Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 952
Filtrar
1.
BMJ Case Rep ; 16(1)2023 Jan 06.
Artigo em Inglês | MEDLINE | ID: mdl-36609420

RESUMO

Herein we present a case of severe alkalaemia (pH 7.81) due to suspected acute-on-chronic respiratory alkalosis in a patient with chronic anxiety and metabolic alkalosis secondary to emesis. The patient was managed in the intensive care unit with significant improvement and discharged in stable condition. The case report emphasises considering a broad differential of aetiologies that can cause acid-base status derangements and identifying the appropriate therapeutic approach.


Assuntos
Alcalose Respiratória , Alcalose , Humanos , Alcalose Respiratória/etiologia , Alcalose/etiologia , Alcalose/terapia , Equilíbrio Ácido-Base , Concentração de Íons de Hidrogênio
2.
Rev Med Chil ; 150(4): 554-558, 2022 Apr.
Artigo em Espanhol | MEDLINE | ID: mdl-36155765

RESUMO

Severe respiratory alkalosis is a life-threatening condition, as it induces hypo- calcaemia and extreme adrenergic sensitivity leading to cerebral and myocardial vasoconstriction. We report a 37-year-old woman with previous consultations for a conversion disorder. While she was infected with SARS-CoV-2 (without pulmonary involvement), she consulted in the emergency room due to panic attacks. On admission, she developed a new conversion crisis with progressive clinical deterioration, hyperventilation, and severe respiratory alkalosis (pH 7.68, Bicarbonate 11.8 mEq/L and PaCO2 10 mmHg). Clinically, she was in a coma, with respiratory and heart rates 55 and 180 per min, a blood pressure of 140/90 mmHg, impaired perfusion (generalized lividity, distal coldness, and severe skin mottling) and tetany. She also had electrocardiographic changes and high troponin levels suggestive of ischemia, and hyperlactatemia. She was managed in the hospital with intravenous benzodiazepines. The clinical and laboratory manifestations resolved quickly, without the need for invasive measures and without systemic repercussions.


Assuntos
Alcalose Respiratória , COVID-19 , Adrenérgicos , Adulto , Alcalose Respiratória/etiologia , Benzodiazepinas , Bicarbonatos , COVID-19/complicações , Feminino , Humanos , Hiperventilação/complicações , SARS-CoV-2 , Troponina
3.
Nutr Clin Pract ; 37(5): 980-989, 2022 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-35752932

RESUMO

An understanding of acid-base physiology is necessary for clinicians to recognize and correct problems that may negatively affect provision of nutrition support and drug therapy. An overview of acid-base physiology, the different acid-base disorders encountered in practice, a stepwise approach to evaluate arterial blood gases, and other key diagnostic tools helpful in formulating a safe and effective medical and nutrition plan are covered in this acid-base primer. Case scenarios are also provided for the application of principles and the development of clinical skills.


Assuntos
Desequilíbrio Ácido-Base , Acidose , Alcalose Respiratória , Alcalose , Equilíbrio Ácido-Base/fisiologia , Desequilíbrio Ácido-Base/diagnóstico , Desequilíbrio Ácido-Base/terapia , Acidose/diagnóstico , Alcalose/diagnóstico , Alcalose Respiratória/diagnóstico , Gasometria , Humanos , Concentração de Íons de Hidrogênio
4.
High Alt Med Biol ; 23(2): 185-191, 2022 06.
Artigo em Inglês | MEDLINE | ID: mdl-35231184

RESUMO

Steele, Andrew R., Philip N. Ainslie, Rachel Stone, Kaitlyn Tymko, Courtney Tymko, Connor A. Howe, David MacLeod, James D. Anholm, Christopher Gasho, and Michael M. Tymko. Global REACH 2018: characterizing acid-base balance over 21 days at 4,300 m in lowlanders. High Alt Med Biol. 23:185-191, 2022. Introduction: High altitude exposure results in hyperventilatory-induced respiratory alkalosis, followed by metabolic compensation to return arterial blood pH (pHa) toward sea level values. However, previous work has limited sample sizes, short-term exposure, and pharmacological confounders (e.g., acetazolamide). The purpose of this investigation was to characterize acid-base balance after rapid ascent to high altitude (i.e., 4,300 m) in lowlanders. We hypothesized that despite rapid bicarbonate ([HCO3-]) excretion during early acclimatization, partial respiratory alkalosis would still be apparent as reflected in elevations in pHa compared with sea level after 21 days of acclimatization to 4,300 m. Methods: In 16 (3 female) healthy volunteers not taking any medications, radial artery blood samples were collected and analyzed at sea level (150 m; Lima, Peru), and on days 1, 3, 7, 14, and 21 after rapid automobile (∼8 hours) ascent to high altitude (4,300 m; Cerro de Pasco, Peru). Results and Discussion: Although reductions in [HCO3-] occurred by day 3 (p < 0.01), they remained stable thereafter and were insufficient to fully normalize pHa back to sea level values over the subsequent 21 days (p < 0.01). These data indicate that only partial compensation for respiratory alkalosis persists throughout 21 days at 4,300 m.


Assuntos
Equilíbrio Ácido-Base , Alcalose Respiratória , Aclimatação , Altitude , Bicarbonatos , Feminino , Humanos
5.
Elife ; 112022 01 04.
Artigo em Inglês | MEDLINE | ID: mdl-34982032

RESUMO

Hyperventilation reliably provokes seizures in patients diagnosed with absence epilepsy. Despite this predictable patient response, the mechanisms that enable hyperventilation to powerfully activate absence seizure-generating circuits remain entirely unknown. By utilizing gas exchange manipulations and optogenetics in the WAG/Rij rat, an established rodent model of absence epilepsy, we demonstrate that absence seizures are highly sensitive to arterial carbon dioxide, suggesting that seizure-generating circuits are sensitive to pH. Moreover, hyperventilation consistently activated neurons within the intralaminar nuclei of the thalamus, a structure implicated in seizure generation. We show that intralaminar thalamus also contains pH-sensitive neurons. Collectively, these observations suggest that hyperventilation activates pH-sensitive neurons of the intralaminar nuclei to provoke absence seizures.


Assuntos
Alcalose Respiratória/patologia , Convulsões , Animais , Dióxido de Carbono , Concentração de Íons de Hidrogênio , Hipóxia , Núcleos Intralaminares do Tálamo/citologia , Masculino , Neurônios/fisiologia , Ratos
6.
A A Pract ; 15(10): e01535, 2021 Oct 20.
Artigo em Inglês | MEDLINE | ID: mdl-34673660

RESUMO

Olanzapine is increasingly used as a sleep aid in hospitalized patients. Although thought to have less extrapyramidal effects, known side effects include oversedation, arrythmias, and hypotension. We present the unusual case of hyperventilation with respiratory alkalosis after the administration of olanzapine for insomnia in an elderly postoperative patient. This led to a second admission to the intensive care unit with invasive interventions including mechanical ventilation and vasopressor support. Caution must be exercised in prescribing antipsychotics for off-label use, especially in a population whose baseline characteristics can affect the pharmacokinetics of second-generation antipsychotics.


Assuntos
Alcalose Respiratória , Antipsicóticos , Hiperventilação , Olanzapina , Distúrbios do Início e da Manutenção do Sono , Idoso , Alcalose Respiratória/induzido quimicamente , Antipsicóticos/efeitos adversos , Humanos , Hiperventilação/induzido quimicamente , Olanzapina/efeitos adversos , Distúrbios do Início e da Manutenção do Sono/tratamento farmacológico
7.
J Crit Care ; 66: 1-5, 2021 12.
Artigo em Inglês | MEDLINE | ID: mdl-34352585

RESUMO

PURPOSE: Although both the Henderson-Hasselbalch method and the Stewart approach can be used to analyze acid-base disturbances and metabolic and respiratory compensation mechanisms, the latter may be superior in detecting subtle metabolic changes. MATERIALS AND METHODS: We analyzed acid-base disturbances using both approaches in six healthy male volunteers practicing extreme voluntary hyperventilation. Arterial blood gas parameters were obtained during a breathing exercise consisting of approximately 30 cycles of powerful hyperventilation followed by breath retention for approximately 2 min. RESULTS: Hyperventilation increased pH from 7.39 ± 0.01 at baseline to 7.74 ± 0.06, PaCO2 decreased from 34.1 ± 1.1 to 12.6 ± 0.7 mmHg, PaO2 increased from 116 ± 4.6 to 156 ± 4.3 mmHg. Baseline apparent strong ion difference was 42.3 ± 0.5 mEq/L, which decreased to 37.1 ± 0.7 mEq/L following hyperventilation. The strong ion gap significantly decreased following hyperventilation, with baseline levels of 10.0 ± 0.9 dropping to 6.4 ± 1.1 mEq/L. CONCLUSIONS: Henderson-Hasselbalch analysis indicated a profound and purely respiratory alkalosis with no metabolic compensation following extreme hyperventilation. The Stewart approach revealed metabolic compensation occurring within minutes. These results challenge the long-held axiom that metabolic compensation of acute respiratory acid-base changes is a slow process.


Assuntos
Desequilíbrio Ácido-Base , Alcalose Respiratória , Equilíbrio Ácido-Base , Gasometria , Humanos , Concentração de Íons de Hidrogênio , Masculino
8.
Pacing Clin Electrophysiol ; 44(12): 2115-2118, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34390012

RESUMO

Bidirectional ventricular tachycardia (BVT) is a rare arrhythmia that is generally observed in patients with catecholaminergic ventricular tachycardia or digoxin overdose. Herein, we present a case of BVT and electrical storm (ES) in an acute ischemic heart failure patient that is typically induced by hypokalemia. The patient was in invasive mechanical ventilator (MV) support and hypokalemia was related to acute respiratory alkalosis and that caused refractory hypokalemia despite intravenous (IV) potassium replacement. We also discuss our approach to solve refractory hypokalemia caused by respiratory alkalosis.


Assuntos
Alcalose Respiratória/complicações , Insuficiência Cardíaca/complicações , Hipopotassemia/complicações , Taquicardia/etiologia , Idoso , Alcalose Respiratória/terapia , Eletrocardiografia , Feminino , Insuficiência Cardíaca/terapia , Humanos , Hipopotassemia/terapia , Taquicardia/terapia
9.
Undersea Hyperb Med ; 48(3): 239-245, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34390628

RESUMO

Breathing less than 50 kPa of oxygen over time can lead to pulmonary oxygen toxicity (POT). Vital capacity (VC) as the sole parameter for POT has its limitations. In this study we try to find out the changes of acid-base status in a POT rat model. Fifty male rats were randomly divided into five groups, exposed to 230 kPa oxygen for three, six, nine and 12 hours, respectively. Rats exposed to air were used as controls. After exposure the mortality and behavior of rats were observed. Arterial blood samples were collected for acid-base status detection and wet-dry (W/D) ratios of lung tissues were tested. Results showed that the acid-base status in rats exposed to 230 kPa oxygen presented a dynamic change. The primary status was in the compensatory period when primary respiratory acidosis was mixed with compensated metabolic alkalosis. Then the status changed to decompensated alkalosis and developed to decompensated acidosis in the end. pH, PCO2, HCO3-, TCO2, and BE values had two phases: an increase and a later decrease with increasing oxygen exposure time, while PaO2 and lung W/D ratio showed continuously increasing trends with the extension of oxygen exposure time. Lung W/D ratio was significantly associated with PaO2 (r = 0.6385, p = 0.002), while other parameters did not show a significant correlation. It is concluded that acid-base status in POT rats presents a dynamic change: in the compensatory period first, then turns to decompensated alkalosis and ends up with decompensated acidosis status. Blood gas analysis is a useful method to monitor the development of POT.


Assuntos
Desequilíbrio Ácido-Base/sangue , Acidose Respiratória/metabolismo , Alcalose Respiratória/metabolismo , Oxigenoterapia Hiperbárica/efeitos adversos , Oxigênio/toxicidade , Desequilíbrio Ácido-Base/etiologia , Animais , Pressão Atmosférica , Bicarbonatos/sangue , Análise Química do Sangue , Gasometria , Dióxido de Carbono/sangue , Oxigenoterapia Hiperbárica/métodos , Pulmão/patologia , Masculino , Modelos Animais , Tamanho do Órgão , Pressão Parcial , Distribuição Aleatória , Ratos , Ratos Sprague-Dawley , Fatores de Tempo , Capacidade Vital
10.
Respir Physiol Neurobiol ; 294: 103740, 2021 12.
Artigo em Inglês | MEDLINE | ID: mdl-34256173

RESUMO

We tested the hypothesis that increasing the respiratory control systems' arterial PCO2 equilibrium point via induced acute metabolic alkalosis by ingestion of sodium bicarbonate (NaHCO3, 0.3 g/kg) would decrease the ventilatory equivalent for CO2 (V̇E/V̇CO2) at its lowest point ("nadir") during constant-load cycle exercise testing performed at 80 % of peak power output in 18 healthy young adults. Compared to the sodium chloride (4 g) control condition, ingestion of NaHCO3: increased arterialized venous pH, HCO3- and PCO2 at rest by 0.05 ± 0.01 units (mean ± SE), 6.4 ± 0.4 mEq/L and 4.3 ± 0.7 mmHg, respectively (all p < 0.0001); and decreased the V̇E/V̇CO2 nadir during exercise by 9.4 % (p < 0.0001) secondary to a 4.7 ± 1.8 L/min decrease in V̇E (p = 0.019). In conclusion, induced acute metabolic alkalosis by ingestion of NaHCO3 decreased the V̇E/V̇CO2 response to strenuous exercise in healthy adults.


Assuntos
Alcalose Respiratória/induzido quimicamente , Alcalose Respiratória/fisiopatologia , Dióxido de Carbono/metabolismo , Exercício Físico/fisiologia , Ventilação Pulmonar/fisiologia , Bicarbonato de Sódio/farmacologia , Adulto , Humanos , Bicarbonato de Sódio/administração & dosagem , Adulto Jovem
11.
PLoS One ; 16(3): e0248264, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33690724

RESUMO

BACKGROUND: Point-of-care arterial blood gas (ABG) is a blood measurement test and a useful diagnostic tool that assists with treatment and therefore improves clinical outcomes. However, numerically reported test results make rapid interpretation difficult or open to interpretation. The arterial blood gas algorithm (ABG-a) is a new digital diagnostics solution that can provide clinicians with real-time interpretation of preliminary data on safety features, oxygenation, acid-base disturbances and renal profile. The main aim of this study was to clinically validate the algorithm against senior experienced clinicians, for acid-base interpretation, in a clinical context. METHODS: We conducted a prospective international multicentre observational cross-sectional study. 346 sample sets and 64 inpatients eligible for ABG met strict sampling criteria. Agreement was evaluated using Cohen's kappa index, diagnostic accuracy was evaluated with sensitivity, specificity, efficiency or global accuracy and positive predictive values (PPV) and negative predictive values (NPV) for the prevalence in the study population. RESULTS: The concordance rates between the interpretations of the clinicians and the ABG-a for acid-base disorders were an observed global agreement of 84,3% with a Cohen's kappa coefficient 0.81; 95% CI 0.77 to 0.86; p < 0.001. For detecting accuracy normal acid-base status the algorithm has a sensitivity of 90.0% (95% CI 79.9 to 95.3), a specificity 97.2% (95% CI 94.5 to 98.6) and a global accuracy of 95.9% (95% CI 93.3 to 97.6). For the four simple acid-base disorders, respiratory alkalosis: sensitivity of 91.2 (77.0 to 97.0), a specificity 100.0 (98.8 to 100.0) and global accuracy of 99.1 (97.5 to 99.7); respiratory acidosis: sensitivity of 61.1 (38.6 to 79.7), a specificity of 100.0 (98.8 to 100.0) and global accuracy of 98.0 (95.9 to 99.0); metabolic acidosis: sensitivity of 75.8 (59.0 to 87.2), a specificity of 99.7 (98.2 to 99.9) and a global accuracy of 97.4 (95.1 to 98.6); metabolic alkalosis sensitivity of 72.2 (56.0 to 84.2), a specificity of 95.5 (92.5 to 97.3) and a global accuracy of 93.0 (88.8 to 95.3); the four complex acid-base disorders, respiratory and metabolic alkalosis, respiratory and metabolic acidosis, respiratory alkalosis and metabolic acidosis, respiratory acidosis and metabolic alkalosis, the sensitivity, specificity and global accuracy was also high. For normal acid-base status the algorithm has PPV 87.1 (95% CI 76.6 to 93.3) %, and NPV 97.9 (95% CI 95.4 to 99.0) for a prevalence of 17.4 (95% CI 13.8 to 21.8). For the four-simple acid-base disorders and the four complex acid-base disorders the PPV and NPV were also statistically significant. CONCLUSIONS: The ABG-a showed very high agreement and diagnostic accuracy with experienced senior clinicians in the acid-base disorders in a clinical context. The method also provides refinement and deep complex analysis at the point-of-care that a clinician could have at the bedside on a day-to-day basis. The ABG-a method could also have the potential to reduce human errors by checking for imminent life-threatening situations, analysing the internal consistency of the results, the oxygenation and renal status of the patient.


Assuntos
Gasometria/métodos , Equilíbrio Ácido-Base/fisiologia , Desequilíbrio Ácido-Base/diagnóstico , Acidose/sangue , Adolescente , Adulto , Idoso , Algoritmos , Alcalose/sangue , Alcalose Respiratória/diagnóstico , Pressão Arterial/fisiologia , Criança , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Concentração de Íons de Hidrogênio , Masculino , Pessoa de Meia-Idade , Modelos Teóricos , Testes Imediatos/tendências , Valor Preditivo dos Testes , Prevalência , Estudos Prospectivos , Reprodutibilidade dos Testes , Sensibilidade e Especificidade
12.
Respir Med ; 179: 106329, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33610050

RESUMO

BACKGROUND: The hyperventilation syndrome (HVS) is characterized by somatic/ psychological symptoms due to sustained hypocapnia and respiratory alkalosis without any organic disease. OBJECTIVE: The purpose of this study was to compare ventilatory parameters and symptoms reproducibility during the hyperventilation provocation test (HVPT) and cardiopulmonary exercise test (CPET) as diagnostic tools in patients with HVS, and to identify the most frequent etiologies of the HVS by a systematic assessment. METHODS: After exclusion of organic causes, 59 patients with HVS according to Nijmegen's questionnaire (NQ) score ≥23 with associated hypocapnia (PaCO2/PETCO2<35 mm Hg) were studied. RESULTS: The most frequent comorbidities of HVS were anxiety and asthma (respectively 95% and 73% of patients). All patients described ≥3 symptoms of NQ during the HVPT vs 14% of patients during the CPET (p<0.01). For similar maximal ventilation (61 L/min during HVPT vs 60 L/min during CPET), the median level of PETCO2 decreased from 30 mmHg at baseline to 15 mmHg during hyperventilation and increased from 31 mmHg at baseline to 34 mmHg at peak exercise (all p<0.01). No significant difference for the ventilatory parameters was found between patients with HVS (n = 16) and patients with HVS + asthma (n = 43). CONCLUSIONS: In term of symptoms reproducibility, HVPT is a better diagnostic tool than CPET for HVS. An important proportion of patients with HVS has an atypical asthma previously misdiagnosed. The exercise-induced hyperventilation did not induce abnormal reduction in PETCO2, suggesting that the exercise could be a therapeutic tool in HVS.


Assuntos
Testes de Provocação Brônquica , Hiperventilação/diagnóstico , Adulto , Alcalose Respiratória/complicações , Ansiedade/epidemiologia , Asma/epidemiologia , Comorbidade , Teste de Esforço , Terapia por Exercício , Feminino , Humanos , Hiperventilação/epidemiologia , Hiperventilação/etiologia , Hiperventilação/terapia , Hipocapnia/complicações , Masculino , Pessoa de Meia-Idade , Espirometria , Inquéritos e Questionários , Síndrome
14.
BMJ Case Rep ; 14(1)2021 Jan 11.
Artigo em Inglês | MEDLINE | ID: mdl-33431479

RESUMO

Here we present the case of a 37-year-old previously healthy man who developed fever, headache and a unilateral, painful neck swelling while working offshore. He had no known contact with anyone with COVID-19; however, due to the ongoing pandemic, a nasopharyngeal swab was performed, which was positive for the virus. After transfer to hospital for assessment his condition rapidly deteriorated, requiring admission to intensive care for COVID-19 myocarditis. One week after discharge he re-presented with unilateral facial nerve palsy. Our case highlights an atypical presentation of COVID-19 and the multifaceted clinical course of this still poorly understood disease.


Assuntos
Alcalose Respiratória/sangue , Paralisia de Bell/fisiopatologia , COVID-19/fisiopatologia , Miocardite/fisiopatologia , Adulto , Alcalose Respiratória/etiologia , Gasometria , Proteína C-Reativa/metabolismo , COVID-19/sangue , COVID-19/terapia , Ecocardiografia , Edema/etiologia , Eletrocardiografia , Humanos , Hipotensão/etiologia , Hipotensão/fisiopatologia , Linfadenite/etiologia , Linfadenite/fisiopatologia , Imageamento por Ressonância Magnética , Masculino , Miocardite/sangue , Miocardite/diagnóstico por imagem , Miocardite/terapia , Peptídeo Natriurético Encefálico/sangue , Pescoço , Oxigenoterapia , Fragmentos de Peptídeos/sangue , Pró-Calcitonina/sangue , Recuperação de Função Fisiológica , SARS-CoV-2 , Troponina T/sangue , Vasoconstritores/uso terapêutico
15.
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue ; 32(8): 976-981, 2020 Aug.
Artigo em Chinês | MEDLINE | ID: mdl-32912413

RESUMO

OBJECTIVE: To judge the type of acid-base balance disorder automatically according to the results of arterial blood gas analysis by using the IF function editing formula in an Excel spreadsheet. METHODS: The four-step analysis was used to carry out programmatically through establishing acid-base balance disorder analysis process: (1) the acid and base types were determined according to pH value and the primary or main type of acid-base balance disorder was determined according to the pH value combined with blood carbon dioxide pressure (PaCO2), HCO3- and their change rate; (2) the expected compensation formula was selected to determine whether there was mixed acid-base imbalance, according to the primary or main acid-base imbalance type; (3) the potential HCO3- should be calculated to replace the measured HCO3- when the primary acid-base imbalance was divided into two parts according to the prior two steps: respiratory acidosis or respiratory alkalosis accompanied with anion gap (AG) increased-metabolic acidosis and compared with the compensatory interval calculated by the predicted compensatory formula for acid or alkali to determine whether there were triple acid-base imbalance (TABD); (4) while the following two parts were judged: metabolic acidosis accompanied with AG increased-metabolic acidosis according to the prior two steps, ΔAG↑/ΔHCO3-↓ should be calculated to determine whether there was metabolic alkalosis or metabolic acidosis with normal AG. The results of arterial blood gas analysis were judged by using the editing formula of IF function in Excel 2003 spreadsheet. A total of 96 patients admitted to the department of intensive care unit (ICU) of Xuzhou Central Hospital were enrolled. According to the results of arterial blood gas analysis, the type of acid-base imbalance of patients was judged by both artificial judgment (artificial group) and Excel spreadsheet automatic judgment (Excel spreadsheet group). The artificial group was composed by 2 associate chief physicians from neonatal intensive care unit (NICU) and 1 attending respiratory physician. If the results were inconsistent, the decision should be made after discussion. In the Excel spreadsheet group, data were input by one NICU attending physician and checked by another. The differences in the results and the time spent in judging the type of acid-base imbalance between the two groups were compared. RESULTS: Forty-two types of acid-base imbalance were obtained by using the four-step analysis method and inputting relevant parameters such as pH, PaCO2, actual HCO3-, Na+, Cl- and compensation time limited into the Excel spreadsheet for blood gas analysis. Data analyses of 96 patients showed that the accuracy of using Excel spreadsheets to automatically determine the type of acid-base imbalance was higher than artificial group, but there was no statistically significant difference between the two groups [normal and simple acid-base imbalance: 100% (26/26) vs. 100% (26/26), mixed acid-base imbalance: 100% (51/51) vs. 96.08% (49/51), TABD: 100% (19/19) vs. 89.47% (17/19), all P > 0.05], and it took less time to judge the results of blood gas analysis by the Excel spreadsheet group compared with the artificial group (s: normal and simple acid-base imbalance: 31.13±4.70 vs. 74.20±16.53, mixed acid-base imbalance: 31.59±5.49 vs. 138.10±22.26, TABD: 30.98±5.40 vs. 308.40±78.12, all P < 0.01). CONCLUSIONS: The automatic judging Excel spreadsheet with blood gas analysis can quickly and accurately determine the type of acid-base imbalance in arterial blood gas analysis.


Assuntos
Desequilíbrio Ácido-Base , Gasometria , Equilíbrio Ácido-Base , Alcalose , Alcalose Respiratória , Humanos , Software
16.
Artigo em Inglês | MEDLINE | ID: mdl-32763467

RESUMO

Respiratory acidosis and subsequent metabolic compensation are well-studied processes in fish exposed to elevated CO2 (hypercapnia). Yet, such exposures in the marine environment are invariably accompanied by a return of environmental CO2 to atmospheric baselines. This understudied phenomenon has the potential to cause a respiratory alkalosis that would necessitate base excretion. Here we sought to explore this question and the associated physiological mechanisms that may accompany base excretions using the red drum (Sciaenops ocellatus). As expected, when high pCO2 (15,000 µatm CO2) acclimated red drum were transferred to normal pCO2, their net H+ excretion shifted from positive (0.157 ± 0.044 µmol g-1 h-1) to negative (-0.606 ± 0.116 µmol g-1 h-1) in the 2 h post-transfer period. Net H+ excretion returned to control rates during the 3 to 24 h flux period. Gene expression and enzyme activity assays demonstrated that while the acidosis resulted in significant changes in several relevant transporters, no significant changes accompanied the alkalosis phase. Confocal microscopy was used to assess alkalosis-stimulated translocation of V-type H+ ATPase to the basolateral membrane previously seen in other marine species; however, no apparent translocation was observed. Overall, these data demonstrate that fluctuations in environmental CO2 result in both acidic and alkalotic respiratory disturbances; however, red drum maintain sufficient regulatory capacity to accommodate base excretion. Furthermore, this work does not support a role for basolateral VHA translocation in metabolic compensation from a systemic alkalosis in teleosts.


Assuntos
Equilíbrio Ácido-Base/fisiologia , Alcalose Respiratória/fisiopatologia , Perciformes/fisiologia , Adenosina Trifosfatases/metabolismo , Animais , Dióxido de Carbono/metabolismo
17.
Chest ; 158(1): e1-e3, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32654733

RESUMO

A 70-year-old woman presented with hemorrhagic shock secondary to hemoperitoneum following a paracentesis. On hospital day 3, she developed respiratory alkalosis and increased respiratory rates observed on the ventilator despite no spontaneous inspiratory effort. Converting to pressure support mode uncovered a cardiogenic oscillatory flow that had been auto-triggering the ventilator. This cardiogenic auto-triggering resolved with large-volume paracentesis. Cardiogenic auto-triggering leads to patient-ventilator dyssynchrony, respiratory alkalosis, lung distension, and difficulty with weaning from the ventilator, and it may be unrecognized in ICUs.


Assuntos
Alcalose Respiratória/etiologia , Hemoperitônio/complicações , Hemoperitônio/terapia , Paracentese , Respiração Artificial/efeitos adversos , Choque Hemorrágico/etiologia , Idoso , Alcalose Respiratória/diagnóstico , Alcalose Respiratória/terapia , Feminino , Humanos , Choque Hemorrágico/diagnóstico , Choque Hemorrágico/terapia
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...