment H + T. Treatment H + T also significantly repaired the intestinal tissue structure damaged by SARA, improved the total antioxidant capacity of the small intestinal mucosa, reduced mRNA expression of inflammatory factors in the small intestine tissue, and increased the mRNA expression of tight junction genes in small intestine tissue. The high-concentrate diet reduced the diversity of intestinal microbiota. When thiamine is added to the high-concentrate diet, the relative abundance of intestinal Firmicutes and beneficial bacteria represented by Lactobacilli were upregulated, and the relative abundance of Proteus, a marker of intestinal dysbacteriosis, returned to normal. In conclusion, thiamine supplementation could alleviate the damage to the intestinal tissue structure and microbial environment caused by SARA condition in dairy goats fed a high-concentrate diet.


Assuntos
Acidose , Doenças dos Bovinos , Doenças das Cabras , Microbiota , Acidose/veterinária , Animais , Bovinos , Dieta/veterinária , Feminino , Cabras , Concentração de Íons de Hidrogênio , Lactação , Leite , Rúmen , Tiamina
11.
Ugeskr Laeger ; 183(33)2021 08 16.
Artigo em Dinamarquês | MEDLINE | ID: mdl-34477100

RESUMO

It is a common but flawed presumption that blood lactate reflects the lactic acid production in the body's tissues. Lactate is formed directly from pyruvate and functions to dampen reductions in intracellular pH through lactate-H+ cotransport to the extracellular space. Though this may give rise to elevated blood lactate, increased lactate production is not the cause of metabolic acidosis in such instances. "Lactic acidosis" is thus an inappropriate term as it indicates causality and in this review, we suggest that in the future, the term "hyperlactataemia-associated metabolic acidosis" should be used instead.


Assuntos
Acidose Láctica , Acidose , Acidose/diagnóstico , Acidose/etiologia , Acidose Láctica/diagnóstico , Acidose Láctica/etiologia , Humanos , Ácido Láctico
12.
Adv Ther ; 38(10): 5238-5252, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34471991

RESUMO

INTRODUCTION: Although hyperkalemia and metabolic acidosis often co-occur in patients with chronic kidney disease (CKD), the prevalence of metabolic acidosis among patients with CKD and hyperkalemia is understudied. Therefore, we used medical record data from the Research Action for Health Network to estimate this prevalence. METHODS: Adult patients with CKD stage 3-5, ≥ 1 outpatient potassium value > 5.0 mEq/l, and ≥ 1 outpatient bicarbonate value available were identified. Patients with end stage kidney disease (ESKD) in the prior year were excluded. The prevalence of metabolic acidosis in each calendar year from 2014 to 2017 among patients with CKD and hyperkalemia was estimated using two definitions of hyperkalemia (potassium > 5.0 mEq/l and > 5.5 mEq/l) and metabolic acidosis (bicarbonate < 18 mEq/l and < 22 mEq/l). RESULTS: In the 2017 patient cohort and among patients with CKD and hyperkalemia, patients with metabolic acidosis were younger (69 versus 74 years), more likely to have advanced CKD (35% versus 13%), and use oral sodium bicarbonate (21% versus 4%) than patients without metabolic acidosis. The prevalence of metabolic acidosis (< 22 mEq/l) ranged from 25 to 29% when hyperkalemia was defined by potassium > 5.0 mEq/l and ranged from 33 to 39% when hyperkalemia was defined by potassium > 5.5 mEq/l. CONCLUSION: Results demonstrated that prevalence estimates of metabolic acidosis varied based on the definition of hyperkalemia and metabolic acidosis utilized.


Assuntos
Acidose , Hiperpotassemia , Insuficiência Renal Crônica , Acidose/epidemiologia , Humanos , Hiperpotassemia/epidemiologia , Potássio , Prevalência , Insuficiência Renal Crônica/complicações , Insuficiência Renal Crônica/epidemiologia
13.
JNMA J Nepal Med Assoc ; 59(239): 692-696, 2021 Jul 30.
Artigo em Inglês | MEDLINE | ID: mdl-34508499

RESUMO

INTRODUCTION: An acid-base disorder is a change in the normal value of extracellular pH that may result when renal or respiratory function is abnormal or when an acid or base load overwhelms their excretory capacity. Clinical acid-base disorders are conventionally defined from the vantage point of their impact on carbonic-acid-bicarbonate buffer system. The aim of the study is to find out the prevalence of acid-base disorder among patients visiting the emergency department of a tertiary care hospital. METHODS: This is a descriptive cross-sectional study conducted among 370 patients who underwent arterial gas analysis at the emergency department of a tertiary care hospital. The study was carried out from 15th July 2016 to 15th July 2017 after receiving ethical approval from Institutional Review Committee. Convenient sampling was done. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data. Data were entered in Microsoft-Excel. Statistical Package for Social Sciences version 17 was used for analysis. RESULTS: Out of 370 patients analyzed, 329 (88.91%) (84.68-91.311 at 95% Confidence Interval) had acid-base disorder. The mixed disorder was the most common finding 80 (21.6%), followed by compensated Respiratory Acidosis 56 (17.8%). The mean age group of male patients studied was 50.72±20.586 and among females, it was 49.95±20.908 Among those most common symptoms were shortness of breath 151 (40.81%) followed by vomiting 91 (24.59%). CONCLUSIONS: Most common acid-base disorder was mixed disorder presenting with prominent symptoms of shortness of breathe in non-geriatric patients wherein the geriatric patient, the most common disorder was compensated respiratory acidosis with the prominent symptom of shortness of breath.


Assuntos
Acidose , Serviço Hospitalar de Emergência , Idoso , Estudos Transversais , Feminino , Humanos , Masculino , Prevalência , Centros de Atenção Terciária
14.
PLoS One ; 16(9): e0255673, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34525094

RESUMO

Bycatch mortality is a major factor contributing to shark population declines. Post-release mortality (PRM) is particularly difficult to quantify, limiting the accuracy of stock assessments. We paired blood-stress physiology with animal-borne accelerometers to quantify PRM rates of sharks caught in a commercial bottom longline fishery. Blood was sampled from the same individuals that were tagged, providing direct correlation between stress physiology and animal fate for sandbar (Carcharhinus plumbeus, N = 130), blacktip (C. limbatus, N = 105), tiger (Galeocerdo cuvier, N = 52), spinner (C. brevipinna, N = 14), and bull sharks (C. leucas, N = 14). PRM rates ranged from 2% and 3% PRM in tiger and sandbar sharks to 42% and 71% PRM in blacktip and spinner sharks, respectively. Decision trees based on blood values predicted mortality with >67% accuracy in blacktip and spinner sharks, and >99% accuracy in sandbar sharks. Ninety percent of PRM occurred within 5 h after release and 59% within 2 h. Blood physiology indicated that PRM was primarily associated with acidosis and increases in plasma potassium levels. Total fishing mortality reached 62% for blacktip and 89% for spinner sharks, which may be under-estimates given that some soak times were shortened to focus on PRM. Our findings suggest that no-take regulations may be beneficial for sandbar, tiger, and bull sharks, but less effective for more susceptible species such as blacktip and spinner sharks.


Assuntos
Acidose/fisiopatologia , Mortalidade/tendências , Potássio/sangue , Tubarões/fisiologia , Estresse Fisiológico , Animais , Pesqueiros , Medição de Risco , Tubarões/sangue , Tubarões/crescimento & desenvolvimento
15.
Int J Mol Sci ; 22(18)2021 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-34576247

RESUMO

Chronic kidney disease (CKD), defined as the presence of irreversible structural or functional kidney damages, increases the risk of poor outcomes due to its association with multiple complications, including altered mineral metabolism, anemia, metabolic acidosis, and increased cardiovascular events. The mainstay of treatments for CKD lies in the prevention of the development and progression of CKD as well as its complications. Due to the heterogeneous origins and the uncertainty in the pathogenesis of CKD, efficacious therapies for CKD remain challenging. In this review, we focus on the following four themes: first, a summary of the known factors that contribute to CKD development and progression, with an emphasis on avoiding acute kidney injury (AKI); second, an etiology-based treatment strategy for retarding CKD, including the approaches for the common and under-recognized ones; and third, the recommended approaches for ameliorating CKD complications, and the final section discusses the novel agents for counteracting CKD progression.


Assuntos
Injúria Renal Aguda/fisiopatologia , Insuficiência Renal Crônica/fisiopatologia , Insuficiência Renal Crônica/terapia , Acidose/fisiopatologia , Injúria Renal Aguda/terapia , Anemia , Meios de Cultivo Condicionados , Complicações do Diabetes/fisiopatologia , Diabetes Mellitus/fisiopatologia , Progressão da Doença , Transição Epitelial-Mesenquimal , Taxa de Filtração Glomerular , Humanos , Hiperpotassemia , Hipertensão/fisiopatologia , Falência Renal Crônica/complicações , Células-Tronco Mesenquimais/metabolismo , Nefrolitíase/fisiopatologia
16.
Rev Med Liege ; 76(7-8): 620-624, 2021 Jul.
Artigo em Francês | MEDLINE | ID: mdl-34357715

RESUMO

The occurrence of metabolic acidosis with increased anion gap in the context of chronic paracetamol intoxication is an easily treatable clinical situation. Its rapid recognition is essential given its complete reversibility in the event of adequate management by eviction of the toxic agent, in this case paracetamol. It has an unknown cause and therefore potentially under-diagnosed, to be considered in the same way as the other more frequent etiologies. Because of this lack of knowledge, its frequency is probably underestimated considering the widespread consumption of paracetamol in the population.


Assuntos
Acetaminofen , Acidose , Equilíbrio Ácido-Base , Acidose/induzido quimicamente , Humanos , Doença Iatrogênica , Ácido Pirrolidonocarboxílico/metabolismo
17.
Nutrients ; 13(8)2021 Jul 24.
Artigo em Inglês | MEDLINE | ID: mdl-34444694

RESUMO

Metabolic acidosis is a severe complication of chronic kidney disease (CKD) which is associated with nefarious impairments such as bone demineralization, muscle wasting, and hormonal alterations, for example, insulin resistance. Whilst it is possible to control this condition with alkali treatment, consisting in the oral administration of sodium citrate or sodium bicarbonate, this type of intervention is not free from side effects. On the contrary, opting for the implementation of a targeted dietetic-nutritional treatment for the control of CKD metabolic acidosis also comes with a range of additional benefits such as lipid profile control, increased vitamins, and antioxidants intake. In our review, we evaluated the main dietary-nutritional regimens useful to counteract metabolic acidosis, such as the Mediterranean diet, the alkaline diet, the low-protein diet, and the vegan low-protein diet, analyzing the potentialities and limits of every dietary-nutritional treatment. Literature data suggest that the Mediterranean and alkaline diets represent a valid nutritional approach in the prevention and correction of metabolic acidosis in CKD early stages, while the low-protein diet and the vegan low-protein diet are more effective in CKD advanced stages. In conclusion, we propose that tailored nutritional approaches should represent a valid therapeutic alternative to counteract metabolic acidosis.


Assuntos
Acidose/dietoterapia , Dieta/métodos , Terapia Nutricional/métodos , Insuficiência Renal Crônica/dietoterapia , Equilíbrio Ácido-Base , Acidose/etiologia , Acidose/prevenção & controle , Dieta Mediterrânea , Dieta com Restrição de Proteínas , Dieta Vegana , Humanos , Insuficiência Renal Crônica/complicações
18.
Am J Kidney Dis ; 78(4): 590-600, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34400023

RESUMO

The anion gap (AG) is a mathematical construct that compares the blood sodium concentration with the sum of the chloride and bicarbonate concentrations. It is a helpful calculation that divides the metabolic acidoses into 2 categories: high AG metabolic acidosis (HAGMA) and hyperchloremic metabolic acidosis-and thereby delimits the potential etiologies of the disorder. When the [AG] is compared with changes in the bicarbonate concentration, other occult acid-base disorders can be identified. Furthermore, finding that the AG is very small or negative can suggest several occult clinical disorders or raise the possibility of electrolyte measurement artifacts. In this installment of AJKD's Core Curriculum in Nephrology, we discuss cases that represent several very common and several rare causes of HAGMA. These case scenarios highlight how the AG can provide vital clues that direct the clinician toward the correct diagnosis. We also show how to calculate and, if necessary, correct the AG for hypoalbuminemia and severe hyperglycemia. Plasma osmolality and osmolal gap calculations are described and when used together with the AG guide appropriate clinical decision making.


Assuntos
Equilíbrio Ácido-Base/fisiologia , Desequilíbrio Ácido-Base/metabolismo , Desequilíbrio Ácido-Base/terapia , Acidose/metabolismo , Acidose/terapia , Currículo , Desequilíbrio Ácido-Base/diagnóstico , Acidose/diagnóstico , Adulto , Idoso , Cetoacidose Diabética/diagnóstico , Cetoacidose Diabética/metabolismo , Cetoacidose Diabética/terapia , Feminino , Hidratação/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Concentração Osmolar , Adulto Jovem
19.
Crit Care ; 25(1): 314, 2021 08 31.
Artigo em Inglês | MEDLINE | ID: mdl-34461963

RESUMO

This article is one of ten reviews selected from the Annual Update in Intensive Care and Emergency Medicine 2021. Other selected articles can be found online at https://www.biomedcentral.com/collections/annualupdate2021 . Further information about the Annual Update in Intensive Care and Emergency Medicine is available from https://link.springer.com/bookseries/8901 .


Assuntos
Acidose/terapia , Terapia de Substituição Renal/normas , Bicarbonato de Sódio/uso terapêutico , Acidose/epidemiologia , Tampões (Química) , Humanos , Unidades de Terapia Intensiva/organização & administração , Unidades de Terapia Intensiva/estatística & dados numéricos , Terapia de Substituição Renal/instrumentação , Terapia de Substituição Renal/métodos
20.
Obstet Gynecol ; 138(3): 366-373, 2021 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-34352847

RESUMO

OBJECTIVE: To evaluate the relationship between umbilical artery cord gas values and fetal tolerance of labor, as reflected by Apgar score. We hypothesized the existence of wide biological variability in fetal tolerance of metabolic acidemia, which, if present, would weaken one fundamental assumption underlying the use of electronic fetal heart rate (FHR) monitoring. METHODS: We conducted a retrospective cohort study of term, singleton, nonanomalous fetuses delivered in our institution between March 2012 and July 2020. Universally obtained umbilical cord gas values and Apgar scores were extracted. We calculated Spearman correlation coefficients and receiver operating characteristic curves for various levels of umbilical artery pH, base excess, and Apgar scores. RESULTS: We analyzed data from 29,787 deliveries. The statistical correlation between umbilical artery pH and base excess and both 1- and 5-minute Apgar scores was weak or nonexistent in all pH range subgroups (range 0.064-0.213). Receiver operating characteristic curve analysis suggested umbilical artery pH value of 7.22 yields the best discrimination for prediction of a severely depressed newborn (5-minute Apgar score less than 4), but sensitivity and specificity for this predictive value remains poor to moderate. CONCLUSION: The use of electronic FHR monitoring is predicated on a documented relationship between FHR patterns and umbilical artery pH, and an assumed correlation between pH and fetal outcomes, reflecting fetal tolerance of labor and delivery. Our data demonstrate a weak-to-absent correlation between metabolic acidemia and even short-term fetal condition, thus significantly weakening this latter assumption. No amount of future modification of FHR pattern interpretation to better predict newborn pH is likely to lead to improved newborn outcomes, given this weakness in a fundamental assumption on which FHR monitoring is based.


Assuntos
Índice de Apgar , Frequência Cardíaca Fetal , Trabalho de Parto , Artérias Umbilicais/fisiopatologia , Acidose/sangue , Adulto , Gasometria , Cardiotocografia , Estudos de Coortes , Feminino , Humanos , Recém-Nascido , Gravidez , Resultado da Gravidez , Estudos Retrospectivos , Sensibilidade e Especificidade
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