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Sample records for acidosis respiratory

  1. Renal tubular acidosis presenting as respiratory paralysis: Report of a case and review of literature

    Kalita J; Nair P; Kumar G; Misra U

    2010-01-01

    Respiratory paralysis due to renal tubular acidosis (RTA) is rare. We report a 22-year-old lady who developed severe bulbar, respiratory and limb paralysis following respiratory infection. She had hypokalemia (1.6 meq/L) and hyperchloremic (110 meq/l) acidosis (pH 7.1). She was diagnosed as distal RTA by ammonium chloride test. She improved following sodium bicarbonate and potassium supplementation. RTA should be differentiated from familial periodic paralysis (FPP) because acetazolamide used...

  2. Renal tubular acidosis presenting as respiratory paralysis: Report of a case and review of literature

    Kalita J

    2010-01-01

    Full Text Available Respiratory paralysis due to renal tubular acidosis (RTA is rare. We report a 22-year-old lady who developed severe bulbar, respiratory and limb paralysis following respiratory infection. She had hypokalemia (1.6 meq/L and hyperchloremic (110 meq/l acidosis (pH 7.1. She was diagnosed as distal RTA by ammonium chloride test. She improved following sodium bicarbonate and potassium supplementation. RTA should be differentiated from familial periodic paralysis (FPP because acetazolamide used in FPP aggravates RTA and sodium bicarbonate used in RTA aggravates hypokalemic periodic paralysis.

  3. Fluoxetine Treatment Abolishes the In Vitro Respiratory Response to Acidosis in Neonatal Mice

    Voituron, Nicolas; Shvarev, Yuri; Menuet, Clément; Bevengut, Michelle; Fasano, Caroline; Vigneault, Erika; Mestikawy, Salah El; Hilaire, Gérard

    2010-01-01

    Background To secure pH homeostasis, the central respiratory network must permanently adapt its rhythmic motor drive to environment and behaviour. In neonates, it is commonly admitted that the retrotrapezoid/parafacial respiratory group of neurons of the ventral medulla plays the primary role in the respiratory response to acidosis, although the serotonergic system may also contribute to this response. Methodology/Principal Findings Using en bloc medullary preparations from neonatal mice, we ...

  4. Cleistanthus collinus induces type I distal renal tubular acidosis and type II respiratory failure in rats

    Maneksh, Delinda; Sidharthan, Anita; Kettimuthu, Kavithapriya; Kanthakumar, Praghalathan; Lourthuraj, Amala A.; Ramachandran, Anup; Subramani, Sathya

    2010-01-01

    Background and Purpose: A water decoction of the poisonous shrub Cleistanthus collinus is used for suicidal purposes. The mortality rate is 28%. The clinical profile includes distal renal tubular acidosis (DRTA) and respiratory failure. The mechanism of toxicity is unclear. Objectives: To demonstrate features of C. collinus toxicity in a rat model and to identify its mechanism(s) of action. Materials and Methods: Rats were anesthetized and the carotid artery was cannulated. Electrocardiogram ...

  5. Systemic lupus erythematosus with distal renal tubular acidosis presenting as hypokalemic paralysis with respiratory failure.

    Koul, Parvaiz Ahmad; Wahid, Abdul; Shah, Bashir Ahmad

    2003-01-01

    An eighteen-year-old woman presented with hypokalemic respiratory failure. She was found to have distal renal tubular acidosis (dRTA) as the underlying cause for hypokalemia. This was treated successfully, and no apparent etiology for the dRTA was discovered. Three years later she presented with full-blown picture of systemic lupus erythematosus (SLE) together with features of persistent dRTA complicated, this time, with bilateral renal calculi and nephrocalcinosis. It is very likely that the dRTA was an early feature that preceded the other markers of SLE. The moral of this case is that patients with dRTA should be followed-up carefully as a primary cause for the dRTA may show up in-due-course and to monitor the treatment so as to prevent long-term complications of the RTA. PMID:18209445

  6. Metabolic acidosis

    Acidosis - metabolic ... Metabolic acidosis occurs when the body produces too much acid. It can also occur when the kidneys are not ... the body. There are several types of metabolic acidosis. Diabetic acidosis develops when acidic substances, known as ...

  7. Lactic Acidosis

    K.Srikanth

    2012-01-01

    Abstract. Lactic acidosis is a broad-anion gap metabolic acidosis caused by lactic acid overproduction or underutilization. The quantitative dimensions of these two mechanisms commonly differ by 1 order of magnitude. Overproduction of lactic acid, also termed type A lactic acidosis, occurs when the body must regenerate ATP without oxygen (tissue hypoxia). Circulatory, pulmonary, or hemoglobin transfer disorders are commonly responsible. Overproduction of lactate also occurs with cyanide poiso...

  8. Lactic Acidosis

    K.Srikanth

    2012-10-01

    Full Text Available Abstract. Lactic acidosis is a broad-anion gap metabolic acidosis caused by lactic acid overproduction or underutilization. The quantitative dimensions of these two mechanisms commonly differ by 1 order of magnitude. Overproduction of lactic acid, also termed type A lactic acidosis, occurs when the body must regenerate ATP without oxygen (tissue hypoxia. Circulatory, pulmonary, or hemoglobin transfer disorders are commonly responsible. Overproduction of lactate also occurs with cyanide poisoning or certain malignancies. Underutilization involves removal of lactic acid by oxidation or conversion to glucose. Liver disease, inhibition of gluconeogenesis, pyruvate dehydrogenase (thiamine deficiency, and uncoupling of oxidative phosphorylation are the most common causes. The kidneys also contribute to lactate removal. Concerns have been raised regarding the role of metformin in the production of lactic acidosis, on the basis of individual case reports. The risk appears to be considerably less than with phenformin and involves patients with underlying severe renal and cardiac dysfunction.

  9. Renal tubular acidosis complicated with hypokalemic periodic paralysis.

    Chang, Y C; Huang, C C; Chiou, Y Y; Yu, C Y

    1995-07-01

    Three Chinese girls with hypokalemic periodic paralysis secondary to different types of renal tubular acidosis are presented. One girl has primary distal renal tubular acidosis complicated with nephrocalcinosis. Another has primary Sjögren syndrome with distal renal tubular acidosis, which occurs rarely with hypokalemic periodic paralysis in children. The third has an isolated proximal renal tubular acidosis complicated with multiple organ abnormalities, unilateral carotid artery stenosis, respiratory failure, and consciousness disturbance. The diagnostic evaluation and emergent and prophylactic treatment for these three types of renal tubular acidosis are discussed. PMID:7575850

  10. Controvérsias acerca da acidose hipercápnica na síndrome do desconforto respiratório agudo Controversies involving hypercapnic acidosis in acute respiratory distress syndrome

    Liliane Nardelli

    2009-12-01

    distress syndrome is the ventilatory support. However, mechanical ventilation can worsen lung injury. In this context, a protective ventilatory strategy with low tidal volume has been proposed. The use of low tidal volume reduced the mortality rate of acute respiratory distress syndrome patients, but result in hypercapnic acidosis. The current article presents a review of literature on the effects of permissive hypercapnia in acute respiratory distress syndrome. To that end, we carried out a systematic review of scientific literature based on established criteria for documental analysis including clinical and experimental articles, using as data bases MedLine, LILACS, SciELO, PubMed, Cochrane. Hypercapnic acidosis has been considered by some authors as a modulator of the inflammatory process of acute respiratory distress syndrome. However, clinical and experimental studies on the effects of hypercapnic acidosis have shown controversial results. Therefore it is important to better elucidate the role of hypercapnic acidosis in acute respiratory distress syndrome.

  11. Acidosis and Urinary Calcium Excretion

    Alexander, R Todd; Cordat, Emmanuelle; Chambrey, Régine;

    2016-01-01

    Metabolic acidosis is associated with increased urinary calcium excretion and related sequelae, including nephrocalcinosis and nephrolithiasis. The increased urinary calcium excretion induced by metabolic acidosis predominantly results from increased mobilization of calcium out of bone and...... renal tubule and then discuss why not all gene defects that cause renal tubular acidosis are associated with hypercalciuria and nephrocalcinosis....

  12. Metabolic acidosis may be as protective as hypercapnic acidosis in an ex-vivo model of severe ventilator-induced lung injury: a pilot study

    Patsouris Efstratios

    2011-04-01

    Full Text Available Abstract Background There is mounting experimental evidence that hypercapnic acidosis protects against lung injury. However, it is unclear if acidosis per se rather than hypercapnia is responsible for this beneficial effect. Therefore, we sought to evaluate the effects of hypercapnic (respiratory versus normocapnic (metabolic acidosis in an ex vivo model of ventilator-induced lung injury (VILI. Methods Sixty New Zealand white rabbit ventilated and perfused heart-lung preparations were used. Six study groups were evaluated. Respiratory acidosis (RA, metabolic acidosis (MA and normocapnic-normoxic (Control - C groups were randomized into high and low peak inspiratory pressures, respectively. Each preparation was ventilated for 1 hour according to a standardized ventilation protocol. Lung injury was evaluated by means of pulmonary edema formation (weight gain, changes in ultrafiltration coefficient, mean pulmonary artery pressure changes as well as histological alterations. Results HPC group gained significantly greater weight than HPMA, HPRA and all three LP groups (P = 0.024, while no difference was observed between HPMA and HPRA groups regarding weight gain. Neither group differ on ultrafiltration coefficient. HPMA group experienced greater increase in the mean pulmonary artery pressure at 20 min (P = 0.0276 and 40 min (P = 0.0012 compared with all other groups. Histology scores were significantly greater in HP vs. LP groups (p Conclusions In our experimental VILI model both metabolic acidosis and hypercapnic acidosis attenuated VILI-induced pulmonary edema implying a mechanism other than possible synergistic effects of acidosis with CO2 for VILI attenuation.

  13. Heliox reduces respiratory system resistance in respiratory syncytial virus induced respiratory failure

    Kneyber, Martin C. J.; van Heerde, Marc; Twisk, Jos W. R.; Plotz, Frans B.; Markhors, Dick G.

    2009-01-01

    Introduction Respiratory syncytial virus (RSV) lower respiratory tract disease is characterised by narrowing of the airways resulting in increased airway resistance, air-trapping and respiratory acidosis. These problems might be overcome using helium-oxygen gas mixture. However, the effect of mechan

  14. Renal tubular acidosis and nerve deafness.

    Dunger, D B; Brenton, D. P.; Cain, A R

    1980-01-01

    Two brothers are described with renal tubular acidosis and nerve deafness: the elder also had rickets and hypokalaemia. The parents were unaffected. Studies of urinary acidification and bicarbonate excretion were consistent with a distal tubular abnormality. This report strengthens the view previously proposed in similar cases that nerve deafness and renal tubular acidosis constitute a genetic entity. Examination for nerve deafness is indicated in any child with renal tubular acidosis.

  15. Dietary Acid Load and Metabolic Acidosis in Renal Transplant Recipients

    Berg, van den Else; Engberink, M.F.; Brink, E.J.; Baak, van M.A.; Joosten, M.M.; Gans, R.O.B.; Navis, G.; Bakker, S.J.L.

    2012-01-01

    Background and objectives Acidosis is prevalent among renal transplant recipients (RTRs) and adversely affects cardiometabolic processes. Factors contributing to acidosis are graft dysfunction and immunosuppressive drugs. Little is known about the potential influence of diet on acidosis in RTRs. Thi

  16. D-Lactic Acidosis in Humans: Review of Update

    Kang, Kyung Pyo; Lee, Sik; Kang, Sung Kyew

    2006-01-01

    D-Lactic acidosis has been well documented in ruminants. In humans, D-lactic acidosis is very rare, but D-lactic acidosis may be more common than generally believed and should be looked for in a case of metabolic acidosis in which the cause of acidosis is not apparent. The clinical presentation of D-lactic acidosis is characterized by episodes of encephalopathy and metabolic acidosis. The entity should be considered as a diagnosis in a patient who presents with metabolic acidosis accompanied ...

  17. [Hypokalemic pareses secondary to renal tubular acidosis].

    Gøransson, L G; Apeland, T; Omdal, R

    2000-01-30

    A 24 year old woman presented with flaccid paralysis, severe hypokalaemia and hyperchloremia, metabolic acidosis. Immunological tests and labial glandular biopsy indicated primary Sjögren's syndrome as the underlying cause of her distal renal tubular acidosis. The patient recovered after alkali and potassium substitution and was put on oral treatment with potassium citrate. PMID:10827521

  18. Protection of benthiactzine on mixed type acidosis of concomitant respiratory failure and circulatory failure induced by intoxication of cholinesterase inhibitor%宾赛克嗪对胆碱酯酶抑制剂中毒所致呼吸衰竭和循环衰竭时混合型酸中毒的影响

    宋丽雪; 唐渊; 龙超良; 王汝欢; 张津津; 汪海

    2012-01-01

    new antidote benthiactzine on mixed type acidosis of concomitant respiratory failure and circulatory failure induced by intoxication of cholinesterase inhibitor ( ChEI) . Methods Seven male dogs,weighing(12 - 15)kg,were injected intermuscularly 1/3 LD soman(l LD = 10 μg/kg)per ten minutes. The mean the pressure of carbondioxide decreased to 60 mmHg and the pressure of oxygen increased to 50 mmHg was defined as respirato ry failure. The mean the blood pressure decreased to (40-45) mmHg was defined as circulatory failure . The changes of arterial blood were evaluated by an eight-channel direct -writing oscillograph, and were observed before and after soman injection. Statistical analysis of the data wag performed using the self control t test with the SAS 6.12 Software Program. Results The results indicated that PaCO2 and PO2 were (45. 5 ±12.3) mmHg and (87. 8 ±14. 3) mmHg with significant difference (P<0.01,n=7); and BE,BB, SB and CH+ were ( -6.7 ±1.7) mmol/L, (41.1 ±1.8) mmol/L, (18.8 ±1.2) mmol/L, and (50.4 ± 10. 5) mmol/L, respectively. When it be continually treated above 6 h, the life feature be recovered in the acidosis dog. When the acidosis induced 2 h by the soman(4 LD) in dog, the blood pressure decreased , MAP was below 45 mmHg, and caused respiratory failure and circulatory failure. After treatment with benthiactzine 1 h, PaCO2, CH+ and PO2 changed to (40. 2 ±7. 9) mmHg, (61.3 ±5.4) mmol/L, (114.5 ±27.1) mmHg,respectively, The other symptoms has not been continuously worsened , and acid poisoning was partially controlled . Conclusion Intoxiciation of cholinest erase inhibitors could lead to compensated primary acute respiratory acidosis complicating continuous metabolic aci -dosis. After treatment with benthiactzine , the symptoms of acidosis will be relieved , and broken away from the acidosis state.

  19. Heliox reduces respiratory system resistance in respiratory syncytial virus induced respiratory failure

    Kneijber, M.C.J.; Heerde, van, H.J.W; Twisk, J W R; Plotz, F.; Markhorst, D.G.

    2009-01-01

    Introduction Respiratory syncytial virus (RSV) lower respiratory tract disease is characterised by narrowing of the airways resulting in increased airway resistance, air-trapping and respiratory acidosis. These problems might be overcome using helium-oxygen gas mixture. However, the effect of mechanical ventilation with heliox in these patients is unclear. The objective of this prospective cross-over study was to determine the effects of mechanical ventilation with heliox 60/40 versus convent...

  20. Acidosis láctica

    Caridad Soler Morejón

    2000-06-01

    Full Text Available Se conoce que el ácido láctico es un producto terminal del metabolismo anaeróbico de la glucosa, que, en condiciones normales, los niveles séricos alcanzan las 2 mEq/L o menos. La mayor parte del lactato se elimina de forma muy eficaz por el hígado y se utiliza en la gluconeogénesis o para obtener energía. Si se producen incrementos considerables de las cifras de lactato sérico con disminución del metabolismo de conversión de lactato a piruvato se instala un cuadro de acidosis metabólica, a menudo grave, que puede llevar al paciente a la muerte. Desde el punto de vista clínico se debe sospechar ante un paciente con acidosis metabólica no bien explicada y anión Gap elevado, el cual se encuentra por encima de 25-30 mEq/L, aún en presencia de insuficiencia renal, de cetoacidosis o de la ingestión de un tóxico. La prevención de la hipoxia hística desempeña un papel importantísimo y en este sentido todas las medidas que contribuyen a garantizar una buena perfusión hística. Se señala la importancia del control adecuado de la diabetes mellitus, la selección más adecuada de hipoglicemiantes, el aporte de tiamina en los pacientes de riesgo, entre otras medidasIt is know that lactic acid is a last product of glucose anaerobic metabolism, that, in normal conditions, serum levels reach 2 mEq/L or less. Most of lactate is released in a very efficacious way by liver and is used in gluconeogenesis or to obtain energy. If there are significant increases of serum lactate figures with a decrease of metabolism of the conversion of lactate in pyruvate, a situation of metabolic acidosis frequently serious will present, which may provoke death of patient. From the clinical point of view, it must be suspected in a patient with non well explained metabolic acidosis and a high anion gap, which is over 25-30 mEq/L, even in presence of renal failure, ketoacidosis or ingestion of a toxic agent. That prevention of tissue hypoxia play a very

  1. Sodium Bicarbonate Therapy in Patients with Metabolic Acidosis

    Adeva-Andany, María M.; Carlos Fernández-Fernández; David Mouriño-Bayolo; Elvira Castro-Quintela; Alberto Domínguez-Montero

    2014-01-01

    Metabolic acidosis occurs when a relative accumulation of plasma anions in excess of cations reduces plasma pH. Replacement of sodium bicarbonate to patients with sodium bicarbonate loss due to diarrhea or renal proximal tubular acidosis is useful, but there is no definite evidence that sodium bicarbonate administration to patients with acute metabolic acidosis, including diabetic ketoacidosis, lactic acidosis, septic shock, intraoperative metabolic acidosis, or cardiac arrest, is beneficial ...

  2. Understanding lactic acidosis in paracetamol (acetaminophen) poisoning

    Shah, Anoop D; Wood, David M; Dargan, Paul I

    2011-01-01

    Paracetamol (acetaminophen) is one of the most commonly taken drugs in overdose in many areas of the world, and the most common cause of acute liver failure in both the UK and USA. Paracetamol poisoning can result in lactic acidosis in two different scenarios. First, early in the course of poisoning and before the onset of hepatotoxicity in patients with massive ingestion; a lactic acidosis is usually associated with coma. Experimental evidence from studies in whole animals, perfused liver sl...

  3. Moduretic-induced metabolic acidosis and hyperkalaemia.

    Wan, H. H.; Lye, M. D.

    1980-01-01

    A patient who developed significant metabolic acidosis and severe hyperkalaemia while taking Moduretic (amiloride and hydrochlorothiazide) is reported. During the period of hyperkalaemia (maximum potassium 7-6 mmol/l) the patient's whole body potassium content was normal. His acid-base balance and serum potassium returned to normal some 10 days after stopping the drug. The possible mechanism of acidosis and hyperkalaemia in this patient is discussed.

  4. Clinical profile of distal renal tubular acidosis

    Ratan Jha; Muthukrishnan, J.; Shekhar Shiradhonkar; Kiran Patro; Harikumar KVS; Modi, K.D.

    2011-01-01

    To determine the clinical profile and progression of renal dysfunction in distal renal tubular acidosis (dRTA), we retrospectively studied 96 consecutive cases of dRTA diagnosed at our center. Patients with unexplained metabolic bone disease, short stature, hypokalemia, re-current renal stones, chronic obstructive uropathy or any primary autoimmune condition known to cause dRTA were screened. Distal RTA was diagnosed on the basis of systemic metabolic acidosis with urine pH >5.5 and positive ...

  5. The genomic analysis of lactic acidosis and acidosis response in human cancers.

    Julia Ling-Yu Chen

    2008-12-01

    Full Text Available The tumor microenvironment has a significant impact on tumor development. Two important determinants in this environment are hypoxia and lactic acidosis. Although lactic acidosis has long been recognized as an important factor in cancer, relatively little is known about how cells respond to lactic acidosis and how that response relates to cancer phenotypes. We develop genome-scale gene expression studies to dissect transcriptional responses of primary human mammary epithelial cells to lactic acidosis and hypoxia in vitro and to explore how they are linked to clinical tumor phenotypes in vivo. The resulting experimental signatures of responses to lactic acidosis and hypoxia are evaluated in a heterogeneous set of breast cancer datasets. A strong lactic acidosis response signature identifies a subgroup of low-risk breast cancer patients having distinct metabolic profiles suggestive of a preference for aerobic respiration. The association of lactic acidosis response with good survival outcomes may relate to the role of lactic acidosis in directing energy generation toward aerobic respiration and utilization of other energy sources via inhibition of glycolysis. This "inhibition of glycolysis" phenotype in tumors is likely caused by the repression of glycolysis gene expression and Akt inhibition. Our study presents a genomic evaluation of the prognostic information of a lactic acidosis response independent of the hypoxic response. Our results identify causal roles of lactic acidosis in metabolic reprogramming, and the direct functional consequence of lactic acidosis pathway activity on cellular responses and tumor development. The study also demonstrates the utility of genomic analysis that maps expression-based findings from in vitro experiments to human samples to assess links to in vivo clinical phenotypes.

  6. Trimethoprim/Sulfamethoxazole-Induced Severe Lactic Acidosis: A Case Report and Review of the Literature.

    Bulathsinghala, Marie; Keefer, Kimberly; Van de Louw, Andry

    2016-04-01

    Propylene glycol (PG) is used as a solvent in numerous medications, including trimethoprim/sulfamethoxazole (TMP/SMX) and lorazepam, and is metabolized in the liver to lactic acid. Cases of lactic acidosis related to PG toxicity have been described and always involved large doses of benzodiazepines and PG. We present the first case of severe lactic acidosis after a 3-day course of TMP/SMX alone, involving allegedly safe amounts of PG.A 31-year-old female with neurofibromatosis and pilocytic astrocytoma, receiving temozolomide and steroids, was admitted to the intensive care unit for pneumonia and acute respiratory failure requiring intubation. Her initial hemodynamic and acid-base statuses were normal. She was treated with intravenous TMP/SMX for possible Pneumocystis jirovecii pneumonia and was successfully extubated on day 2. On day 3, she developed tachypnea and arterial blood gas analysis revealed a severe metabolic acidosis (pH 7.2, PCO2 19 mm Hg, bicarbonates 8 mEq/L) with anion gap of 25 mEq/L and lactate of 12.1 mmol/L. TMP/SMX was discontinued and the lactate decreased to 2.9 mmol/L within 24 hours while her plasma bicarbonates normalized, without additional intervention. The patient never developed hypotension or severe hypoxia, and her renal and liver functions were normal. No other cause for lactic acidosis was identified and it resolved after TMP/SMX cessation alone, suggesting PG toxicity.Although PG-related lactic acidosis is well recognized after large doses of lorazepam, clinicians should bear in mind that TMP/SMX contains PG as well and should suspect PG toxicity in patients developing unexplained metabolic acidosis while receiving TMP/SMX. PMID:27124045

  7. Metabolic acidosis: neo-considerations for general surgeons.

    Martin, L C E; Abah, U; Bean, E; Gupta, S

    2012-11-01

    Hyperchloraemic metabolic acidosis is a documented complication of neobladder formation. However, it usually improves with time and is mild. Severe and persistent metabolic acidosis may manifest when patients undergo further surgery for other reasons. Neobladder formation following radical cystectomy or cystoprostatectomy is becoming increasingly common, and surgeons treating patients with neobladders should recognise and treat metabolic acidosis with intravenous fluids and bicarbonate. PMID:23131216

  8. Late Metabolic Acidosis Caused by Renal Tubular Acidosis in Acute Salicylate Poisoning.

    Sakai, Norihiro; Hirose, Yasuo; Sato, Nobuhiro; Kondo, Daisuke; Shimada, Yuko; Hori, Yasushi

    2016-01-01

    A 16-year-old man was transferred to our emergency department seven hours after ingesting 486 aspirin tablets. His blood salicylate level was 83.7 mg/dL. He was treated with fluid resuscitation and sodium bicarbonate infusion, and his condition gradually improved, with a decline in the blood salicylate level. However, eight days after admission, he again reported nausea, a venous blood gas revealed metabolic acidosis with a normal anion gap. The blood salicylate level was undetectable, and a urinalysis showed glycosuria, proteinuria and elevated beta-2 microglobulin and n-acetyl glucosamine levels, with a normal urinary pH despite the acidosis. We diagnosed him with relapse of metabolic acidosis caused by renal tubular acidosis. PMID:27181539

  9. Lactic Acidosis: Current Treatments and Future Directions.

    Kraut, Jeffrey A; Madias, Nicolaos E

    2016-09-01

    Mortality rates associated with severe lactic acidosis (blood pHreduce mortality. This failure has been attributed to both reduction in serum calcium concentration and generation of excess carbon dioxide with intracellular acidification. In animal studies, hyperventilation and infusion of calcium during sodium bicarbonate administration improves cardiovascular function, suggesting that this approach could allow expression of the positive aspects of sodium bicarbonate. Other buffers, such as THAM or Carbicarb, or dialysis might also provide base with fewer untoward effects. Examination of these therapies in humans is warranted. The cellular injury associated with lactic acidosis is partly due to activation of NHE1, a cell-membrane Na(+)/H(+) exchanger. In animal studies, selective NHE1 inhibitors improve cardiovascular function, ameliorate lactic acidosis, and reduce mortality, supporting future research into their possible use in humans. Two main mechanisms contribute to lactic acid accumulation in sepsis and low-flow states: tissue hypoxia and epinephrine-induced stimulation of aerobic glycolysis. Targeting these mechanisms could allow for more specific therapy. This Acid-Base and Electrolyte Teaching Case presents a patient with acute lactic acidosis and describes current and future approaches to treatment. PMID:27291485

  10. Distal renal tubular acidosis and amelogenesis imperfecta: A rare association

    Ravi, P.; Ekambaranath, T. S.; Arasi, S. Ellil; Fernando, E.

    2013-01-01

    Renal tubular acidosis (RTA) is characterized by a normal anion gap with hyperchloremic metabolic acidosis. Primary distal RTA (type I) is the most common RTA in children. Childhood presentation of distal RTA includes vomiting, failure to thrive, metabolic acidosis, and hypokalemia. Amelogenesis imperfecta (AI) represents a condition where the dental enamel and oral tissues are affected in an equal manner resulting in the hypoplastic or hypopigmented teeth. We report a 10-year-old girl, previ...

  11. Drug-Induced Metabolic Acidosis [version 1; referees: 3 approved

    Amy Quynh Trang Pham

    2015-12-01

    Full Text Available Metabolic acidosis could emerge from diseases disrupting acid-base equilibrium or from drugs that induce similar derangements. Occurrences are usually accompanied by comorbid conditions of drug-induced metabolic acidosis, and clinical outcomes may range from mild to fatal. It is imperative that clinicians not only are fully aware of the list of drugs that may lead to metabolic acidosis but also understand the underlying pathogenic mechanisms. In this review, we categorized drug-induced metabolic acidosis in terms of pathophysiological mechanisms, as well as individual drugs’ characteristics.

  12. Distal renal tubular acidosis in recurrent renal stone formers

    Osther, P J; Hansen, A B; Røhl, H F

    1989-01-01

    metabolic disturbances in renal stone formers. Distal renal tubular acidosis (dRTA) was relatively more common in female stone formers and most often found in patients with bilateral stone disease (36%). Since prophylactic treatment in renal stone formers with renal acidification defects is available, this...... (1.1%) had complete distal renal tubular acidosis and 14 (15.5%) incomplete distal renal tubular acidosis. Our results confirm that distal renal tubular acidification defects are associated with a more severe form of stone disease and make distal renal tubular acidosis one of the most frequent...

  13. Lentiform fork sign: a magnetic resonance finding in a case of acute metabolic acidosis.

    Grasso, Daniela; Borreggine, Carmela; Perfetto, Francesco; Bertozzi, Vincenzo; Trivisano, Marina; Specchio, Luigi Maria; Grilli, Gianpaolo; Macarini, Luca

    2014-06-01

    We report a 33 year-old woman addicted to chronic unspecified solvents abuse with stupor, respiratory disorders, tetraplegia and severe metabolic acidosis. On admission an unenhanced cranial CT scan showed symmetrical hypodensities of both lentiform nuclei. MR imaging performed 12 hours after stupor demonstrates bilateral putaminal hemorrhagic necrosis, bilateral external capsule, corona radiata and deep cerebellar hyperintensities with right cingulate cortex involvement. DWI reflected bilateral putaminal hyperintensities with restricted water diffusion as to citotoxic edema and development of vasogenic edema in the external capsule recalling a fork. On day twenty, after specific treatments MRI demonstrated a bilateral putaminal marginal enhancement. Bilateral putaminal necrosis is a characteristic but non-specific radiological finding of methanol poisoning. Lentiform Fork sign is a rare MRI finding reported in literature in 22 patients with various conditions characterized by metabolic acidosis. Vasogenic edema may be due to the differences in metabolic vulnerability between neurons and astrocytes. We postulate that metabolic acidosis could have an important role to generate this sign. PMID:24976195

  14. Lentiform Fork Sign: a Magnetic Resonance Finding in a Case of Acute Metabolic Acidosis

    Grasso, Daniela; Borreggine, Carmela; Perfetto, Francesco; Bertozzi, Vincenzo; Trivisano, Marina; Specchio, Luigi Maria; Grilli, Gianpaolo; Macarini, Luca

    2014-01-01

    Summary We report a 33 year-old woman addicted to chronic unspecified solvents abuse with stupor, respiratory disorders, tetraplegia and severe metabolic acidosis. On admission an unenhanced cranial CT scan showed symmetrical hypodensities of both lentiform nuclei. MR imaging performed 12 hours after stupor demonstrates bilateral putaminal hemorrhagic necrosis, bilateral external capsule, corona radiata and deep cerebellar hyperintensities with right cingulate cortex involvement. DWI reflected bilateral putaminal hyperintensities with restricted water diffusion as to citotoxic edema and development of vasogenic edema in the external capsule recalling a fork. On day twenty, after specific treatments MRI demonstrated a bilateral putaminal marginal enhancement. Bilateral putaminal necrosis is a characteristic but non-specific radiological finding of methanol poisoning. Lentiform Fork sign is a rare MRI finding reported in literature in 22 patients with various conditions characterized by metabolic acidosis. Vasogenic edema may be due to the differences in metabolic vulnerability between neurons and astrocytes. We postulate that metabolic acidosis could have an important role to generate this sign. PMID:24976195

  15. Primary Sjö-gren's syndrome presenting with distal, renal tubular acidosis and rhabdomyolysis.

    Prakash, E B S; Fernando, M E; Sathiyasekaran, Malathi; Bhoopathy, R M; Jayanth, J J; Samuel, J

    2006-12-01

    Primary Sjögren's syndrome (PSS) is rare in India. Clinically manifest renal disease in PSS is uncommon and is usually an autoimmune tubulointerstitial nephritis presenting with distal renal tubular acidosis (dRTA) or a urinary concentrating defect. Hypokalemic paralysis due to dRTA in PSS is rare but well documented in medical literature. Rhabdomyolysis as a consequence of hypokalemia in PSS is exceptional. We report a case of PSS with dRTA and rhabdomyolysis causing prolonged respiratory failure and quadriparesis. PMID:17334013

  16. Increased levels of inflammatory mediators in children with severe Plasmodium falciparum malaria with respiratory distress

    Awandare, Gordon A; Goka, Bamenla; Boeuf, Philippe;

    2006-01-01

    BACKGROUND: Respiratory distress (RD), a symptom of underlying metabolic acidosis, has been identified as a major risk factor for mortality in children with severe malaria in Africa, yet the molecular mediators involved in the pathogenesis of RD have not been identified. METHODS: We studied...... involved in the pathogenesis of the underlying metabolic acidosis....

  17. Distal Renal Tubular Acidosis and Calcium Nephrolithiasis

    Moe, Orson W.; Fuster, Daniel G.; Xie, Xiao-Song

    2008-09-01

    Calcium stones are commonly encountered in patients with congenital distal renal tubular acidosis, a disease of renal acidification caused by mutations in either the vacuolar H+-ATPase (B1 or a4 subunit), anion exchanger-1, or carbonic anhydrase II. Based on the existing database, we present two hypotheses. First, heterozygotes with mutations in B1 subunit of H+-ATPase are not normal but may harbor biochemical abnormalities such as renal acidification defects, hypercalciuria, and hypocitraturia which can predispose them to kidney stone formation. Second, we propose at least two mechanisms by which mutant B1 subunit can impair H+-ATPase: defective pump assembly and defective pump activity.

  18. Type IV renal tubular acidosis associated with Alport's syndrome.

    Tkácová, R.; Roland, R.; Böör, A.; Kovácová, A.; Lazúrová, I.; Tkác, I.; Hildebrand, T.; Sefara, P.

    1993-01-01

    A case of hereditary nephritis with mild reduction of renal function associated with renal tubular acidosis type IV is described. The patient was admitted with life-threatening hyperkalaemia. To our knowledge, type IV renal tubular acidosis has not been reported previously in association with Alport's syndrome in an adult patient.

  19. An unrecognised case of metabolic acidosis following neobladder augmentation cystoplasty

    David Eldred-Evans

    2015-01-01

    Conclusion: Hyperchloremic metabolic acidosis is a well-established complication of urinary diversion. Patient with orthotopic neobladder with high residual urine and large capacity are at even higher risk of metabolic acidosis. This information should be clearly documented in the post-operative discharge documentation to ensure early recognition by non-specialists.

  20. Clinical profile of distal renal tubular acidosis

    Ratan Jha

    2011-01-01

    Full Text Available To determine the clinical profile and progression of renal dysfunction in distal renal tubular acidosis (dRTA, we retrospectively studied 96 consecutive cases of dRTA diagnosed at our center. Patients with unexplained metabolic bone disease, short stature, hypokalemia, re-current renal stones, chronic obstructive uropathy or any primary autoimmune condition known to cause dRTA were screened. Distal RTA was diagnosed on the basis of systemic metabolic acidosis with urine pH >5.5 and positive urine anion gap. In those patients who had fasting urine pH >5.5 with normal baseline systemic pH and bicarbonate levels (incomplete RTA, acid load test with ammonium chloride was done. A cause of dRTA could be established in 53 (54% patients. Urological defect in children (22/44 and autoimmune disease in adults (11/52 were the commonest causes. Hypokalemic paralysis, proximal muscle weakness and voiding difficulty were the common modes of presentation. Doubling of serum creatinine during the study period was noted in 13 out of 27 patients who had GFR 60 mL/min (P <0.005. In conclusion, urological disorders were the commonest cause of dRTA in children while autoimmune disorders were the commonest asso-ciation in adults. Worse baseline renal function, longer duration of disease and greater frequency of nephrolithiasis/nephrocalcinosis and urological disorders were noted in those who had wor-sening of renal dysfunction during the study period.

  1. Clinical profile of distal renal tubular acidosis.

    Jha, Ratan; Muthukrishnan, J; Shiradhonkar, Shekhar; Patro, Kiran; Harikumar, Kvs; Modi, K D

    2011-03-01

    To determine the clinical profile and progression of renal dysfunction in distal renal tubular acidosis (dRTA), we retrospectively studied 96 consecutive cases of dRTA diagnosed at our center. Patients with unexplained metabolic bone disease, short stature, hypokalemia, re-current renal stones, chronic obstructive uropathy or any primary autoimmune condition known to cause dRTA were screened. Distal RTA was diagnosed on the basis of systemic metabolic acidosis with urine pH >5.5 and positive urine anion gap. In those patients who had fasting urine pH >5.5 with normal baseline systemic pH and bicarbonate levels (incomplete RTA), acid load test with ammonium chloride was done. A cause of dRTA could be established in 53 (54%) patients. Urological defect in children (22/44) and autoimmune disease in adults (11/52) were the commonest causes. Hypokalemic paralysis, proximal muscle weakness and voiding difficulty were the common modes of presentation. Doubling of serum creatinine during the study period was noted in 13 out of 27 patients who had GFR 60 mL/min (P <0.005). In conclusion, urological disorders were the commonest cause of dRTA in children while autoimmune disorders were the commonest asso-ciation in adults. Worse baseline renal function, longer duration of disease and greater frequency of nephrolithiasis/nephrocalcinosis and urological disorders were noted in those who had wor-sening of renal dysfunction during the study period. PMID:21422623

  2. Renal tubular acidosis due to the milk-alkali syndrome.

    Rochman, J; Better, O S; Winaver, J; Chaimowitz, C; Barzilai, A; Jacobs, R

    1977-06-01

    A 60-year-old man with a history of excessive ingestion of calcium carbonate presented with azotemia, hypercalcemia and hyperphosphatemia. His acid-base status was initially normal. Following the cessation of calcium carbonate treatment, the hypercalcemia and azotemia disappeared, and the patient was found to be in metabolic acidosis with blunted acid excretion and a urine pH of 6.1. Kidney biopsy showed focal tubular calcification; the tubular damage was apparently caused by hypercalcemia and had resulted in renal tubular acidosis. During the three months of observation since that time there has been a tendecy for spontaneous remission of the renal tubular acidosis. Impaired renal hydrogen ion excretion prevented the development of metabolic alkalosis despite ingestion of alkali initially, and was later responsible for the metabolic acidosis. Renal tubular acidosis occurring as a sequel to the milk-alkali syndrome may aggravate the danger of nephrocalcinosis in this syndrome. PMID:885714

  3. Distal renal tubular acidosis and amelogenesis imperfecta: A rare association.

    Ravi, P; Ekambaranath, T S; Arasi, S Ellil; Fernando, E

    2013-11-01

    Renal tubular acidosis (RTA) is characterized by a normal anion gap with hyperchloremic metabolic acidosis. Primary distal RTA (type I) is the most common RTA in children. Childhood presentation of distal RTA includes vomiting, failure to thrive, metabolic acidosis, and hypokalemia. Amelogenesis imperfecta (AI) represents a condition where the dental enamel and oral tissues are affected in an equal manner resulting in the hypoplastic or hypopigmented teeth. We report a 10-year-old girl, previously asymptomatic presented with the hypokalemic paralysis and on work-up found out to have type I RTA. The discoloration of teeth and enamel was diagnosed as AI. PMID:24339526

  4. Lactic Acidosis in a Patient with Type 2 Diabetes Mellitus.

    Weisberg, Lawrence S

    2015-08-01

    Lactic acidosis occurs when lactate production exceeds its metabolism. There are many possible causes of lactic acidosis, and in any given patient, several causes may coexist. This Attending Rounds presents a case in point. Metformin's role in the pathogenesis of lactic acidosis in patients with diabetes mellitus is complex, as the present case illustrates. The treatment of lactic acidosis is controversial, except for the imperative to remedy its underlying cause. The use of sodium bicarbonate to treat the often alarming metabolic derangements may be quite efficacious in that regard but is of questionable benefit to patients. Renal replacement therapies (RRTs) have particular appeal in this setting for a variety of reasons, but their effect on clinical outcomes is untested. PMID:25762524

  5. Side Effects of HIV Medicines: HIV and Lactic Acidosis

    ... HIV medicines. All HIV medicines in the nucleoside reverse transcriptase inhibitor (NRTI) drug class may cause lactic acidosis, but ... some HIV medicines. HIV medicines in the nucleoside reverse transcriptase inhibitor (NRTI) drug class can cause the body to ...

  6. [Primary distal renal tubular acidosis: a case report].

    Abdallah, Jihene Ben; Charfeddine, Bassem; Braham, Imen; Neffati, Souhir; Othmen, Leila Ben; Letaief, Affef; Smach, Mohamed Ali; Bourfifa, Zoheier; Dridi, Hedi; Limem, Khalifa

    2011-01-01

    The primary distal renal tubular acidosis is characterized biochemically by the inability of the kidney to produce appropriately acid urine in the presence of systemic metabolic acidosis or after acid loading (e.g. ammonium chloride). It is secondary to defective excretion of H(+) by the cells of the collecting duct. We report the observation of the child MC, 4-year-old, for whom the association of polyuria-polydipsia syndrome, a failure to thrive, nephrolithiasis, hypercalciuria, and especially a high urine pH in the presence of metabolic acidosis did evoke diagnosis of distal renal tubular acidosis. An urine acidification test with ammonium chloride was performed, the urinary pH was always higher than 5.5, thus confirming the diagnosis. PMID:21464016

  7. Acute Isoniazid Intoxication: Convulsion, Rhabdomyolysis and Metabolic Acidosis

    OKUTUR, Sadi Kerem

    2006-01-01

    Isoniazid is one of the most commonly used antituberculous drugs. Acute intoxication is characterized by repetitious convulsions, high anion gap metabolic acidosis and coma. The basis of therapy consists of parenteral pyridoxine administration in a dose equivalent to that of isoniazid ingested. Here we present a case of acute isoniazid intoxication presenting with convulsions and metabolic acidosis with consequent rhabdomyolysis and discuss the clinical signs and pathophysiology of isoniazid ...

  8. Renal tubular acidosis secondary to jejunoileal bypass for morbid obesity

    Schaffalitzky de Muckadell, O B; Ladefoged, Jens; Thorup, Jørgen Mogens

    1985-01-01

    Renal handling of acid and base was studied in patients with persistent metabolic acidosis 3-9 years after jejunoileal bypass for morbid obesity. Excretion of acid was studied before and after intravenous infusion of NH4Cl and excretion of bicarbonate after infusion of NaHCO3. Bypass patients...... groups. Fractional loss of bicarbonate in urine was higher in controls than in bypass patients. The renal impairment is classified as distal renal tubular acidosis....

  9. Treatment of Lactic Acidosis with Dichloroacetate in Dogs

    Park, Robert; Arieff, Allen I.; Leach, William; Lazarowitz, Virginia C.

    1982-01-01

    Lactic acidosis is a clinical condition due to accumulation of H+ ions from lactic acid, characterized by blood lactate levels >5 mM and arterial pH 60%. Dichloroacetate (DCA) is a compound that lowers blood lactate levels under various conditions in both man and laboratory animals. It acts to increase pyruvate oxidation by activation of pyruvate dehydrogenase. We evaluated the effects of DCA in the treatment of two different models of type B experimental lactic acidosis in diabetic dogs: hep...

  10. Metformin-induced lactic acidosis: a case series

    Silvestre Joana; Carvalho Susana; Mendes Vitor; Coelho Luis; Tapadinhas Camila; Ferreira Pedro; Povoa Pedro; Ceia Fatima

    2007-01-01

    Abstract Introduction Unlike other agents used in the treatment of type 2 diabetes mellitus, metformin has been shown to reduce mortality in obese patients. It is therefore being increasingly used in higher doses. The major concern of many physicians is a possible risk of lactic acidosis. The reported frequency of metformin related lactic acidosis is 0.05 per 1000 patient-years; some authors advocate that this rate is equal in those patients not taking metformin. Case presentation We present ...

  11. Benign duodenocolic fistula. A case presenting with acidosis

    Benn, Marianne; Nielsen, F T; Antonsen, H K

    1997-01-01

    A case of benign duodenocolic fistula as a complication to peptic ulcer disease is presented, the case being interesting for the rarity of the diagnosis and by being complicated with acidosis. The etiology, clinical features, diagnosis, and treatment are reviewed.......A case of benign duodenocolic fistula as a complication to peptic ulcer disease is presented, the case being interesting for the rarity of the diagnosis and by being complicated with acidosis. The etiology, clinical features, diagnosis, and treatment are reviewed....

  12. A distal renal tubular acidosis showing hyperammonemia and hyperlactacidemia

    C. Ripoli; Pinna, A.; Marras, S.; M.L. Fenu; Nurchi, A M

    2012-01-01

    Introduction: distal renal tubular acidosis (dRTA) presents itself with variable clinical manifestations and often with late expressions that impact on prognosis. Case report: A 45-day-old male infant was admitted with stopping growth, difficult feeding and vomiting after meals. Clinical tests and labs revealed a type 1 renal tubular acidosis, even if the first blood tests showed ammonium and lactate increase. We had to exclude metabolic diseases before having a certain diagnosis. Conclusions...

  13. Lactic acidosis induced by metformin: incidence, management and prevention.

    Lalau, Jean-Daniel

    2010-09-01

    Lactic acidosis associated with metformin treatment is a rare but important adverse event, and unravelling the problem is critical. First, this potential event still influences treatment strategies in type 2 diabetes mellitus, particularly in the many patients at risk of kidney failure, in those presenting contraindications to metformin and in the elderly. Second, the relationship between metformin and lactic acidosis is complex, since use of the drug may be causal, co-responsible or coincidental. The present review is divided into three parts, dealing with the incidence, management and prevention of lactic acidosis occurring during metformin treatment. In terms of incidence, the objective of this article is to counter the conventional view of the link between metformin and lactic acidosis, according to which metformin-associated lactic acidosis is rare but is still associated with a high rate of mortality. In fact, the direct metformin-related mortality is close to zero and metformin may even be protective in cases of very severe lactic acidosis unrelated to the drug. Metformin has also inherited a negative class effect, since the early biguanide, phenformin, was associated with more frequent and sometimes fatal lactic acidosis. In the second part of this review, the objective is to identify the most efficient patient management methods based on our knowledge of how metformin acts on glucose/lactate metabolism and how lactic acidosis may occur (at the organ and cellular levels) during metformin treatment. The liver appears to be a key organ for both the antidiabetic effect of metformin and the development of lactic acidosis; the latter is attributed to mitochondrial impairment and subsequent adenosine triphosphate depletion, acceleration of the glycolytic flux, increased glucose uptake and the generation of lactate, which effluxes into the circulation rather than being oxidized further. Haemodialysis should systematically be performed in severe forms of lactic

  14. Deficiency of the iron-sulfur clusters of mitochondrial reduced nicotinamide-adenine dinucleotide-ubiquinone oxidoreductase (complex I) in an infant with congenital lactic acidosis.

    Moreadith, R W; Batshaw, M L; Ohnishi, T.; Kerr, D.; Knox, B; Jackson, D; Hruban, R; Olson, J; Reynafarje, B; Lehninger, A L

    1984-01-01

    We report the case of an infant with hypoglycemia, progressive lactic acidosis, an increased serum lactate/pyruvate ratio, and elevated plasma alanine, who had a moderate to profound decrease in the ability of mitochondria from four organs to oxidize pyruvate, malate plus glutamate, citrate, and other NAD+-linked respiratory substrates. The capacity to oxidize the flavin adenine dinucleotide-linked substrate, succinate, was normal. The most pronounced deficiency was in skeletal muscle, the le...

  15. Respiratory System

    ... page from the NHLBI on Twitter. The Respiratory System The respiratory system is made up of organs ... and the muscles that enable breathing. The Respiratory System Figure A shows the location of the respiratory ...

  16. Metabolic Acidosis with Ophthalmic Dorzolamide in a Neonate.

    Capino, Amanda C; Dannaway, Douglas C; Miller, Jamie L

    2016-01-01

    Carbonic anhydrase inhibitors are a common cause of normal anion gap metabolic acidosis; however, development is less commonly associated with ophthalmic administration of these agents. We report a case of a premature neonate who was being treated at our institution with betaxolol, dorzolamide, and latanoprost ophthalmic products for suspected bilateral congenital glaucoma. In addition, the patient was also receiving caffeine, ursodiol, and acidified liquid human milk fortifier. The patient developed a normal anion gap metabolic acidosis, and both dorzolamide ophthalmic solution and the acidified human milk fortifier were considered potential causes. Upon discontinuation of the dorzolamide ophthalmic solution and the switching of liquid human milk fortifiers, the normal anion gap metabolic acidosis gradually resolved. As a result of the pH and acidity, the acidified liquid human milk fortifier is thought to be associated with an anion gap acidosis; therefore, dorzolamide is suspected to be the primary cause of a normal gap acidosis. This case demonstrates that systemic effects can occur with ophthalmic administration of dorzolamide in a premature neonate. Ophthalmic agents should not be overlooked as a potential cause of systemic toxicity. PMID:27453705

  17. Acidosis Promotes Bcl-2 Family-mediated Evasion of Apoptosis

    Ryder, Christopher; McColl, Karen; Zhong, Fei; Distelhorst, Clark W.

    2012-01-01

    Acidosis arises in solid and lymphoid malignancies secondary to altered nutrient supply and utilization. Tumor acidosis correlates with therapeutic resistance, although the mechanism behind this effect is not fully understood. Here we show that incubation of lymphoma cell lines in acidic conditions (pH 6.5) blocks apoptosis induced by multiple cytotoxic metabolic stresses, including deprivation of glucose or glutamine and treatment with dexamethasone. We sought to examine the role of the Bcl-2 family of apoptosis regulators in this process. Interestingly, we found that acidic culture causes elevation of both Bcl-2 and Bcl-xL, while also attenuating glutamine starvation-induced elevation of p53-up-regulated modulator of apoptosis (PUMA) and Bim. We confirmed with knockdown studies that these shifts direct survival decisions during starvation and acidosis. Importantly, the promotion of a high anti- to pro-apoptotic Bcl-2 family member ratio by acidosis renders cells exquisitely sensitive to the Bcl-2/Bcl-xL antagonist ABT-737, suggesting that acidosis causes Bcl-2 family dependence. This dependence appears to be mediated, in part, by the acid-sensing G protein-coupled receptor, GPR65, via a MEK/ERK pathway. PMID:22685289

  18. Neurological damage arising from intrapartum hypoxia/acidosis.

    Rei, M; Ayres-de-Campos, D; Bernardes, J

    2016-01-01

    Complications occurring at any level of foetal oxygen supply will result in hypoxaemia, and this may ultimately lead to hypoxia/acidosis and neurological damage. Hypoxic-ischaemic encephalopathy (HIE) is the short-term neurological dysfunction caused by intrapartum hypoxia/acidosis, and this diagnosis requires the presence of a number of findings, including the confirmation of newborn metabolic acidosis, low Apgar scores, early imaging evidence of cerebral oedema and the appearance of clinical signs of neurological dysfunction in the first 48 h of life. Cerebral palsy (CP) consists of a heterogeneous group of nonprogressive movement and posture disorders, frequently accompanied by cognitive and sensory impairments, epilepsy, nutritional deficiencies and secondary musculoskeletal lesions. Although CP is the most common long-term neurological complication associated with intrapartum hypoxia/acidosis, >80% of cases are caused by other phenomena. Data on minor long-term neurological deficits are scarce, but they suggest that less serious intellectual and motor impairments may result from intrapartum hypoxia/acidosis. This chapter focuses on the existing evidence of neurological damage associated with poor foetal oxygenation during labour. PMID:26148854

  19. Type B Lactic Acidosis Associated With Venlafaxine Overdose.

    Iragavarapu, Chaitanya; Gupta, Tanush; Chugh, Savneek S; Aronow, Wilbert S; Frishman, William H

    2016-01-01

    Lactic acidosis that is not secondary to tissue hypoperfusion or hypoxemia (type B lactic acidosis) is a rare but potentially fatal condition that has been associated with drugs like metformin, linezolid, and nucleoside reverse-transcriptase inhibitors in patients with HIV. We report the first case of type B lactic acidosis caused by overdose of the serotonin-norepinephrine reuptake inhibitor, venlafaxine. A 55-year-old man with no significant medical history was brought to the emergency department after intentional ingestion of around 80 capsules of venlafaxine (a total dose of over 6000 mg) in an attempt to commit suicide. Complete blood count and comprehensive metabolic panel were unremarkable except for a bicarbonate level of 13 mEq/L and an anion gap of 22 mEq/L. An arterial blood gas revealed a pH of 7.39, partial pressure of CO2 of 19 mm Hg, calculated bicarbonate of 11.5 mEq/L, and a lactate level of 8.6 mmol/L. The patient was started on aggressive intravenous hydration with normal saline along with oral activated charcoal with sorbitol. Repeat laboratory work after 4 hours showed an improvement in anion gap (15 mEq/L) and serum lactate (5.6 mmol/L). The patient remained stable throughout the hospital stay and lactic acidosis resolved in 24 hours. In the absence of hypotension, hypoxemia, kidney or liver dysfunction, myopathy, malignancy, or use of other medications, venlafaxine was the most likely cause of lactic acidosis in our case. Rapid improvement of acidosis was probably related to clearance of the drug. PMID:25405896

  20. Coagulopathy induced by acidosis, hypothermia and hypocalcaemia in severe bleeding.

    De Robertis, E; Kozek-Langenecker, S A; Tufano, R; Romano, G M; Piazza, O; Zito Marinosci, G

    2015-01-01

    Acidosis, hypothermia and hypocalcaemia are determinants for morbidity and mortality during massive hemorrhages. However, precise pathological mechanisms of these environmental factors and their potential additive or synergistic anticoagulant and/or antiplatelet effects are not fully elucidated and are at least in part controversial. Best available evidences from experimental trials indicate that acidosis and hypothermia progressively impair platelet aggregability and clot formation. Considering the cell-based model of coagulation physiology, hypothermia predominantly prolongs the initiation phase, while acidosis prolongs the propagation phase of thrombin generation. Acidosis increases fibrinogen breakdown while hypothermia impairs its synthesis. Acidosis and hypothermia have additive effects. The effect of hypocalcaemia on coagulopathy is less investigated but it appears that below the cut-off of 0.9 mmol/L, several enzymatic steps in the plasmatic coagulation system are blocked while above that cut-off effects remain without clinical sequalae. The impact of environmental factor on hemostasis is underestimated in clinical practice due to our current practice of using routine coagulation laboratory tests such as partial thromboplastin time or prothrombin time, which are performed at standardized test temperature, after pH correction, and upon recalcification. Temperature-adjustments are feasible in viscoelastic point-of-care tests such as thrombelastography and thromboelastometry which may permit quantification of hypothermia-induced coagulopathy. Rewarming hypothermic bleeding patients is highly recommended because it improves patient outcome. Despite the absence of high-quality evidence, calcium supplementation is clinical routine in bleeding management. Buffer administration may not reverse acidosis-induced coagulopathy but may be essential for the efficacy of coagulation factor concentrates such as recombinant activated factor VII. PMID:24608516

  1. Ventilatory response in metabolic acidosis and cerebral blood volume in humans.

    Ven, M.T.P. van de; Colier, W.N.J.M.; Sluijs, M.C. van der; Oeseburg, B.; Folgering, H.T.M.

    2001-01-01

    The relationship between alterations in cerebral blood volume (CBV) and central chemosensitivity regulation was studied under neutral metabolic conditions and during metabolic acidosis. Fifteen healthy subjects (5610 years) were investigated. To induce metabolic acidosis, ammonium chloride (NH(4)Cl)

  2. Type 4 renal tubular acidosis in a kidney transplant recipient.

    Kulkarni, Manjunath

    2016-02-01

    We report a case of a 66-year-old diabetic patient who presented with muscle weakness 2 weeks after kidney transplantation. Her immunosuppressive regimen included tacrolimus, mycophenolate mofetil, and steroids. She was found to have hyperkalemia and normal anion gap metabolic acidosis. Tacrolimus levels were in therapeutic range. All other drugs such as beta blockers and trimethoprim - sulfamethoxazole were stopped. She did not respond to routine antikalemic measures. Further evaluation revealed type 4 renal tubular acidosis. Serum potassium levels returned to normal after starting sodium bicarbonate and fludrocortisone therapy. Though hyperkalemia is common in kidney transplant recipients, determining exact cause can guide specific treatment. PMID:27105603

  3. [5-0xoproline (pyroglutamic acid) acidosis and acetaminophen- a differential diagnosis in high anion gap metabolic acidosis].

    Weiler, Stefan; Bellmann, Romuald; Kullak-Ublick, Gerd A

    2015-12-01

    Rare cases of high anion gap metabolic acidosis during long-term paracetamol administration in therapeutic doses with causative 5-oxoproline (pyroglutamic acid} accumulation have been reported. Other concomitant risk factors such as malnutrition, alcohol abuse, renal or hepatic dysfunction, comedication with flue/oxacillin, vigabatrin, netilmicin or sepsis have been described. The etiology seems to be a drug-induced reversible inhibition of glutathione synthetase or 5-oxoprolinase leading to elevated serum and urine levels of 5-oxoproline. Other more frequent differential diagnoses, such as intoxications, ketoacidosis or lactic acidosis should be excluded. Causative substances should be stopped. 5-oxoproline concentrations in urine can be quantified to establish the diagnosis. Adverse drug reactions, which are not listed or insufficiently described in the respective Swiss product information, should be reported to the regional pharmacovigilance centres for early signal detection. 5-0 xoproline acidosis will be integrated as a potential adverse drug reaction in the Swiss product information for paracetamol. PMID:26654818

  4. Cerebrovascular response to acute metabolic acidosis in humans.

    Ven, M.T.P. van de; Colier, W.N.J.M.; Kersten, B.T.P.; Oeseburg, B.; Folgering, H.T.M.

    2003-01-01

    OBJECTIVES: Evaluation of the cerebrovascular response (delta CBV/delta PaCO2) during baseline metabolic conditions and acute metabolic acidosis. METHODS: 15 healthy subjects, 5 m, 10 f, 56 +/- 10 yrs were investigated. For acidification, NH4Cl was given orally. CBV was measured using Near Infrared

  5. Phenylbutyrate Therapy for Pyruvate Dehydrogenase Complex Deficiency and Lactic Acidosis

    Ferriero, Rosa; Manco, Giuseppe; Lamantea, Eleonora; Nusco, Edoardo; Ferrante, Mariella I.; Sordino, Paolo; Stacpoole, Peter W.; Lee, Brendan; Zeviani, Massimo; Brunetti-Pierri, Nicola

    2014-01-01

    Lactic acidosis is a build-up of lactic acid in the blood and tissues, which can be due to several inborn errors of metabolism as well as nongenetic conditions. Deficiency of pyruvate dehydrogenase complex (PDHC) is the most common genetic disorder leading to lactic acidosis. Phosphorylation of specific serine residues of the E1α subunit of PDHC by pyruvate dehydrogenase kinase (PDK) inactivates the enzyme, whereas dephosphorylation restores PDHC activity. We found that phenylbutyrate enhances PDHC enzymatic activity in vitro and in vivo by increasing the proportion of unphosphorylated enzyme through inhibition of PDK. Phenylbutyrate given to C57B6/L wild-type mice results in a significant increase in PDHC enzyme activity and a reduction of phosphorylated E1α in brain, muscle, and liver compared to saline-treated mice. By means of recombinant enzymes, we showed that phenylbutyrate prevents phosphorylation of E1α through binding and inhibition of PDK, providing a molecular explanation for the effect of phenylbutyrate on PDHC activity. Phenylbutyrate increases PDHC activity in fibroblasts from PDHC-deficient patients harboring various molecular defects and corrects the morphological, locomotor, and biochemical abnormalities in the noam631 zebrafish model of PDHC deficiency. In mice, phenylbutyrate prevents systemic lactic acidosis induced by partial hepatectomy. Because phenylbutyrate is already approved for human use in other diseases, the findings of this study have the potential to be rapidly translated for treatment of patients with PDHC deficiency and other forms of primary and secondary lactic acidosis. PMID:23467562

  6. Metformin-induced lactic acidosis: a case series

    Silvestre Joana

    2007-10-01

    Full Text Available Abstract Introduction Unlike other agents used in the treatment of type 2 diabetes mellitus, metformin has been shown to reduce mortality in obese patients. It is therefore being increasingly used in higher doses. The major concern of many physicians is a possible risk of lactic acidosis. The reported frequency of metformin related lactic acidosis is 0.05 per 1000 patient-years; some authors advocate that this rate is equal in those patients not taking metformin. Case presentation We present two case reports of metformin-associated lactic acidosis. The first case is a 77 year old female with a past medical history of hypertension and type 2 diabetes mellitus who had recently been prescribed metformin (3 g/day, perindopril and acetylsalicylic acid. She was admitted to the emergency department two weeks later with abdominal pain and psychomotor agitation. Physical examination revealed only signs of poor perfusion. Laboratory evaluation revealed hyperkalemia, elevated creatinine and blood urea nitrogen and mild leukocytosis. Arterial blood gases showed severe lactic acidemia. She was admitted to the intensive care unit. Vasopressor and ventilatory support was initiated and continuous venovenous hemodiafiltration was instituted. Twenty-four hours later, full clinical recovery was observed, with return to a normal serum lactate level. The patient was discharged from the intensive care unit on the sixth day. The second patient is a 69 year old male with a past medical history of hypertension, type 2 diabetes mellitus and ischemic heart disease who was on metformin (4 g/day, glycazide, acetylsalicylic acid and isosorbide dinitrate. He was admitted to the emergency department in shock with extreme bradycardia. Initial evaluation revealed severe lactic acidosis and elevated creatinine and urea. The patient was admitted to the Intensive Care Unit and commenced on continuous venovenous hemodiafiltration in addition to other supportive measures. A

  7. Development of diabetes-induced acidosis in the rat retina.

    Dmitriev, Andrey V; Henderson, Desmond; Linsenmeier, Robert A

    2016-08-01

    We hypothesized that the retina of diabetic animals would be unusually acidic due to increased glycolytic metabolism. Acidosis in tumors and isolated retina has been shown to lead to increased VEGF. To test the hypothesis we have measured the transretinal distribution of extracellular H(+) concentration (H(+)-profiles) in retinae of control and diabetic dark-adapted intact Long-Evans rats with ion-selective electrodes. Diabetes was induced by intraperitoneal injection of streptozotocin. Intact rat retinae are normally more acidic than blood with a peak of [H(+)]o in the outer nuclear layer (ONL) that averages 30 nM higher than H(+) in the choroid. Profiles in diabetic animals were similar in shape, but diabetic retinae began to be considerably more acidic after 5 weeks of diabetes. In retinae of 1-3 month diabetics the difference between the ONL and choroid was almost twice as great as in controls. At later times, up to 6 months, some diabetics still demonstrated abnormally high levels of [H(+)]o, but others were even less acidic than controls, so that the average level of acidosis was not different. Greater variability in H(+)-profiles (both between animals and between profiles recorded in one animal) distinguished the diabetic retinae from controls. Within animals, this variability was not random, but exhibited regions of higher and lower H(+). We conclude that retinal acidosis begins to develop at an early stage of diabetes (1-3 months) in rats. However, it does not progress, and the acidity of diabetic rat retina was diminished at later stages (3-6 months). Also the diabetes-induced acidosis has a strongly expressed local character. As result, the diabetic retinas show much wider variability in [H(+)] distribution than controls. pH influences metabolic and neural processes, and these results suggest that local acidosis could play a role in the pathogenesis of diabetic retinopathy. PMID:27262608

  8. Metformin-Associated Acute Kidney Injury and Lactic Acidosis

    David Arroyo

    2011-01-01

    Full Text Available Objectives. Metformin is the preferred oral antidiabetic agent for type 2 diabetes. Lactic acidosis is described as a rare complication, usually during an acute kidney injury (AKI. Material and Methods. We conducted a prospective observational study of metformin-associated AKI cases during four years. 29 cases were identified. Previous renal function, clinical data, and outcomes were recorded. Results. An episode of acute gastroenteritis precipitated the event in 26 cases. Three developed a septic shock. Three patients died, the only related factor being liver dysfunction. More severe metabolic acidosis hyperkalemia and anemia were associated with higher probabilities of RRT requirement. We could not find any relationship between previous renal dysfunction and the outcome of the AKI. Conclusions. AKI associated to an episode of volume depletion due to gastrointestinal losses is a serious complication in type 2 diabetic patients on metformin. Previous renal dysfunction (mild-to-moderate CKD has no influence on the severity or outcome.

  9. A distal renal tubular acidosis showing hyperammonemia and hyperlactacidemia

    C. Ripoli

    2012-08-01

    Full Text Available Introduction: distal renal tubular acidosis (dRTA presents itself with variable clinical manifestations and often with late expressions that impact on prognosis. Case report: A 45-day-old male infant was admitted with stopping growth, difficult feeding and vomiting after meals. Clinical tests and labs revealed a type 1 renal tubular acidosis, even if the first blood tests showed ammonium and lactate increase. We had to exclude metabolic diseases before having a certain diagnosis. Conclusions: blood and urine investigations and genetic tests are fundamental to formulate dRTA diagnosis and to plan follow-up, according to possible phenotypic expressions of recessive and dominant autosomal forms in patients with dRTA.

  10. Acidosis ruminal en bovinos lecheros: implicaciones sobre la producción y la salud animal - Ruminal acidosis in dairy cattle: implications for animal health and production

    Granja Salcedo, Yury Tatiana

    2012-04-01

    Full Text Available ResumenLa acidosis ruminal es un importante problema en la producción de bovinos alimentados con dietas ricas en concentrados, especialmente en vacas de alta producción lechera.AbstractRuminal acidosis is a major problem in the production of cattle fed diets rich in concentrates, especially in cows of high milk production.

  11. Blood Parameters Modification at Different Ruminal Acidosis Conditions

    Roberta De Nardi

    2013-09-01

    Full Text Available This study evaluated the reliability of various blood parameters to assess the ruminal acidosis in cattle. Six whole heifers were fed three experimental rations in a 3 x 3 Latin square design. The diets had different starch levels: high (HS, medium (MS or low (CT. Ruminal pH values were continuously measured using wireless sensors. To evaluate the severity of ruminal acidosis, the amount of time per day that the pH was below 5.8, 5.5 and 5.0 was recorded. Blood samples were analyzed for complete blood count, venous blood gas and biochemical profile at 8:00 and 12:00 h. The data were analyzed according to a mixed model. Feeding on CT, MS and HS led to significant differences in DMI (7.7 vs. 6.9 vs. 5.1 kg/d; P < 0.01 which modified the amount of time per day that the pH was below 5.0 (0 vs. 12 vs. 92 min; P < 0.10. Feeding MS and HS diets led to inflammation as indicated by the significant increment of white blood cells when compared to the CT ones and to blood concentration due to the osmotic pressure at ruminal level. Furthermore a significant decrease of bicarbonate level, CO2 partial pressure and oxyhemoglobin was observed as consequence of the activation of metabolic processes aimed to prevent metabolic acidosis. No differences were observed on blood sampling time, suggesting that one daily blood sample was enough to evaluate the metabolic variations related to ruminal acidosis.

  12. Cellular acidosis inhibits assembly, disassembly, and motility of stress granules.

    Chudinova, E M; Nadezhdina, E S; Ivanov, P A

    2012-11-01

    Stress granules (SGs) are large ribonucleoprotein (RNP)-containing particles that form in cytoplasm in response to a variety of acute changes in the cellular environment. One of the general parameters of the cell environment is pH. In some diseases, as well as in muscle fatigue, tissue acidosis occurs, leading to decrease in intracellular pH. Here we studied whether decrease in pH causes the formation of SGs in cultured animal cells, whether it affects the formation of the SGs under the action of arsenite and, if such effects occur, what are the mechanisms of the influence of acidosis. Acidosis was simulated by decreasing the pH of the culture medium, which acidified the cytoplasm. We found that medium acidification to pH 6.0 in itself did not cause formation of SGs in cells. Moreover, acidification prevented the formation of SGs under treatment with sodium arsenite or sodium arsenite together with the proteasome inhibitor MG132, and it inhibited the dissociation of preformed SGs under the influence of cycloheximide. We established that pH decrease did not affect the phosphorylation of eIF2α that occurs under the action of sodium arsenite, and even caused such phosphorylation by itself. We also found that the velocity of SG motion in cytoplasm at acidic pH was very low, and the mobile fraction of SG-incorporated PABP protein revealed by FRAP was decreased. We suppose that acidic pH impairs biochemical processes favoring assembly of RNPs in stress conditions and RNP dissociation on the termination of stress. Thus, in acidosis the reaction of the cellular translation apparatus to stress is modified. PMID:23240565

  13. Metabolic Acidosis Without Clinical Signs of Dehydration in Young Calves

    Kasari, T R; Naylor, J M

    1984-01-01

    Metabolic acidosis without clinical signs of dehydration was diagnosed in four calves between nine and 21 days of age. In each calf either coma or depression with weakness and ataxia was observed. Two calves had slow deep respirations. Treatment with intravenous administration of solutions of sodium bicarbonate was accompanied by a rise in blood pH and a return to normal demeanor, ambulation and appetites, allowing these calves to return to their respective herds.

  14. Lactic acidosis secondary to metformin overdose: a case report

    Timbrell Simon

    2012-08-01

    Full Text Available Abstract Introduction Metformin is a commonly used treatment modality in type 2 diabetes mellitus, with a well documented side effect of lactic acidosis. In the intensive care setting lactate and pH levels are regularly used as a useful predictor of poor prognosis. In this article we highlight how high lactate levels are not an accurate predictor of mortality in deliberate metformin overdose. Case presentation We present the case of a 70-year-old Caucasian man who took a deliberate metformin overdose of unknown quantity. He had a profound lactic acidosis at presentation with a pH of 6.93 and a lactate level of more than 20mmol/L. These figures would normally correspond with a mortality of more than 80%; however, with appropriate management this patient’s condition improved. Conclusion We provide evidence that the decision to treat severe lactic acidosis in deliberate metformin overdose should not be based on arterial lactate and pH levels, as would be the case in other overdoses. We also demonstrate that appropriate treatment with hemodiafiltration and 8.4% sodium bicarbonate, even in patients with a very high lactate and low pH, can be successful.

  15. Acute phase protein response during acute ruminal acidosis in cattle

    Danscher, A. M.; Thoefner, M. B.; Heegaard, Peter M. H.;

    2011-01-01

    The aim of the study was to describe the acute phase protein and leukocyte responses in dairy heifers during acute, oligofructose-induced ruminal acidosis. The study included 2 trials involving oral oligofructose overload (17g/kg BW) to nonpregnant Danish Holstein heifers. Trial 1 included 12...... performed.Heifers receiving oligofructose developed a profound ruminal and systemic acidosis (in Trial 1 and 2 lowest ruminal pH was 4.3±0.2 and 3.8±0.02, respectively, and minimum SBE was −9.3±4.1 and −8.9±2.8, respectively). In Trial 1, SAA concentrations were higher than baseline concentrations on all...... than control heifers at 18 and 24h after overload (max. 13.7±4.3 billions/L). Feeding had no effect on plasma fibrinogen concentrations or WBC in Trial 1.Acute ruminal and systemic acidosis caused by oligofructose overload resulted in distinct acute phase protein and leukocyte responses in dairy...

  16. Hypokalemic quadriparesis and rhabdomyolysis as a rare presentation of distal renal tubular acidosis.

    Ahmad Bhat, Manzoor; Ahmad Laway, Bashir; Mustafa, Farhat; Shafi Kuchay, Mohammad; Mubarik, Idrees; Ahmad Palla, Nazir

    2014-01-01

    Distal renal tubular acidosis is a syndrome of abnormal urine acidification and is characterized by hyperchloremic metabolic acidosis, hypokalemia, hypercalciurea, nephrocalcinosis and nephrolithiasis. Despite the presence of persistent hypokalemia, acute muscular paralysis is rarely encountered in males. Here, we will report an eighteen year old male patient who presented with flaccid quadriparesis and was subsequently found to have rhabdomyolysis, severe short stature, skeletal deformities and primary distal renal tubular acidosis. PMID:25250276

  17. Mixed acid-base disorders, hydroelectrolyte imbalance and lactate production in hypercapnic respiratory failure: the role of noninvasive ventilation.

    Claudio Terzano

    Full Text Available BACKGROUND: Hypercapnic Chronic Obstructive Pulmonary Disease (COPD exacerbation in patients with comorbidities and multidrug therapy is complicated by mixed acid-base, hydro-electrolyte and lactate disorders. Aim of this study was to determine the relationships of these disorders with the requirement for and duration of noninvasive ventilation (NIV when treating hypercapnic respiratory failure. METHODS: Sixty-seven consecutive patients who were hospitalized for hypercapnic COPD exacerbation had their clinical condition, respiratory function, blood chemistry, arterial blood gases, blood lactate and volemic state assessed. Heart and respiratory rates, pH, PaO(2 and PaCO(2 and blood lactate were checked at the 1st, 2nd, 6th and 24th hours after starting NIV. RESULTS: Nine patients were transferred to the intensive care unit. NIV was performed in 11/17 (64.7% mixed respiratory acidosis-metabolic alkalosis, 10/36 (27.8% respiratory acidosis and 3/5 (60% mixed respiratory-metabolic acidosis patients (p = 0.026, with durations of 45.1 ± 9.8, 36.2 ± 8.9 and 53.3 ± 4.1 hours, respectively (p = 0.016. The duration of ventilation was associated with higher blood lactate (p<0.001, lower pH (p = 0.016, lower serum sodium (p = 0.014 and lower chloride (p = 0.038. Hyponatremia without hypervolemic hypochloremia occurred in 11 respiratory acidosis patients. Hypovolemic hyponatremia with hypochloremia and hypokalemia occurred in 10 mixed respiratory acidosis-metabolic alkalosis patients, and euvolemic hypochloremia occurred in the other 7 patients with this mixed acid-base disorder. CONCLUSIONS: Mixed acid-base and lactate disorders during hypercapnic COPD exacerbations predict the need for and longer duration of NIV. The combination of mixed acid-base disorders and hydro-electrolyte disturbances should be further investigated.

  18. Respiratory Failure

    Respiratory failure happens when not enough oxygen passes from your lungs into your blood. Your body's organs, such ... brain, need oxygen-rich blood to work well. Respiratory failure also can happen if your lungs can't ...

  19. Postoperative metabolic acidosis following the minimally invasive radiofrequency maze procedure

    Raymond Patrick Hom

    2016-01-01

    Full Text Available Purpose: Atrial fibrillation (AF is the most common arrhythmia treated in the world. While medical treatment with antiarrhythmic drugs remains the primary treatment modality, symptomatic refractory AF often requires treatment with a catheter or surgical ablation. One minimally invasive therapy is the Mini-Maze procedure, which utilizes epicardial radiofrequency ablation via a subxiphoid approach to rid the heart of arrhythmogenic atrial foci without a median sternotomy or cardiopulmonary bypass. The goal of this retrospective cohort study was to identify clinical factors associated with metabolic acidosis following the Mini-Maze procedure. Materials and Methods: After Institutional Review Board approval, we studied patients undergoing the Mini-Maze procedure, off-pump coronary artery bypass grafting or patients conventional Cox-Maze on cardiopulmonary bypass. The first base deficit value obtained in the Intensive Care Unit was used as a measure of metabolic acidosis. Using logistic regression with Akaike information criteria, we analyzed preoperative, intraoperative, and postoperative data to determine the factors associated with changes in base deficit. Results: A multivariable model using stepwise selection demonstrated that diabetes mellitus and weight were associated with a decrease in the base deficit by 2.87 mEq/L (95% CI: −5.55-−0.19 and 0.04 mEq/L (95%CI: −0.08, 0.004, respectively. Furthermore, creatinine was associated with a 1.57 mEq/L (95% CI: 0.14, 2.99 increase in the base deficit. Conclusion: The Mini-Maze procedure was not associated with postoperative metabolic acidosis. Instead, nondiabetic patients and patients with higher creatinine were associated with greater base deficits after undergoing cardiac surgery.

  20. Risk Factors for Developing Metabolic Acidosis after Radical Cystectomy and Ileal Neobladder

    Yoon, Hyun Suk; Yoon, Hana; Chung, Woo Sik; Sim, Bong Suk; Ryu, Dong-Ryeol; Lee, Dong Hyeon

    2016-01-01

    Purpose To investigate the serial changes of metabolic acidosis and identify associated risk factors in patients who underwent radical cystectomy and ileal neobladder. Material and Methods From January 2010 to August 2014, 123 patients who underwent radical cystectomy and ileal neobladder reconstruction for bladder cancer were included in this study. Metabolic acidosis was defined as a serum bicarbonate level less than 22 mEq/L and impaired renal function was defined as a GFR <50ml/min. The presence of metabolic acidosis was evaluated at 1 month, 1 year, and 2 years after surgery. Multivariate logistic regression analysis was conducted to identify risk factors associated with development of metabolic acidosis. Results Metabolic acidosis was observed in 52%, 19.5%, and 7.3% of patients at 1 month, 1 year, and 2 years after surgery, respectively. At 1 month after surgery, impaired renal function was the only independent risk factor associated with metabolic acidosis (OR 3.87, P = 0.046). At 1 year after surgery, diabetes was the only independent risk factor associated with metabolic acidosis (OR 5.68, P = 0.002). At 2 years post-surgery, both age and diabetes were significant risk factors associated with metabolic acidosis. Conclusion Approximately, half of patients experienced metabolic acidosis one month after ileal neobladder reconstruction. Preoperative impaired renal function was the most significant risk factor for developing metabolic acidosis in the early postoperative period. However, the incidence of metabolic acidosis decreased to less than 20% 1 year after surgery, and diabetes was an independent risk factor during this period. PMID:27384686

  1. Reality of severe metformin-induced lactic acidosis in the absence of chronic renal impairment.

    Bruijstens, L.A.; Luin, M. van; Buscher-Jungerhans, P.M.; Bosch, F.H.

    2008-01-01

    BACKGROUND: Lactic acidosis in metformin use is a widely recognised but rare side effect. Case reports usually describe elderly patients with conditions which in themselves can cause lactic acidosis or with known contraindications to metformin. We present cases of an elderly woman, a younger woman a

  2. Type IV renal tubular acidosis and spironolactone therapy in the elderly.

    O'Connell, J. E.; Colledge, N. R.

    1993-01-01

    Spironolactone therapy is a well-known cause of hyperkalaemia, but in susceptible patient, it may also be associated with metabolic acidosis. We report a case of severe renal tubular acidosis (Type IV) with life-threatening hyperkalaemia caused by spironolactone, and discuss the mechanisms by which this may occur.

  3. Hypokalemic quadriparesis and rhabdomyolysis as a rare presentation of distal renal tubular acidosis

    Ahmad Bhat, Manzoor; Ahmad Laway, Bashir; Mustafa, Farhat; Shafi Kuchay, Mohammad; Mubarik, Idrees; Ahmad Palla, Nazir

    2014-01-01

    Distal renal tubular acidosis is a syndrome of abnormal urine acidification and is characterized by hyperchloremic metabolic acidosis, hypokalemia, hypercalciurea, nephrocalcinosis and nephrolithiasis. Despite the presence of persistent hypokalemia, acute muscular paralysis is rarely encountered in males. Here, we will report an eighteen year old male patient who presented with flaccid quadriparesis and was subsequently found to have rhabdomyolysis, severe short stature, skeletal deformities ...

  4. A perspective on Serum Lactic acid, Lactic Acidosis in a Critical Care Unit

    Agela A.Elbadri

    2013-06-01

    Full Text Available Breast cancer is one of the major surgical problems encountered in Libya. Lactic acidosis is a universal complication in breast cancer patients and can be considered a possible prognostic marker. Therefore, it will be beneficial to correctly understand and review the biochemistry underlying lactic acidosis and its possible significance as a prognostic marker in critical care patients, including breast cancer.

  5. Rumen microbial and fermentation characteristics are affected differently by bacterial probiotic supplementation during induced lactic and subacute acidosis in sheep

    Lettat Abderzak; Nozière Pierre; Silberberg Mathieu; Morgavi Diego P; Berger Claudette; Martin Cécile

    2012-01-01

    Abstract Background Ruminal disbiosis induced by feeding is the cause of ruminal acidosis, a digestive disorder prevalent in high-producing ruminants. Because probiotic microorganisms can modulate the gastrointestinal microbiota, propionibacteria- and lactobacilli-based probiotics were tested for their effectiveness in preventing different forms of acidosis. Results Lactic acidosis, butyric and propionic subacute ruminal acidosis (SARA) were induced by feed chalenges in three groups of four w...

  6. The successful treatment of hypercapnic respiratory failure with oral modafinil

    Parnell H

    2014-04-01

    Full Text Available Helen Parnell,1 Ginny Quirke,1 Sally Farmer,1 Sumbo Adeyemo,2 Veronica Varney11Respiratory Department, 2Pharmacy Department, St Helier Hospital, Carshalton, Surrey, UKAbstract: Hypercapnic respiratory failure is common in advanced chronic obstructive pulmonary disease and is usually treated by nasal ventilation. Not all patients requiring such ventilation can tolerate it, with anxiety and phobia influencing their reaction, along with treatment failure. We report the case histories of six patients with hypercapnic respiratory failure who were at risk of death due to refusal of nasal ventilation or its failure despite ongoing treatment. We report their improvement with oral modafinil 200 mg tablets used as a respiratory stimulant, which led to discharge, improved arterial blood gases, and offset further admissions with hypercapnic respiratory failure. This drug is licensed for narcolepsy and is said to stimulate the respiratory system via the central nervous system. Its use in respiratory failure is an unlicensed indication, and there are no case reports or studies of such use in the literature. Its respiratory stimulant effects appear better than those with protriptyline, which was a drug previously used until its production was discontinued. Our findings suggest that a study of modafinil in hypercapnic respiratory failure would be warranted, especially for patients with treatment failure or intolerance to nasal ventilation. This may offer a way of shortening hospital stay, improving outcome and quality of life, and reducing death and readmissions.Keywords: COPD, chronic obstructive pulmonary disease, nasal ventilation, acidosis, modafinil, hypercapnic respiratory failure

  7. Respiratory Failure

    Özyılmaz, Ezgi

    2014-01-01

    The main function of the lungs is to maintain the exchange between the pulmonary capillary and the air in the alveoli. By this way, the arteriel oxygen and carbondioxide tension remains constant. Respiratory failure is a syndrome which is defined as the loss of the ability of respiratory system to exchange oxygen and carbondioxide elimination function. The main pathophysiological causes of respiratory failure include ventilation-perfusion mismatch, alveolar hypoventilation, impaired diffusion...

  8. Deficiency of the iron-sulfur clusters of mitochondrial reduced nicotinamide-adenine dinucleotide-ubiquinone oxidoreductase (complex I) in an infant with congenital lactic acidosis.

    Moreadith, R W; Batshaw, M L; Ohnishi, T; Kerr, D; Knox, B; Jackson, D; Hruban, R; Olson, J; Reynafarje, B; Lehninger, A L

    1984-09-01

    We report the case of an infant with hypoglycemia, progressive lactic acidosis, an increased serum lactate/pyruvate ratio, and elevated plasma alanine, who had a moderate to profound decrease in the ability of mitochondria from four organs to oxidize pyruvate, malate plus glutamate, citrate, and other NAD+-linked respiratory substrates. The capacity to oxidize the flavin adenine dinucleotide-linked substrate, succinate, was normal. The most pronounced deficiency was in skeletal muscle, the least in kidney mitochondria. Enzymatic assays on isolated mitochondria ruled out defects in complexes II, III, and IV of the respiratory chain. Further studies showed that the defect was localized in the inner membrane mitochondrial NADH-ubiquinone oxidoreductase (complex I). When ferricyanide was used as an artificial electron acceptor, complex I activity was normal, indicating that electrons from NADH could reduce the flavin mononucleotide cofactor. However, electron paramagnetic resonance spectroscopy performed on liver submitochondrial particles showed an almost total loss of the iron-sulfur clusters characteristic of complex I, whereas normal signals were noted for other mitochondrial iron-sulfur clusters. This infant is presented as the first reported case of congenital lactic acidosis caused by a deficiency of the iron-sulfur clusters of complex I of the mitochondrial electron transport chain. PMID:6432847

  9. Respiratory mechanics

    Wilson, Theodore A

    2016-01-01

    This book thoroughly covers each subfield of respiratory mechanics: pulmonary mechanics, the respiratory pump, and flow. It presents the current understanding of the field and serves as a guide to the scientific literature from the golden age of respiratory mechanics, 1960 - 2010. Specific topics covered include the contributions of surface tension and tissue forces to lung recoil, the gravitational deformation of the lung, and the interdependence forces that act on pulmonary airways and blood vessels. The geometry and kinematics of the ribs is also covered in detail, as well as the respiratory action of the external and internal intercostal muscles, the mechanics of the diaphragm, and the quantitative compartmental models of the chest wall is also described. Additionally, flow in the airways is covered thoroughly, including the wave-speed and viscous expiratory flow-limiting mechanisms; convection, diffusion and the stationary front; and the distribution of ventilation. This is an ideal book for respiratory ...

  10. Atypical presentation of distal renal tubular acidosis in two siblings.

    Tasic, Velibor; Korneti, Petar; Gucev, Zoran; Hoppe, Bernd; Blau, Nenad; Cheong, Hae Il

    2008-07-01

    Primary distal renal tubular acidosis (dRTA) is an inherited disease characterized by the inability of the distal tubule to lower urine pH hypokalemic paralysis. Laboratory investigations revealed proximal tubular dysfunction (low molecular weight proteinuria, generalized hyperaminoaciduria, hypophosphatemia with hyperphosphaturia, and hypouricemia with hyperuricosuria). There was significant hyperoxaluria and laboratory evidence for mild rhabdomyolysis. Under potassium and alkali therapy, proximal tubular abnormalities, muscular enzymes, and oxaluria normalized. A homozygous mutation in the ATP6V1B1 gene, which is responsible for dRTA with early hearing loss, was detected in both siblings. In conclusion, proximal tubular dysfunction and hyperoxaluria may be found in children with dRTA and are reversible under appropriate therapy. PMID:18386070

  11. Screening renal stone formers for distal renal tubular acidosis

    Osther, P J; Hansen, A B; Røhl, H F

    1989-01-01

    A group of 110 consecutive renal stone formers were screened for distal renal tubular acidosis (RTA) using morning fasting urinary pH (mfUpH) levels followed by a short ammonium chloride loading test in patients with levels above 6.0. In 14 patients (12.7%) a renal acidification defect was noted......; 13 had incomplete and 1 had complete distal RTA. Distal RTA was found particularly in recurrent stone formers (17%), and especially in those with bilateral stone disease, where a distal renal tubular acidification defect was found in 50%. We have been unable to differentiate primary from secondary...... RTA in renal stone formers. Regardless of whether the acidification defect is primary or secondary to stone formation, however, all renal stone formers with distal RTA can expect to benefit from prophylactic alkaline therapy and it is recommended that the screening procedure, which is easy to use in...

  12. Markers of acidosis and stress in a sprint versus a conducted electrical weapon.

    Ho, Jeffrey D; Dawes, Donald M; Nystrom, Paul C; Collins, Donal P; Nelson, Rebecca S; Moore, Johanna C; Miner, James R

    2013-12-10

    Both profound acidosis and catecholamine excess have been proposed as underlying physiologic derangements in subjects at high risk for arrest related death (ARD). In this study, the objective was to determine a level of physical exertion that is "equivalent" in terms of levels of acidosis and catecholamines to a "standard" TASER X26 exposure. Data were collected on subjects who underwent a 5-s TASER X26 exposure or a sprint of variable distances during a law enforcement training exercise. Our results show that levels of acidosis and catecholamines are less among subjects exposed to the TASER X26 than among subjects who sprinted 20 yards or more. PMID:24314505

  13. Treatment of respiratory failure in COPD

    Stephan Budweiser

    2008-12-01

    Full Text Available Stephan Budweiser1, Rudolf A Jörres2, Michael Pfeifer1,31Center for Pneumology, Hospital Donaustauf, Donaustauf, Germany; 2Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, Ludwig-Maximilians-University, Munich, Germany; 3Department of Internal Medicine II, Division of Respirology, University of Regensburg, Regensburg, GermanyAbstract: Patients with advanced COPD and acute or chronic respiratory failure are at high risk for death. Beyond pharmacological treatment, supplemental oxygen and mechanical ventilation are major treatment options. This review describes the physiological concepts underlying respiratory failure and its therapy, as well as important treatment outcomes. The rationale for the controlled supply of oxygen in acute hypoxic respiratory failure is undisputed. There is also a clear survival benefit from long-term oxygen therapy in patients with chronic hypoxia, while in mild, nocturnal, or exercise-induced hypoxemia such long-term benefits appear questionable. Furthermore, much evidence supports the use of non-invasive positive pressure ventilation in acute hypercapnic respiratory failure. It application reduces intubation and mortality rates, and the duration of intensive care unit or hospital stays, particularly in the presence of mild to moderate respiratory acidosis. COPD with chronic hypercapnic respiratory failure became a major indication for domiciliary mechanical ventilation, based on pathophysiological reasoning and on data regarding symptoms and quality of life. Still, however, its relevance for long-term survival has to be substantiated in prospective controlled studies. Such studies might preferentially recruit patients with repeated hypercapnic decompensation or a high risk for death, while ensuring effective ventilation and the patients’ adherence to therapy.Keywords: respiratory failure, COPD, mechanical ventilation, non-invasive ventilation long-term oxygen therapy, chronic

  14. Lactic acidosis, potassium, and the heart rate deflection point in professional road cyclists

    Lucia, A.; Hoyos, J; Santalla, A; Perez, M; Carvajal, A.; Chicharro, J.

    2002-01-01

    Objective: To determine the influence of lactic acidosis, the Bohr effect, and exercise induced hyperkalaemia on the occurrence of the heart rate deflection point (HRDP) in elite (professional) cyclists.

  15. Improving the welfare of dairy goats: Feeding behaviour identifies goats at risk of subacute rumen acidosis

    Giger-Reverdin, Sylvie; Sauvant, Daniel; Duvaux-Ponter, Christine

    2013-01-01

    Main messages: Feeding behaviour is highly variable between animals. Feeding behaviour modifies rumen pH pattern and occurrence of subacute ruminal acidosis (SARA). Avoiding SARA increases animal welfare, milk production and therefore farm profit - ability.

  16. Distal renal tubular acidosis and hypokalemic paralysis in a patient with hypothyroidism

    Parvaiz Ahmad Koul; Wahid, A.

    2011-01-01

    A 43- year- old woman on treatment for primary hypothyroidism presented with 1- day progressive weakness of all her limbs and history of similar episodes in the past. Clinical examination revealed grade 2 hyporeflexive weakness. Investigations revealed features of hypokalemia, metabolic acidosis, alkaline urine, and a fractional bicarbonate excretion of 3.5%, consistent with distal renal tubular acidosis. Antithyroid peroxidase and antithroglobulin antibodies were positive, suggesting an auto...

  17. Osteomalacia complicating renal tubular acidosis in association with Sjogren's syndrome.

    El Ati, Zohra; Fatma, Lilia Ben; Boulahya, Ghada; Rais, Lamia; Krid, Madiha; Smaoui, Wided; Maiz, Hedi Ben; Beji, Soumaya; Zouaghi, Karim; Moussa, Fatma Ben

    2014-09-01

    Renal involvement in Sjogren's syndrome (SS) is not uncommon and may precede other complaints. Tubulointerstitial nephritis is the most common renal disease in SS and may lead to renal tubular acidosis (RTA), which in turn may cause osteomalacia. Nevertheless, osteomalacia rarely occurs as the first manifestation of a renal tubule disorder due to SS. We herewith describe a 43-year-old woman who was admitted to our hospital for weakness, lumbago and inability to walk. X-ray of the long bones showed extensive demineralization of the bones. Laboratory investigations revealed chronic kidney disease with serum creatinine of 2.3 mg/dL and creatinine clearance of 40 mL/min, hypokalemia (3.2 mmol/L), hypophosphatemia (0.4 mmol/L), hypocalcemia (2.14 mmol/L) and hyperchloremic metabolic acidosis (chlorine: 114 mmol/L; alkaline reserve: 14 mmol/L). The serum alkaline phosphatase levels were elevated. The serum levels of 25-hydroxyvitamin D and 1,25-dihydroxy vitamin D were low and borderline low, respectively, and the parathyroid hormone level was 70 pg/L. Urinalysis showed inappropriate alkaline urine (urinary PH: 7), glycosuria with normal blood glucose, phosphaturia and uricosuria. These values indicated the presence of both distal and proximal RTA. Our patient reported dryness of the mouth and eyes and Schirmer's test showed xerophthalmia. An accessory salivary gland biopsy showed changes corresponding to stage IV of Chisholm and Masson score. Kidney biopsy showed diffuse and severe tubulo-interstitial nephritis with dense lymphoplasmocyte infiltrates. Sicca syndrome and renal interstitial infiltrates indicated SS as the underlying cause of the RTA and osteomalacia. The patient received alkalinization, vitamin D (Sterogyl ®), calcium supplements and steroids in an initial dose of 1 mg/kg/day, tapered to 10 mg daily. The prognosis was favorable and the serum creatinine level was 1.7 mg/dL, calcium was 2.2 mmol/L and serum phosphate was 0.9 mmol/L. PMID:25193912

  18. Respiratory Failure

    Ezgi Ozyilmaz

    2014-06-01

    Full Text Available The main function of the lungs is to maintain the exchange between the pulmonary capillary and the air in the alveoli. By this way, the arteriel oxygen and carbondioxide tension remains constant. Respiratory failure is a syndrome which is defined as the loss of the ability of respiratory system to exchange oxygen and carbondioxide elimination function. The main pathophysiological causes of respiratory failure include ventilation-perfusion mismatch, alveolar hypoventilation, impaired diffusion capacity and increased shunt. A number of diseases may result in respiratory failure by different pathophysiological reasons. The most common causes are Type 1 (hypoxemic and Type 2 (hypercapnic respiratory failure. When suspected with clinical signs and symptoms, the diagnosis should be confirmed with arterial blood gases. At this step, other diagnostic interventions, which could be performed, may be used to enlighten the underlying pathophysiological cause. Although the main therapeutic approach is similar, specific treatment are also required based on the underlying cause. The basic pathophysiological points, diagnosis and basic treatment approach have been evaluated in this review article. [Cukurova Med J 2014; 39(3.000: 428-442

  19. Distal renal tubular acidosis with multiorgan autoimmunity: a case report.

    van den Wildenberg, Maria J; Hoorn, Ewout J; Mohebbi, Nilufar; Wagner, Carsten A; Woittiez, Arend-Jan; de Vries, Peter A M; Laverman, Gozewijn D

    2015-04-01

    A 61-year-old woman with a history of pernicious anemia presented with progressive muscle weakness and dysarthria. Hypokalemic paralysis (serum potassium, 1.4 mEq/L) due to distal renal tubular acidosis (dRTA) was diagnosed. After excluding several possible causes, dRTA was considered autoimmune. However, the patient did not meet criteria for any of the autoimmune disorders classically associated with dRTA. She had very high antibody titers against parietal cells, intrinsic factor, and thyroid peroxidase (despite normal thyroid function). The patient consented to a kidney biopsy, and acid-base transporters, anion exchanger type 1 (AE1), and pendrin were undetectable by immunofluorescence. Indirect immunofluorescence detected diminished abundance of AE1- and pendrin-expressing intercalated cells in the kidney, as well as staining by the patient's serum of normal human intercalated cells and parietal cells expressing the adenosine triphosphatase hydrogen/potassium pump (H(+)/K(+)-ATPase) in normal human gastric mucosa. The dRTA likely is caused by circulating autoantibodies against intercalated cells, with possible cross-reactivity against structures containing gastric H(+)/K(+)-ATPase. This case demonstrates that in patients with dRTA without a classic autoimmune disorder, autoimmunity may still be the underlying cause. The mechanisms involved in autoantibody development and how dRTA can be caused by highly specific autoantibodies against intercalated cells have yet to be determined. PMID:25533600

  20. Pyruvate carboxylase deficiency: An underestimated cause of lactic acidosis

    F. Habarou

    2015-03-01

    Full Text Available Pyruvate carboxylase (PC is a biotin-containing mitochondrial enzyme that catalyzes the conversion of pyruvate to oxaloacetate, thereby being involved in gluconeogenesis and in energy production through replenishment of the tricarboxylic acid (TCA cycle with oxaloacetate. PC deficiency is a very rare metabolic disorder. We report on a new patient affected by the moderate form (the American type A. Diagnosis was nearly fortuitous, resulting from the revision of an initial diagnosis of mitochondrial complex IV (C IV defect. The patient presented with severe lactic acidosis and pronounced ketonuria, associated with lethargy at age 23 months. Intellectual disability was noted at this time. Amino acids in plasma and organic acids in urine did not show patterns of interest for the diagnostic work-up. In skin fibroblasts PC showed no detectable activity whereas biotinidase activity was normal. We had previously reported another patient with the severe form of PC deficiency and we show that she also had secondary C IV deficiency in fibroblasts. Different anaplerotic treatments in vivo and in vitro were tested using fibroblasts of both patients with 2 different types of PC deficiency, type A (patient 1 and type B (patient 2. Neither clinical nor biological effects in vivo and in vitro were observed using citrate, aspartate, oxoglutarate and bezafibrate. In conclusion, this case report suggests that the moderate form of PC deficiency may be underdiagnosed and illustrates the challenges raised by energetic disorders in terms of diagnostic work-up and therapeutical strategy even in a moderate form.

  1. Acidosis environment promotes osteoclast formation by acting on the last phase of preosteoclast differentiation: a study to elucidate the action points of acidosis and search for putative target molecules.

    Kato, Kohtaro; Morita, Ikuo

    2011-08-01

    Acidosis promoted tartaric acid-resistant acid phosphatase-positive multinuclear cell (TRAP+MNC) or osteoclast formation. Large osteoclast or TRAP+LMNC formation was observed far more in an acidosis environment than in a physiologically neutral environment. One of the major action points of acidosis was determined to be located in the last phase of preosteoclast differentiation using a co-culture system and a soluble RANKL-dependent bone marrow cell culture system. On-going osteoclast formation in an acidosis environment markedly deteriorated when the medium was replaced with physiologically neutral medium within the first 6h; however, bone marrow cells previously stimulated in an acidosis environment for 9h differentiated into TRAP+LMNC in pH 7.4 medium. Messenger RNA (mRNA) expression levels of DC-STAMP, a key molecule in cell fusion, and NFATc1 did not increase in the acidosis environment compared with those under physiologically neutral conditions. Ruthenium red, a general TRP antagonist, deteriorated acidosis-promoted TRAP+LMNC formation. 4-Alpha-PDD, a TRPV4-specific agonist, added in the last 21 h of preosteoclast differentiation, potentiated TRAP+LMNC formation in a mild acidosis environment, showing synergism between TRPV4 activation and acidosis. RN1734, a TRPV4-specific antagonist, partly inhibited acidosis-promoted TRAP+LMNC formation. We thus narrowed down the major action points of acidosis in osteoclast formation and elucidated the characteristics of this system in detail. Our results show that acidosis effectively uses TRPV4 to drive large-scale cell fusion and also utilizes systems independently of TRPV4. PMID:21575626

  2. A Rare Case of Type I RenalTubular Acidosis with Membranous Nephropathy Presenting as Hypokalemic Paralysis

    Sunder, Sham; Sathi, Satyanand; K Venkataramanan; Verma, Himanshu; Bhardwaj, Minakshi; Rajesh, J.; Mahapatra, Himanshu

    2013-01-01

    Type 1 renal tubular acidosis (RTA), or distal RTA (dRTA), is a disorder of renal tubular acidification, which is generally asymptomatic but may rarely present as hypokalemic paralysis. Here, we report the case of a young male who presented with sudden onset weakness of all 4 limbs and a 2-month history of swelling of the legs. An investigation revealed hypokalemia, metabolic acidosis, and nephrotic syndrome. Additional analyses revealed normal anion gap metabolic acidosis with a positive uri...

  3. RESPIRATORY SYSTEM

    2004-01-01

    9. 1 Upper respiratory tract disease and bronchial asthma2004223 Inhibitive effect on airway mucus overproduction of DNA vaccine based on xenogeneic homologous calcium-activated chloride channel in asthmatic mice. SONG Liqiang (宋立强), et al. Dept Respir Med, Xijing Hosp , 4th Milit Med Univ, Xi’an 710032. Natl Med J China 2004;84(4):329-333.

  4. Effect of sodium bicarbonate administration on mortality in patients with lactic acidosis: a retrospective analysis.

    Hyun Jeong Kim

    Full Text Available BACKGROUND: Lactic acidosis is a common cause of high anion gap metabolic acidosis. Sodium bicarbonate may be considered for an arterial pH <7.15 but paradoxically depresses cardiac performance and exacerbates acidosis by enhancing lactate production. This study aimed to evaluate the cause and mortality rate of lactic acidosis and to investigate the effect of factors, including sodium bicarbonate use, on death. METHODS: We conducted a single center analysis from May 2011 through April 2012. We retrospectively analyzed 103 patients with lactic acidosis among 207 patients with metabolic acidosis. We used SOFA and APACHE II as severity scores to estimate illness severity. Multivariate logistic regression analysis and Cox regression analysis models were used to identify factors that affect mortality. RESULTS: Of the 103 patients with a mean age of 66.1±11.4 years, eighty-three patients (80.6% died from sepsis (61.4%, hepatic failure, cardiogenic shock and other causes. The percentage of sodium bicarbonate administration (p = 0.006, catecholamine use, ventilator care and male gender were higher in the non-survival group than the survival group. The non-survival group had significantly higher initial and follow-up lactic acid levels, lower initial albumin, higher SOFA scores and APACHE II scores than the survival group. The mortality rate was significantly higher in patients who received sodium bicarbonate. Sodium bicarbonate administration (p = 0.016 was associated with higher mortality. Independent factors that affected mortality were SOFA score (Exp (B = 1.72, 95% CI = 1.12-2.63, p = 0.013 and sodium bicarbonate administration (Exp (B = 6.27, 95% CI = 1.10-35.78, p = 0.039. CONCLUSIONS: Lactic acidosis, which has a high mortality rate, should be evaluated in patients with metabolic acidosis. In addition, sodium bicarbonate should be prescribed with caution in the case of lactic acidosis because sodium bicarbonate

  5. Haptoglobin and serum amyloid a in subacute ruminal acidosis in goats

    F.H.D. González

    2010-12-01

    Full Text Available Ruminal acidosis is a frequent disorder that occurs in goats as a consequence of feedingmistakes in animals not adapted to a diet of easily fermentable carbohydrates. The subacuteform of the disease is difficult to diagnose because no apparent signs are shownand the acid-base parameters may remain within the normal range. The present studyaimed at testing the hypothesis that haptoglobin (Hp and serum amyloid A (SAA,the two major acute phase proteins in ruminants, may be useful as markers of subacuteacidosis in goats.A subacute acidosis was induced in six Murciano-Granadina goats through a diet of60% mixed feed-40% alfalfa hay offered during 5 days to goats not adapted to eatmixed feed. Two goats were rumen-fistulated to investigate the effect of feeding onruminal pH. Sampling of blood and urine of all animals was done before the inductionof the acidosis, during 5 days after the onset of induction and for 18 days after theinduction (recovery period.Ruminal pH in the fistulated goats dropped to less than 5.5 during the inductionperiod, and half of the goats had diarrhea on the third day after the induction of acidosis.Acid-base parameters showed that the acid-base compensatory mechanisms wereefficient in maintaining the equilibrium. Serum Hp had a moderate increase duringthe induction period, while SAA did not change. These results suggest that Hp mightbe a potential marker for ruminal acidosis in goats.

  6. Respiratory Distress

    1976-01-01

    The University of Miami School of Medicine asked the Research Triangle Institute for assistance in improvising the negative pressure technique to relieve respiratory distress in infants. Marshall Space Flight Center and Johnson Space Center engineers adapted this idea to the lower-body negative-pressure system seals used during the Skylab missions. Some 20,000 babies succumb to respiratory distress in the U.S. each year, a condition in which lungs progressively lose their ability to oxygenate blood. Both positive and negative pressure techniques have been used - the first to force air into lungs, the second to keep infant's lungs expanded. Negative pressure around chest helps the baby expand his lungs and maintain proper volume of air. If doctors can keep the infant alive for four days, the missing substance in the lungs will usually form in sufficient quantity to permit normal breathing. The Skylab chamber and its leakproof seals were adapted for medical use.

  7. Acidosis láctica por metformina desencadenada por una insuficiencia renal aguda Metformin-induced lactic acidosis due to acute renal failure

    M.D. Macías-Robles

    2011-04-01

    Full Text Available La acidosis láctica es una complicación grave pero infrecuente asociada al empleo de metformina. Se discuten los mecanismos fisiopatológicos implicados en la acidosis láctica, con especial atención al papel potencial del fármaco. Presentamos un caso severo de este efecto secundario de la metformina en una paciente con diabetes tipo 2 que ingresó en el Servicio de Urgencias Hospitalario por un cuadro de insuficiencia renal aguda. El diagnóstico quedó apoyado por unos niveles séricos elevados de la biguanida, procedimiento escasamente utilizado en la práctica clínica. El tratamiento consiste en suspender la administración del fármaco e iniciar de forma inmediata la hemodiálisis con bicarbonato, lo cual proporciona un tratamiento sintomático y etiológico al eliminar del suero tanto el lactato como el antidiabético oral. Los síntomas de la acidosis láctica por metformina son inespecíficos y el comienzo es sutil, lo que hace necesario un alto nivel de sospecha para establecer un diagnostico precoz.Lactic acidosis is a serious but uncommon side effect of metformin use. We discuss the pathophysiological mechanisms of lactic acidosis with particular regard to the role played by the drug as a potential cause of the entity. We report on a severe case of this kind of drug toxicity in a patient with type 2 diabetes mellitus, admitted to the emergency department with acute renal failure symptoms. The diagnosis was supported by elevated serum levels of the biguanide, a procedure scarcely used in clinical practice. The management of this complication consists in drug discontinuation and hemodialysis with bicarbonate that provides symptomatic and ethiological treatment by removing both the lactate and the hypoglycemic agent from the serum. Since the symptoms of metformin-associated lactic acidosis are unspecific and its onset is subtle, a high level of suspicion is needed to establish an early diagnosis.

  8. Hypokalemic periodic paralysis in Sjogren's syndrome secondary to distal renal tubular acidosis.

    Yılmaz, Hakkı; Kaya, Mustafa; Özbek, Mustafa; ÜUreten, Kemal; Safa Yıldırım, İ

    2013-07-01

    We report a 53-year-old Turkish female presented with progressive weakness and mild dyspnea. Laboratory results demonstrated severe hypokalemia with hyperchloremic metabolic acidosis. The urinary anion gap was positive in the presence of acidemia, thus she was diagnosed with hypokalemic paralysis from a severe distal renal tubular acidosis (RTA). Immunologic work-up showed a strongly positive ANA of 1:3,200 and positive antibodies to SSA and SSB. Schirmer's test was abnormal. Autoimmune and other tests revealed Sjögren syndrome as the underlying cause of the distal renal tubular acidosis. Renal involvement in Sjogren's syndrome (SS) is not uncommon and may precede sicca complaints. The pathology in most cases is a tubulointerstitial nephritis causing among other things, distal RTA, and, rarely, hypokalemic paralysis. Treatment consists of potassium repletion, alkali therapy, and corticosteroids. Primary SS could be a differential in women with acute weakness and hypokalemia. PMID:22212410

  9. Renal Tubular Acidosis after Jejunoileal Bypass for Morbid Obesity: role of secondary hyperparathyroidism

    Andersen, NN; Ladefoged, NN

    1991-01-01

    The effect of calcium infusion was studied in patients with renal tubular acidosis (RTA) and secondary hyperparathyroidism. Both developed after jejunoileal bypass operation (JIB) for morbid obesity. In three of four cases the acidification defect was abolished, probably due to a decrease of serum...... parathyroid hormone. As we found RTA in 9% (95% confidence limits 2-21%) of our patients, screening for acidosis is recommended in obesity patients after malabsorptive operations. RTA can be verified through an ammonium loading test. Before deciding on re-establishing bowel continuity due to RTA, we suggest...

  10. Indomethacin abolishes cerebral blood flow increase in response to acetazolamide-induced extracellular acidosis

    Wang, Qian; Paulson, O B; Lassen, N A

    1993-01-01

    by acetazolamide (Az), a drug that induces brain extracellular acidosis, which triggers its effect on CBF. We compared the results to the inhibitory effect of indomethacin on the CBF increase during hypercapnia. Indomethacin but not diclofenac, another potent cyclooxygenase inhibitor, was found to...... block almost completely the CBF increase caused by Az-induced extracellular acidosis or by CO2, but it did not influence the CBF increase produced by sodium nitroprusside or papaverine. The results suggest that indomethacin exerts its action on CO2 reactivity by a nonprostaglandin-mediated mechanism...

  11. Distal renal tubular acidosis and hypokalemic paralysis in a patient with hypothyroidism

    Parvaiz Ahmad Koul

    2011-01-01

    Full Text Available A 43- year- old woman on treatment for primary hypothyroidism presented with 1- day progressive weakness of all her limbs and history of similar episodes in the past. Clinical examination revealed grade 2 hyporeflexive weakness. Investigations revealed features of hypokalemia, metabolic acidosis, alkaline urine, and a fractional bicarbonate excretion of 3.5%, consistent with distal renal tubular acidosis. Antithyroid peroxidase and antithroglobulin antibodies were positive, suggesting an autoimmune basis for the pathogenesis of the functional tubular defect. Bicarbonate therapy resulted in a sustained clinical recovery.

  12. Distal renal tubular acidosis and hypokalemic paralysis in a patient with hypothyroidism.

    Koul, Parvaiz Ahmad; Wahid, A

    2011-09-01

    A 43- year- old woman on treatment for primary hypothyroidism presented with 1- day progressive weakness of all her limbs and history of similar episodes in the past. Clinical examination revealed grade 2 hyporeflexive weakness. Investigations revealed features of hypokalemia, metabolic acidosis, alkaline urine, and a fractional bicarbonate excretion of 3.5%, consistent with distal renal tubular acidosis. Antithyroid peroxidase and antithroglobulin antibodies were positive, suggesting an autoimmune basis for the pathogenesis of the functional tubular defect. Bicarbonate therapy resulted in a sustained clinical recovery. PMID:21912036

  13. Identification of neonatal near miss by systematic screening for metabolic acidosis at birth

    Bonnaerens, A.; Thaens, A.; Mesens, T.; Van Holsbeke, C; E. T. M. de Jonge; Gyselaers, Wilfried

    2011-01-01

    Aims: To evaluate the relevance of systematic screening for neonatal metabolic acidosis at birth as part of perinatal audit. Methods: For every baby, born in Ziekenhuis Oost Limburg, Genk Belgium between 1/1/2010 and 31/12/2010, cord blood was analysed to diagnose metabolic acidosis, defined as arterial or venous pH ≤ 7.05 or 7.17 respectively, in association with base excess of ≤ -10 mmol/L. Three observers identified indicators for suboptimal peripartal care with likely contribution to ...

  14. Calcium citrate improves the epithelial-to-mesenchymal transition induced by acidosis in proximal tubular cells

    Maria José Rodriguez Cabalgante; Liliana Gadola; Leonella Luzardo; María Márquez; José Boggia; Mirian Aparecida Boim

    2012-01-01

    INTRODUCTION: Epithelial-to-mesenchymal transition (EMT) is a key event in renal fibrosis. The aims of the study were to evaluate acidosis induced EMT, transforming-growth-factor (TGF) β1 role and citrate effect on it. METHODS: HK2 cells (ATCC 2290) were cultured in DMEM/HAM F12 medium, pH 7.4. At 80% confluence, after 24 hr under serum free conditions, cells were distributed in three groups (24 hours): A) Control: pH 7.4, B) Acidosis: pH 7.0 and C) Calcium citrate (0.2 mmol/L) + pH 7.0. Chan...

  15. [Gastric emptying and metabolic acidosis. III. Study of gastric retention of a sodium citrate solution using an experimental model of metabolic acidosis in rats].

    Baracat, E C; Collares, E F

    1992-01-01

    The gastric emptying of sodium citrate solution 0.25 mEq/ml was studied in rats with metabolic acidosis induced by orogastric infusion of 0.5 M ammonium chloride solution. Two control groups were used: one infused with 0.5 M sodium chloride and the other with water. The 3 solutions content was 2 ml/100 g weight of the animal. Six hours after the infusion, there was a moderate metabolic acidosis in the group with ammonium citrate. This 6 hour interval marked the beginning of the gastric emptying study. The test meal (sodium citrate 0.25 mEq/ml) was utilized containing 6 mg% red fenol as a marker. The gastric emptying of sodium citrate was studied at 5, 10, 20 and 30 minutes after the infusion, and the results showed no differences between the 3 groups. The data suggest that the duodenal receptors to pH were more effective do determine the pattern of gastric response than the acidosis. PMID:1339143

  16. Respiratory System

    2007-01-01

    8.1 Respiratory failure2007204 Comparison of the effects of BiPAP ventilation combined with lung recruitment maneuvers and low tidal volume A/C ventilation in patients with acute respiratory distress syndrome. WANG Xiaozhi(王晓芝),et al. Dept Respir & Intensive Care Unit, Binzhou Med Coll, Binzhou 256603. Chin J Tuberc Respir Dis 2007;30(1):44-47. Objective To compare the effects of BiPAP ventilation combined with lung recruitment maneuvers(LRM) with low tidal volume A/C ventilation in patients with acute respiratory distress syndrome (ARDS). Methods A prospective, randomized comparison of BiPAP mechanical ventilation combined with lung recruitment maneuvers(test group) with low tidal volume A/C ventilation (control group) was conducted in 28 patients with ARDS. FiO2/PaO2 ratio, respiratory system compliance(Cs), central venous pressure (CVP), duration of ventilation support were recorded at 0 h, 48 h and 72 h separately. The ventilation associated lung injury and mortality at 28 d were also recorded. Results The FiO2/PaO2 ratio were (298±16) and (309±16) cm H2O, Cs were (38.4±2.2) and (42.0±1.3) ml/cm H2O, CVP were (13.8±0.8) and (11.6±0.7) cm H2O in the test group at 48 h and 72 h separately. In the control group, FiO2/PaO2 ratio were (212±12) and (246±17) cm H2O, Cs were (29.5±1.3) and (29.0±1.0) ml/cm H2O, CVP were 18.6±1.1 and (16.8±1.0) cm H2O. The results were better in the test group as compared with the control group (t=10.03-29. 68, all P<0.01). The duration of ventilation support in the test group was shorter than the control group [(14±3) d vs (19±3)d, t=4.80, P<0.01]. The mortality in 28 d and ventilation associated lung injury were similar in the two groups. Conclusion The results show that combination of LRM with BiPAP mode ventilation, as compared with the control group, contributes to the improved FiO2/PaO2 ratio, pulmonary compliance, stable homodynamic and shorter duration of ventilation support in patients with ARDs.

  17. Acute respiratory distress syndrome assessment after traumatic brain injury

    Shahrooz Kazemi

    2016-01-01

    Full Text Available Background: Acute respiratory distress syndrome (ARDS is one of the most important complications associated with traumatic brain injury (TBI. ARDS is caused by inflammation of the lungs and hypoxic damage with lung physiology abnormalities associated with acute respiratory distress syndrome. Aim of this study is to determine the epidemiology of ARDS and the prevalence of risk factors. Methods: This prospective study performed on patients with acute traumatic head injury hospitalization in the intensive care unit of the Shohaday-e Haftom-e-Tir Hospital (September 2012 to September 2013 done. About 12 months, the data were evaluated. Information including age, sex, education, employment, drug and alcohol addiction, were collected and analyzed. The inclusion criteria were head traumatic patients and exclusion was the patients with chest trauma. Questionnaire was designed with doctors supervision of neurosurgery. Then the collected data were analysis. Results: In this study, the incidence of ARDS was 23.8% and prevalence of metabolic acidosis was 31.4%. Most injury with metabolic acidosis was Subarachnoid hemorrhage (SAH 48 (60% and Subdural hemorrhage (SDH was Next Level with 39 (48% Correlation between Glasgow Coma Scale (GCS and Respiratory Distress Syndrome (ARDS were significantly decreased (P< 0.0001. The level of consciousness in patients with skull fractures significantly lower than those without fractures (P= 0.009 [(2.3±4.6 vs (4.02±7.07]. Prevalence of metabolic acidosis during hospitalization was 80 patients (31.4%. Conclusion: Acute respiratory distress syndrome is a common complication of traumatic brain injury. Management and treatment is essential to reduce the mortality. In this study it was found the age of patients with ARDS was higher than patients without complications. ARDS risk factor for high blood pressure was higher in men. Most victims were pedestrians. The most common injury associated with ARDS was SDH. Our analysis

  18. Scalp blood lactate for intra-partum assessment of fetal metabolic acidosis

    Heinis, A.M.; Spaanderman, M.E.A.; Gunnewiek, J.M.; Lotgering, F.K.

    2011-01-01

    Objective. To study to what extent the fetal scalp blood lactate concentration during labor correlates with fetal scalp pH and base deficit, and metabolic acidosis at birth, and to suggest lactate cut-off values to serve as indicators for either reassurance or immediate intervention. Design. A retro

  19. Tumour-specific metabolic adaptation to acidosis is coupled to epigenetic stability in osteosarcoma cells.

    Chano, Tokuhiro; Avnet, Sofia; Kusuzaki, Katsuyuki; Bonuccelli, Gloria; Sonveaux, Pierre; Rotili, Dante; Mai, Antonello; Baldini, Nicola

    2016-01-01

    The glycolytic-based metabolism of cancers promotes an acidic microenvironment that is responsible for increased aggressiveness. However, the effects of acidosis on tumour metabolism have been almost unexplored. By using capillary electrophoresis with time-of-flight mass spectrometry, we observed a significant metabolic difference associated with glycolysis repression (dihydroxyacetone phosphate), increase of amino acid catabolism (phosphocreatine and glutamate) and urea cycle enhancement (arginino succinic acid) in osteosarcoma (OS) cells compared with normal fibroblasts. Noteworthy, metabolites associated with chromatin modification, like UDP-glucose and N(8)-acetylspermidine, decreased more in OS cells than in fibroblasts. COBRA assay and acetyl-H3 immunoblotting indicated an epigenetic stability in OS cells than in normal cells, and OS cells were more sensitive to an HDAC inhibitor under acidosis than under neutral pH. Since our data suggest that acidosis promotes a metabolic reprogramming that can contribute to the epigenetic maintenance under acidosis only in tumour cells, the acidic microenvironment should be considered for future therapies. PMID:27186436

  20. Severity and Nature of Acidosis in Diarrheic Calves Over and Under One Week of Age

    Naylor, Jonathan M.

    1987-01-01

    A prospective study of the severity of dehydration and acidosis was carried out in 42 calves under 35 days of age presented for treatment of neonatal diarrhea. Clinically the mean level of dehydration was 8 to 10%. The plasma volume was 65% of that in the hydrated calf but the calves only gained 6.5% in weight during therapy.

  1. Tumour-specific metabolic adaptation to acidosis is coupled to epigenetic stability in osteosarcoma cells

    Chano, Tokuhiro; Avnet, Sofia; Kusuzaki, Katsuyuki; Bonuccelli, Gloria; Sonveaux, Pierre; Rotili, Dante; Mai, Antonello; Baldini, Nicola

    2016-01-01

    The glycolytic-based metabolism of cancers promotes an acidic microenvironment that is responsible for increased aggressiveness. However, the effects of acidosis on tumour metabolism have been almost unexplored. By using capillary electrophoresis with time-of-flight mass spectrometry, we observed a significant metabolic difference associated with glycolysis repression (dihydroxyacetone phosphate), increase of amino acid catabolism (phosphocreatine and glutamate) and urea cycle enhancement (arginino succinic acid) in osteosarcoma (OS) cells compared with normal fibroblasts. Noteworthy, metabolites associated with chromatin modification, like UDP-glucose and N8-acetylspermidine, decreased more in OS cells than in fibroblasts. COBRA assay and acetyl-H3 immunoblotting indicated an epigenetic stability in OS cells than in normal cells, and OS cells were more sensitive to an HDAC inhibitor under acidosis than under neutral pH. Since our data suggest that acidosis promotes a metabolic reprogramming that can contribute to the epigenetic maintenance under acidosis only in tumour cells, the acidic microenvironment should be considered for future therapies. PMID:27186436

  2. Lungs and Respiratory System

    ... to Know About Zika & Pregnancy Lungs and Respiratory System KidsHealth > For Parents > Lungs and Respiratory System Print ... have taken at least 600 million breaths. Respiratory System Basics All of this breathing couldn't happen ...

  3. Respiratory Issues in OI

    ... delivery, and other respiratory disorders may lead to respiratory failure and death particularly in people with OI Type ... have OI. It is a sobering fact that respiratory failure is the leading cause of death for people ...

  4. Lactic acidosis occurrence during exercises in the smoke chamber in a 53-year-old firefighter with no significant medical history

    Agata Bronisz

    2014-04-01

    Full Text Available Lactic acidosis is a form of metabolic acidosis with a high anion gap, reduced rate of arterial blood pH under 7.35 mmol/l, and lactic acid concentration over 7 mmol/l. In the literature we can find some descriptions of the cases of lactic acidosis in patients with severe systemic diseases (cancer, acquired immunodeficiency syndrome, sepsis, diabetes with cardiovascular disease and after organ transplantations. We present the case of lactic acidosis in a patient with no chronic disease - a firefighter in whom lactic acidosis has developed during standard exercises in the smoke chamber.

  5. Construction and validation of a decision tree for treating metabolic acidosis in calves with neonatal diarrhea

    Trefz Florian M

    2012-12-01

    Full Text Available Abstract Background The aim of the present prospective study was to investigate whether a decision tree based on basic clinical signs could be used to determine the treatment of metabolic acidosis in calves successfully without expensive laboratory equipment. A total of 121 calves with a diagnosis of neonatal diarrhea admitted to a veterinary teaching hospital were included in the study. The dosages of sodium bicarbonate administered followed simple guidelines based on the results of a previous retrospective analysis. Calves that were neither dehydrated nor assumed to be acidemic received an oral electrolyte solution. In cases in which intravenous correction of acidosis and/or dehydration was deemed necessary, the provided amount of sodium bicarbonate ranged from 250 to 750 mmol (depending on alterations in posture and infusion volumes from 1 to 6.25 liters (depending on the degree of dehydration. Individual body weights of calves were disregarded. During the 24 hour study period the investigator was blinded to all laboratory findings. Results After being lifted, many calves were able to stand despite base excess levels below −20 mmol/l. Especially in those calves, metabolic acidosis was undercorrected with the provided amount of 500 mmol sodium bicarbonate, which was intended for calves standing insecurely. In 13 calves metabolic acidosis was not treated successfully as defined by an expected treatment failure or a measured base excess value below −5 mmol/l. By contrast, 24 hours after the initiation of therapy, a metabolic alkalosis was present in 55 calves (base excess levels above +5 mmol/l. However, the clinical status was not affected significantly by the metabolic alkalosis. Conclusions Assuming re-evaluation of the calf after 24 hours, the tested decision tree can be recommended for the use in field practice with minor modifications. Calves that stand insecurely and are not able to correct their position if pushed

  6. Middle East Respiratory Syndrome

    2014-07-07

    This podcast discusses Middle East Respiratory Syndrome, or MERS, a viral respiratory illness caused by Middle East Respiratory Syndrome Coronavirus—MERS-CoV.  Created: 7/7/2014 by National Center for Immunization and Respiratory Diseases (NCIRD).   Date Released: 7/7/2014.

  7. The acidosis-induced right shift of the HbO2 dissociation curve is maintained during erythrocyte storage

    Opdahl, Helge; Strømme, Tæwje A; Jørgensen, Lise; Bajelan, Livia; Heier, Hans E

    2011-01-01

    Background and objectives . In fresh blood, tissue hypoxia increases microcirculatory acidosis, which enhances erythrocyte O2 unloading and increases the amount of available O2. Storage of eryfhrocytes increases the HbO2 affinity and reduces O2 unloading. We examined the development of the affinity change during a period of 5 weeks of storage by present blood bank standards, and investigated to what extent acidosis offsets the affinity change. Materials and methods . Blood from volunteer dono...

  8. Rumen microbial and fermentation characteristics are affected differently by bacterial probiotic supplementation during induced lactic and subacute acidosis in sheep

    Lettat Abderzak

    2012-07-01

    Full Text Available Abstract Background Ruminal disbiosis induced by feeding is the cause of ruminal acidosis, a digestive disorder prevalent in high-producing ruminants. Because probiotic microorganisms can modulate the gastrointestinal microbiota, propionibacteria- and lactobacilli-based probiotics were tested for their effectiveness in preventing different forms of acidosis. Results Lactic acidosis, butyric and propionic subacute ruminal acidosis (SARA were induced by feed chalenges in three groups of four wethers intraruminally dosed with wheat, corn or beet pulp. In each group, wethers were either not supplemented (C or supplemented with Propionibacterium P63 alone (P or combined with L. plantarum (Lp + P or L. rhamnosus (Lr + P. Compared with C, all the probiotics stimulated lactobacilli proliferation, which reached up to 25% of total bacteria during wheat-induced lactic acidosis. This induced a large increase in lactate concentration, which decreased ruminal pH. During the corn-induced butyric SARA, Lp + P decreased Prevotella spp. proportion with a concomitant decrease in microbial amylase activity and total volatile fatty acids concentration, and an increase in xylanase activity and pH. Relative to the beet pulp-induced propionic SARA, P and Lr + P improved ruminal pH without affecting the microbial or fermentation characteristics. Regardless of acidosis type, denaturing gradient gel electrophoresis revealed that probiotic supplementations modified the bacterial community structure. Conclusion This work showed that the effectiveness of the bacterial probiotics tested depended on the acidosis type. Although these probiotics were ineffective in lactic acidosis because of a deeply disturbed rumen microbiota, some of the probiotics tested may be useful to minimize the occurrence of butyric and propionic SARA in sheep. However, their modes of action need to be further investigated.

  9. A Rare Cause of Metabolic Acidosis: Fatal Transdermal Methanol Intoxication in an Infant.

    Sahbudak Bal, Zumrut; Can, Fulya Kamit; Anil, Ayse Berna; Bal, Alkan; Anil, Murat; Gokalp, Gamze; Yavascan, Onder; Aksu, Nejat

    2016-08-01

    Oral methanol intoxication is common, but dermal intoxication is rare. We report a previously healthy 19-month-old female infant admitted to the emergency department (ED) with vomiting and tonic-clonic seizure. On physical examination, she was comatose and presented signs of decompensated shock with Kussmaul breathing. Her left thigh was edematous, with purple coloration. Methanol intoxication was suspected due to high anion gap metabolic acidosis (pH, 6.89; HCO3, occipital lobe were detected by computed tomography of the brain. The patient died after 7 days.Although methanol intoxication occurs predominantly in adults, it must be considered in children with high-anion gap metabolic acidosis. This case report demonstrates that fatal transdermal methanol intoxication can occur in children, and it is the second report in the English literature of transdermal methanol intoxication in an infant. PMID:26196361

  10. Alteration in Fecal Microbiota Associated with Grain-induced Subacute Ruminal Acidosis Challenge in Dairy Cows

    Danscher, Anne Mette; Derakshani, Hooman; Li, Shucong;

    2014-01-01

    Introduction: High prevalence of subacute rumen acidosis (SARA) in dairy herds has been reported with large impact on production and welfare. The field diagnosis of SARA is currently unclear and primarily based on point measurements of rumen pH, which are inaccurate. Consequently, SARA cases in t...... markers of the disease. bovine, subacute ruminal acidosis, fecal microbiome, biological marker Host publication information...... field are often not detected. Thus, other and better markers of SARA are needed. The purpose of this research was to study the feces microbiome during SARA and assess the possibilities of using feces microbial markers as indicators of SARA. Methods: Six lactating, rumen cannulated, Danish Holstein cows...... predictive value was estimated to R2: 87.0 and Q2: 73.2, respectively. Conclusion: Results confirm that intensive grain feeding changes the feces microbiome. The identification of specific taxa characteristic of SARA could provide new knowledge of the pathogenesis and might be useful as future biological...

  11. Rapid Revival of a Patient after very Severe Metabolic Acidosis: A Case Report

    Sajad Ahmadi

    2013-01-01

    Full Text Available Background: Metabolic acidosis is a fatal finding in trauma patients thatcomplicates the process of resuscitation.Case: The case was a 37-year-old man with open fracture in both legs and fracturein second lumbar vertebral (L2. The serial arterial blood gas (ABG test resultsshowed a pH value of 6.7 indicating a very severe and special case of metabolicacidosis. The rate of mortality for such a case was very high. The patient wastreated with sodium bicarbonate and successfully revived after four hours posttreatment and metabolic acidosis was resolved.Conclusion: This indicated that bicarbonate administration is useful for verysevere cases. The good condition of the patient after survival from the severeacademia allowed for extubation.

  12. Hyperchloremic Metabolic Acidosis due to Cholestyramine: A Case Report and Literature Review.

    Kamar, Fareed B; McQuillan, Rory F

    2015-01-01

    Cholestyramine is a bile acid sequestrant that has been used in the treatment of hypercholesterolemia, pruritus due to elevated bile acid levels, and diarrhea due to bile acid malabsorption. This medication can rarely cause hyperchloremic nonanion gap metabolic acidosis, a complication featured in this report of an adult male with concomitant acute kidney injury. This case emphasizes the caution that must be taken in prescribing cholestyramine to patients who may also be volume depleted, in renal failure, or taking spironolactone. PMID:26425378

  13. Muscle oxidative metabolism accelerates with mild acidosis during incremental intermittent isometric plantar flexion exercise

    Homma, Toshiyuki; Hamaoka, Takafumi; Sako, Takayuki; Murakami, Motohide; Esaki, Kazuki; Kime, Ryotaro; Katsumura, Toshihito

    2005-01-01

    Background It has been thought that intramuscular ADP and phosphocreatine (PCr) concentrations are important regulators of mitochondorial respiration. There is a threshold work rate or metabolic rate for cellular acidosis, and the decrease in muscle PCr is accelerated with drop in pH during incremental exercise. We tested the hypothesis that increase in muscle oxygen consumption (o2mus) is accelerated with rapid decrease in PCr (concomitant increase in ADP) in muscles with drop in pH occurs d...

  14. Dermal bone in early tetrapods: a palaeophysiological hypothesis of adaptation for terrestrial acidosis

    Janis, Christine M.; Devlin, Kelly; Warren, Daniel E.; Witzmann, Florian

    2012-01-01

    The dermal bone sculpture of early, basal tetrapods of the Permo-Carboniferous is unlike the bone surface of any living vertebrate, and its function has long been obscure. Drawing from physiological studies of extant tetrapods, where dermal bone or other calcified tissues aid in regulating acid–base balance relating to hypercapnia (excess blood carbon dioxide) and/or lactate acidosis, we propose a similar function for these sculptured dermal bones in early tetrapods. Unlike the condition in m...

  15. Sjögren’s, Renal Tubular Acidosis And Osteomalacia - An Asian Indian Series

    Sandhya, Pulukool; Danda, Debashish; Rajaratnam, Simon; Thomas, Nihal

    2014-01-01

    Objective: To study the profile of Renal Tubular Acidosis (RTA) in Asian Indian patients with Primary Sjögren's Syndrome (pSS). Methods: The Electronic medical records of patients with a diagnosis of pSS seen between 2003 and 2010 at our tertiary care teaching hospital were screened for RTA. Clinical features, immunological profile, acid-base balance and electrolyte status, 25-hydroxyvitamin D (25(OH) D3) levels, histopathological changes in minor salivary gland biopsy samples and radiologica...

  16. Management of Metformin-Associated Lactic Acidosis by Continuous Renal Replacement Therapy

    Keller, Geoffray; Cour, Martin; Hernu, Romain; Illinger, Julien; Robert, Dominique; Argaud, Laurent

    2011-01-01

    Background Metformin-associated lactic acidosis (MALA) is a severe metabolic failure with high related mortality. Although its use is controversial, intermittent hemodialysis is reported to be the most frequently used treatment in conjunction with nonspecific supportive measures. Our aim was to report the evolution and outcome of cases managed by continuous renal replacement therapy (CRRT). Methodology and Principal Findings Over a 3-year period, we retrospectively identified patients admitte...

  17. Multiplexed Microneedle-based Biosensor Array for Characterization of Metabolic Acidosis

    Miller, Philip R; Skoog, Shelby A.; Edwards, Thayne L.; Lopez, DeAnna M.; David R. Wheeler; Dulce C Arango; Xiao, Xiaoyin; Brozik, Susan M.; Wang, Joseph; Polsky, Ronen; Roger J. Narayan

    2011-01-01

    The development of a microneedle-based biosensor array for multiplexed in situ detection of exercise-induced metabolic acidosis, tumor microenvironment, and other variations in tissue chemistry is described. Simultaneous and selective amperometric detection of pH, glucose, and lactate over a range of physiologically-relevant concentrations in complex media is demonstrated. Furthermore, materials modified with a cell-resistant (Lipidure®) coating were shown to inhibit macrophage adhesion; no s...

  18. Hearing impairment in association with distal renal tubular acidosis among Saudi children.

    Zakzouk, S M; Sobki, S H; Mansour, F; al Anazy, F H

    1995-10-01

    A follow-up of seven patients with the autosomal recessive inherited syndrome of distal renal tubular acidosis (RTA) and sensorineural hearing loss is described. Five patients were diagnosed as having primary distal renal tubular acidosis and rickets, four were found to have severe sensorineural hearing loss of over 80 dB: two of which are brothers. Two patients were diagnosed as having secondary distal renal acidosis due to a genetic disorder called osteopetrosis; they are brothers and their audiograms showed a mild conductive hearing loss of an average 35 dB bilaterally. All patients had growth retardation with improvement due to alkaline therapy but their hearing loss was not affected by the medication. The pedigrees of two families with half sibs showed the familial incidence for consanguineous marriage. Consanguinity was found to be positive in five out of the seven patients. The tribal tradition in Saudi Arabia fosters consanguineous marriages for cultural and social reasons and pre-arranged marriages are still seen. PMID:7499943

  19. High anion gap refractory metabolic acidosis as a critical presentation of endosulfan poisoning

    Raj Kumar Sharma

    2011-01-01

    Full Text Available Organochloride insecticides are chlorinated cyclic hydrocarbons. One of such insecticides is endosulfan (6,7,8,9,10-10 hexachloro 1,5,5a,6,9,9a-hexahydro-6-methano-2,4,3-hexadithioxanthiep in 3-oxide and it has been widely used in agriculture since 1960. The uncontrolled use of these compounds in developing countries has resulted in the deaths of animals and humans. Characteristic clinical signs following acute exposure are indicative of CNS disturbances or overstimulation. Mortality and morbidity rates are high and there is no specific antidote. We present an uncommon presentation of endosulfan poisoning in a 32-year-old male with high anion gap severe refractory metabolic acidosis. The patient was treated with continuous renal replacement therapy and was salvaged. Till date, there is no case report from India for endosulfan poisoning with severe metabolic acidosis and hypotension. Through this case report, we emphasize the role of continuous renal replacement therapy as a rescue therapy for endosulfan poisoning with severe refractory metabolic acidosis and hypotension, even though it is a non dialyzable poison.

  20. Branched-chain amino acid metabolism in rat muscle: abnormal regulation in acidosis

    May, R.C.; Hara, Y.; Kelly, R.A.; Block, K.P.; Buse, M.G.; Mitch, W.E.

    1987-06-01

    Branched-chain amino acid (BCAA) metabolism is frequently abnormal in pathological conditions accompanied by chronic metabolic acidosis. To study how metabolic acidosis affects BCAA metabolism in muscle, rats were gavage fed a 14% protein diet with or without 4 mmol NH/sub 4/Cl x 100 g body wt/sup -1/ x day/sup -1/. Epitrochlearis muscles were incubated with L-(1-/sup 14/C)-valine and L-(1-/sup 14/C)leucine, and rates of decarboxylation, net transamination, and incorporation into muscle protein were measured. Plasma and muscle BCAA levels were lower in acidotic rats. Rates of valine and leucine decarboxylation and net transamination were higher in muscles from acidotic rats; these differences were associated with a 79% increase in the total activity of branched-chain ..cap alpha..-keto acid dehydrogenase and a 146% increase in the activated form of the enzyme. They conclude that acidosis affects the regulation of BCAA metabolism by enhancing flux through the transaminase and by directly stimulating oxidative catabolism through activation of branched-chain ..cap alpha..-keto acid dehydrogenase.

  1. Avian respiratory system disorders

    Olsen, G.H.

    1989-01-01

    Diagnosing and treating respiratory diseases in avian species requires a basic knowledge about the anatomy and physiology of this system in birds. Differences between mammalian and avian respiratory system function, diagnosis, and treatment are highlighted.

  2. Acute respiratory distress syndrome

    ... chap 33. Lee WL, Slutsky AS. Acute hypoxemic respiratory failure and ARDS. In: Broaddus VC, Mason RJ, Ernst JD, et al, eds. Murray and Nadel's Textbook of Respiratory Medicine . 6th ed. Philadelphia, PA: Elsevier Saunders; 2016: ...

  3. What Causes Respiratory Failure?

    ... page from the NHLBI on Twitter. What Causes Respiratory Failure? Diseases and conditions that impair breathing can cause ... injure your lungs. Normal Lungs and Conditions Causing Respiratory Failure Figure A shows the location of the lungs, ...

  4. Acute respiratory distress syndrome

    ... chap 33. Lee WL, Slutsky AS. Acute hypoxemic respiratory failure and ARDS. In: Broaddus VC, Mason RJ, Ernst ... A.M. Editorial team. Related MedlinePlus Health Topics Respiratory Failure Browse the Encyclopedia A.D.A.M., Inc. ...

  5. Lungs and Respiratory System

    ... How Can I Help a Friend Who Cuts? Lungs and Respiratory System KidsHealth > For Teens > Lungs and ... you didn't breathe, you couldn't live. Lungs & Respiratory System Basics Each day we breathe about ...

  6. Acidosis Decreases c-Myc Oncogene Expression in Human Lymphoma Cells: A Role for the Proton-Sensing G Protein-Coupled Receptor TDAG8

    Zhigang Li; Lixue Dong; Eric Dean; Yang, Li V.

    2013-01-01

    Acidosis is a biochemical hallmark of the tumor microenvironment. Here, we report that acute acidosis decreases c-Myc oncogene expression in U937 human lymphoma cells. The level of c-Myc transcripts, but not mRNA or protein stability, contributes to c-Myc protein reduction under acidosis. The pH-sensing receptor TDAG8 (GPR65) is involved in acidosis-induced c-Myc downregulation. TDAG8 is expressed in U937 lymphoma cells, and the overexpression or knockdown of TDAG8 further decreases or partia...

  7. Respiratory Syncytial Virus

    ... Things to Know About Zika & Pregnancy Respiratory Syncytial Virus KidsHealth > For Parents > Respiratory Syncytial Virus Print A A A Text Size What's in ... RSV When to Call the Doctor en español Virus respiratorio sincitial About RSV Respiratory syncytial (sin-SISH- ...

  8. Approach to the evaluation of a patient with an increased serum osmolal gap and high-anion-gap metabolic acidosis.

    Kraut, Jeffrey A; Xing, Shelly Xiaolei

    2011-09-01

    An increase in serum osmolality and serum osmolal gap with or without high-anion-gap metabolic acidosis is an important clue to exposure to one of the toxic alcohols, which include methanol, ethylene glycol, diethylene glycol, propylene glycol, or isopropanol. However, the increase in serum osmolal gap and metabolic acidosis can occur either together or alone depending on several factors, including baseline serum osmolal gap, molecular weight of the alcohol, and stage of metabolism of the alcohol. In addition, other disorders, including diabetic or alcoholic ketoacidosis, acute kidney injury, chronic kidney disease, and lactic acidosis, can cause high-anion-gap metabolic acidosis associated with an increased serum osmolal gap and therefore should be explored in the differential diagnosis. It is essential for clinicians to understand the value and limitations of osmolal gap to assist in reaching the correct diagnosis and initiating appropriate treatment. In this teaching case, we present a systematic approach to diagnosing high serum osmolality and increased serum osmolal gap with or without high-anion-gap metabolic acidosis. PMID:21794966

  9. Distal renal tubular acidosis as a cause of osteomalacia in a patient with primary Sjögren's syndrome

    Jovelić Aleksandra

    2005-01-01

    Full Text Available Background. One half of the patients with primary Sjögren’s syndrome has extraglandular manifestations, including renal involvement. The most frequent renal lesion is tubulo-interstitial nephritis, which manifests clinically as distal tubular acidosis and may result in the development of osteomalacia. Case report. In a 29 - year-old female patient, with bilateral nephrolithiasis, the diagnosis of primary Sjögren’s syndrome, tubulo-interstitial nephritis, distal renal tubular acidosis, and hypokalemia were established. She was treated for hypokalemia. Two years later she developed bone pains and muscle weakness, she wasn’t able to walk, her proximal muscles and pelvic bones were painful, with radiological signs of pelvic bones osteopenia and pubic bones fractures. The diagnosis of osteomalacia was established and the treatment started with Schol’s solution, vitamin D and calcium. In the following two months, acidosis was corrected, and the patient started walking. Conclusion. In our patient with primary Sjögren’s syndrome and interstitial nephritis, osteomalacia was a result of the long time decompensate acidosis, so the correction of acidosis, and the supplementation of vitamin D and calcium were the integral part of the therapy.

  10. Effect of metabolic acidosis on renal tubular sodium handling in rats as determined by lithium clearance

    Menegon L.F.

    1998-01-01

    Full Text Available Systemic metabolic acidosis is known to cause a decrease in salt and water reabsorption by the kidney. We have used renal lithium clearance to investigate the effect of chronic, NH4Cl-induced metabolic acidosis on the renal handling of Na+ in male Wistar-Hannover rats (200-250 g. Chronic acidosis (pH 7.16 ± 0.13 caused a sustained increase in renal fractional Na+ excretion (267.9 ± 36.4%, accompanied by an increase in fractional proximal (113.3 ± 3.6% and post-proximal (179.7 ± 20.2% Na+ and urinary K+ (163.4 ± 5.6% excretion when compared to control and pair-fed rats. These differences occurred in spite of an unchanged creatinine clearance and Na+ filtered load. A lower final body weight was observed in the acidotic (232 ± 4.6 g and pair-fed (225 ± 3.6 g rats compared to the controls (258 ± 3.7 g. In contrast, there was a significant increase in the kidney weights of acidotic rats (1.73 ± 0.05 g compared to the other experimental groups (control, 1.46 ± 0.05 g; pair-fed, 1.4 ± 0.05 g. We suggest that altered renal Na+ and K+ handling in acidotic rats may result from a reciprocal relationship between the level of metabolism in renal tubules and ion transport.

  11. Effect of chronic metabolic acidosis on bone density and bone architecture in vivo in rats.

    Gasser, Jürg A; Hulter, Henry N; Imboden, Peter; Krapf, Reto

    2014-03-01

    Chronic metabolic acidosis (CMA) might result in a decrease in vivo in bone mass based on its reported in vitro inhibition of bone mineralization, bone formation, or stimulation of bone resorption, but such data, in the absence of other disorders, have not been reported. CMA also results in negative nitrogen balance, which might decrease skeletal muscle mass. This study analyzed the net in vivo effects of CMA's cellular and physicochemical processes on bone turnover, trabecular and cortical bone density, and bone microarchitecture using both peripheral quantitative computed tomography and μCT. CMA induced by NH4Cl administration (15 mEq/kg body wt/day) in intact and ovariectomized (OVX) rats resulted in stable CMA (mean Δ[HCO3(-)]p = 10 mmol/l). CMA decreased plasma osteocalcin and increased TRAP5b in intact and OVX animals. CMA decreased total volumetric bone mineral density (vBMD) after 6 and 10 wk (week 10: intact normal +2.1 ± 0.9% vs. intact acidosis -3.6 ± 1.2%, P effect attributable to a decrease in cortical thickness and, thus, cortical bone mass (no significant effect on cancellous vBMD, week 10) attributed to an increase in endosteal bone resorption (nominally increased endosteal circumference). Trabecular bone volume (BV/TV) decreased significantly in both CMA groups at 6 and 10 wk, associated with a decrease in trabecular number. CMA significantly decreased muscle cross-sectional area in the proximal hindlimb at 6 and 10 wk. In conclusion, chronic metabolic acidosis induces a large decrease in cortical bone mass (a prime determinant of bone fragility) in intact and OVX rats and impairs bone microarchitecture characterized by a decrease in trabecular number. PMID:24352505

  12. Sjögren’s, Renal Tubular Acidosis And Osteomalacia - An Asian Indian Series

    Sandhya, Pulukool; Danda, Debashish; Rajaratnam, Simon; Thomas, Nihal

    2014-01-01

    Objective: To study the profile of Renal Tubular Acidosis (RTA) in Asian Indian patients with Primary Sjögren's Syndrome (pSS). Methods: The Electronic medical records of patients with a diagnosis of pSS seen between 2003 and 2010 at our tertiary care teaching hospital were screened for RTA. Clinical features, immunological profile, acid-base balance and electrolyte status, 25-hydroxyvitamin D (25(OH) D3) levels, histopathological changes in minor salivary gland biopsy samples and radiological findings were retrieved. RTA was diagnosed in cases of hyperchloremic metabolic acidosis with urinary pH values higher than 5.5. Those with known features suggestive of RTA including hypokalemic paralysis, hyperchloremia and nephrocalcinosis without acidosis were defined as incomplete RTA. Results: Of the 380 patients with clinically suspected pSS, 25 had RTA. The median age was 32 (18-60) years. Nineteen patients had complete RTA. Six had incomplete RTA. Only 10 patients (40%) had symptoms related to RTA at presentation. Sixteen patients (64%) had present or past history of hypokalemic paralysis. Pseudofractures were seen in 7 patients and an additional 2 had subclinical radiological osteomalacia. Majority of the patients (61.2%) had a normal 25(OH) D3 level. Those with osteomalacia had significantly lower serum phosphate, blood ph and higher alkaline phosphatase. Serum calcium and 25(OH) D3 levels were not significantly different between patients with osteomalacia and those without. Conclusion: Most patients were asymptomatic for RTA inspite of clinically overt and elicitable features. Skeletal manifestation was a common finding in patients with Sjögren and RTA, despite normal levels of 25 (OH) D3 in a majority. PMID:25584094

  13. PRIMARY SJOGREN’S SYNDROME AND DISTAL RENAL TUBULAR ACIDOSIS: PRESENTING WITH NEPHROGENIC DIABETES INSI PIDUS SECONDARY TO SEVERE HYPOKALEMIA-A CASE REPORT

    Ksh. Achouba

    2013-02-01

    Full Text Available NTRODUCTION: Sjogren’s syndrome is a slowly progressing autoimmun e disease characterized by lymphocytic infiltration of the exo crine glands, mainly the lacrimal and salivary glands, resulting in their impaired secreto ry function. Simultaneously, systemic involvement and symptoms of cutaneous, respiratory, r enal, hepatic, neurologic, and vascular systems often occur.[ 1 ] This syndrome can present either alone (as primary Sjogren’s syndrome or in the context of an underlying connec tive tissue disease (as secondary Sjogren’s syndrome.[ 2 ] Renal involvement is a well recognized extra glan dular manifestation of primary Sjogren’s syndrome (pSS. Most common manifestations are related to tubular dysfunction, resulting from chronic interstitial nephritis, which can manifest as distal renal tubular acidosis (dRTA, proximal RTA(pRTA, tubular proteinuria, or nephrogenic diabetes insipidus.[ 3 , 4 ] Hypokalemic periodic paralysis, urolithiasis, or osteo malacia are uncommon renal manifestations of pSS.[ 1 ] Here, we present a case of primary Sjogren’s syndr ome predominantly presenting as a renal manifestation in the form of nephrogenic Diabetes Insipidus secondary to severe hypokalemia due to dRTA .

  14. SYSTEMIC LUPUS ERYTHEMATOSUS PRESENTING AS HYPOKALEMIC PERIODIC PARALYSIS SECONDARY TO DISTAL RENAL TUBULAR ACIDOSIS

    Ranjeet; Gurinder

    2014-01-01

    Systemic lupus erythematosus, referred to as SLE or lupus, is sometimes called the “great imitator.” Why? Because of its wide range of symptoms, people often confuse lupus with other health problems. We report the case of a 22-year-old woman who presented with a flaccid paralysis of limbs due to severe hypokalemia as a consequence of distal renal tubular acidosis (dRTA). A search for the cause of dRTA revealed latent Systemic Lupus Erythematosus (SLE). SLE presenting as dRTA ...

  15. SYSTEMIC LUPUS ERYTHEMATOSUS PRESENTING AS HYPOKALEMIC PERIODIC PARALYSIS SECONDARY TO DISTAL RENAL TUBULAR ACIDOSIS

    Ranjeet

    2014-05-01

    Full Text Available Systemic lupus erythematosus, referred to as SLE or lupus, is sometimes called the “great imitator.” Why? Because of its wide range of symptoms, people often confuse lupus with other health problems. We report the case of a 22-year-old woman who presented with a flaccid paralysis of limbs due to severe hypokalemia as a consequence of distal renal tubular acidosis (dRTA. A search for the cause of dRTA revealed latent Systemic Lupus Erythematosus (SLE. SLE presenting as dRTA is uncommon

  16. Serum acute phase proteins in cows with SARA (Subacute Ruminal Acidosis) suspect

    C. Cannizzo; Gianesella, M.; Giudice, E.; Messina, V; G. Piccione; M. Morgante

    2012-01-01

    The aim of this study was to evaluate the variations of Acute Phase Proteins (APPs) and other blood constituents during the onset of the sub-acute ruminal acidosis (SARA) pathological status. A total of 108 cows from 12 dairy herds were randomly selected and divided into three Groups of 36 animals each. All animals were subjected to a rumenocentesis. Group A was composed by subjects with a rumen pH>5.8, Group B was composed by subjects with a rumen pH ≤5.5≤5.8 and Group C was composed by subj...

  17. Metabolic acidosis in late pregnancy due to 5-oxoproline (pyroglutamic acid)—A case report

    K. Jeyanthan; Sahathevan Sathiyathasan; Hamid, R.

    2012-01-01

    Introduction: Accumulation of 5-oxoproline (pyroglutamic acid) is a rare cause of severe, high anion gap metabolic acidosis in adults. Case: A 21 year old lady presented at 39 weeks gestation in her first pregnancy with 2 weeks history of shortness of breath. She suffered from ear ache and had been taking Paracetamol on regular basis for a year. She was admitted to having regular alcohol intake until the pregnancy when she stopped. She was not in acute distress and all her observations were s...

  18. D-Lactic Acidosis: An Underrecognized Complication of Short Bowel Syndrome

    N. Gurukripa Kowlgi; Lovely Chhabra

    2015-01-01

    D-lactic acidosis or D-lactate encephalopathy is a rare condition that occurs primarily in individuals who have a history of short bowel syndrome. The unabsorbed carbohydrates act as a substrate for colonic bacteria to form D-lactic acid among other organic acids. The acidic pH generated as a result of D-lactate production further propagates production of D-lactic acid, hence giving rise to a vicious cycle. D-lactic acid accumulation in the blood can cause neurologic symptoms such as delirium...

  19. Linfoma marginal del bazo asociado a acidosis láctica tipo B: Caso clínico Type B lactic acidosis associated with marginal lymphoma of the spleen: Report of one case

    Jorge Vega; María de los Ángeles Rodríguez; Armando Peña; Alejadro Vásquez

    2012-01-01

    Lactic acidosis in the absence of hypoxia or tissue hypoperfusion (type B) is very rare and is associated with the use of some drugs or malignancy. We report a 79-year-old woman, with a marginal non-Hodgkin's lymphoma of the spleen that was subjected to a splenectomy one year ago. She presented with unexplained tachypnea associated with pancytopenia and elevation of IgM to 10 times over the higher normal limit. Laboratory tests showed the presence of metabolic acidosis and high lactic acid le...

  20. Anemia and performance status as prognostic markers in acute hypercapnic respiratory failure due to chronic obstructive pulmonary disease

    Haja Mydin H

    2013-03-01

    Full Text Available Helmy Haja Mydin, Stephen Murphy, Howell Clague, Kishore Sridharan, Ian K TaylorDepartment of Respiratory Medicine, Sunderland Royal Infirmary, Sunderland, United KingdomBackground: In patients with acute hypercapnic respiratory failure (AHRF during exacerbations of COPD, mortality can be high despite noninvasive ventilation (NIV. For some, AHRF is terminal and NIV is inappropriate. However there is no definitive method of identifying patients who are unlikely to survive. The aim of this study was to identify factors associated with inpatient mortality from AHRF with respiratory acidosis due to COPD.Methods: COPD patients presenting with AHRF and who were treated with NIV were studied prospectively. The forced expiratory volume in 1 second (FEV1, World Health Organization performance status (WHO-PS, clinical observations, a composite physiological score (Early Warning Score, routine hematology and biochemistry, and arterial blood gases prior to commencing NIV, were recorded.Results: In total, 65 patients were included for study, 29 males and 36 females, with a mean age of 71 ± 10.5 years. Inpatient mortality in the group was 33.8%. Mortality at 30 days and 12 months after admission were 38.5% and 58.5%, respectively. On univariate analysis, the variables associated with inpatient death were: WHO-PS ≥ 3, long-term oxygen therapy, anemia, diastolic blood pressure < 70 mmHg, Early Warning Score ≥ 3, severe acidosis (pH < 7.20, and serum albumin < 35 g/L. On multivariate analysis, only anemia and WHO-PS ≥ 3 were significant. The presence of both predicted 68% of inpatient deaths, with a specificity of 98%.Conclusion: WHO-PS ≥ 3 and anemia are prognostic factors in AHRF with respiratory acidosis due to COPD. A combination of the two provides a simple method of identifying patients unlikely to benefit from NIV.Keywords: acute exacerbations of COPD, noninvasive ventilation, emphysema, prognostic markers

  1. Draft Genome Sequence of Lactobacillus delbrueckii Strain #22 Isolated from a Patient with Short Bowel Syndrome and Previous d-Lactic Acidosis and Encephalopathy.

    Domann, Eugen; Fischer, Florence; Glowatzki, Fabian; Fritzenwanker, Moritz; Hain, Torsten; Zechel-Gran, Silke; Giffhorn-Katz, Susanne; Neubauer, Bernd A

    2016-01-01

    d-Lactic acidosis with associated encephalopathy caused by overgrowth of intestinal lactic acid bacteria is a rarely diagnosed neurological complication of patients with short bowel syndrome. Here, we report the draft genome sequence of Lactobacillus delbrueckii strain #22 isolated from a patient with short bowel syndrome and previous d-lactic acidosis/encephalopathy. PMID:27469967

  2. Recurrent Anion Gap Acidosis: An Unusual Presentation of X-Linked Adrenoleukodystrophy in a Five-year-old Male

    Schwab, Joel; Pena, Loren; Sigman, Laura; Waggoner, Darrel

    2010-01-01

    We are presenting a five-year-old male with recurrent anion gap acidosis. During his last admission, it was detected that he had elevated VLCFA and the evaluation discovered that he had X-linked Adrenooleukodystrophy. He had the Addisonian only phenotype without any clinical or radiographic CNS findings. We were unable to find any other reports of this presentation of ALD. If the work-up of recurrent anion gap acidosis does not uncover an etiology, X-linked ALD should be considered in the dif...

  3. [Higher Brain Dysfunction in Mitochondrial Myopathy, Encephalopathy, Lactic Acidosis and Stroke-Like Episodes (MELAS)].

    Ichikawa, Hiroo

    2016-02-01

    Stroke-like episodes are one of the cardinal features of mitochondrial myopathy, encephalopathy, lactic acidosis and stroke-like episodes (MELAS), and occur in 84-99% of the patients. The affected areas detected on neuroimaging do not have classical vascular distribution, and involve predominantly the temporal, parietal and occipital lobes. Thus, the neurological symptoms including higher brain dysfunction correlate with this topographical distribution. In association with the occipital lobe involvement, the most frequent symptom is cortical blindness. Other symptoms have been occasionally reported in case reports: visual agnosia, prosopagnosia, cortical deafness, auditory agnosia, topographical disorientation, various types of aphasia, hemispatial neglect, and so on. On the other hand, cognitive decline associated with more diffuse brain impairment rather than with focal stroke-like lesions has been postulated. This condition is also known as mitochondrial dementia. Domains of cognitive dysfunction include abstract reasoning, verbal memory, visual memory, language (naming and fluency), executive or constructive functions, attention, and visuospatial function. Cognitive functions and intellectual abilities may decline from initially minimal cognitive impairment to dementia. To date, the neuropsychological and neurologic impairment has been reported to be associated with cerebral lactic acidosis as estimated by ventricular spectroscopic lactate levels. PMID:26873235

  4. Magnetic resonance imaging detects placental hypoxia and acidosis in mouse models of perturbed pregnancies.

    Gabriele Bobek

    Full Text Available Endothelial dysfunction as a result of dysregulation of anti-angiogenic molecules secreted by the placenta leads to the maternal hypertensive response characteristic of the pregnancy complication of preeclampsia. Structural abnormalities in the placenta have been proposed to result in altered placental perfusion, placental oxidative stress, cellular damage and inflammation and the release of anti-angiogenic compounds into the maternal circulation. The exact link between these factors is unclear. Here we show, using Magnetic Resonance Imaging as a tool to examine placental changes in mouse models of perturbed pregnancies, that T 2 contrast between distinct regions of the placenta is abolished at complete loss of blood flow. Alterations in T 2 (spin-spin or transverse relaxation times are explained as a consequence of hypoxia and acidosis within the tissue. Similar changes are observed in perturbed pregnancies, indicating that acidosis as well as hypoxia may be a feature of pregnancy complications such as preeclampsia and may play a prominent role in the signalling pathways that lead to the increased secretion of anti-angiogenic compounds.

  5. Lipoyltransferase 1 Gene Defect Resulting in Fatal Lactic Acidosis in Two Siblings

    Taché, Véronique; Bivina, Liga; White, Sophie; Gregg, Jeffrey; Deignan, Joshua; Boyadjievd, Simeon A.; Poulain, Francis R.

    2016-01-01

    A term male neonate developed severe intractable lactic acidosis on day of life 1 and died the same day at our institution. The family previously lost another term, female newborn on day of life 1 from suspected sepsis at an outside hospital. After performing an autopsy on the neonate who died at our institution, extensive and lengthy neonatal and parental genetic testing, as well as biochemical analyses, and whole exome sequencing analysis identified compound heterozygous mutations in the lipoyltransferase 1 (LIPT1) gene responsible for the lipoylation of the 2-keto dehydrogenase complexes in the proband. These mutations were also identified in the deceased sibling. The clinical manifestations of these two siblings are consistent with those recently described in two unrelated families with lactic acidosis due to LIPT1 mutations, an underrecognized and underreported cause of neonatal death. Conclusions. Our observations contribute to the delineation of a new autosomal recessive metabolic disorder, leading to neonatal death. Our case report also highlights the importance of an interdisciplinary team in solving challenging cases. PMID:27247813

  6. Lipoyltransferase 1 Gene Defect Resulting in Fatal Lactic Acidosis in Two Siblings.

    Taché, Véronique; Bivina, Liga; White, Sophie; Gregg, Jeffrey; Deignan, Joshua; Boyadjievd, Simeon A; Poulain, Francis R

    2016-01-01

    A term male neonate developed severe intractable lactic acidosis on day of life 1 and died the same day at our institution. The family previously lost another term, female newborn on day of life 1 from suspected sepsis at an outside hospital. After performing an autopsy on the neonate who died at our institution, extensive and lengthy neonatal and parental genetic testing, as well as biochemical analyses, and whole exome sequencing analysis identified compound heterozygous mutations in the lipoyltransferase 1 (LIPT1) gene responsible for the lipoylation of the 2-keto dehydrogenase complexes in the proband. These mutations were also identified in the deceased sibling. The clinical manifestations of these two siblings are consistent with those recently described in two unrelated families with lactic acidosis due to LIPT1 mutations, an underrecognized and underreported cause of neonatal death. Conclusions. Our observations contribute to the delineation of a new autosomal recessive metabolic disorder, leading to neonatal death. Our case report also highlights the importance of an interdisciplinary team in solving challenging cases. PMID:27247813

  7. Lipoyltransferase 1 Gene Defect Resulting in Fatal Lactic Acidosis in Two Siblings

    Véronique Taché

    2016-01-01

    Full Text Available A term male neonate developed severe intractable lactic acidosis on day of life 1 and died the same day at our institution. The family previously lost another term, female newborn on day of life 1 from suspected sepsis at an outside hospital. After performing an autopsy on the neonate who died at our institution, extensive and lengthy neonatal and parental genetic testing, as well as biochemical analyses, and whole exome sequencing analysis identified compound heterozygous mutations in the lipoyltransferase 1 (LIPT1 gene responsible for the lipoylation of the 2-keto dehydrogenase complexes in the proband. These mutations were also identified in the deceased sibling. The clinical manifestations of these two siblings are consistent with those recently described in two unrelated families with lactic acidosis due to LIPT1 mutations, an underrecognized and underreported cause of neonatal death. Conclusions. Our observations contribute to the delineation of a new autosomal recessive metabolic disorder, leading to neonatal death. Our case report also highlights the importance of an interdisciplinary team in solving challenging cases.

  8. Mechanism of potassium depletion during chronic metabolic acidosis in the rat

    Pair-fed rats on a normal K diet were given either 1.5% NH4Cl or water for 4 days. The acid-fed animals developed metabolic acidosis, negative K balance, and K depletion. Urinary Na excretion and urinary flow were not different between the groups beyond the first day. After the 4 days, isolated kidneys from animals in each of these groups were perfused at normal pH and bicarbonate concentrations. Urinary K excretion was similar between the groups despite the potassium depletion in the acid-fed animals. In contrast, isolated kidneys from animals with comparable K depletion induced by dietary K restriction readily conserved K. Sodium excretion and urinary flow were similar among the three groups of isolated kidneys. Plasma aldosterone concentrations were greater in the acid-fed rats after the 4 days of NH4Cl ingestion than in the control animals. Adrenalectomized rats were treated with either normal (4 μg/day) or high (22 μg/day) aldosterone replacement while ingesting NH4Cl for 4 days. Only in the presence of high aldosterone replacement did the acid-fed adrenalectomized animals develop K depletion. The authors conclude that chronic metabolic acidosis stimulates aldosterone secretion, and that aldosterone maintains the inappropriately high urinary potassium excretion and K depletion seen in this acid-base disorder

  9. Metabolic acidosis mimicking diabetic ketoacidosis after use of calorie-free mineral water.

    Dahl, Gry T; Woldseth, Berit; Lindemann, Rolf

    2012-09-01

    A previously healthy boy was admitted with fever, tachycardia, dyspnea, and was vomiting. A blood test showed a severe metabolic acidosis with pH 7.08 and an anion gap of 36 mmol/L. His urine had an odor of acetone. The serum glucose was 5.6 mmol/L, and no glucosuria was found. Diabetic ketoacidosis could therefore be eliminated. Lactate level was normal. Tests for the most common metabolic diseases were negative. Because of herpes stomatitis, the boy had lost appetite and only been drinking Diet Coke and water the last days. Diet Coke or Coca-Cola Light is sweetened with a blend containing cyclamates, aspartame, and acesulfame potassium, all free of calories. The etiology of the metabolic acidosis appeared to be a catabolic situation exaggerated by fasting with no intake of calories. The elevated anion gap was due to a severe starvation ketoacidosis, mimicking a diabetic ketoacidosis. Pediatricians should recommend carbohydrate/calorie-containing fluids for rehydration of children with acute fever, diarrhea, or illness. PMID:22457081

  10. D-Lactic Acidosis: An Underrecognized Complication of Short Bowel Syndrome

    N. Gurukripa Kowlgi

    2015-01-01

    Full Text Available D-lactic acidosis or D-lactate encephalopathy is a rare condition that occurs primarily in individuals who have a history of short bowel syndrome. The unabsorbed carbohydrates act as a substrate for colonic bacteria to form D-lactic acid among other organic acids. The acidic pH generated as a result of D-lactate production further propagates production of D-lactic acid, hence giving rise to a vicious cycle. D-lactic acid accumulation in the blood can cause neurologic symptoms such as delirium, ataxia, and slurred speech. Diagnosis is made by a combination of clinical and laboratory data including special assays for D-lactate. Treatment includes correcting the acidosis and decreasing substrate for D-lactate such as carbohydrates in meals. In addition, antibiotics can be used to clear colonic flora. Although newer techniques for diagnosis and treatment are being developed, clinical diagnosis still holds paramount importance, as there can be many confounders in the diagnosis as will be discussed subsequently.

  11. Tumor environmental factors glucose deprivation and lactic acidosis induce mitotic chromosomal instability--an implication in aneuploid human tumors.

    Chunyan Dai

    Full Text Available Mitotic chromosomal instability (CIN plays important roles in tumor progression, but what causes CIN is incompletely understood. In general, tumor CIN arises from abnormal mitosis, which is caused by either intrinsic or extrinsic factors. While intrinsic factors such as mitotic checkpoint genes have been intensively studied, the impact of tumor microenvironmental factors on tumor CIN is largely unknown. We investigate if glucose deprivation and lactic acidosis--two tumor microenvironmental factors--could induce cancer cell CIN. We show that glucose deprivation with lactic acidosis significantly increases CIN in 4T1, MCF-7 and HCT116 scored by micronuclei, or aneuploidy, or abnormal mitosis, potentially via damaging DNA, up-regulating mitotic checkpoint genes, and/or amplifying centrosome. Of note, the feature of CIN induced by glucose deprivation with lactic acidosis is similar to that of aneuploid human tumors. We conclude that tumor environmental factors glucose deprivation and lactic acidosis can induce tumor CIN and propose that they are potentially responsible for human tumor aneuploidy.

  12. Episodic, transient systemic acidosis delays evolution of the malignant phenotype: Possible mechanism for cancer prevention by increased physical activity

    Maini Philip K

    2010-04-01

    Full Text Available Abstract Background The transition from premalignant to invasive tumour growth is a prolonged multistep process governed by phenotypic adaptation to changing microenvironmental selection pressures. Cancer prevention strategies are required to interrupt or delay somatic evolution of the malignant invasive phenotype. Empirical studies have consistently demonstrated that increased physical activity is highly effective in reducing the risk of breast cancer but the mechanism is unknown. Results Here we propose the hypothesis that exercise-induced transient systemic acidosis will alter the in situ tumour microenvironment and delay tumour adaptation to regional hypoxia and acidosis in the later stages of carcinogenesis. We test this hypothesis using a hybrid cellular automaton approach. This model has been previously applied to somatic evolution on epithelial surfaces and demonstrated three phases of somatic evolution, with cancer cells escaping in turn from the constraints of limited space, nutrient supply and waste removal. In this paper we extend the model to test our hypothesis that transient systemic acidosis is sufficient to arrest, or at least delay, transition from in situ to invasive cancer. Conclusions Model simulations demonstrate that repeated episodes of transient systemic acidosis will interrupt critical evolutionary steps in the later stages of carcinogenesis resulting in substantial delay in the evolution to the invasive phenotype. Our results suggest transient systemic acidosis may mediate the observed reduction in cancer risk associated with increased physical activity. Reviewers This article was reviewed by Natalia Komarova (nominated by Marek Kimmel, Heiko Enderling (nominated by Marek Kimmel, Mark Little (nominated by Marek Kimmel and Yang Kuang.

  13. Endocrine and metabolic emergencies in children: hypocalcemia, hypoglycemia, adrenal insufficiency, and metabolic acidosis including diabetic ketoacidosis.

    Kim, Se Young

    2015-12-01

    It is important to fast diagnosis and management of the pediatric patients of the endocrine metabolic emergencies because the signs and symptoms of these disorders are nonspecific. Delayed diagnosis and treatment may lead to serious consequences of the pediatric patients, for example, cerebral dysfunction leading to coma or death of the patients with hypoglycemia, hypocalcemia, adrenal insufficiency, or diabetic ketoacidosis. The index of suspicion of the endocrine metabolic emergencies should be preceded prior to the starting nonspecific treatment. Importantly, proper diagnosis depends on the collection of blood and urine specimen before nonspecific therapy (intravenous hydration, electrolytes, glucose or calcium injection). At the same time, the taking of precise history and searching for pathognomonic physical findings should be performed. This review was described for fast diagnosis and proper management of hypoglycemic emergencies, hypocalcemia, adrenal insufficiency, and metabolic acidosis including diabetic ketoacidosis. PMID:26817004

  14. An unusual case of refractory metabolic acidosis after homeopathic medicinal treatment

    Sameer Saraf

    2014-01-01

    Full Text Available Homeopathy is one of the most frequently used and controversial systems of complementary and alternative medicine (CAM. It is based on the ′principle of similars′, whereby highly diluted preparations of substances that cause symptoms in healthy individuals are used to stimulate healing in patients who have similar symptoms when ill 1. General trends show a rise in the number of individuals utilising naturopathic and homeopathic therapeutic methods 2. The patients who seek homeopathic treatment are primarily those suffering from long-standing, chronic disease 1. Certainly, the CAM can show clinical benefits. However, some of these also involve a considerable risk of sometimes severe side-effects. We here are reporting an unusual case of refractory metabolic acidosis after homeopathic medicinal treatment.

  15. Dermal bone in early tetrapods: a palaeophysiological hypothesis of adaptation for terrestrial acidosis.

    Janis, Christine M; Devlin, Kelly; Warren, Daniel E; Witzmann, Florian

    2012-08-01

    The dermal bone sculpture of early, basal tetrapods of the Permo-Carboniferous is unlike the bone surface of any living vertebrate, and its function has long been obscure. Drawing from physiological studies of extant tetrapods, where dermal bone or other calcified tissues aid in regulating acid-base balance relating to hypercapnia (excess blood carbon dioxide) and/or lactate acidosis, we propose a similar function for these sculptured dermal bones in early tetrapods. Unlike the condition in modern reptiles, which experience hypercapnia when submerged in water, these animals would have experienced hypercapnia on land, owing to likely inefficient means of eliminating carbon dioxide. The different patterns of dermal bone sculpture in these tetrapods largely correlates with levels of terrestriality: sculpture is reduced or lost in stem amniotes that likely had the more efficient lung ventilation mode of costal aspiration, and in small-sized stem amphibians that would have been able to use the skin for gas exchange. PMID:22535781

  16. Serum acute phase proteins in cows with SARA (Subacute Ruminal Acidosis suspect

    C. Cannizzo

    2012-02-01

    Full Text Available The aim of this study was to evaluate the variations of Acute Phase Proteins (APPs and other blood constituents during the onset of the sub-acute ruminal acidosis (SARA pathological status. A total of 108 cows from 12 dairy herds were randomly selected and divided into three Groups of 36 animals each. All animals were subjected to a rumenocentesis. Group A was composed by subjects with a rumen pH>5.8, Group B was composed by subjects with a rumen pH ≤5.5≤5.8 and Group C was composed by subjects with a rumen pH<5.5. Blood samples were collected by jugular venipuncture and Haptoglobin (Hp, Serum Amyloid A (SAA, Total Proteins, Albumin and White Blood Cells (WBC were determined. One-way ANOVA showed a statistical significance on Rumen pH, Hp, SAA. SARA seems not stimulate the APPs production from liver.

  17. Profound Intraoperative Metabolic Acidosis and Hypotension in a Child Undergoing Multilevel Spinal Fusion

    Mohanad Shukry

    2009-01-01

    Full Text Available The prone position may cause cardiovascular system depression. Yet, the mechanisms involved and preemptive measures are not well understood (Edgcombe et al. (2008. During spinal surgery in the prone position, hypotension may occur. Implicated factors include prolonged abdominal compression impeding venous return resulting in increased blood loss, decreased cardiovascular reserve, and the use of total intravenous anesthesia (TIVA which has been shown to blunt the sympathetic response more than inhalation anesthesia. We present a case of hypotension during spinal surgery with all its challenges. Hypotension and acidosis persisted despite all supporting measures, and only to improve with supine positioning. Differential diagnosis for such an event are discussed. Although abdominal compression may not be obvious before the start of surgery, compressing the spine during surgery may lead to abdominal compression and hypoperfusion to abdominal organs.

  18. Esubacute acidosis in rumen of high-yield dairy cows: Prevalence and prevention

    Petrujkić Branko T.

    2008-01-01

    Full Text Available The objective of the investigations presented in this paper was to establish the frequency of the incidence of subacute acidosis in the rumen of cows (SARA in the first three months of lactation and the possibilities for its prevention using a mineral mix based on bentonite, zeolite, magnesium oxide, and sodium bicarbonate (Mix plus. The values obtained for the rumen pH content show that subacute rumen acidosis occurs in in 20 percent of the examined cows in the early stage of lactation. For these investigations, cows in early stages of lactation were chosen and divided into 2 groups. Cows of the experimental group were administered a fodder mix which contained the mineral mix for a buffer effect (Mix plus. The average values of the rumen pH content in the control and the experimental group of cows at the beginning and on the 30th day of the experiment were approximately the same and did not differ significantly (p>0.05. On the 60th day of the experiment, the values for the electrochemical reaction of the rumen content for the control group amounted to an average of 6.219±0.18, and for the experimental group of cows it was 6.772±0.23. The obtained difference was statistically very significant (p<0.001. At the end of the experiment, on the 90th day, the average pH value of the rumen content of cows of the control group was 6.308±0.16, while this value in the experimental group of cows was significantly higher and amounted to 6.676±0.29 (p<0.01.

  19. Diagnostic Challenge in a Patient with Severe Anion Gap Metabolic Acidosis

    Eugene M. Tan

    2015-01-01

    Full Text Available The approach to the patient with acute renal failure and elevated anion and osmolal gap is difficult. Differential diagnoses include toxic alcohol ingestion, diabetic or starvation ketoacidosis, or 5-oxoproline acidosis. We present a 76-year-old female with type 2 diabetes mellitus, who was found at home in a confused state. Laboratory analysis revealed serum pH 6.84, bicarbonate 5.8 mmol/L, pCO2 29 mmHg, anion gap 22.2 mmol/L, osmolal gap 17.4 mOsm/kg, elevated beta-hydroxybutyrate (4.2 mmol/L, random blood sugar 213 mg/dL, creatinine 2.1 mg/dL, and potassium 7.5 mmol/L with no electrocardiogram (EKG changes. Fomepizole and hemodialysis were initiated for presumed ethylene glycol or methanol ingestion. Drug screens returned negative for ethylene glycol, alcohols, and acetaminophen, but there were elevated urine levels of acetone (11 mg/dL. The acetaminophen level was negative, and 5-oxoproline was not analyzed. After 5 days in the intensive care unit (ICU, her mental status improved with supportive care. She was discharged to a nursing facility. Though a diagnosis was not established, our patient’s presentation was likely due to starvation ketosis combined with chronic acetaminophen ingestion. Acetone ingestion is less likely. Overall, our case illustrates the importance of systematically approaching an elevated osmolal and anion gap metabolic acidosis.

  20. Successful recovery from iatrogenic severe hypernatremia and severe metabolic acidosis resulting from accidental use of inappropriate bicarbonate concentrate for hemodialysis treatment

    Guruprasad P Bhosale

    2015-01-01

    Full Text Available Bicarbonate dialysis is the treatment modality of choice for correction of metabolic acidosis in chronic renal failure. However, improper selection of dialysate concentrate can result in life-threatening human errors. We report a case of iatrogenic severe hypernatremia (sodium 207 mEq/L and severe metabolic acidosis (pH 6.65 that resulted due to accidental use of inappropriate bicarbonate concentrate for hemodialysis treatment. There was successful recovery in this patient with no neurological sequelae. To the best of our knowledge, this is the first case report in adults of severe hypernatremia along with severe metabolic acidosis due to error in the preparation of dialysis fluid.

  1. Newborn Respiratory Distress.

    Hermansen, Christian L; Mahajan, Anand

    2015-12-01

    Newborn respiratory distress presents a diagnostic and management challenge. Newborns with respiratory distress commonly exhibit tachypnea with a respiratory rate of more than 60 respirations per minute. They may present with grunting, retractions, nasal flaring, and cyanosis. Common causes include transient tachypnea of the newborn, respiratory distress syndrome, meconium aspiration syndrome, pneumonia, sepsis, pneumothorax, persistent pulmonary hypertension of the newborn, and delayed transition. Congenital heart defects, airway malformations, and inborn errors of metabolism are less common etiologies. Clinicians should be familiar with updated neonatal resuscitation guidelines. Initial evaluation includes a detailed history and physical examination. The clinician should monitor vital signs and measure oxygen saturation with pulse oximetry, and blood gas measurement may be considered. Chest radiography is helpful in the diagnosis. Blood cultures, serial complete blood counts, and C-reactive protein measurement are useful for the evaluation of sepsis. Most neonates with respiratory distress can be treated with respiratory support and noninvasive methods. Oxygen can be provided via bag/mask, nasal cannula, oxygen hood, and nasal continuous positive airway pressure. Ventilator support may be used in more severe cases. Surfactant is increasingly used for respiratory distress syndrome. Using the INSURE technique, the newborn is intubated, given surfactant, and quickly extubated to nasal continuous positive airway pressure. Newborns should be screened for critical congenital heart defects via pulse oximetry after 24 hours but before hospital discharge. Neonatology consultation is recommended if the illness exceeds the clinician's expertise and comfort level or when the diagnosis is unclear in a critically ill newborn. PMID:26760414

  2. Neonatal lactic acidosis, complex I/IV deficiency, and fetal cerebral disruption

    van Straaten, HLM; van Tintelen, JP; Trijbels, JMF; van den Heuvel, LP; Troost, D; Rozemuller, JM; Duran, M; de Vries, LS; Schuelke, M; Barth, PG

    2005-01-01

    Cerebral developmental abnormalities occur in various inborn errors of metabolism including peroxisomal deficiencies, pyruvate dehydrogenase complex deficiency and others. Associations with abnormalities of the respiratory chain are rare. Here we report male and female siblings with microcephaly, a

  3. Noninvasive respiratory monitoring

    This book contains 10 selections. Some of the titles are: Transcutaneous Monitoring of Respiratory Gases; Computed Tomography of the Chest; Measurement and Monitoring of Exhaled Carbon Dioxide; Oximetry; and Ultrasonic Evaluation of the Chest Wall and Pleura

  4. Noninvasive respiratory monitoring

    Nochomovitz, M.L.; Cherniack, N.S.

    1986-01-01

    This book contains 10 selections. Some of the titles are: Transcutaneous Monitoring of Respiratory Gases; Computed Tomography of the Chest; Measurement and Monitoring of Exhaled Carbon Dioxide; Oximetry; and Ultrasonic Evaluation of the Chest Wall and Pleura.

  5. Upper respiratory infections.

    Grief, Samuel N

    2013-09-01

    Upper respiratory infections (URIs) are infections of the mouth, nose, throat, larynx (voice box), and trachea (windpipe). This article outlines the epidemiology, etiology, diagnosis, and management of URIs, including nasopharyngitis (common cold), sinusitis, pharyngitis, laryngitis, and laryngotracheitis. PMID:23958368

  6. Living with Respiratory Failure

    ... tips below. Ongoing Care If you have respiratory failure, see your doctor for ongoing medical care. Your doctor may refer you to pulmonary rehabilitation (rehab). Rehab can involve exercise training, education, and counseling. Your rehab team might include doctors, ...

  7. Linfoma marginal del bazo asociado a acidosis láctica tipo B: Caso clínico Type B lactic acidosis associated with marginal lymphoma of the spleen: Report of one case

    Jorge Vega

    2012-02-01

    Full Text Available Lactic acidosis in the absence of hypoxia or tissue hypoperfusion (type B is very rare and is associated with the use of some drugs or malignancy. We report a 79-year-old woman, with a marginal non-Hodgkin's lymphoma of the spleen that was subjected to a splenectomy one year ago. She presented with unexplained tachypnea associated with pancytopenia and elevation of IgM to 10 times over the higher normal limit. Laboratory tests showed the presence of metabolic acidosis and high lactic acid levels in the absence of infection, tissue hypoxia or hypoperfusion. She was treated with sodium bicarbonate and steroids without obtaining a reduction in lactate levels. Twelve days after admission, a single dose of Rituximab quickly normalized lactate concentrations and platelet count. After the fourth dose of Rituximab, pancytopenia disappeared and IgM fell to 25% of its baseline concentration.

  8. Obesity and respiratory diseases

    Christopher Zammit; Helen Liddicoat; Ian Moonsie; et al

    2010-01-01

    Christopher Zammit, Helen Liddicoat, Ian Moonsie, Himender MakkerSleep and Ventilation Unit, Department of Respiratory Medicine, North Middlesex University Hospital, London, UKAbstract: The obesity epidemic is a global problem, which is set to increase over time. However, the effects of obesity on the respiratory system are often underappreciated. In this review, we will discuss the mechanical effects of obesity on lung physiology and the function of adipose tissue as an endocrine organ produ...

  9. Microspectrophotometry of respiratory pigments

    Kavanagh, Karen Yvonne, (Thesis)

    2003-01-01

    This research thesis describes the design, construction and optical testing of three fibre-optic microspectrophotometer systems to monitor the reduction of mitochondrial respiratory pigments. The optical and biochemical characteristics of mitochondrial respiration are discussed and the current optical techniques employed in the biochemical analysis of respiratory enzymes are presented. The primary focus of this study is the system parameters surrounding the spectrophotometric determination of...

  10. Respiratory Syncytial Virus (RSV)

    2013-02-04

    Respiratory Syncytial Virus, or RSV, causes cold-like symptoms but can be serious for infants and older adults. In this podcast, CDC’s Dr. Eileen Schneider discusses this common virus and offers tips to prevent its spread.  Created: 2/4/2013 by National Center for Immunization and Respiratory Diseases (NCIRD), Division of Viral Diseases (DVD).   Date Released: 2/13/2013.

  11. Non-Specific Inhibition of Ischemia- and Acidosis-Induced Intracellular Calcium Elevations and Membrane Currents by α-Phenyl-N-tert-butylnitrone, Butylated Hydroxytoluene and Trolox

    Christopher Katnik; Javier Cuevas

    2014-01-01

    Ischemia, and subsequent acidosis, induces neuronal death following brain injury. Oxidative stress is believed to be a key component of this neuronal degeneration. Acute chemical ischemia (azide in the absence of external glucose) and acidosis (external media buffered to pH 6.0) produce increases in intracellular calcium concentration ([Ca2+] i ) and inward membrane currents in cultured rat cortical neurons. Two α-tocopherol analogues, trolox and butylated hydroxytoluene (BHT), and the spin t...

  12. Successful recovery from iatrogenic severe hypernatremia and severe metabolic acidosis resulting from accidental use of inappropriate bicarbonate concentrate for hemodialysis treatment

    Bhosale, Guruprasad P; Veena R Shah

    2015-01-01

    Bicarbonate dialysis is the treatment modality of choice for correction of metabolic acidosis in chronic renal failure. However, improper selection of dialysate concentrate can result in life-threatening human errors. We report a case of iatrogenic severe hypernatremia (sodium 207 mEq/L) and severe metabolic acidosis (pH 6.65) that resulted due to accidental use of inappropriate bicarbonate concentrate for hemodialysis treatment. There was successful recovery in this patient with no neurologi...

  13. Pathophysiology of incomplete renal tubular acidosis in recurrent renal stone formers: evidence of disturbed calcium, bone and citrate metabolism

    Osther, P J; Bollerslev, Jens; Hansen, A B;

    1993-01-01

    Urinary acidification, bone metabolism and urinary excretion of calcium and citrate were evaluated in 10 recurrent stone formers with incomplete renal tubular acidosis (iRTA), 10 recurrent stone formers with normal urinary acidification (NUA) and 10 normal controls (NC). Patients with iRTA had......-carbonic acidosis during fasting may be a pathophysilogical factor of both nephrolithiasis and disturbed bone metabolism in stone formers with iRTA....... significantly increased in iRTA compared with NUA and NC (P <0.01), indicating increased bone turnover in stone formers with iRTA. Stone formers with iRTA thus presented with disturbed calcium, bone and citrate metabolism--the same metabolic abnormalities which characterize classic type 1 RTA. Mild non...

  14. Hypokalemic paralysis and osteomalacia secondary to renal tubular acidosis in a case with primary Sjögren's syndrome.

    Kawashima, Masanori; Amano, Tetsuki; Morita, Yoshitaka; Yamamura, Masahiro; Makino, Hirofumi

    2006-01-01

    A 39-year-old Japanese woman was admitted to our hospital for severe weakness owing to potassium deficiency caused by type 1 renal tubular acidosis (RTA1). Sicca complex, serological tests, and lip biopsy revealed that she had Sjögren's syndrome (SS). Acidosis was corrected by alkali supplement treatment. She also had an impaired renal function with proteinuria, and high absorbance on Ga scintigram was recognized in both kidneys. She was taking warfarin potassium after aortic valve substitution due to aortic regurgitation, therefore renal biopsy was not performed. Prednisone (20 mg/day) was administered for renal inflammation. One month later, she suffered severe chest wall pains with some local tender points over the costae of both sides, which was presumed to be due to pseudo-fractures based on osteomalacia. Hypokalemic paralysis and osteomalacia should be taken into consideration in the diagnosis of SS with RTA1. PMID:16622725

  15. Osteomalacia complicating renal tubular acidosis in association with Sjogren′s syndrome

    Zohra El Ati

    2014-01-01

    Full Text Available Renal involvement in Sjogren′s syndrome (SS is not uncommon and may precede other complaints. Tubulointerstitial nephritis is the most common renal disease in SS and may lead to renal tubular acidosis (RTA, which in turn may cause osteomalacia. Nevertheless, osteomalacia rarely occurs as the first manifestation of a renal tubule disorder due to SS. We herewith describe a 43-year-old woman who was admitted to our hospital for weakness, lumbago and inability to walk. X-ray of the long bones showed extensive demineralization of the bones. Laboratory investigations revealed chronic kidney disease with serum creatinine of 2.3 mg/dL and creatinine clearance of 40 mL/min, hypokalemia (3.2 mmol/L, hypophosphatemia (0.4 mmol/L, hypocalcemia (2.14 mmol/L and hyperchloremic metabolic acidosis (chlorine: 114 mmol/L; alkaline reserve: 14 mmol/L. The serum alkaline phosphatase levels were elevated. The serum levels of 25-hydroxyvitamin D and 1,25-dihydroxy vitamin D were low and borderline low, respectively, and the parathyroid hormone level was 70 pg/L. Urinalysis showed inappropriate alkaline urine (urinary PH: 7, glycosuria with normal blood glucose, phosphaturia and uricosuria. These values indicated the presence of both distal and proximal RTA. Our patient reported dryness of the mouth and eyes and Schirmer′s test showed xerophthalmia. An accessory salivary gland biopsy showed changes corresponding to stage IV of Chisholm and Masson score. Kidney biopsy showed diffuse and severe tubulo-interstitial nephritis with dense lymphoplasmocyte infiltrates. Sicca syndrome and renal interstitial infiltrates indicated SS as the underlying cause of the RTA and osteomalacia. The patient received alkalinization, vitamin D (Sterogyl ®, calcium supplements and steroids in an initial dose of 1 mg/kg/day, tapered to 10 mg daily. The prognosis was favorable and the serum creatinine level was 1.7 mg/dL, calcium was 2.2 mmol/L and serum phosphate was 0.9 mmol/L.

  16. Oral rehydration therapy: efficacy of sodium citrate equals to sodium bicarbonate for correction of acidosis in diarrhoea.

    Islam, M. R.; Samadi, A R; Ahmed, S. M. [وسمية محمد أحمد; Bardhan, P K; Ali, A.

    1984-01-01

    Forty patients with moderate degrees of dehydration and acidosis because of acute watery diarrhoea were successfully treated randomly with either WHO recommended oral rehydration solution containing 2.5 g sodium bicarbonate or an oral solution containing 2.94 g sodium citrate in place of sodium bicarbonate per litre of oral rehydration rehydration solution. Efficacies were compared by measuring oral fluid intake, stool and vomitus output, change in body weight, hydration status, and rate of c...

  17. Sympathetic activation in exercise is not dependent on muscle acidosis. Direct evidence from studies in metabolic myopathies

    Vissing, J.; Vissing, S. F.; MacLean, D. A.; Saltin, B.; Quistorff, B.; Haller, R. G.; Blomqvist, C. G. (Principal Investigator)

    1998-01-01

    Muscle acidosis has been implicated as a major determinant of reflex sympathetic activation during exercise. To test this hypothesis we studied sympathetic exercise responses in metabolic myopathies in which muscle acidosis is impaired or augmented during exercise. As an index of reflex sympathetic activation to muscle, microneurographic measurements of muscle sympathetic nerve activity (MSNA) were obtained from the peroneal nerve. MSNA was measured during static handgrip exercise at 30% of maximal voluntary contraction force to exhaustion in patients in whom exercise-induced muscle acidosis is absent (seven myophosphorylase deficient patients; MD [McArdle's disease], and one patient with muscle phosphofructokinase deficiency [PFKD]), augmented (one patient with mitochondrial myopathy [MM]), or normal (five healthy controls). Muscle pH was monitored by 31P-magnetic resonance spectroscopy during handgrip exercise in the five control subjects, four MD patients, and the MM and PFKD patients. With handgrip to exhaustion, the increase in MSNA over baseline (bursts per minute [bpm] and total activity [%]) was not impaired in patients with MD (17+/-2 bpm, 124+/-42%) or PFKD (65 bpm, 307%), and was not enhanced in the MM patient (24 bpm, 131%) compared with controls (17+/-4 bpm, 115+/-17%). Post-handgrip ischemia studied in one McArdle patient, caused sustained elevation of MSNA above basal suggesting a chemoreflex activation of MSNA. Handgrip exercise elicited an enhanced drop in muscle pH of 0.51 U in the MM patient compared with the decrease in controls of 0.13+/-0.02 U. In contrast, muscle pH increased with exercise in MD by 0.12+/-0.05 U and in PFKD by 0.01 U. In conclusion, patients with glycogenolytic, glycolytic, and oxidative phosphorylation defects show normal muscle sympathetic nerve responses to static exercise. These findings indicate that muscle acidosis is not a prerequisite for sympathetic activation in exercise.

  18. Thiamine Deficiency in a Developed Country: Acute Lactic Acidosis in Two Neonates Due to Unsupplemented Parenteral Nutrition.

    Salvatori, Guglielmo; Mondì, Vito; Piersigilli, Fiammetta; Capolupo, Irma; Pannone, Veronica; Vici, Carlo Dionisi; Rizzo, Cristiano; Dotta, Andrea

    2016-08-01

    Thiamine is a water-soluble vitamin implicated in several metabolic processes. Its deficiency, due to prolonged parenteral nutrition without adequate vitamin supplementation, can lead to multiorgan failure characterized by cardiovascular impairment and metabolic acidosis refractory to bicarbonate administration. Only thiamine administration allows the remission of symptoms. We report 2 preterm infants with acute thiamine deficiency due to prolonged parenteral nutrition without adequate vitamin supplementation. PMID:25591974

  19. An Uncommon Presentation of HDR Syndrome: Distal Renal Tubular Acidosis in a Patient with Sjögren's Syndrome

    Ebru Sevinç OK

    2015-12-01

    Full Text Available HDR syndrome is an autosomal dominant disorder characterized by hypoparathyroidism, sensorineural deafness and renal dysplasia. Haploinsufficiency of GATA3 on chromosome 10p15 is implicated in the pathogenesis of the syndrome. It may manifest itself with clinical features other than the classical triad. Here we report a case of HDR syndrome with concomitant Sjögren’s syndrome in a 33-year-old who female presented with distal renal tubular acidosis (dRTA.

  20. Acidosis decreases c-Myc oncogene expression in human lymphoma cells: a role for the proton-sensing G protein-coupled receptor TDAG8.

    Li, Zhigang; Dong, Lixue; Dean, Eric; Yang, Li V

    2013-01-01

    Acidosis is a biochemical hallmark of the tumor microenvironment. Here, we report that acute acidosis decreases c-Myc oncogene expression in U937 human lymphoma cells. The level of c-Myc transcripts, but not mRNA or protein stability, contributes to c-Myc protein reduction under acidosis. The pH-sensing receptor TDAG8 (GPR65) is involved in acidosis-induced c-Myc downregulation. TDAG8 is expressed in U937 lymphoma cells, and the overexpression or knockdown of TDAG8 further decreases or partially rescues c-Myc expression, respectively. Acidic pH alone is insufficient to reduce c-Myc expression, as it does not decrease c-Myc in H1299 lung cancer cells expressing very low levels of pH-sensing G protein-coupled receptors (GPCRs). Instead, c-Myc is slightly increased by acidosis in H1299 cells, but this increase is completely inhibited by ectopic overexpression of TDAG8. Interestingly, TDAG8 expression is decreased by more than 50% in human lymphoma samples in comparison to non-tumorous lymph nodes and spleens, suggesting a potential tumor suppressor function of TDAG8 in lymphoma. Collectively, our results identify a novel mechanism of c-Myc regulation by acidosis in the tumor microenvironment and indicate that modulation of TDAG8 and related pH-sensing receptor pathways may be exploited as a new approach to inhibit Myc expression. PMID:24152439

  1. Acidosis Decreases c-Myc Oncogene Expression in Human Lymphoma Cells: A Role for the Proton-Sensing G Protein-Coupled Receptor TDAG8

    Zhigang Li

    2013-10-01

    Full Text Available Acidosis is a biochemical hallmark of the tumor microenvironment. Here, we report that acute acidosis decreases c-Myc oncogene expression in U937 human lymphoma cells. The level of c-Myc transcripts, but not mRNA or protein stability, contributes to c-Myc protein reduction under acidosis. The pH-sensing receptor TDAG8 (GPR65 is involved in acidosis-induced c-Myc downregulation. TDAG8 is expressed in U937 lymphoma cells, and the overexpression or knockdown of TDAG8 further decreases or partially rescues c-Myc expression, respectively. Acidic pH alone is insufficient to reduce c-Myc expression, as it does not decrease c-Myc in H1299 lung cancer cells expressing very low levels of pH-sensing G protein-coupled receptors (GPCRs. Instead, c-Myc is slightly increased by acidosis in H1299 cells, but this increase is completely inhibited by ectopic overexpression of TDAG8. Interestingly, TDAG8 expression is decreased by more than 50% in human lymphoma samples in comparison to non-tumorous lymph nodes and spleens, suggesting a potential tumor suppressor function of TDAG8 in lymphoma. Collectively, our results identify a novel mechanism of c-Myc regulation by acidosis in the tumor microenvironment and indicate that modulation of TDAG8 and related pH-sensing receptor pathways may be exploited as a new approach to inhibit Myc expression.

  2. Topiramate and severe metabolic acidosis: case report Acidose metabólica grave por topiramato: relato de caso

    Jayme E. Burmeister

    2005-06-01

    Full Text Available Topiramate infrequently induces anion gap metabolic acidosis through carbonic anhydrase inhibition on the distal tubule of the nephron - a type 2 renal tubular acidosis. We report on a 40 years old woman previously healthy that developed significant asymptomatic metabolic acidosis during topiramate therapy at a dosage of 100mg/day for three months. Stopping medication was followed by normalization of the acid-base status within five weeks. This infrequent side effect appears unpredictable and should be given careful attention.Topiramato pode produzir raramente uma acidose metabólica através da inibição da anidrase carbônica no túbulo distal do néfron - acidose tubular renal do tipo 2. Relatamos o caso de mulher de 40 anos previamente saudável que desenvolveu quadro de acidose metabólica assintomática grave, sem outra etiologia identificável, durante uso de topiramato na dose de 100mg/dia por três meses. Este efeito colateral, embora infrequente, parece ser imprevisível e requer atenção cuidadosa.

  3. Acute respiratory failure in Pakistani patients: risk factors associated with mortality

    Objective: To assess the outcome and risk factors associated with mortality in patients with acute respiratory failure (ARF). Design: Observational study. Place and Duration of Study: The Aga Khan University Hospital, Karachi, between January 1997 and June 2001. Patients and Methods: All adult patients admitted with a medical cause of acute respiratory failure were reviewed. The primary outcome measure was mortality and secondary outcome measures were factors associated with mortality in ARF. Multiple logistic regression analysis was used to identify the independent risk factors for mortality. Results: A total of 270 patients were admitted with ARF. Hypercapnic respiratory failure was seen in 186 (69%) and hypoxemic in 84 (31%) cases. Pneumonia and COPD exacerbation were the most common underlying causes of ARF. Ventilator support was required in 93 (34.4%) patients. Hospital mortality was 28%. Chronic renal failure, malignancy, hypokalemia, severe acidosis (pH <7.25), septicemia and ARDS independently correlated with mortality. Mortality rate increased sharply (84%) with the presence of three or more risk factors. Conclusion: Acute respiratory failure has a high mortality rate (28%). Development of ARDS or septicemia was associated with high mortality. Presence of more than one risk factor significantly increased the mortality rate. (author)

  4. Obesity and respiratory diseases

    Christopher Zammit

    2010-10-01

    Full Text Available Christopher Zammit, Helen Liddicoat, Ian Moonsie, Himender MakkerSleep and Ventilation Unit, Department of Respiratory Medicine, North Middlesex University Hospital, London, UKAbstract: The obesity epidemic is a global problem, which is set to increase over time. However, the effects of obesity on the respiratory system are often underappreciated. In this review, we will discuss the mechanical effects of obesity on lung physiology and the function of adipose tissue as an endocrine organ producing systemic inflammation and effecting central respiratory control. Obesity plays a key role in the development of obstructive sleep apnea and obesity hypoventilation syndrome. Asthma is more common and often harder to treat in the obese population, and in this study, we review the effects of obesity on airway inflammation and respiratory mechanics. We also discuss the compounding effects of obesity on chronic obstructive pulmonary disease (COPD and the paradoxical interaction of body mass index and COPD severity. Many practical challenges exist in caring for obese patients, and we highlight the complications faced by patients undergoing surgical procedures, especially given the increased use of bariatric surgery. Ultimately, a greater understanding of the effects of obesity on the respiratory disease and the provision of adequate health care resources is vital in order to care for this increasingly important patient population.Keywords: obesity, lung function, obstructive sleep apnea, obesity hypoventilation syndrome, anesthesia

  5. Tolerance of acute hypercapnic acidosis by the European eel ( Anguilla anguilla)

    McKenzie, D J; Taylor, E W; Dalla Valle, A Z;

    2002-01-01

    throughout, as a consequence of a significant increase in stroke volume at PwCO(2)s of 40, 60 and 80 mm Hg. The eels maintained O(2) uptake at routine normocapnic levels throughout hypercapnic exposure. A comparison of the rates of blood O(2) delivery (calculated from CO and caO(2)) against O(2) consumption...... at PwCO(2)s of 60 mm Hg and 80 mm Hg indicated that a portion of O(2) uptake was due to cutaneous respiration. Thus, the European eel's exceptional tolerance of acute hypercapnia is probably a consequence of the tolerance of its heart to acidosis and hypoxia, and a contribution to O(2) uptake from......European eels ( Anguilla anguilla) were exposed sequentially to partial pressures of CO(2) in the water ( PwCO(2)) of 5, 10, 20, 40, 60 then 80 mm Hg (equivalent to 0.66-10.5 kPa), for 30 min at each level. This caused a profound drop in arterial plasma pH, from 7.9 to below 7.2, an increase...

  6. Lactic acidosis and diastolic hypotension after intermittent albuterol nebulization in a pediatric patient

    Tehila A. Saadia

    2015-01-01

    Full Text Available We describe a case of 13-year-old female with intermittent asthma who developed lactic acidosis and diastolic hypotension after receiving intermittent albuterol nebulizer treatment. She presented to the emergency department (ED with sudden onset of shortness of breath and chest pain. She received two albuterol nebulizer treatments at home without symptomatic relief. She was treated in the ED with intermittent albuterol nebulization for a total of 22.5 mg over the next 5 hours. A decrease in diastolic blood pressure from 60 mmHg to 40 mmHg was noted after the treatment. Blood lactate level was 5.9 mmol/L. She recovered from it and was discharged to home but she had recurrence of shortness of breath and presented to the ED two days later. She was treated with albuterol nebulization for a total of 17.5 mg over the next two and half hours and developed diastolic hypotension again, as low as 30 mm Hg. After discontinuation of albuterol nebulization, her BP normalized. Cardiopulmonary and metabolic side effects of continuous albuterol therapy have been reported in the recent medical literature. Our patient, however, developed these adverse effects on intermittent albuterol nebulizer treatment. It is important for the pediatrician to recognize the adverse effects of β2-agonist therapy to avoid carrying out extensive workup for hypotension and hyperlactatemia prolonging hospital stay.

  7. Metabolic Acidosis and Strong Ion Gap in Critically Ill Patients with Acute Kidney Injury

    Cai-Mei Zheng

    2014-01-01

    Full Text Available Purpose. To determine the influence of physicochemical parameters on survival in metabolic acidosis (MA and acute kidney injury (AKI patients. Materials and Methods. Seventy-eight MA patients were collected and assigned to AKI or non-AKI group. We analyzed the physiochemical parameters on survival at 24 h, 72 h, 1 week, 1 month, and 3 months after AKI. Results. Mortality rate was higher in the AKI group. AKI group had higher anion gap (AG, strong ion gap (SIG, and apparent strong ion difference (SIDa values than non-AKI group. SIG value was higher in the AKI survivors than nonsurvivors and this value was correlated serum creatinine, phosphate, albumin, and chloride levels. SIG and serum albumin are negatively correlated with Acute Physiology and Chronic Health Evaluation IV scores. AG was associated with mortality at 1 and 3 months post-AKI, whereas SIG value was associated with mortality at 24 h, 72 h, 1 week, 1 month, and 3 months post-AKI. Conclusions. Whether high or low SIG values correlate with mortality in MA patients with AKI depends on its correlation with serum creatinine, chloride, albumin, and phosphate (P levels. AG predicts short-term mortality and SIG value predicts both short- and long-term mortality among MA patients with AKI.

  8. Respiratory muscle training increases respiratory muscle strength and reduces respiratory complications after stroke: a systematic review

    Kênia KP Menezes

    2016-07-01

    Full Text Available Question: After stroke, does respiratory muscle training increase respiratory muscle strength and/or endurance? Are any benefits carried over to activity and/or participation? Does it reduce respiratory complications? Design: Systematic review of randomised or quasi-randomised trials. Participants: Adults with respiratory muscle weakness following stroke. Intervention: Respiratory muscle training aimed at increasing inspiratory and/or expiratory muscle strength. Outcome measures: Five outcomes were of interest: respiratory muscle strength, respiratory muscle endurance, activity, participation and respiratory complications. Results: Five trials involving 263 participants were included. The mean PEDro score was 6.4 (range 3 to 8, showing moderate methodological quality. Random-effects meta-analyses showed that respiratory muscle training increased maximal inspiratory pressure by 7 cmH2O (95% CI 1 to 14 and maximal expiratory pressure by 13 cmH2O (95% CI 1 to 25; it also decreased the risk of respiratory complications (RR 0.38, 95% CI 0.15 to 0.96 compared with no/sham respiratory intervention. Whether these effects carry over to activity and participation remains uncertain. Conclusion: This systematic review provided evidence that respiratory muscle training is effective after stroke. Meta-analyses based on five trials indicated that 30 minutes of respiratory muscle training, five times per week, for 5 weeks can be expected to increase respiratory muscle strength in very weak individuals after stroke. In addition, respiratory muscle training is expected to reduce the risk of respiratory complications after stroke. Further studies are warranted to investigate whether the benefits are carried over to activity and participation. Registration: PROSPERO (CRD42015020683. [Menezes KKP, Nascimento LR, Ada L, Polese JC, Avelino PR, Teixeira-Salmela LF (2016 Respiratory muscle training increases respiratory muscle strength and reduces respiratory

  9. Differential effects of acidosis, high potassium concentrations, and metabolic inhibition on noradrenaline release and its presynaptic muscarinic regulation.

    Haunstetter, Armin; Schulze Icking, Babette; Backs, Johannes; Krüger, Carsten; Haass, Markus

    2002-03-01

    It was the aim of the present study to characterize the effect of single components of ischaemia, such as inhibition of aerobic and anaerobic energy production by combined anoxic and glucose-free perfusion (metabolic inhibition), high extracellular potassium concentrations (hyperkalaemia), and acidosis, on (1). the stimulated release of noradrenaline from the in situ perfused guinea-pig heart and (2). its presynaptic modulation by the muscarinic agonist carbachol. The release of endogenous noradrenaline from efferent cardiac sympathetic nerve endings was induced by electrical stimulation of the left stellate ganglion (1 min, 5 V, 12 Hz) and quantified in the coronary venous effluent by high-performance liquid chromatography. Under control conditions, two consecutive electrical stimulations (S1, S2) elicited a similar noradrenaline overflow (S2/S1: 0.98 plus minus 0.05). After 10 min of global myocardial ischaemia overflow of endogenous noradrenaline was significantly reduced (S2/S1: 0.18 plus minus 0.03; P< 0.05). When studied separately, metabolic inhibition, hyperkalaemia (16 mM), and acidosis (pH 6.0) each markedly attenuated stimulated noradrenaline overflow (S2/S1: 0.65 plus minus 0.05, 0.43 plus minus 0.14, and 0.37 plus minus 0.09, respectively; P< 0.05). The muscarinic agonist carbachol (10 microM) inhibited stimulated noradrenaline release under normoxic conditions (S2/S1: 0.41 plus minus 0.07; P< 0.05). However, after 10 min of global myocardial ischaemia the inhibitory effect of carbachol on noradrenaline overflow was completely lost. Single components of ischaemia had a differential effect on presynaptic muscarinic modulation. Whereas hyperkalaemia (8-16 mM) did not affect muscarinic inhibition of noradrenaline release, carbachol lost its inhibitory effect during acidosis and metabolic inhibition. In conclusion, hyperkalaemia, metabolic inhibition, and severe acidosis each contribute to reduced overflow of noradrenaline after 10 min of myocardial

  10. Incidence of lactic acidosis toxicity among patients on stavudine or zidovudine containing antiretroviral therapy at Lighthouse clinics

    W Ng'ambi

    2012-11-01

    Full Text Available Although stavudine and zidovudine remain frequently used in low-income countries in Africa, they are associated with long-term toxicities. Lactic acidosis is one of the most serious toxicities in antiretroviral treatment (ART and occurs predominantly in regimens containing stavudine (D4T or zidovudine (AZT. We conducted this study to determine the incidence and risk factors for lactic acidosis among HIV-positive patients that have been on ART for at least 6 months. This study will bridge the gap that exists due to scarcity of data on the extent of toxicities due to long-term use of D4T and AZT. We conducted a retrospective cohort study using routine clinic data from the Lighthouse and Martin Preuss Centre electronic data systems. We used the clinic data collected between 1st January 2004 and 31st December 2011. We included into the analysis all patients that have been on D4T- or AZT-containing ARV drugs for at least 6 months. We analysed the data using Poisson regression of the number of cases of lactic acidosis (LA on gender, age at ART initiation, baseline BMI, and lipodystrophy in order to determine the incidence and risk factors for lactic acidosis. All statistical analyses were done at 5% significance level. We identified 14,854 patients that have ever been on D4T- or AZT-containing ARV drugs for longer than 5 months. Of these, 43% were male and median age was 34 years. The total number of cases of confirmed LA was 342 with observed mortality rate 40% more than the patients without confirmed LA. There were 23.02 cases of LA for every 1000 patient-years on D4T- or AZT-containing ART regimens. The strongest risk factor identified for developing LA was having a baseline BMI >25 with incidence rate ratio (IRR 3.11 (95% CI: 2.49, 3.88. The IRR for patients with a diagnosis of lipodystrophy was 1.77 (95% CI: 1.35, 2.32. Patients aged <30 years at ART initiation had 31% reduced risk of developing LA as compared to patients aged>39 years at ART

  11. Risk factors for mortality in children with diabetic keto acidosis from developing countries

    Varadarajan; Poovazhagi

    2014-01-01

    Diabetic keto acidosis(DKA) is the major cause for mortality in children with Diabetes mellitus(DM). With increasing incidence of type 1 DM worldwide, there is an absolute increase of DM among children between 0-14 year age group and overall incidence among less than 30 years remain the same. This shift towards younger age group is more of concern especially in developing countries where mortality in DKA is alarmingly high. Prior to the era of insulin, DKA was associated with 100% mortality and subsequently mortality rates have come down and is now, 0.15%-0.31% in developed countries. However the scenario in developing countries like India, Pakistan, and Bangladesh are very different and mortality is still high in children with DKA. Prospective studies on DKA in children are lacking in developing countries. Literature on DKA related mortality are based on retrospective studies and are very recent from countries like India, Pakistan and Bangladesh. There exists an urgent need to understand the differences between developed and developing countries with respect to mortality rates and factors associated with increased mortality in children with DKA. Higher mortality rates, increased incidence of cerebral edema, sepsis, shock and renal failure have been identified among DKA in children from developing countries.Root cause for all these complications and increased mortality in DKA could be delayed diagnosis in children from developing countries. This necessitates creating awareness among parents, public and physicians by health education to identify symptoms of DM/DKA in children, in order to decrease mortality in DKA. Based on past experience in Parma, Italy it is possible to prevent occurrence of DKA both in new onset DM and in children with established DM, by simple interventions to increase awareness among public and physicians.

  12. Progress in Diagnosing Mitochondrial Myopathy, Encephalopathy, Lactic Acidosis, and Stroke-like Episodes

    Ying-Xin Wang; Wei-Dong Le

    2015-01-01

    Objective:Mitochondrial myopathy,encephalopathy,lactic acidosis,and stroke-like episodes (MELAS) is a progressive,multisystem affected mitochondrial disease associated with a number of disease-related defective genes.MELAS has unpredictable presentations and clinical course,and it can be commonly misdiagnosed as encephalitis,cerebral infarction,or brain neoplasms.This review aimed to update the diagnosis progress in MELAS,which may provide better understanding of the disease nature and help make the right diagnosis as well.Data Sources:The data used in this review came from published peer review articles from October 1984 to October 2014,which were obtained from PubMed.The search term is "MELAS".Study Selection:Information selected from those reported studies is mainly based on the progress on clinical features,blood biochemistry,neuroimaging,muscle biopsy,and genetics in diagnosing MELAS.Results:MELAS has a wide heterogeneity in genetics and clinical manifestations.The relationship between mutations and phenotypes remains unclear.Advanced serial functional magnetic resonance imaging (MRI) can provide directional information on this disease.Muscle biopsy has meaningful value in diagnosing MELAS,which shows the presence of ragged red fibers and mosaic appearance of cytochrome oxidase negative fibers.Genetic studies have reported that approximately 80% of MELAS cases are caused by the mutation m.3243A>G of the mitochondrial transfer RNA (Leu (UUR)) gene (MT-TL1).Conclusions:MELAS involves multiple systems with variable clinical symptoms and recurrent episodes.The prognosis of MELAS patients depends on timely diagnosis.Therefore,overall diagnosis of MELAS should be based on the maternal inheritance family history,clinical manifestation,and findings from serial MRI,muscle biopsy,and genetics.

  13. Fatores de risco maternos associados à acidose fetal Maternal risk factors associated with fetal acidosis

    José Mauro Madi

    2010-09-01

    Full Text Available OBJETIVOS: avaliar os fatores de risco maternos associados à acidose fetal. MÉTODOS: estudo tipo caso-controle composto por 188 recém-nascidos, sendo que 47 compuseram o grupo casos (pH de artéria umbilical OBJECTIVES: to assess maternal risk factors associated with fetal acidosis. METHODS: a case-control type study was conducted of 188 neonates, of whom 47 comprised the case group (umbilical arterial pH <7.0 and 141 the control (umbilical arterial pH E7.1 <7.3. The study included only single-gestation neonates without congenital malformations. Both maternal and fetal variables were taken into consideration. Statistical analysis involved the calculation of the raw and adjusted Odds Ratio, Student's t-test, the chi-squared test and multivariate analysis using Enter-method non-conditional logistic regression. The level of statistical significance was set at p<0.05. RESULTS: in the case group higher percentages of caesarian sections and pre-term births were observed, involving almost five times as much intensive care and twenty-five times more likelihood of Apgar in the 5th minute <7. No association was observed between the groups and fetal presentation, mother's age, history of miscarriage, years of schooling of mother or attendance at prenatal sessions. After multivariate analysis, the only risk factors that remained significant were complications relating to the placenta or the umbilical cord. Deliveries involving complications relating to the placenta or the umbilical cord were three times more likely to involve fetal acidemia. CONCLUSIONS: acidemia among neonates was associated with a higher percentage of caesarians, premature births, a need for intensive care and treatment and an Apgar index of <7 in the 5th minute. After multivariate analysis, complications relating to premature displacement of the placenta and the umbilical cord were the only remaining risk factors associated with fetal acidemia.

  14. Reversible lactic acidosis in a newborn with thiamine transporter-2 deficiency.

    Pérez-Dueñas, Belén; Serrano, Mercedes; Rebollo, Mónica; Muchart, Jordi; Gargallo, Eva; Dupuits, Celine; Artuch, Rafael

    2013-05-01

    Thiamine transporter-2 deficiency is a recessive disease caused by mutations in the SLC19A3 gene. Patients manifest acute episodes of encephalopathy; symmetric lesions in the cortex, basal ganglia, thalami or periaqueductal gray matter, and a dramatic response to biotin or thiamine. We report a 30-day-old patient with mutations in the SLC19A3 gene who presented with acute encephalopathy and increased level of lactate in the blood (8.6 mmol/L) and cerebrospinal fluid (7.12 mmol/L), a high excretion of α-ketoglutarate in the urine, and increased concentrations of the branched-chain amino acids leucine and isoleucine in the plasma. MRI detected bilateral and symmetric cortico-subcortical lesions involving the perirolandic area, bilateral putamina, and medial thalami. Some lesions showed low apparent diffusion coefficient values suggesting an acute evolution; others had high values likely to be subacute or chronic, most likely related to the perinatal period. After treatment with thiamine and biotin, irritability and opisthotonus disappeared, and the patient recovered consciousness. Biochemical disturbances also disappeared within 48 hours. After discontinuing biotin, the patient remained stable for 6 months on thiamine supplementation (20 mg/kg/day). The examination revealed subtle signs of neurologic sequelae, and MRI showed necrotic changes and volume loss in some affected areas. Our observations suggest that patients with thiamine transporter 2 deficiency may be vulnerable to metabolic decompensation during the perinatal period, when energy demands are high. Thiamine defects should be excluded in newborns and infants with lactic acidosis because prognosis largely depends on the time from diagnosis to thiamine supplementation. PMID:23589815

  15. Your Lungs and Respiratory System

    ... Help White House Lunch Recipes Your Lungs & Respiratory System KidsHealth > For Kids > Your Lungs & Respiratory System Print A A A Text Size What's in ... your body, and they work with your respiratory system to allow you to take in fresh air, ...

  16. Climate change and respiratory disease: European Respiratory Society position statement.

    Ayres, J G; Forsberg, B; Annesi-Maesano, I; Dey, R; Ebi, K L; Helms, P J; Medina-Ramón, M; Windt, M; Forastiere, F

    2009-08-01

    Climate change will affect individuals with pre-existing respiratory disease, but the extent of the effect remains unclear. The present position statement was developed on behalf of the European Respiratory Society in order to identify areas of concern arising from climate change for individuals with respiratory disease, healthcare workers in the respiratory sector and policy makers. The statement was developed following a 2-day workshop held in Leuven (Belgium) in March 2008. Key areas of concern for the respiratory community arising from climate change are discussed and recommendations made to address gaps in knowledge. The most important recommendation was the development of more accurate predictive models for predicting the impact of climate change on respiratory health. Respiratory healthcare workers also have an advocatory role in persuading governments and the European Union to maintain awareness and appropriate actions with respect to climate change, and these areas are also discussed in the position statement. PMID:19251790

  17. Non-Specific Inhibition of Ischemia- and Acidosis-Induced Intracellular Calcium Elevations and Membrane Currents by α-Phenyl-N-tert-butylnitrone, Butylated Hydroxytoluene and Trolox

    Christopher Katnik

    2014-02-01

    Full Text Available Ischemia, and subsequent acidosis, induces neuronal death following brain injury. Oxidative stress is believed to be a key component of this neuronal degeneration. Acute chemical ischemia (azide in the absence of external glucose and acidosis (external media buffered to pH 6.0 produce increases in intracellular calcium concentration ([Ca2+]i and inward membrane currents in cultured rat cortical neurons. Two α-tocopherol analogues, trolox and butylated hydroxytoluene (BHT, and the spin trapping molecule α-Phenyl-N-tert-butylnitrone (PBN were used to determine the role of free radicals in these responses. PBN and BHT inhibited the initial transient increases in [Ca2+]i, produced by ischemia, acidosis and acidic ischemia and increased steady state levels in response to acidosis and the acidic ischemia. BHT and PBN also potentiated the rate at which [Ca2+]i increased after the initial transients during acidic ischemia. Trolox inhibited peak and sustained increases in [Ca2+]i during ischemia. BHT inhibited ischemia induced initial inward currents and trolox inhibited initial inward currents activated by acidosis and acidic ischemia. Given the inconsistent results obtained using these antioxidants, it is unlikely their effects were due to elimination of free radicals. Instead, it appears these compounds have non-specific effects on the ion channels and exchangers responsible for these responses.

  18. Acidosis promotes Bcl-2 family-mediated evasion of apoptosis: involvement of acid-sensing G protein-coupled receptor Gpr65 signaling to Mek/Erk.

    Ryder, Christopher; McColl, Karen; Zhong, Fei; Distelhorst, Clark W

    2012-08-10

    Acidosis arises in solid and lymphoid malignancies secondary to altered nutrient supply and utilization. Tumor acidosis correlates with therapeutic resistance, although the mechanism behind this effect is not fully understood. Here we show that incubation of lymphoma cell lines in acidic conditions (pH 6.5) blocks apoptosis induced by multiple cytotoxic metabolic stresses, including deprivation of glucose or glutamine and treatment with dexamethasone. We sought to examine the role of the Bcl-2 family of apoptosis regulators in this process. Interestingly, we found that acidic culture causes elevation of both Bcl-2 and Bcl-xL, while also attenuating glutamine starvation-induced elevation of p53-up-regulated modulator of apoptosis (PUMA) and Bim. We confirmed with knockdown studies that these shifts direct survival decisions during starvation and acidosis. Importantly, the promotion of a high anti- to pro-apoptotic Bcl-2 family member ratio by acidosis renders cells exquisitely sensitive to the Bcl-2/Bcl-xL antagonist ABT-737, suggesting that acidosis causes Bcl-2 family dependence. This dependence appears to be mediated, in part, by the acid-sensing G protein-coupled receptor, GPR65, via a MEK/ERK pathway. PMID:22685289

  19. Acidosis láctica fatal en paciente con síndrome de inmunodeficiencia adquirido y tratamiento antiretroviral de alto grado de actividad: comunicación de un caso Fatal lactic acidosis in a patient with acquired immunodeficiency syndrome treated with highly active antiretroviral therapy: Report of one case

    Martín Lasso B; Jorge Pérez G; L. Miguel Noriega R; Rebeca Northland A

    2000-01-01

    Type B lactic acidosis occurs without any evidence of cellular hypoxia and is associated with the use of drugs or toxins. We report a 36 years old woman with acquired immunodeficiency syndrome that was admitted to the hospital with a severe lactic acidosis. She had been treated with didanosine, stavudine and efavirenz for four months prior to admission. Despite the use of high bicarbonate doses and vasoactive drugs, the patient had a catastrophic evolution and died in shock and multiple organ...

  20. Acute Respiratory Distress Syndrome: A Rare Complication in Pediatric Diabetic Ketoacidosis.

    Sudhanshu, Siddhnath; Jevalikar, Ganesh; Das, Pravin K; Singh, Pramod K; Bhatia, Eesh; Bhatia, Vijayalakshmi

    2016-05-01

    Cerebral edema (CE) and non cardiogenic pulmonary edema (acute respiratory distress syndrome, ARDS) are life-threatening complications of diabetic ketoacidosis (DKA). In contrast to CE complicating DKA, which is primarily reported in pediatric patients, ARDS is rarely described in this age group. Here, the authors present a child with DKA who developed both cerebral edema and ARDS during the course of her management. It is feasible that severe acidosis, hypotension, azotemia, hypoalbuminemia and the superimposed aggressive intravenous fluid administration were important risk factors for the development of cerebral edema and ARDS in the index patient. The report highlights the importance of early diagnosis and aggressive therapy in the management of ARDS, and summarizes the published literature on this rarely reported complication of pediatric DKA. PMID:26666907

  1. Effects of tight versus non tight control of metabolic acidosis on early renal function after kidney transplantation

    Etezadi Farhad

    2012-09-01

    Full Text Available Abstract Background Recently, several studies have been conducted to determine the optimal strategy for intra-operative fluid replacement therapy in renal transplantation surgery. Since infusion of sodium bicarbonate as a buffer seems to be safer than other buffer compounds (lactate, gluconate, acetatethat indirectly convert into it within the liver, We hypothesized tight control of metabolic acidosis by infusion of sodium bicarbonate may improve early post-operative renal function in renal transplant recipients. Methods 120 patients were randomly divided into two equal groups. In group A, bicarbonate was infused intra-operatively according to Base Excess (BE measurements to achieve the normal values of BE (−5 to +5 mEq/L. In group B, infusion of bicarbonate was allowed only in case of severe metabolic acidosis (BE ≤ −15 mEq/L or bicarbonate ≤ 10 mEq/L or PH ≤ 7.15. Minute ventilation was adjusted to keep PaCO2 within the normal range. Primary end-point was sampling of serum creatinine level in first, second, third and seventh post-operative days for statistical comparison between groups. Secondary objectives were comparison of cumulative urine volumes in the first 24 h of post-operative period and serum BUN levels which were obtained in first, second, third and seventh post-operative days. Results In group A, all of consecutive serum creatinine levels were significantly lower in comparison with group B. With regard to secondary outcomes, no significant difference between groups was observed. Conclusion Intra-operative tight control of metabolic acidosis by infusion of Sodium Bicarbonate in renal transplant recipients may improve early post-operative renal function.

  2. A Comparison of Treating Metabolic Acidosis in CKD Stage 4 Hypertensive Kidney Disease with Fruits and Vegetables or Sodium Bicarbonate

    Goraya, Nimrit; Simoni, Jan; Jo, Chan-Hee

    2013-01-01

    Summary Background and objectives Current guidelines recommend Na+-based alkali for CKD with metabolic acidosis and plasma total CO2 (PTCO2) < 22 mM. Because diets in industrialized societies are typically acid-producing, we compared base-producing fruits and vegetables with oral NaHCO3 (HCO3) regarding the primary outcome of follow-up estimated GFR (eGFR) and secondary outcomes of improved metabolic acidosis and reduced urine indices of kidney injury. Design, setting, participants, & measurements Individuals with stage 4 (eGFR, 15–29 ml/min per 1.73 m2) CKD due to hypertensive nephropathy, had a PTCO2 level < 22 mM, and were receiving angiotensin-converting enzyme inhibition were randomly assigned to 1 year of daily oral NaHCO3 at 1.0 mEq/kg per day (n=35) or fruits and vegetables dosed to reduce dietary acid by half (n=36). Results Plasma cystatin C–calculated eGFR did not differ at baseline and 1 year between groups. One-year PTCO2 was higher than baseline in the HCO3 group (21.2±1.3 versus 19.5±1.5 mM; P<0.01) and the fruits and vegetables group (19.9±1.7 versus 19.3±1.9 mM; P<0.01), consistent with improved metabolic acidosis, and was higher in the HCO3 than the fruits and vegetable group (P<0.001). One-year urine indices of kidney injury were lower than baseline in both groups. Plasma [K+] did not increase in either group. Conclusions One year of fruits and vegetables or NaHCO3 in individuals with stage 4 CKD yielded eGFR that was not different, was associated with higher-than-baseline PTCO2, and was associated with lower-than-baseline urine indices of kidney injury. The data indicate that fruits and vegetables improve metabolic acidosis and reduce kidney injury in stage 4 CKD without producing hyperkalemia. PMID:23393104

  3. Endolymphatic Sac Enlargement in a Girl with a Novel Mutation for Distal Renal Tubular Acidosis and Severe Deafness

    Rink Nikki; Bitzan Martin; O'Gorman Gus; Nagel Mato; Torban Elena; Goodyer Paul

    2012-01-01

    Hereditary distal renal tubular acidosis (dRTA) is caused by mutations of genes encoding subunits of the H+-ATPase (ATP6V0A4 and ATP6V1B1) expressed in α -intercalated cells of the distal renal tubule and in the cochlea. We report on a 2-year-old girl with distal RTA and profound speech delay which was initially misdiagnosed as autism. Genetic analysis showed compound heterozygous mutations with one known and one novel mutation of the ATP6V1B1 gene; cerebral magnetic resonance imaging (MRI) r...

  4. Survival after cardiopulmonary arrest with extreme hyperkalaemia and hypothermia in a patient with metformin-associated lactic acidosis

    Tay, Stan; Lee, I-Lynn

    2012-01-01

    Potassium levels are regularly used as a prognostic factor to cease resuscitation in significant hypothermia. In this case report, we highlight how survival is still possible with extreme hyperkalaemia in severe hypothermia. We present a case of a 65-year-old Caucasian man who presented with metformin associated lactic acidosis. On presentation he had potassium of 9.1 mmol/l and a temperature of 31.5°C. Cardiopulmonary resuscitation was commenced when he went into asystolic arrest. This prese...

  5. An Unusual Initial Presentation of Sjögren’s Syndrome: Severe Hypokalemic Paralysis Secondary to Distal Renal Tubular Acidosis

    Sengul, Erkan; Bunul, Fatih; Yazici, Ayten; Sengul, Aysun; Dindar, Sevim; Halhalli, Gökçen Selma Kilic; Binnetoglu, Emine

    2013-01-01

    Sjögren’s syndrome is mainly affects the exocrine glands. Patients usually complain of persistent dryness of the mouth and eyes. However, nonexocrine organs such as the kidneys are often affected in these patients. Distal renal tubular acidosis (dRTA) and interstitiel nephritis are common in Sjögren’s syndrome. Nonetheless, severe hypokalemia and paralysis secondary to dRTA are unusual initial manifestation of Sjögren’s syndrome. Here, we describe a case of a 48 year old women admitted to the...

  6. Successfully Treated Calcific Uremic Arteriolopathy: Two Cases of a High Anion Gap Metabolic Acidosis with Intravenous Sodium Thiosulfate

    Joshua L. Rein

    2014-01-01

    Full Text Available Calcific uremic arteriolopathy (CUA is a rare and potentially fatal disorder of calcification involving subcutaneous small vessels and fat in patients with renal insufficiency. We describe the successful use of intravenous sodium thiosulfate (STS for the treatment of CUA in two patients. The first case was complicated by the development of a severe anion gap metabolic acidosis, which was accompanied by a seizure. Both patients had complete wound healing within five months. Although STS should be considered in the treatment of CUA, little is known about pharmacokinetics and additional studies are required to determine dosing strategies to minimize severe potential side effects.

  7. Effects of acidosis and NO on nicorandil-activated KATP channels in guinea-pig ventricular myocytes

    Moncada, Gustavo A; Kishi, Yukio; Numano, Fujio; Hiraoka, Masayasu; Sawanobori, Tohru

    2000-01-01

    Nicorandil is a hybrid compound of K+ channel opener and nitrate. We investigated a possible interaction of acidosis and nitric oxide (NO)-donors on the nicorandil-activated ATP-sensitive K+ channel (KATP) in guinea-pig ventricular myocytes using the patch-clamp technique.In whole-cell recordings, external application of 300 μM nicorandil activated KATP in the presence of 2 mM intracellular ATP concentration ([ATP]i) at external pH (pHo) 7.4, but the activated current was decreased by reducin...

  8. Persistent lactic acidosis after chronic topical application of silver sulfadiazine in a pediatric burn patient: a review of the literature

    Willis, Monte S.; Cairns, Bruce A; Purdy, Ashley; Bortsov, Andrey V; Jones, Samuel W.; Ortiz-Pujols, Shiara M; Willis, Tina M Schade; Jr, Benny L Joyner

    2013-01-01

    A 3-year old male who sustained 2nd and 3rd degree burns that covered approximately 60% TBSA presented to a large adult and pediatric verified burn center. On hospital day (HD) 26 of his stay, Candida fungemia was identified by blood culture, delaying operative management until HD 47. On HD 47, after his first operative intervention, the patient developed a persistent metabolic and lactic acidosis. On HD 66, a search for a cause of his osmol gap of 56 mOsm/kg revealed a potential source-propy...

  9. Analysis of arterial blood gas for 113 patients with acute respiratory stress syndrome%急性呼吸窘迫综合征的动态血气监测113例分析

    张玉梅; 周泽芬; 任成山

    2001-01-01

    目的 探讨动态监测血气对急性呼吸窘迫综合征(ARDS)的早期诊断、治疗和预后判断的临床意义。方法 回顾分析了我院16年间危重病患者并发ARDS 113例655例次动脉血气分析、酸碱紊乱类型和氧合指数(PaO2/FiO2)等资料。结果 (1)酸碱失衡类型:113例中单纯酸碱紊乱44例,含呼碱20例,呼酸11例,代酸10例,代碱3例;二重酸碱紊乱53例,含呼碱并代酸12例,呼碱并代碱14例,呼酸并代酸21例,呼酸并代碱6例;三重酸碱失衡(TABD)16例,含呼碱型TABD11例,呼酸型TABD5例。治愈各组以单纯呼碱(17例)和呼碱并代碱(12例)等类型多见;死亡组以呼酸并代酸(19例)、TABD(14例)、呼酸(9例)等类型多见;(2)氧合指数:113例患者的氧合指数均<26.7kPa;(3)113例ARDS治愈52例(46.0%),死亡61例(54.0%)。结论 通过对113例危重患者并发ARDS的血气分析,动态监测血气和计算氧合指数,对ARDS的早期诊断和治疗具有重要的临床价值,而正确分析、判断酸碱失衡类型是正确治疗和提高治愈率的重要环节。%Objective To explore the significance of dynamic determination of arterial blood gas for early diagnosis, treatment and prognosis of patients with acute respiratory stress syndrome(ARDS). Methods The results of 655 times arterial blood gas assayed in 113 patients with ARDS were analysed retrospectively.Results (1)Types of acid-basic disturbance:The simple acid-base disturbances were 44 cases,in which respiratory alkalosis were 20 cases, respiratory acidosis 11 cases, metabolic acidosis 10 cases, metabolic alkalosis 3 cases. Complex acid-base disturbances were 53 cases,in which respiratory alkalosis with metabolic acidosis were12 cases, respiratory alkalosis with metabolic alkalosis 14 cases, respiratory acidosis with metabolic acidosis 21 cases, respiratory alkalosis with metabolic alkalosis 6 cases. Triple acid-base disturbances (TABD) were 16

  10. Adult respiratory distress syndrome

    Due to improved emergency resuscitation procedures, and with advancing medical technology in the field of critical care, an increasing number of patients survive the acute phase of shock and catastrophic trauma. Patients who previously died of massive sepsis, hypovolemic or hypotensive shock, multiple fractures, aspiration, toxic inhalation, and massive embolism are now surviving long enough to develop previously unsuspected and unrecognized secondary effects. With increasing frequency, clinicians are recognizing the clinical and radiographic manifestations of pathologic changes in the lungs occurring secondary to various types of massive insult. This paper gives a list of diseases that have been shown to precipitate or predispose to diffuse lung damage. Various terms have been used to describe the lung damage and respiratory failure secondary to these conditions. The term adult respiratory distress syndrome (ARDS) is applied to several cases of sudden respiratory failure in patients with previously healthy lungs following various types of trauma or shock. Numerous investigations and experiments have studied the pathologic changes in ARDS, and, while there is still no clear indication of why it develops, there is now some correlation of the sequential pathologic developments with the clinical and radiographic changes

  11. Nanotechnology in respiratory medicine.

    Omlor, Albert Joachim; Nguyen, Juliane; Bals, Robert; Dinh, Quoc Thai

    2015-01-01

    Like two sides of the same coin, nanotechnology can be both boon and bane for respiratory medicine. Nanomaterials open new ways in diagnostics and treatment of lung diseases. Nanoparticle based drug delivery systems can help against diseases such as lung cancer, tuberculosis, and pulmonary fibrosis. Moreover, nanoparticles can be loaded with DNA and act as vectors for gene therapy in diseases like cystic fibrosis. Even lung diagnostics with computer tomography (CT) or magnetic resonance imaging (MRI) profits from new nanoparticle based contrast agents. However, the risks of nanotechnology also have to be taken into consideration as engineered nanomaterials resemble natural fine dusts and fibers, which are known to be harmful for the respiratory system in many cases. Recent studies have shown that nanoparticles in the respiratory tract can influence the immune system, can create oxidative stress and even cause genotoxicity. Another important aspect to assess the safety of nanotechnology based products is the absorption of nanoparticles. It was demonstrated that the amount of pulmonary nanoparticle uptake not only depends on physical and chemical nanoparticle characteristics but also on the health status of the organism. The huge diversity in nanotechnology could revolutionize medicine but makes safety assessment a challenging task. PMID:26021823

  12. Respiratory Effects of Sarafotoxins from the Venom of Different Atractaspis Genus Snake Species.

    Malaquin, Stéphanie; Bayat, Sam; Abou Arab, Osama; Mourier, Gilles; Lorne, Emmanuel; Kamel, Saïd; Dupont, Hervé; Ducancel, Frédéric; Mahjoub, Yazine

    2016-01-01

    Sarafotoxins (SRTX) are endothelin-like peptides extracted from the venom of snakes belonging to the Atractaspididae family. A recent in vivo study on anesthetized and ventilated animals showed that sarafotoxin-b (SRTX-b), extracted from the venom of Atractaspis engaddensis, decreases cardiac output by inducing left ventricular dysfunction while sarafotoxin-m (SRTX-m), extracted from the venom of Atractaspis microlepidota microlepidota, induces right ventricular dysfunction with increased airway pressure. The aim of the present experimental study was to compare the respiratory effects of SRTX-m and SRTX-b. Male Wistar rats were anesthetized, tracheotomized and mechanically ventilated. They received either a 1 LD50 IV bolus of SRTX-b (n = 5) or 1 LD50 of SRTX-m (n = 5). The low-frequency forced oscillation technique was used to measure respiratory impedance. Airway resistance (Raw), parenchymal damping (G) and elastance (H) were determined from impedance data, before and 5 min after SRTX injection. SRTX-m and SRTX-b injections induced acute hypoxia and metabolic acidosis with an increased anion gap. Both toxins markedly increased Raw, G and H, but with a much greater effect of SRTX-b on H, which may have been due to pulmonary edema in addition to bronchoconstriction. Therefore, despite their structural analogy, these two toxins exert different effects on respiratory function. These results emphasize the role of the C-terminal extension in the in vivo effect of these toxins. PMID:27409637

  13. Respiratory Effects of Sarafotoxins from the Venom of Different Atractaspis Genus Snake Species

    Stéphanie Malaquin

    2016-07-01

    Full Text Available Sarafotoxins (SRTX are endothelin-like peptides extracted from the venom of snakes belonging to the Atractaspididae family. A recent in vivo study on anesthetized and ventilated animals showed that sarafotoxin-b (SRTX-b, extracted from the venom of Atractaspis engaddensis, decreases cardiac output by inducing left ventricular dysfunction while sarafotoxin-m (SRTX-m, extracted from the venom of Atractaspis microlepidota microlepidota, induces right ventricular dysfunction with increased airway pressure. The aim of the present experimental study was to compare the respiratory effects of SRTX-m and SRTX-b. Male Wistar rats were anesthetized, tracheotomized and mechanically ventilated. They received either a 1 LD50 IV bolus of SRTX-b (n = 5 or 1 LD50 of SRTX-m (n = 5. The low-frequency forced oscillation technique was used to measure respiratory impedance. Airway resistance (Raw, parenchymal damping (G and elastance (H were determined from impedance data, before and 5 min after SRTX injection. SRTX-m and SRTX-b injections induced acute hypoxia and metabolic acidosis with an increased anion gap. Both toxins markedly increased Raw, G and H, but with a much greater effect of SRTX-b on H, which may have been due to pulmonary edema in addition to bronchoconstriction. Therefore, despite their structural analogy, these two toxins exert different effects on respiratory function. These results emphasize the role of the C-terminal extension in the in vivo effect of these toxins.

  14.  Distal Renal Tubular Acidosis, Hypokalemic Paralysis, Nephrocalcinosis, Primary Hypothyroidism, Growth Retardation, Osteomalacia and Osteoporosis Leading to Pathological Fracture: A Case Report

    Mayada Mohammad Swar

    2011-07-01

    Full Text Available  Renal tubular acidosis (RTA is a constellation of syndromes arising from different derangements of tubular acid transport. Recent advances in the biology of urinary acidification have allowed us to discern various molecular mechanisms responsible for these syndromes. RTA often presents as renal stone disease with nephrocalcinosis, ricket/osteomalacia and growth retardation in children with ultimate short stature in adulthood. The case reported here has features of distal renal tubular acidosis (dRTA, hypokalemic paralysis, primary hypothyroidism, growth retardation, osteomalacia and osteopenia leading to stress fracture. All these features presenting in a single case (as in our case is a rare occurrence, so far other cases of distal renal tubular acidosis (dRTA have been reported.

  15. Distal renal tubular acidosis, hypokalemic paralysis, nephrocalcinosis, primary hypothyroidism, growth retardation, osteomalacia and osteoporosis leading to pathological fracture: a case report.

    Basak, Ramen C; Sharkawi, Khairy Mostafa; Rahman, Mohammad Mizanur; Swar, Mayada Mohammad

    2011-07-01

    Renal tubular acidosis (RTA) is a constellation of syndromes arising from different derangements of tubular acid transport. Recent advances in the biology of urinary acidification have allowed us to discern various molecular mechanisms responsible for these syndromes. RTA often presents as renal stone disease with nephrocalcinosis, ricket/osteomalacia and growth retardation in children with ultimate short stature in adulthood. The case reported here has features of distal renal tubular acidosis (dRTA), hypokalemic paralysis, primary hypothyroidism, growth retardation, osteomalacia and osteopenia leading to stress fracture. All these features presenting in a single case (as in our case) is a rare occurrence, so far other cases of distal renal tubular acidosis (dRTA) have been reported. PMID:22043434

  16. [Respiratory preparation before surgery in patients with chronic respiratory failure].

    Delay, Jean-Marc; Jaber, Samir

    2012-03-01

    Scheduled and/or thoracic, abdominal surgeries increase the risk of respiratory postoperative complications. In patients with chronic respiratory failure, preoperative evaluation should be performed to evaluate respiratory function in aim to optimize perioperative management. Preoperative gas exchange abnormalities (hypoxemia or hypercapnia) are associated with respiratory postoperative complications. Respiratory physiotherapy and prophylactic non-invasive ventilation should be integrated in a global rehabilitation management for cardiothoracic or abdominal surgery procedures, which are at high risk of postoperative respiratory dysfunction. Stopping tobacco consummation should be benefit, but decease risk of postoperative complications is relevant only after a period for 6 to 8 weeks of cessation. Bronchodilatator aerosol therapy (beta-agonists and atropinics) and inhaled corticotherapy allow a rapid preparation for 24 to 48 h. Systematic preoperative antibiotherapy should not be recommended. PMID:22004791

  17. Presentation and clinical investigation of mitochondrial respiratory chain disease. A study of 51 patients.

    Jackson, M J; Schaefer, J A; Johnson, M A; Morris, A A; Turnbull, D M; Bindoff, L A

    1995-04-01

    Defects of the mitochondrial respiratory chain are associated with a great variety of clinical disorders. Whilst recognition of these conditions is increasing, the need for sophisticated biochemical and molecular studies has tended to limit both their investigation and diagnosis to a few specialist centres. Using a group of 51 patients with histochemically, biochemically and/or genetically defined respiratory chain defects, we have examined both the clinical heterogeneity of these disorders and how they may be investigated most effectively in non-specialist centres. We evaluated the use of the following routinely available clinical investigations--fasting intermediary metabolites (lactate, pyruvate, ketone bodies, etc.) in blood and cerebrospinal fluid, serum creatine kinase estimation, EMG, EEG, CT, MRI and histological/histochemical muscle biopsy analysis. Our studies show that, in addition to well-recognized syndromes (e.g. chronic progressive external ophthalmoplegia, mitochondrial encephalopathy lactic acidosis and stroke like episodes, and myoclonus epilepsy with ragged red-fibres, a significant number of patients present with non-specific encephalopathic disorders. Furthermore, even within those categories of respiratory chain disease which have been genetically defined, a wide variation of presenting symptoms and signs were found. Where there was initial doubt concerning the diagnosis, the following clinical features were helpful in suggesting respiratory chain disease: ophthalmoplegia; a maternal pattern of inheritance; the presence of myopathy or deafness in association with encephalopathy. Of the clinical investigations we assessed, elevated lactate in blood or cerebrospinal fluid and low density lesions in the basal ganglia were helpful in identifying patients with respiratory chain dysfunction. Histochemical analysis of muscle was, however, the single most useful investigation being diagnostic in patients with chronic progressive external

  18. Respiratory Syncytial Virus in Lower Respiratory Tract Infections

    Anita Chakravarti; Bineeta Kashyap

    2007-01-01

    Objective: Acute lower respiratory infections lead to high morbidity and mortality rates in children from developing countries. The aim of this study was to look into the extent of respiratory syncytial virus infections in children with special reference to the role of specific immunoglobulins in protection against infection as well as the association with bacterial pathogens. Material & Methods: Nasopharyngeal aspirates were tested for respiratory syncytial virus antigen by enzyme immunoassa...

  19. Ácidosis D-láctica secundaria a síndrome de intestino corto D-Lactic acidosis secondary to short bowel syndrome

    M. J. Tapia Guerrero

    2010-10-01

    Full Text Available El síndrome de intestino corto aparece por la reducción de la superficie absortiva intestinal efectiva por pérdida funcional o anatómica de una parte de intestino delgado. Se presenta el caso de una mujer de 35 años con síndrome de intestino corto severo secundario a isquemia intestinal aguda en la edad adulta, que presenta a los 5 años de evolución episodios de mareos con inestabilidad en la marcha y pérdida de fuerza en las manos, llegándose al diagnóstico de acidosis D-láctica. La acidosis D-láctica representa una complicación infrecuente, pero importante por su sintomatología, de este síndrome. Se debe a un cambio en la flora intestinal debido a un sobrecrecimiento de bacterias acidolácticas, que producen D-lactato. Debe sospecharse en aquellos casos de acidosis sin causa aparente y manifestaciones neurológicas sin focalidad en pacientes con síndrome de intestino corto o intervenidos de by-pass yeyuno-ileal. El tratamiento apropiado resuelve con frecuencia los síntomas neurológicos y previene o reduce las recurrencias.The short bowel syndrome appears for the reduction of intestinal absorptive surface due to functional or anatomical loss of part of the small bowel. We present the case of a 35-year-old woman with severe short bowel syndrome secondary to acute intestinal ischemia in adults, who presented at 5 years of evolution episodes of dizziness with gait instability and loss of strength in hands. The diagnosis was D-lactic acidosis. D-lactic acidosis is a rare complication, but important for their symptoms, of this syndrome. It is due to a change in intestinal flora secondary to an overgrowth of lactic acid bacteria that produce D-lactate. D-lactic acidosis should be looked for in cases of metabolic acidosis in which the identity of acidosis is not apparent, neurological manifestations without focality and the patient has short bowel syndrome or patients who have had jejunoileal bypass surgery. Appropiate treatment

  20. Endolymphatic Sac Enlargement in a Girl with a Novel Mutation for Distal Renal Tubular Acidosis and Severe Deafness

    Rink Nikki

    2012-01-01

    Full Text Available Hereditary distal renal tubular acidosis (dRTA is caused by mutations of genes encoding subunits of the H+-ATPase (ATP6V0A4 and ATP6V1B1 expressed in α-intercalated cells of the distal renal tubule and in the cochlea. We report on a 2-year-old girl with distal RTA and profound speech delay which was initially misdiagnosed as autism. Genetic analysis showed compound heterozygous mutations with one known and one novel mutation of the ATP6V1B1 gene; cerebral magnetic resonance imaging (MRI revealed bilateral enlargement of the endolymphatic sacs of the inner ear. With improved cooperation, audiometric testing showed that hearing loss was most profound on the right, where endolymphatic sac enlargement was greatest, demonstrating a clear link between the degree of deafness and the degree of inner ear abnormality. This case indicates the value of MRI for diagnosis of inner ear involvement in very young children with distal RTA. Although citrate therapy quickly corrects the acidosis and restores growth, early diagnosis of deafness is crucial so that hearing aids can be used to assist acquisition of speech and to provide enough auditory nerve stimulation to assure the affected infants remain candidates for cochlear implantation.

  1. Endolymphatic sac enlargement in a girl with a novel mutation for distal renal tubular acidosis and severe deafness.

    Nikki, Rink; Martin, Bitzan; Gus, O'Gorman; Mato, Nagel; Elena, Torban; Paul, Goodyer

    2012-01-01

    Hereditary distal renal tubular acidosis (dRTA) is caused by mutations of genes encoding subunits of the H(+)-ATPase (ATP6V0A4 and ATP6V1B1) expressed in α-intercalated cells of the distal renal tubule and in the cochlea. We report on a 2-year-old girl with distal RTA and profound speech delay which was initially misdiagnosed as autism. Genetic analysis showed compound heterozygous mutations with one known and one novel mutation of the ATP6V1B1 gene; cerebral magnetic resonance imaging (MRI) revealed bilateral enlargement of the endolymphatic sacs of the inner ear. With improved cooperation, audiometric testing showed that hearing loss was most profound on the right, where endolymphatic sac enlargement was greatest, demonstrating a clear link between the degree of deafness and the degree of inner ear abnormality. This case indicates the value of MRI for diagnosis of inner ear involvement in very young children with distal RTA. Although citrate therapy quickly corrects the acidosis and restores growth, early diagnosis of deafness is crucial so that hearing aids can be used to assist acquisition of speech and to provide enough auditory nerve stimulation to assure the affected infants remain candidates for cochlear implantation. PMID:22966473

  2. Short Review of Our Work - “Chronic Metabolic Acidosis Destroys Pancreas” with Focus on the Functional Exocrine Pancreatic Disorders

    linic of San Fran

    2015-07-01

    Full Text Available We deeply appreciate your publishing of our work - “Chronic metabolic acidosis destroys pancreas” in JOP (2014 [1]. We feel that our work can give the food for thought to many young researchers and health practitioners. A short review of our work may generate various questions and ideas for further investigations. In our work, we have focused on negative affects of the chronic metabolic acidosis on pancreatic function including: • Premature activation of the proteases within the pancreas • Diminishing the antimicrobial activity of the pancreatic juice • Suppressing of the flushing out zymogens from the pancreas • Precipitation of the aggressive bile acids • Calcification Authors believe that further research may provide more details of how the acidification destroys the pancreas and causes chronic pancreatitis. We would like to share some of our thoughts on this subject as follows: Descriptions of symptoms of chronic pancreatitis such as pain, malabsorption syndrome, steatorrhea, and weight loss are found in almost all medical books, textbooks, and articles. The medical literature refers to these conditions as “pancreatic insufficiency”. It is known that these symptoms occur when only 10 % of the exocrine pancreatic function is left intact. This is not an “insufficiency.” It is a pancreatic “failure” when the therapeutic opportunities are very limited.

  3. Respiratory failure in diabetic ketoacidosis

    2015-01-01

    Respiratory failure complicating the course of diabeticketoacidosis (DKA) is a source of increased morbidityand mortality. Detection of respiratory failure in DKA requiresfocused clinical monitoring, careful interpretationof arterial blood gases, and investigation for conditionsthat can affect adversely the respiration. Conditions thatcompromise respiratory function caused by DKA can bedetected at presentation but are usually more prevalentduring treatment. These conditions include deficits ofpotassium, magnesium and phosphate and hydrostatic ornon-hydrostatic pulmonary edema. Conditions not causedby DKA that can worsen respiratory function under theadded stress of DKA include infections of the respiratorysystem, pre-existing respiratory or neuromuscular diseaseand miscellaneous other conditions. Prompt recognitionand management of the conditions that can lead torespiratory failure in DKA may prevent respiratory failureand improve mortality from DKA.

  4. Paediatric respiratory infections

    Mark L. Everard

    2016-03-01

    Full Text Available Pulmonary infections remain a major cause of infant and child mortality worldwide and are responsible for a substantial burden of morbidity. During the 2015 European Respiratory Society International Congress in Amsterdam, some of the main findings from peer-reviewed articles addressing this topic that were published in the preceding 12 months were reviewed in a Paediatric Clinical Year in Review session. The following article highlights some of the insights provided by these articles into the complex interactions of the human host with the extensive and dynamic populations of microorganisms that call an individual “home”.

  5. Respiratory System Disease.

    Goetz, Danielle M; Singh, Shipra

    2016-08-01

    Respiratory system involvement in cystic fibrosis is the leading cause of morbidity and mortality. Defects in the cystic fibrosis transmembrane regulator (CFTR) gene throughout the sinopulmonary tract result in recurrent infections with a variety of organisms including Pseudomonas aeruginosa, methicillin-resistant Staphylococcus aureus, and nontuberculous mycobacteria. Lung disease occurs earlier in life than once thought and ideal methods of monitoring lung function, decline, or improvement with therapy are debated. Treatment of sinopulmonary disease may include physiotherapy, mucus-modifying and antiinflammatory agents, antimicrobials, and surgery. In the new era of personalized medicine, CFTR correctors and potentiators may change the course of disease. PMID:27469180

  6. Recurrent respiratory papillomatosis.

    Venkatesan, Naren N; Pine, Harold S; Underbrink, Michael P

    2012-06-01

    Recurrent respiratory papillomatosis (RRP) is a rare, benign disease with no known cure. RRP is caused by infection of the upper aerodigestive tract with the human papillomavirus (HPV). Passage through the birth canal is thought to be the initial transmission event, but infection may occur in utero. HPV vaccines have helped to provide protection from cervical cancer; however, their role in the prevention of RRP is undetermined. Clinical presentation of initial symptoms of RRP may be subtle. RRP course varies, and current management focuses on surgical debulking of papillomatous lesions with or without concurrent adjuvant therapy. PMID:22588043

  7. Respiratory tract and mediastinum

    Respiratory tract problems originating in attempts to diagnose and treat illness are commonplace. They range from pharyngeal trauma during intubation to radiation-induced thyroid carcinoma. Occasionally, as with pulmonary hypervolemia accompanying drug-induced renal failure, they originate at a distance. Their actual number far exceeds those brought to clinical attention. Familiarity with the procedures which give rise to these complications is helpful in detecting and remedying them. It is important, therefore, to discuss their pathogenesis as well as their clinical and radiological findings

  8. Current devices of respiratory physiotherapy

    Hristara-Papadopoulou, A; Tsanakas, J; Diomou, G; Papadopoulou, O.

    2008-01-01

    In recent years patients with respiratory diseases use various devices, which help the removal of mucus from the airways and the improvement of pulmonary function. The aim of the present study is to determine the effectiveness of the current devices of respiratory physiotherapy, as it comes from the review of literature. The current devices of physiotherapy for patients with respiratory diseases, are presented as an alternative therapy method or a supplemental therapy and they can motivate pa...

  9. Auscultation of the respiratory system

    2015-01-01

    Auscultation of the lung is an important part of the respiratory examination and is helpful in diagnosing various respiratory disorders. Auscultation assesses airflow through the trachea-bronchial tree. It is important to distinguish normal respiratory sounds from abnormal ones for example crackles, wheezes, and pleural rub in order to make correct diagnosis. It is necessary to understand the underlying pathophysiology of various lung sounds generation for better understanding of disease proc...

  10. Respiratory failure in diabetic ketoacidosis

    Konstantinov, Nikifor K; Rohrscheib, Mark; Agaba, Emmanuel I.; Dorin, Richard I.; Murata, Glen H.; Tzamaloukas, Antonios H.

    2015-01-01

    Respiratory failure complicating the course of diabetic ketoacidosis (DKA) is a source of increased morbidity and mortality. Detection of respiratory failure in DKA requires focused clinical monitoring, careful interpretation of arterial blood gases, and investigation for conditions that can affect adversely the respiration. Conditions that compromise respiratory function caused by DKA can be detected at presentation but are usually more prevalent during treatment. These conditions include de...

  11. Management of Postoperative Respiratory Failure.

    Mulligan, Michael S; Berfield, Kathleen S; Abbaszadeh, Ryan V

    2015-11-01

    Despite best efforts, postoperative complications such as postoperative respiratory failure may occur and prompt recognition of the process and management is required. Postoperative respiratory failure, such as postoperative pneumonia, postpneumonectomy pulmonary edema, acute respiratory distress-like syndromes, and pulmonary embolism, are associated with high morbidity and mortality. The causes of these complications are multifactorial and depend on preoperative, intraoperative, and postoperative factors, some of which are modifiable. The article identifies some of the risk factors, causes, and treatment strategies for successful management of the patient with postoperative respiratory failure. PMID:26515943

  12. Submersion and acute respiratory failure

    Yu-Jang Su

    2014-01-01

    Conclusions: Submersion patients who are hypothermic on arrival of emergency department (ED are risky to respiratory failure and older, more hypothermic, longer hospital stay in suicidal submersion patients.

  13. Respiratory symptoms of megaesophagus

    Fabio Di Stefano

    2013-03-01

    Full Text Available Megaesophagus as the end result of achalasia is the consequence of disordered peristalsis and the slow decompensation of the esophageal muscular layer. The main symptoms of achalasia are dysphagia, regurgitation, chest pain and weight loss, but respiratory symptoms, such as coughing, particularly when patients lie in a horizontal position, may also be common due to microaspiration. A 70-year old woman suffered from a nocturnal cough and shortness of breath with stridor. She reported difficulty in swallowing food over the past ten years, but had adapted by eating a semi-liquid diet. Chest X-ray showed right hemithorax patchy opacities projecting from the posterior mediastinum. Chest computed tomography scan showed a marked dilatation of the esophagus with abundant food residues. Endoscopy confirmed the diagnosis of megaesophagus due to esophageal achalasia, excluding other causes of obstruction, such as secondary esophagitis, polyps, leiomyoma or leiomyosarcoma. In the elderly population, swallowing difficulties due to esophageal achalasia are often underestimated and less troublesome than the respiratory symptoms that are caused by microaspiration. The diagnosis of esophageal achalasia, although uncommon, should be considered in patients with nocturnal chronic coughs and shortness of breath with stridor when concomitant swallowing difficulties are present.

  14. 重度乳酸性酸中毒并心脏骤停一例诊治分析%Characteristics of Severe Lactic Acidosis Complicated with Cardiac Arrest and the Related Literature Review

    刘红升; 苏琴; 曹阳; 姚咏明; 赵晓东

    2015-01-01

    目的:探讨重度乳酸性酸中毒(lactic acidosis, LA)的临床特征及治疗方法,以提高救治成功率。方法对我院收治的重度 LA 并心脏骤停1例的临床资料进行回顾性分析。结果本例因腹泻3 d、剧烈上腹痛1 h 以急性心肌梗死(心梗)急诊入院。有糖尿病史,长期口服二甲双胍,未定期检测血糖。入院后出现腰背剧痛,经相关检查排除急性心梗、主动脉夹层,查血乳酸脱氢酶277.0 U/ L,乳酸17 mmol/ L,血气分析示代谢性酸中毒,入院诊断为糖尿病、重度 LA。入院1 h 后发生心脏骤停,经积极复苏抢救,病情逐步缓解,1个月后临床治愈出院。结论重度 LA 可以剧烈胸腹部疼痛为主要表现,甚至发生心脏骤停,及时诊断及正确评估病情对预后极为重要,积极液体复苏及有效呼吸支持、早期血液透析是救治成功的保证。%Objective To investigate the clinical features and the treatment of severe lactic acidosis (LA) and to im-prove the success rate. Methods We carried out a retrospective analysis of clinical data of a patient suffering from cardiac ar-rest with severe LA and a review of the related literature review was made. Results The patient suffered from diarrhea for 3 d, severe abdominal pain for 1 h and was admitted into our hospital for acute myocardial infarction. The patient had a history of diabetes and diabetic nephropathy and took a long-term oral metformin without testing blood sugar regularly. Relevant exam-inations ruled out acute myocardial infarction and aortic dissection, and then, and the blood lactate dehydrogenase was 277. 0 U/ L, and lactic acid was 17 mmol/ L and blood gas analysis revealed metabolic acidosis. Above all, the patient was di-agnosed with diabetes and severe LA. The patient suffered sudden cardiac arrest one hour after admission, then the condition was alleviated gradually after active recovery treatment, and in the end the patient was clinically cured and was

  15. Lactate production retards, not causes, acidosis: a theoretical approach for physical education students.

    R. Hohl

    2005-07-01

    increased blood  lactate detection  is the  effect  not  the  cause  of acidosis.   The  students  must  understand that if muscles do not  produce  lactate, acidoses and fatigue  would accour faster,  impairing  high intensity exercise performance.  This information must be considered  in their  training schedules.

  16. Subacute ruminal acidosis challenge changed in situ degradability of feedstuffs in dairy goats.

    Li, Fei; Cao, Yangchun; Liu, Nannan; Yang, Xinjian; Yao, Junhu; Yan, Dabing

    2014-01-01

    This study investigated the effects of wheat-induced subacute ruminal acidosis (SARA) on rumen bacterial populations and in situ degradabilities of NDF, starch, and crude protein of feeds. Four multiparous dairy goats (BW=60±3.3kg) fitted with ruminal cannulas were assigned to a 2×2 crossover design (28-d treatment periods separated by a 7-d washout interval). The treatment diets consisted of 2 levels of cracked wheat: 0 (control, corn based concentrate) and 35% (diet-induced SARA, wheat-based concentrate), with a constant forage- (45% alfalfa hay and 5% corn silage of DM) to-concentrate (50% of DM) ratio. Results indicate that diets with a 35% wheat decreased ruminal pH (6.21 vs. 5.98) and increased the duration (1.13 vs. 4.72h/d) and area (0.12 vs. 0.78 pH × h/d) of ruminal pH below 5.6 and induced SARA. The SARA increased ruminal total volatile fatty acid concentration, from 105.0 to 123.8mM, and decreased the acetate molar proportion (62.8 vs. 56.6mol/100mol) and the acetate-to-propionate ratio (3.5 vs. 2.8). Compared with the control group, SARA decreases the relative abundance of Fibrobacter succinogenes (-59.3%) and Ruminococcus flavefaciens (-68.4%), whereas it increased Succinimonas amylolytica (198.1%) and Ruminobacter amylophilus (125.2%). The SARA decreased 24- and 48-h dry matter (DM) and neutral detergent fiber (NDF) degradabilities of corn silage. The 48-h degradabilities of DM (51.0 vs. 48.2%) and NDF (40.3 vs. 36.0%) in alfalfa hay were not affected by SARA, but the SARA tended to reduce the 24-h DM (49.6 vs. 46.3%) and NDF (37.8 vs. 33.2%) degradabilities. The effective ruminal degradabilities of DM and NDF in alfalfa hay and corn silage were reduced during SARA. In situ degradability parameters of DM and starch of wheat were not affected by SARA, but starch degradability of corn (9.5 vs. 13.3%/h) increased. The SARA reduced in situ 12-h degradabilities of DM and crude protein of soybean meal and extruded soybean without affecting the

  17. Implementing change in respiratory care.

    Stoller, James K

    2010-06-01

    Though people are generally averse to change, change and innovation are critically important in respiratory care to maintain scientific and clinical progress. This paper reviews the issue of change in respiratory care. I summarize several available models of organizational and personal change (ie, those of Kotter and of Silversin and Kornacki, and the Intentional Change Theory of Boyatzis), review the characteristics of change-avid respiratory therapy departments, offer an example of a change effort in respiratory care (implementation of respiratory care protocols) and then analyze this change effort as it took place at one institution, the Cleveland Clinic, using these models. Finally, I present the results of an analysis of change-avid respiratory therapy departments and offer some suggestions regarding change management for the profession and for individual respiratory care clinicians. Common features of theories of organizational change include developing a sense of urgency, overcoming resistance, developing a guiding coalition, and involving key stakeholders early. With the understanding that change efforts may seem unduly "clean" and orderly in retrospect, the models help explain the sustainable success of efforts to implement the Respiratory Therapy Consult Service at the Cleveland Clinic. By implication, these models offer value in planning change efforts prospectively. Further analysis of features of change-avid respiratory therapy departments indicates 11 highly desired features, of which four that especially characterize change-avid departments include: having an up-to-date leadership team; employee involvement in change; celebrating wins; and an overall sense of progressiveness in the department. This analysis suggests that understanding and embracing change is important. To anchor change in our profession, greater attention should be given to developing a pipeline of respiratory care clinicians who, by virtue of their advanced training, have the skills

  18. Ibuprofen-Induced Hypokalemia and Distal Renal Tubular Acidosis: A Patient’s Perceptions of Over-the-Counter Medications and Their Adverse Effects

    Mark D. Salter

    2013-01-01

    Full Text Available We highlight a case of distal renal tubular acidosis secondary to ibuprofen and codeine use. Of particular interest in this case are the patient’s perception of over-the-counter (OTC medication use, her own OTC use prior to admission, and her knowledge of adverse reactions or side effects of these medications prior to taking them.

  19. Unsuspected myasthenia gravis presenting as respiratory failure.

    Mier, A; Laroche, C; Green, M

    1990-01-01

    A patient developed respiratory failure after surgical removal of a recurrent thymoma, which necessitated removal of part of the diaphragm. The respiratory failure was due to previously undiagnosed myasthenia gravis, which had selectively affected the respiratory muscles.

  20. Mucosal necrosis of the small intestine in myopathy,encephalopathy, lactic acidosis, and stroke-like episodes syndrome

    Keita Fukuyama; Yasuhide Ishikawa; Tetsuro Ogino; Hidenobu Inoue; Ryoya Yamaoka; Tetsuro Hirose; Tomohiko Nishihira

    2012-01-01

    This report presents a case of massive mucosal necrosis of the small intestine in a patient with mitochondrial myopathy,encephalopathy,lactic acidosis,and stroke-like episodes (MELAS),which particularly affects the brain,nervous system and muscles.A 45-year-old Japanese female,with an established diagnosis of MELAS,presented with vomiting.Computed tomography showed portomesenteric venous gas and pneumatosis intestinalis.She underwent a resection of the small intestine.A microscopic study showed necrosis of the mucosa and vacuolar degeneration of smooth muscle cells in the arterial wall.Immunohistochemistry showed anti-mitochondrial antibody to be highly expressed in the crypts adjacent the necrotic mucosa.The microscopic and immunohistochemical findings suggested the presence of a large number of abnormal mitochondria in MELAS to be closely linked to mucosal necrosis of the small intestine.

  1. Knock-down of hypoxia-induced carbonic anhydrases IX and XII radiosensitizes tumor cells by increasing intracellular acidosis

    Jérôme eDoyen

    2013-01-01

    Full Text Available The relationship between acidosis within the tumor microenvironment and radioresistance of hypoxic tumor cells remains unclear. Previously we reported that hypoxia-induced carbonic anhydrases CAIX and CAXII constitute a robust pHi-regulating system that confers a survival advantage on hypoxic human colon carcinoma LS174Tr cells in acidic microenvironments. Here we investigate the role of acidosis, CAIX and CAXII knock-down in combination with ionizing radiation. Fibroblasts cells (-/+ CAIX and LS174Tr cells (inducible knock-down for ca9/ca12 were analyzed for cell cycle phase distribution and survival after irradiation in extracellular pHo manipulations and hypoxia (1% O2 exposure. Radiotherapy was used to target ca9/ca12-silenced LS174Tr tumors grown in nude mice. We found that diminishing the pHi-regulating capacity of fibroblasts through inhibition of NHE-1 sensitize cells to radiation-induced cell death. Secondly, the pHi-regulating function of CAIX plays a key protective role in irradiated fibroblasts in an acidic environment as accompanied by a reduced number of cells in the radiosensitive phases of the cell cycle. Thirdly, we demonstrate that irradiation of LS174Tr spheroids, silenced for either ca9 or both ca9/ca12, showed a respective 50% and 75% increase in cell death as a result of a decrease in cell number in the radioresistant S phase and a disruption of CA-mediated pHi regulation. Finally, LS174Tr tumor progression was strongly decreased when ca9/ca12 silencing was combined with irradiation in vivo. These findings highlight the combinatory use of radiotherapy with targeting of the pHi-regulating carbonic anhydrases as an anti-cancer strategy.

  2. Effects of grain, fructose, and histidine on ruminal pH and fermentation products during an induced subacute acidosis protocol.

    Golder, H M; Celi, P; Rabiee, A R; Heuer, C; Bramley, E; Miller, D W; King, R; Lean, I J

    2012-04-01

    The effects of grain, fructose, and histidine on ruminal pH and fermentation products were studied in dairy cattle during an induced subacute acidosis protocol. Thirty Holstein heifers were randomly allocated to 5 treatment groups: (1) control (no grain); (2) grain [fed at a crushed triticale dry matter intake (DMI) of 1.2% of body weight (BW)]; (3) grain (0.8% of BW DMI)+fructose (0.4% of BW DMI); (4) grain (1.2% of BW DMI)+histidine (6 g/head); and (5) grain (0.8% of BW DMI)+fructose (0.4% of BW DMI)+histidine (6 g/head) in a partial factorial arrangement. Heifers were fed 1 kg of grain daily with ad libitum access to ryegrass silage and alfalfa hay for 10 d. Feed was withheld for 14 h before challenge day, on which heifers were fed 200 g of alfalfa hay and then the treatment diets immediately thereafter. Rumen samples were collected 5 min after diet ingestion, 60 min later, and at 3 subsequent 50-min intervals. Grain decreased ruminal pH and increased ammonia, total volatile fatty acid (VFA), acetate, butyrate, propionate, and valerate concentrations compared with controls. The addition of grain had no effect on ruminal D- and L-lactate concentrations. Fructose markedly decreased ruminal pH and markedly increased D- and L-lactate concentrations. Fructose increased total VFA and butyrate and decreased valerate concentrations. Although histidine did not have a marked effect on ruminal fermentation, increased concentrations of histamine were observed following feeding. This study demonstrates that the substitution of some grain for fructose can lower ruminal pH and increase VFA and lactate concentrations, warranting further investigation into the role of sugars on the risk of acidosis in dairy cattle. PMID:22459843

  3. Acidosis láctica fatal en paciente con síndrome de inmunodeficiencia adquirido y tratamiento antiretroviral de alto grado de actividad: comunicación de un caso Fatal lactic acidosis in a patient with acquired immunodeficiency syndrome treated with highly active antiretroviral therapy: Report of one case

    Martín Lasso B

    2000-10-01

    Full Text Available Type B lactic acidosis occurs without any evidence of cellular hypoxia and is associated with the use of drugs or toxins. We report a 36 years old woman with acquired immunodeficiency syndrome that was admitted to the hospital with a severe lactic acidosis. She had been treated with didanosine, stavudine and efavirenz for four months prior to admission. Despite the use of high bicarbonate doses and vasoactive drugs, the patient had a catastrophic evolution and died in shock and multiple organ failure, 68 hours after admission. (Rev Méd Chile 2000; 128: 1139-43.

  4. Applying a low-flow CO2 removal device in severe acute hypercapnic respiratory failure.

    Sharma, Ajay S; Weerwind, Patrick W; Strauch, Uli; van Belle, Arne; Maessen, Jos G; Wouters, Emiel F M

    2016-03-01

    A novel and portable extracorporeal CO2-removal device was evaluated to provide additional gas transfer, auxiliary to standard therapy in severe acute hypercapnic respiratory failure. A dual-lumen catheter was inserted percutaneously in five subjects (mean age 55 ± 0.4 years) and, subsequently, connected to the CO2-removal device. The median duration on support was 45 hours (interquartile range 26-156), with a blood flow rate of approximately 500 mL/min. The mean PaCO2 decreased from 95.8 ± 21.9 mmHg to 63.9 ± 19.6 mmHg with the pH improving from 7.11 ± 0.1 to 7.26 ± 0.1 in the initial 4 hours of support. Three subjects were directly weaned from the CO2-removal device and mechanical ventilation, one subject was converted to ECMO and one subject died following withdrawal of support. No systemic bleeding or device complications were observed. Low-flow CO2 removal adjuvant to standard therapy was effective in steadily removing CO2, limiting the progression of acidosis in subjects with severe acute hypercapnic respiratory failure. PMID:26040584

  5. Multiplex detection of respiratory pathogens

    McBride, Mary (Brentwood, CA); Slezak, Thomas (Livermore, CA); Birch, James M. (Albany, CA)

    2012-07-31

    Described are kits and methods useful for detection of respiratory pathogens (influenza A (including subtyping capability for H1, H3, H5 and H7 subtypes) influenza B, parainfluenza (type 2), respiratory syncytial virus, and adenovirus) in a sample. Genomic sequence information from the respiratory pathogens was analyzed to identify signature sequences, e.g., polynucleotide sequences useful for confirming the presence or absence of a pathogen in a sample. Primer and probe sets were designed and optimized for use in a PCR based, multiplexed Luminex assay to successfully identify the presence or absence of pathogens in a sample.

  6. Acute Respiratory Distress Syndrome.

    Yadam, Suman; Bihler, Eric; Balaan, Marvin

    2016-01-01

    Acute respiratory distress syndrome (ARDS) is a serious inflammatory disorder with high mortality. Its main pathologic mechanism seems to result from increased alveolar permeability. Its definition has also changed since first being described according to the Berlin definition, which now classifies ARDS on a severity scale based on PaO2 (partial pressure of oxygen, arterial)/FIO2 (fraction of inspired oxygen) ratio. The cornerstone of therapy was found to be a low tidal volume strategy featuring volumes of 6 to 8 mL per kg of ideal body weight that has been shown to have decreased mortality as proven by the ARDSnet trials. There are other areas of treatment right now that include extracorporeal membrane oxygenation, as well for severe refractory hypoxemia. Other methods that include prone positioning for ventilation have also shown improvements in oxygenation. Positive end-expiratory pressure with lung recruitment maneuvers has also been found to be helpful. Other therapies that include vasodilators and neuromuscular agents are still being explored and need further studies to define their role in ARDS. PMID:26919679

  7. Achromobacter respiratory infections.

    Swenson, Colin E; Sadikot, Ruxana T

    2015-02-01

    Achromobacteria are ubiquitous environmental organisms that may also become opportunistic pathogens in certain conditions, such as cystic fibrosis, hematologic and solid organ malignancies, renal failure, and certain immune deficiencies. Some members of this genus, such as xylosoxidans, cause primarily nosocomially acquired infections affecting multiple organ systems, including the respiratory tract, urinary tract, and, less commonly, the cardiovascular and central nervous systems. Despite an increasing number of published case reports and literature reviews suggesting a global increase in achromobacterial disease, most clinicians remain uncertain of the organism's significance when clinically isolated. Moreover, effective treatment can be challenging due to the organism's inherent and acquired multidrug resistance patterns. We reviewed all published cases to date of non-cystic fibrosis achromobacterial lung infections to better understand the organism's pathogenic potential and drug susceptibilities. We found that the majority of these cases were community acquired, typically presenting as pneumonias (88%), and were most frequent in individuals with hematologic and solid organ malignancies. Our findings also suggest that achromobacterial lung infections are difficult to treat, but respond well to extended-spectrum penicillins and cephalosporins, such as ticarcillin, piperacillin, and cefoperazone. PMID:25706494

  8. [Vaccinations in respiratory medicine].

    Lode, H M; Stahlmann, R

    2015-09-01

    Vaccinations are the most successful and cost-effective measures for prevention of infections. Important pathogens of respiratory tract infections (e.g. influenza viruses and pneumococci) can be effectively treated by vaccinations. The seasonal trivalent and recently now quadrivalent influenza vaccines include antigens from influenza A and B type viruses, which have to be modified annually oriented to the circulating strains. The effective protection by influenza vaccination varies considerably (too short protection time, mismatch); therefore, administration late in the year is the best approach (November/December). Two pneumococcal vaccines are recommended for adults: the over 30-year-old 23-valent polysaccharide vaccine (PPV23) and the 4-year-old 13-valent conjugate vaccine (PCV13). The immunological and clinical efficacy of PPV23 is controversially discussed; however, a moderate reduction of invasive pneumococcal infections is widely accepted. The PCV13 stimulates a T-cell response and has currently demonstrated its clinical efficacy in an impressive study (CAPiTA). The problem of PCV13 is the relatively limited coverage of only 47% of the currently circulating invasive pneumococcal serotypes. PMID:26330051

  9. How Is Respiratory Failure Treated?

    ... Once your doctor figures out what's causing your respiratory failure, he or she will plan how to treat that disease or condition. Treatments may include medicines, procedures, and other therapies. Rate This Content: NEXT >> Updated: December 19, 2011 Twitter ...

  10. Research outputs in respiratory medicine

    Rippon, I; Lewison, G; Partridge, M

    2005-01-01

    Background: There is currently little information regarding how much the distribution of research activity in respiratory medicine reflects the interests of its clinicians and scientists, the disease burden in any country, or the availability of funding.

  11. Middle East Respiratory Syndrome (MERS)

    Middle East Respiratory Syndrome Coronavirus; MERS-CoV; Novel coronavirus; nCoV ... Centers for Disease Control and Prevention. Middle East ... 2, 2015. www.cdc.gov/coronavirus/mers/faq.html . Accessed April ...

  12. Macrophage Heterogeneity in Respiratory Diseases

    Boorsma, Carian E.; Christina Draijer; Barbro N. Melgert

    2013-01-01

    Macrophages are among the most abundant cells in the respiratory tract, and they can have strikingly different phenotypes within this environment. Our knowledge of the different phenotypes and their functions in the lung is sketchy at best, but they appear to be linked to the protection of gas exchange against microbial threats and excessive tissue responses. Phenotypical changes of macrophages within the lung are found in many respiratory diseases including asthma, chronic obstructive pulmon...

  13. The acute respiratory distress syndrome

    Modrykamien, Ariel M.; Gupta, Pooja

    2015-01-01

    The acute respiratory distress syndrome (ARDS) is a major cause of acute respiratory failure. Its development leads to high rates of mortality, as well as short- and long-term complications, such as physical and cognitive impairment. Therefore, early recognition of this syndrome and application of demonstrated therapeutic interventions are essential to change the natural course of this devastating entity. In this review article, we describe updated concepts in ARDS. Specifically, we discuss t...

  14. Climate Change and Respiratory Infections.

    Mirsaeidi, Mehdi; Motahari, Hooman; Taghizadeh Khamesi, Mojdeh; Sharifi, Arash; Campos, Michael; Schraufnagel, Dean E

    2016-08-01

    The rate of global warming has accelerated over the past 50 years. Increasing surface temperature is melting glaciers and raising the sea level. More flooding, droughts, hurricanes, and heat waves are being reported. Accelerated changes in climate are already affecting human health, in part by altering the epidemiology of climate-sensitive pathogens. In particular, climate change may alter the incidence and severity of respiratory infections by affecting vectors and host immune responses. Certain respiratory infections, such as avian influenza and coccidioidomycosis, are occurring in locations previously unaffected, apparently because of global warming. Young children and older adults appear to be particularly vulnerable to rapid fluctuations in ambient temperature. For example, an increase in the incidence in childhood pneumonia in Australia has been associated with sharp temperature drops from one day to the next. Extreme weather events, such as heat waves, floods, major storms, drought, and wildfires, are also believed to change the incidence of respiratory infections. An outbreak of aspergillosis among Japanese survivors of the 2011 tsunami is one such well-documented example. Changes in temperature, precipitation, relative humidity, and air pollution influence viral activity and transmission. For example, in early 2000, an outbreak of Hantavirus respiratory disease was linked to a local increase in the rodent population, which in turn was attributed to a two- to threefold increase in rainfall before the outbreak. Climate-sensitive respiratory pathogens present challenges to respiratory health that may be far greater in the foreseeable future. PMID:27300144

  15. Urgencias respiratorias Respiratory emergencies

    E. Martínez

    2004-01-01

    Full Text Available Las urgencias respiratorias en un paciente con cáncer pueden tener su origen en patologías de la vía aérea, del parénquima pulmonar o de los grandes vasos. La causa puede ser el propio tumor o complicaciones concomitantes. La obstrucción de la vía aérea debería ser inicialmente evaluada con procedimientos endoscópicos. En situaciones severas, la cirugía raramente es posible. El emplazamiento endobronquial de stents e isótopos radiactivos (braquiterapia, la ablación tumoral por láser o la terapia fotodinámica, pueden aliviar de forma rápida los síntomas y reestablecer el flujo aéreo. El manejo de la hemoptisis depende de la causa que la provoque y de la cuantía de la misma. La broncoscopia sigue siendo el procedimiento de primera línea en la mayor parte de los casos; aporta información diagnóstica y puede interrumpir el sangrado mediante lavados con suero helado, taponamiento endobronquial o inyecciones tópicas de adrenalina o trombina. La radioterapia externa sigue siendo un procedimiento extraordinariamente útil para tratar la hemoptisis de causa tumoral y en situaciones bien seleccionadas la terapia endobronquial con láser o braquiterapia y la embolización arterial bronquial pueden proporcionar un gran rendimiento paliativo. Las urgencias respiratorias por enfermedad del parénquima pulmonar en un paciente oncológico, pueden tener causa tumoral, iatrogénica o infecciosa. El reconocimiento precoz de cada una de ellas determina la administración del tratamiento específico y las posibilidades de éxito.Respiratory emergencies in a patient with cancer can have their origin in pathologies of the airway, of the pulmonary parenchyma or the large vessels. The cause can be the tumour itself or concomitant complications. Obstruction of the airway should be initially evaluated with endoscopic procedures. Surgery is rarely possible in serious situations. The endobronchial placement of stents or radioactive isotopes

  16. Rigid spine syndrome with respiratory failure.

    Morita, H.; Kondo, K.; Hoshino, K; Maruyama, K; Yanagisawa, N

    1990-01-01

    The pathogenesis and therapy of respiratory failure in the rigid spine syndrome are discussed in two cases who improved with respiratory assistance. In both cases, the partial pressures of oxygen and carbon dioxide were reversed in arterial blood gas analysis and %VC was less than 30%. Remission from respiratory failure has been obtained by the use of a ventilator during the night. The cause of the respiratory failure in both cases was severe restrictive respiratory dysfunction due to extreme...

  17. Ácidosis D-láctica secundaria a síndrome de intestino corto D-Lactic acidosis secondary to short bowel syndrome

    M. J. Tapia Guerrero; Olveira Fuster, G.; M. Bravo Utrera; N. Colomo Rodríguez; Fernández García, J. C.

    2010-01-01

    El síndrome de intestino corto aparece por la reducción de la superficie absortiva intestinal efectiva por pérdida funcional o anatómica de una parte de intestino delgado. Se presenta el caso de una mujer de 35 años con síndrome de intestino corto severo secundario a isquemia intestinal aguda en la edad adulta, que presenta a los 5 años de evolución episodios de mareos con inestabilidad en la marcha y pérdida de fuerza en las manos, llegándose al diagnóstico de acidosis D-láctica. La acidosis...

  18. Arrhythmogenic Biophysical Phenotype for SCN5A Mutation S1787N Depends upon Splice Variant Background and Intracellular Acidosis.

    Rou-Mu Hu

    Full Text Available SCN5A is a susceptibility gene for type 3 long QT syndrome, Brugada syndrome, and sudden infant death syndrome. INa dysfunction from mutated SCN5A can depend upon the splice variant background in which it is expressed and also upon environmental factors such as acidosis. S1787N was reported previously as a LQT3-associated mutation and has also been observed in 1 of 295 healthy white controls. Here, we determined the in vitro biophysical phenotype of SCN5A-S1787N in an effort to further assess its possible pathogenicity.We engineered S1787N in the two most common alternatively spliced SCN5A isoforms, the major isoform lacking a glutamine at position 1077 (Q1077del and the minor isoform containing Q1077, and expressed these two engineered constructs in HEK293 cells for electrophysiological study. Macroscopic voltage-gated INa was measured 24 hours after transfection with standard whole-cell patch clamp techniques. We applied intracellular solutions with pH7.4 or pH6.7. S1787N in the Q1077 background had WT-like INa including peak INa density, activation and inactivation parameters, and late INa amplitude in both pH 7.4 and pH 6.7. However, with S1787N in the Q1077del background, the percentages of INa late/peak were increased by 2.1 fold in pH 7.4 and by 2.9 fold in pH 6.7 when compared to WT.The LQT3-like biophysical phenotype for S1787N depends on both the SCN5A splice variant and on the intracellular pH. These findings provide further evidence that the splice variant and environmental factors affect the molecular phenotype of cardiac SCN5A-encoded sodium channel (Nav1.5, has implications for the clinical phenotype, and may provide insight into acidosis-induced arrhythmia mechanisms.

  19. Persistent lactic acidosis in neonatal hypoxic-ischaemic encephalopathy correlates with EEG grade and electrographic seizure burden.

    Murray, D M

    2012-02-03

    BACKGROUND: Predicting at birth which infants with perinatal hypoxic-ischaemic injury will progress to significant encephalopathy remains a challenge. OBJECTIVE: To determine whether lactic acidosis at birth in asphyxiated neonates could predict the grade of EEG encephalopathy by examining the relationship between time taken for the normalisation of lactate, severity of encephalopathy and seizure burden. METHODS: Continuous early video-EEG monitoring was performed in babies at risk for hypoxic-ischaemic encephalopathy. Encephalopathy was graded from the EEG data. Total seizure burden (seconds) was calculated for each baby. Initial blood gas measurements of pH, base deficit and lactate were taken within 30 minutes of delivery. Time to normal serum lactate was determined in hours from birth for each infant. RESULTS: All 50 term infants had raised initial serum lactate (median (lower, upper quartiles) 11.7 (10.2, 14.9)). There were no significant differences between the initial serum lactate, pH and base deficit in infants with normal\\/mildly abnormal (n = 24), moderately abnormal (n = 14), severely abnormal (n = 5) and inactive EEGs (n = 7). Time to normal lactate varied significantly with EEG grade (median (lower, upper quartile) 6.0 (4.1, 9.5) for mild\\/normal EEG, 13.5 (6.8, 23.5) moderate EEG, 41.5 (30.0, 55.5) severe group, 12.0 (8.1, 21.5) inactive group; p<0.001). Time to normal lactate correlated significantly with EEG seizure burden (seconds; R = 0.446, p = 0.002). Mean (SD) time to normal lactate was 10.0 (7.2) hours in infants who did not have seizures and 27.3 (19.0) hours in the 13 infants with electrographic seizures (p = 0.002). CONCLUSIONS: Serum lactate levels in the first 30 minutes of life do not predict the severity of the ensuing encephalopathy. In contrast, sustained lactic acidosis is associated with severe encephalopathy on EEG and correlates with seizure burden.

  20. Acidosis Sensing Receptor GPR65 Correlates with Anti-Apoptotic Bcl-2 Family Member Expression in CLL Cells: Potential Implications for the CLL Microenvironment

    Rosko, Ashley E.; McColl, Karen S.; Zhong, Fei; Ryder, Christopher B; Chang, Ming-Jin; Sattar, Abdus; Caimi, Paolo F.; Hill, Brian T; Al-harbi, Sayer; Almasan, Alexandru; Distelhorst, Clark W.

    2014-01-01

    The tumor microenvironment is generally an acidic environment, yet the effect of extracellular acidosis on chronic lymphocytic leukemia (CLL) is not well established. Here we are the first to report that the extracellular acid sensing G-protein coupled receptor, GPR65, is expressed in primary CLL cells where its level correlate strongly with anti-apoptotic Bcl-2 family member levels. GPR65 expression is found normally within the lymphoid lineage and has not been previously reported in CLL. We...

  1. Distal Renal Tubular Acidosis, Hypokalemic Paralysis, Nephrocalcinosis, Primary Hypothyroidism, Growth Retardation, Osteomalacia and Osteoporosis Leading to Pathological Fracture: A Case Report

    Mayada Mohammad Swar; Mohammad Mizanur Rahman; Khairy Mostafa Sharkawi; Basak, Ramen C.

    2011-01-01

     Renal tubular acidosis (RTA) is a constellation of syndromes arising from different derangements of tubular acid transport. Recent advances in the biology of urinary acidification have allowed us to discern various molecular mechanisms responsible for these syndromes. RTA often presents as renal stone disease with nephrocalcinosis, ricket/osteomalacia and growth retardation in children with ultimate short stature in adulthood. The case reported here has features of distal renal tubular acido...

  2. The diversity of the fecal bacterial community and its relationship with the concentration of volatile fatty acids in the feces during subacute rumen acidosis in dairy cows

    Mao Shengyong; Zhang Ruiyang; Wang Dongsheng; Zhu Weiyun

    2012-01-01

    Abstract Background Sub-acute ruminal acidosis (SARA) is a well-recognized digestive disorder found in particular in well-managed dairy herds. SARA can result in increased flow of fermentable substrates to the hindgut, which can increase the production of volatile fatty acids, alter the structure of the microbial community, and have a negative effect on animal health and productivity. However, little is known about changes in the structure of the microbial community and its relationship with ...

  3. 奶牛瘤胃酸中毒的发病机制和防治措施%The Mechanism and Prevention of Dairy Cow Rumen Acidosis

    杨艳玲; 沈赞明

    2015-01-01

    The cow rumen acidosis is caused by the high concentrated feed used .It has improved ruminal pH ,microbial flora ,eventually led to a decline in milk production and milk quality ,triggering a series of nutritional and metabolic disease ,great harm to dairy production .This pa‐per reviews several aspects of acute acidosis and subacute ruminal acidosis in the etiology ,pathogenesis and prevention measures to provide sci‐entific and theoretical basis for actual production .%奶牛瘤胃酸中毒是由于大量饲喂易发酵的碳水化合物日粮引起的,造成奶牛瘤胃酸度增加,微生物菌群失调,最终导致奶牛产奶量和乳品质下降,进而引发一系列的营养代谢病,对奶牛生产危害极大。文章就急性瘤胃酸中毒和亚急性瘤胃酸中毒的发病病因、发病机理及防治措施等几方面进行综述,为实际生产提供科学的理论依据。

  4. Hyperlactatemia and metabolic acidosis in critically ill patient%重症患者的高乳酸血症与代谢性酸中毒

    杜微; 刘大为

    2011-01-01

    高乳酸血症和代谢性酸中毒的关系一直是讨论的热点,涉及到休克复苏、机体内环境稳定及营养支持等方面.一方面重症患者组织低灌注时无氧酵解增加带来的乳酸生成增多会加重代谢性酸中毒,而另一方面乳酸在器官水平和细胞水平被利用会引起血乳酸水平降低进而减轻代谢性酸中毒,最终血乳酸水平取决于两者的平衡.%The relationship between hyperlactatemia and metabolic acidosis, which may involve shock resuscitation,homoiostasis, and nutritional support, remains a hot topic. On one hand, increased production of lac-tate due to anaerobic glycolysis during tissue hypoperfusion can aggravate metabolic acidosis; on the other hand,the utilization of lactate at organ and cell levels may lower blood lactate level, and thus alleviate metabolic acidosis.The ultimate blood lactate level depends on the balance of these two action mechanisms.

  5. The Clinical Study on Hyponatremia as Complicated by Respiratory Failure due to Chronic Obstructive Disease%慢性阻塞性肺疾病呼吸衰竭并发低钠血症的临床研究

    童长刚

    2013-01-01

    目的:探讨慢性阻塞性肺疾病合并呼吸衰竭患者并发低钠血症的影响因素,寻找最佳的防治措施。方法:回顾性分析2010-2013年本院收治的106例慢性阻塞性肺疾病呼吸衰竭并发低钠血症患者,通过分析临床资料,找出低钠血症发生的原因及有效的治疗方案。结果:106例患者除原发疾病外,有85例伴随不同程度的精神症状和体征,全部患者的血钠平均水平为(119.77±6.53)mmol/L,伴有代偿性呼吸性酸中毒的患者18例,伴有失代偿性呼吸性酸中毒的患者52例,呼吸性酸中毒合并代谢性碱中毒17例,呼吸性酸中毒合并代谢性酸中毒14例。在综合治疗的基础上补钠,纠正电解质紊乱,治疗后患者痊愈77例,好转26例,病情恶化死亡3例。死亡的3例患者中,2例死于多器官衰竭,1例死于重度低钠血症。结论:慢性阻塞性肺疾病呼吸衰竭的患者并发低钠血症的发生率较高,临床医生需要仔细观察患者表现,做到早期发现、明确诊断、有效干预。%Objective:To investigate the pathogenic causes of chronic obstructive pneumonic disease(COPD)with respiratory failure and hyponatremia,and formulate the best preventive measure. Method:To select clinical data of 106 management of COPD with respiratory failure and hyponatremia patients admitted in our hospital during 2010 to 2013 and retrospectively analyze. The pathogenic causes and effective treatments of hyponatremia were identified. Result:In 106 patients with primary disease,85 cases accompany with different degree of mental symptoms and signs. The serum sodium average of all patients was(119.77±6.53)mmol/L. 106 patients included compensatory respiratory acidosis(18 cases),decompensate respiratory acidosis(52 cases),respiratory acidosis and metabolic alkalosis(17 cases),and respiratory acidosis and metabolic acidosis(14 cases). On the basis of comprehensive therapy,patients were

  6. Altered Respiratory Physiology in Obesity

    Krishnan Parameswaran

    2006-01-01

    Full Text Available The major respiratory complications of obesity include a heightened demand for ventilation, elevated work of breathing, respiratory muscle inefficiency and diminished respiratory compliance. The decreased functional residual capacity and expiratory reserve volume, with a high closing volume to functional residual capacity ratio of obesity, are associated with the closure of peripheral lung units, ventilation to perfusion ratio abnormalities and hypoxemia, especially in the supine position. Conventional respiratory function tests are only mildly affected by obesity except in extreme cases. The major circulatory complications are increased total and pulmonary blood volume, high cardiac output and elevated left ventricular end-diastolic pressure. Patients with obesity commonly develop hypoventilation and sleep apnea syndromes with attenuated hypoxic and hypercapnic ventilatory responsiveness. The final result is hypoxemia, pulmonary hypertension and progressively worsening disability. Obese patients have increased dyspnea and decreased exercise capacity, which are vital to quality of life. Decreased muscle, increased joint pain and skin friction are important determinants of decreased exercise capacity, in addition to the cardiopulmonary effects of obesity. The effects of obesity on mortality in heart failure and chronic obstructive pulmonary disease have not been definitively resolved. Whether obesity contributes to asthma and airway hyper-responsiveness is uncertain. Weight reduction and physical activity are effective means of reversing the respiratory complications of obesity.

  7. Diffusion and Perfusion Characteristics of MELAS (Mitochondrial Myopathy, Encephalopathy, Lactic Acidosis, and Stroke-Like Episode) in Thirteen Patients

    We analyzed the diffusion and perfusion characteristics of acute MELAS (mitochondrial myopathy, encephalopathy, lactic acidosis, and stroke-like episode) lesions in a large series to investigate the controversial changes of the apparent diffusion coefficient (ADC) that were reported in prior studies. We analyzed 44 newly appearing lesions during 28 stroke-like episodes in 13 patients with MELAS. We performed a visual assessment of the MR images including the ADC and perfusion maps, comparison of the ADC between the normal and abnormal areas, comparison of % ADC between the 44 MELAS lesions and the 30 acute ischemic infarcts. In addition, the patterns of evolution on follow-up MR images were analyzed. Decreased, increased, and normal ADCs were noted in 16 (36%), 16 (36%), and 12 (27%) lesions, respectively. The mean % ADC was 102 ± 40.9% in the MELAS and 64 ± 17.8% in the acute vascular infarcts (p < 0.001), while perfusion imaging demonstrated hyper-perfusion in six acute MELAS lesions. On follow-up images, resolution, progression, and tissue loss were noted in 10, 4, and 17 lesions, respectively. The cytotoxic edema gradually evolves following an acute stroke-like episode in patients with MELAS, and this may overlap with hyper-perfusion and vasogenic edema. The edematous swelling may be reversible or it may evolve to encephalomalacia, suggesting irreversible damage

  8. Macrophage Heterogeneity in Respiratory Diseases

    Carian E. Boorsma

    2013-01-01

    Full Text Available Macrophages are among the most abundant cells in the respiratory tract, and they can have strikingly different phenotypes within this environment. Our knowledge of the different phenotypes and their functions in the lung is sketchy at best, but they appear to be linked to the protection of gas exchange against microbial threats and excessive tissue responses. Phenotypical changes of macrophages within the lung are found in many respiratory diseases including asthma, chronic obstructive pulmonary disease (COPD, and pulmonary fibrosis. This paper will give an overview of what macrophage phenotypes have been described, what their known functions are, what is known about their presence in the different obstructive and restrictive respiratory diseases (asthma, COPD, pulmonary fibrosis, and how they are thought to contribute to the etiology and resolution of these diseases.

  9. Submersion and acute respiratory failure

    Yu-Jang Su

    2014-01-01

    Objectives:To know the relationship between hypothermia, etiology, respiratory failure and prognosis of submersion in environmental emergency medicine.Methods:FromDecember1, 2002 toSeptember30,2007, there were52 hospitalized near- drowning cases in a medical center at northernTaiwan.Retrospective study of52 submersion patients who were hospitalized during the duration was analyzed.Results:The hypothermic groups are more commonly seen in acute respiratory failure after submersion,36%vs.21%,P<0.05.The hypothermic submersion patients who are older in age than normothermic submersion patients(44vs.27 years old,P<0.05).The suicidal submersion patients are older, hypothermic and longer length of stay than accidental submersion patients.Conclusions:Submersion patients who are hypothermic on arrival of emergency department(ED) are risky to respiratory failure and older, more hypothermic, longer hospital stay in suicidal submersion patients.

  10. Respiratory disease surveillance in Hungary

    Agocs, M.M.; Rudnai, P.; Etzel, R.A. (Division of Environmental Hazards and Health Effects, Centers for Disease Control, Budapest (Hungary))

    1992-08-28

    In October 1989, the Hungarian National Institute of Hygiene initiated the Children's Acute Respiratory Morbidity (CHARM) Surveillance System to assess the association between nine reportable respiratory diseases and air pollution. The weekly number of physician-diagnosed, reportable respiratory diseases among four age groups of children (less than 1, 1-2, 3-5, and 6-14 years) was tabulated for Sopron, a city with 60,000 residents. We calculated the proportion of diseases occurring during weeks with low, moderate, and high sulfur dioxide (SO2) and nitrogen dioxide (NO2) concentrations. The weekly averages of the 24-hour median SO2 concentrations were divided into thirds at less than or equal to 17.6, greater than 17.6 to less than or equal to 26.3, and greater than 26.3 micrograms/m3 (range: 0.9-79.6 micrograms/m3), and the NO2 concentrations at less than or equal to 29.8, greater than 29.8 to less than or equal to 44.1, and greater than 44.1 micrograms/m3 (range: 4.2-90.1 micrograms/m3). During 1990, 11,474 respiratory disease cases occurred among the 4,020 children less than 15 years of age living in Sopron and monitored by the CHARM system. The two most frequently reported disease categories were rhinitis/tonsillitis/pharyngitis (71.5%) and acute bronchitis (8.5%). Sixty-seven percent of pneumonia cases occurred when SO2 concentrations were highest. We found no association between levels of NO2 and respiratory diseases. The CHARM Surveillance System may characterize more fully which groups of children develop particular respiratory diseases following exposure to air pollution.

  11. Respiratory tract infection during Hajj

    Alzeer Abdulaziz

    2009-01-01

    Full Text Available Respiratory tract infection during Hajj (pilgrimage to Mecca is a common illness, and it is responsible for most of the hospital admissions. Influenza virus is the leading cause of upper respiratory tract infection during Hajj, and pneumonia can be serious. Taking into account the close contacts among the pilgrims, as well as the crowding, the potential for transmission of M. tuberculosis is expected to be high. These pilgrims can be a source for spreading infection on their return home. Although vaccination program for influenza is implemented, its efficacy is uncertain in this religious season. Future studies should concentrate on prevention and mitigation of these infections.

  12. Hypoventilatory respiratory failure in generalised scleroderma

    Iliffe, Gerald D; Pettigrew, Norman M

    1983-01-01

    A patient with generalised cutaneous and gastrointestinal scleroderma subsequently died from respiratory failure secondary to hyperventilation. At necropsy changes consistent with scleroderma of the diaphragm were found; these were thought to have contributed appreciably to the terminal respiratory failure.

  13. Cystic Fibrosis (CF) Respiratory Screen: Sputum

    ... Tropical Delight: Melon Smoothie Pregnant? Your Baby's Growth Cystic Fibrosis (CF) Respiratory Screen: Sputum KidsHealth > For Parents > Cystic Fibrosis (CF) Respiratory Screen: Sputum Print A A A ...

  14. Molecular detection of respiratory viruses: clinical impact

    van de Pol, A.C.

    2009-01-01

    Viral respiratory tract infections (LRTIs) cause major morbidity in infants and children. Traditionally, respiratory viruses are detected with conventional tests (viral culture and direct immunofluorescence (DIF)), however nowadays viral diagnostics are being revolutionized by the increased implemen

  15. House Dust Mite Respiratory Allergy

    Calderón, Moisés A; Kleine-Tebbe, Jörg; Linneberg, Allan;

    2015-01-01

    Although house dust mite (HDM) allergy is a major cause of respiratory allergic disease, specific diagnosis and effective treatment both present unresolved challenges. Guidelines for the treatment of allergic rhinitis and asthma are well supported in the literature, but specific evidence on the...

  16. Health Instruction Packages: Respiratory Therapy.

    Lavich, Margot; And Others

    Text, illustrations, and exercises are utilized in these four learning modules to teach respiratory therapy students a variety of job-related skills. The first module, "Anatomy and Physiology of the Central Controls of Respiration" by Margot Lavich, describes the functions of the five centers of the brain that control respiration and identifies…

  17. Guide to industrial respiratory protection

    The Occupational Safety and Health Act of 1970 has increased the emphasis on proper selection and use of respirators in situations where engineering controls are not feasible or are being implemented. Although a great deal of information on respiratory protection has been published, most of it is more technical than necessary for the average user faced with day-to-day problems of respiratory protection in industrial environments. This Guide is to provide the industrial user a single reference source containing enough information for establishing and maintaining a respirator program that meets the OSHA requirements outlined in 29 CFR Part 1910.134. It includes chapters on respirator selection, use, maintenance, and inspection, a complete description of all types of respirators and their advantages and limitations, and chapters on respirator fitting and wearer training, respiratory physiology, respiratory hazards, and physiological and psychological limitations. Also included are samples of the decision logic used in respirator selection, guidance on setting up an adequate respirator program through formulation of written standard operating procedures, and discussion of the meaning of the approved respirator

  18. The Effect of Additional Dead Space on Respiratory Exchange Ratio and Carbon Dioxide Production Due to Training

    Lukasz Smolka

    2014-03-01

    Full Text Available The purpose of the study was to investigate the effects of implementing additional respiratory dead space during cycloergometry-based aerobic training. The primary outcome measures were respiratory exchange ratio (RER and carbon dioxide production (VCO2. Two groups of young healthy males: Experimental (Exp, n = 15 and Control (Con, n = 15, participated in this study. The training consisted of 12 sessions, performed twice a week for 6 weeks. A single training session consisted of continuous, constant-rate exercise on a cycle ergometer at 60% of VO2max which was maintained for 30 minutes. Subjects in Exp group were breathing through additional respiratory dead space (1200ml, while subjects in Con group were breathing without additional dead space. Pre-test and two post-training incremental exercise tests were performed for the detection of gas exchange variables. In all training sessions, pCO2 was higher and blood pH was lower in the Exp group (p < 0.001 ensuring respiratory acidosis. A 12-session training program resulted in significant increase in performance time in both groups (from 17”29 ± 1”31 to 18”47 ± 1”37 in Exp; p=0.02 and from 17”20 ± 1”18 to 18”45 ± 1”44 in Con; p = 0.02, but has not revealed a significant difference in RER and VCO2 in both post-training tests, performed at rest and during submaximal workload. We interpret the lack of difference in post-training values of RER and VCO2 between groups as an absence of inhibition in glycolysis and glycogenolysis during exercise with additional dead space.

  19. Detection of Respiratory Viruses by Molecular Methods

    Mahony, James B.

    2008-01-01

    Summary: Clinical laboratories historically diagnose seven or eight respiratory virus infections using a combination of techniques including enzyme immunoassay, direct fluorescent antibody staining, cell culture, and nucleic acid amplification tests. With the discovery of six new respiratory viruses since 2000, laboratories are faced with the challenge of detecting up to 19 different viruses that cause acute respiratory disease of both the upper and lower respiratory tracts. The application o...

  20. Introduction to circulatory and respiratory system modeling

    Ferrari, Gianfranco; Darowski, Marek; Golczewski, Tomasz; Gorczynska, Krystyna; Kozarski, Maciej

    2010-01-01

    This chapter is focused on circulatory and respiratory system modeling. It includes a brief history of circulatory and respiratory system modeling development and a short description of the state of art. In the chapter also basic classification of mechanical circulatory and respiratory assistance is presented. The last part of the chapter deals with innovative approaches to modeling of both circulatory and respiratory system which concern hybrid models and virtual organs. Hybrid modeling cons...

  1. Dialysis Disequilibrium Syndrome: Brain death following hemodialysis for metabolic acidosis and acute renal failure – A case report

    Bagshaw Sean M

    2004-08-01

    Full Text Available Abstract Background Dialysis disequilibrium syndrome (DDS is the clinical phenomenon of acute neurologic symptoms attributed to cerebral edema that occurs during or following intermittent hemodialysis (HD. We describe a case of DDS-induced cerebral edema that resulted in irreversible brain injury and death following acute HD and review the relevant literature of the association of DDS and HD. Case Presentation A 22-year-old male with obstructive uropathy presented to hospital with severe sepsis syndrome secondary to pneumonia. Laboratory investigations included a pH of 6.95, PaCO2 10 mmHg, HCO3 2 mmol/L, serum sodium 132 mmol/L, serum osmolality 330 mosmol/kg, and urea 130 mg/dL (46.7 mmol/L. Diagnostic imaging demonstrated multifocal pneumonia, bilateral hydronephrosis and bladder wall thickening. During HD the patient became progressively obtunded. Repeat laboratory investigations showed pH 7.36, HCO3 19 mmol/L, potassium 1.8 mmol/L, and urea 38.4 mg/dL (13.7 mmol/L (urea-reduction-ratio 71%. Following HD, spontaneous movements were absent with no pupillary or brainstem reflexes. Head CT-scan showed diffuse cerebral edema with effacement of basal cisterns and generalized loss of gray-white differentiation. Brain death was declared. Conclusions Death is a rare consequence of DDS in adults following HD. Several features may have predisposed this patient to DDS including: central nervous system adaptations from chronic kidney disease with efficient serum urea removal and correction of serum hyperosmolality; severe cerebral intracellular acidosis; relative hypercapnea; and post-HD hemodynamic instability with compounded cerebral ischemia.

  2. Effects of Aging on the Respiratory System.

    Levitzky, Michael G.

    1984-01-01

    Relates alterations in respiratory system functions occurring with aging to changes in respiratory system structure during the course of life. Main alterations noted include loss of alveolar elastic recoil, alteration in chest wall structure and decreased respiratory muscle strength, and loss of surface area and changes in pulmonary circulation.…

  3. Atypical respiratory complications of dengue fever

    Naveen Kumar; AK Gadpayle; Deepshikha Trisal

    2013-01-01

    In last decade, dengue has emerged as one of the most important vector born disease.With increasing cases, uncommon presentations and complications are now commonly recognized. Here, we report two cases of rare pattern of respiratory involvement in dengue: acute respiratory distress syndrome and bronchiolitis with respiratory failure.

  4. Postperfusion lung syndrome: Respiratory mechanics, respiratory indices and biomarkers

    Shi-Min Yuan

    2015-01-01

    Postperfusion lung syndrome is rare but lethal. Secondary inflammatory response was the popularly accepted theory for the underlying etiology. Respiratory index (RI) and arterial oxygen tension/fractional inspired oxygen can be reliable indices for the diagnosis of this syndrome as X-ray appearance is always insignificant at the early stage of the onset. Evaluations of extravascular lung water content and pulmonary compliance are also helpful in the definite diagnosis. Multiorgan failure and ...

  5. PCA-induced respiratory depression simulating stroke following endoluminal repair of abdominal aortic aneurysm: a case report

    Ahmad Javed

    2007-07-01

    Full Text Available Abstract Aim To report a case of severe respiratory depression with PCA fentanyl use simulating stroke in a patient who underwent routine elective endoluminal graft repair for abdominal aortic aneurysm (AAA Case presentation A 78-year-old obese lady underwent routine endoluminal graft repair for AAA that was progressively increasing in size. Following an uneventful operation postoperative analgesia was managed with a patient-controlled analgesia (PCA device with fentanyl. On the morning following operation the patient was found to be unusually drowsy and unresponsive to stimuli. Her GCS level was 11 with plantars upgoing bilaterally. A provisional diagnosis of stroke was made. Urgent transfer to a high-dependency unit (HDU was arranged and she was given ventilatory support with a BiPap device. CT was performed and found to be normal. Arterial blood gas (ABG analysis showed respiratory acidosis with PaCO2 81 mmHg, PaO2 140 mmHg, pH 7.17 and base excess -2 mmol/l. A total dose of 600 mcg of fentanyl was self-administered in the 16 hours following emergence from general anaesthesia. Naloxone was given with good effect. There was an increase in the creatinine level from 90 μmol/L preoperatively to 167 μmol/L on the first postoperative day. The patient remained on BiPap for two days that resulted in marked improvement in gas exchange. Recovery was complete.

  6. Habituation in neural processing and subjective perception of respiratory sensations

    von Leupoldt, Andreas; Vovk, Andrea; Bradley, Margaret M.; Lang, Peter J.; Davenport, Paul W.

    2010-01-01

    Reduced perception of respiratory sensations is associated with negative treatment outcome in asthma. We examined whether habituation in the neural processing of repeatedly experienced respiratory sensations may underlie subjective reports of reduced respiratory perception. Respiratory-related evoked potentials (RREP) elicited by inspiratory occlusions and reports of respiratory perception were compared between early and late experimental periods in healthy subjects. Reports of respiratory pe...

  7. Does high-dose metformin cause lactic acidosis in type 2 diabetic patients after CABG surgery? A double blind randomized clinical trial

    Rahman Ghafari

    2011-06-01

    Full Text Available Metformin is a dimethyl biguanide oral anti-hyperglycemic agent. Lactic acidosis due to metformin is a fatal metabolic condition that limits its use in patients in poor clinical condition, consequently reducing the number of patients who benefit from this medication. In a double blind randomized clinical trial, we investigated 200 type 2 diabetic patients after coronary artery bypass surgery in the open heart ICU of the Mazandaran Heart Center, and randomly assigned them to equal intervention and control groups. The intervention group received regular insulin infusion along with 2 metformin 500 mg tablets every twelve hours, while the control group received only intravenous insulin with 2 placebo tablets every twelve hours. Lactate level, pH, base excess, blood glucose and serum creatinine were measured over five 12 h periods, with data averaged for each period. The primary outcome in this study was high lactate levels. Comparison between the 2 groups was made by independent Student’s t-test. To compare changes in multiple measures in each group and analysis of group interaction, a repeated measurement ANOVA test was used. There was no significant difference between the 2 groups regarding pH, base excess, or bicarbonate intake (P>0.05. No patient showed lactic acidosis in either group. Lactate levels were 23.0 vs 23.4 in the insulin-metformin and insulin only groups when the study was started, respectively. At the end of the study, those levels were 18.7 vs 18.9, respectively. In addition, the ANOVA repeated measurement test did not show a significant difference in terms of changes in the amount of lactate level between the 2 groups during the five measurement tests of the study period (P>0.05. High-dose metformin (1,000 mg twice daily with insulin does not cause lactic acidosis in type 2 diabetic patients after coronary artery

  8. Evaluating in vitro dose-response effects of Lavandula officinalis essential oil on rumen fermentation characteristics, methane production and ruminal acidosis

    Yadeghari, Shahin; Malecky, Mostafa; Dehghan Banadaky, Mehdi; Navidshad, Bahman

    2015-01-01

    Four in vitro experiments (Exp.) were conducted to evaluate lavender essential oil (LEO) effects at 0 (control), 250 (low dose), 500 (medium dose), 750 and 1000 µL per L (high doses) of incubation medium on rumen gas production kinetics (Exp.1), ruminal digestibility and fermentation (Exp.2), methane production (Exp.3) and rumen acidosis (Exp.4). The asymptote of gas production (A) increased quadratically (p < 0.001), but the lag phase (L) increased (p = 0.003), and gas production rate (µ) de...

  9. Atp6v0a4 knockout mouse is a model of distal renal tubular acidosis with hearing loss, with additional extrarenal phenotype

    Elizabeth E. Norgett; Golder, Zoe J.; Lorente-Cánovas, Beatriz; Ingham, Neil; Steel, Karen P; Karet Frankl, Fiona E.

    2012-01-01

    Autosomal recessive distal renal tubular acidosis (dRTA) is a severe disorder of acid–base homeostasis, often accompanied by sensorineural deafness. We and others have previously shown that mutations in the tissue-restricted a4 and B1 subunits of the H+-ATPase underlie this syndrome. Here, we describe an Atp6v0a4 knockout mouse, which lacks the a4 subunit. Using β-galactosidase as a reporter for the null gene, developmental a4 expression was detected in developing bone, nose, eye, and skin, i...

  10. Mutations in GTPBP3 Cause a Mitochondrial Translation Defect Associated with Hypertrophic Cardiomyopathy, Lactic Acidosis, and Encephalopathy

    Kopajtich, Robert; Nicholls, Thomas J.; Rorbach, Joanna; Metodiev, Metodi D.; Freisinger, Peter; Mandel, Hanna; Vanlander, Arnaud; Ghezzi, Daniele; Carrozzo, Rosalba; Taylor, Robert W.; Marquard, Klaus; Murayama, Kei; Wieland, Thomas; Schwarzmayr, Thomas; Mayr, Johannes A.

    2014-01-01

    Respiratory chain deficiencies exhibit a wide variety of clinical phenotypes resulting from defective mitochondrial energy production through oxidative phosphorylation. These defects can be caused by either mutations in the mtDNA or mutations in nuclear genes coding for mitochondrial proteins. The underlying pathomechanisms can affect numerous pathways involved in mitochondrial physiology. By whole-exome and candidate gene sequencing, we identified 11 individuals from 9 families carrying comp...

  11. Middle East Respiratory Syndrome Coronavirus.

    O'Keefe, Louise C

    2016-05-01

    Middle East Respiratory Syndrome Coronavirus (MERS-CoV) is an emerging infectious disease that can present with flu-like symptoms. In individuals with comorbidities or who are immunosuppressed, it can be deadly. The disease is transmitted through contact with someone who has MERS-CoV. The occupational health nurse must be cognizant of and educate the workforce about MERS-CoV transmission, prevention, and treatment. PMID:26407596

  12. Stem cells and respiratory diseases

    Soraia Carvalho Abreu; Tatiana Maron-Gutierrez; Cristiane Sousa Nascimento Baez Garcia; Marcelo Marcos Morales; Patricia Rieken Macedo Rocco

    2008-01-01

    Stem cells have a multitude of clinical implications in the lung. This article is a critical review that includes clinical and experimental studies of MedLine and SciElo database in the last 10 years, where we highlight the effects of stem cell therapy in acute respiratory distress syndrome or more chronic disorders such as lung fibrosis and emphysema. Although, many studies have shown the beneficial effects of stem cells in lung development, repair and remodeling; some important questions ne...

  13. Supramolecular Organization of Respiratory Complexes.

    Enríquez, José Antonio

    2016-01-01

    Since the discovery of the existence of superassemblies between mitochondrial respiratory complexes, such superassemblies have been the object of a passionate debate. It is accepted that respiratory supercomplexes are structures that occur in vivo, although which superstructures are naturally occurring and what could be their functional role remain open questions. The main difficulty is to make compatible the existence of superassemblies with the corpus of data that drove the field to abandon the early understanding of the physical arrangement of the mitochondrial respiratory chain as a compact physical entity (the solid model). This review provides a nonexhaustive overview of the evolution of our understanding of the structural organization of the electron transport chain from the original idea of a compact organization to a view of freely moving complexes connected by electron carriers. Today supercomplexes are viewed not as a revival of the old solid model but rather as a refined revision of the fluid model, which incorporates a new layer of structural and functional complexity. PMID:26734886

  14. Respiratory analysis system and method

    Liu, F. F. (Inventor)

    1973-01-01

    A system is described for monitoring the respiratory process in which the gas flow rate and the frequency of respiration and expiration cycles can be determined on a real time basis. A face mask is provided with one-way inlet and outlet valves where the gas flow is through independent flowmeters and through a mass spectrometer. The opening and closing of a valve operates an electrical switch, and the combination of the two switches produces a low frequency electrical signal of the respiratory inhalation and exhalation cycles. During the time a switch is operated, the corresponsing flowmeter produces electric pulses representative of the flow rate; the electrical pulses being at a higher frequency than that of the breathing cycle and combined with the low frequency signal. The high frequency pulses are supplied to conventional analyzer computer which also receives temperature and pressure inputs and computes mass flow rate and totalized mass flow of gas. From the mass spectrometer, components of the gas are separately computed as to flow rate. The electrical switches cause operation of up-down inputs of a reversible counter. The respective up and down cycles can be individually monitored and combined for various respiratory measurements.

  15. Incidence of respiratory distress syndrome

    Objective: To determine the incidence of respiratory distress syndrome (RDS) in hospital born babies. Subjects and Methods: All live born infants delivered at the hospital and who fulfilled the diagnostic criteria of respiratory distress syndrome (RDS) were included in the study. Results: Ninety-four neonates developed RDS. Out of these, 88 (93.61%) were preterm and 06 (6.38%) were term infants. There was a male preponderance (65.95%). RDS was documented in 1.72% of total live births. 37.28% of preterm and 0.11% of term neonates born at the hospital. The incidence of RDS was 100% at 26 or less weeks of gestation, 57.14% at 32 weeks, and 3.70% at 36 weeks. The mortality with RDS was 41 (43.61%). Conclusion: RDS is the commonest cause of respiratory distress in the newborn, particularly, in preterm infants. It carries a high mortality rate and the incidence is more than that documented in the Western world. (author)

  16. (Uncommon) Mechanisms of Branchial Ammonia Excretion in the Common Carp (Cyprinus carpio) in Response to Environmentally Induced Metabolic Acidosis.

    Wright, Patricia A; Wood, Chris M; Hiroi, Junya; Wilson, Jonathan M

    2016-01-01

    Freshwater fishes generally increase ammonia excretion in acidic waters. The new model of ammonia transport in freshwater fish involves an association between the Rhesus (Rh) protein Rhcg-b, the Na(+)/H(+) exchanger (NHE), and a suite of other membrane transporters. We tested the hypothesis that Rhcg-b and NHE3 together play a critical role in branchial ammonia excretion in common carp (Cyprinus carpio) chronically exposed to a low-pH environment. Carp were exposed to three sequential environmental treatments-control pH 7.6 water (24 h), pH 4.0 water (72 h), and recovery pH 7.6 water (24 h)-or in a separate series were simply exposed to either control (72 h) or pH 4.0 (72 h) water. Branchial ammonia excretion was increased by ∼2.5-fold in the acid compared with the control period, despite the absence of an increase in the plasma-to-water partial pressure NH3 gradient. Alanine aminotransferase activity was higher in the gills of fish exposed to pH 4 versus control water, suggesting that ammonia may be generated in gill tissue. Gill Rhcg-b and NHE3b messenger RNA levels were significantly elevated in acid-treated relative to control fish, but at the protein level Rhcg-b decreased (30%) and NHE3b increased (2-fold) in response to water of pH 4.0. Using immunofluorescence microscopy, NHE3b and Rhcg-b were found to be colocalized to ionocytes along the interlamellar space of the filament of control fish. After 72 h of acid exposure, Rhcg-b staining almost disappeared from this region, and NHE3b was more prominent along the lamellae. We propose that ammoniagenesis within the gill tissue itself is responsible for the higher rates of branchial ammonia excretion during chronic metabolic acidosis. Unexpectedly, gill Rhcg-b does not appear to be important in gill ammonia transport in low-pH water, but the strong induction of NHE3b suggests that some NH4(+) may be eliminated directly in exchange for Na(+). These findings contrast with previous studies in larval zebrafish

  17. Carnosine inhibits carbonic anhydrase IX-mediated extracellular acidosis and suppresses growth of HeLa tumor xenografts

    Carbonic anhydrase IX (CA IX) is a transmembrane enzyme that is present in many types of solid tumors. Expression of CA IX is driven predominantly by the hypoxia-inducible factor (HIF) pathway and helps to maintain intracellular pH homeostasis under hypoxic conditions, resulting in acidification of the tumor microenvironment. Carnosine (β-alanyl-L-histidine) is an anti-tumorigenic agent that inhibits the proliferation of cancer cells. In this study, we investigated the role of CA IX in carnosine-mediated antitumor activity and whether the underlying mechanism involves transcriptional and translational modulation of HIF-1α and CA IX and/or altered CA IX function. The effect of carnosine was studied using two-dimensional cell monolayers of several cell lines with endogenous CA IX expression as well as Madin Darby canine kidney transfectants, three-dimensional HeLa spheroids, and an in vivo model of HeLa xenografts in nude mice. mRNA and protein expression and protein localization were analyzed by real-time PCR, western blot analysis, and immunofluorescence staining, respectively. Cell viability was measured by a flow cytometric assay. Expression of HIF-1α and CA IX in tumors was assessed by immunohistochemical staining. Real-time measurement of pH was performed using a sensor dish reader. Binding of CA IX to specific antibodies and metabolon partners was investigated by competitive ELISA and proximity ligation assays, respectively. Carnosine increased the expression levels of HIF-1α and HIF targets and increased the extracellular pH, suggesting an inhibitory effect on CA IX-mediated acidosis. Moreover, carnosine significantly inhibited the growth of three-dimensional spheroids and tumor xenografts compared with untreated controls. Competitive ELISA showed that carnosine disrupted binding between CA IX and antibodies specific for its catalytic domain. This finding was supported by reduced formation of the functional metabolon of CA IX and anion exchanger 2 in the

  18. 儿童远端肾小管酸中毒1例%1 Case of Children With Distal Renal Tubular Acidosis

    王瑞彬

    2015-01-01

    在儿科临床工作中,如果小儿有烦渴,多饮,多尿,腹泻,乏力,低钾血症,不明原因的代谢性酸中毒,生长发育落后,佝偻病,要考虑到本病,进一步检查血离子,血气,肾功能,尿常规,双肾超声,腕骨 X 线片。注意酸碱度,有无高氯性酸中毒,电解质紊乱,活动性佝偻病,肾结石,肾钙化。%In pediatric clinical work if the child has thirst, polydipsia, polyuria, diarrhea, fatigue, hypokalemia, metabolic acidosis, unexplained, growth retardation, rickets, taking into account the disease, further examination of blood ions, blood gas, kidney function, urine routine, renal ultrasound, Carpale x-ray. Note that the pH is hyperchloremic acidosis, electrolyte disorder, activity of rickets, kidney stones, renal calcification.

  19. The Pathogenesis and Prevention of Ruminal Acidosis in Cattle%牛瘤胃酸中毒发病机制与防治的研究进展

    陈渊; 朱家增; 邓立新; 李小波; 贺丛; 贺秀媛

    2011-01-01

    With the development of intensive cultivation on cattle, the high-concentrated feed has been used more and more widely. It has improved the bovine performance trait and caused some nutrition metabolic diseases, especially ruminal acidosis's occurrence, which has resulted in enormously economic losses. The pathogenesis and prevention of ruminal acidosis are discussed systematically in this article in order to provide theoretical instruction for preventing the occurrence of this disease.%随着牛集约化养殖的发展,高精饲料的使用越来越广泛,这在不断提高牛生产性能的同时也引起了一些营养代谢病,特别是瘤胃酸中毒的发生,给养殖业造成了巨大的经济损失.作者就牛瘤胃酸中毒的发病机制与防治进行了较为系统地论述,以期为临床生产中更有效地预防和控制该病的发生和流行提供一定的理论参考.

  20. [Gastric emptying and metabolic acidosis. II. Study, in an experimental model in rats, of gastric retention of a sodium bicarbonate solution].

    Belangero, V M; Collares, E F

    1992-01-01

    The gastric emptying of a 0.25 M sodium bicarbonate solution was studied in rats with metabolic acidosis induced by a previous (6 hours) orogastric infusion of a 0.5 M ammonium chloride solution. Two control groups were used: one previously infused with 0.5 M sodium chloride and the other with water, in the same volume that further solutions. Every animal was fed with 2 ml/100 g of its weight of these solutions. The test meal (bicarbonate solution) was utilized containing 6 mg% red fenol as a marker. The gastric retentions were determined 6 hours after those first meals at 5, 10, 20 and 30 minutes. The results demonstrated that the gastric retentions of the bicarbonate solution were significantly lower in the acidotic group than that one of water group (at 20 minutes) and that one of the sodium chloride (at 10, 20 and 30 minutes). The data here presented suggest that metabolic acidosis accelerates the gastric emptying of a sodium bicarbonate solution. PMID:1339142

  1. Renal Tubular Acidosis

    ... is normal, but too much acid—acidosis—can disturb many bodily functions. Healthy kidneys help maintain acid- ... disseminates research findings through its clearinghouses and education programs to increase knowledge and understanding about health and ...

  2. Relationship of hyperlactatemia and metabolic acidosis%高乳酸血症与代谢性酸中毒的相互关系

    杜微; 刘大为; 石岩; 隆云; 芮曦; 王小亭

    2011-01-01

    目的 观察重症患者的高乳酸血症与代谢性酸中毒的相关性,以提供更为准确的反映组织灌注的指标.方法 回顾了2009年8月至2010年4月,9个月间所有重症医学科(ICU)患者的血气分析结果.入选标准为患者同时抽取的一份动脉血标本同时送检血气分析、血清电解质、血清白蛋白检查,其中血气分析结果中乳酸升高,满足高乳酸血症标准(Lac≥2 mmol/L)的结果.结果 在这一乳酸升高(Lac≥2)的人群中用传统方法判断代酸,代酸发生率33.9%,用Stewart's方法判断代酸,代酸发生率为56.0%.但该组人群血清pH值不具有典型酸血症的特点(7.42±0.07),存活组中乳酸占代酸的百分比为(33.6±17.9)%,死亡组中乳酸占代酸的百分比为(42.1±18.5)%,P=0.008;存活组中SIG占代酸百分比为(28.6±23.5)%,死亡组中SIG占代酸的百分比(44.9±23.0)%,P=0.000.结论 在ICU乳酸升高的人群中,乳酸并不是引起代酸的主要成分,乳酸和SIG共同组成代酸的主要组分,但乳酸占代酸的百分比和SIG占代酸的百分比升高可能提示预后不佳,这两个指标也许能为临床提供更准确的反映组织灌注的信息.%Objective To investigate the acid-base abnormalities of the patients with hyperlactatemia and explore the relationship of hyperlactatemia and metabolic acidosis so as to seek a more precise index of reflecting organ perfusion. Methods From August 2009 to April 2010, all consecutive patients admitted into intensive care unit received an analysis of blood gas. Those individuals with arterial lactate ≥2 mmol/L were selected. Results In the group of hyperlactatemic patients, the occurrence of metabolic acidosis as judged by the traditional method was less than that by the Stewart's method (33.9% vs 56. 0% ). No typical acidemia was found. And all components of metabolic acidosis were calculated. Lactate and SIG (strong ion gap ) contributed a certain percentage to metabolic acidosis in the

  3. Visual aided pacing in respiratory maneuvers

    Rambaudi, L R [Laboratorio de Biofisica y Fisiologia ' Antonio Sadi Frumento' (Argentina); Rossi, E [Catedra de Bioingenieria II (Argentina); Mantaras, M C [Catedra de Bioingenieria II (Argentina); Perrone, M S [Laboratorio de Biofisica y Fisiologia ' Antonio Sadi Frumento' (Argentina); Siri, L Nicola [Catedra de Bioingenieria II (Argentina)

    2007-11-15

    A visual aid to pace self-controlled respiratory cycles in humans is presented. Respiratory manoeuvres need to be accomplished in several clinic and research procedures, among others, the studies on Heart Rate Variability. Free running respiration turns to be difficult to correlate with other physiologic variables. Because of this fact, voluntary self-control is asked from the individuals under study. Currently, an acoustic metronome is used to pace respiratory frequency, its main limitation being the impossibility to induce predetermined timing in the stages within the respiratory cycle. In the present work, visual driven self-control was provided, with separate timing for the four stages of a normal respiratory cycle. This visual metronome (ViMet) was based on a microcontroller which power-ON and -OFF an eight-LED bar, in a four-stage respiratory cycle time series handset by the operator. The precise timing is also exhibited on an alphanumeric display.

  4. Visual aided pacing in respiratory maneuvers

    A visual aid to pace self-controlled respiratory cycles in humans is presented. Respiratory manoeuvres need to be accomplished in several clinic and research procedures, among others, the studies on Heart Rate Variability. Free running respiration turns to be difficult to correlate with other physiologic variables. Because of this fact, voluntary self-control is asked from the individuals under study. Currently, an acoustic metronome is used to pace respiratory frequency, its main limitation being the impossibility to induce predetermined timing in the stages within the respiratory cycle. In the present work, visual driven self-control was provided, with separate timing for the four stages of a normal respiratory cycle. This visual metronome (ViMet) was based on a microcontroller which power-ON and -OFF an eight-LED bar, in a four-stage respiratory cycle time series handset by the operator. The precise timing is also exhibited on an alphanumeric display

  5. Respiratory Distress Syndrome and its Complications

    Eren Kale Cekinmez

    2013-08-01

    Full Text Available Respiratory distress syndrome in premature babies is one of the most common and most important health problems in newborns. Respiratory distress syndrome of newborn is a syndrome in premature infants caused by developmental insufficiency of surfactant production and structural immaturity in the lungs. Respiratory distress syndrome begins shortly after birth and is manifest by tachypnea, tachycardia, chest wall retractions, expiratory grunting, nasal flaring and cyanosis during breathing efforts. Respiratory distress syndrome or complications caused by respiratory distress syndrome are the most important causes of mortality and morbidity in premature infants. This article briefly reviews respiratory distress syndrome and its complications. [Archives Medical Review Journal 2013; 22(4.000: 615-630

  6. Respiratory consequences of late preterm birth.

    Pike, Katharine C; Lucas, Jane S A

    2015-06-01

    In developed countries most preterm births occur between 34 and 37 weeks' gestation. Deliveries during this 'late preterm' period are increasing and, since even mild prematurity is now recognised to be associated with adverse health outcomes, this presents healthcare challenges. Respiratory problems associated with late preterm birth include neonatal respiratory distress, severe RSV infection and childhood wheezing. Late preterm birth prematurely interrupts in utero lung development and is associated with maternal and early life factors which adversely affect the developing respiratory system. This review considers 1) mechanisms underlying the association between late preterm birth and impaired respiratory development, 2) respiratory morbidity associated with late preterm birth, particularly long-term outcomes, and 3) interventions which might protect respiratory development by addressing risk factors affecting the late preterm population, including maternal smoking, early life growth restriction and vulnerability to viral infection. PMID:25554628

  7. Can patients with moderate to severe acute respiratory failure from COPD be treated safely with noninvasive mechanical ventilation on the ward?

    Yalcinsoy M

    2016-05-01

    Full Text Available Murat Yalcinsoy,1 Cuneyt Salturk,2 Selahattin Oztas,2 Sinem Gungor,2 Ipek Ozmen,2 Feyyaz Kabadayi,2 Aysem Askim Oztim,2 Emine Aksoy,2 Nalan Adıguzel,2 Ozlem Oruc,2 Zuhal Karakurt2 1Department of Pulmonary Medicine, Inonu University Medical Faculty, Turgut Ozal Medical Center, Malatya, 2Department of Pulmonary Medicine, Sureyyapaşa Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey Purpose: Noninvasive mechanical ventilation (NIMV usage outside of intensive care unit is not recommended in patients with COPD for severe acute respiratory failure (ARF. We assessed the factors associated with failure of NIMV in patients with ARF and severe acidosis admitted to the emergency department and followed on respiratory ward.Patients and methods: This is a retrospective observational cohort study conducted in a tertiary teaching hospital specialized in chest diseases and thoracic surgery between June 1, 2013 and May 31, 2014. COPD patients who were admitted to our emergency department due to ARF were included. Patients were grouped according to the severity of acidosis into two groups: group 1 (pH=7.20–7.25 and group 2 (pH=7.26–7.30.Results: Group 1 included 59 patients (mean age: 70±10 years, 30.5% female and group 2 included 171 patients (mean age: 67±11 years, 28.7% female. On multivariable analysis, partial arterial oxygen pressure to the inspired fractionated oxygen (PaO2/FiO2 ratio <200, delta pH value <0.30, and pH value <7.31 on control arterial blood gas after NIMV in the emergency room and peak C-reactive protein were found to be the risk factors for NIMV failure in COPD patients with ARF in the ward.Conclusion: NIMV is effective not only in mild respiratory failure but also with severe forms of COPD patients presenting with severe exacerbation. The determination of the failure criteria of NIMV and the expertise of the team is critical for treatment success. Keywords: noninvasive mechanical ventilation

  8. Respiratory Health among Cement Workers in Ethiopia

    Zeleke, Zeyede K.

    2011-01-01

    Background: Little is known on dust exposure and respiratory health among cement cleaners. There are only a few follow-up studies on respiratory health among cement factory workers and also studies on acute effects of cement dust exposure are limited in numbers. Objective: This study aimed at assessing cement dust exposure and adverse respiratory health effects among Ethiopian cement production workers, with particular focus on cement cleaners. Method: The first paper was...

  9. Viral respiratory infections : Diagnosis and epidemiology

    Rotzén Östlund, Maria

    2008-01-01

    Background. Respiratory viral infections are common causes of human morbidity and mortality in children as well as in adults. Adenovirus, influenza virus, parainfluenza virus and respiratory syncytial virus (RSV) have been recognized for many years. During recent years two main events have influenced both the diagnosis and our knowledge of respiratory virus epidemiology: (1) Five new viruses have been described; (2) the use of molecular methods for the diagnosis of respirato...

  10. Respiratory Microbiome of New-Born Infants

    Gallacher, David J.; Kotecha, Sailesh

    2016-01-01

    The respiratory tract, once believed to be sterile, harbors diverse bacterial communities. The role of microorganisms within health and disease is slowly being unraveled. Evidence points to the neonatal period as a critical time for establishing stable bacterial communities and influencing immune responses important for long-term respiratory health. This review summarizes the evidence of early airway and lung bacterial colonization and the role the microbiome has on respiratory health in the ...

  11. Small animal disease surveillance: respiratory disease

    Sánchez-Vizcaíno, Fernando; Daly, Janet M.; Philip H Jones; Dawson, Susan; Gaskell, Rosalind; Menacere, Tarek; Heayns, Bethaney; Wardeh, Maya; Newman, Jenny; Everitt, Sally; Day, Michael J.; McConnell, Katie; Noble, Peter J.M.; Radford, Alan D

    2016-01-01

    This second Small Animal Disease Surveillance report focuses on syndromic surveillance of i) respiratory disease in veterinary practice and ii) feline calicivirus (FCV) based on laboratory diagnosis, in a large veterinary-visiting pet population of the UK between January 2014 and December 2015. Presentation for respiratory disease comprised 1.7%, 2.3% and 2.5% of canine, feline and rabbit consultations, respectively. In dogs, the most frequent respiratory sign reported was coughing (71.1% of ...

  12. Respiratory system involvement in Costello syndrome.

    Gomez-Ospina, Natalia; Kuo, Christin; Ananth, Amitha Lakshmi; Myers, Angela; Brennan, Marie-Luise; Stevenson, David A; Bernstein, Jonathan A; Hudgins, Louanne

    2016-07-01

    Costello syndrome (CS) is a multisystem disorder caused by heterozygous germline mutations in the HRAS proto-oncogene. Respiratory system complications have been reported in individuals with CS, but a comprehensive description of the full spectrum and incidence of respiratory symptoms in these patients is not available. Here, we report the clinical course of four CS patients with respiratory complications as a major cause of morbidity. Review of the literature identified 56 CS patients with descriptions of their neonatal course and 17 patients in childhood/adulthood. We found that in the neonatal period, respiratory complications are seen in approximately 78% of patients with transient respiratory distress reported in 45% of neonates. Other more specific respiratory diagnoses were reported in 62% of patients, the majority of which comprised disorders of the upper and lower respiratory tract. Symptoms of upper airway obstruction were reported in CS neonates but were more commonly diagnosed in childhood/adulthood (71%). Analysis of HRAS mutations and their respiratory phenotype revealed that the common p.Gly12Ser mutation is more often associated with transient respiratory distress and other respiratory diagnoses. Respiratory failure and dependence on mechanical ventilation occurs almost exclusively with rare mutations. In cases of prenatally diagnosed CS, the high incidence of respiratory complications in the neonatal period should prompt anticipatory guidance and development of a postnatal management plan. This may be important in cases involving rarer mutations. Furthermore, the high frequency of airway obstruction in CS patients suggests that otorhinolaryngological evaluation and sleep studies should be considered. © 2016 Wiley Periodicals, Inc. PMID:27102959

  13. Pathophysiology and Classification of Respiratory Failure.

    Lamba, Tejpreet Singh; Sharara, Rihab Saeed; Singh, Anil C; Balaan, Marvin

    2016-01-01

    Respiratory failure is a condition in which the respiratory system fails in one or both of its gas exchange functions. It is a major cause of morbidity and mortality in patients admitted to intensive care units. It is a result of either lung failure, resulting in hypoxemia, or pump failure, resulting in alveolar hypoventilation and hypercapnia. This article covers the basic lung anatomy, pathophysiology, and classification of respiratory failure. PMID:26919670

  14. Central Neurogenic Respiratory Failure: A Challenging Diagnosis

    Carvalho, Flávio A.; Bernardino, Tenille; Maciel, Ricardo O.H.; Felizola, Sérgio F.A.; Costa, Eduardo L.V.; Silva, Gisele S

    2011-01-01

    Background Central nervous system lesions are rare causes of respiratory failure. Simple observation of the breathing pattern can help localize the lesion, but the examiner needs to be aware of potential pitfalls such as metabolic or pulmonary alterations. Methods We describe 3 cases in which central neurogenic respiratory failure occurred simultaneously with other alterations or in an unusual presentation. Results All patients were diagnosed with central neurogenic respiratory failure and tr...

  15. The respiratory neuromuscular system in Pompe disease☆

    Fuller, David D.; Mai K. ElMallah; Barbara K Smith; Corti, Manuela; Lawson, Lee Ann; Falk, Darin J.; Byrne, Barry J

    2013-01-01

    Pompe disease is due to mutations in the gene encoding the lysosomal enzyme acid α-glucosidase (GAA). Absence of functional GAA typically results in cardiorespiratory failure in the first year; reduced GAA activity is associated with progressive respiratory failure later in life. While skeletal muscle pathology contributes to respiratory insufficiency in Pompe disease, emerging evidence indicates that respiratory neuron dysfunction is also a significant part of dysfunction in motor units. Ani...

  16. Respiratory Distress Syndrome and its Complications

    Eren Kale Cekinmez; Hacer Yapicioglu Yildizdas; Ferda Ozlu

    2013-01-01

    Respiratory distress syndrome in premature babies is one of the most common and most important health problems in newborns. Respiratory distress syndrome of newborn is a syndrome in premature infants caused by developmental insufficiency of surfactant production and structural immaturity in the lungs. Respiratory distress syndrome begins shortly after birth and is manifest by tachypnea, tachycardia, chest wall retractions, expiratory grunting, nasal flaring and cyanosis during breathing effor...

  17. Respiratory Dysfunction in Chronic Neck Pain

    Dimitriadis, Zacharias

    2011-01-01

    Background: Patients with chronic neck pain have a number of factors that could constitute a predisposition for respiratory dysfunction. However, the existing evidence is limited and not well established, and many questions such as the association of neck pain deficits with respiratory function remain unanswered. Thus, the aim of this study was to investigate whether patients with chronic neck have accompanying respiratory dysfunction and which are the neck pain deficits which principally pre...

  18. Live-Attenuated Respiratory Syncytial Virus Vaccines

    Karron, Ruth A.; Buchholz, Ursula J.; Collins, Peter L.

    2013-01-01

    Live-attenuated respiratory syncytial virus (RSV) vaccines offer several advantages for immunization of infants and young children: (1) they do not cause vaccine-associated enhanced RSV disease; (2) they broadly stimulate innate, humoral, and cellular immunity, both systemically and locally in the respiratory tract; (3) they are delivered intranasally; and (4) they replicate in the upper respiratory tract of young infants despite the presence of passively acquired maternally derived RSV neutr...

  19. Henipavirus Pathogenesis in Human Respiratory Epithelial Cells

    Escaffre, Olivier; Borisevich, Viktoriya; Carmical, J. Russ; Prusak, Deborah; Prescott, Joseph; Feldmann, Heinz; Rockx, Barry

    2013-01-01

    Hendra virus (HeV) and Nipah virus (NiV) are deadly zoonotic viruses for which no vaccines or therapeutics are licensed for human use. Henipavirus infection causes severe respiratory illness and encephalitis. Although the exact route of transmission in human is unknown, epidemiological studies and in vivo studies suggest that the respiratory tract is important for virus replication. However, the target cells in the respiratory tract are unknown, as are the mechanisms by which henipaviruses ca...

  20. Coal Mining-Related Respiratory Diseases

    ... ray Surveillance Program (CWXSP) Frequently Asked Questions Coal Miner Health Surveillance Coal Mining-Related Respiratory Diseases CWHSP Data Query System CWHSP Public Data Digital Imaging Activity ...

  1. Bovine respiratory syncytial virus (BRSV): A review

    Larsen, Lars Erik

    2000-01-01

    Bovine respiratory syncytial virus (BRSV) infection is the major cause of respiratory disease in calves during the first year of life. The study of the virus has been difficult because of its lability and very poor growth in cell culture. However, during the last decade, the introduction of new...... complex and unpredictable which makes the diagnosis and subsequent therapy very difficult. BRSV is closely related to human respiratory syncytial virus (HRSV) which is an important cause of respiratory disease in young children. In contrast to BRSV, the recent knowledge of HRSV is regularly extensively...

  2. Occurrence and phylogenetic analysis of bovine respiratory syncytial virus in outbreaks of respiratory disease in Norway

    Klem, Thea; Rimstad, Espen; Stokstad, Maria

    2014-01-01

    Background Bovine respiratory syncytial virus (BRSV) is one of the major pathogens involved in the bovine respiratory disease (BRD) complex. The seroprevalence to BRSV in Norwegian cattle herds is high, but its role in epidemics of respiratory disease is unclear. The aims of the study were to investigate the etiological role of BRSV and other respiratory viruses in epidemics of BRD and to perform phylogenetic analysis of Norwegian BRSV strains. Results BRSV infection was detected either serol...

  3. The effect of anxiety on respiratory sensory gating measured by respiratory-related evoked potentials

    Chan, Pei-Ying S.; von Leupoldt, Andreas; Bradley, Margaret M.; Lang, Peter J.; Davenport, Paul W.

    2012-01-01

    Respiratory sensory gating is evidenced by decreased amplitudes of the respiratory-related evoked poten-Received 24 September 2011 tials (RREP) N1 peak for the second (S2) compared to the first occlusion (S1) when two paired occlusions Accepted 2 July 2012 are presented with a 500-millisecond (ms) inter-stimulus-interval during one inspiration. Because anxiety is prevalent in respiratory diseases and associated with altered respiratory perception, we tested whether anxiety can modulate indivi...

  4. [Phytotherapy of respiratory tract diseases].

    Bylka, Wiesława; Witkowska-Banaszczak, Ewa; Studzińska-Sroka, Elzbieta; Matławska, Irena

    2012-01-01

    Herbal medicines have been used in cough due to their antitussive and expectorant activity. Antitussives act either centrally on the cough center of the brain or peripherally on the cough receptors in the respiratory passages. The antitussive effect of many herbs results from the content of mucilage, which exerts protective and demulcent activity. The activity of expectorant herbs results primarily from their influence on the gastric mucose (saponins and ipec alkaloids). This proves reflex stimulation which leads to an increase in the secretion of bronchial glands. Volatile-oil type expectorant herbs exert a direct stimulatory effect on the bronchial glands by means of local irritation with antibacterial activity. In colds and flu, herbs containing volatile oil can be used; also, volatile oils are ingredients of syrups and liquids as well as external phytomedicines in the form of liniments, ointments, and inhalations. The paper shows the herbs and phytomedicines present on the Polish market used for the treatment of respiratory tract diseases. PMID:23289257

  5. Peripartal changes in reticuloruminal pH and temperature in dairy cows differing in the susceptibility to subacute rumen acidosis.

    Humer, E; Ghareeb, K; Harder, H; Mickdam, E; Khol-Parisini, A; Zebeli, Q

    2015-12-01

    The present study aimed to investigate changes in the reticuloruminal pH and temperature dynamics in periparturient dairy cows. Reticuloruminal pH and temperature measurements were conducted from 7 d before until 8 d after parturition using indwelling sensors. Nine Simmental and 4 Brown Swiss dairy cows were fed a close-up total mixed ration (52.5% neutral detergent fiber, 5.68MJ of net energy for lactation per kg of dry matter) with additional 1kg/cow per d concentrate mixture (29.5% neutral detergent fiber and 6.25MJ of net energy for lactation per kg of dry matter), starting from 2 wk before the estimated calving date. Postpartum, all cows had free access to the same close-up diet and were gradually fed increasing amounts of a concentrate-rich total mixed ration for early-lactation cows (32.7% neutral detergent fiber, 7.22MJ of net energy for lactation per kg of dry matter). Data showed depressed reticuloruminal pH early postpartum, but only in the group of cows defined as subacute ruminal acidosis (SARA) susceptible (n=8), which had a higher duration time of pH cows (n=5; 15±6min/d). Also, compared with SARA-tolerant cows (112±91min/d), the SARA-susceptible group showed longer (1,049±75min/d) duration time of pH cows (6.25±0.05), but no differences were observed in the duration of pH cows produced more milk (30.4±1.2kg/d) compared with Brown Swiss cows (27.9±1.3kg/d). Neither total dry matter intake nor milk yield were different between SARA-susceptible and SARA-tolerant groups. However, SARA-tolerant cows consumed greater amounts of the close-up total mixed ration than their SARA-susceptible counterparts, whereas no difference was observed in the intake of the early-lactating total mixed ration between the groups. Reticuloruminal temperature was not affected by breed or SARA susceptibility. Interestingly, the mean reticuloruminal temperature and the time duration of temperature >39.5°C abruptly dropped from d 2 to 1 before calving by 0.35°C and 430min

  6. Postperfusion lung syndrome: Respiratory mechanics, respiratory indices and biomarkers

    Shi-Min Yuan

    2015-01-01

    Full Text Available Postperfusion lung syndrome is rare but lethal. Secondary inflammatory response was the popularly accepted theory for the underlying etiology. Respiratory index (RI and arterial oxygen tension/fractional inspired oxygen can be reliable indices for the diagnosis of this syndrome as X-ray appearance is always insignificant at the early stage of the onset. Evaluations of extravascular lung water content and pulmonary compliance are also helpful in the definite diagnosis. Multiorgan failure and triple acid-base disturbances that might develop secondary to postperfusion lung syndrome are responsible for the poor prognosis and increased mortality rather than postperfusion lung syndrome itself. Mechanical ventilation with low tidal volume (TV and proper positive end-expiratory pressure can be an effective treatment strategy. Use of ulinastatin and propofol may benefit the patients through different mechanisms.

  7. Respiratory rate assessment from photoplethysmographic imaging.

    Karlen, Walter; Garde, Ainara; Myers, Dorothy; Scheffer, Cornie; Ansermino, J Mark; Dumont, Guy A

    2014-01-01

    We present a study investigating the suitability of a respiratory rate estimation algorithm applied to photoplethysmographic imaging on a mobile phone. The algorithm consists of a cascade of previously developed signal processing methods to detect features and extract respiratory induced variations in photoplethysmogram signals to estimate respiratory rate. With custom-built software on an Android phone (Camera Oximeter), contact photoplethysmographic imaging videos were recorded using the integrated camera from 19 healthy adults breathing spontaneously at respiratory rates between 6 and 40 breaths/min. Capnometry was simultaneously recorded to obtain reference respiratory rates. Two hundred and ninety-eight Camera Oximeter recordings were available for analysis. The algorithm detected 22 recordings with poor photoplethysmogram quality and 46 recordings with insufficient respiratory information. Of the 232 remaining recordings, a root mean square error of 5.9 breaths/min and a median absolute error of 2.3 breaths/min was obtained. The study showed that it is feasible to estimate respiratory rates by placing a finger on a mobile phone camera, but that it becomes increasingly challenging at respiratory rates higher than 20 breaths/min. PMID:25571214

  8. Diagnosing and treating respiratory syncytial virus bronchiolitis.

    Napierkowski, Daria B

    2016-09-22

    Respiratory syncytial virus (RSV) is one of the major causes of respiratory tract illness in children and can lead to significant infection and death. This article discusses the incidence, clinical presentation, diagnosis, current treatment, and prevention options to successfully diagnose and treat infections caused by RSV. PMID:27552683

  9. Perceived Competence and Comfort in Respiratory Protection

    Burgel, Barbara J.; Novak, Debra; Burns, Candace M.; Byrd, Annette; Carpenter, Holly; Gruden, MaryAnn; Lachat, Ann; Taormina, Deborah

    2015-01-01

    In response to the Institute of Medicine (2011) report Occupational Health Nurses and Respiratory Protection: Improving Education and Training, a nationwide survey was conducted in May 2012 to assess occupational health nurses’ educational preparation, roles, responsibilities, and training needs in respiratory protection. More than 2,000 occupational health nurses responded; 83% perceived themselves as competent, proficient, or expert in respiratory protection, reporting moderate comfort with 12 respiratory program elements. If occupational health nurses had primary responsibility for the respiratory protection program, they were more likely to perceive higher competence and more comfort in respiratory protection, after controlling for occupational health nursing experience, highest education, occupational health nursing certification, industry sector, Association of Occupational Health Professionals in Healthcare membership, taking a National Institute for Occupational Safety and Health spirometry course in the prior 5 years, and perceiving a positive safety culture at work. These survey results document high perceived competence and comfort in respiratory protection. These findings support the development of targeted educational programs and interprofessional competencies for respiratory protection. PMID:23429638

  10. Abnormal lung lymphatics and respiratory failure.

    Moss, S F; Currie, D C; Sheffield, E A; M. Baxter; Corrin, B.; Evans, T. W.

    1989-01-01

    A 65 year old man presented with respiratory failure, pleural effusions, fine reticulonodular shadowing on a chest radiograph, and severe impairment of carbon monoxide diffusing capacity (transfer factor). Open lung biopsy showed only dilated pleural and subpleural lymphatic channels. Hypoplastic deep pulmonary lymphatics may have led to respiratory failure.

  11. Detection of respiratory pathogens in aerosols from acutely infected pigs

    Infectious agents that cause respiratory disease in pigs include porcine reproductive respiratory syndrome virus (PRRSV), porcine circovirus type 2 (PCV2), swine influenza virus (SIV), porcine respiratory corona virus (PRCV), Mycoplasma hyopneumoniae, and Bordetella bronchiseptica. The objective of...

  12. Perioperative modifications of respiratory function.

    Duggan, Michelle

    2012-01-31

    Postoperative pulmonary complications contribute considerably to morbidity and mortality, especially after major thoracic or abdominal surgery. Clinically relevant pulmonary complications include the exacerbation of underlying chronic lung disease, bronchospasm, atelectasis, pneumonia and respiratory failure with prolonged mechanical ventilation. Risk factors for postoperative pulmonary complications include patient-related risk factors (e.g., chronic obstructive pulmonary disease (COPD), tobacco smoking and increasing age) as well as procedure-related risk factors (e.g., site of surgery, duration of surgery and general vs. regional anaesthesia). Careful history taking and a thorough physical examination may be the most sensitive ways to identify at-risk patients. Pulmonary function tests are not suitable as a general screen to assess risk of postoperative pulmonary complications. Strategies to reduce the risk of postoperative pulmonary complications include smoking cessation, inspiratory muscle training, optimising nutritional status and intra-operative strategies. Postoperative care should include lung expansion manoeuvres and adequate pain control.

  13. The respiratory system in equations

    Maury, Bertrand

    2013-01-01

    The book proposes an introduction to the mathematical modeling of the respiratory system. A detailed introduction on the physiological aspects makes it accessible to a large audience without any prior knowledge on the lung. Different levels of description are proposed, from the lumped models with a small number of parameters (Ordinary Differential Equations), up to infinite dimensional models based on Partial Differential Equations. Besides these two types of differential equations, two chapters are dedicated to resistive networks, and to the way they can be used to investigate the dependence of the resistance of the lung upon geometrical characteristics. The theoretical analysis of the various models is provided, together with state-of-the-art techniques to compute approximate solutions, allowing comparisons with experimental measurements. The book contains several exercises, most of which are accessible to advanced undergraduate students.

  14. Stem cells and respiratory diseases

    Soraia Carvalho Abreu

    2008-12-01

    Full Text Available Stem cells have a multitude of clinical implications in the lung. This article is a critical review that includes clinical and experimental studies of MedLine and SciElo database in the last 10 years, where we highlight the effects of stem cell therapy in acute respiratory distress syndrome or more chronic disorders such as lung fibrosis and emphysema. Although, many studies have shown the beneficial effects of stem cells in lung development, repair and remodeling; some important questions need to be answered to better understand the mechanisms that control cell division and differentiation, therefore enabling the use of cell therapy in human respiratory diseases.As células-tronco têm uma infinidade de implicações clínicas no pulmão. Este artigo é uma revisão crítica que inclui estudos clínicos e experimentais advindos do banco de dados do MEDLINE e SciElo nos últimos 10 anos, onde foram destacados os efeitos da terapia celular na síndrome do desconforto respiratório agudo ou doenças mais crônicas, como fibrose pulmonar e enfisema. Apesar de muitos estudos demonstrarem os efeitos benéficos das células-tronco no desenvolvimento, reparo e remodelamento pulmonar; algumas questões ainda precisam ser respondidas para um melhor entendimento dos mecanismos que controlam a divisão celular e diferenciação, permitindo o uso da terapia celular nas doenças respiratórias.

  15. Respiratory load compensation in uremia.

    Heinzmann, H G; Kassabian, J; Naqui, M N; Lavietes, M H

    1981-01-01

    The clinical significance of respiratory-system load-compensation is unknown. We have measured the responses to random presentation of single, elastic inspiratory loads in 36 subjects: 8 normal personnel (N), 9 with obesity (O), 10 with chronic renal failure under hemodialysis (H), 5 with pneumonia (P), and 4 with interstitial lung disease (CILD). We have expressed these responses as: (1) the ratio of elastance (or rigidity) of the system during loaded breathing to the elastance without loading (E'RS/ERS); (2) the ratio of tidal volume (VT) achieved when breathing from an inspiratory load to the VT predicted in the absence of load compensation (VTL/VTP); (3) the ratio of inspiratory flow rates during loaded and unloaded breaths; (4) the ratio of inspiratory time of loaded and unloaded breaths. We found E'RS/ERS in the O, H and P groups less than that of either CILD patients or N controls (F = 6.79; p less than 0.001). Passive elastance (ERS) although greater in groups O and H than in N (F = 3.88; p less than 0.025) did not account for the difference i E'RS in all groups. When expressed as VTL/VTP, the response to a 37-cm H2O/l load for groups H, O and P was less than that for N (F = 5.51; p less than 0.05). Diminished inspiratory time was observed in H, O and P patients when inspiring from this load. In contrast, inspiratory flow did not differ from that of normal subjects. Nerve conduction velocity was slightly reduced or normal in the H patients. Respiratory load compensation is deficient in H, O and P patients. The mechanism, which does not involve peripheral neuropathy, is unclear. PMID:7244394

  16. Comparison of conventional and diffusion-weighted MRI and proton MR spectroscopy in patients with mitochondrial encephalomyopathy, lactic acidosis, and stroke-like events

    Abe, K.; Hikita, T.; Sakoda, S. [Department of Neurology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, 565-0871, Osaka (Japan); Yoshimura, H.; Tanaka, H.; Fujita, N. [Department of Radiology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, 565-0871, Osaka (Japan)

    2004-02-01

    The mechanism of neurological disturbances in patients with mitochondrial myopathy, encephalopathy, lactic acidosis, and stroke-like episodes (MELAS) is controversial. We studied 12 patients with MELAS using conventional and diffusion weighted MRI (DWI) and MR spectroscopy (MRS), to look at the physiopathology of the stroke-like events. Although conventional MRI showed lesions in all patients, DWI was more sensitive. One patient did not show high signal on DWI 48 h after a from stroke-like episode, but MRS demonstrated a lactate peak in left occipital lobe; 2 weeks after the attack, high signal was demonstrated on the right frontal lobe where MRS had shown a lactate peak. Our findings suggest a possible predictive ability of {sup 1}H-MRS, in showing early MELAS lesions and supports the hypothesis that mitochondrial metabolic dysfunction may precedes abnormalities on DWI. (orig.)

  17. Predisposition to metabolic acidosis induced by topiramate Predisposição a acidose metabólica induzida por topiramato

    MARIA AUGUSTA MONTENEGRO

    2000-12-01

    Full Text Available RATIONALE: Metabolic acidosis induced by topiramate is a well documented but infrequent adverse event. The objective was to demonstrate the lowering of carbon dioxide serum levels, which is usually asymptomatic but may facilitate the occurrence of metabolic acidosis in patients using topiramate. METHODS: We evaluated, prospectively, the carbon dioxide serum levels of 18 patients seen at the epilepsy clinic of our university hospital, before and 3 months after introducing topiramate. RESULTS: Five patients were female and 13 were male, age ranging from 2 to 16 years old (mean=9.3. Carbon dioxide mean serum levels were 25 and 21.2 mmol/L (normal = 22 to 30, before and 3 months after introducing topiramate, respectively. Dose ranged from 2.08 to 11.76 mg/kg/day (mean=6.7mg/kg/day. Adverse events were anorexia, nausea and somnolence. CONCLUSION: We conclude that the lowering of carbon dioxide serum levels induced by topiramate is mostly asymptomatic, but may facilitate the occurrence of metabolic acidosis. Since patients in use of topiramate have refractory epilepsy, they may need epilepsy surgery, and must be carefully monitored for the risk of metabolic acidosis during surgery.INTRODUÇÃO: Acidose metabólica induzida por topiramato é evento adverso pouco frequente, mas bem documentado. Nosso objetivo foi demonstrar a diminuição dos níveis de dióxido de carbono, muitas vezes assintomática, mas que pode predispor ao aparecimento de acidose metabólica. MATERIAL E MÉTODO: Avaliamos prospectivamente os níveis de dióxido de carbono de 18 pacientes acompanhados no ambulatório de epilepsia infantil da UNICAMP, antes e 3 meses após o início do uso de topiramato. RESULTADOS: Foram avaliados 18 pacientes com idade entre 2 e 16 anos (média = 9,3 anos. Cinco pacientes eram do sexo feminino e 13, do sexo masculino. Os níveis médios de dióxido de carbono antes e após o uso de topiramato foram 25 e 21,2 mmol/L (normal = 22 a 30

  18. Activation of P-glycoprotein (Pgp)-mediated drug efflux by extracellular acidosis: in vivo imaging with 68Ga-labelled PET tracer

    In vitro it has been shown that the functional activity of P-glycoprotein (Pgp), an important drug transporter responsible for multidrug resistance, can be strongly increased by extracellular acidosis. Here mitogen-activated protein kinases (MAPK) (p38, ERK1/2) seem to play an important role for signal transduction. However, it is unclear whether these effects are also relevant in vivo. With the newly developed PET tracer Schiff base-based 68Ga-MFL6.MZ the functional Pgp activity was visualized under acidic conditions and during inhibition of MAPKs non-invasively by means of microPET in rat tumours. Tumours were acidified either by inspiratory hypoxia (8% O2) or by injection of lactic acid. Inhibitors of the MAPK were injected intratumourally. With increasing tumour volume the tumour pH changed from 7.0 to 6.7 and simultaneously the Pgp activity increased almost linearly. When the tumour was acidified by direct lactic acid injection the PET tracer uptake was reduced by 20% indicating a higher transport rate out of the cells. Changing the inspiratory O2 fraction to 8% dynamically led to a reduction of extracellular pH and in parallel to a decrease of tracer concentration. While inhibition of the p38 pathway reduced the Pgp transport rate, inhibition of ERK1/2 had practically no impact. An acidic extracellular environment significantly stimulates the Pgp activity. The p38 MAPK pathway plays an important role for Pgp regulation in vivo, whereas ERK1/2 is of minor importance. From these results new strategies for overcoming multidrug resistance (e.g. reducing tumour acidosis, inhibition of p38) may be developed. (orig.)

  19. Activation of P-glycoprotein (Pgp)-mediated drug efflux by extracellular acidosis: in vivo imaging with {sup 68}Ga-labelled PET tracer

    Thews, Oliver; Dillenburg, Wolfgang [University Medicine Mainz, Institute of Physiology and Pathophysiology, Mainz (Germany); Fellner, Marco; Roesch, Frank [University of Mainz, Institute of Nuclear Chemistry, Mainz (Germany); Buchholz, Hans-Georg; Bausbacher, Nicole; Schreckenberger, Mathias [University Medicine Mainz, Department of Nuclear Medicine, Mainz (Germany)

    2010-10-15

    In vitro it has been shown that the functional activity of P-glycoprotein (Pgp), an important drug transporter responsible for multidrug resistance, can be strongly increased by extracellular acidosis. Here mitogen-activated protein kinases (MAPK) (p38, ERK1/2) seem to play an important role for signal transduction. However, it is unclear whether these effects are also relevant in vivo. With the newly developed PET tracer Schiff base-based {sup 68}Ga-MFL6.MZ the functional Pgp activity was visualized under acidic conditions and during inhibition of MAPKs non-invasively by means of microPET in rat tumours. Tumours were acidified either by inspiratory hypoxia (8% O{sub 2}) or by injection of lactic acid. Inhibitors of the MAPK were injected intratumourally. With increasing tumour volume the tumour pH changed from 7.0 to 6.7 and simultaneously the Pgp activity increased almost linearly. When the tumour was acidified by direct lactic acid injection the PET tracer uptake was reduced by 20% indicating a higher transport rate out of the cells. Changing the inspiratory O{sub 2} fraction to 8% dynamically led to a reduction of extracellular pH and in parallel to a decrease of tracer concentration. While inhibition of the p38 pathway reduced the Pgp transport rate, inhibition of ERK1/2 had practically no impact. An acidic extracellular environment significantly stimulates the Pgp activity. The p38 MAPK pathway plays an important role for Pgp regulation in vivo, whereas ERK1/2 is of minor importance. From these results new strategies for overcoming multidrug resistance (e.g. reducing tumour acidosis, inhibition of p38) may be developed. (orig.)

  20. Glucocorticoid activity and metabolism with NaCl-induced low-grade metabolic acidosis and oral alkalization: results of two randomized controlled trials.

    Buehlmeier, Judith; Remer, Thomas; Frings-Meuthen, Petra; Maser-Gluth, Christiane; Heer, Martina

    2016-04-01

    Low-grade metabolic acidosis (LGMA), as induced by high dietary acid load or sodium chloride (NaCl) intake, has been shown to increase bone and protein catabolism. Underlying mechanisms are not fully understood, but from clinical metabolic acidosis interactions of acid-base balance with glucocorticoid (GC) metabolism are known. We aimed to investigate GC activity/metabolism under alkaline supplementation and NaCl-induced LGMA. Eight young, healthy, normal-weight men participated in two crossover designed interventional studies. In Study A, two 10-day high NaCl diet (32 g/d) periods were conducted, one supplemented with 90 mmol KHCO3/day. In Study B, participants received a high and a low NaCl diet (31 vs. 3 g/day), each for 14 days. During low NaCl, the diet was moderately acidified by replacement of a bicarbonate-rich mineral water (consumed during high NaCl) with a non-alkalizing drinking water. In repeatedly collected 24-h urine samples, potentially bioactive-free GCs (urinary-free cortisol + free cortisone) were analyzed, as well as tetrahydrocortisol (THF), 5α-THF, and tetrahydrocortisone (THE). With supplementation of 90 mmol KHCO3, the marker of total adrenal GC secretion (THF + 5α-THF + THE) dropped (p = 0.047) and potentially bioactive-free GCs were reduced (p = 0.003). In Study B, however, GC secretion and potentially bioactive-free GCs did not exhibit the expected fall with NaCl-reduction as net acid excretion was raised by 30 mEq/d. Diet-induced acidification/alkalization affects GC activity and metabolism, which in case of long-term ingestion of habitually acidifying western diets may constitute an independent risk factor for bone degradation and cardiometabolic diseases. PMID:26349936

  1. Management of respiratory symptoms in ALS.

    Hardiman, Orla

    2011-03-01

    Respiratory insufficiency is a frequent feature of ALS and is present in almost all cases at some stage of the illness. It is the commonest cause of death in ALS. FVC is used as important endpoint in many clinical trials, and in decision-making events for patients with ALS, although there are limitations to its predictive utility. There are multiple causes of respiratory muscle failure, all of which act to produce a progressive decline in pulmonary function. Diaphragmatic fatigue and weakness, coupled with respiratory muscle weakness, lead to reduced lung compliance and atelectasis. Increased secretions increase the risk of aspiration pneumonia, which further compromises respiratory function. Bulbar dysfunction can lead to nutritional deficiency, which in turn increases the fatigue of respiratory muscles. Early recognition of respiratory decline and symptomatic intervention, including non-invasive ventilation can significantly enhance both quality of life and life expectancy in ALS. Patients with respiratory failure should be advised to consider an advance directive to avoid emergency mechanical ventilation.

  2. Endothelin involvement in respiratory centre activity.

    Albertini, M; Lafortuna, C L; Ciminaghi, B; Mazzola, S; Clement, M G

    2001-09-01

    To evaluate the role of endothelin (ET) in respiratory homeostasis we studied the effects of the ET(A) and ET(B) receptor blocking agent bosentan on respiratory mechanics and control in seven anaesthetised spontaneously breathing pigs, for 180 min after single bolus administration (20 mg/kg i.v.). The results show that the block of ET receptors induced a significant increase in compliance and decrease in resistance of the respiratory system, entailing a significant reduction of diaphragmatic electromyographic activity, without affecting the centroid frequency of the power spectrum. Bosentan administration induced a significant increase in tidal volume (V(T)), accompanied by a significant decrease in respiratory frequency, without any significant change in pulmonary ventilation, CO(2) arterial blood gas pressure or pH. Since the relationship between V(T) and inspiratory time remained substantially constant after bosentan administration, the changes in respiratory pattern appear to be the result of an upward shift in inspiratory off-switch threshold. Both inspiratory and expiratory times during occluded breathing were increased by block of ET receptors, suggesting also a central respiratory neuromodulator effect of ET. In conclusion the present results suggest that the block of ET receptors in spontaneously breathing pigs exerts a role on mechanical properties of the respiratory system as well as on peripheral and central mechanisms of breathing control. PMID:11728166

  3. SMART phones and the acute respiratory patient.

    Gleeson, L

    2012-05-01

    Definition of Respiratory Failure using PaO2 alone is confounded when patients are commenced on oxygen therapy prior to arterial blood gas (ABG) measurement. Furthermore, classification of Respiratory Failure as Type 1 or Type 2 using PaCO2 alone can give an inaccurate account of events as both types can co-exist. 100 consecutive presentations of acute respiratory distress were assessed initially using PaO2, and subsequently PaO2\\/FiO2 ratio, to diagnose Respiratory Failure. Respiratory Failure cases were classified as Type 1 or Type 2 initially using PaCO2, and subsequently alveolar-arterial (A-a) gradient. Any resultant change in management was documented. Of 100 presentations, an additional 16 cases were diagnosed as Respiratory Failure using PaO2\\/FiO2 ratio in place of PaO2 alone (p = 0.0338). Of 57 cases of Respiratory Failure, 22 cases classified as Type 2 using PaCO2 alone were reclassified as Type 1 using A-a gradient (p < 0.001). Of these 22 cases, management changed in 18.

  4. Management of respiratory symptoms in ALS.

    Hardiman, Orla

    2012-02-01

    Respiratory insufficiency is a frequent feature of ALS and is present in almost all cases at some stage of the illness. It is the commonest cause of death in ALS. FVC is used as important endpoint in many clinical trials, and in decision-making events for patients with ALS, although there are limitations to its predictive utility. There are multiple causes of respiratory muscle failure, all of which act to produce a progressive decline in pulmonary function. Diaphragmatic fatigue and weakness, coupled with respiratory muscle weakness, lead to reduced lung compliance and atelectasis. Increased secretions increase the risk of aspiration pneumonia, which further compromises respiratory function. Bulbar dysfunction can lead to nutritional deficiency, which in turn increases the fatigue of respiratory muscles. Early recognition of respiratory decline and symptomatic intervention, including non-invasive ventilation can significantly enhance both quality of life and life expectancy in ALS. Patients with respiratory failure should be advised to consider an advance directive to avoid emergency mechanical ventilation.

  5. Pesticides and respiratory symptoms among farmers

    Faria Neice Müller Xavier

    2005-01-01

    Full Text Available OBJECTIVE: Despite the intensive use of pesticides in agriculture there are few studies assessing the risk of respiratory conditions from this exposure. The study aimed at quantifying the prevalence of respiratory symptoms among farmers and evaluating its relationship with occupational use of pesticides and the prevalence of respiratory symptoms. METHODS: A cross-sectional study was conducted among 1,379 farmers from two municipalities of Southern Brazil in 1996. Frequency and type of chemical exposure and pesticide poisoning were recorded for both sexes. All subjects aged 15 years or older with at least 15 weekly hours of agricultural activity were interviewed. An adapted questionnaire developed by the American Thoracic Society was used for the assessment of respiratory symptoms. Multivariate logistic regression analysis was carried out. RESULTS: More than half (55% of interviewees were male. The prevalence of asthma symptoms was 12% and chronic respiratory disease symptoms was 22%. Higher odds ratios for both asthma (OR=1.51; 95% CI: 1.07-2.14 and chronic respiratory disease (OR=1.34; 95% CI 1.00-1.81 symptoms were found in women. Logistic regression analysis identified associations between many forms of exposure to pesticides and increased respiratory symptoms. Occurrence of pesticide poisoning was associated with higher prevalence of asthma symptoms (OR=1.54; 95% CI: 1.04-2.58 and chronic respiratory disease symptoms (OR=1.57; 95% CI: 1.08-2.28. CONCLUSIONS: In spite of causality limitations, the study results provide evidence that farming exposure to pesticides is associated with higher prevalence of respiratory symptoms, especially when the exposure is above two days per month.

  6. Ventilation and respiratory gas exchanges of the lugworm Arenicola marina (L.) as functions of ambient PO2 (20-700 torr).

    Toulmond, A; Tchernigovtzeff, C

    1984-09-01

    Ventilatory regulation of intact, unrestrained lugworms Arenicola marina living in glass-tube artificial burrows was examined for values of inspired seawater PO2, PIO2, from 20 to 700 torr, at constant ambient pH and PCO2 values. The water ventilation rate and the respiratory characteristics of the ventilated seawater were measured. The water convection requirement and the corresponding specific rates of O2 uptake and CO2 production were calculated. The mean ventilatory water flow was a complex function of PIO2: decrease in hyperoxia, increase in hypoxia, decrease in extreme hypoxia. Compared to the normoxic responses, hyperoxia led to a hypercapnia (and acidosis) and moderate hypoxia to a hypocapnia (and alkalosis) in the expired water, variations which presumably reflect blood acid-base balance changes. Thus, as in other water breathers, the regulation of the organism's oxygenation may override the regulation of its acid-base balance. The lugworm's oxygen exchanger is highly efficient. However, below a critical partial pressure, PIO2 ca 120 torr, values of O2 consumption and ventilation decreased. A second critical O2 partial pressure appeared at PIO2 values between 80 and 40 torr; a 'switch-on' of anaerobic metabolism. These phenomena may be viewed as features of an adaptative respiratory strategy selected for in relation with the lugworm's particular peristaltic ventilatory mechanism and its intertidal mode of life. PMID:6441215

  7. Respiratory Depression Caused by Heroin Use

    Kadir Hakan Cansiz

    2012-04-01

    Full Text Available Summary Heroin is a semisynthetic narcotic analgesic and heroin abuse is common due to its pleasure-inducing effect. For the last 30 years heroin abuse has become an important worldwide public health problem. Heroin can be administered in many different ways as preferred. Heroin affects many systems including respiratory system, cardiovascular system and particulary the central nervous system. Overdose use of heroin intravenously can be fatal due to respiratory depression. In this letter, we wanted to engage attention to respiratory depression caused by heroin abuse and potential benefits of using naloxone. [TAF Prev Med Bull 2012; 11(2.000: 248-250

  8. Respiratory Disease: Diagnostic Approaches in the Horse.

    Hewson, Joanne; Arroyo, Luis G

    2015-08-01

    Evaluation of the upper and lower respiratory tract of horses requires strategic selection of possible diagnostic tests based on location of suspected pathologic lesions and purpose of testing and must also include consideration of patient status. This article discusses the various diagnostic modalities that may be applied to the respiratory system of horses under field conditions, indications for use, and aspects of sample collection, handling, and laboratory processing that can impact test results and ultimately a successful diagnosis in cases of respiratory disease. PMID:26037608

  9. Flow-Synchronized Nasal Intermittent Positive Pressure Ventilation for Infants <32 Weeks' Gestation with Respiratory Distress Syndrome

    C. Gizzi

    2012-01-01

    Full Text Available Aim. To evaluate whether synchronized-NIPPV (SNIPPV used after the INSURE procedure can reduce mechanical ventilation (MV need in preterm infants with RDS more effectively than NCPAP and to compare the clinical course and the incidence of short-term outcomes of infants managed with SNIPPV or NCPAP. Methods. Chart data of inborn infants 0.4, respiratory acidosis, or intractable apnoea that occurred within 72 hours of surfactant administration. Results. Eleven out of 31 (35.5% infants in the NCPAP group and 2 out of 33 (6.1% infants in the SNIPPV group failed the INSURE approach and underwent MV (. Fewer infants in the INSURE/SNIPPV group needed a second dose of surfactant, a high caffeine maintenance dose, and pharmacological treatment for PDA. Differences in O2 dependency at 28 days and 36 weeks of postmenstrual age were at the limit of significance in favor of SNIPPV treated infants. Conclusions. SNIPPV use after INSURE technique in our NICU reduced MV need and favorably affected short-term morbidities of our premature infants.

  10. Chaotic dynamics of respiratory sounds

    There is a growing interest in nonlinear analysis of respiratory sounds (RS), but little has been done to justify the use of nonlinear tools on such data. The aim of this paper is to investigate the stationarity, linearity and chaotic dynamics of recorded RS. Two independent data sets from 8 + 8 healthy subjects were recorded and investigated. The first set consisted of lung sounds (LS) recorded with an electronic stethoscope and the other of tracheal sounds (TS) recorded with a contact accelerometer. Recurrence plot analysis revealed that both LS and TS are quasistationary, with the parts corresponding to inspiratory and expiratory flow plateaus being stationary. Surrogate data tests could not provide statistically sufficient evidence regarding the nonlinearity of the data. The null hypothesis could not be rejected in 4 out of 32 LS cases and in 15 out of 32 TS cases. However, the Lyapunov spectra, the correlation dimension (D 2) and the Kaplan-Yorke dimension (D KY) all indicate chaotic behavior. The Lyapunov analysis showed that the sum of the exponents was negative in all cases and that the largest exponent was found to be positive. The results are partly ambiguous, but provide some evidence of chaotic dynamics of RS, both concerning LS and TS. The results motivate continuous use of nonlinear tools for analysing RS data

  11. Chaotic dynamics of respiratory sounds

    Ahlstrom, C. [Department of Biomedical Engineering, Linkoepings Universitet, IMT/LIU, Universitetssjukhuset, S-58185 Linkoeping (Sweden) and Biomedical Engineering, Orebro University Hospital, S-70185 Orebro (Sweden)]. E-mail: christer@imt.liu.se; Johansson, A. [Department of Biomedical Engineering, Linkoepings Universitet, IMT/LIU, Universitetssjukhuset, S-58185 Linkoeping (Sweden); Hult, P. [Department of Biomedical Engineering, Linkoepings Universitet, IMT/LIU, Universitetssjukhuset, S-58185 Linkoeping (Sweden); Biomedical Engineering, Orebro University Hospital, S-70185 Orebro (Sweden); Ask, P. [Department of Biomedical Engineering, Linkoepings Universitet, IMT/LIU, Universitetssjukhuset, S-58185 Linkoeping (Sweden); Biomedical Engineering, Orebro University Hospital, S-70185 Orebro (Sweden)

    2006-09-15

    There is a growing interest in nonlinear analysis of respiratory sounds (RS), but little has been done to justify the use of nonlinear tools on such data. The aim of this paper is to investigate the stationarity, linearity and chaotic dynamics of recorded RS. Two independent data sets from 8 + 8 healthy subjects were recorded and investigated. The first set consisted of lung sounds (LS) recorded with an electronic stethoscope and the other of tracheal sounds (TS) recorded with a contact accelerometer. Recurrence plot analysis revealed that both LS and TS are quasistationary, with the parts corresponding to inspiratory and expiratory flow plateaus being stationary. Surrogate data tests could not provide statistically sufficient evidence regarding the nonlinearity of the data. The null hypothesis could not be rejected in 4 out of 32 LS cases and in 15 out of 32 TS cases. However, the Lyapunov spectra, the correlation dimension (D {sub 2}) and the Kaplan-Yorke dimension (D {sub KY}) all indicate chaotic behavior. The Lyapunov analysis showed that the sum of the exponents was negative in all cases and that the largest exponent was found to be positive. The results are partly ambiguous, but provide some evidence of chaotic dynamics of RS, both concerning LS and TS. The results motivate continuous use of nonlinear tools for analysing RS data.

  12. Sexual intercourse and respiratory failure.

    Polverino, Francesca; Santoriello, Carlo; De Sio, Vittorio; Andò, Filippo; de Blasio, Francesco; Polverino, Mario

    2008-06-01

    Sexual activity is an important component of quality of life in patients suffering from chronic illnesses. To our knowledge, the effects of sexual activity on gas exchange in patients with respiratory failure have not been yet studied. To such an extent, we evaluated the oxygen saturation (SaO2), by a pulse oxymeter, during three different sexual performances in a 63-yr-old patient affected by chronic obstructive pulmonary disease (COPD) on long-term oxygen therapy (LTOT). The sexual performances were divided in four periods: basal, sex, 10 min after sex and relax. In each performance during sex, we observed a significant increase of either heart rate (HR) or SaO2, with the highest value of the latter achieved within the 10 min of the post-sex period. SaO2 returned to basal value (pre-sex) by the end of the relax period. We conclude that the observed improvement of SaO2 during sexual activity might be due to a better ventilation/perfusion ratio (V/Q) obtained for either an increase of ventilation (hyperventilation) and perfusion (tachycardia), without significant muscle expenditure. PMID:18394872

  13. [Respiratory mechanics in professional flautists].

    Cossette, I

    2002-04-01

    Oesophageal, gastric, mouth, transdiaphragmatic, transpulmonary pressures, diaphragmatic EMG, sound and chest wall excursion were measured directly in 3 professional flautists whilst playing their instruments to determine: - what respiratory muscles and percent vital capacity were being used; - how mouth pressure, embouchure resistance, embouchure aperture, airflow and velocity affect sound loudness and frequency. Lung volume was estimated from transpulmonary pressure during playing and the static deflation pressure-volume curve was measured separately; flow was calculated from delta volume/delta time; embouchure resistance was calculated from mouth pressure/flow; velocity was calculated using Bernouilli's equation and mouth pressure. Staccati and sustained tones at different frequency and intensity were performed. Sound loudness was mainly related to airflow whilst sound frequency was determined by velocity. Flow and velocity were independently controlled by mouth pressure and embouchure aperture. Mean mouth pressures varied little from individual to an other (6-11 cm H(2)O) but the flautists used between 72-83% of their vital capacity suggesting inspiratory muscle activity while playing. However, rib cage and abdominal motion were different for each subject. Although different flautists use different strategies to control mouth pressure, their individual mastery of the instrument permits control of airflow and velocity to produce the desired intensity and frequency of sound. PMID:12040320

  14. RESPIRATORY SYNCYTIAL VIRUS INFECTION AMONG YOUNG CHILDREN WITH ACUTE RESPIRATORY INFECTION

    Milani, M

    2003-01-01

    Respiratory syncytial virus (RSV) is the major cause of lower respiratory tract infections in infants,and also an important factor for hospitalization during the winter months. To determine the prevalence and importance of RSV as a cause of acute lower respiratory tract infection, we carried out a prospective study during 5 months period from November to March 1998 in 6 pediatric hospitals. A nasopharyngeal aspirate was obtained for detection of RSV in all cases. Sociodemographic data, clinic...

  15. Efficient and Cost-effective Estimation of the Influence of Respiratory Variables on Respiratory Sinus Arrhythmia

    Egizio, Victoria B.; Eddy, Michael; Robinson, Matthew; Jennings, J. Richard

    2010-01-01

    Researchers are interested in respiratory sinus arrhythmia (RSA) as an index of cardiac vagal activity. Yet, debate exists about how to account for respiratory influences on quantitative indices of RSA. Ritz and colleagues (2001) developed a within-individual correction procedure by which the effects of respiration on RSA may be estimated using regression models. We replicated their procedure substituting a spectral high-frequency measure of RSA for a time-domain statistic and a respiratory b...

  16. Diagnosis of influenza from lower respiratory tract sampling after negative upper respiratory tract sampling.

    Bogoch, Isaac I; Andrews, Jason R; Zachary, Kimon C; Hohmann, Elizabeth L

    2013-01-01

    In this retrospective cohort study, we demonstrate that PCR-confirmed diagnoses of influenza were made solely by lower respiratory sampling in 6.9% of cases, as traditional upper respiratory tract tests were negative, indeterminate or not performed. Clinical features of these cases are presented. Clinicians should consider lower respiratory tract sampling in select cases of influenza-like illness for diagnosis. PMID:23135351

  17. Diagnosis of influenza from lower respiratory tract sampling after negative upper respiratory tract sampling

    Bogoch, Isaac I.; Andrews, Jason R.; Zachary, Kimon C.; Hohmann, Elizabeth L.

    2013-01-01

    In this retrospective cohort study, we demonstrate that PCR-confirmed diagnoses of influenza were made solely by lower respiratory sampling in 6.9% of cases, as traditional upper respiratory tract tests were negative, indeterminate or not performed. Clinical features of these cases are presented. Clinicians should consider lower respiratory tract sampling in select cases of influenza-like illness for diagnosis. PMID:23135351

  18. Noninvasive Mechanical Ventilation in Acute Respiratory Failure Patients: A Respiratory Therapist Perspective

    Hidalgo, V.; Giugliano-Jaramillo, C; Pérez, R.; Cerpa, F; Budini, H; Cáceres, D.; Gutiérrez, T.; Molina, J; Keymer, J; Romero-Dapueto, C

    2015-01-01

    Physiotherapist in Chile and Respiratory Therapist worldwide are the professionals who are experts in respiratory care, in mechanical ventilation (MV), pathophysiology and connection and disconnection criteria. They should be experts in every aspect of the acute respiratory failure and its management, they and are the ones who in medical units are able to resolve doubts about ventilation and the setting of the ventilator. Noninvasive mechanical ventilation should be the first-line of treatmen...

  19. Increased fatigue resistance of respiratory muscles during exercise after respiratory muscle endurance training

    Verges, S; Lenherr, O; Haner, A C; Schulz, C.; Spengler, C M

    2007-01-01

    Respiratory muscle fatigue develops during exhaustive exercise and can limit exercise performance. Respiratory muscle training, in turn, can increase exercise performance. We investigated whether respiratory muscle endurance training (RMT) reduces exercise-induced inspiratory and expiratory muscle fatigue. Twenty-one healthy, male volunteers performed twenty 30-min sessions of either normocapnic hyperpnoea (n = 13) or sham training (CON, n = 8) over 4-5 wk. Before and after training, subjects...

  20. Respiratory system impedance from 4 to 40 Hz in paralyzed intubated infants with respiratory disease.

    Dorkin, H L; Stark, A. R.; Werthammer, J W; Strieder, D J; Fredberg, J.J.; Frantz, I D

    1983-01-01

    To describe the mechanical characteristics of the respiratory system in intubated neonates with respiratory disease, we measured impedance and resistance in six paralyzed intubated infants with respiratory distress syndrome, three of whom also had pulmonary interstitial emphysema. We subtracted the effects of the endotracheal tube after showing that such subtraction was valid. Oscillatory flow was generated from 4 to 40 Hz by a loudspeaker, airway pressure was measured, and flow was calculate...

  1. Investigations of respiratory control systems simulation

    Gallagher, R. R.

    1973-01-01

    The Grodins' respiratory control model was investigated and it was determined that the following modifications were necessary before the model would be adaptable for current research efforts: (1) the controller equation must be modified to allow for integration of the respiratory system model with other physiological systems; (2) the system must be more closely correlated to the salient physiological functionings; (3) the respiratory frequency and the heart rate should be expanded to illustrate other physiological relationships and dependencies; and (4) the model should be adapted to particular individuals through a better defined set of initial parameter values in addition to relating these parameter values to the desired environmental conditions. Several of Milhorn's respiratory control models were also investigated in hopes of using some of their features as modifications for Grodins' model.

  2. Respiratory acoustic impedance in left ventricular failure.

    Depeursinge, F B; Feihl, F; Depeursinge, C; Perret, C H

    1989-12-01

    The measurement of respiratory acoustic impedance (Zrs) by forced pseudorandom noise provides a simple means of assessing respiratory mechanics in nonintubated intensive care patients. To characterize the lung mechanical alterations induced by acute vascular congestion of the lung, Zrs was measured in 14 spontaneously breathing patients hospitalized for acute left ventricular failure. The Zrs data in the cardiac patients were compared with those of 48 semirecumbent normal subjects and those of 23 sitting asthmatic patients during allergen-induced bronchospasm. In the patients with acute left ventricular failure, the Zrs abnormalities noted were an excessive frequency dependence of resistance from 10 to 20 Hz and an abnormally low reactance at all frequencies, abnormalities qualitatively similar to those observed in the asthmatic patients but of lesser magnitude. Acute lung vascular congestion modifies the acoustic impedance of the respiratory system. Reflex-induced bronchospasm might be the main mechanism altering respiratory acoustic impedance in acute left ventricular failure. PMID:2582846

  3. Retrotrapezoid nucleus, respiratory chemosensitivity and breathing automaticity

    Guyenet, Patrice G.; Bayliss, Douglas A.; Stornetta, Ruth L.; Fortuna, Michal G.; Abbott, Stephen B.; Depuy, Seth D.

    2009-01-01

    SUMMARY Breathing automaticity and CO2 regulation are inseparable neural processes. The retrotrapezoid nucleus (RTN), a group of glutamatergic neurons that express the transcription factor Phox2b, may be a crucial nodal point through which breathing automaticity is regulated to maintain CO2 constant. This review updates the analysis presented in prior publications. Additional evidence that RTN neurons have central respiratory chemoreceptor properties is presented but this is only one of many factors that determine their activity. The RTN is also regulated by powerful inputs from the carotid bodies and, at least in the adult, by many other synaptic inputs. We also analyze how RTN neurons may control the activity of the downstream central respiratory pattern generator. Specifically, we review the evidence which suggests that RTN neurons a) innervate the entire ventral respiratory column, and b) control both inspiration and expiration. Finally, we argue that the RTN neurons are the adult form of the parafacial respiratory group in neonate rats. PMID:19712903

  4. National prevalence of respiratory allergic disorders

    Dahl, R; Andersen, PS; Chivato, T; Valovirta, E; De Monchy, J

    2004-01-01

    Background: Many epidemiological studies have assessed the prevalence of respiratory allergic disorders in confined geographical locations. However, no study has yet established nationally prevalence data in a uniform manner representing whole countries and, thus, enabling cross-national comparisons

  5. CAUSES OF RESPIRATORY DISTRESS IN CHILDREN

    M M Karambin

    2008-11-01

    Full Text Available "nThere is a lack of large, prospective epidemiologic studies concerning acute lung injury (ALI and acute respiratory distress syndrome (ARDS in pediatric population. To determine the different causes of respiratory distress in children, we prepared a retrospective study and included the whole 567 children with respiratory distress referred to 17-Shahrivar Hospital, Rasht, Guilan. Using their medical files, data including age, sex, and causes of respiratory distress were collected. SPSS 13.0 (statistical software applied for statistical analysis. Pneumonia, asthma, and croup were the major causes of ARDS in children with a rate of 38.4, 19.04, and 16.5 percent, respectively. It seems that infectious factors are at the top of the list of ARDS causing factors which can be helpful to approach and manage such patients. We suggest vaccinating these at risk groups against common infectious factors such as H. Influenza and RSV which can cause either pneumonia or inducing asthma.

  6. Occupational exposure to pesticides and respiratory health

    Ali Mamane; Isabelle Baldi; Jean-François Tessier; Chantal Raherison; Ghislaine Bouvier

    2015-01-01

    This article aims to review the available literature regarding the link between occupational exposure to pesticides and respiratory symptoms or diseases. Identification of epidemiological studies was performed using PubMed. 41 articles were included, 36 regarding agricultural workers and five regarding industry workers. Among the 15 cross-sectional studies focusing on respiratory symptoms and agricultural pesticide exposure, 12 found significant associations with chronic cough, wheeze, dyspno...

  7. Clowns Benefit Children Hospitalized for Respiratory Pathologies

    Giuseppe Curcio; Elena Isola; Giuseppe Paolone; Mario Bertini

    2011-01-01

    The study aims at evaluating health-generating function of humor therapy in a hospital ward hosting children suffering from respiratory pathologies. The main scope of this study is to investigate possible positive effects of the presence of a clown on both the clinical evolution of the on-going disease, and on some physiological and pain parameters. Forty-three children with respiratory pathologies participated in the study: 21 of them belonged to the experimental group (EG) and 22 children t...

  8. Respiratory Depression Caused by Heroin Use

    Kadir Hakan Cansiz; Gokhan Inangil; Murat Kuyumcu; Ahmet Erturk Yedekci; Huseyin Sen; Sezai Ozkan; Guner Dagli

    2012-01-01

    Summary Heroin is a semisynthetic narcotic analgesic and heroin abuse is common due to its pleasure-inducing effect. For the last 30 years heroin abuse has become an important worldwide public health problem. Heroin can be administered in many different ways as preferred. Heroin affects many systems including respiratory system, cardiovascular system and particulary the central nervous system. Overdose use of heroin intravenously can be fatal due to respiratory depression. In this letter, we ...

  9. Respiratory health of cigar factory workers

    Uitti, J; Nordman, H.; Huuskonen, M. S.; Roto, P.; Husman, K.; Reiman, M.

    1998-01-01

    OBJECTIVES: To determine whether occupational exposure to raw tobacco causes respiratory or allergic diseases, an excess of respiratory symptoms, a decrease in lung function, or parenchymal changes in chest radiography among Finnish cigar workers. METHODS: This cross sectional study included all Finnish cigar workers (n = 106) exposed to raw tobacco and also a group of unexposed matched referents. Data were collected with a self administered questionnaire, flow volume spirometry, measur...

  10. Respiratory System Model Take into Account Pathology

    He Zhonghai; Ma Zhenhe

    2013-01-01

    In this study, nonlinear phenomenon of respiratory system is analyzed. Airway is partitioned into four parts by different morphology which causes different fluid dynamic character. Reasons that cause nonlinear phenomenon for different parts are given. To simplify the representation, corresponding parameters are selected to compromise the complicity and precision. Then, the suggested representation of respiratory system is summarized so that the model can be used easily in lung simulator.

  11. Effects of Pleural Effusion on Respiratory Function

    Mitrouska, I; M Klimathianaki; NM Siafakas

    2004-01-01

    The accumulation of pleural effusion has important effects on respiratory system function. It changes the elastic equilibrium volumes of the lung and chest wall, resulting in a restrictive ventilatory effect, chest wall expansion and reduced efficiency of the inspiratory muscles. The magnitude of these alterations depends on the pleural fluid volume and the underlying disease of the respiratory system. The decrease in lung volume is associated with hypoxemia mainly due to an increase in right...

  12. Emergency thyroidectomy: Due to acute respiratory failure

    Zulfu Bayhan; Sezgin Zeren; Bercis Imge Ucar; Isa Ozbay; Yalcin Sonmez; Metin Mestan; Onur Balaban; Nilufer Araz Bayhan; Mehmet Fatih Ekici

    2014-01-01

    INTRODUCTION: Giant cervical and mediastinal goiter may lead to acute respiratory failure caused by laryngotracheal compression and airway obstruction. Here, we present a case admitted to the emergency service with a giant goiter along with respiratory failure and poor general health status, which required urgent surgical intervention. PRESENTATION OF CASE: A 71-year-old female admitted to the emergency room with shortness of breath and poor general health status resulting from a giant cer...

  13. Airway Reflux, Cough and Respiratory Disease

    Molyneux, Ian D.; Morice, Alyn H.

    2011-01-01

    It is increasingly accepted that the effects of gastro-oesophageal reflux are not limited to the gastrointestinal tract. The adjacent respiratory structures are also at risk from material ejected from the proximal oesophagus as a result of the failure of anatomical and physiological barriers. There is evidence of the influence of reflux on several respiratory and otorhinological conditions and although in many cases the precise mechanism has yet to be elucidated, the association alone opens p...

  14. Degeneracy as a Substrate for Respiratory Regulation

    Mellen, Nicholas M.

    2010-01-01

    Recent studies in vivo and in vitro suggest that both respiratory rhythmogenesis and its central chemosensory modulation arise from multiple, mechanistically and/or anatomically distinct networks whose outputs are similar. These observations are consistent with degeneracy, defined as the ability of structurally distinct elements to generate similar function. This review argues that degeneracy is an essential feature of respiratory networks, ensuring the survival of the individual organism ove...

  15. Amyloid myopathy presenting with respiratory failure.

    Ashe, J.; Borel, C O; Hart, G.; Humphrey, R L; Derrick, D A; Kuncl, R W

    1992-01-01

    Amyloidosis is a rare cause of myopathy. Its prominent or presenting feature may be respiratory failure. Physiological measurement of transdiaphragmatic pressure and biopsy specimens of muscle show the pathological mechanism to be diaphragm weakness due to amyloid infiltration of the diaphragm rather than parenchymal lung involvement. Thus amyloid myopathy even without the typical macroglossia and muscle pseudohypertrophy should be considered as one of the neurological causes of respiratory f...

  16. Preoperative respiratory physical therapy in cardiac surgery

    Hulzebos, H.J.

    2006-01-01

    Cardiac surgery is one of the most common surgical procedures and accounts for more resources expended in cardiovascular medicine than any other single procedure. Because cardiac surgery involves sternal incision and cardiopulmonary bypass, patients usually have a restricted respiratory function in the postoperative period. Moreover, anesthesia and analgesia affect respiratory function during and after the surgical intervention, causing changes in lung volume, diaphragmatic dysfunction, respi...

  17. Respiratory Review of 2013: Critical Care Medicine

    Choi, Hye Sook

    2013-01-01

    Several papers on respiratory and critical care published from March 2012 to February 2013 were reviewed. From these, this study selected and summarized ten articles, in which the findings were notable, new, and interesting: effects of high-frequency oscillation ventilation on acute respiratory distress syndrome (ARDS); safety and efficacy of hydroxyethyl starch as a resuscitation fluid; long-term psychological impairments after ARDS; safety and efficacy of dexmedetomidine for sedation; B-typ...

  18. Prevention of respiratory syncytial virus infection

    Samson, L

    2009-01-01

    Respiratory syncytial virus (RSV) infection is the leading cause of lower respiratory tract infection in young children, with significant numbers of premature infants and those with other risk factors requiring hospitalization in Canada each year. Palivizumab, an RSV-specific monoclonal antibody, can reduce the hospitalization rate and severity of illness for a small group of high-risk or premature infants during their first RSV season. The present statement reviews the published literature a...

  19. Respiratory poliomyelitis: a follow-up study.

    Alcock, A J; Hildes, J. A.; Kaufert, P A; Kaufert, J. M.; Bickford, J.

    1984-01-01

    Data from the medical records of 113 patients living in Manitoba who had contracted respiratory poliomyelitis between 1952 and 1959 were compared with information obtained from interviews with these patients in 1980. The study was designed to determine whether the patients' respiratory function, mobility, ability to perform daily tasks, and employment, residential and marital status had changed between 1 year after the onset of polio and 1980. The patients' dependence on mechanical aids and o...

  20. The panic disorder respiratory ratio: a dimensional approach to the respiratory subtype

    Rafael Christophe Freire

    2013-03-01

    Full Text Available OBJECTIVE: The respiratory ratio is a dimensional construct of the respiratory subtype of panic disorder (PD. The respiratory subtype has been correlated with an increased sensitivity to CO2 inhalation, positive family history of PD and low comorbidity with depression. The objective of our study was to determine whether the respiratory ratio is correlated with CO2-induced panic attacks and other clinical and demographic features. METHODS: We examined 91 patients with PD and submitted them to a double-breath 35% CO2 challenge test. The respiratory ratio was calculated based on the Diagnostic Symptom Questionnaire (DSQ scores recorded in a diary in the days preceding the CO2 challenge. The scores of the respiratory symptoms were summed and divided by the total DSQ score. RESULTS: The respiratory ratio was correlated with CO2 sensitivity, and there was a non-statistically significant trend towards a correlation with a family history of PD. CONCLUSIONS: The positive correlation between the respiratory ratio and the anxiety elicited by the CO2 inhalation indicates that the intensity of respiratory symptoms may be proportional to the sensitivity to carbon dioxide.

  1. Human metapneumovirus and respiratory syncytial virus in hospitalized danish children with acute respiratory tract infection

    von Linstow, Marie-Louise; Larsen, Hans Henrik; Eugen-Olsen, Jesper;

    2004-01-01

    The newly discovered human metapneumovirus (hMPV) has been shown to be associated with respiratory illness. We determined the frequencies and clinical features of hMPV and respiratory syncytial virus (RSV) infections in 374 Danish children with 383 episodes of acute respiratory tract infection...... children 1-6 months of age. Asthmatic bronchitis was diagnosed in 66.7% of hMPV and 10.6% of RSV-infected children (p < 0.001). Overall symptoms and clinical findings were similar among hMPV and RSV positive episodes, but more RSV-infected children required respiratory support. hMPV is present in young...

  2. Real-Time Surveillance for Respiratory Disease Outbreaks, Ontario, Canada

    van Dijk, Adam; Aramini, Jeff; Edge, Graham; Moore, Kieran M.

    2009-01-01

    To validate the utility of a chief complaint–based emergency department surveillance system, we compared it with respiratory diagnostic data and calls to Telehealth Ontario about respiratory disease. This local syndromic surveillance system accurately monitored status of respiratory diseases in the community and contributed to early detection of respiratory disease outbreaks.

  3. Stress significantly increases mortality following a secondary bacterial respiratory infection

    Hodgson Paul D; Aich Palok; Stookey Joseph; Popowych Yurij; Potter Andrew; Babiuk Lorne; Griebel Philip J

    2012-01-01

    Abstract A variety of mechanisms contribute to the viral-bacterial synergy which results in fatal secondary bacterial respiratory infections. Epidemiological investigations have implicated physical and psychological stressors as factors contributing to the incidence and severity of respiratory infections and psychological stress alters host responses to experimental viral respiratory infections. The effect of stress on secondary bacterial respiratory infections has not, however, been investig...

  4. Diseases of the respiratory tract of chelonians.

    Origgi, F C; Jacobson, E R

    2000-05-01

    Diseases of the respiratory tract commonly occur in captive chelonians, and several diseases also have occurred in wild chelonians. Infectious causes include viruses, bacteria, fungi, and parasites. Herpesviruses have surfaced as important pathogens of the oral cavity and respiratory tract in Hermann's tortoise (Testudo hermanii), spur-thighed tortoise (Testudo graeca), and other tortoises in Europe and the United States. Herpesvirus-associated respiratory diseases also have been reported in the green turtle, Chelonia mydas, in mariculture in the Cayman Islands. Of diseases caused by bacteria, an upper respiratory tract disease caused by Mycoplasma sp has been reported in free-hanging and captive gopher tortoises in the southeastern United States and in desert tortoises in the Mojave Desert of the southwestern United States. Mycotic pulmonary disease is commonly reported in captive chelonians, especially in those maintained at suboptimal temperatures. An intranuclear coccidia has been seen in several species of captive tortoises in the United States, and, in one case, a severe proliferative pneumonia was associated with organisms in the lung. The most common noninfectious cause of respiratory disease in chelonians results from trauma to the carapace. Although pulmonary fibromas commonly occur in green turtles with fibropapillomatosis, for the most part, tumors of the respiratory tract are uncommon in chelonians. PMID:11228895

  5. Environmental exposure to pesticides and respiratory health

    Ali Mamane

    2015-09-01

    Full Text Available Respiratory effects of environmental exposure to pesticides are debated. Here we aimed to review epidemiological studies published up until 2013, using the PubMed database. 20 studies dealing with respiratory health and non-occupational pesticide exposure were identified, 14 carried out on children and six on adults. In four out of nine studies in children with biological measurements, mothers' dichlorodiphenyldichloroethylene (DDE blood levels during pregnancy were associated with asthma and wheezing in young children. An association was also found between permethrin in indoor air during pregnancy and wheezing in children. A significant association between asthma and DDE measured in children's blood (aged 7–10 years was observed in one study. However, in three studies, no association was found between asthma or respiratory infections in children and pesticide levels in breast milk and/or infant blood. Lastly, in three out of four studies where post-natal pesticide exposure of children was assessed by parental questionnaire an association with respiratory symptoms was found. Results of the fewer studies on pesticide environmental exposure and respiratory health of adults were much less conclusive: indeed, the associations observed were weak and often not significant. In conclusion, further studies are needed to confirm whether there is a respiratory risk associated with environmental exposure to pesticides.

  6. Respiratory Management in the Patient with Spinal Cord Injury

    Rita Galeiras Vázquez; Pedro Rascado Sedes; Mónica Mourelo Fariña; Antonio Montoto Marqués; M. Elena Ferreiro Velasco

    2013-01-01

    Spinal cord injuries (SCIs) often lead to impairment of the respiratory system and, consequently, restrictive respiratory changes. Paresis or paralysis of the respiratory muscles can lead to respiratory insufficiency, which is dependent on the level and completeness of the injury. Respiratory complications include hypoventilation, a reduction in surfactant production, mucus plugging, atelectasis, and pneumonia. Vital capacity (VC) is an indicator of overall pulmonary function; patients with s...

  7. The role of image guidance in respiratory gated radiotherapy

    Korreman, Stine Sofia; Juhler-Nøttrup, Trine; Fredberg Persson, Gitte;

    2008-01-01

    Respiratory gating for radiotherapy beam delivery is a widely available technique, manufactured and sold by most of the major radiotherapy machine vendors. Respiratory gated beam delivery is intended to limit the irradiation of tumours moving with respiration to selected parts of the respiratory ...... therefore of utmost importance for the safe introduction of respiratory gating. In this short overview, suitable image guidance strategies for respiratory gated radiotherapy are reviewed for two cancer sites; breast cancer and lung tumours....

  8. Evaluation of the Usefulness of the Respiratory Guidance System in the Respiratory Gating Radiation Therapy

    Lee, Yeong Cheol; Kim, Sun Myung; Do, Gyeong Min; Park, Geun Yong; Kim, Gun Oh; Kim, Young Bum [Dept. of Radiation Oncology, Guro Hospital, Korea Univeristy, Seoul (Korea, Republic of)

    2012-09-15

    The respiration is one of the most important factors in respiratory gating radiation therapy (RGRT). We have developed an unique respiratory guidance system using an audio-visual system in order to support and stabilize individual patient's respiration and evaluated the usefulness of this system. Seven patients received the RGRT at our clinic from June 2011 to April 2012. After breathing exercise standard deviations by the superficial contents of respiratory cycles and functions, and analyzed them to examine changes in their breathing before and with the audio-visual system, we measured their spontaneous respiration and their respiration with the audio-visual system respectively. With the measured data, we yielded after the therapy. The PTP (peak to peak) of the standard deviations of the free breathing, the audio guidance system, and the respiratory guidance system were 0.343, 0.148, and 0.078 respectively. The respiratory cycles were 0.645, 0.345, and 0.171 respectively and the superficial contents of the respiratory functions were 2.591, 1.008, and 0.877 respectively. The average values of the differences in the standard deviations among the whole patients at the CT room and therapy room were 0.425 for the PTP, 1.566 for the respiratory cycles, and 3.671 for the respiratory superficial contents. As for the standard deviations before and after the application of the PTP respiratory guidance system, that of the PTP was 0.265, that of the respiratory cycles was 0.474, and that of the respiratory superficial contents. The results of t-test of the values before and after free breathing and the audio-visual guidance system showed that the P-value of the PTP was 0.035, that of the cycles 0.009, and that of the respiratory superficial contents 0.010. The respiratory control could be one of the most important factors in the RGRT which determines the success or failure of a treatment. We were able to get more stable breathing with the audio-visual respiratory

  9. Evaluation of the Usefulness of the Respiratory Guidance System in the Respiratory Gating Radiation Therapy

    The respiration is one of the most important factors in respiratory gating radiation therapy (RGRT). We have developed an unique respiratory guidance system using an audio-visual system in order to support and stabilize individual patient's respiration and evaluated the usefulness of this system. Seven patients received the RGRT at our clinic from June 2011 to April 2012. After breathing exercise standard deviations by the superficial contents of respiratory cycles and functions, and analyzed them to examine changes in their breathing before and with the audio-visual system, we measured their spontaneous respiration and their respiration with the audio-visual system respectively. With the measured data, we yielded after the therapy. The PTP (peak to peak) of the standard deviations of the free breathing, the audio guidance system, and the respiratory guidance system were 0.343, 0.148, and 0.078 respectively. The respiratory cycles were 0.645, 0.345, and 0.171 respectively and the superficial contents of the respiratory functions were 2.591, 1.008, and 0.877 respectively. The average values of the differences in the standard deviations among the whole patients at the CT room and therapy room were 0.425 for the PTP, 1.566 for the respiratory cycles, and 3.671 for the respiratory superficial contents. As for the standard deviations before and after the application of the PTP respiratory guidance system, that of the PTP was 0.265, that of the respiratory cycles was 0.474, and that of the respiratory superficial contents. The results of t-test of the values before and after free breathing and the audio-visual guidance system showed that the P-value of the PTP was 0.035, that of the cycles 0.009, and that of the respiratory superficial contents 0.010. The respiratory control could be one of the most important factors in the RGRT which determines the success or failure of a treatment. We were able to get more stable breathing with the audio-visual respiratory guidance

  10. A novel heterozygous mutation in the ATP6V0A4 gene encoding the V-ATPase a4 subunit in an adult patient with incomplete distal renal tubular acidosis.

    Imai, Eri; Kaneko, Shuzo; Mori, Takayasu; Okado, Tomokazu; Uchida, Shinichi; Tsukamoto, Yusuke

    2016-06-01

    A 40-year-old Japanese man who had a medical history of hypokalemic periodic paralysis 4 months prior was hospitalized to undergo a cholecystectomy. Hypokalemia, nephrocalcinosis and alkaluria suggesting distal renal tubular acidosis (dRTA) were detected, but metabolic acidosis was not evident. An ammonium chloride/furosemide-fludrocortisone/bicarbonate loading test demonstrated a remarkable disability in urinary H(+) excretion. A novel heterozygous mutation in the ATP6V0A4 gene encoding the vacuolar H(+)-ATPase (V-ATPase) a4 subunit p.S544L was detected. Among cases of V-ATPase a4 mutations, this is the first case in which a heterozygous mutation developed to an incomplete or latent form of dRTA. PMID:27274828

  11. L-Arginine Affects Aerobic Capacity and Muscle Metabolism in MELAS (Mitochondrial Encephalomyopathy, Lactic Acidosis and Stroke-Like Episodes Syndrome.

    Lance H Rodan

    Full Text Available To study the effects of L-arginine (L-Arg on total body aerobic capacity and muscle metabolism as assessed by (31Phosphorus Magnetic Resonance Spectroscopy ((31P-MRS in patients with MELAS (Mitochondrial Encephalomyopathy with Lactic Acidosis and Stroke-like episodes syndrome.We performed a case control study in 3 MELAS siblings (m.3243A>G tRNA(leu(UUR in MTTL1 gene with different % blood mutant mtDNA to evaluate total body maximal aerobic capacity (VO(2peak using graded cycle ergometry and muscle metabolism using 31P-MRS. We then ran a clinical trial pilot study in MELAS sibs to assess response of these parameters to single dose and a 6-week steady-state trial of oral L-Arginine.At baseline (no L-Arg, MELAS had lower serum Arg (p = 0.001. On 3(1P-MRS muscle at rest, MELAS subjects had increased phosphocreatine (PCr (p = 0.05, decreased ATP (p = 0.018, and decreased intracellular Mg(2+ (p = 0.0002 when compared to matched controls. With L-arginine therapy, the following trends were noted in MELAS siblings on cycle ergometry: (1 increase in mean % maximum work at anaerobic threshold (AT (2 increase in % maximum heart rate at AT (3 small increase in VO(2peak. On (31P-MRS the following mean trends were noted: (1 A blunted decrease in pH after exercise (less acidosis (2 increase in Pi/PCr ratio (ADP suggesting increased work capacity (3 a faster half time of PCr recovery (marker of mitochondrial activity following 5 minutes of moderate intensity exercise (4 increase in torque.These results suggest an improvement in aerobic capacity and muscle metabolism in MELAS subjects in response to supplementation with L-Arg. Intramyocellular hypomagnesemia is a novel finding that warrants further study.Class III evidence that L-arginine improves aerobic capacity and muscle metabolism in MELAS subjects.ClinicalTrials.gov NCT01603446.

  12. Clinical characteristics, diagnosis and management of respiratory distress syndrome in full-term neonates

    FENG Zhi-chun; SHI Yun; DONG Jian-ying; ZHENG Tian; LI Jing-ya; LU Li-li; LIU Jing-jing; LIANG Jing; ZHANG Hao

    2010-01-01

    Background Respiratory distress syndrome (RDS) is one of the most common causes of neonatal respiratory failure and neonatal death, however, its clinical characteristics are very different from premature RDS, and these characteristics have not been well documented as yet. This study was to investigate the pathogenesis, clinical characteristics and management strategies of RDS in full-term neonates, with the aim of developing a working protocol for improving the outcome in full-term neonates with RDS.Methods A total of 125 full-term infants with RDS were enrolled in this study. Their clinical and laboratory data were collected for analyzing the characteristics of full-term neonatal RDS.Results (1) The 125 cases included 94 male and 31 female infants, vaginal delivery occurred in 80 cases and cesarean section in 45 cases. (2) The onset time of RDS was (3.11±3.59) hours after birth. (3)The possible reasons included severe perinatal infections in 63 patients, elective cesarean section in 34 cases, severe birth asphyxia in 12 patients,meconium aspiration syndrome in 9 patients, pulmonary hemorrhage in 4 patients and matemal diabetes in 3 patients. (4)Complications included multiple organ system failure (MOSF) in 49 patients, persistent pulmonary hypertension of newborn (PPHN) in 25 patients, acute renal failure in 18 patients, severe hyperkalemia in 25 patients, severe metabolic acidosis in 6 cases, severe myocardial injury in 9 cases, pulmonary hemorrhage in 3 cases, disseminated intravascular coagulation in 14 patients and shock in 12 patients.(5) Four patients died, the mortality was therefore 3.2% with the main cause of septicemia complicating of MOSF, but their prognosis was improved while comprehensive treatment measures including early mechanical ventilation and broad spectrum antibiotics were taken into account.Conclusions RDS is not an uncommon disease in full-term infants and is associated with a higher mortality, its clinical characteristics are very

  13. Deficiency of the reduced nicotinamide adenine dinucleotide dehydrogenase component of complex I of mitochondrial electron transport. Fatal infantile lactic acidosis and hypermetabolism with skeletal-cardiac myopathy and encephalopathy.

    Hoppel, C L; Kerr, D S; Dahms, B; Roessmann, U

    1987-01-01

    A mitochondrial defect was investigated in an infant with fatal congenital lactic acidosis (3-14 mM), high lactate-to-pyruvate ratio, hypotonia, and cardiomyopathy. His sister had died with a similar disorder. Resting oxygen consumption was 150% of controls. Pathological findings included increased numbers of skeletal muscle mitochondria (many with proliferated, concentric cristae), cardiomegaly, fatty infiltration of the viscera, and spongy encephalopathy. Mitochondria from liver and muscle ...

  14. Respiratory infections precede adult-onset asthma.

    Aino Rantala

    Full Text Available BACKGROUND: Respiratory infections in early life are associated with an increased risk of developing asthma but there is little evidence on the role of infections for onset of asthma in adults. The objective of this study was to assess the relation of the occurrence of respiratory infections in the past 12 months to adult-onset asthma in a population-based incident case-control study of adults 21-63 years of age. METHODS/PRINCIPAL FINDINGS: We recruited all new clinically diagnosed cases of asthma (n = 521 during a 2.5-year study period and randomly selected controls (n = 932 in a geographically defined area in South Finland. Information on respiratory infections was collected by a self-administered questionnaire. The diagnosis of asthma was based on symptoms and reversible airflow obstruction in lung function measurements. The risk of asthma onset was strongly increased in subjects who had experienced in the preceding 12 months lower respiratory tract infections (including acute bronchitis and pneumonia with an adjusted odds ratio (OR 7.18 (95% confidence interval [CI] 5.16-9.99, or upper respiratory tract infections (including common cold, sinusitis, tonsillitis, and otitis media with an adjusted OR 2.26 (95% CI 1.72-2.97. Individuals with personal atopy and/or parental atopy were more susceptible to the effects of respiratory infections on asthma onset than non-atopic persons. CONCLUSIONS/SIGNIFICANCE: This study provides new evidence that recently experienced respiratory infections are a strong determinant for adult-onset asthma. Reducing such infections might prevent onset of asthma in adulthood, especially in individuals with atopy or hereditary propensity to it.

  15. Pathobiology of acute respiratory distress syndrome.

    Sapru, Anil; Flori, Heidi; Quasney, Michael W; Dahmer, Mary K

    2015-06-01

    The unique characteristics of pulmonary circulation and alveolar-epithelial capillary-endothelial barrier allow for maintenance of the air-filled, fluid-free status of the alveoli essential for facilitating gas exchange, maintaining alveolar stability, and defending the lung against inhaled pathogens. The hallmark of pathophysiology in acute respiratory distress syndrome is the loss of the alveolar capillary permeability barrier and the presence of protein-rich edema fluid in the alveoli. This alteration in permeability and accumulation of fluid in the alveoli accompanies damage to the lung epithelium and vascular endothelium along with dysregulated inflammation and inappropriate activity of leukocytes and platelets. In addition, there is uncontrolled activation of coagulation along with suppression of fibrinolysis and loss of surfactant. These pathophysiological changes result in the clinical manifestations of acute respiratory distress syndrome, which include hypoxemia, radiographic opacities, decreased functional residual capacity, increased physiologic deadspace, and decreased lung compliance. Resolution of acute respiratory distress syndrome involves the migration of cells to the site of injury and re-establishment of the epithelium and endothelium with or without the development of fibrosis. Most of the data related to acute respiratory distress syndrome, however, originate from studies in adults or in mature animals with very few studies performed in children or juvenile animals. The lack of studies in children is particularly problematic because the lungs and immune system are still developing during childhood and consequently the pathophysiology of pediatric acute respiratory distress syndrome may differ in significant ways from that seen in acute respiratory distress syndrome in adults. This article describes what is known of the pathophysiologic processes of pediatric acute respiratory distress syndrome as we know it today while also presenting the much

  16. Evaluation of exercise-respiratory system modifications and preliminary respiratory-circulatory system integration scheme

    Gallagher, R. R.

    1974-01-01

    The respiratory control system, functioning as an independent system, is presented with modifications of the exercise subroutine. These modifications illustrate an improved control of ventilation rates and arterial and compartmental gas tensions. A very elementary approach to describing the interactions of the respiratory and circulatory system is presented.

  17. Respiratory gated beam delivery cannot facilitate margin reduction, unless combined with respiratory correlated image guidance

    Korreman, S.S.; Boyer, A.L.; Juhler-Nøttrup, Trine

    2008-01-01

    for 17 lung cancer patients in separate protocols at Rigshospitalet and Stanford Cancer Center. Respiratory curves for external optical markers and implanted fiducials were collected using equipment based on the RPM system (Varian Medical Systems). A total of 861 respiratory curves represented...

  18. Non-invasive versus invasive mechanical ventilation for respiratory failure in severe acute respiratory syndrome

    Loretta YC Yam; Alfred YF Chan; Thomas MT Cheung; Eva LH Tsui; Jane CK Chan; Vivian CW Wong

    2005-01-01

    Background Severe acute respiratory syndrome is frequently complicated by respiratory failure requiring ventilatory support. We aimed to compare the efficacy of non-invasive ventilation against invasive mechanical ventilation treating respiratory failure in this disease. Methods Retrospective analysis was conducted on all respiratory failure patients identified from the Hong Kong Hospital Authority Severe Acute Respiratory Syndrome Database. Intubation rate, mortality and secondary outcome of a hospital utilizing non-invasive ventilation under standard infection control conditions (NIV Hospital) were compared against 13 hospitals using solely invasive ventilation (IMV Hospitals). Multiple logistic regression analyses with adjustments for confounding variables were performed to test for association between outcomes and hospital groups. Results Both hospital groups had comparable demographics and clinical profiles, but NIV Hospital (42 patients) had higher lactate dehydrogenase ratio and worse radiographic score on admission and ribavirin-corticosteroid commencement. Compared to IMV Hospitals (451 patients), NIV Hospital had lower adjusted odds ratios for intubation (0.36, 95% CI 0.164-0.791, P=0.011) and death (0.235, 95% CI 0.077-0.716, P=0.011), and improved earlier after pulsed steroid rescue. There were no instances of transmission of severe acute respiratory syndrome among health care workers due to the use of non-invasive ventilation.Conclusion Compared to invasive mechanical ventilation, non-invasive ventilation as initial ventilatory support for acute respiratory failure in the presence of severe acute respiratory syndrome appeared to be associated with reduced intubation need and mortality.

  19. Four-Dimensional Computed Tomography Based Respiratory-Gated Radiotherapy with Respiratory Guidance System: Analysis of Respiratory Signals and Dosimetric Comparison

    2014-01-01

    Purpose. To investigate the effectiveness of respiratory guidance system in 4-dimensional computed tomography (4DCT) based respiratory-gated radiation therapy (RGRT) by comparing respiratory signals and dosimetric analysis of treatment plans. Methods. The respiratory amplitude and period of the free, the audio device-guided, and the complex system-guided breathing were evaluated in eleven patients with lung or liver cancers. The dosimetric parameters were assessed by comparing free breathing ...

  20. Respiratory trace feature analysis for the prediction of respiratory-gated PET quantification

    The benefits of respiratory gating in quantitative PET/CT vary tremendously between individual patients. Respiratory pattern is among many patient-specific characteristics that are thought to play an important role in gating-induced imaging improvements. However, the quantitative relationship between patient-specific characteristics of respiratory pattern and improvements in quantitative accuracy from respiratory-gated PET/CT has not been well established. If such a relationship could be estimated, then patient-specific respiratory patterns could be used to prospectively select appropriate motion compensation during image acquisition on a per-patient basis. This study was undertaken to develop a novel statistical model that predicts quantitative changes in PET/CT imaging due to respiratory gating. Free-breathing static FDG-PET images without gating and respiratory-gated FDG-PET images were collected from 22 lung and liver cancer patients on a PET/CT scanner. PET imaging quality was quantified with peak standardized uptake value (SUVpeak) over lesions of interest. Relative differences in SUVpeak between static and gated PET images were calculated to indicate quantitative imaging changes due to gating. A comprehensive multidimensional extraction of the morphological and statistical characteristics of respiratory patterns was conducted, resulting in 16 features that characterize representative patterns of a single respiratory trace. The six most informative features were subsequently extracted using a stepwise feature selection approach. The multiple-regression model was trained and tested based on a leave-one-subject-out cross-validation. The predicted quantitative improvements in PET imaging achieved an accuracy higher than 90% using a criterion with a dynamic error-tolerance range for SUVpeak values. The results of this study suggest that our prediction framework could be applied to determine which patients would likely benefit from respiratory motion compensation

  1. Microglia modulate respiratory rhythm generation and autoresuscitation.

    Lorea-Hernández, Jonathan-Julio; Morales, Teresa; Rivera-Angulo, Ana-Julia; Alcantara-Gonzalez, David; Peña-Ortega, Fernando

    2016-04-01

    Inflammation has been linked to the induction of apneas and Sudden Infant Death Syndrome, whereas proinflammatory mediators inhibit breathing when applied peripherally or directly into the CNS. Considering that peripheral inflammation can activate microglia in the CNS and that this cell type can directly release all proinflammatory mediators that modulate breathing, it is likely that microglia can modulate breathing generation. It might do so also in hypoxia, since microglia are sensitive to hypoxia, and peripheral proinflammatory conditions affect gasping generation and autoresuscitation. Here, we tested whether microglial activation or inhibition affected respiratory rhythm generation. By measuring breathing as well as the activity of the respiratory rhythm generator (the preBötzinger complex), we found that several microglial activators or inhibitors, applied intracisternally in vivo or in the recording bath in vitro, affect the generation of the respiratory rhythms both in normoxia and hypoxia. Furthermore, microglial activation with lipopolysaccharide affected the ability of the animals to autoresuscitate after hypoxic conditions, an effect that is blocked when lipopolysaccharide is co-applied with the microglial inhibitor minocycline. Moreover, we found that the modulation of respiratory rhythm generation induced in vitro by microglial inhibitors was reproduced by microglial depletion. In conclusion, our data show that microglia can modulate respiratory rhythm generation and autoresuscitation. PMID:26678570

  2. Dynamics of human respiratory system mycoflora

    Anna Biedunkiewicz

    2014-08-01

    Full Text Available The study aimed at determing the prevalence of individual species of fungi in the respiratory systems of women and men, analysis of the dynamics of the fungi in individual sections of the respiratory system as concerns their quantity and identification of phenology of the isolated fungi coupled with an attempt at identifying their possible preferences for appearing during specific seasons of thc year. During 10 years of studies (1989- 1998. 29 species of fungi belonging: Candida, Geolrichum, Saccharomyces, Saccharomycopsis, Schizosaccharomyces, Torulopsis, Trichosporon and Aspergillus were isolated from the ontocenoses of the respiratory systems of patients at the Independent Public Center for Pulmonology and Oncology in Olsztyn. Candida albicans was a clearly dominating fungus. Individual species appeared individually, in twos or threes in a single patient, they were isolated more frequently in the spring and autumn, less frequently during the winter and summer. The largest number of fungi species were isolated from sputum (29 species, bronchoscopic material (23 species and pharyngeal swabs (15 species. Sacchoromycopsis capsularis and Trichosporon beigelii should be treated as new for the respiratory system. Biodiversity of fungi, their numbers and continous fluctuations in frequency indicate that the respiratory system ontocenose offers the optimum conditions for growth and development of the majority of the majority of yeasts - like fungi.

  3. Control Measures for Human Respiratory Viral Infection.

    Bennett, Lesley; Waterer, Grant

    2016-08-01

    New viral respiratory pathogens are emerging with increasing frequency and have potentially devastating impacts on the population worldwide. Recent examples of newly emerged threats include severe acute respiratory syndrome coronavirus, the 2009 H1N1 influenza pandemic, and Middle East respiratory syndrome coronavirus. Experiences with these pathogens have shown up major deficiencies in how we deal globally with emerging pathogens and taught us salient lessons in what needs to be addressed for future pandemics. This article reviews the lessons learnt from past experience and current knowledge on the range of measures required to limit the impact of emerging respiratory infections from public health responses down to individual patient management. Key areas of interest are surveillance programs, political limitations on our ability to respond quickly enough to emerging threats, media management, public information dissemination, infection control, prophylaxis, and individual patient management. Respiratory physicians have a crucial role to play in many of these areas and need to be aware of how to respond as new viral pathogens emerge. PMID:27486741

  4. Occupational exposure to pesticides and respiratory health

    Ali Mamane

    2015-06-01

    Full Text Available This article aims to review the available literature regarding the link between occupational exposure to pesticides and respiratory symptoms or diseases. Identification of epidemiological studies was performed using PubMed. 41 articles were included, 36 regarding agricultural workers and five regarding industry workers. Among the 15 cross-sectional studies focusing on respiratory symptoms and agricultural pesticide exposure, 12 found significant associations with chronic cough, wheeze, dyspnoea, breathlessness or chest tightness. All four studies on asthma found a relationship with occupational exposure, as did all three studies on chronic bronchitis. The four studies that performed spirometry reported impaired respiratory function linked to pesticide exposure, suggestive of either obstructive or restrictive syndrome according to the chemical class of pesticide. 12 papers reported results from cohort studies. Three out of nine found a significant relationship with increased risk of wheeze, five out of nine with asthma and three out of three with chronic bronchitis. In workers employed in pesticide production, elevated risks of chronic obstructive pulmonary disease (two studies out of three and impaired respiratory function suggestive of an obstructive syndrome (two studies out of two were reported. In conclusion, this article suggests that occupational exposure to pesticides is associated with an increased risk of respiratory symptoms, asthma and chronic bronchitis, but the causal relationship is still under debate.

  5. Acidosis differentially modulates inactivation in NaV1.2, NaV1.4, and NaV1.5 channels

    PeterRuben

    2012-06-01

    Full Text Available NaV channels play a crucial role in neuronal and muscle excitability. Using whole-cell recordings we studied effects of low extracellular pH on the biophysical properties of NaV1.2, NaV1.4, and NaV1.5, expressed in cultured mammalian cells. Low pH produced different effects on different channel subtypes. Whereas NaV1.4 exhibited very low sensitivity to acidosis, primarily limited to partial block of macroscopic currents, the effects of low pH on gating in NaV1.2 and NaV1.5 were profound. In NaV1.2 low pH reduced apparent valence of steady-state fast inactivation, shifted the τ(V to depolarizing potentials and decreased channels availability during onset to slow and use-dependent inactivation. In contrast, low pH delayed open-state inactivation in NaV1.5, right-shifted the voltage-dependence of window current, and increased channel availability during onset to slow and use-dependent inactivation. These results suggest that protons affect channel availability in an isoform-specific manner. A computer model incorporating these results demonstrates their effects on membrane excitability.

  6. EVALUATION OF MITOCHONDRIAL ENCEPHALOMYOPATHY WITH LACTIC ACIDOSIS AND STROKE-LIKE EPISODES WITH MAGNETIC RESONANCE IMAGING AND PROTON MAGNETIC RESONANCE SPECTROSCOPY

    Feng Feng; Hui You; Jing Gao; Xiao-zhen Li; Chun-ling Meng; Hong-yi Sun; Zheng-yu Jin; Yu-pu Guo

    2006-01-01

    Objective To study the characteristics of spectra on proton magnetic resonance spectroscopy (1H-MRS) and its value in patients with mitochondrial encephalomyopathy with lactic acidosis and stroke-like episodes (MELAS).Methods Seven clinically diagnosed patients with MELAS underwent magnetic resonance imaging (MRI) and 1H-MRS examinations.The 1H-MRS techniques,characteristics of the spectra,and its correlation with the laboratory tests were analyzed.Results Cerebral abnormalities were revealed in all 7 patients on conventional MR images,and most abnormal signals were observed in bilateral occipital,parietal,and temporal lobes.We found 4 cases with basal ganglia involvement,2 cases with mild frontal lobe lesions,and 1 case with involvement of lateral cerebral peduncles and thalami.Additionally,1 patient was involved with left insular lobe.Spectra from prominent lesions in brain parenchyma showed lactate doublet peak in 6 patients,3 of whom were also noted lactate peak in ventricular cerebrospinal fluid (CSF).Conclusion 1H-MRS may provide more direct information about the metabolism changes,which aids to affirm the diagnosis,and may replace the conventional invasive method of quantifying lactate in CSF.

  7. Animal models for diseases of respiratory system

    R. Adil

    2012-07-01

    Full Text Available Latest trends in understanding of respiratory diseases in human beings can be derived from thorough clinical studies of these diseases occurring in man, but conducting such studies in man is difficult in terms of experimental manipulation. In the last 2 decades, various types of experimental respiratory disease models has been developed and utilized by investigators, which have contributed a lot to the understanding of respiratory diseases in man, but only little investigation has been done on the naturally occurring pulmonary diseases of animals as potential models which could have added to our knowledge. There are certain selected examples of spontaneous pulmonary disease in animals that may serve as exploitable models for human chronic bronchitis, bronchiectasis, emphysema, interstitial lung disease, hypersensitivity pneumonitis, hyaline membrane disease, and bronchial asthma.

  8. AIR POLLUTION FROM TRAFFIC AND RESPIRATORY HEALTH

    Maja Nikolić

    2004-12-01

    Full Text Available Air pollution has very important influence on human health. Earlier investigations were not employed with estimation of influence of air pollution, which spring from traffic, on people health who live near busy cross – road.The aim of this paper was to determine how living near busy cross – road influences on appearance of respiratory symptoms and illness.400 adult people between 18-76 age who live five year least on this location at took a part in investigation. One group (200 live in Nis near the busiest cross-road, another group live in Niska Banja near cross-road with the smallest concentration of pollutants in last five years.We have determined that examines, who live near busy cross – road had statistical signify greater prevalence of all respiratory symptoms and pneumonia.Our investigation showed that living near busy cross road present risk factor for appearance of respiratory symptoms and pneumonia.

  9. Genetic identification of a respiratory arsenate reductase

    Saltikov, Chad W.; Newman, Dianne K.

    2003-01-01

    For more than a decade, it has been recognized that arsenate [H2AsO41-; As(V)] can be used by microorganisms as a terminal electron acceptor in anaerobic respiration. Given the toxicity of arsenic, the mechanistic basis of this process is intriguing, as is its evolutionary origin. Here we show that a two-gene cluster (arrAB; arsenate respiratory reduction) in the bacterium Shewanella sp. strain ANA-3 specifically confers respiratory As(V) reductase activity. Mutants with in-frame deletions of...

  10. Small animal disease surveillance: respiratory disease.

    Sánchez-Vizcaíno, Fernando; Daly, Janet M; Jones, Philip H; Dawson, Susan; Gaskell, Rosalind; Menacere, Tarek; Heayns, Bethaney; Wardeh, Maya; Newman, Jenny; Everitt, Sally; Day, Michael J; McConnell, Katie; Noble, Peter J M; Radford, Alan D

    2016-04-01

    Presentation for respiratory disease comprised 1.7 per cent, 2.3 per cent and 2.5 per cent of canine, feline and rabbit consultations, respectively, between January 2014 and December 2015Coughing was the most frequent respiratory sign reported in dogs (71.1 per cent of consultations); in cats it was sneezing (42.6 per cent)Mean percentage of samples testing positive for feline calicivirus (FCV) was 30.1 per cent in 2014 and 27.9 per cent in 2015January was the month with the highest percentage of FCV-positive samples in both 2014 and 2015. PMID:27056810

  11. Intravenous naloxone in acute respiratory failure.

    Ayres, J.; J Rees; Lee, T.; Cochrane, G M

    1982-01-01

    A 58-year-old man presented with acute on chronic respiratory failure. In the acute stage of his illness an infusion of the opiate antagonist naloxone caused an improvement in oxygen saturation as measured by ear oximetry from 74% to 85%, while a saline infusion resulted in a return of oxygen saturation to the original value. When he had recovered from the acute episode the same dose of naloxone had no effect on oxygen saturation. These findings suggest that in acute respiratory failure there...

  12. Hereditary mucoepithelial dysplasia and severe respiratory distress

    Mahmoud Halawa

    2015-01-01

    Full Text Available Hereditary mucoepithelial dysplasia (HMD is a rare autosomal dominant disorder characterized by mucoepithelial disruption of the skin, hair and mucous membranes. It results from defective gap junction formation and leads to non-scarring alopecia, mucosal erythema, perineal erythematous intertrigo, involvement of the conjunctival mucosa, and pulmonary disease. We present a case of severe respiratory distress in an initially healthy full term infant born to a mother with HMD. This infant later developed signs and symptoms of HMD. A high index of suspicion for pulmonary infection with atypical organism is essential in infants with a family history of HMD who present with respiratory distress.

  13. Occupational respiratory disease caused by acrylates.

    Savonius, B; Keskinen, H; Tuppurainen, M; Kanerva, L

    1993-05-01

    Acrylates are compounds used in a variety of industrial fields and their use is increasing. They have many features which make them superior to formerly used chemicals, regarding both their industrial use and their possible health effects. Contact sensitization is, however, one of their well known adverse health effects but they may also cause respiratory symptoms. We report on 18 cases of respiratory disease, mainly asthma, caused by different acrylates, 10 cases caused by cyanoacrylates, four by methacrylates and two cases by other acrylates. PMID:8334539

  14. Radiological features of lower respiratory infection by respiratory syncytial virus in infants and young children

    Respiratory syncytial virus is the most common cause of lower respiratory infection (bronchiolitis and pneumonia) of infancy and early childhood. We analyzed clinical and radiological features of 76 patients with lower respiratory infections by respiratory syncytial virus, which were diagnosed by indirect immunofluorescent test or culture of nasal aspirate in Hep-2-cell monolayer, during the period of January- December, 1991. There were peaks of incidences in March-May and November- December, accounting for 87% of eases. Sixty-two cases (82%) were under 1 year of age. Fifty cases (66%) had underlying diseases. Major radiographical findings were overaeration (83%), parahilar peribronchial infiltrates (67%), segmental or subsegmental atelectasis (32%), and segmental or lobar consolidation (16%). In 15 cases (20%), overaeration was the only radiological findings. There was no evidence of pleural effusion or lymph node enlargement in all cases. By considering clinical features (symptoms, age, underlying diseases, epidemic seasons) in addition to the radiological findings, radiologists would be familiar with lower respiratory infection by respiratory syncytial virus. Air space consolidation, which is generally thought to represent bacterial pneumonia, is also observed not infrequently in respiratory syncytial virus infection

  15. Respiratory viruses in children hospitalized for acute lower respiratory tract infection in Ghana

    Kwofie Theophilus B

    2012-04-01

    Full Text Available Abstract Background Acute respiratory tract infections are one of the major causes of morbidity and mortality among young children in developing countries. Information on the viral aetiology of acute respiratory infections in developing countries is very limited. The study was done to identify viruses associated with acute lower respiratory tract infection among children less than 5 years. Method Nasopharyngeal samples and blood cultures were collected from children less than 5 years who have been hospitalized for acute lower respiratory tract infection. Viruses and bacteria were identified using Reverse Transcriptase Real-Time Polymerase Chain Reaction and conventional biochemical techniques. Results Out of 128 patients recruited, 33(25.88%%, 95%CI: 18.5% to 34.2% were positive for one or more viruses. Respiratory Syncytial Virus (RSV was detected in 18(14.1%, 95%CI: 8.5% to 21.3% patients followed by Adenoviruses (AdV in 13(10.2%, 95%CI: 5.5% to 16.7%, Parainfluenza (PIV type: 1, 2, 3 in 4(3.1%, 95%CI: 0.9% to 7.8% and influenza B viruses in 1(0.8%, 95%CI: 0.0 to 4.3. Concomitant viral and bacterial co-infection occurred in two patients. There were no detectable significant differences in the clinical signs, symptoms and severity for the various pathogens isolated. A total of 61.1% (22/36 of positive viruses were detected during the rainy season and Respiratory Syncytial Virus was the most predominant. Conclusion The study has demonstrated an important burden of respiratory viruses as major causes of childhood acute respiratory infection in a tertiary health institution in Ghana. The data addresses a need for more studies on viral associated respiratory tract infection.

  16. Human metapneumovirus and respiratory syncytial virus in hospitalized danish children with acute respiratory tract infection

    von Linstow, Marie-Louise; Henrik Larsen, Hans; Koch, Anders; Eugen-Olsen, Jesper; Nordmann Winther, Thilde; Meyer, Anne-Marie; Westh, Henrik Torkil; Lundgren, Bettina; Melbye, Mads; Høgh, Birthe

    2004-01-01

    The newly discovered human metapneumovirus (hMPV) has been shown to be associated with respiratory illness. We determined the frequencies and clinical features of hMPV and respiratory syncytial virus (RSV) infections in 374 Danish children with 383 episodes of acute respiratory tract infection.......6%) ARTI episodes by real-time reverse transcription-polymerase chain reaction using primers targeting the hMPV N gene and the RSV L gene. Two children were co-infected with hMPV and RSV. They were excluded from statistical analysis. Hospitalization for ARTI caused by hMPV was restricted to very young...

  17. ECG testing as a function of the respiratory therapy department.

    Falck, S

    1983-01-01

    The merger of cardiopulmonary and respiratory therapy services is under way, and the trend toward consolidation is likely to continue. Future-minded respiratory therapists are banking on cardiopulmonary skills to contribute to career growth. PMID:10262997

  18. A Qualitative Analogy for Respiratory Mechanics

    Baptista, Vander

    2010-01-01

    The geometric configuration and mechanical properties of the integral elements of the respiratory system, as well as the modus operandi of the interacting parts in the ventilation process, comprise a hard-to-visualize system, making the mechanics of pulmonary ventilation a confusing topic for students and a difficult task for the teacher. To…

  19. Respiratory risks in broiler production workers

    M do CB de Alencar

    2004-03-01

    Full Text Available There are many situations that involve health risks to the Brazilian rural worker, and animal production is just one of them. Inhalation of organic dust, which has many microorganisms, leads in general to respiratory allergic reactions in some individuals, "asthma-like syndrome", and mucous membrane inflammation syndrome, that is a complex of nasal, eye, and throat complaints. Furthermore, workers might have farmer's hypersensitivity pneumonia, that is a respiratory health risk along the years. The objective of this study was to evaluate the potential pulmonary health risks in poultry production workers in the region of Curitiba, PR, Brazil. Interviews using a pre-elaborated questionnaire with 40 questions were made with 37 broiler production workers, which were submitted to a pulmonary function test. Results of restrictive function with lower FEV1 (the maximum respiratory potential, the forced expiratory volume in the first second of exhalation and FVC (forced vital capacity represented 24.32% of the total of workers, and severe obstruction represented 2.70%. Other symptoms were found in 67.57% of the workers as well. The results showed that those who work more than 4 years and within more than one poultry house, exceeding 5 hours per day of work, presented higher pulmonary health risks. It is concluded that the activities within broiler houses may induce allergic respiratory reaction in workers. The use of IPE (individual protection equipment besides special attention to the air quality inside the housing may be advised in a preventive way.

  20. Immunocompromised Children with Severe Adenoviral Respiratory Infection

    Joanna C. Tylka

    2016-01-01

    Full Text Available Purpose. To investigate the impact of severe respiratory adenoviral infection on morbidity and case fatality in immunocompromised children. Methods. Combined retrospective-prospective cohort study of patients admitted to the intensive care unit (ICU in four children’s hospitals with severe adenoviral respiratory infection and an immunocompromised state between August 2009 and October 2013. We performed a secondary case control analysis, matching our cohort 1 : 1 by age and severity of illness score with immunocompetent patients also with severe respiratory adenoviral infection. Results. Nineteen immunocompromised patients were included in our analysis. Eleven patients (58% did not survive to hospital discharge. Case fatality was associated with cause of immunocompromised state (p=0.015, multiple organ dysfunction syndrome (p=0.001, requirement of renal replacement therapy (p=0.01, ICU admission severity of illness score (p=0.011, and treatment with cidofovir (p=0.005. Immunocompromised patients were more likely than matched controls to have multiple organ dysfunction syndrome (p=0.01, require renal replacement therapy (p=0.02, and not survive to hospital discharge (p=0.004. One year after infection, 43% of immunocompromised survivors required chronic mechanical ventilator support. Conclusions. There is substantial case fatality as well as short- and long-term morbidity associated with severe adenoviral respiratory infection in immunocompromised children.

  1. Respiratory bacterial infections in cystic fibrosis

    Ciofu, Oana; Hansen, Christine R; Høiby, Niels

    2013-01-01

    PURPOSE OF REVIEW: Bacterial respiratory infections are the main cause of morbidity and mortality in patients with cystic fibrosis (CF). Pseudomonas aeruginosa remains the main pathogen in adults, but other Gram-negative bacteria such as Achromobacter xylosoxidans and Stenotrophomonas maltophilia...

  2. The European Community Respiratory Health Survey II

    Jarvis, D

    2002-01-01

    The European Community Respiratory Health Survey (ECRHS) II will determine the incidence of and risk factors for the development of allergic disease, atopy and rapid loss of lung function in middle-aged adults living in Europe. From 1991-1993, >18,000 individuals took part in ECRHS I and provided in

  3. Dihydroxyoctadecamonoenoate esters inhibit the neutrophil respiratory burst

    David Alan Thompson; Bruce D Hammock

    2007-03-01

    The leukotoxins [9(10)- and 12(13)-EpOME] are produced by activated inflammatory leukocytes such as neutrophils. High EpOME levels are observed in disorders such as acute respiratory distress syndrome and in patients with extensive burns. Although the physiological significance of the EpOMEs remains poorly understood, in some systems, the EpOMEs act as a protoxin, with their corresponding epoxide hydrolase metabolites, 9,10- and 12,13-DiHOME, specifically exerting toxicity. Both the EpOMEs and the DiHOMEs were also recently shown to have neutrophil chemotactic activity. We evaluated whether the neutrophil respiratory burst, a surge of oxidant production thought to play an important role in limiting certain bacterial and fungal infections, is modulated by members of the EpOME metabolic pathway. We present evidence that the DiHOMEs suppress the neutrophil respiratory burst by a mechanism distinct from that of respiratory burst inhibitors such as cyclosporin H or lipoxin A4, which inhibit multiple aspects of neutrophil activation.

  4. CYTOKINE PROFILING FOR CHEMICAL RESPIRATORY SENSITIZERS

    CYTOKINE PROFILING FOR CHEMICAL RESPIRATORY SENSITIZERS. LM Plitnick1, SE Loveless2, GS Ladics2, MP Holsapple3, MJ Selgrade4, DM Sailstad4 & RJ Smialowicz4. 1UNC, Chapel Hill, NC; 2DuPont Co., Haskell Laboratory, Newark, DE; 3Dow Chemical, Midland, MI & 4USEPA, NHEERL, RTP, NC.

  5. [Respiratory complications after oesophagectomy for cancer].

    D'journo, X-B; Michelet, P; Avaro, J-P; Trousse, D; Giudicelli, R; Fuentes, P; Doddoli, C; Thomas, P

    2008-06-01

    Surgery is the cornerstone of treatment for resectable tumours of the oesophagus. Recent advances of surgical techniques and anaesthesiology have led to a substantial decrease in mortality and morbidity. Respiratory complications affect about 30% of patients after oesophagectomy and 80% of these complications occur within the first five days. Respiratory complications include sputum retention, pneumonia and ARDS. They are the major cause of morbidity and mortality after oesophageal resection and numerous studies have identified the factors associated with these complications. The mechanisms are not very different from those observed after pulmonary resection. Nevertheless, there is an important lack of definition, and evaluation of the incidence is particularly difficult. Furthermore, respiratory complications are related to many factors. Careful medical history, physical examination and pulmonary function testing help to identify the risk factors and provide strategies to reduce the risk of pulmonary complications. Standardized postoperative management and a better understanding of the pathogenesis of pulmonary complications are necessary to reduce hospital mortality. This article discusses preoperative, intraoperative, and postoperative factors affecting respiratory complications and strategies to reduce the incidence of these complications after oesophagectomy. PMID:18772826

  6. Respiratory Monitoring for Anesthesia and Sedation

    Anderson, Jay A.

    1987-01-01

    This article reviews the theory and practice of routine respiratory monitoring during anesthesia and sedation. Oxygen monitoring and capnography methods are reviewed. The current ventilation monitoring system of choice is considered a combination of the pulse oximeter and capnography. Guidelines are provided for monitoring standards.

  7. Attentional Demands on Motor-Respiratory Coordination

    Hessler, Eric E.; Amazeen, Polemnia G.

    2009-01-01

    Athletic performance requires the pacing of breathing with exercise, known as motor-respiratory coordination (MRC). In this study, we added cognitive and physical constraints while participants intentionally controlled their breathing locations during rhythmic arm movement. This is the first study to examine a cognitive constraint on MRC.…

  8. Recent advances in paediatric respiratory medicine.

    Turnbull, Andrew; Balfour-Lynn, Ian M

    2016-02-01

    This review highlights important advances in paediatric respiratory medicine since 2014, excluding cystic fibrosis. It focuses mainly on the more common conditions, bronchopulmonary dysplasia, bronchiolitis and preschool wheezing, asthma, pneumonia and sleep, and highlights some of the rarer conditions such as primary ciliary dyskinesia and interstitial lung disease (ILD). PMID:26289061

  9. Preoperative respiratory physical therapy in cardiac surgery

    Hulzebos, H.J.

    2006-01-01

    Cardiac surgery is one of the most common surgical procedures and accounts for more resources expended in cardiovascular medicine than any other single procedure. Because cardiac surgery involves sternal incision and cardiopulmonary bypass, patients usually have a restricted respiratory function in

  10. Liver transplantation in mitochondrial respiratory chain disorders

    Sokal, EM; Sokol, R; Cormier, [No Value; Lacaille, F; McKiernan, P; Van Spronsen, FJ; Bernard, O; Saudubray, JM

    1999-01-01

    Mitochondrial respiratory chain disease may lead to neonatal or late onset liver failure, requiring liver transplantation. In rare cases, the disease is restricted to the liver and the patient is cured after surgery. More frequently, other organs are simultaneously involved and neuromuscular or othe

  11. Mechanisms of infection in the respiratory tract.

    Baskerville, A

    1981-12-01

    Related to its potential vulnerability the respiratory tract has a very complex and effective defence apparatus. The interaction between these defence mechanisms and certain characteristics of aetiological agents results in a pattern in which initial infections by these agents tend to occur at specific sites in the tract. Infections in which the primary portal of entry is in the upper respiratory tract include Bordetella bronchiseptica and Haemophilus spp in pigs; Pasteurella spp in cattle, sheep, pigs; Mycoplasma spp in cattle, sheep, pigs and poultry; equine herpesvirus 1 in horses; infectious bovine rhinotracheitis in cattle; parainfluenza 3 in cattle and sheep; infectious laryngo-tracheitis and infectious bronchitis in poultry; feline viral rhinotracheitis and calicivirus in cats; Aujeszky's disease virus and swine influenza in pigs; and equine influenza in horses. Infections in which the primary portal of entry is in the lower respiratory tract include Aspergillus fumigatus in poultry and mammals, respiratory syncytial virus in cattle, distemper virus in dogs and adenovirus in cattle and dogs. A fuller understanding of the interactions between an agent and the host at the point of entry would make it much easier to develop effective vaccines and therapeutic agents. PMID:16030806

  12. K+ channels and the microglial respiratory burst.

    Khanna, R; Roy, L; Zhu, X; Schlichter, L C

    2001-04-01

    Microglial activation following central nervous system damage or disease often culminates in a respiratory burst that is necessary for antimicrobial function, but, paradoxically, can damage bystander cells. We show that several K+ channels are expressed and play a role in the respiratory burst of cultured rat microglia. Three pharmacologically separable K+ currents had properties of Kv1.3 and the Ca2+/calmodulin-gated channels, SK2, SK3, and SK4. mRNA was detected for Kv1.3, Kv1.5, SK2, and/or SK3, and SK4. Protein was detected for Kv1.3, Kv1.5, and SK3 (selective SK2 and SK4 antibodies not available). No Kv1.5-like current was detected, and confocal immunofluorescence showed the protein to be subcellular, in contrast to the robust membrane localization of Kv1.3. To determine whether any of these channels play a role in microglial activation, a respiratory burst was stimulated with phorbol 12-myristate 13-acetate and measured using a single cell, fluorescence-based dihydrorhodamine 123 assay. The respiratory burst was markedly inhibited by blockers of SK2 (apamin) and SK4 channels (clotrimazole and charybdotoxin), and to a lesser extent, by the potent Kv1.3 blocker agitoxin-2. PMID:11245596

  13. Neonatal respiratory depression associated with epidural analgesia

    Alberto Gálvez Toro

    2013-06-01

    Full Text Available Background: Epidural analgesia is the most effective analgesics used during childbirth but is not without its problems.In the Hospital San Juan de la Cruz of Ubeda from November 2011 we have detected 3 cases of newborn infants with signs of respiratory depression. Appeared in them: normal cardiotocographic records during childbirth, use of epidural associated with fentanyl, termination by vacuum and elevated temperature in one case.ObjectivesKnow if the neonatal adaptation to extrauterine life may be influenced by the use of epidural analgesia in childbirth. Review what role can have the rise in maternal temperature and the use of epidural fentanyl with the appearance of newborn respiratory distress.MethodsLiterature Review conducted in February of 2012 in Pubmed and the Cochrane Library, using the key words: childbirth, epidural analgesia, neonatal respiratory depression.ResultsOn the respiratory depression associated with fentanyl, a Cochrane review found indicating that newborns of mothers with an epidural, had a lower pH and were less need for administration of naloxone.On PubMed we find a review study that indicates that the respiratory depression caused by the administration of opioids via neuroaxial is rare, placing it below 1 per 1000, and a clinical case that concluded that doses of fentanyl exceeding 300 µg (approx. 5 µg/kg for 4 hours previous to childbirth, have a high risk of neonatal respiratory depression at birth.The same Cochrane review indicates that the women with epidural analgesia had increased risk of maternal fever of at least 38 ° C and a recent cohort study relates this increase in temperature with a greater likelihood of neonatal adverse events (from 37.5 ° C.ConclusionsThe studies found considered safe epidurals to the neonate and the mother, except when certain conditions are met. The literature and our clinical experience have been reports linking neonatal respiratory depression with increasing temperature (37

  14. Respiratory Gating for Radiotherapy: Main Technical Aspects and Clinical Benefits

    Giraud, Philippe; Houle, Annie

    2013-01-01

    Respiratory-gated radiotherapy offers a significant potential for improvement in the irradiation of tumor sites affected by respiratory motion such as lung, breast, and liver tumors. An increased conformality of irradiation fields leading to decreased complication rates of organs at risk is expected. Five main strategies are used to reduce respiratory motion effects: integration of respiratory movements into treatment planning, forced shallow breathing with abdominal compression, breath-hold ...

  15. Introducing a new HERMES project on respiratory infections

    Alexandra Niculescu; Julie-Lyn Noel; Stefano Aliberti; Gernot Rohde

    2016-01-01

    In 2014, the European Respiratory Society (ERS) took the lead in harmonising training programmes in a field of emerging interest across Europe, respiratory infections. In order to establish defined standards of knowledge and skills in this new field, the ERS has launched the educational task force “Respiratory Infections” under the HERMES (Harmonised Education in Respiratory Medicine for European Specialists) initiative (hermes.ersnet.org). Most countries do not have their own system for trai...

  16. Defence System of Respiratory Tract and Clearence of Inhalation Agents

    Nesrin Ocal

    2016-01-01

    It is well known that inhaled urban air contains many particles and gases. On the other hand, the anesthetic agents used in respiratory diseases comprise pharmaceutical particles. Deposition and cleaning processes of both the inhaled foreign particles and gases from room air, and inhalation agents from respiratory tract are very important clinically. These processes are carried out by the defense mechanisms of the respiratory system. In this review, the defence system of respiratory tract and...

  17. Non-Contact Respiratory Rate Measurement Validation for Hospitalized Patients

    Droitcour, Amy D.; Seto, Todd B; Park, Byung-Kwon; Yamada, Shuhei; Vergara, Alex; El Hourani, Charles; Shing, Tommy; Yuen, Andrea; Lubecke, Victor M.; Boric-Lubecke, Olga

    2009-01-01

    This paper presents the first clinical results for validating the accuracy of respiratory rate obtained for hospitalized patients using a non-contact, low power 2.4 GHz Doppler radar system. Twenty-four patients were measured in this study. The respiratory rate accuracy was benchmarked against the respiratory rate obtained using Welch Allyn Propaq Encore model 242, the Embla Embletta system with Universal XactTrace respiratory effort sensor and Somnologica for Embletta software, and by counti...

  18. Detection, pathogenesis, and therapy of respiratory syncytial virus infections.

    Welliver, R C

    1988-01-01

    Respiratory syncytial virus (RSV) infection is a major cause of serious lower respiratory disease in infancy and early childhood. The unique pathogenesis of lower respiratory illness due to RSV offers some intriguing clues to the role of the human immune system in both protection against and development of respiratory illness. More than any other virus, rapid diagnostic techniques have been especially successful in identifying RSV infection. Many of these techniques could be easily adaptable ...

  19. Cardio-Respiratory Coordination Increases during Sleep Apnea

    Riedl, M.; Müller, A.; Kraemer, J. F.; Penzel, T; Kurths, J.; Wessel, N.

    2014-01-01

    Cardiovascular diseases are the main source of morbidity and mortality in the United States with costs of more than $170 billion. Repetitive respiratory disorders during sleep are assumed to be a major cause of these diseases. Therefore, the understanding of the cardio-respiratory regulation during these events is of high public interest. One of the governing mechanisms is the mutual influence of the cardiac and respiratory oscillations on their respective onsets, the cardio-respiratory coord...

  20. Decreased respiratory symptoms in cannabis users who vaporize

    Barnwell Sara; Earleywine Mitch

    2007-01-01

    Abstract Cannabis smoking can create respiratory problems. Vaporizers heat cannabis to release active cannabinoids, but remain cool enough to avoid the smoke and toxins associated with combustion. Vaporized cannabis should create fewer respiratory symptoms than smoked cannabis. We examined self-reported respiratory symptoms in participants who ranged in cigarette and cannabis use. Data from a large Internet sample revealed that the use of a vaporizer predicted fewer respiratory symptoms even ...

  1. Pulmonary Function Tests and Work-Related Respiratory and Allergic

    Boskabady Mohammad Hosein; Taheri Ehsan; Ahmadi Sina; Ebrahimi Kolsoumeh; Soudaneh Malihe; Mohammadi Fatemeh; Sabourhasanzadeh Alireza

    2009-01-01

    Bakers are frequently exposed to various irritant chemicals during work which can induce respiratory problems. In this study, pulmonary function tests and self-reported respiratory and allergic symptoms in bakers were compared with matched control subjects. The frequency of respiratory and allergic symptoms was evaluated in a sample of 58 Iranian bakers and 58 control subjects using a questionnaire. Pulmonary function tests (PFT) were also measured in all participants. All respiratory symptom...

  2. Conference summary: computers in respiratory care.

    Nelson, Steven B

    2004-05-01

    Computers and data management in respiratory care reflect the larger practices of hospital information systems: the diversity of conference topics provides evidence. Respiratory care computing has shown a steady, slow progression from writing programs that calculate shunt equations to departmental management systems. Wider acceptance and utilization have been stifled by costs, both initial and on-going. Several authors pointed out the savings that were realized from information systems exceeded the costs of implementation and maintenance. The most significant finding from one of the presentations was that no other structure or skilled personnel could provide respiratory care more efficiently or cost-effectively than respiratory therapists. Online information resources have increased, in forms ranging from peer-reviewed journals to corporate-sponsored advertising posing as authoritative treatment regimens. Practitioners and patients need to know how to use these resources as well as how to judge the value of information they present. Departments are using computers for training on a schedule that is more convenient for the staff, providing information in a timely manner and potentially in more useful formats. Portable devices, such as personal digital assistants (PDAs) have improved the ability not only to share data to dispersed locations, but also to collect data at the point of care, thus greatly improving data capture. Ventilators are changing from simple automated bellows to complex systems collecting numerous respiratory parameters and offering feedback to improve ventilation. Clinical databases routinely collect information from a wide variety of resources and can be used for analysis to improve patient outcomes. What could possibly go wrong? PMID:15107142

  3. Patient training in respiratory-gated radiotherapy

    Respiratory gating is used to counter the effects of organ motion during radiotherapy for chest tumors. The effects of variations in patient breathing patterns during a single treatment and from day to day are unknown. We evaluated the feasibility of using patient training tools and their effect on the breathing cycle regularity and reproducibility during respiratory-gated radiotherapy. To monitor respiratory patterns, we used a component of a commercially available respiratory-gated radiotherapy system (Real Time Position Management (RPM) System, Varian Oncology Systems, Palo Alto, CA 94304). This passive marker video tracking system consists of reflective markers placed on the patient's chest or abdomen, which are detected by a wall-mounted video camera. Software installed on a PC interfaced to this camera detects the marker motion digitally and records it. The marker position as a function of time serves as the motion signal that may be used to trigger imaging or treatment. The training tools used were audio prompting and visual feedback, with free breathing as a control. The audio prompting method used instructions to 'breathe in' or 'breathe out' at periodic intervals deduced from patients' own breathing patterns. In the visual feedback method, patients were shown a real-time trace of their abdominal wall motion due to breathing. Using this, they were asked to maintain a constant amplitude of motion. Motion traces of the abdominal wall were recorded for each patient for various maneuvers. Free breathing showed a variable amplitude and frequency. Audio prompting resulted in a reproducible frequency; however, the variability and the magnitude of amplitude increased. Visual feedback gave a better control over the amplitude but showed minor variations in frequency. We concluded that training improves the reproducibility of amplitude and frequency of patient breathing cycles. This may increase the accuracy of respiratory-gated radiation therapy

  4. Respiratory syncytial virus epidemiology in Turkey.

    Kanra, Güler; Tezcan, Sabahat; Yilmaz, Gülden

    2005-01-01

    Respiratory syncytial virus (RSV) is the leading cause of lower respiratory tract infections in infants and young children worldwide. This study was conducted to determine the prevalence of RSV among high-risk children admitted with respiratory symptoms in a developing country. This is a multicenter study conducted among children less than 24 months of age and admitted to the hospital with respiratory symptoms. The inclusion criteria included: lower respiratory tract symptoms on admission, gestational age less than 35 weeks, and admission age less than six months, or children less than 24 months of age with a diagnosis of bronchopulmonary dysplasia requiring medical treatment or intervention during the last six months or with an uncorrected congenital heart disease (other than patent ductus arteriosus). Nasopharyngeal samples were obtained with one of the three standard methods: nasopharyngeal aspirate, nasopharyngeal wash or nasopharyngeal swab. RSV antigen was determined by enzyme immunoassay using Abbott TESTPACK RSV (No. 8100/2027-16). Statistical analysis was performed using Student's t-test and chi-square test. In this study, 332 children (135 females, 40.7%; 197 males, 59.3%) were included, and the nasopharyngeal specimens of 98 (29.5%) children were determined to be RSV-positive. There were no differences in sex, age of gestation, age of admission, family education, number of siblings and smoking at home for RSV-positive and -negative cases. Furthermore, underlying disease and duration of hospital and intensive care unit stay were similar among groups. Only otitis media was more common among RSV-positive cases. No fatality at hospital was recorded. Frozen samples revealed more negative results. Most cases presented during winter and the number of RSV-positive cases was higher in cold and economically poor areas. Premature children and children with underlying medical condition acquire RSV irrespective of other sociodemographic risk factors, and most of them

  5. Changes in respiratory mechanics during respiratory physiotherapy in mechanically ventilated patients

    Moreira, Fernanda Callefe; Teixeira, Cassiano; Savi, Augusto; Xavier, Rogério

    2015-01-01

    Objective To evaluate the changes in ventilatory mechanics and hemodynamics that occur in patients dependent on mechanical ventilation who are subjected to a standard respiratory therapy protocol. Methods This experimental and prospective study was performed in two intensive care units, in which patients dependent on mechanical ventilation for more than 48 hours were consecutively enrolled and subjected to an established respiratory physiotherapy protocol. Ventilatory variables (dynamic lung ...

  6. 28 CFR 79.46 - Proof of nonmalignant respiratory disease.

    2010-07-01

    ... 28 Judicial Administration 2 2010-07-01 2010-07-01 false Proof of nonmalignant respiratory disease... nonmalignant respiratory disease. (a) In determining whether a claimant developed a nonmalignant respiratory disease following pertinent employment as a miner, the Assistant Director shall resolve all...

  7. 28 CFR 79.55 - Proof of nonmalignant respiratory disease.

    2010-07-01

    ... 28 Judicial Administration 2 2010-07-01 2010-07-01 false Proof of nonmalignant respiratory disease... nonmalignant respiratory disease. (a) In determining whether a claimant developed a nonmalignant respiratory disease following pertinent employment as a miller, the Assistant Director shall resolve all...

  8. 28 CFR 79.65 - Proof of nonmalignant respiratory disease.

    2010-07-01

    ... 28 Judicial Administration 2 2010-07-01 2010-07-01 false Proof of nonmalignant respiratory disease... nonmalignant respiratory disease. (a) In determining whether a claimant developed a nonmalignant respiratory disease following pertinent employment as an ore transporter, the Assistant Director shall resolve...

  9. 30 CFR 70.300 - Respiratory equipment; respirable dust.

    2010-07-01

    ... Respiratory equipment; respirable dust. Respiratory equipment approved by NIOSH under 42 CFR part 84 shall be made available to all persons whenever exposed to concentrations of respirable dust in excess of the... 30 Mineral Resources 1 2010-07-01 2010-07-01 false Respiratory equipment; respirable dust....

  10. Ocena bolnikovega stanja v respiratorni fizioterapiji: Assessment in respiratory physiotherapy:

    Bukovec, Adrijana; Grošelj, Irena

    2013-01-01

    An assessment protocol encompassing all areas that influence breathing is necessary for physiotherapeutic assessment of the respiratory system. It is important to assess respiratory mechanics, respiratory muscle strength andendurance, quality of cough, rate of dyspnea, coordination of speech and breathing and breathing during activity, and to perform spirometry.

  11. Viral and Bacterial Interactions in the Upper Respiratory Tract

    Bosch, Astrid A. T. M.; Biesbroek, Giske; Trzcinski, Krzysztof; Sanders, Elisabeth A. M.; Bogaert, Debby

    2013-01-01

    Respiratory infectious diseases are mainly caused by viruses or bacteria that often interact with one another. Although their presence is a prerequisite for subsequent infections, viruses and bacteria may be present in the nasopharynx without causing any respiratory symptoms. The upper respiratory t

  12. Anatomy and physiology of respiratory system relevant to anaesthesia

    Apeksh Patwa; Amit Shah

    2015-01-01

    Clinical application of anatomical and physiological knowledge of respiratory system improves patient's safety during anaesthesia. It also optimises patient's ventilatory condition and airway patency. Such knowledge has influence on airway management, lung isolation during anaesthesia, management of cases with respiratory disorders, respiratory endoluminal procedures and optimising ventilator strategies in the perioperative period. Understanding of ventilation, perfusion and their relation wi...

  13. Genioglossal inspiratory activation: central respiratory vs mechanoreceptive influences

    Pillar, Giora; Fogel, Robert B.; Malhotra, Atul; Beauregard, Josée; Edwards, Jill K.; Shea, Steven A.; White, David P.

    2001-01-01

    Upper airway dilator muscles are phasically activated during respiration. We assessed the interaction between central respiratory drive and local (mechanoreceptive) influences upon genioglossal (GG) activity throughout inspiration. GGEMG and airway mechanics were measured in 16 awake subjects during baseline spontaneous breathing, increased central respiratory drive (inspiratory resistive loading; IRL), and decreased respiratory drive (hypocapnic negative pressure ventilation), both prior to ...

  14. Respiratory Belt Transducer Constructed Using a Singing Greeting Card Beeper

    Bhaskar, Anand; Subramani, Selvam; Ojha, Rajdeep

    2013-01-01

    An article by Belusic and Zupancic described the construction of a finger pulse sensor using a singing greeting card beeper. These authors felt that this beeper made of piezoelectric material could be easily modified to function as a respiratory belt transducer to monitor respiratory movements. Commercially available respiratory belt transducers,…

  15. Respiratory Failure in Acute Organophosphorus Pesticide Self-Poisoning

    Eddleston, Michael; Mohamed, Fahim; Davies, James OJ; Eyer, Peter; Worek, Franz; Sheriff, Mh Rezvi; Buckley, Nick A.

    2006-01-01

    Background: Acute organophosphorus (OP) pesticide poisoning is a major clinical problem in the developing world. Textbooks ascribe most deaths to respiratory failure occurring in one of two distinct clinical syndromes - acute cholinergic respiratory failure or the intermediate syndrome. The delayed failure appears to be due to respiratory muscle weakness, but its pathophysiology is not yet clear.

  16. Follow your breath: Respiratory interoceptive accuracy in experienced meditators

    Daubenmier, J; Sze, J.; Kerr, CE; Kemeny, ME; Mehling, W

    2013-01-01

    Attention to internal bodily sensations is a core feature of mindfulness meditation. Previous studies have not detected differences in interoceptive accuracy between meditators and nonmeditators on heartbeat detection and perception tasks. We compared differences in respiratory interoceptive accuracy between meditators and nonmeditators in the ability to detect and discriminate respiratory resistive loads and sustain accurate perception of respiratory tidal volume during nondistracted and dis...

  17. RESPIRATORY SYNCYTIAL VIRUS INFECTION AMONG YOUNG CHILDREN WITH ACUTE RESPIRATORY INFECTION

    M. Milani

    2003-08-01

    Full Text Available Respiratory syncytial virus (RSV is the major cause of lower respiratory tract infections in infants,and also an important factor for hospitalization during the winter months. To determine the prevalence and importance of RSV as a cause of acute lower respiratory tract infection, we carried out a prospective study during 5 months period from November to March 1998 in 6 pediatric hospitals. A nasopharyngeal aspirate was obtained for detection of RSV in all cases. Sociodemographic data, clinical signs, diagnosis and hospital admissions were documented. During this study period, 365 young infants (51.5% male, 48.5% female with respiratory tract infection were visited in 6 hospitals. The median age of patients was 24 months (range: 1 month to 5 years.RSV infection was found in 70 out of 365 patients (19.18%.Among the 70 children with RSV infection, 29 patients (41.42% were under 12 months of age.The main clinical manifestations of RSV infection were cough (88.57% and coryza (78.57%. There were no significant differences between patients who were tested positive for RSV and those who were tested negative with regard to demographic variables and clinical diagnoses. This study indicates that RSV is an important cause of respiratory tract infection in infants and young children .Distinguishing RSV from other respiratory infection is difficult because of the similarity in clinical presentation among children.

  18. SUSCEPTIBILIDADE DE BOVINOS DAS RAÇAS JERSEY E GIR À ACIDOSE LÁCTICA RUMINAL: II - ACIDOSE METABÓLICAE METABOLIZAÇÃO DO LACTATO-L SUSCEPTIBILITY OF JERSEY AND GIR STEERS TO RUMEN LACTIC ACIDOSIS: II - METABOLIC ACIDOSIS AND L-LACTATE METABOLISM

    Celso Akio Maruta

    2002-02-01

    Full Text Available Quatro garrotes Jersey (J (Bos taurus e quatro Gir (G (Bos indicus foram utilizados para comparar a susceptibilidade de zebuínos e taurinos à acidose láctica ruminal (ALR. Neste trabalho, acompanhou-se o grau da acidose metabólica (AM e a metabolização do lactato-L. A ALR foi induzida com a administração de sacarose intraruminal. Amostras de sangue foram colhidas nos seguintes momentos: zero, 14, 16, 18, 20, 22 e 24 horas. Foram determinadas as concentrações de lactato total, de seus isômeros L e D e o perfil hemogasométrico. Nos momentos mais críticos observados (14ªh a 18ªh, a AM foi severa em ambas as raças, porém, ao término do experimento, esta passou a grau moderado nos garrotes G, mantendo-se severa nos J. Os animais J absorveram, do rúmen, maiores quantidades de lactato-D, o qual apresentou correlação negativa com o pH sangüíneo (r = - 0,78. Por outro lado, o lactato-L foi mais absorvido e utilizado nos bovinos G, contribuindo para a restauração parcial do equilíbrio ácido-básico e gerando alterações nas pCO2 e pO2. Os garrotes zebuínos da raça Gir apresentaram menor susceptibilidade à AM que os taurinos da raça Jersey.In order to compare the susceptibility to acute rumen lactic acidosis (RLA, four Jersey (J (Bos taurus and four Gir (G (Bos indicus steers were used to evaluate the degree of metabolic acidosis (MA and the metabolism of L-lactate during the RLA. The RLA was induced by the administration of sucrose into the rumen. Blood samples were collected at following times: zero, 14th,16th, 18th, 20th, 22nd and 24th h. Total lactic acid and its isomers, and blood gas determination were measured. At the most critical moments (14th to 18th h the MA was severe in both breeds, but the MA became moderate in the G steers and remained severe in the J steers at the end of the trial. Higher amounts of D-lactate was absorbed from the rumen to the blood of the J steers; the higher the D-lactate plasma level, the

  19. 10例HIV/AIDS患者HAART后继发高乳酸血症或乳酸酸中毒临床分析%Clinical analysis of hyperlactacidemia/lactic acidosis after receiving HAART in 10 HIV/AIDS patients

    黄维; 黄葵; 蓝珂; 邬剑威; 刘宁; 蒙江明

    2012-01-01

    目的 探讨HIV/AIDS患者高效抗反转录病毒治疗(highly active antiretroviral therapy,HAART)后继发高乳酸血症或乳酸酸中毒的临床表现和治疗方案.方法 回顾性分析10例HIV/AIDS患者HAART后继发高乳酸血症或乳酸酸中毒的临床表现、实验室检测结果和治疗效果等资料.结果 10例在继发高乳酸血症或乳酸酸中毒前均服用过含有核苷类反转录酶抑制剂(nucleoside reverse transcriptase inhibitors,NRTIs)组合的HAART方案,临床症状以乏力、恶心、腹胀、肌肉酸痛和呼吸困难多见,血乳酸浓度为5.14~10.74mmol/L,其中8例出现高乳酸血症或乳酸酸中毒的相关症状,2例未出现.6例经换药或停药处理后好转,4例死亡.结论 引起高乳酸血症或乳酸酸中毒的主要原因是使用含有NRTIs的组合方案,其中司他夫定最为常见,其次为齐多夫定.治疗时应立刻换药或停药.%Objective To investigate the clinical manifestations and treatment of HIV/AIDS patients who are affected with hy-perlactacidemia/lactic acidosis after receiving highly active antiretroviral therapy (HAART). Methods The clinical manifestations, laboratory findings and treatment efficacy were retrospectively analyzed in 10 HIV/AIDS patients who were affected with hyperlacta-cidemia/lactic acidosis after receiving HAART. Results All the 10 HIV/AIDS patients had received HAART regimens including nu-cleoside reverse transcriptase inhibitors (NRTIs) before being affected with hyperlactacidemia/lactic acidosis. The common clinical symptoms were fatigue, nausea, abdominal distension, muscle aches and difficulty of breathing. The blood lactic acid level of the 10 patients was 5.14-10.74 mmol/L, symptoms related to hyperlactacidemia/lactic acidosis occurring in 8 patients. Six patients were improved on cessation or switching to another medication, and 4 died. Conclusions The major cause that leads to hyperlactacidemia/ lactic acidosis is receiving HAART including

  20. Comprehensive non-clinical respiratory evaluation of promising new drugs

    The need to evaluate the potential for new drugs to produce adverse effects on respiratory function in non-clinical safety assessment is based on the known effects of drugs from a variety of pharmacological/therapeutic classes on the respiratory system, the life-threatening consequences of respiratory dysfunction, and compliance with world-wide regulatory safety guidelines. The objective of this article is to provide a brief overview of the functional disorders of the respiratory system and to present the strategy and techniques considered to be most appropriate for detecting and characterizing drug-induced respiratory disorders in non-clinical safety studies

  1. Raised respiratory rate in elderly patients: a valuable physical sign.

    McFadden, J P; Price, R.C.; Eastwood, H D; Briggs, R S

    1982-01-01

    Measurements of respiratory rate in 82 long-stay patients aged 67-101 years yielded a normal range of 16-25 breaths a minute. In a prospective study of 60 consecutive acute admissions to a geriatric unit, 19 out of 21 patients diagnosed as lower respiratory tract infections had respiratory rates above the upper limit of normal on the day of diagnosis; the rise in respiratory rate preceded the clinical diagnosis. All eight patients who were diagnosed on admission as having a lower respiratory ...

  2. PRIMARY SJOGREN’S SYNDROME AND DISTAL RENAL TUBULAR ACIDOSIS: PRESENTING WITH NEPHROGENIC DIABETES INSI PIDUS SECONDARY TO SEVERE HYPOKALEMIA-A CASE REPORT

    Ksh. Achouba; Banashree Devi; Kh. Lokeshwar; Ram

    2013-01-01

    NTRODUCTION: Sjogren’s syndrome is a slowly progressing autoimmun e disease characterized by lymphocytic infiltration of the exo crine glands, mainly the lacrimal and salivary glands, resulting in their impaired secreto ry function. Simultaneously, systemic involvement and symptoms of cutaneous, respiratory, r enal, hepatic, neurologic, and vascular systems often occur.[ 1 ] This syndrome can present either alone (as primary Sjogren’s syndrome) or in the...

  3. Scientific Respiratory Symposium, Paris June 2010

    Dalglish G

    2011-06-01

    Full Text Available Gavin Dalglish, Graham PriestleyHorizon Medical Publishing, Chichester, UKAbstract: At a 2010 Respiratory Symposium in Paris, chaired by Professors Bousquet and Roche of the University of Paris, recent trends in research, therapy and treatment guidelines for asthma and chronic obstructive pulmonary disease (COPD were reviewed and discussed by a faculty of expert European and US respiratory physicians. This article reviews five key clinical presentations with particular emphasis given to the importance of small airways in the pathology and treatment of asthma and COPD. Further analysis of the economics of treatment in Europe and the US shows a wide variance in direct and indirect costs.Keywords: COPD, asthma, small airways, real-life clinical practice

  4. The Microbiome and the Respiratory Tract.

    Dickson, Robert P; Erb-Downward, John R; Martinez, Fernando J; Huffnagle, Gary B

    2016-01-01

    Although the notion that "the normal lung is free from bacteria" remains common in textbooks, it is virtually always stated without citation or argument. The lungs are constantly exposed to diverse communities of microbes from the oropharynx and other sources, and over the past decade, novel culture-independent techniques of microbial identification have revealed that the lungs, previously considered sterile in health, harbor diverse communities of microbes. In this review, we describe the topography and population dynamics of the respiratory tract, both in health and as altered by acute and chronic lung disease. We provide a survey of current techniques of sampling, sequencing, and analysis of respiratory microbiota and review technical challenges and controversies in the field. We review and synthesize what is known about lung microbiota in various diseases and identify key lessons learned across disease states. PMID:26527186

  5. Fabry disease, respiratory symptoms, and airway limitation

    Svensson, Camilla Kara; Feldt-Rasmussen, Ulla; Backer, Vibeke

    2015-01-01

    BACKGROUND: Fabry disease is an X-linked disorder caused by a deficiency of the lysosomal enzyme α-galactosidase A, resulting in accumulation of glycosphingolipids in multiple organs, primarily heart, kidneys, skin, CNS, and lungs. MATERIALS AND METHOD: A systematic literature search was performed...... remaining 27 articles were relevant for this review. RESULTS: The current literature concerning lung manifestations describes various respiratory symptoms such as dyspnoea or shortness of breath, wheezing, and dry cough. These symptoms are often related to cardiac involvement in Fabry disease as respiratory...... examinations are seldom performed. Pulmonary function tests primarily show obstructive airway limitation, but a few articles also report of patients with restrictive limitation and a mixture of both. No significant association has been found between smoking and the development of symptoms or spirometry...

  6. Porcine Reproductive and Respiratory Syndrome Virus (PRRSV)

    Kvisgaard, Lise Kirstine

    This PhD thesis presents the diversity of Porcine Reproductive and Respiratory Syndrome viruses (PRRSV) circulating in the Danish pig population. PRRS is a disease in pigs caused by the PRRS virus resulting in reproductive failures in sows and gilts and respiratory diseases in pigs . Due to genetic...... heterogeneity, PRRSV is divided into two genotypes, Type 1 and Type 2. Type 1 PRRS viruses are further divided into at least 3 subtypes. The virus evolves rapidly and reports of high pathogenic variants of both Type 1 and Type 2 appearing in Europe, North America, and Asia have been reported within recent years...... viruses showed both a higher diversity to the other Danish viruses and to the vaccine strain and one virus harbored the largest deletion in NSP2 reported in Danish Type 2 PRRSV. Manuscript IV is focusing on an experimental infection study in pigs with a Type 2 PRRS virus causing significant clinical...

  7. Impact of bone marrow on respiratory disease.

    Rankin, Sara M

    2008-06-01

    The bone marrow is not only a site of haematopoiesis but also serves as an important reservoir for mature granulocytes and stem cells, including haematopoietic stem cells, mesenchymal stem cells and fibrocytes. In respiratory diseases, such as asthma and idiopathic pulmonary fibrosis these cells are mobilised from the bone marrow in response to blood-borne mediators and subsequently recruited to the lungs. Although the granulocytes contribute to the inflammatory reaction, stem cells may promote tissue repair or remodelling. Understanding the factors and molecular mechanisms that regulate the mobilisation of granulocytes and stem cells from the bone marrow may lead to the identification of novel therapeutic targets for the treatment of a wide range of respiratory disorders. PMID:18372214

  8. Didactic tools for understanding respiratory physiology

    The challenges in Bioengineering are not only the application of engineering knowledge to the measurement of physiological variables, but also the simulation of biological systems. Experience has shown that the physiology of the respiratory system involves a set of concepts that cannot be effectively taught without the help of a group of didactic tools that contribute to the measurement of characteristic specific variables and to the simulation of the system itself. This article describes a series of tools designed to optimize the teaching of the respiratory system, including the use of spirometers and software developed entirely by undergraduate Bioengineering students from Universidad Nacional de Entre Rios (UNER). The impact these resources have caused on the understanding of the topic and how each of them has facilitated the interpretation of the concepts by the students is also discussed

  9. Respiratory and sleep disorders in mucopolysaccharidosis

    Berger, Kenneth I.; Fagondes, Simone C.; Giugliani, Roberto; Hardy, Karen A.; Lee, Kuo Sheng; McArdle, Ciarán; Scarpa, Maurizio; Tobin, Martin J.; Ward, Susan A.; Rapoport, David M

    2012-01-01

    MPS encompasses a group of rare lysosomal storage disorders that are associated with the accumulation of glycosaminoglycans (GAG) in organs and tissues. This accumulation can lead to the progressive development of a variety of clinical manifestations. Ear, nose, throat (ENT) and respiratory problems are very common in patients with MPS and are often among the first symptoms to appear. Typical features of MPS include upper and lower airway obstruction and restrictive pulmonary disease, which c...

  10. Acute Respiratory Distress Due to Methane Inhalation

    Jo, Jun Yeon; Kwon, Yong Sik; Lee, Jin Wook; Park, Jae Seok; Rho, Byung Hak; Choi, Won-Il

    2013-01-01

    Inhalation of toxic gases can lead to pneumonitis. It has been known that methane gas intoxication causes loss of consciousness or asphyxia. There is, however, a paucity of information about acute pulmonary toxicity from methane gas inhalation. A 21-year-old man was presented with respiratory distress after an accidental exposure to methane gas for one minute. He came in with a drowsy mentality and hypoxemia. Mechanical ventilation was applied immediately. The patient's symptoms and chest rad...

  11. Acute respiratory failure following ovarian hyperstimulation syndrome

    Antonello Nicolini

    2013-03-01

    Full Text Available Ovarian hyperstimulation syndrome is a serious and potentially life-threatening physiological complication that may be encountered in patients who undergo controlled ovarian hyperstimulation cycles. The syndrome is typically associated with regimes of exogenous gonadotropins, but it can be seen, albeit rarely, when clomiphene is administered during the induction phase. Although this syndrome is widely described in scientific literature and is well known by obstetricians, the knowledge of this pathological and potentially life-threatening condition is generally less than satisfactory among physicians. The dramatic increase in therapeutic strategies to treat infertility has pushed this condition into the realm of acute care therapy. The potential complications of this syndrome, including pulmonary involvement, should be considered and identified so as to allow a more appropriate diagnosis and management. We describe a case of a woman with an extremely severe (Stage 6 ovarian hyperstimulation syndrome who presented ascites, bilateral pleural effusion and severe respiratory failure treated with non-invasive ventilation. The patient was admitted to the intensive care unit because of severe respiratory failure, ascites, and bilateral pleural effusion due to ovarian hyperstimulation syndrome. Treatment included non-invasive ventilation and three thoracentesis procedures, plus the administration of albumin, colloid solutions and high-dose furosemid. Severe form of ovarian hyperstimulation syndrome is observed in 0.5-5% of the women treated, and intensive care may be required for management of thromboembolic complications, renal failure and severe respiratory failure. Pulmonary intensive care may involve thoracentesis, oxygen supplementation and, in more severe cases, assisted ventilation. To our knowledge, there have been only two studies in English language medical literature that describe severe respiratory failure treated with non

  12. Hereditary mucoepithelial dysplasia and severe respiratory distress

    Mahmoud Halawa; Abu-Hasan, Mutasim N; ElMallah, Mai K.

    2015-01-01

    Hereditary mucoepithelial dysplasia (HMD) is a rare autosomal dominant disorder characterized by mucoepithelial disruption of the skin, hair and mucous membranes. It results from defective gap junction formation and leads to non-scarring alopecia, mucosal erythema, perineal erythematous intertrigo, involvement of the conjunctival mucosa, and pulmonary disease. We present a case of severe respiratory distress in an initially healthy full term infant born to a mother with HMD. This infant later...

  13. Dynamics of cardiovascular and respiratory system

    Převorovská, Světlana; Maršík, František; Musil, Jan

    Praha: FTVS UK Praha, Česká společnost pro biomechaniku, 2002 - (Jelen, K.; Kušová, S.; Chalupová, M.; Otáhal, J.), s. 51-53 ISBN 80-86317-23-4. [Biomechanics of man 2002. Čejkovice (CZ), 12.11.2002-15.11.2002] Institutional research plan: CEZ:AV0Z2076919 Keywords : cardiovascular system * respiratory system * numerical model Subject RIV: BK - Fluid Dynamics

  14. Energy transduction by respiratory complex I

    Batista, Ana P.

    2010-01-01

    The aim of the work presented in this dissertation was to provide a contribution to the understanding of the energy transducing mechanism of respiratory complex I. This enzyme is present in most bacteria and in all mitochondrial systems and it is characterized by its large number of subunits, its prosthetic groups (flavin and iron-sulfur centers), and its NADH:quinone oxidoreductase activity sensitive to specific inhibitors and coupled with charge translocation across the membrane.(...)

  15. Airport atmospheric environment : respiratory health at work

    Léa Touri; Hélène Marchetti; Irène Sari-Minodier; Nicolas Molinari; Pascal Chanez

    2013-01-01

    Air traffic is increasing, raising concern about local pollution and its adverse health effects on the people living in the vicinity of large airports. However, the highest risk is probably occupational exposure due to proximity. Jet exhaust is one of the main concerns at an airport and may have a health impact, particularly on the respiratory tract. Current studies are neither numerous enough nor strong enough to prove this kind of association. Yet, more and more people work in airports, and...

  16. S-Nitrosothiol Signaling in Respiratory Biology

    Gaston, Benjamin; Singel, David; Doctor, Allan; Stamler, Jonathan S.

    2006-01-01

    Genetic and biochemical data demonstrate a pivotal role for S-nitrosothiols (SNOs) in mediating the actions of nitric oxide synthases (NOSs). SNOs serve to convey NO bioactivity and to regulate protein function. This understanding is of immediate interest to the pulmonary clinical and research communities. This article reviews the following: (1) biochemical and cellular evidence that SNOs in amino acids, peptides, and proteins elicit NOS-dependent signaling in the respiratory system and (2) s...

  17. Animal models for protein respiratory sensitizers.

    Ward, Marsha D W; Selgrade, Maryjane K

    2007-01-01

    Protein induced respiratory hypersensitivity, particularly atopic disease in general, and allergic asthma in particular, has increased dramatically over the last several decades in the US and other industrialized nations as a result of ill-defined changes in living conditions in modern western society. In addition, work-related asthma has become the most frequently diagnosed occupational respiratory illness. Animal models have demonstrated great utility in developing an understanding of the etiology and mechanisms of many diseases. A few models been developed as predictive models to identify a protein as an allergen or to characterize its potency. Here we describe animal models that have been used to investigate and identify protein respiratory sensitizers. In addition to prototypical experimental design, methods for exposure route, sample collection, and endpoint assessment are described. Some of the most relevant endpoints in assessing the potential for a given protein to induce atopic or allergic asthma respiratory hypersensitivity are the development of cytotropic antibodies (IgE, IgG1), eosinophil influx into the lung, and airway hyperresponsiveness to the sensitizing protein and/or to non-antigenic stimuli (Mch). The utility of technologies such as PCR and multiplexing assay systems is also described. These models and methods have been used to elucidate the potential for protein sources to induce allergy, identify environmental conditions (pollutants) to impact allergy responsiveness, and establish safe exposure limits. As an example, data are presented from an experiment designed to compare the allergenicity of a fungal biopesticide Metarhizium anisopliae (MACA) crude extract with the one of its components, conidia (CON) extract. PMID:17161304

  18. Management of respiratory tract infections in children

    PAUL, Siba Prosad

    2014-01-01

    Siba Prosad Paul,1 Rachel Wilkinson,2 Christine Routley3 1Southmead Hospital, Bristol, 2St Richard's Hospital, Chichester, 3Paediatric Services, Yeovil District Hospital, Yeovil, UK Abstract: Respiratory tract infections (RTIs) in children are one of the most common reasons for parents consulting health professionals. Most RTIs are self-limiting viral illnesses that will resolve with time and supportive management. However, it is important for the health professional to identify any ...

  19. Management of respiratory tract infections in children

    Paul SP; Wilkinson R; Routley C

    2014-01-01

    Siba Prosad Paul,1 Rachel Wilkinson,2 Christine Routley3 1Southmead Hospital, Bristol, 2St Richard's Hospital, Chichester, 3Paediatric Services, Yeovil District Hospital, Yeovil, UK Abstract: Respiratory tract infections (RTIs) in children are one of the most common reasons for parents consulting health professionals. Most RTIs are self-limiting viral illnesses that will resolve with time and supportive management. However, it is important for the health professional to identify any RTI ...

  20. Estimating instantaneous respiratory rate from the photoplethysmogram.

    Dehkordi, Parastoo; Garde, Ainara; Molavi, Behnam; Petersen, Christian L; Ansermino, J Mark; Dumont, Guy A

    2015-08-01

    The photoplethysmogram (PPG) obtained from pulse oximetry shows the local changes of blood volume in tissues. Respiration induces variation in the PPG baseline due to the variation in venous blood return during each breathing cycle. We have proposed an algorithm based on the synchrosqueezing transform (SST) to estimate instantaneous respiratory rate (IRR) from the PPG. The SST is a combination of wavelet analysis and a reallocation method which aims to sharpen the time-frequency representation of the signal and can provide an accurate estimation of instantaneous frequency. In this application, the SST was applied to the PPG and IRR was detected as the predominant ridge in the respiratory band (0.1 Hz - 1 Hz) in the SST plane. The algorithm was tested against the Capnobase benchmark dataset that contains PPG, capnography, and expert labelled reference respiratory rate from 42 subjects. The IRR estimation accuracy was assessed using the root mean square (RMS) error and Bland-Altman plot. The median RMS error was 0.39 breaths/min for all subjects which ranged from the lowest error of 0.18 breaths/min to the highest error of 13.86 breaths/min. A Bland-Altman plot showed an agreement between the IRR obtained from PPG and reference respiratory rate with a bias of -0.32 and limits agreement of -7.72 to 7.07. Extracting IRR from PPG expands the functionality of pulse oximeters and provides additional diagnostic power to this non-invasive monitoring tool. PMID:26737696