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Sample records for alkalosis

  1. Hypochloremic metabolic alkalosis or strong ion alkalosis: A review

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    David Alexander Martínez Rodríguez

    2016-06-01

    Full Text Available Over the past 100 years numerous studies sought to elucidate the mechanisms of acid-base balance in humans and animals. Based on these investigations, different approaches have been developed; among them, the model proposed by Henderson-Hasselbalch (H-H is the most widespread in the medical and medical-veterinary community. In recent years, another method proposed by Stewart has gained importance, and it corresponds to the strong ion difference, which aims to take a broader look in order to understand the different processes involved in acid-base balance. Both in human and veterinary medicine, one of the most common acid-base disorder in ICUs is hypochloremic metabolic alkalosis, which results from vomiting in humans and from abomasal disorders in ruminants. This disorder can remain for long periods during which acidic urine occurs and it is known as paradoxical aciduria develops. This article reviews the different pathophysiological mechanisms occurring during this acid-base disorder and the different approaches to explain its occurrence.

  2. Time course of hemolysis in respiratory alkalosis

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    A. Babaknia

    1969-01-01

    Full Text Available Blood pH and plasma hemoglobin concentration were measured in dog undergoing hyperventilation with or without 6 %CO 2. Blood pH rose in the first minutes in the alkalotic group and hemolysis appeared mostly during second hour after alkalosis was established. It increased gradually during the following hours of hyperventilation. No hemolysis was observed in the group undergoing hyperventilation with 6% C02. It is concluded thal hemolysis is unrelated to mechanical action of hyperventilatroi n and in due to alkalosis. the possible cause of hemo lysis and related Iitrature is discussed.

  3. Metabolic Alkalosis resulting from a Congenital Duodenal Diaphragm

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    Annalisa Passariello

    2014-10-01

    Full Text Available Duodenal diaphragm is an unusual cause of upper intestinal obstruction. We present here a neonate with duodenal diaphragm who presented with features of metabolic alkalosis. Further, an algorithm of management of metabolic alkalosis in a newborn is suggested.

  4. Uteroplacental blood flow during alkalosis in the sheep

    International Nuclear Information System (INIS)

    Uteroplacental blood flow was measured by the radioactive-microsphere technique in eight near-term pregnant ewes during a normal control period and during maternal metabolic alkalosis. All measurements were made on awake, unanesthetized animals. Alkalosis, defined for this study as an arterial pH of 7.60 or greater, was produced by the oral administration of sodium bicarbonate, 3 g/kg body wt. The rise in pH thus produced was unaccompanied by significant changes in systemic arterial blood pressure and cardiac output, while maternal arterial P/sub CO2/ rose slightly from control levels. Cotyledonary blood flow declined from a control value of 1.177 ml/min to 1.025 ml/min during alkalosis. This decline of 13 percent in cotyledonary blood flow is significant (P less than 0.02). Blood flow to the remaining uterine tissue, or noncotyledonary uterus, did not change with alkalosis, being maintained at approximately 195 ml/min. It is concluded that maternal alkalosis, unaccompanied by major changes in P /sub CO2/ and systemic arterial pressure, causes a small increase in the resistance of the uteroplacental circulation

  5. [The course of rumen fermentation during alkalosis in cows].

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    Zawadzki, W; Hejłasz, Z; Nicpoń, J

    1991-01-01

    The aim of the study was the investigation of rumen fermentation during alkalosis in cows. The study comprised some parameters of rumen fermentation, such as: pH, ammonia and volatile fatty acids (VFA) levels, also relationship between VFA, numbers of population of protozoa and bacteria, total production of gases in vitro particularly CO2 and CH4, amounts of lactic and total protein in rumen fluid and non-glucogenic/glucogenic ratio (NGGR) in the VFA mixture. On the basis of obtained results the amounts of fermented hexose, cell yield, ATP produced and hydrogen utilization were calculated. During alkalosis there was observed significant fall of VFA production, especially acetic and butyric acids, also lower production of gases, particularly CH4--probably as a result of selective reduction of methanogenic strain bacteria. The levelling of value of rumen pattern of fermentation occurred after the beginning of lactation probably as a result of metabolism products excretion together with milk. PMID:1842617

  6. Cerebrospinal fluid ionic regulation, cerebral blood flow, and glucose use during chronic metabolic alkalosis

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    Schroeck, H.K.; Kuschinsky, W. (Univ. of Bonn (Germany, F.R.))

    1989-10-01

    Chronic metabolic alkalosis was induced in rats by combining a low K+ diet with a 0.2 M NaHCO3 solution as drinking fluid for either 15 or 27 days. Local cerebral blood flow and local cerebral glucose utilization were measured in 31 different structures of the brain in conscious animals by means of the iodo-(14C)antipyrine and 2-(14C)deoxy-D-glucose method. The treatment induced moderate (15 days, base excess (BE) 16 mM) to severe (27 days, BE 25 mM) hypochloremic metabolic alkalosis and K+ depletion. During moderate metabolic alkalosis no change in cerebral glucose utilization and blood flow was detectable in most brain structures when compared with controls. Cerebrospinal fluid (CSF) K+ and H+ concentrations were significantly decreased. During severe hypochloremic alkalosis, cerebral blood flow was decreased by 19% and cerebral glucose utilization by 24% when compared with the control values. The decrease in cerebral blood flow during severe metabolic alkalosis is attributed mainly to the decreased cerebral metabolism and to a lesser extent to a further decrease of the CSF H+ concentration. CSF K+ concentration was not further decreased. The results show an unaltered cerebral blood flow and glucose utilization together with a decrease in CSF H+ and K+ concentrations at moderate metabolic alkalosis and a decrease in cerebral blood flow and glucose utilization together with a further decreased CSF H+ concentration at severe metabolic alkalosis.

  7. Ectopic adrenocorticotropic hormone syndrome presenting as hypokalemic metabolic alkalosis and hypertension

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    Mansoor C Abdulla

    2016-01-01

    Full Text Available The ectopic adrenocorticotropic hormone (ACTH syndrome is an uncommon cause of hypercortisolism, which should be considered in patients with hypokalemic metabolic alkalosis and hypertension in the context of lung neoplasm. We report a 60-year-old male patient with severe hypertension, metabolic alkalosis, and hypokalemia as the initial manifestations of an ACTH-secreting small cell lung carcinoma. Ectopic Cushing's syndrome should always be ruled out in patients with severe hypertension and hypokalemia.

  8. Metabolic alkalosis in children: Study of patients admitted to pediatrics center

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    Sobhani A

    2001-07-01

    Full Text Available Metabolic alkalosis is characterized by high HCO3- as it is seen in chronic respiratory acidosis, but PH differentiates the two disorders. There is no characteristic symptom or sign. Orthostatic hypotension may be encountered. Weakness and hyporeflexia occur if serum K+ is markerdly low. Tetany and neuromuscular irritability occur rarely. We report the results of retrospective data analysis of metabolic alkalosis in 15463 patients hospitalized Pediatric Medical Center in Tehran during years 1995-1997. We found 50 cases of metabolic alkalosis (rate of 0.32 percent. 64 precent male and 36 percent female. Most of them had growth failure (40% were bellow 3 percentile of height by age, 44% bellow 5 percentile of weight by height. More than 60 percent had hypokalemia, hypocloremia and hyponatremia. The most common cause of Metabolic alkalosis was cystic fibrosis and pyloric stenosis. Fifty percent of cystic fibrosis patients and Bartter cases had metabolic alkalosis. Metabolic alkalosis should be considered in every pediatric patient presented with projectile vomitting.

  9. Evaluation of intracellular pH regulation and alkalosis defense mechanisms in preimplantation embryos.

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    Dagilgan, Senay; Dundar-Yenilmez, Ebru; Tuli, Abdullah; Urunsak, Ibrahim Ferhat; Erdogan, Seref

    2015-04-01

    Intracellular pH (pHi) regulation is an important homeostatic function of cells. There are three major pHi-regulatory mechanisms: HCO3(-)/Cl(-) exchanger (anion exchanger [AE]), which alleviates alkalosis, and the Na(+)/H(+) and Na(+),HCO3(-)/Cl(-) exchangers, both of which alleviate acidosis. We hypothesized that there would be developmental changes in pHi-regulatory activity in preimplantation embryos as conditions in the oviduct are alkaline but acidic in the uterus. This study focused on the AE mechanism in pronuclear (PN) zygotes, two-cell (2-c), four-cell (4-c), morula, and blastocyst stage embryos from Balb/c mice. Microspectrofluorometry was used to monitor changes in pHi in embryos subjected to Cl(-)-free media in presence or absence of an AE inhibitor, DIDS, and in embryos recovering from NH4Cl-induced alkalosis. Real-time polymerase chain reaction was used to identify AE isoforms. The pHi changes were greatest in PN zygotes (0.086 ± 007 pHU/min) but fell as embryos developed to the 2-c, 4-c, morula, and blastocyst stages (0.063 ± 006; 0.035 ± 007; 0.024 ± 004, and 0.014 ± 004 pHU/min, respectively). DIDS significantly reduced the rise in pHi caused by Cl(-) removal in all embryos; the finding pointed out that this pHi changes are due to AE activity. But DIDS only inhibited the recovery responses of PN zygote, 2-c and 4-c embryos but not morula or blastocyst stage embryos. In bicarbonate-containing medium, all embryos recovered from induced alkalosis but only the morula and blastocyst stages could fully compensate from ammonium induced-alkalosis in bicarbonate-free medium. The finding showed that commonly used ammonium pulse method to investigate AE function against alkalosis is not suitable for morula and blastocyst embryonic stages. All embryos expressed SLC4A2 and SLC4A4 coding for AE-2 and AE-4, but none expressed either AE-1 or AE-3. The gradual change in the response to alkalosis in preimplantation embryos may be adaptations to their

  10. Differential effect of metabolic alkalosis and hypoxia on high-intensity cycling performance.

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    Flinn, Samantha; Herbert, Kathryn; Graham, Kenneth; Siegler, Jason C

    2014-10-01

    The purpose of this study was to investigate the effects of sodium bicarbonate (NaHCO3) ingestion and acute hypoxic exposure on repeated bouts of high-intensity cycling to task failure. Twelve subjects completed 4 separate intermittent cycling bouts cycling bouts to task failure (120% peak power output for 30-second interspersed with 30-second active recovery) under the following conditions: normoxia (FIO2% at 20.93%) alkalosis (NA), normoxia placebo (NP), hypoxia (FIO2% at 14.7%) alkalosis (HA), and hypoxia placebo (HP). For the NA and HA trials, the buffer solution (0.3 g·kg of NaHCO3) was dispensed into gelatin capsules and consumed over 90 minutes with 1 L of water. Whole-blood acid-base findings demonstrated metabolic alkalosis in both NA and HA before exercise (HCO3: 32.8 ± 1.8 mmol·L). Time to task failure was significantly impaired in the hypoxic conditions (NA: 199.1 ± 62.3 seconds, NP: 183.8 ± 45.0 seconds, HA: 127.8 ± 27.9 seconds, HP: 133.3 ± 28.7 seconds; p hypoxia and NaHCO3 concurrently to improve performance under these conditions does not seem warranted. PMID:24983849

  11. Proximal tubular bicarbonate reabsorption and PCO2 in chronic metabolic alkalosis in the rat.

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    Maddox, D A; Gennari, F J

    1983-01-01

    Studies were undertaken to define the pattern of proximal tubular bicarbonate reabsorption and its relation to tubular and capillary PCO2 in rats with chronic metabolic alkalosis (CMA). CMA was induced by administering furosemide to rats ingesting a low electrolyte diet supplemented with NaHCO3 and KHCO3. Proximal tubular bicarbonate reabsorption and PCO2 were measured in CMA rats either 4-7 or 11-14 d after furosemide injection, in order to study a wide range of filtered bicarbonate loads. A...

  12. Hypokalaemic paresis, hypertension, alkalosis and adrenal-dependent hyperadrenocorticism in a dog.

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    Davies, D R; Foster, S F; Hopper, B J; Staudte, K L; O'Hara, A J; Irwin, P J

    2008-04-01

    Generalised paresis, severe hypokalaemia and kaliuresis, metabolic alkalosis and hypertension, characteristic of mineralocorticoid excess, were identified in a dog with hyperadrenocorticism due to a functional adrenocortical carcinoma. Aldosterone concentration was decreased and deoxycorticosterone concentration increased in the presence of hypokalaemia. These metabolic abnormalities resolved with resection of the carcinoma. Mineralocorticoid excess in dogs with hyperadrenocorticism is generally considered to be of little clinical significance but resulted in the acute presentation of this patient. The possible pathogenesis of mineralocorticoid excess in this case of canine hyperadrenocorticism is discussed.

  13. Severe metabolic alkalosis and recurrent acute on chronic kidney injury in a patient with Crohn's disease

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    Schmid Axel

    2010-04-01

    Full Text Available Abstract Background Diarrhea is common in patients with Crohn's disease and may be accompanied by acid base disorders, most commonly metabolic acidosis due to intestinal loss of bicarbonate. Case Presentation Here, we present a case of severe metabolic alkalosis in a young patient suffering from M. Crohn. The patient had undergone multiple resections of the intestine and suffered from chronic kidney disease. He was now referred to our clinic for recurrent acute kidney injury, the nature of which was pre-renal due to profound volume depletion. Renal failure was associated with marked hypochloremic metabolic alkalosis which only responded to high volume repletion and high dose blockade of gastric hypersecretion. Intestinal failure with stomal fluid losses of up to 5.7 litres per day required port implantation to commence parenteral nutrition. Fluid and electrolyte replacement rapidly improved renal function and acid base homeostasis. Conclusions This case highlights the important role of gastrointestinal function to maintain acid base status in patients with Crohn's disease.

  14. Anesthetic Management of a Patient with Sustained Severe Metabolic Alkalosis and Electrolyte Abnormalities Caused by Ingestion of Baking Soda

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    Jose Soliz; Jeffrey Lim; Gang Zheng

    2014-01-01

    The use of alternative medicine is prevalent worldwide. However, its effect on intraoperative anesthetic care is underreported. We report the anesthetic management of a patient who underwent an extensive head and neck cancer surgery and presented with a severe intraoperative metabolic alkalosis from the long term ingestion of baking soda and other herbal remedies.

  15. Anesthetic Management of a Patient with Sustained Severe Metabolic Alkalosis and Electrolyte Abnormalities Caused by Ingestion of Baking Soda

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    Jose Soliz

    2014-01-01

    Full Text Available The use of alternative medicine is prevalent worldwide. However, its effect on intraoperative anesthetic care is underreported. We report the anesthetic management of a patient who underwent an extensive head and neck cancer surgery and presented with a severe intraoperative metabolic alkalosis from the long term ingestion of baking soda and other herbal remedies.

  16. Acetazolamide-mediated decrease in strong ion difference accounts for the correction of metabolic alkalosis in critically ill patients.

    NARCIS (Netherlands)

    Moviat, M.; Pickkers, P.; Voort, P.H. van der; Hoeven, J.G. van der

    2006-01-01

    INTRODUCTION: Metabolic alkalosis is a commonly encountered acid-base derangement in the intensive care unit. Treatment with the carbonic anhydrase inhibitor acetazolamide is indicated in selected cases. According to the quantitative approach described by Stewart, correction of serum pH due to carbo

  17. Adaptation to alkalosis induces cell cycle delay and apoptosis in cortical collecting duct cells: role of Aquaporin-2.

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    Rivarola, Valeria; Flamenco, Pilar; Melamud, Luciana; Galizia, Luciano; Ford, Paula; Capurro, Claudia

    2010-08-01

    Collecting ducts (CD) not only constitute the final site for regulating urine concentration by increasing apical membrane Aquaporin-2 (AQP2) expression, but are also essential for the control of acid-base status. The aim of this work was to examine, in renal cells, the effects of chronic alkalosis on cell growth/death as well as to define whether AQP2 expression plays any role during this adaptation. Two CD cell lines were used: WT- (not expressing AQPs) and AQP2-RCCD(1) (expressing apical AQP2). Our results showed that AQP2 expression per se accelerates cell proliferation by an increase in cell cycle progression. Chronic alkalosis induced, in both cells lines, a time-dependent reduction in cell growth. Even more, cell cycle movement, assessed by 5-bromodeoxyuridine pulse-chase and propidium iodide analyses, revealed a G2/M phase cell accumulation associated with longer S- and G2/M-transit times. This G2/M arrest is paralleled with changes consistent with apoptosis. All these effects appeared 24 h before and were always more pronounced in cells expressing AQP2. Moreover, in AQP2-expressing cells, part of the observed alkalosis cell growth decrease is explained by AQP2 protein down-regulation. We conclude that in CD cells alkalosis causes a reduction in cell growth by cell cycle delay that triggers apoptosis as an adaptive reaction to this environment stress. Since cell volume changes are prerequisite for the initiation of cell proliferation or apoptosis, we propose that AQP2 expression facilitates cell swelling or shrinkage leading to the activation of channels necessary to the control of these processes. PMID:20432437

  18. Severe Uncompensated Metabolic Alkalosis due to Plasma Exchange in a Patient with Pulmonary-Renal Syndrome: A Clinician’s Challenge

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    Mohsin Ijaz

    2015-01-01

    Full Text Available Metabolic alkalosis secondary to citrate toxicity from plasma exchange is very uncommon in patients with normal renal function. In patients with advanced renal disease this can be a fatal event. We describe a case of middle-aged woman with Goodpasture’s syndrome treated with plasma exchange who developed severe metabolic alkalosis. High citrate load in plasma exchange fluid is the underlying etiology. Citrate metabolism generates bicarbonate and once its level exceeds the excretory capacity of kidneys, the severe metabolic alkalosis ensues. Our patient presented with generalized weakness, fever, and oliguria and developed rapidly progressive renal failure. Patient had positive serology for antineutrophilic cytoplasmic antibodies myeloperoxidase (ANCA-MPO and anti-glomerular basement membrane antibodies (anti-GBM. Renal biopsy showed diffuse necrotizing and crescentic glomerulonephritis with linear glomerular basement membrane staining. Patient did not respond to intravenous steroids. Plasma exchange was started with fresh frozen plasma but patient developed severe metabolic alkalosis. This metabolic alkalosis normalized with cessation of plasma exchange and initiation of low bicarbonate hemodialysis. ANCA-MPO and anti-GBM antibodies levels normalized within 2 weeks and remained undetectable at 3 months. Patient still required maintenance hemodialysis.

  19. Volume-independent reductions in glomerular filtration rate in acute chloride-depletion alkalosis in the rat. Evidence for mediation by tubuloglomerular feedback.

    OpenAIRE

    Galla, J. H.; Bonduris, D N; Sanders, P W; Luke, R. G.

    1984-01-01

    We have recently described reduced superficial nephron glomerular filtration rate (SNGFR) in chloride-depletion alkalosis (CDA) without volume depletion. To elucidate the mechanism of this phenomenon, we studied three degrees of increasing severity of CDA (groups CDA-1, 2, and 3) produced by one or two peritoneal dialyses against 0.15 M NaHCO3 and electrolyte infusions of different Cl and HCO3 content in Sprague-Dawley rats; control rats (CON) were dialyzed against and infused with Ringers-HC...

  20. Delay in onset of metabolic alkalosis during regional citrate anti-coagulation in continous renal replacement therapy with calcium-free replacement solution

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    See Kay

    2009-01-01

    Full Text Available Regional citrate anti-coagulation for continuous renal replacement therapy chelates calcium to produce the anti- coagulation effect. We hypothesise that a calcium-free replacement solution will require less citrate and produce fewer metabolic side effects. Fifty patients, in a Medical Intensive Care Unit of a tertiary teaching hospital (25 in each group, received continuous venovenous hemofiltration using either calcium-containing or calcium-free replacement solutions. Both groups had no significant differences in filter life, metabolic alkalosis, hypernatremia, hypocalcemia, and hypercalcemia. However, patients using calcium-containing solution developed metabolic alkalosis earlier, compared to patients using calcium-free solution (mean 24.6 hours,CI 0.8-48.4 vs. 37.2 hours, CI 9.4-65, P = 0.020. When calcium-containing replacement solution was used, more citrate was required (mean 280ml/h, CI 227.2-332.8 vs. 265ml/h, CI 203.4-326.6, P = 0.069, but less calcium was infused (mean 21.2 ml/h, CI 1.2-21.2 vs 51.6ml/h, CI 26.8-76.4, P ≤ 0.0001.

  1. 重症烧伤休克期代谢性碱中毒原因分析%Cause analysis of Severe burns shock stage metabolic alkalosis

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    邢溢庆; 骆永红; 徐琦; 赵全; 王玉莲

    2009-01-01

    目的 了解重症烧伤休克期代谢性碱中毒(Metabolic alkalosis)的病因、治疗方法以及监测手段等相关因素,以预防其发生.方法 收集13例重症烧伤患者自入院至发生代谢性碱中毒发现时所有临床资料,从治疗措施、液体入量及种类、碱性药物、利尿剂、血管扩张剂的应用情况,以及代谢性碱中毒发现后钾入量和盐酸精氨酸的应用情况等方面,比较二氧化碳结合力与血气分析的临床敏感性.结果 13例患者休克期第1个24 h平均液体总入量达到(3.3 ±0.80)m1.kg-1·1%TBSA.其中乳酸钠林格氏液(5285±2003)ml,血浆为(3450±2498)ml:13例患者中,在伤后第一天发生代谢性碱中毒的6例患者,均于伤后短时间内应用5%碳酸氢钠125 ml~570 ml.13例患者休克期分别应用呋塞米、多巴胺、20%甘露醇、利尿,致第1个24 h尿量平均达到(125±49)ml.经对血气分析中BE、HCO3与血C02-CP同时相、同量标本数监测凝据比较,前两者均高于正常参考值,而后者均在正常参考值内.13例患者经积极处理原发病,适当补钾,静脉输入盐酸精氨酸等临床治疗,所有患者的代谢性碱中毒全部得到纠正.结论 重症烧伤休克期补液量应在有创和无创监测下平稳达到复苏指标,尿量以1 ml·kg-1·h-1为度.患者入院后即行血气分析监测,或可预警代谢性碱中毒的发生.%Objective To investigate cause,therapy and monitoring measures of severe burns with metabolic alkalosis so as to prevent metabolic alkalosis. Methods Therapy measures of 13 severe burns patients were studied from their admission to onset of metabolic alkalosis, including liquid amount and category, usage of alkaline drug, diuretic agent and vasodilator, dosage of potassium and arginine hydrochloride after metabolic alkalosis. The clinical sensitivity of carbon dioxide combining power and blood gas analysis were compared. Results The occurrence of metabolic alkalosis in 13 patients

  2. Clinical Characteristics of Primary Renal Tubular Hypokalemic Alkalosis%原发肾小管性低钾碱中毒的临床特点

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    范树颖; 张碧丽; 王文红; 张碹; 李莉; 杜悦新

    2011-01-01

    Objective To explore the clinical characteristics of primary renal tubular hypokalemic alkalosis. Methods Eight patients with primary renal tubular hypokalemic alkalosis were selected in the Children's Hospital of Tianjin. There were 4 patients with Bartter syndrome(BS) and 4 patients with Gitelman syndrome(GS). Clinical data,biochemical tests,therapy and outcome were retrospectively analyzed.Results The onset age of BS were at infancy stage. The main symptoms included diarrhea, vomiting, dehydration and growth retardation. And the onset age of GS ranged from 10 to 15 years old with the main symptoms of weakness,paralysis and tetany. They had normal blood pressure.The biochemical tests showed hypokalemic, metabolic alkalosis, increase of urine potassium and urine chlorine in all patients. Four patients with BS had hyperreninemia and hyperaldosteronism. Angiotonin was elevated in all 4 patients with GS ,while rennin was elevated in 3 patients of them and aldosterone was obviously elevated in 2 patients. The urine Ca/Cr ratio in BS was elevated(>0.2) ,while patients with GS had hyponagnesaemia and low level of urine Ca/Ct ratio(<0.2). B - type ultrasonic wave showed that both kidneys's resonance had even reinforce in 2 patients with BS, and one of them had left pyelectasis. All symptoms resolved after treatment with potassium or combined magnesium supplementation,indomethacin,spironolactone and captopril. Conclusions Prinary renal tubular hypokalemic alkalosis is characterized by hypokalemic, metabolic alkalosis, hyperreninemic, hyperaldosteronism and normal blood pressure. Measured level of serum magnesium, urine potassium and chlorine and Ca/Ct ratio, rennin angiotonin and aldosterone can help make diagnosis. There are differences in onset mechanism,clinical manifestation,treatment and prognosis between BS and GS.%目的 探讨原发肾小管性低钾碱中毒的临床特点.方法 收集在天津市儿童医院住院治疗的原发肾

  3. Clinical analysis and treatment of respiratory alkalosis after tonsillectomy%扁桃体切除术后呼吸性碱中毒的临床分析及处理

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    周兵

    2015-01-01

    目的:探讨扁桃体切除术后呼吸性碱中毒的临床诊断及处理。方法:收治全麻下扁桃体切除术后出现呼吸性碱中毒患者5例,对其临床资料进行分析。结果:所有患者在临床处理半小时后症状缓解,1 h后患者心率、呼吸平稳,安然入睡,第2天后未再发生呼吸性碱中毒的症状,1周后顺利出院。结论:呼吸性碱中毒主要与术后精神紧张、疼痛有关,镇静、止痛是最关键的处理方式。%Objective:To investigate the clinical diagnosis and treatment of respiratory alkalosis after tonsillectomy.Methods: 5 patients with respiratory alkalosis after tonsillectomy under general anesthesia were selected,we analyzed the clinical datas of them.Results:The symptoms of all patients were remised after half an hour of the clinical treatment,the heart rate,breathe of the patients smoothly after 1h,and went to sleep peacefully,after the second day there were no recurrence of the symptoms of respiratory alkalosis,and discharged after 1 weeks.Conclusion:Respiratory alkalosis mainly relate with the postoperative mental tension,pain,sedation,pain relief is the most critical process.

  4. Alkalosis and hypoxemia in patients with liver cirrhosis accompanied by hepatic encephalopathy%肝硬化并发肝性脑病时碱中毒与低氧血症

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    吴炎; 田怡; 吴鸿悌

    2001-01-01

    目的:探讨肝硬化患者并发肝性脑病(HE)时的碱中毒与低氧血症。方法:肝硬化患者64例;并发HE组21例,无HE组43例。两组均行动脉血气分析,并同步检测血清电解质。结果:酸碱平衡失常54例(84.4%),其中呼吸性碱中毒(呼碱)48例(88.9%)。并发HE组与无HE组呼碱发生率分别为90.5%和67.4%(P<0.05)。64例中动脉低氧血症42例(65.6%),其中重度6例均为并发HE者。并发HE组与无HE组低氧血症发生率分别为95.2%和51.2%(P<0.005)。结论:肝硬化,尤其在并发肝性脑病时,极易发生碱中毒与低氧血症;其中以单纯性呼碱发生率为高。低氧血症的程度明显影响患者预后。%Objective:To investigate the alkalosis and hypoxemia in patientswith liver cirrhosis accompanied by hepatic encephalopathy(HE).Methods:Of the 64 patients with liver cirrhosis,21 cases were accompanied by HE,while 43 cases were not.Arterial blood-gas analysis and serum electrolytes were determined in both groups.Results:Fifty-four patients were found with disturbance of acid-base balance(84.4%).Among them 48 cases had respiratory alkalosis(88.9%).The incidence of respiratory alkalosis in the groups with HE was 90.5%,and in the group without HE 67.4%(P<0.05). Forty-two patients were found with arterial hypoxemia in the 64 cases(65.6%) and 6 cases with severe arterial hypoxemia were all in the patients accompanied by HE. In the group with HE and without HE,hypoxemia was 95.2% and 51.2%(P<0.005) respectively.Conclusions:The patients with liver cirrhosis and those accompanied by HE were easy to acquire alkalosis and hypoxemia.Among them,the incidence of simple respiratory alkalosis was the highest.The degrees of PaO2 decrease affected the prognosis of the patients obviously.

  5. Effect of alleviation of respiratory alkalosis covering mouth and nose with wet towels in hysteria patient%湿毛巾捂口鼻减轻癔症患者呼吸性碱中毒的效果

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    王玲敏; 张凤华

    2013-01-01

    Objective To observe the effect of covering mouth and nose with wet towels on alleviation of respiratory alkalosis in hysteria patients.Methods One hundred and ninety patients with respiratory alkalosis induced by hysteria were chosen and randomly divided into three groups.The experimental group of 110 cases received the covering mouth and nose with the wet towel.The control group of 80 patients was divided into two groups according to random number tables,among them,40 patients received long barrel bag,and 40 patients received disposal double-layer masks.Results The effective rate of experimental group (100%) is higher than the control group (72.5%,77.5%),and the difference was statistically significant among three groups (Hc =17.41,P <0.05).Contusions Covering nose and mouth with wet towel to alleviate respiratory alkalosis in hysteria patients is a correct,timely and effective method,which can promote patient recovery and reduce the waste of medical resources.%目的 观察湿毛巾捂口鼻减轻癔症患者呼吸性碱中毒的效果.方法 选择转换性癔症致呼吸性碱中毒患者190例,采用随机数字法分为三组,湿毛巾捂口鼻组(n=ll0)采用湿毛巾捂口鼻的方法,长筒袋叩口鼻组(n=40)采用长筒袋开口叩于患者口鼻上方位置,口罩覆盖口鼻组(n=40)采用双层一次性医用口罩覆盖口鼻,评价三组患者的干预效果.结果 湿毛巾捂口鼻组有效率为100%,明显高于长筒袋叩口鼻组(72.5%)及口罩覆盖口鼻组(77.5%),三组疗效比较差异有统计学意义(Hc=17.41,P<0.05).结论 利用湿毛巾捂口鼻减轻癔症呼吸性碱中毒,是一种及时、有效的治疗和护理方法,可促进患者康复,减少医疗资源的浪费.

  6. Study on the Prevention and Cure of the Newborn's Respiratory Alkalosis Caused by Ventilator%呼吸器引起新生儿呼吸性碱中毒的防治措施

    Institute of Scientific and Technical Information of China (English)

    刘海樱; 徐英美; 李蓉

    2001-01-01

    Objective To discuss the reasons for newborn's respiratory alkalosis caused by ventilator and its prevention or cure method.Method 65 cases of ventilator using newborns selected in NICU from 1992 to 1996 as the first group.57 cases of ventilator using newborns selected from 1985 to 1989 as the second group.The date of the two groups were compared.Result The incidence rate of respiratory alkalosis in the first group (11/65,16.92%) was significantly higher than that of the second group(21/57,36.84%)(P<0.05).Conclusion In order to decrease the respiratory alkalosis caused by ventilator,it is necessary to adjust ventilator setting on time according to the condition of respiratory or increase the value of PEEP.It is suggested that lung function test is necessary to be used.%目的:探讨应用呼吸器引起新生儿呼吸性碱中毒(呼碱)的病因及防治措施。方法:将我院1992~1996年在NICU住院应用呼吸器治疗的65例新生儿作为甲组,1985~1989年应用呼吸器治疗的57例新生儿作为乙组进行总结分析。结果:甲组发生呼碱11例(16.92%),明显低于乙组(21例,36.84%)(χ2=6.38,P<0.05)。结论:为了进一步降低应用呼吸器引起的碱中毒发生率,应根据病情选择合适的吸气峰值(PIP)和呼吸频率,根据病情、血气分析随时调整呼吸器参数,降低呼吸频率,必要时提高呼气末正压(PEEP),有条件的医院可开展新生儿肺功能检测。

  7. 奥美拉唑快速纠正先天性肥厚性幽门狭窄代谢性碱中毒的临床研究%The clinical study of omeprazole in rapid correction of metabolic alkalosis in congenital hypertrophic pyloric stenosis

    Institute of Scientific and Technical Information of China (English)

    孙邡; 刘斌; 张宏伟; 禚保彪; 刘丰丽; 方允

    2014-01-01

    Objetive To explore the function of omeprazole in rapid correction of metabolic alkalosis in congenital hypertrophic pyloric stenosis(CHPS). Methods 80 infants with CHPS were randomly divided into two groups,treatment group 40 cases,control group 40 cases.According to the pH on admission ,those patients were divided into pH>7.5 group (treatment group 21 cases,control group 22 cases),pH≤7.5 group (treat-ment group19 cases,control group18 cases ).The control group was given conventional normal saline,equilibri-um liquid to correct electrolyte and acid-base balance disorders,the treatment group in addition to routine thera-py was given omeprazole 0.7 mg/(kg.d)qd intravenous injection.The arterial blood gas analysis were detec-ted in every 12 h after admission,The SPSS13.0 software of statistics analyzed the primary data. Results pH>7.5 group:12 h after admission treatment group with 8 cases (8/21,38.1%)pH returned to normal,while control group only with 2 cases (2/22,9.1%),(P0.05).Conclusion Intravenous omeprazole administration can rapidly normalize severe meta-bolic alkalosis in CHPS patients,particularly for moderately severe metabolic alkalosis.As a result,pyloromyoto-my can be performed sooner reducing both hospital stay and costs.%目的:探讨奥美拉唑在快速纠正先天性肥厚性幽门狭窄代谢性碱中毒中的作用。方法将本院80例诊断为先天性肥厚性幽门狭窄的患儿随机分成两组,治疗组40例,对照组40例。根据入院时pH值又分为pH>7.5组(治疗组21例,对照组22),pH≤7.5组(治疗组19例,对照组18例)。对照组采用补充生理盐水、平衡液等纠正电解质紊乱及酸碱失衡,治疗组除采用上述治疗外加用奥美拉唑0.7 mg·kg-1·d-1静脉滴注,每日1次。入院后每12 h行动脉血气分析,数据通过SPSS13.0软件包进行统计学处理。结果 pH>7.5组:入院后12h治疗组有8例(8/21,38.1%)pH

  8. Hypoxia silences retrotrapezoid nucleus respiratory chemoreceptors via alkalosis.

    Science.gov (United States)

    Basting, Tyler M; Burke, Peter G R; Kanbar, Roy; Viar, Kenneth E; Stornetta, Daniel S; Stornetta, Ruth L; Guyenet, Patrice G

    2015-01-14

    In conscious mammals, hypoxia or hypercapnia stimulates breathing while theoretically exerting opposite effects on central respiratory chemoreceptors (CRCs). We tested this theory by examining how hypoxia and hypercapnia change the activity of the retrotrapezoid nucleus (RTN), a putative CRC and chemoreflex integrator. Archaerhodopsin-(Arch)-transduced RTN neurons were reversibly silenced by light in anesthetized rats. We bilaterally transduced RTN and nearby C1 neurons with Arch (PRSx8-ArchT-EYFP-LVV) and measured the cardiorespiratory consequences of Arch activation (10 s) in conscious rats during normoxia, hypoxia, or hyperoxia. RTN photoinhibition reduced breathing equally during non-REM sleep and quiet wake. Compared with normoxia, the breathing frequency reduction (Δf(R)) was larger in hyperoxia (65% FiO2), smaller in 15% FiO2, and absent in 12% FiO2. Tidal volume changes (ΔV(T)) followed the same trend. The effect of hypoxia on Δf(R) was not arousal-dependent but was reversed by reacidifying the blood (acetazolamide; 3% FiCO2). Δf(R) was highly correlated with arterial pH up to arterial pH (pHa) 7.5 with no frequency inhibition occurring above pHa 7.53. Blood pressure was minimally reduced suggesting that C1 neurons were very modestly inhibited. In conclusion, RTN neurons regulate eupneic breathing about equally during both sleep and wake. RTN neurons are the first putative CRCs demonstrably silenced by hypocapnic hypoxia in conscious mammals. RTN neurons are silent above pHa 7.5 and increasingly active below this value. During hyperoxia, RTN activation maintains breathing despite the inactivity of the carotid bodies. Finally, during hypocapnic hypoxia, carotid body stimulation increases breathing frequency via pathways that bypass RTN.

  9. Experimental febrile seizures are precipitated by a hyperthermia-induced respiratory alkalosis

    OpenAIRE

    Schuchmann, Sebastian; Schmitz, Dietmar; Rivera, Claudio; Vanhatalo, Sampsa; Salmen, Benedikt; Mackie, Ken; Sipilä, Sampsa T; Voipio, Juha; Kaila, Kai

    2006-01-01

    Febrile seizures are frequent during early childhood, and prolonged (complex) febrile seizures are associated with an increased susceptibility to temporal lobe epilepsy. The pathophysiological consequences of febrile seizures have been extensively studied in rat pups exposed to hyperthermia. The mechanisms that trigger these seizures are unknown, however. A rise in brain pH is kn...

  10. Alkalosis and Dialytic Clearance of Phosphate Increases Phosphatase Activity: A Hidden Consequence of Hemodialysis.

    Directory of Open Access Journals (Sweden)

    Ricardo Villa-Bellosta

    Full Text Available Extracellular pyrophosphate is a potent endogenous inhibitor of vascular calcification, which is degraded by alkaline phosphatase (ALP and generated by hydrolysis of ATP via ectonucleotide pyrophosphatase/phosphodiesterase 1 (eNPP1. ALP activity (as routinely measured in clinical practice represents the maximal activity (in ideal conditions, but not the real activity (in normal or physiological conditions. For the first time, the present study investigated extracellular pyrophosphate metabolism during hemodialysis sessions (including its synthesis via eNPP1 and its degradation via ALP in physiological conditions.45 patients in hemodialysis were studied. Physiological ALP activity represents only 4-6% of clinical activity. ALP activity increased post-hemodialysis by 2% under ideal conditions (87.4 ± 3.3 IU/L vs. 89.3 ± 3.6 IU/L and 48% under physiological conditions (3.5 ± 0.2 IU/L vs. 5.2 ± 0.2 IU/L. Pyrophosphate synthesis by ATP hydrolysis remained unaltered post-hemodialysis. Post-hemodialysis plasma pH (7.45 ± 0.02 significantly increased compared with the pre-dialysis pH (7.26 ± 0.02. The slight variation in pH (~0.2 units induced a significant increase in ALP activity (9%. Addition of phosphate in post-hemodialysis plasma significantly decreased ALP activity, although this effect was not observed with the addition of urea. Reduction in phosphate levels and increment in pH were significantly associated with an increase in physiological ALP activity post-hemodialysis. A decrease in plasma pyrophosphate levels (3.3 ± 0.3 μmol/L vs. 1.9 ± 0.1 μmol/L and pyrophosphate/ATP ratio (1.9 ± 0.2 vs. 1.4 ± 0.1 post-hemodialysis was also observed.Extraction of uremic toxins, primarily phosphate and hydrogen ions, dramatically increases the ALP activity under physiological conditions. This hitherto unknown consequence of hemodialysis suggests a reinterpretation of the clinical value of this parameter.

  11. Metabolic alkalosis reduces exercise-induced acidosis and potassium accumulation in human skeletal muscle interstitium

    DEFF Research Database (Denmark)

    Street, D.; Nielsen, Jens Jung; Bangsbo, Jens;

    2005-01-01

    Skeletal muscle releases potassium during activity. Interstitial potassium accumulation is important for muscle function and the development of fatigue resulting from exercise. In the present study we used sodium citrate ingestion as a tool to investigate the relationship between interstitial H......+ concentration and K+ accumulation during exercise. Seven healthy subjects performed one-legged knee-extensor exercise on two separate days with and without sodium citrate ingestion. Interstitial H+ and K+ concentrations were measured with the microdialysis technique. Citrate ingestion reduced the plasma H......+ concentration and increased the plasma HCO3- concentration. Citrate had no effect on interstitial H+ at rest. The increase in interstitial H+ concentration during intense exercise was significantly lower (P citrate ingestion compared to control (peak interstitial H+ concentration 79 versus 131 n...

  12. Alkalosis and cirrhotic ascites%碱血症和肝硬化腹水

    Institute of Scientific and Technical Information of China (English)

    王成红; 王成轾; 张振所

    1999-01-01

    目的:探讨碱血症和肝硬化腹水相关性.方法:对住院确诊的肝硬化失代偿患者300例(其中发生腹水的152例)用肝素针筒抽取动脉血0.5ml立即送检.采用丹麦产ABL4型血气分析仪测定.结果:低氧血症,无腹水组50.9%(75/148),腹水组92.1%(130/152).酸碱失调,无腹水组43.2%(64/148),腹水组81.6%(121/152).将两组对比,血气分析常用指标有明显差异,特别是pH>7.45,无腹水组40.5%(60/148),腹水组78.6%(121/152),P<0.01.结论:碱中毒时血管收缩,减少肾血流量和增加门脉阻力,发生腹水.另外腹水时隔肌抬高,造成通气过度,引起pH升高.碱血症和肝硬化腹水是互为因果,引起和加重的原因之一.

  13. The therapeutic strategy of metabolic alkalosis%代谢性碱中毒的治疗策略

    Institute of Scientific and Technical Information of China (English)

    汤耀卿

    2006-01-01

    长期以来,代谢性酸中毒(metabolic acidosis)是最为受到关注的一种酸碱紊乱,首先因其常见,如不作紧急有效处理,很快会影响生命体征。然而,代谢性碱中毒(metabolic alkalosis,下称代碱),也是临床非常常见的一种酸碱紊乱,其发生率约占全部酸碱紊乱的50%,远高于代谢性酸中毒。根据Wilson等报道的177例治疗结果,pH7.54~7.56者,死亡率为40%;pH7.65~7.70者,死亡率为80%。Anderson等报道显示,动脉血pH为7.55和7.65的病人,其死亡率分别为45%和80%。两项报道均提示代碱相关死亡率极高,

  14. Effects of acidosis, alkalosis, hyperthermia and hypothermia on haemostasis : results of point of care testing with the thromboelastography analyser

    NARCIS (Netherlands)

    Ramaker, Albert J. D. W. R.; Meyer, Peter; van der Meer, Jan; Struys, Michel M. R. F.; Lisman, Ton; van Oeveren, Wim; Hendriks, Herman G. D.

    2009-01-01

    In this study we assessed the effects of changes in pH, temperature, and their combination in whole blood on thromboelastographic variables. Blood was collected from six healthy volunteers. Thromboelastograph (TEG series 5000; Haemoscope Corporation, Illinois, USA) channels were set at temperatures

  15. Bicarbonate secretion in vivo by rat distal tubules during alkalosis induced by dietary chloride restriction and alkali loading.

    OpenAIRE

    Levine, D Z; Iacovitti, M; Harrison, V

    1991-01-01

    To examine in vivo the separate effects on distal tubule JtCO2, of dietary chloride restriction, bicarbonate loading, and changes in luminal chloride concentration, we microperfused distal tubules at a physiologic flow rate (8 nl/min) with solutions containing either 45 or 0 mM chloride (after gluconate substitution). Rats were fed a diet containing zero, minimal, or normal amounts of chloride, while drinking either water or a solution of 0.15 M sodium bicarbonate. Neither extracellular fluid...

  16. 急性危重病人并发碱中毒769例分析%Acute of critical patients complicated by alkalosis an analysis of 769 cases

    Institute of Scientific and Technical Information of China (English)

    胡林; 任成山; 陆海华; 郭中杰; 高全杰; 杨颂华

    2001-01-01

    目的提高对急性危重病人并发碱中毒的认识和救治水平.方法分析了769例急性危重病人的动脉血气、血清电解质参数及临床资料.结果急性危重病人碱中毒的类型依次为呼吸性碱中毒(呼碱)并代谢性碱中毒(代碱)216例(28.1%),单纯呼碱159例(20.7%),呼碱并代谢性酸中毒(代酸)105例(13.6%),单纯代碱93例(12.1%),三重酸碱失衡90例(11.7%),呼吸性酸中毒(呼酸)并代碱64例(8.3%)和代碱并代酸42例(5.5%).769例中PaO2<8.0 kPa(1 kPa=7.5 mmHg)者386例(50.2%).全组中死亡者316例(41.1%).结论急性危重病人碱中毒是常见的,其中以呼碱并代碱和单纯性呼碱为最常见,通常原发疾病因素引起呼碱或伴有低氧血症.救治原则为积极治疗原发疾病,从纠正原发失衡着手,维持水电解质平衡,对于合并多脏器功能损害的重度碱中毒患者,可行血液透析或血液超滤法快速纠正严重的碱血症和过多的体液负荷.尽快使pH恢复正常至关重要.

  17. Study on metabolic alkalosis in growers induced by high dietary calcium%高钙日粮致鸡代谢性碱中毒的研究

    Institute of Scientific and Technical Information of China (English)

    郭小权; 黄克和; 陈甫; 骆建兵; 潘翠玲

    2006-01-01

    将100羽35日龄伊沙蛋鸡随机均分为对照组(含钙1.00%)和高钙组(含钙3.78%).在饲喂高钙日粮32 d时对2组鸡作动脉血血气分析及血清电解质测定,并采用结肠造口术收集尿液,测定鸡尿液电解质的变化,以探讨高钙日粮对鸡体内酸碱度和电解质变化的影响.结果表明,高钙日粮能致鸡腹泻;高钙组尿量增加,尿液pH值较对照组显著升高;与对照组相比,高钙组鸡血液pH值、碳酸氢根以及剩余碱显著升高,动脉血氧分压、二氧化碳分压和血氧饱和度显著降低;高钙组血清无机磷和钾显著降低,血清钙显著升高,血清镁、氯稍有下降,钠稍有升高,但差异不显著(P>0.05);高钙组鸡尿液中的钾相对含量和24 h总量稍低于对照组(P>0.05);高钙组尿钙及尿氯相对含量和24 h总量均显著高于对照组,高钙组尿磷、尿钠与尿镁相对含量和24 h总量显著低于对照组.说明高钙日粮能引起鸡代谢性碱中毒和电解质代谢紊乱.

  18. Diagnosis and treatment of pediatric hypochloremia alkalosis%低氯性碱中毒的病因、诊断与治疗

    Institute of Scientific and Technical Information of China (English)

    刘春峰; 袁壮

    2004-01-01

    低氯性碱中毒为代谢性碱中毒的一种类型,在儿科重症抢救室较为常见。代谢性碱中毒对机体有较大危害,除引起酸碱平衡及电解质紊乱外,严重者可危及生命。由于它多发生于危重患儿,并多在其他疾病基础之上(如呼吸系统、消化系统、神经系统等),常为原发病所掩盖,而且临床表现多样

  19. Clinical analysis of alkalosis in 868 critically ill patients%868例危重患者碱中毒的分析

    Institute of Scientific and Technical Information of China (English)

    钱桂生; 陈维中; 赵志强

    2000-01-01

    目的:探讨危重患者碱中毒类型、特点及原因.方法:分析了868例危重患者1 470例次动脉血气、血电解质参数及临床资料.结果:危重患者碱中毒类型依次为呼吸性碱中毒(呼碱,668例次,45.44%),代谢性碱中毒(代碱,362例次,24.63%),呼碱并代碱(270例次,18.37%),呼碱型三重酸碱失衡(102例次,6.94%),呼吸性酸中毒(呼酸)并代碱(68例次,4.63%).其中773例次PaO2<8 kPa(52.59%,1 kPa=7.5 mmHg).引起碱中毒原因多样.结论:危重患者碱中毒是常见的,以呼碱最常见,常同时伴有Ⅰ型呼吸衰竭.通常是既往呼吸功能正常的危重患者的原发疾病引起呼碱伴有低氧血症,而代碱大部分是医源性因素引起的.多脏器功能损害的危重患者可出现呼碱型三重酸碱失衡.

  20. Chloride Test

    Science.gov (United States)

    ... electrolyte or metabolic panel, may be ordered when acidosis or alkalosis is suspected or when someone has ... base is lost from the body (producing metabolic acidosis ) or when a person hyperventilates (causing respiratory alkalosis ). ...

  1. Efectos de la alcalosis metabólica inducida por la dieta en el rendimiento anaeróbico de alta intensidad Effects of the metabolic alkalosis induced by the diet in the high intensity anaerobic performance

    Directory of Open Access Journals (Sweden)

    O. Ríos Enríquez

    2010-10-01

    Full Text Available Objetivos: El propósito principal de este estudio es comparar el efecto de una alcalosis y acidosis inducidas por la dieta sobre el rendimiento en un esfuerzo anaeróbico láctico mantenido. Métodos: Para ello, trece sujetos activos se sometieron de forma cruzada a sendas dietas durante dos días y medio. Inmediatamente después realizaron una prueba de esfuerzo anaeróbica láctica máxima de estado estable hasta el agotamiento sobre cicloergómetro a 250 W. Resultados: La valoración de las dietas mostró una diferencia significativa en la excreción renal neta de ácidos (NAE estimada, así como un déficit calórico del 54% en la dieta alcalinizante, debido principalmente a una ingesta reducida de hidratos de carbono. En un 83% de los sujetos aumentó el pH urinario tras la dieta alcalinizante. El 77% incrementó sus niveles de lactato en sangre en la prueba tras la dieta alcalina. Los tiempos hasta la extenuación durante la prueba mejoraron o se mantuvieron en un 58% de los sujetos, siendo las mujeres las que mejor respondieron a la dieta con un 83% de casos. Conclusiones: Parece haber evidencias de mejora de rendimiento en esfuerzos de tipo anaeróbico láctico hasta el agotamiento de 60 s a 2 min de duración tras consumir una dieta con potencial alcalinizante.Objectives: The purpose of this study is to compare the effects of two diets, one acidifier and the other alkalizer, on the sport performance in an extreme anaerobic stress test. Methods: For that purpose thirteen individuals were subjected to two such diets in a crossed test for two and a half days. Immediately after, they were tested in a maximum lactic anaerobic stress test of stable state to exhaustion on an ergo-cycle at 250W. Results: The assessment of the diets yielded a significant difference in the estimated NAE (net acid excretion and a caloric deficit of 54% on the alkalizer diet, mainly due to a reduced ingestion of carbohydrates. The urinary pH increased by 83% for the individuals subjected to the alkalizer diet, 77% of those subjects experienced an increase in their blood lactate level during the test. The time to exhaustion while on the test improved or remained in 58% of the subjects, being the females who reacted best to the diet in 83% of the cases. Conclusions: There seems to be evidence of improvement in extreme anaerobic stress test to exhaustion from 60s to 2 mins of duration after consuming a diet with alkalizer potential.

  2. 危重儿代谢性碱中毒82例临床分析%Clinical Analysis of Metabolic Alkalosis in 82 Cases of Critically Acute Children

    Institute of Scientific and Technical Information of China (English)

    孙晓敏; 张英丽

    2007-01-01

    目的 探讨引起危重儿代谢性碱中毒(代碱)的原因和临床特点.方法 检测危重儿血气分析390例,并分析代碱的类型及代碱严重程度与死亡率的关系.结果 共检测出代碱82例(21%),其中代碱+呼酸26例,代碱+呼碱24例,代碱+代酸5例,单纯代碱27例.pH7.45~7.60 21例,死亡率4.8%,pH7.60~7.70 39例,死亡率10.26%,pH7.70~7.90 22例,死亡率22.7%,各组间差异显著(P<0.01).结论 危重儿代碱随着pH增高,死亡率明显增高,故临床应注意避免其发生并及时纠正,以提高危重儿抢救成功率.

  3. 新生儿机械通气时呼吸性碱中毒多因素分析%Multifactor Analysis of Neonatal Respiratory Alkalosis during Mechanical Ventilation

    Institute of Scientific and Technical Information of China (English)

    刘勇

    2006-01-01

    目的了解影响新生儿呼吸性碱中毒(呼碱)的发生因素并探讨解决方法.方法通过比较47例不同年份、孕周、体质量、肺部疾病、转归、上机时间新生儿呼碱发生率;呼碱和非呼碱时呼吸机参数,以发现影响呼碱发生因素.并对这些因素进行Logistic回归分析.结果不同孕周、原发病、通气方式之间,呼碱的发生率有显著性差异;呼碱组与非吸碱组呼气末正压(PEEP)、吸气时间(TI)有显著差异.经多因素回归分析显示,TI延长、PEEP提高和原发病是影响呼碱发生的重要因素.结论正确调节呼吸机参数并考虑不同疾病的性质,可减少呼碱发生.

  4. 新生儿呼吸衰竭人工呼吸器治疗及有关呼碱调节的探讨%Mechanical ventilation therapy and management of respiratoy alkalosis in respiatosy failuse of newborr

    Institute of Scientific and Technical Information of China (English)

    汤泽中; 虞人杰

    1995-01-01

    本文通过对我院两年来34例呼吸器供氧治疗呼吸衰竭(呼衰)作了总结,结果:1.鼻塞CPAP17例,全部成活.IPPV+PEEP(CPPV)17例,成活12例,CPPV成活率为70.6%.2.对呼吸性碱中毒(9/17)原因及处理加以分析,过度通气、初调值偏高为主要原因,血气分析不及时造成呼碱程度加重.处理上除调节PIP,RR,F和I:R外还可使用IMV.3.对IMV使用指征加以扩充:轻度呼衰,呼吸器撤离前的过渡和伴随自主呼吸的呼吸性碱中毒可首选使用IMV.

  5. The Clinical Significance of Hyperventilation and Respiratory Alkalosis in the Patients with Liver Cirrhosis%肝硬化患者过度通气及呼吸性碱中毒的临床意义

    Institute of Scientific and Technical Information of China (English)

    张宇川; 张尤历; 陈世耀; 范钰

    2006-01-01

    目的:探讨肝硬化患者过度通气及其引起的呼吸性碱中毒的临床意义.方法:97例诊断明确的肝硬化患者,其中代偿期肝硬化34例;失代偿期肝硬化无肝性脑病35例;失代偿期肝硬化合并肝性脑病的28例.所有病例均进行动脉血气分析,比较3组患者低二氧化碳血症和呼吸性碱中毒的发生率及严重程度.结果:①代偿期肝硬化组、失代偿期肝硬化无肝性脑病组、失代偿期肝硬化合并肝性脑病组低二氧化碳血症发生率依次增高(P<0.01);3组PaCO2依次降低(P<0.01);②代偿期肝硬化组、失代偿期肝硬化无肝性脑病组、失代偿期肝硬化合并肝性脑病组呼吸性碱中毒的发生率依次增高(P<0.05),呼吸性碱中毒也依次加重(P<0.01).结论:肝硬化患者随着肝功能的减退,容易发生过度通气,而过度通气造成呼吸性碱中毒,进一步加重肝硬化患者的病情.在治疗肝硬化时应注意监测和纠正酸硷紊乱.

  6. Influence of Alkalosis on Intrinsic Properties and Encoding of Cerebral GABAergic Neurons in Mice%碱中毒对小鼠皮质GABA能神经元特性和编码能力的影响

    Institute of Scientific and Technical Information of China (English)

    孙玲; 张忠玲; 常明秀; 方婧; 陆云婷

    2016-01-01

    目的:研究碱中毒对小鼠皮质GABA能神经元内在特性和编码能力的影响,探讨碱中毒引起大脑功能障碍的机制.方法:选择17-22天FVB-Tg小鼠行脑片体外培养,实验对象分为碱中毒组和对照组.DIC光学显微镜下选择皮层Ⅱ-Ⅲ层GABA神经元,运用AxoPatch 200B放大器全细胞模式,记录并分析神经元内在特性(包括阈电位、绝对不应期)的改变;记录与去极化脉冲相对应的峰值,分析GABA能神经元的编码能力.结果:1.阈电位峰值在对照组分别是24.58±0.68,25.44± 0.82,27.02±0.78,27.55±0.74和28.66±0.79毫伏,碱中毒组分别是28.32±0.78,30.10±0.91,32.22±0.80,32.88士0.76和33.54± 0.74毫伏,碱中毒组阈电位升高;绝对不应期在对照组和碱中毒组分别是4.15±0.06和5.09±0.08毫秒,碱中毒绝对不应期延长.2.两组在相同去极化刺激下诱发的连续峰值波形发生明显改变,碱中毒组产生峰值的能力下降.结论:1、碱中毒使皮质GABA能神经元动阈电位升高和绝对不应期延长;2、碱中毒降低皮质GABA能神经元编码峰值能力.

  7. Ⅱ型呼吸衰竭合并代谢性碱中毒48例临床分析%Analysis of 48 Cases of Type Ⅱ Respiratory Failure with Complication of Metabolic Alkalosis

    Institute of Scientific and Technical Information of China (English)

    陈建永; 林杰

    2007-01-01

    目的 探讨Ⅱ型呼吸衰竭患者发生代谢性碱中毒的原因.方法 对48例慢性阻塞性肺疾病(COPD)出现Ⅱ型呼吸衰竭合并代谢性碱中毒患者进行回顾性分析.结果 应用糖皮质激素40例,利尿剂35例,呼吸兴奋剂11例,碱性药物10例,人工机械通气3例.全部病例均在住院治疗过程中发生.结论 Ⅱ型呼吸衰竭合并代谢性碱中毒大部分是医源性的,应及时予以纠正,避免病情加重.

  8. Ⅱ型呼吸衰竭合并医源性代谢性碱中毒32例分析%Clinical analysis of 32 cases of II respiratory failure with latrogenic metabolic alkalosis

    Institute of Scientific and Technical Information of China (English)

    陈海珍; 邹德奇

    2005-01-01

    目的探讨Ⅱ型呼吸衰竭合并医源性代谢性碱中毒的原因与防治.方法结合动脉血气分析结果,分析32例Ⅱ型呼吸衰竭合并医源性代谢性碱中毒的临床特点.结果Ⅱ型呼吸衰竭合并代谢性碱中毒的原因96.9%与药物使用不当有关.结论Ⅱ型呼吸衰竭患者的治疗应结合血气分析的结果并恰当的使用药物是预防医源性代谢性碱中毒的方法之一.

  9. PPH术后并发呼吸性碱中毒的临床分析%The clinical analysis of respiratory alkalosis in the patients with the complications prolapse and hemorrhoids

    Institute of Scientific and Technical Information of China (English)

    汤国辉; 伍洲颂; 刘丽兵; 邓秋林; 邢佼涛

    2015-01-01

    目的 探讨吻合器痔上粘膜环切术(PPH)术后并发呼吸性碱中毒的诊断及处理.方法 对2010年-2014年我科PPH术后出现呼吸性碱中毒的病例资料进行回顾性分析.结果 所有患者经过精神引导,湿纱布或面罩置于口鼻重复呼吸、药物治疗等积极治疗,临床症状均可于短时间内缓解.对治疗前后血气主要指标进行统计学处理,差异有高度显著性(P<001).结论 PPH术后出现呼吸性碱中毒的并发症在临床上较少见,临床医生应该加强对此并发症的认识.

  10. Effect of Arginine and Naloxone in treating 33 cases of patients with hepatic encephalopathy and alkalosis%精氨酸联合纳洛酮治疗肝性脑病合并碱中毒33例

    Institute of Scientific and Technical Information of China (English)

    崔进昌

    2010-01-01

    目的 观察精氨酸联合纳洛酮治疗肝性脑病合并碱中毒的疗效.方法 肝性脑病患者33例,均有不同程度的碱中毒.治疗前后测定患者血氨的含量,并观察精氨酸联合纳洛酮对肝性脑病的疗效.结果 肝性脑病合并碱中毒患者血氨含量明显增加,且与肝性脑病程度相关.精氨酸联合纳洛酮治疗后血氨含量下降程度较为明显,治疗前后相比具有显著性差异(P<0.01).此外,精氨酸联合纳洛酮治疗患者清醒率达81.82%,效果良好.结论 精氨酸联合纳洛酮对肝性脑病合并碱中毒具有明显疗效.

  11. Proposal of a new method of judging metabolic acidosis and metabolic alkalosis in the condition of high anion gap%改进高阴离子间隙代谢性酸中毒判断方法

    Institute of Scientific and Technical Information of China (English)

    周寿生

    2008-01-01

    目的 改进高AG代酸的判断方法.方法 通过分析人体血浆中阴离子间变化的特殊关系,提出高AG代酸判断新方法.结果 到目前为止国内外在对高AG代酸的判断中的确存在明显的过度判断问题,判断方法需要改进.结论 对于高AG代酸过去一直没有较好的判断方法,误判漏判现象常有发生.改进判断方法后可以防止误判漏判.

  12. 肺心病呼吸性酸中毒合并代谢性碱中毒52例临床分析%The lung worry breath acidosis combines clinical supersession nature alkalosis 52 examples analysis

    Institute of Scientific and Technical Information of China (English)

    孟晓皓

    2009-01-01

    目的:对肺心病急性发作期呼吸性酸中毒合并代谢性碱中毒患者的诊断及治疗进行探讨.方法:对52例肺心病急性发作期呼吸性酸中毒合并代谢性碱中毒患者的血气分析及电解质进行调查,并查找诱发因素.结果:因为不适当应用利尿剂24例,糖皮质激素18例,应用碱性药物1例,呼吸兴奋剂3例,呼吸机治疗1例,呕吐4例,呕血3例,有两种以上诱因8例,死亡3例.结论:呼吸性酸中毒合并代谢性碱中毒对肺心病患者极为不利,临床要重视该酸碱平衡紊乱.

  13. 围手术期危重症患者代谢性碱中毒维持因素的临床研究%Clinical study of maintenance factors in metabolic alkalosis of critically ill patients during perioperative period

    Institute of Scientific and Technical Information of China (English)

    沈勤军; 朱蕾; 何礼贤; 钮善福

    2008-01-01

    目的 研究肾脏在围手术期代谢性碱中毒维持阶段所起的作用.方法 选择中山医院2004年11月~2005年2月在外科监护室中发生代谢性碱中毒,且符合入选标准的患者作为病例组;对照组为与病例组同期的肝外科手术有可比性,并除外发生酸碱失衡的患者.对入选患者进行常规检查并记录以下指标:内生肌酐清除率[Ccr,用于评价肾小球滤过率(GFR)]、尿可滴定酸(TA)、铵离子(NH4+)、碳酸氢根离子(HCO3-)及净泌酸量(NAE)等.结果 (1)病例组和对照组术后Ccr分别为(76.2±37.1)mL/min和(98.5±31.9)mL/min,前者降低22.6%(P=0.042).[NH4+]分别为(140.6±81.6)mmol/24 h和(78.7±16.3)mmol/24 h(P=0.002);NAE分别为(156.5±84.3)mmol/24 h和(117.5±32.1)mmol/24 h(P=0.047);TA分别为(25.2±19.4)mmol/24 h和(49.9±26.4)mmol/24 h(P=0.002).(2)病例组与对照组术后电解质变化:[K+]分别为(3.51±0.67)mmol/L和(4.14±0.59)mmol/L(P=0.002);[Cl-]分别为(98.4±8.3)mmol/L和(102.8±3.0)mmol/L(P=0.035);[Ca2+]分别为(2.14±0.21)mmol/L和(2.25±0.14)mmol/L(P=0.049);[P]分别为(0.83±0.34)mmoL/L和(1.11±0.23)mmol/L(P=0.004);[Na+]分别为(139.6±7.7)mmol/L和(140.8±4.6)mmol/L(P=0.535);[Mg2+]分别为(0.94±0.15)mmol/L和(0.90±0.16)mmol/L(P=0.338).结论 肾小球滤过率下降以及肾脏酸化功能增强是维持代谢性碱中毒持续存在的重要因素.代谢性碱中毒时K+、Cl-、Ca2+及P均下降,Na+和Mg2+无明显变化.

  14. 过度通气对血液碱化后脑脊液酸碱变化的影响%Effect of hyperventilation on cerebrospinal fluid acid-base variables after blood alkalosis

    Institute of Scientific and Technical Information of China (English)

    金发光; 钱桂生

    1999-01-01

    目的:探讨过度通气对血液碱化后脑脊液(CSF)酸碱变化的影响. 方法:10只麻醉犬,分为碱中毒过度通气组(Ⅰ组)和碱中毒自主通气组(Ⅱ组). 两组犬均由静脉输入50 g/L碳酸氢钠(50 mmol/kg),1 h内使[( )]a上升到(30.0±2.5) mmol/L. Ⅰ组控制过度通气,Ⅱ组自主呼吸,两组同步分别在过度通气后20,40,60 min采集动脉血和CSF标本,检测其主要酸碱变量. 结果:在两组碱中毒无显著差异时,Ⅰ组CSF酸碱变化同动脉血一致,CSF pH升高,Ⅱ组CSF酸碱变化同动脉血相反,CSF呈酸中毒. 结论:快速静脉输入碳酸氢钠可引起血液碱化后CSF酸中毒,而过度通气可预防血液碱化后CSF酸中毒.

  15. 慢性阻塞性肺病呼吸衰竭机械通气并发代谢性碱中毒20例临床分析%Ventilation Treatment of Complicated COPD Respiratory Failure Metabolic Alkalosis an Analysis of 20 Cases

    Institute of Scientific and Technical Information of China (English)

    李子明; 胡福定; 梁晓; 胡莎

    2002-01-01

    目的:探讨COPDⅡ型呼吸衰竭机械通气并发代谢性碱中毒的病因和治疗、预防的方法.方法:62例COPD急性发作期Ⅱ型呼吸衰竭行机械通气持续72?h以上,其中20例并发代谢性碱中毒,对该组病例通气前、后24?h,48?h,72?h进行血气及电解质测定并进行比较分析.结果:20例COPDⅡ型呼吸衰竭患者机械通气前有低钠、低氯存在,机械通气后CO2排出过快,pH值升高,出现不同程度的兴奋、躁动等碱中毒症状.结论:CO2排出过快及低钠、低氯是造成机械通气中代谢性碱中毒的原因,可容许高碳血酸症和及时补钠、氯是预防和治疗代谢性碱中毒的主要方法.

  16. The effects of the hydrochloride arginine treatment by intravenous injection continuously on the head injury patients with severe metabolic alkalosis%盐酸精氨酸治疗脑外伤严重代谢性碱中毒30例分析

    Institute of Scientific and Technical Information of China (English)

    刘威; 于荣国; 叶勇; 龚书榕; 周晓芬

    2011-01-01

    目的 分析盐酸精氨酸持续微量泵输入治疗脑外伤患者严重代谢性碱中毒的量效关系及对近期患者预后的影响.方法 选择成年严重颅脑外伤合并严重碱中毒患者30例,持续微量泵输注盐酸精氩酸0.55 g/(h·kg),通过血气分析观察治疗前后碱剩余(BE)变化情况,计算精氨酸治疗碱中毒的量效关系.结果 盐酸精氨酸治疗严重代谢性碱中毒后,BE下降(11.94±3.45,8.74±3.67,P<0.001),pH(7.47±0.06,7.45±0.05,P<0.05),PaCO2也同时有下降(49.73±10.48,46.53±9.26,P<0.05),Na+、Cl-和K+变化不明显;BE下降梯度为△3.19±2.24.结论 盐酸精氨酸持续微量泵输入可以有效纠正脑外伤患者严重碱中毒.

  17. Potassium test

    Science.gov (United States)

    ... also be done if your provider suspects metabolic acidosis (for example, caused by uncontrolled diabetes) or alkalosis ( ... Hypoaldosteronism (very rare) Kidney failure Metabolic or respiratory acidosis Red blood cell destruction Too much potassium in ...

  18. Generaliserede kramper som debutsymptom ved Gitelmans syndrom

    DEFF Research Database (Denmark)

    Hvelplund, Carolina; Jeppesen, Eva Mosfeldt; Mortensen, Henrik B;

    2009-01-01

    Gitelman's syndrome is a rare autosomal recessive syndrome presenting with hypocalciuria, hypomagnesiemia and hypokalemic metabolic alkalosis. This case reports a patient admitted with generalized seizures with the above-mentioned biochemical abnormalities, thus representing a rare onset of Gitel......Gitelman's syndrome is a rare autosomal recessive syndrome presenting with hypocalciuria, hypomagnesiemia and hypokalemic metabolic alkalosis. This case reports a patient admitted with generalized seizures with the above-mentioned biochemical abnormalities, thus representing a rare onset...

  19. Profile of acid-base disturbances in an intensive care unit of Fortaleza, Ceará, Brazil.

    Directory of Open Access Journals (Sweden)

    Renan Barbosa Rodrigues

    2014-09-01

    Full Text Available Introduction: Acid – base disturbances are entities caused by the deregulation of the concentration of bicarbonate ions, the concentration of hydrogen ions and the partial pressure of carbon dioxide in the blood. These disturbances modify most cell fuctions when present, jeopardizing the proper functioning of organs.Methods: Cross-sectional analytical study based upon data collected from medical files of patients in ICU as seen from August 1 to December 31, 2013 at the Dr. José Frota Institute in Fortaleza, Ceará. The variables studied were: age, sex, cause of ICU admission, pH, HCO3-, pO2, pCO2 , glomerular filtration rate ( GFR , serum potassium concentrarion, serum magnesium concentration, serum creatinine and hemoglobin levels.Results: The most frequent disorders were primary respiratory alkalosis with               33 ( 38,4 % cases, 30 ( 34,9 % of metabolic alkalosis, 13 ( 15.1% of metabolic acidosis,    7 ( 8,2% did not present acid-base disorders and respiratory acidosis           3 ( 3,5%. Patients admitted with TBI had respiratory alkalosis as the most common primary disorder, followed by metabolic alkalosis, 16 ( 47,0 % and 13 ( 38,2 % , respectively. The main disturbances were mixed respiratory alkalosis with metabolic alkalosis and respiratory alkalosis with metabolic alkalosis found in 15.12% of patients in each of these combinations. Conclusion:The importance  of a detailed evaluation of acid-base disturbances is necessary since these disorders lead to higher mortality rates, so it is necessary to establish the main types of disorders that are associated with a particular cause of hospitalization .

  20. Acid-base balance, dentinogenesis and dental caries:experimental studies in rats

    OpenAIRE

    Bäckman, T. (Tuula)

    1999-01-01

    Abstract High-sucrose diet and metabolic acidosis have some similar effects on bone and they both reduce the formation of dentine. This series of experiments was conducted in order to get information about the effects of acidosis and alkalosis on dentine during primary dentinogenesis and also to ascertain if high-sucrose diet affects dentine formation via acidosis. Chronic metabolic acidosis (0.25 mol/L of NH4Cl in drinking water), chronic metabolic alkalosis (0.25 mol/L of NaHCO3 in drink...

  1. Metabolic Alkalosis:A Real Danger of Overdiuresis in Patients with Heart Failure

    Institute of Scientific and Technical Information of China (English)

    Yaseen Ali; Amila M. Parekh; Rahul K. Rao; Mirza R. Baig

    2015-01-01

    Chronic heart failure is one of the most common reasons for hospital admissions in the United States. A patient is diagnosed with heart failure when the heart is unable to do its physiological work of pumping the blood to the peripheral organs. At this time, the excess volume of lfuid can accumulate easily, leading to signs of lfuid overload. Loop diuretics has been at the forefront to alleviate these symptoms. It has its own side effects, but a lesser known and monitored is metabolic alkalosis. Herein, we reviewed a case where a patient developed metabolic alkalosis due to loop diuretics.

  2. Milk alkali syndrome induced by calcitriol and calcium bicarbonate in a patient with hypoparathyroidism

    Directory of Open Access Journals (Sweden)

    Eda Altun

    2013-01-01

    Full Text Available The milk-alkali syndrome (MAS was a common cause of hypercalcemia, metabolic alkalosis, and renal failure in the early 20 th century. This syndrome was first recognized secondary to treatment of peptic ulcer disease with milk and absorbable alkali. Its incidence fell after the introduction of H2-blocker and proton pump inhibitor. Persistent ingestion of calcium carbonate and vitamin D caused MAS. We report a patient presenting with a triad of hypercalcemia, metabolic alkalosis and renal failure secondary to treatment of idiopathic hypoparathyroidism.

  3. Furosemide Induced Electrolyte Imbalance: A Real Danger of Overdiuresis in Patients with Heart Failure

    Directory of Open Access Journals (Sweden)

    Yaseen Ali

    2014-12-01

    Full Text Available Background: Chronic heart failure is one of the most common reasons for hospital admissions in the United States. There have been several approaches for treating heart failure but loop diuretics has been at the forefront to alleviate the symptoms. Loop diuretics have their own side effects as with any medication use, and a lesser known and monitored one is metabolic alkalosis. Case report: The patient was a 76 years old female with past medical history of diabetes, hypertension, chronic kidney disease, dyslipidemia and chronic heart failure who came to the hospital with progressive shortness of breath for the past few days and was started on aggressive diuresis with intravenous loop diuretics and well responded. On the morning of d 6 of her admission, she was kept on the floor and started on BIPAP to correct hypercarbia and respiratory acidosis due to metabolic alkalosis and back to baseline with normal mentation by the middle of the day. Conclusion: Hypokalemia due to the diuretic effect can cause alkalosis by resulting in the shift of hydrogen ions intracellularly, stimulating the apical H+/K+ ATPase in the collecting duct, stimulating renal ammonia genesis, reabsorption, and secretion, leading to impaired chloride ion reabsorption in the distal nephron and reducing the glomerular filtration rate (GFR. The patient improved after being started on oxygen therapy and switched to acetazolamide as an alternative diuretic, indicating that acetazolamide corrected the effect of metabolic alkalosis by causing metabolic acidosis due to decrease reclamation of bicarbonate at the level of proximal convoluted tubule.

  4. Lactate: panicking doctor or panicking patient?

    OpenAIRE

    de Ridder, Stijn; Kuijpers, Petra; Crijns, Harry

    2010-01-01

    We report a case of a 51-year-old man with a first panic attack associated with high serum lactate due to hyperventilation induced alkalosis. Hyperlactataemia may trigger somatically oriented tests and divert attention from diagnosing panic disorder (PD). Factors associated with underdiagnosis of PD as well as pathophysiology of hyperlactataemia will be discussed.

  5. Reverse ventilation--perfusion mismatch

    International Nuclear Information System (INIS)

    Patients having lobar airway obstruction or consolidation usually have decreases of both ventilation and perfusion on lung scans. We report three patients in whom hypoxic vasoconstriction was apparently incomplete, resulting in a ''reversed'' ventilation-perfusion mismatch. Perfusion of the hypoxic lobe on the radionuclide scan was associated with metabolic alkalosis, pulmonary venous and pulmonary arterial hypertension in these patients

  6. Altered renal distal tubule structure and renal Na(+) and Ca(2+) handling in a mouse model for Gitelman's syndrome.

    NARCIS (Netherlands)

    Loffing, J.; Vallon, V.; Loffing-Cueni, D.; Aregger, F.; Richter, K.H.; Pietri, L.; Bloch-Faure, M.; Hoenderop, J.G.J.; Shull, G.E.; Meneton, P.; Kaissling, B.

    2004-01-01

    Gitelman's syndrome, an autosomal recessive renal tubulopathy caused by loss-of-function mutations in the thiazide-sensitive NaCl co-transporter (NCC) of the distal convoluted tubule (DCT), is characterized by mild renal Na(+) wasting, hypocalciuria, hypomagnesemia, and hypokalemic alkalosis. For ga

  7. Effect of urinary pH on the progression of urinary bladder tumours

    NARCIS (Netherlands)

    Lina, B.A.R.; Garderen-Hoetmer, A. van

    1999-01-01

    Systemic alkalosis has been postulated to enhance tumorigenesis, whereas systemic acidosis has been implicated to exert a favourable influence on tumour control and regression. In the present study the urinary pH was influenced by feeding acid-forming or base-forming diets, and the effect of alkalin

  8. Effect of acute metabolic acid/base shifts on the human airway calibre.

    NARCIS (Netherlands)

    Brijker, F.; Elshout, F.J.J. van den; Heijdra, Y.F.; Bosch, F.H.; Folgering, H.T.M.

    2001-01-01

    Acute metabolic alkalosis (NaHCO(3)), acidosis (NH(4)Cl), and placebo (NaCl) were induced in 15 healthy volunteers (12 females, median age 34 (range 24-56) years) in a double blind, placebo controlled study to evaluate the presence of the effects on airway calibre. Acid-base shifts were determined b

  9. Gitelman syndrome.

    NARCIS (Netherlands)

    Knoers, N.V.A.M.; Levtchenko, E.N.

    2008-01-01

    Gitelman syndrome (GS), also referred to as familial hypokalemia-hypomagnesemia, is characterized by hypokalemic metabolic alkalosis in combination with significant hypomagnesemia and low urinary calcium excretion. The prevalence is estimated at approximately 1:40,000 and accordingly, the prevalence

  10. Dynamics of Ca2+i and pHi in Ehrlich ascites tumor cells after Ca2+-mobilizing agonists or exposure to hypertonic solution

    DEFF Research Database (Denmark)

    Pedersen, Stine F.; Jørgensen, Nanna K.; Hoffmann, Else Kay

    1998-01-01

    , apparently via stimulation of Ca2+ influx, whereas shrinkage-induced intracellular alkalinization did not stimulate Ca2+ influx. Thus, cell shrinkage appears to inhibit the Ca2+ influx otherwise resulting from alkalosis. In agreement with that notion, thapsigargin-induced Ca2+ influx was inhibited by cell...

  11. Novel NCC mutants and functional analysis in a new cohort of patients with Gitelman syndrome

    NARCIS (Netherlands)

    Glaudemans, B.; Yntema, H.G.; San-Cristobal, P.; Schoots, J.; Pfundt, R.; Kamsteeg, E.J.; Bindels, R.J.; Knoers, N.V.; Hoenderop, J.G.J.; Hoefsloot, L.H.

    2012-01-01

    Gitelman syndrome (GS) is an autosomal recessive disorder characterized by hypokalemic metabolic alkalosis in conjunction with significant hypomagnesemia and hypocalciuria. The GS phenotype is caused by mutations in the solute carrier family 12, member 3 (SLC12A3) gene that encodes the thiazide-sens

  12. Gitelman's syndrome: towards genotype-phenotype correlations?

    NARCIS (Netherlands)

    Riveira-Munoz, E.; Chang, Q.; Bindels, R.J.M.; Devuyst, O.

    2007-01-01

    Gitelman's syndrome (GS) is a salt-losing tubulopathy characterized by hypokalemic alkalosis with hypomagnesemia and hypocalciuria. The disease is associated with inactivating mutations in the SLC12A3 gene that codes for the thiazide-sensitive Na+-Cl- cotransporter (NCCT) that is expressed in the ap

  13. Bartter syndrome Type III and congenital anomalies of the kidney and urinary tract: an antenatal presentation

    NARCIS (Netherlands)

    Westland, R.; Hack, W.W.; Horst, H.J. van der; Uittenbogaard, L.B.; Hagen, J.M. van; Valk, P. van der; Kamsteeg, E.J.; Heuvel, L.P. van den; Wijk, J.A. van

    2012-01-01

    Bartter syndrome encompasses a variety of inheritable renal tubular transport disorders characterized by hypokalemia and hypochloremic metabolic alkalosis. Bartter syndrome Type III is caused by genetic alterations in the chloride channel kidney B (CLCNKB) gene and often presents in the first 2 year

  14. Acid-base status determines the renal expression of Ca2+ and Mg2+ transport proteins.

    NARCIS (Netherlands)

    Nijenhuis, T.; Renkema, K.Y.R.; Hoenderop, J.G.J.; Bindels, R.J.M.

    2006-01-01

    Chronic metabolic acidosis results in renal Ca2+ and Mg2+ wasting, whereas chronic metabolic alkalosis is known to exert the reverse effects. It was hypothesized that these adaptations are mediated at least in part by the renal Ca2+ and Mg2+ transport proteins. The aim of this study, therefore, was

  15. Over-the-counter kaolin and morphine: two hazards in one

    OpenAIRE

    Boland, Alison; Tunnard, Gavin Jonathan; Bazaz, Rohit

    2010-01-01

    A 56-year-old woman, who was admitted with hypokalaemia, hypertension and metabolic alkalosis, was found to be dependent on kaolin and morphine, a common agent used for the treatment of diarrhoea. This case report highlights the problems of an over-the-counter (OTC) medicine such as kaolin and morphine when it can be purchased in large quantities.

  16. Furosemide Induced Electrolyte Imbalance: A Real Danger of Overdiuresis in Patients with Heart Failure

    Institute of Scientific and Technical Information of China (English)

    Yaseen Ali; Amila M. Parekh; Rahul K. Rao; Mirza R. Baig

    2014-01-01

    Background: Chronic heart failure is one of the most common reasons for hospital admissions in the United States. There have been several approaches for treating heart failure but loop diuretics has been at the forefront to alleviate the symptoms. Loop diuretics have their own side effects as with any medication use, and a lesser known and monitored one is metabolic alkalosis. Case report: The patient was a 76-year-old female with past medical history of diabetes, hypertension, chronic kidney disease, dyslipidemia and chronic heart failure who came to the hospital with progressive shortness of breath for the past few days and was started on aggressive diuresis with intravenous loop diuretics and well responded. On the morning of d 6 of her admission, she was kept on the lfoor and started on BIPAP to correct hypercarbia and respiratory acidosis due to metabolic alkalosis and back to baseline with normal mentation by the middle of the day. Conclusion: Hypokalemia due to the diuretic effect can cause alkalosis by resulting in the shift of hydrogen ions intracellularly, stimulating the apical H+/K+ ATPase in the collecting duct, stimulating renal ammonia genesis, reabsorption, and secretion, leading to impaired chloride ion reabsorption in the distal nephron and reducing the glomerular ifltration rate (GFR). The patient improved after being started on oxygen therapy and switched to acetazolamide as an alternative diuretic, indicating that acetazolamide corrects the effect of metabolic alkalosis by causing metabolic acidosis due to decrease reclamation of bicarbonate at the level of proximal convoluted tubule.

  17. Changes of Electrolyte and Acid-Base Balance Following Definitive Procedure for Hischsprung's Disease%小儿腹部大手术后碱中毒的发生及电解质的改变

    Institute of Scientific and Technical Information of China (English)

    夏慧敏; 邵景范; 周蓉儿

    1992-01-01

    对35例小儿腹部大手术巨结肠根治术患儿,手术前后体内水,电解质及酸碱内环境的改变进行了动态观察.结果发现:大手术患儿术后血钾明显下降,术后1、3天碱中毒的发生率分别为42.9%,28.6%,说明碱中毒与低血钾互为因果关系是巨结肠根治术后最常见的电解质及酸碱平衡紊乱,术后应及时补充钾及慎用碱性药物.%The chznges of the fluid,electrolyte and acidbase balance in blood were observed in 35 postoperative children with Hischsprung's disease.The results showed:hypokalemia appeared on the first and the third day but recovered to normal potassium lave1 on the 7th day;the incidence of alkalosis is 42.9% and 28.6% on the first and the 3rd day respectively;incidence of alkalosis in hypokalemic children was higher than that in children with normal potassium level.The authors believe that there would be a correlation between hypokalemia and alkalosis;hypokalemic alkalosis is the most common acid-base pattern in the postoperative children with Hischsprung's disease.The authors suggest:(1) blood gas and electrolyte should be monitored;(2) drugs that may cause alkalosis should be avoided;(3) if there is too much naso-gasteric drainage,potassium level should be checked up.

  18. Gitelman's syndrome: a rare presentation mimicking cauda equina syndrome.

    LENUS (Irish Health Repository)

    Quinlan, C S

    2012-02-01

    We describe a case of bilateral weakness of the lower limbs, sensory disturbance and intermittent urinary incontinence, secondary to untreated Gitelman\\'s syndrome, in a 42-year-old female who was referred with presumed cauda equina syndrome. On examination, the power of both legs was uniformly reduced, and the perianal and lower-limb sensation was altered. However, MRI of the lumbar spine was normal. Measurements of serum and urinary potassium were low and blood gas analysis revealed metabolic alkalosis. Her symptoms resolved following potassium replacement. We emphasise the importance of measurement of the plasma and urinary levels of electrolytes in the investigation of patients with paralysis of the lower limbs and suggest that they, together with blood gas analysis, allow the exclusion of unusual causes of muscle weakness resulting from metabolic disorders such as metabolic alkalosis.

  19. Pronounced increase in breathing rate in the "hair dryer model" of experimental febrile seizures.

    Science.gov (United States)

    Schuchmann, Sebastian; Tolner, Else A; Marshall, Pepin; Vanhatalo, Sampsa; Kaila, Kai

    2008-05-01

    In a study using a heated chamber for induction of experimental febrile seizures (eFS) in rat pups, ictal activity was shown to be precipitated by a respiratory alkalosis (Schuchmann et al., 2006). In sharp contrast to this, in a recent review Dubé et al., (2007) suggest that the respiratory alkalosis is model specific, and that no increase in respiratory rate is observed in the widely used "hair dryer model" of eFS. The data in the present work, based on well-established techniques for measuring respiratory rates in rat pups, show a pronounced increase in the "hair dryer model" with values that are slightly higher than those recorded in the heated chamber model. Hence, a temperature-evoked increase in respiration is a common feature of these two models of eFS.

  20. Gitelman Syndrome: A Case Report

    Directory of Open Access Journals (Sweden)

    F Tabatabaei

    2012-10-01

    Full Text Available Background: Gitelman syndrome is a rare autosomal recessive disorder that typically presents with recurrent muscle cramps, carpopedal spasms, hypokalemic metabolic alkalosis, hypocalciuria and hypomagnesemia and high urine magnesium during adolescence. Mutation in the gene encoding for sodium chloride co-transporter in distal convoluted tubule causes electrolyte imbalance.Case presentation: We present a 10-year-old boy complaining of carpopedal spasms, tingling of fingers and facial parestesia for three years prior to his admission in endocrinology clinic of H. Ali-Asghar Pediatric Hospital. The patient had metabolic alkalosis, hypokalemia, hypocalciuria, increased urine fraction excretion of Mg, serum magnesium of 1.8 mg/dl, normal serum calcium and phosphorus and normal blood pressure. His clinical manifestations recovered after potassium and magnesium administration.Conclusion: A patient with Gitelman syndrome with normal serum Mg. is presented.

  1. [Do the variations in water carbon dioxide pressure and PH have an effect on the nature of end products of protein catabolism, ammonia and urea, in the clawed frog Xenopus laevis?].

    Science.gov (United States)

    Dejours, P; Armand, J; Beekenkamp, H

    1991-01-01

    The effects of PCO2 and pH changes in the ambient water on the nitrogen catabolism and the proportions of the excreted nitrogenous end products, ammonia and urea, were studied in the clawed frog, Xenopus laevis, at 24 degrees C. In animals living in artificial fresh water, the exposure to a hypocapnic alkalosis (PCO2 = 0.7 Torr instead of 10 Torr) did not entail any change in the nitrogen catabolism. In animals who lived in a water loaded with NaCl and had therefore a higher oxygen consumption, an intense nitrogen catabolism and a marked ureotelism, the hypocapnic alkalosis seems to have increased the intensity of the nitrogen catabolism. In neither group were there signs of ammonia toxicity.

  2. An adolescent with tingling and numbness of hand: Gitelman syndrome

    Directory of Open Access Journals (Sweden)

    Atul Poudel

    2015-01-01

    Full Text Available Context: Gitelman syndrome is an inherited autosomal recessive disorder. It is usually diagnosed incidentally during adolescence or early adulthood based on clinical and biochemical findings. Case Report: We present a case of 16 years old adolescent female presenting with recurrent chest pain, tingling, and numbness of bilateral hands. Diagnosis was established by the typical biochemical abnormalities with hypokalemia, hypomagnesemia, hypocalciuria, metabolic alkalosis, and hyperreninemic hyperaldosteronism. Genetic diagnosis was confirmed by sequence analysis of the SLC12A3 gene showing the compound heterozygous mutation encoding the thiazide-sensitive sodium chloride co-transporter. The patient was treated with oral potassium, magnesium, and amiloride with complete improvement of symptoms and biochemical profile. Conclusion: Gitelman syndrome should be considered as a differential diagnosis in work up of hypokalemia, especially in adolescent age group. The presence of hypokalemia, metabolic alkalosis, hypomagnesaemia, hypocalciuria, and mutation analysis provides the final diagnosis.

  3. Blood pH and brain uptake of /sup 14/C-morphine

    Energy Technology Data Exchange (ETDEWEB)

    Schulman, D.S.; Kaufman, J.J.; Eisenstein, M.M.; Rapoport, S.I.

    1984-11-01

    /sup 14/C-Morphine was injected iv in control awake rats or in rats subjected to metabolic alkalosis or acidosis. Ten minutes later, radioactivity was determined within each of seven brain regions, after correction was made for intravascular tracer. In each region, parenchymal radioactivity was correlated positively and significantly (P less than 0.05) with arterial blood pH. Brain radioactivity was twofold to threefold greater in alkalotic rats (mean pH . 7.62) than in acidotic rats (mean pH . 7.16). The results are consistent with the pH-partition hypothesis for drug entry into the brain and indicate that morphine uptake can be increased by elevating the fraction of lipid-soluble uncharged morphine base in blood, by means of alkalosis. The observations may account for an exaggerated morphine-induced analgesia in alkalotic patients.

  4. Furosemide Induced Electrolyte Imbalance: A Real Danger of Overdiuresis in Patients with Heart Failure

    OpenAIRE

    Yaseen Ali; Amila M. Parekh; Rahul K. Rao; Baig, Mirza R

    2014-01-01

    Background: Chronic heart failure is one of the most common reasons for hospital admissions in the United States. There have been several approaches for treating heart failure but loop diuretics has been at the forefront to alleviate the symptoms. Loop diuretics have their own side effects as with any medication use, and a lesser known and monitored one is metabolic alkalosis. Case report: The patient was a 76 years old female with past medical history of diabetes, hypertension, chronic kidne...

  5. Necessity Of ABG Analysis In HPS

    OpenAIRE

    Kalantari M; Raeisosadat MA; Ahmadi J; Nahvi H; Fallahi G; Mehrabi V

    2005-01-01

    Background: The purpose of this study is to determine the incidence of electrolyte and ABG abnormalities in infants with HPS and also we evaluate other parameters of the study. ‎ Materials and Methods: This descriptive study covers 161 infants with HPS hospitalized in children Medical center of Tehran university underwent surgical repair from march 1996 to march 2002 . ‎ Results & Conclusion: The results indicated that Hypokalemic metabolic alkalosis had occurred in 40% of patients. ‎The ...

  6. Hypophosphatemia. From retrospective analysis to the analysis of the potential role of phosphatemia in panic disorders

    OpenAIRE

    Alessandro Riccardi; Laura Pastorino; Luca Corti; Grazia Guiddo; Fiorella Robba; Pierangela Minuto; Maria Ghinatti; Bruno Chiarbonello; Francesco Maritato; Marina Castelli; Roberto Lerza

    2010-01-01

    The detection of a low serum phosphate level is not unusual in an Emergency Department, especially in clinical conditions linked to hyperventilation and subsequent respiratory alkalosis, asthma, sepsis, severe pain, anxiety. Symptoms of hypophosphatemia are typically not specific when the imbalance is not particularly severe, but if hyphophosphatemia does not resolve rhabdomyolisis, hemolysis, decreased tissue oxygenation and respiratory failure can be observed. Only recently some authors hav...

  7. The 'think test': a further technique to elicit hyperventilation.

    OpenAIRE

    Nixon, P. G.; Freeman, L J

    1988-01-01

    Hyperventilation can undermine cardiovascular homeostasis by generating autonomic imbalance, sympathetic dominance, hypokalaemia, and intracellular alkalosis with calcium ion shifts. The role of hyperventilation in episodic disorders such as arrhythmia and coronary vasospasm can be difficult to identify if the patient does not present in an attack and so a provocation challenge is required. Today, the standard challenge is the forced hyperventilation provocation test (FHPT). A capnograph enab...

  8. Hypokalemic rhabdomyolysis: a rare manifestation of primary aldosteronism.

    Science.gov (United States)

    Zavatto, A; Concistrè, A; Marinelli, C; Zingaretti, V; Umbro, I; Fiacco, F; Tinti, F; Petramala, L; Mitterhofer, A P; Letizia, C

    2015-10-01

    Rhabdomyolysis is a rare presentation of hypokalemia, although muscle weakness is a well-known manifestation of hypokalemia. Primary aldosteronism is characterized by hypertension, suppressed plasma renin activity, increased aldosterone excretion and hypokalemia with metabolic alkalosis. Rhabdomyolysis is not common in primary aldosteronism. We present here a 40-year-old woman presenting with rhabdomyolysis accompanied by severe hypokalemia as heralding symptom of primary aldosteronism.

  9. Concurrence of Bartter syndrome and minimal change nephrotic syndrome

    Institute of Scientific and Technical Information of China (English)

    SHEN Hui-jun; DAI Yu-wen; MAO Jian-hua; LIU Ai-min

    2009-01-01

    @@ Nephrotic syndrome(NS)is a common disease in children with a group of symptoms including heavy proteinuria(≥50 mg/kg per 24 hours),hypoalbuminaemia,hypercholesterolaemia and edema.Bartter syndrome(BS)is a clinically and genetically heterogenous kidney disease characterized by hypokalemia,hypochloremic metabolic alkalosis,obvious increase of rennin,angiotesin II,and normal blood pressure.

  10. Renal ammonia excretion in response to hypokalemia: effect of collecting duct-specific Rh C glycoprotein deletion

    OpenAIRE

    Lee, Hyun-Wook; Verlander, Jill W.; Bishop, Jesse M.; Handlogten, Mary E.; Han, Ki-Hwan; Weiner, I. David

    2012-01-01

    The Rhesus factor protein, Rh C glycoprotein (Rhcg), is an ammonia transporter whose expression in the collecting duct is necessary for normal ammonia excretion both in basal conditions and in response to metabolic acidosis. Hypokalemia is a common clinical condition associated with increased renal ammonia excretion. In contrast to basal conditions and metabolic acidosis, increased ammonia excretion during hypokalemia can lead to an acid-base disorder, metabolic alkalosis, rather than mainten...

  11. Atypical presentation of cystic fibrosis: Obese adolescent with hypertension and pseudo-Bartter’s syndrome

    OpenAIRE

    Sovtić Aleksandar; Minić Predrag; Bogdanović Radovan; Stajić Nataša; Rodić Milan; Marković-Sovtić Gordana

    2012-01-01

    Introduction. Infants with cystic fibrosis may fail to thrive despite recommended caloric intake because of electrolyte disurbances caused by salt depletion resulting in hypochloremic metabolic alkalosis or pseudo-Bartter's syndrome. In most patients reported symptoms began in infancy, but it may be an initial presentation of disease in a previously healthy adolescent. Case report. A 15-year-old boy was admitted for evaluation of recurrent episodes of malaise associated with dehydration...

  12. Reverse ventilation--perfusion mismatch

    Energy Technology Data Exchange (ETDEWEB)

    Palmaz, J.C.; Barnett, C.A.; Reich, S.B.; Krumpe, P.E.; Farrer, P.A.

    1984-01-01

    Patients having lobar airway obstruction or consolidation usually have decreases of both ventilation and perfusion on lung scans. We report three patients in whom hypoxic vasoconstriction was apparently incomplete, resulting in a ''reversed'' ventilation-perfusion mismatch. Perfusion of the hypoxic lobe on the radionuclide scan was associated with metabolic alkalosis, pulmonary venous and pulmonary arterial hypertension in these patients.

  13. Status epilepticus as the only presentation of the neonatal Bartter syndrome

    Directory of Open Access Journals (Sweden)

    Soumya Patra

    2012-01-01

    Full Text Available Bartter syndrome is a rare hereditary (autosomal recessive salt-losing tubulopathy characterized by hypokalemia, hypochloremia, metabolic alkalosis, and normal blood pressure with hyperreninemia, The underlying renal abnormality results in excessive urinary losses of sodium, chloride, and potassium. We report a case of a four-month-old infant with neonatal Bartter syndrome, who presented only with status epilepticus. To the best of our present knowledge, there is no reported case of Bartter syndrome who presented with status epilepticus.

  14. Metabolic effects of chronic ozone exposure on rats

    Energy Technology Data Exchange (ETDEWEB)

    Hathway, J.A.; Terrill, R.E.

    1962-01-01

    Rats were exposed to 0.8 to 1.5 ppm O/sub 3/ for 6 hr/day, 4 days/wk for 19 weeks. Lower titratable acidity after 91 days exposure and higher urine pH after 98 days exposure were observed. No significant differences in urine creatine, creatinine, uric acid/creatinine, or amino acid/creatinine were observed. pH differences suggest respiratory alkalosis, possibly due to subjectively noticed hyperventilation in exposed group.

  15. The effect of pH and ADP on ammonia affinity for human glutamate dehydrogenases

    DEFF Research Database (Denmark)

    Zaganas, Ioannis; Pajecka, Kamilla; Nielsen, Camilla Wendel;

    2013-01-01

    Glutamate dehydrogenase (GDH) uses ammonia to reversibly convert α-ketoglutarate to glutamate using NADP(H) and NAD(H) as cofactors. While GDH in most mammals is encoded by a single GLUD1 gene, humans and other primates have acquired a GLUD2 gene with distinct tissue expression profile. The two h...... of the kidney during systemic acidosis. The reverse could apply for conditions of local or systemic hyperammonemia or alkalosis....

  16. Lazarusfænomen

    DEFF Research Database (Denmark)

    Schierbeck, Louise; Lenz, Katja Charlotte

    2014-01-01

    The pathophysiological mechanisms of auto resuscitation - also called the Lazarus phenomenon - are unknown, but they are thought to be related to matters such as hyperkalaemia, hyperventilation and alkalosis or increased end-expiratory pressure during assisted ventilation. The phenomenon...... is probably underreported and this case report of the Lazarus phenomenon in a patient with severe hyperkalaemia demonstrates the necessity of following recommendations regarding resuscitation such as allowing pauses in assisted ventilation as well as ten minutes post resuscitation monitoring before declaring...

  17. One-Sided Weakness Admitted with Hypokalemic Periodic Paralysis

    OpenAIRE

    Fatih Yaman

    2014-01-01

    Hypokalemic periodic paralysis (HPP) is a genetic disorder that characterized by recurrent attacks of skeletal muscle weakness with associated hypokalemia which is precipitated by hypotermia, stress, infection, carbonhydrate load, glucose infusion, metabolic alkalosis, general anesthesia, steroids and licorice root. 52-year-old male patient while working in a cold enviroment, began to complain of weakness in the arms and legs. The patient was brought to the emergency department due to the con...

  18. Novel molecular variants of the Na-K-2Cl cotransporter gene are responsible for antenatal Bartter syndrome.

    OpenAIRE

    Vargas-Poussou, R; Feldmann, D. (Dirk); Vollmer, M.; Konrad, M; Kelly, L.; van den Heuvel, L.P.; Tebourbi, L; Brandis, M.; Karolyi, L.; Hebert, S C; Lemmink, H.H.; Deschênes, G.; Hildebrandt, F.; Seyberth, H. W.; Guay-Woodford, L.M.

    1998-01-01

    Antenatal Bartter syndrome is a variant of inherited renal-tubular disorders associated with hypokalemic alkalosis. This disorder typically presents as a life-threatening condition beginning in utero, with marked fetal polyuria that leads to polyhydramnios and premature delivery. Another hallmark of this variant is a marked hypercalciuria and, as a secondary consequence, the development of nephrocalcinosis and osteopenia. We have analyzed 15 probands belonging to 13 families and have performe...

  19. Heterozygous mutations of the gene for Kir 1.1 (ROMK) in antenatal Bartter syndrome presenting with transient hyperkalemia, evolving to a benign course.

    OpenAIRE

    Cho, Jong Tae; Guay-Woodford, Lisa Marie

    2003-01-01

    Bartter-like syndrome encompasses a set of inherited renal tubular disorders associated with hypokalemic metabolic alkalosis, renal salt wasting, hyperreninemic hyperaldosteronism, and normal blood pressure. Antenatal Bartter syndrome, a subtype of Bartter-like syndrome, is characterized by polyhydramnios, premature delivery, life-threatening episodes of fever and dehydration during the early weeks of life, growth retardation, hypercalciuria, and early-onset nephrocalcinosis. Mutations in the...

  20. Inherited renal tubular defects with hypokalemia

    OpenAIRE

    Muthukrishnan J; Modi K; Kumar P; Jha Ratan

    2009-01-01

    Bartter′s and Gitelman′s syndrome are two ends of a spectrum of inherited renal tubular disorders that present with hypokalemic metabolic alkalosis of varying severity. Clinical features and associated calcium and magnesium ion abnormalities are used to diagnose these cases after excluding other commoner causes. We report on two cases, the first being a young boy, born of pregnancy complicated by polyhydramnios, who had classical dysmorphic features, polyuria, hypokalemia and hy...

  1. Congenital chloridorrhea in Korean infants.

    OpenAIRE

    Lee, Y. D.; Lee, H. J.; Moon, H. R.

    1988-01-01

    The present paper describes two Korean male infants, 1. 16 year old and newly born neonate from two families who were diagnosed and managed for one of very rare inborn errors of metabolism, congenital chloridorrhea (Darrow-Gamble syndrome). The diagnosis was suggested by one of the authors (HRM) from the unusual combination of metabolic alkalosis with severe gastrointestinal disorder presenting with chronic, profuse watery diarrhea in the newborn period in the first patient; and the maternal ...

  2. Altered mental status and complete heart block: an unusual presentation of aspirin toxicity

    OpenAIRE

    Aggarwal, Nidhi; Kupfer, Yizhak; Chawla, Kabu; Tessler, Sidney

    2013-01-01

    Aspirin is one of the most commonly used medications. We report a patient who presented with severe weakness, altered mental status and complete heart block requiring temporary pacing. Despite the patient's family denying that the patient used aspirin, an arterial blood gas that revealed a respiratory alkalosis and metabolic acidosis suggested the diagnosis of salicylate toxicity. The salicylate level was extremely elevated and the patient was successfully treated with haemodialysis. Our case...

  3. Atypical presentation of cystic fibrosis: Obese adolescent with hypertension and pseudo-Bartter’s syndrome

    Directory of Open Access Journals (Sweden)

    Sovtić Aleksandar

    2012-01-01

    Full Text Available Introduction. Infants with cystic fibrosis may fail to thrive despite recommended caloric intake because of electrolyte disurbances caused by salt depletion resulting in hypochloremic metabolic alkalosis or pseudo-Bartter's syndrome. In most patients reported symptoms began in infancy, but it may be an initial presentation of disease in a previously healthy adolescent. Case report. A 15-year-old boy was admitted for evaluation of recurrent episodes of malaise associated with dehydration and acute renal insufficiency. Laboratory analysis showed hypochloremic metabolic alkalosis with hyponatremia and hypokalemia. On admission the boy was obese, with body weight of 95.5 kg (> P97, height 174 cm (> P75, and body mass index of 31.2 kg/m2 (> P95. Physical examination was inconclusive. Blood pressure holter monitoring proved significant systolic hypertension. Routine urinalysis, protein and electrolyte levels in urine were normal. Plasma renin and aldosteron were normal. Sweat chloride concentration was 63 mmol/L. Genetic testing confirmed the diagnosis of cystic fibrosis. Conclusion. To our knowledge, this is the first reported case of atypical presentation of cystic fibrosis in an adolescent presented with pseudo-Bartter's syndrome and signs of obesity and hypertension. We suggest that every patient with hypochloremic metabolic alkalosis should be evaluated for cystic fibrosis.

  4. Effect of systemic pH on pH sub i and lactic acid generation in exhaustive forearm exercise

    Energy Technology Data Exchange (ETDEWEB)

    Hood, V.L.; Schubert, C.; Keller, U.; Mueller, S. (Univ. of Basel (Switzerland) Univ. of Vermont College of Medicine, Burlington (USA))

    1988-09-01

    To investigate whether changes in systemic pH affect intracellular pH (pH{sub i}), energy-rich phosphates, and lactic acid generation in muscle, eight normal volunteers performed exhaustive forearm exercise with arterial blood flow occluded for 2 min on three occasions. Subjects ingested 4 mmol/kg NH{sub 4}Cl (acidosis; A) or NaHCO{sub 3} (alkalosis; B) or nothing (control; C) 3 h before the exercise. Muscle pH{sub i} and phosphocreatine (PCr) content were measured with {sup 31}P-nuclear magnetic resonance ({sup 31}P-NMR) spectroscopy during exercise and recovery. Lactate output during 0.5-7 min of recovery was calculated as deep venous-arterial concentration differences times forearm blood flow. Before exercise, blood pH and bicarbonate were lower in acidosis than alkalosis and intermediate in control. Lactic acid output during recovery was less with A than B and intermediate in C. PCr utilization and resynthesis were not affected by extracellular pH changes. pH{sub i} did not differ before exercise or at its end. Hence systemic acidosis inhibited and alkalosis stimulated lactic acid output. These findings suggest that systemic pH regulates cellular acid production, protecting muscle pH, at the expense of energy availability.

  5. 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

    Institute of Scientific and Technical Information of China (English)

    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

  6. Acid-base balance and electrolyte changes in patients with acute exacerbation of chronic obstructive pulmonary disease after mechanical ventilation%慢性阻塞性肺疾病急性加重机械通气治疗后酸碱平衡状态及电解质的变化

    Institute of Scientific and Technical Information of China (English)

    李慧平; 张睢扬; 王英; 马建新; 王东霞

    2013-01-01

    Objective To explore the acid-base balance and electrolyte changes caused by mechanical ventilation,to improve the level of application of mechanical ventilation technology.It was important to improve the survival rate of acute exacerbation of chronic obstructive pulmonary disease (AECOPD) and chronic obstructive pulmonary disease (COPD) prognosis.Methods A retrospective analysis of 62 patients with AECOPD associated with type Ⅱ respiratory failure which were treated using mechanical ventilation was carried out.35 patients of AECOPD were treated with the non-invasive mechanical ventilation and 27 patients were treated with invasive mechanical ventilation.Observation and comparison of arterial blood gas and ion sodium,potassium,calcium were made before using mechanical ventilation and after using mechanical ventilation for 1 hour,2 hours,3 hours,24 hours,72 hours and end ventilation.The acid-base balance status and electrolyte changes were summarized in patients before and after using mechanical ventilation.Results There were significantly improved in the arterial blood pH,PaO2,PaCO2,PaO2/FiO2 and SaO2 in 2 groups of patients compared with before and after using mechanical ventilation (P < 0.05).After 3 h ventilation,there were 6 cases (17.14%) of decompensated metabolic alkalosis occurred and after 72 h ventilation,22 cases (62.86%) metabolic alkalosis (including compensatory and decompensated) were occurred including 7 cases (25.93%) decompensated alkalosis which achieved the peak of alkalosis incidence in non-invasive ventilation group.After 2 h ventilation,there were 7 cases(25.93%) of decompensated metabolic alkalosis occurred,and 21 cases (77.77%) metabolic alkalosis occurred after 3 h ventilation which included decompensated alkalosis 9 cases (33.33%) in invasive ventilation group.There were lower Na+ and higher K+ before ventilated,however Na + and K + were restored to normal after ventilation in both group.There were lower Na + and lower K

  7. Acid-base and electrolyte disorders in patients with diabetes mellitus

    Directory of Open Access Journals (Sweden)

    Nikolaos Sotirakopoulos

    2012-01-01

    Full Text Available Diabetes mellitus is the most common metabolic disorder in the community. The diabetics may suffer from acid-base and electrolyte disorders due to complications of diabetes mellitus and the medication they receive. In this study, acid-base and electrolyte disorders were evaluated among outpatient diabetics in our hospital. The study consisted of patients with diabetes mellitus who visited the hospital as outpatients between the period January 1, 2004 to December 31, 2006. The patients′ medical history, age and type of diabetes were noted, including whether they were taking diuretics and calcium channel blockers or not. Serum creatinine, proteins, sodium, potassium and chloride and blood gases were measured in all patients. Proteinuria was measured by 24-h urine collection. Two hundred and ten patients were divided in three groups based on the serum creatinine. Group A consisted of 114 patients that had serum creatinine 3.1 mg/dL. Of the 210 patients, 176 had an acid-base disorder. The most common disorder noted in group A was metabolic alkalosis. In groups B and C, the common disorders were metabolic acidosis and alkalosis, and metabolic acidosis, respectively. The most common electrolyte disorders were hypernatremia (especially in groups A and B, hyponatremia (group C and hyperkalemia (especially in groups B and C. It is concluded that: (a in diabetic outpatients, acid-base and electrolyte disorders occurred often even if the renal function is normal, (b the most common disorders are metabolic alkalosis and metabolic acidosis (the frequency increases with the deterioration of the renal function and (c the common electrolyte disorders are hypernatremia and hypokalemia.

  8. Effect of Intermittent Positive Pressure Ventilation (IPPV on Acid-Base Balance and Plasma Electrolytes during Isoflurane Anaesthesia in Sulphur-Crested Cockatoos (Cacatua galerita galerita

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    Saul Chemonges

    2012-12-01

    Full Text Available The objective of the study was to investigate the effect of Intermittent Positive Pressure Ventilation (IPPV on acid-base balance and plasma electrolytes during isoflurane anaesthesia in sulphur-crested cockatoos (Cacatua galerita galerita Anaesthesia was induced in six birds by mask using a T-piece with 3.0% isoflurane. Blood gases, plasma electrolytes, PCV and Total Protein (TP were monitored for one hour during Spontaneous Ventilation (SV and IPPV. IPPV was instituted by engaging the pop-off valve (IPPVa of the circle absorber or by squeezing the breathing bag (IPPVb. Results showed that during SV, pCO2, pO2, [HCO3-], BE, C+CO2 and PO4- increased significantly, while [Na+], [K+] and [Ca2+] did not change significantlyDuring IPPV, pCO2 and pO2 decreased, while C+CO2 CO2 increased during the initial 30 min. [HCO3-increased during IPPVa only in the first 30 min. BE increased only in the first 30 min of IPPV. There was a marginal increase and decrease in PO4- during SV and IPPV, respectively. [Na+], [K+] and [Ca2+] remained stable during both SV and IPPV. Subtle decreases were noted for [Cl-] TP and PCV during SV. It was concluded that mixed metabolic and respiratory acidosis occurs during SV in isoflurane-anaesthetised cockatoos. Metabolic acidosis that develops during isoflurane anaesthesia in spontaneously ventilating birds is reversible to some extent by IPPV, possibly through a mixed acidosis-alkalosis, respiratory alkalosis and a non-respiratory contribution to alkalosis mechanism. Reversal of Bohr Effect occurs during IPPV in isoflurane-anaesthetised cockatoos. Studies are indicated to understand the causes of decreased oxygen saturation in apparently alkalotic birds.

  9. Severe hypernatremia and hyperchloremia in an elderly patient with IgG-kappa type

    Directory of Open Access Journals (Sweden)

    Berend K

    2013-12-01

    Full Text Available Kenrick BerendSt Elisabeth Hospital, Willemstad, CuraçaoImashuku et al1 describe a 77-year-old male patient with multiple myeloma who was admitted to the hospital after suffering a pelvic bone fracture due to a road traffic accident. Several days after admission the arterial blood gas showed a pH of 7.481; arterial carbon dioxide tension (PaCO2 of 28.2 mmHg; arterial oxygen tension (PaO2 of 84.0 mmHg; HCO3- of 20.8 mmol/L (normal; 23–31 mmol/L; and an anion gap of 8.9 mmol/L (normal;12 mmol/L. These data, as the authors concluded, were suggestive of metabolic acidosis. First, this is not true because a high pH and low PaCO2 confirm a respiratory alkalosis. Since the test was conducted days later we may expect a chronic respiratory alkalosis to be present, perhaps because of pain or a secondary pulmonary problem, as may be expected with a relatively low PaO2. In chronic respiratory alkalosis one would expect the HCO3- to decrease about 4 mmol/L with every 10 mmHg decrease of PaCO2.2 If the initial HCO3- had been about 25 mmol/L, the expected PaCO2 would be about 20.28 mmol/L, almost identical with the patient’s HCO3-.View original paper by Imashuku and colleagues.

  10. Anaesthetic management of a patient with Liddle's syndrome for emergency caesarean hysterectomy.

    LENUS (Irish Health Repository)

    Hayes, N E

    2011-04-01

    We describe the anaesthetic management of a patient with Liddle\\'s syndrome during caesarean section and emergency hysterectomy for placenta accreta associated with significant intrapartum haemorrhage. Liddle\\'s syndrome is a rare autosomal dominant disorder characterised by early onset arterial hypertension and hypokalaemic metabolic alkalosis. Additional issues were the presence of short stature, limb hypertonicity and preeclampsia. Initial management with a low-dose combined spinal-epidural technique was subsequently converted to general anaesthesia due to patient discomfort. The management of Liddle\\'s syndrome in the setting of neuraxial and general anaesthesia in a patient undergoing caesarean section is discussed.

  11. Anaesthetic management of a patient with Liddle's syndrome for emergency caesarean hysterectomy.

    LENUS (Irish Health Repository)

    Hayes, N E

    2012-02-01

    We describe the anaesthetic management of a patient with Liddle\\'s syndrome during caesarean section and emergency hysterectomy for placenta accreta associated with significant intrapartum haemorrhage. Liddle\\'s syndrome is a rare autosomal dominant disorder characterised by early onset arterial hypertension and hypokalaemic metabolic alkalosis. Additional issues were the presence of short stature, limb hypertonicity and preeclampsia. Initial management with a low-dose combined spinal-epidural technique was subsequently converted to general anaesthesia due to patient discomfort. The management of Liddle\\'s syndrome in the setting of neuraxial and general anaesthesia in a patient undergoing caesarean section is discussed.

  12. Intraoperative Autotriggered Pressure Support Ventilation Resistant to Increased Flow Trigger Threshold.

    Science.gov (United States)

    Benitez Lopez, Julio; Rao, Sripad P; McNeer, Richard R; Dudaryk, Roman

    2016-07-01

    Oscillations from cardiac pulsations are normally transmitted to mediastinal structures without any consequence. Autotriggering (AT) of mechanical ventilation occurs when an inspiratory trigger, typically negative inspiratory flow in anesthesia ventilators, is met in the absence of patient effort. AT can lead to respiratory alkalosis, opioid overdose, prolonged mechanical ventilation, and lung hyperinflation. This entity has been reported in both critical care and operating room environments. Increasing the flow trigger usually resolves AT in all cases. We report a case of AT that failed to respond to increasing the flow trigger threshold to its maximal value on the GE Datex-Ohmeda Avance S5® anesthesia station. PMID:27224041

  13. Hypokalemic paralysis and acid-base balance

    Directory of Open Access Journals (Sweden)

    Ivo Casagranda

    2006-10-01

    Full Text Available Three cases of hypokalemic paralysis are reported, presenting to the Emergency Department. The first is a patient with a hypokalemic periodic paralysis with a normal acid-base status, the second is a case of hypokalemic flaccid paralysis of all extremities with a normal anion gap metabolic acidosis, the last is a patient with a hypokalemic distal paralysis of right upper arm with metabolic alkalosis. Afterwards some pathophysiologic principles and the clinical aspects of hypokalemia are discussed and an appropriate approach to do in Emergency Department, to identify the hypokalemic paralysis etiologies in the Emergency Department, is presented, beginning from the evaluation of acid-base status.

  14. Hypercalcemic encephalopathy due to milk alkali syndrome and injection teriparatide

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    Sandeep Kharb

    2012-01-01

    Full Text Available An 82-year-old male, a known case of severe osteoporosis with vertebral fracture and prostatic carcinoma, was treated with gonadotropin releasing hormone analogue, calcium carbonate, cholecalciferol sachet and injection teriparatide. His diet consisted of milk and curd. He developed altered behavior and generalized weakness, and on investigation, hypercalcemia, hypokalemia, and metabolic alkalosis with low parathyroid hormone levels were detected. Injection teriparatide was stopped and he was managed with forced saline diuresis and injection zoledronic acid. He was diagnosed as a case of milk alkali syndrome in whom teriparatide and prolonged immobilization played a permissive role in the development of hypercalcemic encephalopathy.

  15. A novel splicing mutation in CLCNKB in a Chinese patient with Bartter syndrome type Ⅲ

    Institute of Scientific and Technical Information of China (English)

    DONG Yan; JI Gang; FENG Qi-wen; ZENG Xian-ting; JIANG Geng-ru

    2010-01-01

    @@ Bartter syndrome type Ⅲ is a Bartter syndrome subtype, which has a group of autosomal-recessive inherited disorders with clinical characteristics such as renal salt wasting, hypokalemic metabolic alkalosis,elevated renin and aldosterone levels, with normal or low blood pressure.1 Unlike other subtypes that often begin in the neonatal period, type Ⅲ, due to mutations in the CLCNKB gene,2-4 is highly variable and usually presents as a "classic" Barrter variant characterized by an onset in early childhood and less severe or absent hypercalciuria and nephrocalcinosis.3

  16. Monomorphic Outflow Tract Ventricular Tachycardia: Unique Presenting Manifestation of Gitelman’s Syndrome

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    Subba Reddy Vanga, MD

    2010-01-01

    Full Text Available Outflow Tract Ventricular Tachycardia (OTVT is typically seen in young to middle aged people with structurally normal hearts. These arrhythmias are triggered by emotional or stress factors and that responds to medications. Electrolyte abnormalities rarely cause ventricular arrhythmia. Gitelman’s syndrome, a rare autosomal recessive renal disorder causes hypokalemia, metabolic alkalosis and hypomagnesaemia.1 This disorder is often benign with mild clinical symptoms and excellent long-term prognosis. We present a case of Gitelman’s syndrome with symptomatic OTVT as initial manifestation.

  17. Sodium bicarbonate intake improves high-intensity intermittent exercise performance in trained young men

    DEFF Research Database (Denmark)

    Krustrup, Peter; Ermidis, Georgios; Mohr, Magni

    2015-01-01

    Background Sodium bicarbonate intake has been shown to improve exercise tolerance, but the effects on high-intensity intermittent exercise are less clear. Thus, the aim of the present study was to determine the effect of sodium bicarbonate intake on Yo-Yo intermittent recovery level 2 test perfor......-intensity intermittent exercise performance is improved by prior intake of sodium bicarbonate in trained young men, with concomitant elevations in blood alkalosis and peak blood lactate levels, as well as lowered rating of perceived exertion....

  18. (/sup 11/C )-DMO for evaluation of regional tissue pH in patients with hemispheric infarction using positron emission tomography

    Energy Technology Data Exchange (ETDEWEB)

    Castaing, M.; Syrota, A.; Rougemont, D.; Berridge, M.; Chretien, L.; Baron, J.C.; Bousser, M.G.

    1983-06-01

    Changes in brain intracellular pH resulting from cerebral infarction were evaluated using the /sup 11/C-DMO (dimethyloxazolidine-dione) method, in 9 patients. A /sup 15/O/sub 2/-C/sup 15/O/sub 2/ study was performed the day following the DMO examination in order to obtain the values of cerebral blood flow, oxygen extraction and oxygen metabolic rate in the same regions-of-interest. The results emphasized the relationship between tissue alkalosis and luxury perfusion during recent infarction.

  19. A case of Pseudo-Bartter syndrome

    Energy Technology Data Exchange (ETDEWEB)

    Yang, Ik; Choi, Bo Whan; Lee, Yul; Chung, Soo Young [College of Medicine, Hallym University, Seoul (Korea, Republic of)

    1994-10-15

    Pseudo-Bartter Syndrome is a rare medical disease of the kidney characterized by normal blood pressure, hypokalemic metabolic alkalosis, hyperreninemia and hyperaldosteronism with drug history of diuretics. We report US, CT and MRI findings of a patients with clinically proved Pseudo-Bartter syndrome. The patient was a 37 year old woman with a history of long term ingestion of the diuretics(furosemide) for 20 years. Renal US revealed hyperechoic renal medulla at both kidneys. The resistive index(RI), calculated from the duplex doppler waveform is 0.61. Unenhanced CT revealed faint high attenuation along the medulla. T1-weighted MRI revealed indistinct corticomedullary differentiation.

  20. Accelerated leucine decarboxylation in the rat brain in relation to increased blood ammonia levels during acute hepatic failure.

    Directory of Open Access Journals (Sweden)

    Shiota,Tetsuya

    1984-06-01

    Full Text Available Leucine decarboxylation in rat brain was investigated during acute hepatic failure, induced by partial hepatectomy after carbon tetrachloride (CCl4 pretreatment of rats. These rats presented metabolic alkalosis, and had significantly higher levels of arterial blood and brain ammonia than control and CCl4-treated rats. Brain leucine decarboxylation was elevated in rats with hepatic failure. This alteration correlated with arterial blood ammonia concentrations, and probably with elevated brain ammonia levels, as brain ammonia levels were directly related to arterial blood ammonia.

  1. 17-α-Hydroxylase deficiency: An unusual case with primary amenorrhea and hypertension

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    Sunil Kumar Kota

    2011-01-01

    Full Text Available A 14-year-old girl presented with acute onset quadriparesis and newly detected hypertension. Parental consanguinity, delayed puberty with normal stature form the additional information. Hypokalemia with metabolic alkalosis, low cortisol, high ACTH and FSH pointed to the possibility of CAH with 17α hydroxylase deficiency. 46XX karyotype and high progesterone supported this. Normalization of hypokalemia and hypertension with glucocorticoid treatment confirmed the diagnosis. In summary, the possibility of 17 OHD should be suspected in patients with hypokalemic myopathy, Hypertension and hypogonadism so that appropriate therapy can be implemented.

  2. Hyponatremic-Hypertensive Syndrome in an 18-Month-Old Male Child

    Directory of Open Access Journals (Sweden)

    Dilek Yilmaz

    2016-04-01

    Full Text Available An eighteen-month-old boy presented with polyuria, polydipsia, hypertension, severe hyponatremia, metabolic alkalosis and nephrotic-range proteinuria. Hypertension was drug resistant. Renal artery angiogram revealed right renal artery occlusion. Nonfunctional right kidney was also detected on the nuclear renal scan. As percutaneous transluminal renal artery angioplasty was not appropriate for our patient, nephrectomy was performed. Right nephrectomy resulted in the resolution of all the symptoms. Rarity of hyponatremic hypertensive syndrome in children may project its under-recognition. We aimed to increase awareness of early diagnosis of HHS among polyuric, hypertensive and hyponatremic children in order to prevent renal damage and life-threatening complications.

  3. Gitelman syndrome associated with chondrocalcinosis: description of two cases

    Directory of Open Access Journals (Sweden)

    E. Filippucci

    2011-06-01

    Full Text Available Gitelman syndrome is a rare inherited tubulopathy, characterized by hypomagnesemia, hypokalemia, metabolic alkalosis, hypocalciuria and hyperreninemic hyperaldosteronism. The clinical spectrum is wide and includes: cramps, myalgies, muscle weakness, until episodes of carpo-podalic spasm, tetania, rabdomyolisis and paralysis. Some cases have been described in literature underlining the association of this condition with chondrocalcinosis, as a typical example of hypomagnesemia-induced crystal deposition disease. The therapy of Gitelman syndrome consists on the administration of defective electrolytes, althought not always effective. We describe two cases of Gitelman syndrome associated with chondrocalcinosis showing the wide range of presentation of this clinical condition.

  4. Hyperchloremia - Why and how.

    Science.gov (United States)

    Nagami, Glenn T

    2016-01-01

    Hyperchloremia is a common electrolyte disorder that is associated with a diverse group of clinical conditions. The kidney plays an important role in the regulation of chloride concentration through a variety of transporters that are present along the nephron. Nevertheless, hyperchloremia can occur when water losses exceed sodium and chloride losses, when the capacity to handle excessive chloride is overwhelmed, or when the serum bicarbonate is low with a concomitant rise in chloride as occurs with a normal anion gap metabolic acidosis or respiratory alkalosis. The varied nature of the underlying causes of the hyperchloremia will, to a large extent, determine how to treat this electrolyte disturbance. PMID:27267918

  5. Neonatal Bartter syndrome with cholelithiasis and hydrocephalus: Rare association.

    Science.gov (United States)

    Özdemir, Özmert Ma; Çıralı, Ceren; Yılmaz Ağladıoğlu, Sebahat; Evrengül, Havva; Tepeli, Emre; Ergin, Hacer

    2016-09-01

    Neonatal Bartter syndrome (NBS) is a rare autosomal recessive renal tubular disorder. This disease is characterized by hypokalemia, hypochloremia, and metabolic alkalosis that is often associated with failure to thrive and recurrent episodes of dehydration. The combination of BS and cholelithiasis in an infant is very rare. Herein, we report a premature male infant with NBS who developed cholelithiasis and hydrocephalus on clinical follow up. We recommend that periodic routine hepatobiliary ultrasonograpic screening for cholelithiasis should be performed in patients with NBS. PMID:27682612

  6. Nephrocalcinosis and Placental Findings in Neonatal Bartter Syndrome

    OpenAIRE

    Hidehiko Maruyama; Yoko Shinno; Kaori Fujiwara; Akie Nakamura; Toshihiro Tajima; Makoto Nakamura; Misao Kageyama

    2012-01-01

    Neonatal Bartter syndrome (NBS) is an inherited renal tubular disorder associated with hypokalemic alkalosis. Here we report a case of genetically diagnosed NBS. Polyhydramnios was noted at 26 weeks. A boy was born at 31 weeks and 1 day, weighed 1344 g, and had an Apgar score of 8/8. We initiated indomethacin (IND) at a dose of 0.2 mg/kg/d on day 31, and increased it to approximately 3 mg/kg/d. However, his urinary calcium (Ca) levels remained unchanged. At 4 months of age, nephrocalcinosis w...

  7. Congenital Chloride Diarrhea - Novel Mutation in SLC26A3 Gene.

    Science.gov (United States)

    Bhardwaj, Swati; Pandit, Deepti; Sinha, Aditi; Hari, Pankaj; Cheong, Hae Il; Bagga, Arvind

    2016-08-01

    The authors report a case of congenital chloride diarrhea with molecular confirmation of diagnosis. A 10-mo-old boy presented with failure to thrive, voluminous diarrhea, dehydration, hyponatremia, hypokalemia, metabolic alkalosis and history of maternal polyhydramnios. The diagnosis of congenital chloride diarrhea was based on high fecal and low urinary chloride excretion, in addition to biochemical abnormalities. Genetic testing revealed a novel homozygous mutation in exon 4 of the SLC26A3 gene that encodes the protein regulating chloride bicarbonate absorption in distal ileum and colon. Therapy with oral fluids and electrolytes led to decrease in stool frequency and improvement in growth parameters. PMID:26637435

  8. Hippocampal electrical activity of adult rabbits during moderate passive hyperventilation

    International Nuclear Information System (INIS)

    The effects of a moderate passive hyperventilation (HV) were studied in immobilized un-anesthetized rabbits. Hypocapnia (PCO2 = 23.3 ± 2.8 mm Hg) and alkalosis (pH = 7.54 ± 0.07) were measured on arterial samples. PO2 remained stable. The following results were obtained. From the onset of HV, the mean discharge rate (F) of the pyramidal cells (CA1) was modified. Several types of cellular behaviours were defined according to whether F decreased (51 pc of the neurons), increased (39 pc) or remained stable (6 pc). The most marked effect was observed 15 min after HV onset when 87 pc of cells showed a discharge rate lower than in controls. Whatever F variations, the temporal organization of the action potentials remained unchanged in 71 pc of cases. The evoked response resulting from the stimulation of the commissural inputs corresponded with the activity of GABA inhibitory neurons (basket cells). The response threshold, amplitude and latency were not modified by HV. Only the facilitation process resulting from paired pulses was modified in its late stage. These results as well as those concerning unit activity do not support various assumption such as trouble of the neuronal energetic metabolism due to hypoxia, modification of ionic exchanges (Na+, K+, Ca++), or variations of neurotransmitter concentrations (especially GABA). The effects observed could be ascribed to modifications of neuronal membrane resting potential resulting from direct action of CO2 and alkalosis. (author)

  9. The effect of oral sodium acetate administration on plasma acetate concentration and acid-base state in horses

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    Lindinger Michael I

    2007-12-01

    Full Text Available Abstract Aim Sodium acetate (NaAcetate has received some attention as an alkalinizing agent and possible alternative energy source for the horse, however the effects of oral administration remain largely unknown. The present study used the physicochemical approach to characterize the changes in acid-base status occurring after oral NaAcetate/acetic acid (NAA administration in horses. Methods Jugular venous blood was sampled from 9 exercise-conditioned horses on 2 separate occasions, at rest and for 24 h following a competition exercise test (CET designed to simulate the speed and endurance test of 3-day event. Immediately after the CETs horses were allowed water ad libitum and either: 1 8 L of a hypertonic NaAcetate/acetic acid solution via nasogastric tube followed by a typical hay/grain meal (NAA trial; or 2 a hay/grain meal alone (Control trial. Results Oral NAA resulted in a profound plasma alkalosis marked by decreased plasma [H+] and increased plasma [TCO2] and [HCO3-] compared to Control. The primary contributor to the plasma alkalosis was an increased [SID], as a result of increased plasma [Na+] and decreased plasma [Cl-]. An increased [Atot], due to increased [PP] and a sustained increase in plasma [acetate], contributed a minor acidifying effect. Conclusion It is concluded that oral NaAcetate could be used as both an alkalinizing agent and an alternative energy source in the horse.

  10. Quantitative Evaluation of Arteriovenous Shunts of the Brain Under Clinical and Experimental Conditions

    International Nuclear Information System (INIS)

    With the help of a new quantitative method to evaluate shunt function, quantitative evaluations of arteriovenous shunt were carried out on patients with traumatic shunts between the internal carotid artery and the cavernous sinus and with arteriovenous haemangiomata. These indicated that, in traumatic arteriovenous fistulas, up to 90% of the blood from the internal carotid is shunted into the cavernous sinus. In patients with arteriovenous haemangiomata shunt flow ranged from 30 to 7%. Post-operatively, both the cerebral blood flow (measured by 133Xe) and the shunt flow showed a return to normal. Shunt function was also evaluated in 28 test animals, their cerebral blood flow having previously been studied, using 133Xe. Six cats formed a control group, the remaining 22 being divided into two groups of 11 animals each. Respiratory acidosis was induced in one group and respiratory alkalosis in the other. The results revealed that the shunt flow was reduced in acidosis (mean 18.26%) and increased in alkalosis (mean 50.1%). In normal animals it averaged 29.4%. (author)

  11. Population pharmacodynamic modeling and simulation of the respiratory effect of acetazolamide in decompensated COPD patients.

    Directory of Open Access Journals (Sweden)

    Nicholas Heming

    Full Text Available BACKGROUND: Chronic obstructive pulmonary disease (COPD patients may develop metabolic alkalosis during weaning from mechanical ventilation. Acetazolamide is one of the treatments used to reverse metabolic alkalosis. METHODS: 619 time-respiratory (minute ventilation, tidal volume and respiratory rate and 207 time-PaCO2 observations were obtained from 68 invasively ventilated COPD patients. We modeled respiratory responses to acetazolamide in mechanically ventilated COPD patients and then simulated the effect of increased amounts of the drug. RESULTS: The effect of acetazolamide on minute ventilation and PaCO2 levels was analyzed using a nonlinear mixed effect model. The effect of different ventilatory modes was assessed on the model. Only slightly increased minute ventilation without decreased PaCO2 levels were observed in response to 250 to 500 mg of acetazolamide administered twice daily. Simulations indicated that higher acetazolamide dosage (>1000 mg daily was required to significantly increase minute ventilation (P0.75 L min(-1 in 60% of the population. The model also predicts that 45% of patients would have a decrease of PaCO2>5 mmHg with doses of 1000 mg per day. CONCLUSIONS: Simulations suggest that COPD patients might benefit from the respiratory stimulant effect after the administration of higher doses of acetazolamide.

  12. Neuroblastoma Presenting with Acute Kidney Injury, Hyponatremic-Hypertensive-Like Syndrome and Nephrotic Proteinuria in a 10-Month-Old Child

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    Giovanni Maria Poggi

    2011-08-01

    Full Text Available Neuroblastoma is the most common extracranial solid tumor in childhood. Its presenting signs and symptoms may be highly variable, depending on the location of the primary tumor and its local or metastatic diffusion and, rarely, with paraneoplastic syndrome such as opsoclonus-myoclonus-ataxia syndrome and gastrointestinal disturbances, due to autoantibodies or to aberrant secretion of vasoactive intestinal peptide. Herein we describe a 10-month-old child with neuroblastoma presenting with a complex clinical picture characterized by acute kidney injury manifested by renal insufficiency and signs and symptoms of tubulointerstitial damage, with polyuria, polydipsia, glucosuria, aminoaciduria and hypochloremic metabolic alkalosis, and of glomerular damage with heavy proteinuria. Imaging study documented a suprarenal mass enveloping the aorta and its abdominal and renal ramifications and bilaterally renal veins. This clinical picture shows some analogies with the hyponatremic-hypertensive syndrome concerning the renovascular disease; however, in absence of systemic arterial hypertension, the heavy proteinuria and the polyuria could be explained by sectional increased intraglomerular pressure, due to local renal blood vessels constriction. Hypochloremic metabolic alkalosis probably developed because of local production of renin, responsible of renin-angiotensin-aldosterone system activation, but above all because of chloride loss through sweating. The long lasting dehydration, due to vomiting, sweating and polyuria, caused prolonged prerenal failure evolving in proximal tubular damage manifestations.

  13. Gitelman Syndrome in a School Boy Who Presented with Generalized Convulsion and Had a R642H/R642W Mutation in the SLC12A3 Gene

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    Shigeru Makino

    2014-01-01

    Full Text Available An 8-year-old Japanese boy presented with a generalized convulsion. He had hypokalemia (serum K 2.4 mEq/L, hypomagnesemia, and metabolic alkalosis (BE 5.7 mmol/L. In addition, his plasma renin activity was elevated. He was tentatively diagnosed with epilepsy on the basis of the electroencephalogram findings and was treated by potassium L-aspartate and carbamazepine to control the hypokalemia and seizure, respectively. However, a year later, the patient continued to have similar abnormal laboratory data. A presumptive diagnosis of Gitelman syndrome (GS was then made and the patient’s peripheral blood mononuclear cells were subjected to sequence analysis of the SLC12A3 gene, which encodes a thiazide-sensitive sodium-chloride cotransporter. The patient was found to have compound heterozygous mutations, namely, R642H inherited from his father and R642W inherited from his mother. Thus, if a patient shows persistent hypokalemia and metabolic alkalosis, GS must be considered, even if the patient exhibits atypical clinical symptoms.

  14. Calcium Unresponsive Hypocalcemic Tetany: Gitelman Syndrome with Hypocalcemia

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    Madhav Desai

    2013-01-01

    Full Text Available Introduction. Gitelman’s syndrome (GS is autosomal recessive renal tubular disorder characterized by hypokalemia, hypomagnesemia, hypocalciuria, metabolic alkalosis, and hyperreninemic hyperaldosteronism. It is usually associated with normal serum calcium. We report a patient presented with hypocalcemic tetany, and evaluation showed Gitelman’s syndrome with hypocalcemia. Case Report. A 28-year-old woman presented with cramps of the arms, legs, fatigue, and carpal spasms of one week duration. She has history of similar episodes on and off for the past two years. Her blood pressure was 98/66 mmHg. Chvostek’s sign and Trousseau’s sign were positive. Evaluation showed hypokalemia, hypocalcemia, hypomagnesemia, metabolic alkalosis, and hypocalciuria. Self-medication, diuretic use, laxative abuse, persistent vomiting, and diarrhoea were ruled out. Urinary prostaglandins and genetic testing could not be done because of nonavailability. To differentiate Gitelman syndrome from Bartter’s syndrome (BS, thiazide loading test was done. It showed blunted fractional chloride excretion. GS was confirmed and patient was treated with spironolactone along with magnesium, calcium, and potassium supplementation. Symptomatically, she improved and did not develop episodes of tetany again. Conclusion. In tetany patient along with serum calcium measurement, serum magnesium, serum potassium, and arterial blood gases should be measured. Even though hypocalcemia in Gitelman syndrome is rare, it still can occur.

  15. Ultrasound-guided paravertebral block for pyloromyotomy in 3 neonates with congenital hypertrophic pyloric stenosis

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    Javier Mata-Gómez

    2015-08-01

    Full Text Available BACKGROUND AND OBJECTIVES: Hypertrophic pyloric stenosis is a relatively common affection of gastrointestinal tract in childhood that results in symptoms, such as projectile vomiting and metabolic disorders that imply a high risk of aspiration during anesthetic induction. In this way, the carrying out of a technique with general anesthesia and intravenous rapid sequence induction, preoxygenation and cricoid pressure are recommended. After the correction of systemic metabolic alkalosis and pH normalization, cerebrospinal fluid can keep a state of metabolic alkalosis. This circumstance, in addition to the residual effect of neuromuscular blocking agents, inhalant anesthetics and opioids could increase the risk of postoperative apnea after a general anesthesia.CASE REPORT: We present the successful management in 3 neonates in those a pyloromyotomy was carried out because they had presented congenital hypertrophic pyloric stenosis. This procedure was done under general anesthesia with orotracheal intubation and rapid sequence induction. Then, ultrasound-guided paravertebral block was performed as analgesic method without the need for administrating opioids within intraoperative period and keeping an appropriate analgesic level.CONCLUSIONS: Local anesthesia has demonstrated to be safe and effective in pediatric practice. We consider the ultrasound-guided paravertebral block with one dose as a possible alternative for other local techniques described, avoiding the use of opioids and neuromuscular blocking agents during general anesthesia, and reducing the risk of central apnea within postoperative period.

  16. Breathing in thin air: acclimatization to altitude in ducks.

    Science.gov (United States)

    Powell, Frank L; Shams, Hashim; Hempleman, Steven C; Mitchell, Gordon S

    2004-12-15

    We measured ventilation (VI) and arterial blood gases in Pekin ducks during acclimatization to 3800 m altitude for 1-90 days. Four experimental series were conducted over 4 years using both natural altitude and a hypobaric chamber. PaCO2 decreased to 3.5 Torr, relative to the value measured during acute hypoxia after 1 day and remained at this level for up to 90 days. However, PaO2 did not increase. Arterial pH showed an unexpected metabolic alkalosis during the first hours at altitude but after 3 days, a metabolic acidosis partially compensated the respiratory alkalosis and pHa was constant thereafter. When normoxia was restored after hypoxia, PaCO2 was 5.5 Torr less than the original normoxic control value, but PaO2 was not increased. VI showed variable changes during acclimatization but if metabolic rate was constant in our study, as reported by others, then effective parabronchial V(VP) increased during acclimatization. Increased VP tends to restore PaO2 toward normoxic levels and decreases adverse effects of gas exchange limitation, which apparently increased during acclimatization in ducks.

  17. RELATIONS BETWEEN SELECTED INDICATORS OF BLOOD AND MILK OF DAIRY COWS WITH METABOLIC DISORDERS

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    Jaroslav Kováčik

    2013-02-01

    Full Text Available The aim of this work was to monitor the relations between selected indicators of technological properties of milk and blood biochemical parameters of dairy cows with metabolic disorders. Thirty-two cows were chosen, which were divided into 3 groups: first group - cows with metabolic problems of acidosis, second group - cows with metabolic problems of alkalosis, third group - healthy cows. Blood, urine and milk samples were collected. Urea, total lipids, total proteins, glucose and calcium was determined in the blood serum. Pure acidobasic forms, pH and density of urine were determined. Proteins, lactose, non-fat-solids, somatic cells count, calcium, urea, titratable acidity, fermentability, rennetability and thermostability were determined in samples of milk. Significant negative dependences were observed in the group of cows with metabolic problems of acidosis between urea in blood and in milk (r = -0.694, P <0.05, between calcium in blood and in milk (r = -0.653, P <0, 05, and between calcium in milk and glucose in blood (r = -0.648, P <0.05. In the group of cows with alkalosis, statistically significant correlation between total lipids in blood and fat in milk was found (r = -0.879, P <0.05.

  18. 成分输血对急性失血患者酸碱平衡的影响%The acid-base balance influence of blood component transfusion on acute blood loss patients

    Institute of Scientific and Technical Information of China (English)

    吴胜楠; 洪澄英; 温隽珉; 周志强; 赖旭春

    2009-01-01

    目的:探讨成分输血对急性失血患者酸碱平衡的影响.方法:对88例急性失血患者进行输血前及输血后定时血气分析监测,根据血气监测结果分析成分输血对酸碱平衡的影响.结果:观察期间14例患者存在其他影响酸碱平衡因素退出.纳入分析的74例中,44例输血前存在不同程度代谢性酸中毒的患者输血后26例酸中毒消失,17例减轻,1例略加重.74例患者中输血后发生输血相关性碱中毒24例,其24 h内新鲜冰冻血浆(FFP)平均用量2 063 ml,明显高于非碱中毒患者.输血相关性碱中毒的病例未使用酸性药物进行治疗,停止输血后13~48 h自动恢复.结论:急性失血患者输血前大部分存在程度不同的代谢性酸中毒,经有效止血、输血后多能缓解.成分输血对急性失血患者酸碱平衡的影响主要表现为代谢性碱中毒,代谢性酸中毒罕见.输血相关性碱中毒一般为自限性,停止输血后可自行恢复.%Objective:To investigate the acid-base balance influence of blood component transfusion on acute blood loss patients. Methods:We detected the blood gas analysis of 88 acute blood loss patients before and after blood component transfusion, to analyze the acid-base balance influence of blood component transfusion according to the blood gas analysis. Results:Fourteen patients were quit for the acid-base balance influence of other factors during the observation, Seventy-four patients were bring into the acid-base balance analysis; Among the forty-four patients with different degree acidosis before, Twenty-six patient's acidosis vanished after blood component transfusion,Seventeen patient's acidosis alleviated af-ter blood componenttransfusion, One patient's acidosis aggravated slightly after blood component transfusion;Twenty-four patients had blood transfusion relevent alkalosis in all seventy-four patients after transfusion, And their average usage amount of fresh frozen plasma (FFP) was 2 063

  19. Clinical observations and acid-base imbalances in sheep during chronic copper poisoningAvaliação clínica e hemogasométrica de ovinos com intoxicação cúprica acumulativa

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    Clara Satsuk Mori

    2011-08-01

    Full Text Available Twelve male sheep were intoxicated with copper and four served as controls. When hemoglobinuria was first diagnosed, the poisoned sheep were randomly distributed into two groups: 4 untreated and 8 tetratiomolybdate-treated. Blood samples and clinical evaluation were performed daily, from the onset of poisoning until the 30th day. Analysis of packed cell volume, plasma free hemoglobin, and blood gas were made. Elevated heart rates and rectal temperature, and reduced respiratory and ruminal movement rates were recorded in the intoxicated group. The poisoned sheep developed mild alkalosis caused by bicarbonate retention, while a short-periodic increase of pCO2 occurred to compensate the ongoing alkalosis. Elevated degree of anemia was directly proportional to heart rate, while high degree of alkalosis was inversely proportional to respiratory rate. Further, there was an elevated positive relationship between plasma free hemoglobin and rectal temperature, and an increase in rectal temperature accompanied a reduced ruminal movement.Foram utilizados 16 cordeiros, sendo 12 submetidos à intoxicação cúprica e quatro animais controle. Quando foi verificada a presença de hemoglobinúria, os animais intoxicados foram aleatoriamente distribuídos em dois grupos, quatro animais não tratados e oito animais tratados com tetratiomolybidato de amônia. Foi realizado exame clínico e coleta de sangue diariamente desde o início da intoxicação até 30 dias após. Foram analisados o volume globular, concentração de hemoglobina plasmática e avaliação hemogasométrica. Nos animais intoxicados, foi observado elevação da freqüência cardíaca e da temperatura retal e redução da freqüência respiratória e dos movimentos ruminais. Os ovinos intoxicados desenvolveram alcalose moderada causada por retenção de bicarbonato seguido de um aumento pontual da pCO2 para compensar a alcalose em curso. Quanto maior o grau de anemia foi maior a freqüência card

  20. Recovery by the Norway lobster Nephrops norvegicus (L.) from the physiological stresses of trawling: Influence of season and live-storage position

    DEFF Research Database (Denmark)

    Lund, H. S.; Wang, T.; Chang, E. S.;

    2009-01-01

    -base status. In winter, a potential metabolic lactic acidosis was compensated by a marked respiratory alkalosis, with significantly increased haemolymph pH and decreased CO2 total content and partial pressure. These effects disappeared gradually over 96 h. Summer lobsters showed combined metabolic...... different live-storage positions, either resting vertically on the tail or sitting horizontally. In winter, many animals were alive when brought on board and approximately 86% were still alive at the end of experimentation (96 h). In summer very few animals were alive when brought on board and, of these...... significantly at 24 h, whereas it exhibited a further significant increase at 24 h in summer. Live-storage position had no significant effect on survival or recovery from capture stresses in either season. The results demonstrate that Nephrops were much more stressed by trawling at high summer temperatures...

  1. Autopsy report on pseudo-Bartter syndrome with renal calcification induced by diuretics and diet pills

    Science.gov (United States)

    Unuma, Kana; Tojo, Akihiro; Harada, Kazuki; Saka, Kanju; Nakajima, Makoto; Ishii, Takeshi; Fujita, Toshiro; Yoshida, Ken-ichi

    2009-01-01

    A woman in her mid-forties had repeated vomiting and diarrhoea accompanied by muscle weakness soon after she started taking seven different diet pills imported from Thailand. After she had taken the pills for 8 days, respiratory depression progressed rapidly to arrest. Blood tests at the Emergency Department showed severe hypokalaemia with metabolic alkalosis. We diagnosed that she had developed pseudo-Bartter syndrome from the findings based on ionic abnormalities and high renin and aldosterone levels, and hyperplasia of the juxtaglomerular apparatus. A postmortem blood analysis indicated subtherapeutic levels of furosemide. We concluded that the patient died from pseudo-Bartter syndrome, which was triggered by chronic self-administration of furosemide and aggravated by the diet pills. This is the first pseudo-Bartter syndrome autopsy report to show histological localisation of calcification in the kidneys. PMID:21686346

  2. [ACTH's ectopic secretion in a patient with precedents of Cushing's disease].

    Science.gov (United States)

    Dal Verme, Agustín; Cejas, Carlos; Margan, Mercedes; Siguelboim, Daniel; Canosa, Victoria; Peralta, Christian

    2015-01-01

    A 54-year-old man, with a history of Cushing's disease diagnosed 32 years earlier, presented with edema, asthenia and general malaise. Abnormal laboratory studies depicted hypokalemia and metabolic alkalosis. A CT scan of the chest revealed a 3×3 cm tumor in the anterior mediastinum. The pathology was consistent with a thymic carcinoid. These findings led to a diagnosis of biochemical Cushing's syndrome secondary to ectopic secretion of ACTH. Thus, this patient suffered twice of Cushing's syndrome. The first instance was the consequence of an ACTH--secreting pituitary adenoma and the second of an ectopic secretion of ACTH. To the best of our knowledge this is the first such case reported in the medical literature.

  3. Hypercholermic metabolic alcalsosis as a presentation of cystic fibrosis: presentation of two cases = Alcalosis metabólica hipoclorémica como presentación de la fibrosis quística. Informe de dos casos

    Directory of Open Access Journals (Sweden)

    Olga Lucía Morales Múnera

    2013-07-01

    Full Text Available Introduction: We describe two cases of patients with hyperchloremic metabolic acidosis as an initial presentation of cystic fibrosis (CF or as part of a second CF exacerbation. Clinical Cases: Two patients, 6 and 9 months old, consulted for cough, fever, and dyspnea. The first had syndrome of recurrent bronchial obstruction, without a diagnosis of CF on admission. Both presented with difficulty breathing, dehydration, and malnutrition. Arterial blood gases showed metabolic acidosis, hypokalemia, and severe hypochloremia. Treatment with sodium chloride and potassium improved their electrolyte balance and acid-base status. They did not present with renal or gastrointestinal losses of chloride. CF and pseudo-Barter’s Syndrome were diagnosed. Conclusion: Metabolic alkalosis can present as an initial manifestation of CF in infants with recurrent bronchiolitis and short stature suspected of having CF: equally it can be an acute exacerbation in patients with known CF. Your recognition and treatment are an opportunity to decrease morbidity.

  4. Primary hyperaldosteronism presenting with rhabdomyolysis in emergency room-Case report

    Institute of Scientific and Technical Information of China (English)

    Ilkay Cakir; Serkan Senol; Yasin Simsek; Zuleyha Karaca; Kursad Unluhizarci; Fatih Tanrverdi

    2016-01-01

    Primary hyperaldosteronism, is a well-known cause of secondary hypertension, mostly idiopathic hypertension or arising from aldosterone-producing adenomas. It is charac-terized with resistant hypertension, hypokalemia and metabolic alkalosis related with aldosterone production excess and plasma renin activity suppression. Hypokalemic rhabdomyolysis usually presents with muscle pain, cramps, fatigability and generalized weakness. Rhabdomyolysis due to hypokalemia is a rare complication of primary hyperaldosteronism reported within a limited number of cases in medical literature. Diagnosis and treatment of primary hyperaldosteronism is fundamentally important because of the probability of certain cure with accurate surgery. Here, we report a 38-year-old female with hypertension related with primary hyperaldosteronism who pre-sented with rhabdomyolysis most likely due to profound hypokalemia.

  5. Acid-base disturbance in patients with cirrhosis

    DEFF Research Database (Denmark)

    Henriksen, Jens H; Bendtsen, Flemming; Møller, Søren

    2015-01-01

    PURPOSE: Acid-base disturbances were investigated in patients with cirrhosis in relation to hemodynamic derangement to analyze the hyperventilatory effects and the metabolic compensation. METHODS: A total of 66 patients with cirrhosis and 44 controls were investigated during a hemodynamic study. ...... alterations in serum albumin and water retention that may result in a delicate acid-base balance in these patients.......PURPOSE: Acid-base disturbances were investigated in patients with cirrhosis in relation to hemodynamic derangement to analyze the hyperventilatory effects and the metabolic compensation. METHODS: A total of 66 patients with cirrhosis and 44 controls were investigated during a hemodynamic study......, and effects of unidentified ions (all Pacid-base disturbances could not be identified. CONCLUSION: Hypocapnic alkalosis is related to disease severity and hyperdynamic systemic circulation in patients with cirrhosis. The metabolic compensation includes...

  6. Acid-base balance of dairy cows and its relationship with alcoholic stability and mineral composition of milk

    Directory of Open Access Journals (Sweden)

    Rafael Fagnani

    2014-05-01

    Full Text Available This study aimed to associate the occurrence of acid-base disorders with the alcoholic stability of milk from animals in the field, and to evaluate differences between the mineral composition of milk that was both stable and unstable in alcohol. The sample comprised 96 dairy cows, where the milk and blood of each corresponding animal was collected. The mineral composition of stable and unstable milk in alcohol was different and may be related to acid-base disturbances. The average amount of phosphate was lower in the milk that was unstable in alcohol, while potassium was greater. Frequency of the alcoholically unstable milk cases was higher in the cows with acid-base disturbances. Respiratory alkalosis was the disorder that was most observed.

  7. Mass psychogenic systemic illness in school children in relation to the Tokyo photochemical smog

    Energy Technology Data Exchange (ETDEWEB)

    Araki, S.; Honma, T.

    1986-05-01

    To clarify the pathogenic mechanism of epidemics with acute systemic neurobehavioral illness associated with photochemical air pollution in Japan, we re-examined our past records in sixteen junior high school children, and compared them with major epidemics that occurred in 1970-1972 during which time Japanese society faced a new and unusual type of air pollution (Tokyo smog). Dysfunction of alveolar-arterial gas exchange, together with respiratory alkalosis, was newly found in these children, who suffered from chest discomfort, ocular irritation, emotional distress, tetany, and unconsciousness. It was concluded that anxiety reaction, precipitated by the physical effects of photochemical oxidants and athletic performance, possibly led to many outbreaks of mass psychogenic systemic illness (hyperventilation syndrome) among school children.

  8. Opiate Withdrawal Complicated by Tetany and Cardiac Arrest

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    Irfanali R. Kugasia

    2014-01-01

    Full Text Available Patients with symptoms of opiate withdrawal, after the administration of opiate antagonist by paramedics, are a common presentation in the emergency department of hospitals. Though most of opiate withdrawal symptoms are benign, rarely they can become life threatening. This case highlights how a benign opiate withdrawal symptom of hyperventilation led to severe respiratory alkalosis that degenerated into tetany and cardiac arrest. Though this patient was successfully resuscitated, it is imperative that severe withdrawal symptoms are timely identified and immediate steps are taken to prevent catastrophes. An easier way to reverse the severe opiate withdrawal symptom would be with either low dose methadone or partial opiate agonists like buprenorphine. However, if severe acid-base disorder is identified, it would be safer to electively intubate these patients for better control of their respiratory and acid-base status.

  9. Technetium-99m methoxyisobutylisonitrile localizes an ectopic ACTH-producing tumour: case report and review of the literature

    Energy Technology Data Exchange (ETDEWEB)

    Jacobsson, H. (Dept. of Diagnostic Radiology, Karolinska Hospital, Stockholm (Sweden)); Wallin, G. (Dept. of Surgery, Karolinska Hospital, Stockholm (Sweden)); Werner, S. (Dept. of Endocrinology and Diabetology, Karolinska Hospital, Stockholm (Sweden)); Larsson, S.A. (Dept. of Hospital Physics, Karolinska Hospital, Stockholm (Sweden))

    1994-06-01

    Extensive investigation including whole-body examinations with computed tomography and magnetic resonance imaging did not detect the suspected ectopic ACTH-producing tumour in a patient with advanced Cushing's syndrome and hypokalemic alkalosis. Gamma camera examination with technetium-99m methoxyisobutylisonitrile (MIBI) depicted the tumour, which was localized in the anterior neck and mediastinum. This was later verified by surgery. [sup 99m]Tc-MIBI is normally used for myocardial scintigraphy. Its accumulation is unspecific and merely reflects metabolic activity. Despite this, the present case shows that examination with this agent can provide important information with regard to tumour localization in a given situation, thereby serving as a complement to other imaging modalities. The current literature on [sup 99m]Tc-MIBI for tumour diagnosis is reviewed. (orig.)

  10. Rare presentation of pancreatitis secondary to intussusception of duodenal duplication cyst, a pediatric case report

    Directory of Open Access Journals (Sweden)

    Valentina Shakhnovich

    2014-12-01

    Full Text Available Duodenal duplication cysts are rare congenital malformations of which there is limited literature in the pediatric population. The most common presentation in symptomatic patients is abdominal pain and pancreatitis. We present a case of a 14 year old female that presented with emesis, abdominal pain, weight loss, and admission biochemical profile concerning for acute pancreatitis in conjunction with severe hypochloremic, hypokalemic metabolic alkalosis. Further imaging was highly suggestive of duodeno-duodenal intussusception causing obstruction of the pancreatic duct. Patient was taken emergently to the operating room for exploration. Patient underwent laparoscopic assisted reduction of intussusception and resection of duodenal duplication cyst. Patient tolerated the surgery well, and was able to be discharged home in stable condition soon after. There have been no cases reported in the literature that describe pancreatitis secondary to intussusception of duodenal duplication cyst. When diagnosed early, these patients can be safely managed laparoscopically even in emergent settings.

  11. Computed tomography diagnosis of malrotation with midgut volvulus and superior mesenteric vein thrombosis beyond infancy

    Directory of Open Access Journals (Sweden)

    Bhawna Satija

    2014-05-01

    Full Text Available Malrotation can be difficult to diagnose beyond the newborn period because of its non-specific symptoms and clinical findings. We present an unusual case of malrotation with midgut volvulus and superior mesenteric vein thrombosis in an adolescent. An 11-year-old girl presented to the paediatric emergency department with persistent vomiting, dyselectrolytemia, and metabolic alkalosis. An unremarkable abdominal radiograph and ultrasonography examination prompted a computerised scan of the abdomen. The diagnosis of malrotation with midgut volvulus and superior mesenteric vein thrombosis was made. The findings were confirmed on laproscopy and the patient underwent successful Ladd’s procedure. This case report emphasizes the importance of imaging, especially computed tomography, in making accurate diagnosis of malrotation and its complications, beyond the newborn period

  12. Catalytically and noncatalytically treated automobile exhaust: biological effects in rats

    Energy Technology Data Exchange (ETDEWEB)

    Cooper, G.P. (Univ. of Cincinnati); Lewkowski, J.P.; Hastings, L.; Malanchuk, M.

    1977-12-01

    Chronic exposure to catalytically treated or noncatalytically treated automobile exhaust significantly depressed the spontaneous locomotor activity (SLA) of rats. Exposure to H/sub 2/SO/sub 4/ alone or CO at comparable levels did not alter the SLA. Exposure to noncatalytically treated exhaust resulted in significant reductions in growth rate and food and water intake. However, these effects were not evident in the exposure to catalytically treated exhaust or in the control H/sub 2/SO/sub 4/ and CO exposures. Blood acid-base analyses indicated that exposure to either catalytically treated exhaust or H/sub 2/SO/sub 4/ elicits a metabolic alkalosis, while exposure to CO alone results in a metabolic acidosis. All acid-base parameters were within the normal range several weeks after the termination of exposure.

  13. Bilateral acute lupus pneumonitis in a case of rhupus syndrome

    Directory of Open Access Journals (Sweden)

    Supriya Sarkar

    2012-01-01

    Full Text Available Rhupus syndrome, the overlap of rheumatoid arthritis (RA and systemic lupus erythematosus (SLE, is an extremely uncommon condition. Organ damages found due to SLE are usually mild in rhupus. Lupus pneumonitis in rhupus syndrome has not been reported worldwide. We are reporting a 23-year-old female with bilateral symmetric erosive arthritis, oral ulcer, alopecia, polyserositis, anemia, leucopenia, positive RA-factor, anti nuclear antibody (ANA and anti ds-DNA. She presented with acute onset dyspnea, high fever, chest pain, tachycardia, tachypnea, hypoxia and respiratory alkalosis. High resolution computed tomography (HRCT-thorax showed bilateral, basal consolidation with air bronchogram. Repeated sputum and single broncho alveolar lavage (BAL fluid examination revealed no organism or Hemosiderin-laden macrophage. The diagnosis of rhupus was confirmed by combined manifestations of RA and SLE, and the diagnosis of acute lupus pneumonitis was established by clinico-radiological picture and by excluding other possibilities.

  14. Case Report: Cervical chondrocalcinosis as a complication of Gitelman syndrome [version 1; referees: 2 approved

    Directory of Open Access Journals (Sweden)

    Zahra Iqbal

    2016-05-01

    Full Text Available Gitelman syndrome is an inherited tubulopathy leading to a hypokalaemic metabolic alkalosis with hypomagnesaemia and hypocalciuria. Most cases are due to mutations in SLC12A3, encoding the apical thiazide sensitive co-transporter in the distal convoluted tubule. Musculoskeletal effects of Gitelman syndrome are common, including muscle weakness, tetany and cramps. Chronic hypomagnesaemia can lead to chondrocalcinosis, which often affects knees but can affect other joints. Here we present a case of Gitelman syndrome complicated by cervical chondrocalcinosis leading to neck pain and numbness of the fingers. Treatments directed at correcting both hypokalaemia and hypomagnesaemia were initiated and allowed conservative non-surgical management of the neck pain. Recognition of chondrocalcinosis is important and treatments must be individualised to correct the underlying hypomagnesaemia.

  15. A Case of Hyperemesis Gravidarum due to Gastric Cancer Masquerading as Preeclampsia

    Directory of Open Access Journals (Sweden)

    Daniel R. Hersh

    2011-12-01

    Full Text Available Nausea and vomiting are symptoms frequently seen in normal pregnancy. We report a patient with gastric carcinoma who presented with severe hyperemesis gravidarum that led to extreme volume depletion, hypertension, proteinuria, and acute renal failure. A 35-year-old woman (para 2-1-0-1 with a prenatal course significant for persistent nausea, vomiting, and poor weight gain presented at 36 weeks' gestation with elevated blood pressure (157/114 mm Hg, proteinuria (4+, hypochloremic metabolic alkalosis, and severe intravascular volume contraction. A presumptive diagnosis of severe preeclampsia was made, the patient was given intravenous MgSO4, and cesarean delivery was accomplished uneventfully. When significant emesis persisted in the postoperative period, esophagogastroduodenoscopy revealed an antral/prepyloric mass with a biopsy-proven poorly differentiated adenocarcinoma. To our knowledge, this is the first report of a case of hyperemesis gravidarum with gastric cancer masquerading as preeclampsia.

  16. Inherited renal tubular defects with hypokalemia

    Directory of Open Access Journals (Sweden)

    Muthukrishnan J

    2009-01-01

    Full Text Available Bartter′s and Gitelman′s syndrome are two ends of a spectrum of inherited renal tubular disorders that present with hypokalemic metabolic alkalosis of varying severity. Clinical features and associated calcium and magnesium ion abnormalities are used to diagnose these cases after excluding other commoner causes. We report on two cases, the first being a young boy, born of pregnancy complicated by polyhydramnios, who had classical dysmorphic features, polyuria, hypokalemia and hypercalciuria and was diagnosed as having Bartter′s syndrome. The second patient is a lady who had recurrent tetany as the only manifestation of Gitelman′s syndrome, which is an unusual presentation. Potassium replacement with supplementation of other deficient ions led to satisfactory clinical and biochemical response.

  17. Prevention and treatment of severe acute pancreatitis com-plicated with pancreatic infection%重症急性胰腺炎并发胰腺感染的防治

    Institute of Scientific and Technical Information of China (English)

    毛恩强

    2008-01-01

    Pancreatic infection is an independent risk factor leading to death. Early prophylaxis, diagnosis and treat-ment are three keys to raise the survival rate. Strategies of prevention include prevention of bacteria translacation, fluid sequestration and antibiotic prophylaxis usage. The principal methods to decrease bacteria translocation are shortening of interval of intestinal iscbemia, decreasing of abdominal pressure, selective digestive decontamination and total enteral nutrition as early as possible. And strategy of controlling fluid resuscitation is the key point to decrease fluid sequestration. Early diagnostic criteria of pancreatic infection include at least 4 indexes of the following: white blood cell count, temperature, heart beat, intraabdominal pressure, procalcitonin, air bubble, blood pressure, prealbumin, total bilirubin and respiratory alkalosis, and addition of 2 weeks after the onset of the disease and exclusion of infection from other sites. If pancreatic infection has not been controlled by intensive nonoperative therapy for 48 hours, surgical intervention should be performed.

  18. A Case Report of Multiple Endocrine Neoplasia Type IIa Associated with Cushing Syndrome

    Directory of Open Access Journals (Sweden)

    Sh. Borzouei

    2013-10-01

    Full Text Available Introduction: Multiple endocrine neoplasia type IIa (MEN IIa is an autosomal dominant syn-drome characterized bypheochromocytoma ,medullary thyroid carcinoma and hyperparathy-roidism. Pheochromocytoma approximately occurs in 50% of patients with MEN IIa. This tumor has the capacity to produce ACTH ectopically and becomes manifest like Cushing syndrome,although it is very rare. Case Report: We report a 26-year-old woman patient with severe muscle weakness, skin le-sions in extremity, hypertension, new onset diabetes and in the laboratory data hypokalemia, metabolic alkalosis, high serum level of cortisol, metanephrine, normetanephrine, calcitonin and bilateral adrenal mass in computed tomography as the first clinical manifestations of an ACTH-secreting pheochromocytoma. Conclusion: In the patients with hypertension, new onset diabetes and hypokalemia Cushing syndrome and pheochromocytoma should always be ruled out. (Sci J Hamadan Univ Med Sci 2013; 20 (3:260-265

  19. Infantile variant of Bartter syndrome and sensorineural deafness: A new autosomal recessive disorder

    Energy Technology Data Exchange (ETDEWEB)

    Landau, D.; Shalev, H.; Carmi, Rivka; Ohaly, M. [Univ. of the Negev, Ashkelon (Israel)

    1995-12-04

    The infantile variant of Bartter syndrome (IBS) is usually associated with maternal polyhydramnios, premature birth, postnatal polyuria and hypokalemic hypochloremic metabolic alkalosis and a typical appearance. IBS is thought to be an autosomal recessive trait. Several congenital tubular defects are associated with sensorineural deafness (SND). However, an association between the IBS and SND has not been reported so far. Here we describe 5 children of an extended consanguineous Bedouin family with IBS and SND. In 3 of the cases, the typical electrolyte imbalance and facial appearance were detected neonatally. SND was detected as early as age 1 month, suggesting either coincidental homozygotization of 2 recessive genes or a pleiotropic effect of one autosomal recessive gene. This association suggests that evaluation of SND is warranted in every case of IBS. 35 refs., 2 figs., 2 tabs.

  20. Effect of hypoxaemia on water and sodium homeostatic hormones and renal function

    DEFF Research Database (Denmark)

    Olsen, Niels Vidiendal

    1995-01-01

    the advantage of opposing excessive sodium and water retention, which characterizes acute mountain sickness. Short-term isocapnic or hypocapnic hypoxaemia in spontaneously breathing humans causes moderate if any increases in renal blood flow and only minor changes in GFR. In contrast, renal blood flow and GFR......Changes in body fluid homeostasis during acute hypoxaemia suggest a crucial role of renal function in acclimatization processes. Hypoxaemia stimulates sympathetic nervous activity, and also the cardiovascular system is affected with increases in heart rate and cardiac output. In most subjects......, a hypoxic ventilatory response produces hypocapnia and respiratory alkalosis. Acute hypoxaemia depresses aldosterone secretion secondary to a direct effect on adrenal cells. Also plasma renin is decreased in resting hypoxaemic conditions, but the mechanism remains unknown. These hormonal changes may have...

  1. in Critically Ill Patients: Success and Limits

    Directory of Open Access Journals (Sweden)

    Filippo Mariano

    2011-01-01

    Full Text Available Citrate anticoagulation has risen in interest so it is now a real alternative to heparin in the ICUs practice. Citrate provides a regional anticoagulation virtually restricted to extracorporeal circuit, where it acts by chelating ionized calcium. This issue is particularly true in patients ongoing CRRT, when the “continuous” systemic anticoagulation treatment is per se a relevant risk of bleeding. When compared with heparin most of studies with citrate reported a longer circuit survival, a lower rate of bleeding complications, and transfused packed red cell requirements. As anticoagulant for CRRT, the infusion of citrate is prolonged and it could potentially have some adverse effects. When citrate is metabolized to bicarbonate, metabolic alkalosis may occur, or for impaired metabolism citrate accumulation leads to acidosis. However, large studies with dedicated machines have indeed demonstrated that citrate anticoagulation is well tolerated, safe, and an easy to handle even in septic shock critically ill patients.

  2. [Sauna effect on blood oxygen transport function and proxidant/antioxidant balance in youths].

    Science.gov (United States)

    Zinchuk, V V; Zhad'ko, D D

    2012-01-01

    There was investigated sauna effect on blood oxygen transport function and proxidant/antioxidant balance in 18 to 22 years old males. Subjects being tested underwent thermal exposure once per week over a period of 5 months (20 procedures). There were two exposure over the course of sauna bathing (temperature 85-90 degrees C, humidity 10-15%): the first exposure lasted for 5 minutes and the second one for 10 minutes. Dry air sauna in youth's leads to respiratory alkalosis, increases pO2, decreases haemoglobin binding capacity to venous blood oxygen thus facilitating oxygen transport into body tissues. Single sauna visit results in oxidative stress (augmentation of free radical processes and deterioration of antioxidant defence mechanisms), while its manifestations being diminished after multiple thermal exposures. Increase in nitrogen monoxide formation being observed might matter for the modification of the oxygen dependent processes of the human body.

  3. Gitelman's syndrome in pregnancy: case report and review of the literature.

    LENUS (Irish Health Repository)

    McCarthy, Fergus P

    2012-01-31

    Gitelman\\'s syndrome (GS), a rare renal disorder, results in hypokalaemia, hypomagnesaemia, hypocalciuria and a metabolic alkalosis. It is unclear if an alteration in management is necessary or beneficial during pregnancy. A 32-year-old woman with GS was managed in her second pregnancy. Antenatally, the patient required 39 (principally day case) admissions to the hospital for intravenous (IV) therapy and received a cumulative total of 47 l of IV 0.9% saline solution, 47 doses of 20 mmol magnesium chloride and 46 doses of 80 mmol potassium chloride. She delivered a 2940-g female infant in excellent condition by caesarean section. We would suggest that close attention to maternal weight gain during pregnancy is an easily available clinical tool to assess adequacy of fluid and electrolyte repletion in this condition.

  4. A case of liddle′s syndrome; unusual presentation with hypertensive encephalopathy

    Directory of Open Access Journals (Sweden)

    Sunil Kumar Kota

    2014-01-01

    Full Text Available Liddle′s syndrome is a rare cause of secondary hypertension. Identification of this disorder is important because treatment differs from other forms of hypertension. We report an interesting case of a 35-year-old lady, a known diabetic and hypertensive patient, who presented with features of hypertensive encephalopathy. The family history was unremarkable. Past treat-ment with various combinations of antihypertensive medications including spironolactone, all at high doses, failed to control her blood pressure. Upon evaluation, the patient had hypokalemic alkalosis, low 24-h urine potassium and suppressed plasma renin activity. Although these findings were similar to hyperaldosteronism, plasma aldosterone was lower than the normal range. Blood pressure decreased markedly after administration of amiloride. Along with hyporeninemic hypo-aldosteronism, the non-responsiveness to spironolactone and good response to amiloride esta-blished the diagnosis of Liddle′s syndrome.

  5. Hypokalemic paralysis and respiratory failure due to excessive intake of licorice syrup

    Directory of Open Access Journals (Sweden)

    Mehmet Oguzhan Ay

    2014-04-01

    Full Text Available Licorice is the root of Glycyrrhiza glabra, which has a herbal ingredient, glycyrrhizic acid. Excessive intake of licorice may cause a hypermineralocorticoidism-like syndrome characterized by sodium and water retention, hypokalemia, hypertension, metabolic alkalosis, low-renin activity, and hypoaldosteronism. In this paper, an 34 years old man who admitted to the emergency department with respiratory failure and marked muscle weakness of all extremities that progressed to paralysis after excessive intake of licorice syrup was presented. It was aimed to draw attention to the necessity of questioning whether there is excessive intake of licorice or not in patients who admitted to emergency department with paralysis and dyspnea. Plasma potassium concentration of the patient was 1.4 mmol/L. The patient\\'s respiratory distress and loss of muscle strength recovered completely after potassium replacement. [Cukurova Med J 2014; 39(2.000: 387-391

  6. Neonatal bartter syndrome

    International Nuclear Information System (INIS)

    A pre-term baby girl was born following a pregnancy complicated by severe polyhydramnios at a gestational age of 36 weeks. She was initially suffering from respiratory distress consistent with idiopathic respiratory distress syndrome, and altered electrolyte imbalance with hyponatremia, hypokalemia and hypochloremic metabolic alkalosis. However, during the third week of life when she had dehydration along with significant electrolyte imbalance, Bartter's syndrome was considered which was supported by findings of high renin and aldosterone levels. Treatment was done by correction of electrolytes and dehydration along with indomethacin. The drug was well tolerated. The infant showed correction of electrolyte imbalance. The features of this case suggest an extreme form of Bartter's syndrome presenting from the early days of life. The syndrome is reported because of it's rarity and alerts pediatricians to the antenatal and neonatal variant of Bartter's syndrome. (author)

  7. [Human life at high altitudes: myths and realities].

    Science.gov (United States)

    Vargas, E; Villena, M

    1989-01-01

    Life at high altitude presents very interesting biological and medical aspects. For countries such as the Andeans, it also has socio-economical implications. The most important towns of Bolivia are situated between 3,000 and 4,850 m. It's to say that a great percentage of the population is permanently staying there. Moreover owing to the improvement of the roads and transport, an extensive migration (professional life, business, tourism, sport) developed some years ago. At 3,000 to 4,850 m, an oxygen arterial pressure (PaO2) between 40 and 70 mm Hg is resulting from the environmental hypoxia. The adaptation to hypoxia takes place in two phases: --that incomplete, observed at short time in people who recently arrived, --that at very long time, observed in the native. The rapid arrival at more than 3,000 m, exposes the traveller to an hypoxic ventilatory stimulus which produces a hyperventilation response to increased PaO2. This hyperventilation brings out a decreasing of carbon dioxide arterial pressure (PaCO2) and alkalosis of the blood. This respiratory alkalosis seems to be responsible for most troubles which are present in the Acute Mountain Sickness linked to the CO2 role in cerebral blood circulation. At the same time but more slowly the classical high altitude polycythemia develops which permits compensate partially the hypoxic effect in 3 to 4 weeks. In the native the adaptation implies physiological variations of some parameters concerning the individual development. The principal studies showed that the native present a notable hyposensitivity to hypoxia and also to the stimulus CO2-H+. The Chronic Mountain Sickness patients have a less sensitivity to the same stimuli than the natives. PMID:2699275

  8. Study on acid- base disturbance in patients with posttraumatic multiple organ dysfunction syndrome

    Institute of Scientific and Technical Information of China (English)

    2000-01-01

    Objective: To investigate the classification and incidence of acid-base disturbance (ABD) in the patients with post-traumatic multiple organ dysfunction syndrome (MODS). Methods: A total of 119 patients with MODS were examined with arterial blood gas analysis and serum electrolytes detection for 675 times in this study. Results: Different types of ABD existed in 647 times out of 675 times (95.9%) of blood-gas analyses. There were 270 times (41.7%) of simple ABD, 271 times (41.9%) of double ABD and 106 times (16.4%) of triple ABD. Among which, 404 times (62.4%) were in respiratory alkalosis (RAL), 332 times (51.3%) in metabolic acidosis (MA), 227 times (35.1% ) in metabolic alkalosis (MAL) and 167 times (25.8%) in respiratory acidosis (RA). In this study, 79 cases (66.4%) out of 119cases with MODS died from these kinds of ABD. Conclusions: It suggests that in the early stage of MODS, RAL with or without hypoxemia may exist, and later on, MA or even triple ABD may occur. In order to detect and correct the primary disorders as early as possible, it is important to keep the balance of hydrolyte. The treatment of primary diseases is also important.Disorders of acid-base balance were corrected according to pH standard values, anion gap (AG) and the potential [HCO3- ] were also calculated simultaneously. When pH was more than 7.50 or lower than 7.20, it is necessary to give drugs of acidity or alkalinity to the patients with ABD to maintain pH value within a normal range.

  9. Effects of plasma total ammonia content and pH on urea excretion in Nile tilapia.

    Science.gov (United States)

    McKenzie, D J; Piraccini, G; Felskie, A; Romano, P; Bronzi, P; Bolis, C L

    1999-01-01

    Nile tilapia (Oreochromis niloticus) were infused with ammonium salts, acid, and base to investigate the effects of changes in arterial plasma total ammonia content (Tamm) and pH (pHa) on plasma urea-nitrogen (urea-N) levels and urea-N excretory fluxes (Jurea-N). The tilapia did not possess a functional hepatic ornithine urea-cycle (no significant carbamyl phosphate synthetase III activity). Infused substances were dissolved in a saline vehicle and injected twice (5 mL kg-1), the first infusion to "prime" the animal and promote a more marked response to the second infusion, given 2.5 h later. The results reported are those of the second infusion. Infusion of 200 mM NH4Cl increased Tamm, reduced pHa, and increased plasma urea-N and Jurea-N. Two hundred mM NH4HCO3 increased Tamm and arterial plasma total CO2 content (TaCO2), reduced pHa, and increased Jurea-N. Fifty mM HCl reduced pHa but had no effects on urea dynamics. Fifty mM NaOH increased pHa, plasma urea-N levels, and Jurea-N. Two hundred mM NaHCO3 increased pHa, TaCO2, plasma urea-N levels, and Jurea-N. Infusion of the saline vehicle was without effect. The results indicate that ammonia loading and plasma alkalosis both stimulate urea excretion in uricolytic fish. The responses to hyperammonemia or alkalosis were not modified when combined with elevated plasma bicarbonate levels.

  10. Pseudo-Bartter’s syndrome in patients with cystic fibrosis: A case series and review of the literature

    Directory of Open Access Journals (Sweden)

    Vilotijević-Dautović Gordana

    2015-01-01

    Full Text Available Introduction. Pseudo-Bartter syndrome (PBS is characterized by hyponatremic, hypochloremic metabolic alkalosis that mimics Bartter syndrome but with no pathology in the renal tubules. We present five patients with cystic fibrosis (CF and PBS. Cases Outline. Four children aged between three and five-and-one-half months with previously diagnosed CF and one aged 17 months with previously undiagnosed disease, were hospitalized during the summer season, with severe dehydration, oliguria, apathy and adynamia. Additionally, one of them had an ileostomy due to meconium ileus after birth. All children were on a diet without additional salt intake. Laboratory analysis on admission showed hyponatremia (115-133 mmol/L, mean 122.4 mmol/L, high plasma renin activity (229-500 pg/ml, mean 324 pg/ml and metabolic alkalosis (pH 7.5-7.6, mean 7.56 in all the patients, and in four of them high blood level of aldosterone (74-560 pg/ml, mean 295.9 pg/ml, hypokalemia (2.3-2.8 mmol/L, mean 2.6 mmol/L, hypochloremia (59-71 mmol/L, mean 66 mmol/L and low urinary sodium (5-12 mmol/L, mean 9 mmol/L. After intravenous rehydration followed by additional use of sodium and chloride in mean dosis of 1.78 mmol/kg per day, all the patients made a complete recovery. With advice for additional use of salt in the mentioned amount, the patients were discharged from the hospital. Conclusion. PBS is one of CF complications, especially in infants and young children in situations accompanied by increased sweating and/or other causes of additional loss of sodium and chlorine. Sometimes, as was the case with one of our patients, PBS may be the initial presentation form of the disease.

  11. Sodium bicarbonate-augmented stress thallium myocardial scintigraphy

    Energy Technology Data Exchange (ETDEWEB)

    Sarin, Badal; Chugh, Pradeep Kumar; Kaushal, Dinesh; Soni, Nakse Lal; Sawroop, Kishan; Mondal, Anupam; Bhatnagar, Aseem [Department of Nuclear Medicine, Institute of Nuclear Medicine and Allied Sciences, Brig. S. K. Mazumdar Road, 110054, Delhi (India)

    2004-04-01

    It is well known that sodium bicarbonate in pharmacological doses induces transient alkalosis, causing intracellular transport of serum potassium. The aims of this study were (a) to investigate whether, in humans, myocardial thallium-201 uptake can be augmented by pretreatment with a single bolus of sodium bicarbonate at a pharmacological dose, (b) to verify general safety aspects of the intervention and (c) to evaluate the clinical implications of augmentation of {sup 201}Tl uptake, if any. Routine exercise myocardial scintigraphy was performed twice in eight adult volunteers (five normal and three abnormal), once without intervention and the second time (within a week) following intravenous administration of sodium bicarbonate (88 mEq in 50 ml) as a slow bolus 1 h prior to the injection of {sup 201}Tl. Conventional myocardial thallium study was compared with sodium bicarbonate interventional myocardial scintigraphy with respect to myocardial uptake (counts per minute per mCi injected dose), washout patterns in normal and abnormal myocardial segments, and overall clinical interpretation based on planar and single-photon emission tomographic (SPET) images. All patients remained asymptomatic after the intervention. A mean increase of 53% in myocardial uptake of thallium was noted in post-exercise acquisitions after the intervention, confirming uptake of the tracer via the potassium-hydrogen pump and its augmentation by transient alkalosis. The washout pattern remained unchanged. The visual quality of planar and SPET images improved significantly after the intervention. Out of the five abnormal myocardial segments identified in three cases, four showed significant filling-in after the intervention, causing the diagnosis to be upgraded from ''partial scar'' to ''ischaemia'', or from ''ischaemia'' to ''normal''. The overall scan impression changed in two out of three such cases. Sodium

  12. Absence of transepithelial anion exchange by rabbit OMCD: Evidence against reversal of cell polarity

    Energy Technology Data Exchange (ETDEWEB)

    Hayashi, Matsuhiko; Schuster, V.L.; Stokes, J.B. (Univ. of Iowa College of Medicine, Iowa City (USA))

    1988-08-01

    In the rabbit cortical collecting duct (CCD), Cl tracer crosses the epithelium predominantly via an anion exchange system that operates in either a Cl-Cl or Cl-HCO{sub 3} exchange mode. In the present study, the authors used the {sup 36}Cl lumen-to-bath rate coefficient (K{sub Cl}, nm/s), a sensitive measurement of CCD transepithelial anion transport, to investigate the nature of Cl transport in the medullary collecting duct dissected from inner stripe, outer medulla (OMCD). The K{sub Cl} in OMCD perfused and bathed in HCO{sub 3}-Ringer solution was low and similar to that value observed in the CCD when anion exchange is inhibited and Cl permeates the epithelium by diffusion. To test the hypothesis that metabolic alkalosis could reverse the polarity of intercalated cells and thus induce an apical Cl-HCO{sub 3} exchanger in H{sup +}-secreting OMCD cells, they measured K{sub Cl} in OMCD from rabbits make alkalotic by deoxycorticosterone and furosemide. Although the base-line K{sub Cl} was slightly higher than in OMCD from control rabbits, the value was still far lower than the K{sub Cl} under comparable conditions in CCD. They conclude (1) Cl transport across the MCD by anion exchange is immeasurably low or nonexistent; (2) unlike the CCD, Cl transport in OMCD is not responsive to cAMP; and (3) metabolic alkalosis does not induce an apical anion exchanger in OMCD, i.e., does not cause epithelial polarity reversal.

  13. Different Placebos, Different Mechanisms, Different Outcomes: Lessons for Clinical Trials.

    Directory of Open Access Journals (Sweden)

    Fabrizio Benedetti

    Full Text Available Clinical trials use placebos with the assumption that they are inert, thus all placebos are considered to be equal. Here we show that this assumption is wrong and that different placebo procedures are associated to different therapeutic rituals which, in turn, trigger different mechanisms and produce different therapeutic outcomes. We studied high altitude, or hypobaric hypoxia, headache, in which two different placebos were administered. The first was placebo oxygen inhaled through a mask, whereas the second was placebo aspirin swallowed with a pill. Both placebos were given after a conditioning procedure, whereby either real oxygen or real aspirin was administered for three consecutive sessions to reduce headache pain. We found that after real oxygen conditioning, placebo oxygen induced pain relief along with a reduction in ventilation, blood alkalosis and salivary prostaglandin (PGE2, yet without any increase in blood oxygen saturation (SO2. By contrast, after real aspirin conditioning, placebo aspirin induced pain relief through the inhibition of all the products of cyclooxygenase, that is, PGD2, PGE2, PGF2, PGI2, thromboxane (TXA2, without affecting ventilation and blood alkalosis. Therefore, two different placebos, associated to two different therapeutic rituals, used two different pathways to reduce headache pain. The analgesic effect following placebo oxygen was superior to placebo aspirin. These findings show that different placebos may use different mechanisms to reduce high altitude headache, depending on the therapeutic ritual and the route of administration. In clinical trials, placebos and outcome measures should be selected very carefully in order not to incur in wrong interpretations.

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

    Directory of Open Access Journals (Sweden)

    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.

  15. {sup 1}H and {sup 31}P-magnetic resonance spectroscopy of cerebral infarction in rats

    Energy Technology Data Exchange (ETDEWEB)

    Yamamuro, Manabu; Katayama, Yasuo; Igarashi, Hironaka; Terashi, Akiro [Nippon Medical School, Tokyo (Japan)

    1997-04-01

    Magnetic resonance spectroscopy (MRS) allows the noninvasive study of metabolism in vivo. In order to further understand the time course of biochemical changes during cerebral infarction, we performed the MRS study with pathological analysis. The left middle cerebral artery (MCA) was occluded in spontaneously hypertensive male rats (SHR) by the method of Tamura et al. The spectra were obtained from the infarcted hemisphere by placing the surface coils over the left side of the calvarium. {sup 31}P and {sup 1}H-MRS were performed at 3 hours, 24 hours and 7 days after MCA occlusion. Ischemic lesions caused by the left MCA occlusion extended into the parietal lobe and caudate putamen. After 3 hours of ischemia, vacuolated neurophils and shrunken neurons were observed. At 24 hours, these changes were severe. After 7 days, infiltration of monocytes and capillary hyperplasia were seen, and neurons had disappeared. At the acute stage of ischemia the phosphocreatine/inorganic phosphate (PCr/Pi) peak ratio decreased. After 7 days of ischemia, these changes became obscure. The intracellular pH (pHi) decreased after 3 hours of ischemia and recovered almost to the control level at 24 hours post ischemia. Alkalosis was apparent 7 days after ischemia. This alkalosis might be due to increased permeability of the deteriorated blood brain barrier. Although the lactate level was high 24 hours post ischemia, the pHi was almost normal. The N-acetyl-aspartate/creatine ratio decreased significantly from the acute stage of stroke. This decrease correlated with pathological changes. The correlation of the magnetic resonance spectra with the histological results may open aspects for monitoring stroke therapy and a new approach to tissue characterization. (author)

  16. 家族性Gitelman综合征诊治经验%Diagnostic experience on familial Gitelman syndrome

    Institute of Scientific and Technical Information of China (English)

    季文; 何薇; 殷琪淇; 张路遥; 廖志红

    2015-01-01

    目的 报道2例家族性Gitelman综合征;重点介绍其基因、分类、治疗、预后.方法 分析2例家族性Gitelman综合征患者1年的随访临床资料.结果 2例患者血压均正常,低血钾性碱中毒、低血镁、低尿钙,这些异常在使用静脉补镁补钾、螺内酯、吲哚美辛治疗3d后近乎完全被纠正,但1年随访仍疗效欠佳.结论 Gitelman综合征的电解质紊乱、碱中毒可被纠正,使用PGE2合成酶抑制剂尚有不同意见,能否耐受长期服药将会是影响治疗效果重要因素.%Objective To report two cases of familial Gitelman syndrome and literature review regarding the updates of relevant genes,classification,treatment,and prognosis.Methods The clinical data of two sisters with Gitelman syndrome were retrospectively analyzed.Results Their blood pressures were within normal range.Hypokalaemic alkalosis,hypomagnesemia,and hypocalciuria were corrected almost completely after three days of intravenous magnesium and potassium infusion,spirolactone and indometacin.However,the maintenance of normal potassium was unsuccessful over one year.Conclusion Hypokalaemic alkalosis,hypomagnesemia,and hypocalciuria were normalized in Gitelman syndrome.There was some debate in regard to using PGE2 synthetase inhibitors.Tolerance of long-term medication will be the big challenge for curative effect.

  17. The use of the standard exercise test to establish the clinical significance of mild echocardiographic changes in a Thoroughbred poor performer : clinical communication

    Directory of Open Access Journals (Sweden)

    C. Meyer

    2004-06-01

    Full Text Available A 4-year-old Thoroughbred gelding racehorse was referred to the Onderstepoort Veterinary Academic Hospital (OVAH with a history of post-race distress and collapse. In the absence of any obvious abnormalities in the preceding diagnostic work-up, a standard exercise test was performed to determine an underlying cause for the post-race distress reported. In this particular case oxygen desaturation became evident at speeds as slow as 6 m/s, where PO2 was measured at 82.3 mm Hg. Similarly at a blood pH of 7.28, PCO2 had dropped to 30.0mm Hg indicating a combined metabolic acidosis and respiratory alkalosis. The cause of the distress was attributed to a severe hypoxia, with an associated hypocapnoea, confirmed on blood gas analyses, where PO2 levels obtained were as low as 56.6 mm Hg with a mean PCO2 level of 25.4 mm Hg during strenuous exercise. Arterial oxygenation returned to normal immediately after cessation of exercise to 106.44 mm Hg, while the hypocapnoeic alkalosis, PCO2 25.67 mm Hg, persisted until the animal's breathing normalized. The results obtained were indicative of a dynamic cardiac insufficiency present during exercise. The combination of an aortic stenosis and a mitral valve insufficiency may have resulted in a condition similar to that described as high-altitude pulmonary oedema, with respiratory changes and compensation as for acute altitude disease. The results obtained were indicative of a dynamic cardiac insufficiency present during exercise and substantiate the fact that an extensive diagnostic regime may be required to establish a cause for poor performance and that the standard exercise test remains an integral part of this work-up.

  18. Hamm及周寿生酸碱失衡预计代偿公式的对比分析%Comparison of Hamm and Zhoushousheng's formulae for expected compensation in acid-base imbalance

    Institute of Scientific and Technical Information of China (English)

    韦国强; 陈娟; 王印国; 罗小春; 姚新丰

    2010-01-01

    目的 比较Hamm及周寿生2组酸碱失衡预计代偿范围计算公式的差别及其合理性.方法 将745份实测异常血气分析结果同时用2组公式判断其酸碱失衡类型,用Kappa检验2组公式的一致性.结果 两组公式判断108份代谢性酸中毒一致率为70.4%(Kappa值0.41,P<0.01);判断132份代谢性碱中毒一致率为59.1%(Kappa值0.18,P<0.05);判断81份急性呼吸性酸中毒一致率为65.4%(Kappa值0.31,P<0.01);判断168份急性呼吸性碱中毒一致率为54.8%(Kappa值0.24,P<0.01):判断119份慢性呼吸性酸中毒一致率为67.2%(Kappa值0.41,P<0.01);判断137份慢性呼吸性碱中毒一致率为66.6%(Kappa值0.43,P<0.01).结论 用Hamm和周寿生2组公式判断酸碱失衡类型存在明显差别,周寿生公式组转化后,其继发变化的最大预计代偿系数略高于其原始采纳的代偿系数.%Objective To compare the difference and rationalities between Harmm and Zhou' s formulae for expected acid-base compensation in acid-base imbalance. Methods 745 cases of arterial blood gas analysis results of acid-base disorder were evaluated respectively by Hamm and Zhou' s formulae, and the concordance was judged. Results For metabolic acidosis ( 108 cases), the concordance rate was 70. 4% between Hamm and Zhou's( Kappa value =0. 41 ,P <0. 01 ) ;for metabolic alkalosis ( 132 cases) ,the concordance rate was 59. 1% ( Kappa value =0. 18 ,P <0. 05) ;for acute respiratory acidosis(81 cases) ,the concordance rate was 65.43% ( Kappa value = 0. 31, P < 0. 01 ) ;for acute respiratory alkalosis ( 168 cases), the concordance rate was 54. 8% ( Kappa value = 0. 24%, P < 0. 01 ); for chronic respiratory acidosis ( 119 cases ), the concordance rate was 67.2% ( Kappa value = 0. 41, P < 0. 01 ) ;for chronic respiratory alkalosis( 137 cases), the concordance rate was 66. 6% ( Kappa value = 0. 43, P < 0. 01 ). Conclusion The difference between Hamm and Zhou' s formulae for expected acid

  19. Pattern of acid base abnormalities in critically ill patinets

    International Nuclear Information System (INIS)

    To find out the pattern of acid base abnormalities in critically ill patients in a tertiary care health facility. Study Design: A descriptive study. Place and Duration of Study: The study was carried out in the department of pathology, Combined Military Hospital Kharian from January 2013 to June 2013. Patients and Methods: Two hundred and fifty patients suffering from various diseases and presenting with exacerbation of their clinical conditions were studied. These patients were hospitalized and managed in acute care units of the hospital. Arterial blood gases were analysed to detect acid base status and their correlation with their clinical condition. Concomitant analysis of electrolytes was carried out. Tests related to concurrent illnesses e.g. renal and liver function tests, cardiac enzymes and plasma glucose were assayed by routine end point and kinetic methods. Standard reference materials were used to ensure internal quantify control of analyses. Results: Two hundred and fifteen patients out of 250 studied suffered from acid base disorders. Gender distribution showed a higher percentage of male patients and the mean age was 70.5 ± 17.4 years. Double acid base disorders were the commonest disorders (34%) followed by metabolic acidosis (30%). Anion gap was calculated to further stratify metabolic acidosis and cases of diabetic ketoacidosis were the commonest in this category (47%). Other simple acid base disorders were relatively less frequent. Delta bicarbonate was calculated to unmask the superimposition of respiratory alkalosis or acidosis with metabolic acidosis and metabolic alkalosis. Though triple acid base disorders were noted in a small percentage of cases (05%), but were found to be the most complicated and challenging. Mixed acid base disorders were associated with high mortality. Conclusion: A large number of critically ill patients manifested acid base abnormalities over the full spectrum of these disorders. Mixed acid base disorders were

  20. Blood gas analysis of patients with malignant ascites in 42 cases%恶性腹水患者42例血气分析

    Institute of Scientific and Technical Information of China (English)

    谭斌; 辛瑞娟; 陈慧; 冯雅宁; 白飞虎

    2015-01-01

    Objective:To explore the clinical significance of blood gas analysis indexes of patients with malignant ascites.Methods:The blood gas parameters of the malignant ascites group and the healthy control group were detected by using automatic blood gas analyzer.The blood sodium(Na+),the blood chlorine(Cl-) concentration were detected in the venous blood.Results:pH value,PCO2, PO2 and HCO3- of the malignant ascites group were compared with those of the control group,and the differences were all statistically significant(P<0.05).The incidence rate of hypoxemia in the malignant ascites group was 69.0%,the incidence rate of acid-base imbalance was 66.7%,the acid-base imbalance was give priority to with simple respiratory alkalosis,the incidence rate was 44.89%.Conclusion:Patients with malignant ascites easily have acid-base imbalance and hypoxia,the acid-base imbalance is give priority to with respiratory alkalosis.It should monitor the blood gas analysis in a timely manner and give timely symptomatic treatment to improve the life quality of the patients.%目的:探讨恶性腹水患者血气分析指标的临床意义。方法:采用全自动血气分析仪检测恶性腹水组和健康对照组血气参数,静脉血测定血钠(Na+)、血氯(Cl-)浓度。结果:恶性腹水组pH值、PCO2、PO2和HCO3-与对照组比较,差异均有统计学意义。恶性腹水组低氧血症的发生率69.0%,酸碱失衡的发生率66.7%,酸碱失衡以单纯性呼吸性碱中毒为主,发生率44.89%。结论:恶性腹水患者易发生酸碱失衡及低氧血症,酸碱失衡以呼吸性碱中毒为主,应及时进行血气分析,及时对症治疗,提高患者生活质量。

  1. Pseudohyperaldosteronism caused by compound glycyrrhizin tablets%复方甘草酸苷片致假性醛固酮增多症

    Institute of Scientific and Technical Information of China (English)

    张颖; 于刚; 王炎焱; 赵伟; 张江林

    2013-01-01

    One 51-year-old male patient with psoriasis arthritis developed elevation of AST and ALT and received compound glycyrrhizin tablets (2 tablets, tid) for the treatment of drug-induced hepatitis, which caused by methotrexate. After a week of the treatment, the patient developed weakness in lower legs and hard walking. After 2 weeks, he appeared edema in the face and lower extremity, and the blood pressure increased to 160/90 mm Hg. He suffered from upper limbs weakness and shivering, and the blood pressure was 160/90 mm Hg after 3 weeks of the treatment. After stopping use of compound glycyrrhizin for one week, the symptoms of weakness, hard walking and upper limb shaking relieved, the blood pressure returned to 130/76 mmHg, while the patient appeared hypokalemia with blood potassium 1.76 mmol·L-1 and metabolic alkalosis. The combination use of medication was not found. The functions of thyroid and adrenal were normal. After the treatment of potassium supplementation for 5 days, blood potassium recovered to 4.22 mmol·L-1, metabolic alkalosis was corrected.%1例51岁男性患者,因银屑病性关节炎口服甲氨蝶呤片,治疗过程中出现AST、ALT轻度升高,考虑药物性肝损害,给予复方甘草酸苷片2片,tid。1周后患者出现下肢乏力、行走费力,2周时出现颜面及下肢水肿,BP 160/90 mm Hg,3周时出现上肢乏力、发抖,BP 160/90 mm Hg。停药1周后乏力、行走费力、上肢发抖症状缓解,BP 130/76 mm Hg,血钾1.76 mmol· L-1、代谢性碱中毒。期间无联合用药,查甲功、肾上腺功能等未见异常。经补钾治疗5 d后患者血钾恢复至4.22 mmol· L-1,代谢性碱中毒纠正。

  2. Variability of Acid-Base Status in Acetate-Free Biofiltration 84% versus Bicarbonate Dialysis

    Directory of Open Access Journals (Sweden)

    Harzallah Kais

    2008-01-01

    Full Text Available The ultimate goal of hemodialysis (HD treatment is to achieve the highest level of efficacy in the presence of maximal clinical tolerance. With an aim to offer good hemodynamic stability, as observed during the acetate-free biofiltration 14% (AFB 14% to patients who are intolerant to bicarbonate dialysis (BD and with less cost, we have developed since June 1994, a new HD technique, namely AFB 84%. This study was carried out to analyze acid-base variations during the AFB 84% in comparison to BD in hemodynamically stable patients on regular HD. This was a prospective randomized crossover study carried out on 12 patients (6 males and 6 females for a total of 144 HD sessions (72 BD and 72 AFB 84%. Patients with decompensated cardiomyopathy, respiratory diseases or uncontrolled hypertension were not included in the trial. All the patients were treated with BD or AFB 84%; the latter is characterized by the absence of acetate in the dialysate and a complete correction of buffer balance by post-dilutional infusion of bicarbonate-based replacement solution. The comparison of pre-dialysis arterial acid-base and blood-gas parameters revealed no significant differences of pH, HCO 3 - and paCO 2 levels between the two techniques. Analysis of post-dialysis parameters showed that, among patients dialyzed with BD, there was over correction of metabolic acidosis with a tendency towards metabolic alkalosis. In contrast, in patients dialyzed with AFB 84%, we observed a significant improvement in pH and HCO 3 - levels but the increase in paCO2 level was not significant. A comparison of these parameters between the two techniques showed statistically significant difference in pH, HCO3 - and paCO2 levels, but not for paO2 level. AFB 84% can offer some important advantages with the complete absence of acetate from the substitution fluids, and permits a better correction of metabolic acidosis than BD, without causing alkalosis.

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

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    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

  4. Analysis of Arterial Blood Gas Report in Chronic Kidney Diseases – Comparison between Bedside and Multistep Systematic Method

    Science.gov (United States)

    Dhat, Vaishali; Tilak, Mona A; Roy, Indranath

    2016-01-01

    Introduction Acid Base Disorders (ABDs) are commonly encountered in critically ill Chronic Kidney Disease (CKD) patients. Timely and correct analysis of Arterial Blood Gases (ABG) is critical for the diagnosis, treatment and prediction of outcome of the patients. Aim The aim was to explore type and prevalence of ABDs in 31 critically ill CKD patients from a tertiary care hospital in Maharashtra, to compare two methods of analysis- bedside and systematic approaches and to clinically correlate the nature of ABDs in these patients. Materials and Methods The initial ABG reports of 31 consecutive CKD patients were analysed by two methods. Medica Easy stat analyser was the equipment for analysis with Principle of potentiometry and ion selective electrode for pH and pCO2 and amperometry for pO2. Serum albumin was also measured by Bromocresol green dye binding method using liquixx albumin kit in Erba XL 300 autoanalyser. Statistical Analysis Chi-square test was used for statistical analysis using Epi Info version 3.5.4 and SPSS 14.0 softwares. Results The systematic method showed a significantly higher prevalence of mixed disorders (50%) compared to bedside method (12.9%). Most prevalent disorder by bedside method was metabolic acidosis in 15 cases (48.39%). By the systematic method, 3 reports were invalid. As a single category, most prevalent type was both simple respiratory alkalosis and mixed metabolic acidosis with respiratory alkalosis- 6 of 31 cases in each type (19.36% each). As a whole, metabolic acidosis (including both High Anion Gap Metabolic Acidosis or HAGMA and Non Anion Gap Metabolic Acidosis or NAGMA with 4 in each type) was most prevalent- 8 of 31(25.8%). Conclusion Systematic approach was more effective in diagnosing mixed acid base disorders. By systematic method the findings of analysis in most cases could be correlated with the clinical condition and provisional diagnosis. Thus interpretation of ABDs by using stepwise approach could be useful to the

  5. Hypoxia and Its Acid-Base Consequences: From Mountains to Malignancy.

    Science.gov (United States)

    Swenson, Erik R

    2016-01-01

    Hypoxia, depending upon its magnitude and circumstances, evokes a spectrum of mild to severe acid-base changes ranging from alkalosis to acidosis, which can alter many responses to hypoxia at both non-genomic and genomic levels, in part via altered hypoxia-inducible factor (HIF) metabolism. Healthy people at high altitude and persons hyperventilating to non-hypoxic stimuli can become alkalotic and alkalemic with arterial pH acutely rising as high as 7.7. Hypoxia-mediated respiratory alkalosis reduces sympathetic tone, blunts hypoxic pulmonary vasoconstriction and hypoxic cerebral vasodilation, and increases hemoglobin oxygen affinity. These effects and others can be salutary or counterproductive to tissue oxygen delivery and utilization, based upon magnitude of each effect and summation. With severe hypoxia either in the setting of profound arterial hemoglobin desaturation and reduced O2 content or poor perfusion (ischemia) at the global or local level, metabolic and hypercapnic acidosis develop along with considerable lactate formation and pH falling to below 6.8. Although conventionally considered to be injurious and deleterious to cell function and survival, both acidoses may be cytoprotective by various anti-inflammatory, antioxidant, and anti-apoptotic mechanisms which limit total hypoxic or ischemic-reperfusion injury. Attempts to correct acidosis by giving bicarbonate or other alkaline agents under these circumstances ahead of or concurrent with reoxygenation efforts may be ill advised. Better understanding of this so-called "pH paradox" or permissive acidosis may offer therapeutic possibilities. Rapidly growing cancers often outstrip their vascular supply compromising both oxygen and nutrient delivery and metabolic waste disposal, thus limiting their growth and metastatic potential. However, their excessive glycolysis and lactate formation may not necessarily represent oxygen insufficiency, but rather the Warburg effect-an attempt to provide a large amount

  6. Responses of serum electrolytes of goats to twelve hours of road transportation during the hot-dry season in Nigeria, and the effect of pretreatment with ascorbic acid

    Directory of Open Access Journals (Sweden)

    J.O. Ayo

    2009-09-01

    Full Text Available Twenty goats which served as the experimental group were administered ascorbic acid (AA per os at a dosage rate of 100 mg/kg body mass, while 20 others served as controls and were given 10 mt each of sterile water. Forty minutes after the administration and loading, the goats were transported for 12 h. Handling and loading of the experimental and control groups of goats decreased (P < 0.05 the potassium and sodium serum concentrations. The concentration of serum chloride, sodium and calcium increased significantly (P< 0.05 immediately post-transportation, while potassium and magnesium decreased (P < 0.05 in the control goats. In AA-treated goats sodium and magnesium concentrations decreased abruptly (P< 0.05, while calcium increased significantly (P< 0.05 after transportation. Handling, loading and transportation adversely affected the electrolyte balance of the goats which suggested respiratory alkalosis, dehydration and muscular damage in the transported goats, and the administration of AA alleviated the adverse effects of road transportation stress on serum electrolytes.

  7. Responses of serum electrolytes of goats to twelve hours of road transportation during the hot-dry season in Nigeria, and the effect of pretreatment with ascorbic acid.

    Science.gov (United States)

    Ayo, J O; Minka, N S; Sackey, A K B; Adelaiye, A B

    2009-12-01

    Twenty goats which served as the experimental group were administered ascorbic acid (AA) per os at a dosage rate of 100 mg/kg body mass, while 20 others served as controls and were given 10 ml each of sterile water. Forty minutes after the administration and loading, the goats were transported for 12 h. Handling and loading of the experimental and control groups of goats decreased (P < 0.05) the potassium and sodium serum concentrations. The concentration of serum chloride, sodium and calcium increased significantly (P < 0.05) immediately post-transportation, while potassium and magnesium decreased (P < 0.05) in the control goats. In AA-treated goats sodium and magnesium concentrations decreased abruptly (P < 0.05), while calcium increased significantly (P < 0.05) after transportation. Handling, loading and transportation adversely affected the electrolyte balance of the goats which suggested respiratory alkalosis, dehydration and muscular damage in the transported goats, and the administration of AA alleviated the adverse effects of road transportation stress on serum electrolytes.

  8. Analisis Gas Darah pada Kucing yang Mengalami Laparohisterotomi dengan Anestesi Xylazin-Ketamin dan Xylazin-Propofol (BLOOD GAS ANALYSIS OF XYLAZIN- KETAMIN AND XYLAZIN-PROPOFOL FOR ANESTHESIA TO LAPARO-HISTEROTOMY SURGERY IN CAT

    Directory of Open Access Journals (Sweden)

    Ira Sari Yudaniayanti

    2012-03-01

    Full Text Available The aim of this research was to study the safety application of xylazine-ketamine and xylazinepropofolrecurrent dosage combination as anesthesia for laparo-histerotomy surgery in cat. Thisresearch used 10 female cats, 12-18 months of age, followed randomly divided into two groups, P1:atropine 0,04 mg/kgBW/SC + xylazine 2 mg/kg BW/IM + ketamine 20 mg/kg BW/IM; P2 : atropine0,04mg/kg BW/SC + xylazine 2 mg/kg BW/IM + Propofol 20 mg/kg BW/IV. The blood of the allgroups was taken from vena femuralis at 0 minute (before treatment, 15, 30, 45 and 60 minutesduring anesthesia for measurement of blood gas value pH, pCO2 and HCO3. After all animals wereanesthetized, the animals were treated laparo-histerotomy surgery. The data were analyzed byusing Randomized Complete Block Design (RCBD. The result showed both of groups were notsignificantly difference (p>0,05 to blood gas values for pH, pCO2 dan HCO3. Besides, both groupsanaesthetic agent perfectly caused metabolic acidosis with respiratory alkalosis compensationperfectly, therefore it is relatively safe to use as anaesthetic agent for surgery that needs long timeprocedure, as laparo-histerotomy.

  9. Association between serum bicarbonate and pH with depression, cognition and sleep quality in hemodialysis patients.

    Science.gov (United States)

    Afsar, Baris; Elsurer, Rengin

    2015-07-01

    Metabolic acidosis is a common feature in chronic renal failure patients, worsening progressively as renal function declines. There are conflicting data in hemodialysis (HD) patients with regard to acidosis, alkalosis and mortality. In HD patients, cognitive impairment, depression, sleep disorders and impaired quality of life are very common. Besides, these conditions are related with increased morbidity and mortality. However, no previous study investigated the relationship between pH, venous bicarbonate and anion gap with depression, sleep problems and cognitive function in HD patients. In this study we investigated these relationships. In total, 65 HD patients were included. The demographic parameters and laboratory parameters including bicarbonate, pH and anion gap was measured for all patients. Depressive symptoms, sleep quality and cognitive function, were measured by Beck depression inventory, The Pittsburgh Sleep Quality Index and by Mini Mental State Examination, respectively. We found that, sleep quality but not cognitive function or depression was independently related with venous pH and bicarbonate. Anion gap has no independent relationship with sleep quality, cognitive function and depression. In conclusion, metabolic acidosis and bicarbonate levels were independently related with sleep quality in HD patients. However, there was no association between metabolic acidosis and bicarbonate levels with cognitive function and depression.

  10. Association between serum bicarbonate and pH with depression, cognition and sleep quality in hemodialysis patients.

    Science.gov (United States)

    Afsar, Baris; Elsurer, Rengin

    2015-07-01

    Metabolic acidosis is a common feature in chronic renal failure patients, worsening progressively as renal function declines. There are conflicting data in hemodialysis (HD) patients with regard to acidosis, alkalosis and mortality. In HD patients, cognitive impairment, depression, sleep disorders and impaired quality of life are very common. Besides, these conditions are related with increased morbidity and mortality. However, no previous study investigated the relationship between pH, venous bicarbonate and anion gap with depression, sleep problems and cognitive function in HD patients. In this study we investigated these relationships. In total, 65 HD patients were included. The demographic parameters and laboratory parameters including bicarbonate, pH and anion gap was measured for all patients. Depressive symptoms, sleep quality and cognitive function, were measured by Beck depression inventory, The Pittsburgh Sleep Quality Index and by Mini Mental State Examination, respectively. We found that, sleep quality but not cognitive function or depression was independently related with venous pH and bicarbonate. Anion gap has no independent relationship with sleep quality, cognitive function and depression. In conclusion, metabolic acidosis and bicarbonate levels were independently related with sleep quality in HD patients. However, there was no association between metabolic acidosis and bicarbonate levels with cognitive function and depression. PMID:25894326

  11. Clinical management of critically ill patients with Cushing's disease due to ACTH-secreting pituitary macroadenomas: effectiveness of presurgical treatment with pasireotide.

    Science.gov (United States)

    Cannavo, S; Messina, E; Albani, A; Ferrau, F; Barresi, V; Priola, S; Esposito, F; Angileri, F

    2016-06-01

    The management of critically ill Cushing's disease (CD) patients is extremely challenging. Pasireotide is indicated for the treatment of CD patients when pituitary surgery is unfeasible or has not been curative, but no data are available about the use of this drug as pre-operative treatment in critically ill patients. We report the effects of presurgical pasireotide therapy in CD patients in whom hypercortisolism caused life-threatening hypokalemia, alkalosis, and cardio-respiratory complications precluding surgical approach. Clinical, biochemical, and radiological data of two critically ill patients with ACTH-secreting pituitary macroadenoma, before and during first-line presurgical pasireotide treatment (600 μg s.c. bid). During the first 21 days of treatment, pasireotide therapy induced a rapid, partial decrease of plasma ACTH, serum cortisol, and urinary free cortisol levels, with the consequent normalization of serum potassium concentration and arterial blood gases parameters, in both the patients. They did not experience unmanageable side effects and underwent endoscopic transsphenoidal surgery after 4 weeks of effective treatment. Pre-operative MRI evaluation did not show pituitary tumor shrinkage. Surgical cure of CD was obtained in the first patient, while debulking allowed the pharmacological control of hypercortisolism in the second case. We suggest that pasireotide can induce a rapid improvement of clinical and metabolic conditions in critically ill CD patients in whom surgical approach is considered hazardous and need to be delayed.

  12. Myocardial protection: what the anesthesiologist does.

    Science.gov (United States)

    Merin, R G

    1990-09-01

    The role of the anesthesiologist in myocardial protection is to optimize myocardial oxygen balance during the perioperative period. Nonpharmacological steps that can be taken to achieve this revolve around maintaining a satisfactory hemoglobin concentration and oxyhemoglobin saturation through maximizing ventilation. In addition, alkalosis and hypothermia should be prevented since they cause a left shift of the oxyhemoglobin dissociation curve, thus interfering with tissue oxygen delivery. Hypocarbia increases coronary vascular resistance. Blood volume must be adequate with an optimal hemoglobin concentration. Pharmacological measures should also be used, and it is important to continue through the perioperative period any previously administered cardioactive drugs. Furthermore, in the prebypass period, tachycardia may not be controlled by anesthetics; unless the tachycardia is paroxysmal, beta blockers are the drugs of choice. Depending on the cause, diastolic hypotension also needs to be treated either with volume, vasoconstrictors, or inotropes. Likewise, major hypertension can produce increased demand and, again depending on the cause, either anesthetics, vasodilators, beta blockers, or calcium blockers may be useful. Finally, myocardial ischemia without obvious cause probably should be treated with nitroglycerin or calcium blockers. During surgery, the effect of the anesthetic drugs on myocardial oxygen balance is important. PMID:2133851

  13. Differences in Hematological Traits between High- and Low-Altitude Lizards (Genus Phrynocephalus).

    Science.gov (United States)

    Lu, Songsong; Xin, Ying; Tang, Xiaolong; Yue, Feng; Wang, Huihui; Bai, Yucheng; Niu, Yonggang; Chen, Qiang

    2015-01-01

    Phrynocephalus erythrurus (Lacertilia: Agamidae) is considered to be the highest living reptile in the world (about 4500-5000 m above sea level), whereas Phrynocephalus przewalskii inhabits low altitudes (about 1000-1500 m above sea level). Here, we report the differences in hematological traits between these two different Phrynocephalus species. Compared with P. przewalskii, the results indicated that P. erythrurus own higher oxygen carrying capacity by increasing red blood cell count (RBC), hemoglobin concentration ([Hb]) and hematocrit (Hct) and these elevations could promote oxygen carrying capacity without disadvantage of high viscosity. The lower partial pressure of oxygen in arterial blood (PaO2) of P. erythrurus did not cause the secondary alkalosis, which may be attributed to an efficient pulmonary system for oxygen (O2) loading. The elevated blood-O2 affinity in P. erythrurus may be achieved by increasing intrinsic O2 affinity of isoHbs and balancing the independent effects of potential heterotropic ligands. We detected one α-globin gene and three β-globin genes with 1 and 33 amino acid substitutions between these two species, respectively. Molecular dynamics simulation results showed that amino acids substitutions in β-globin chains could lead to the elimination of hydrogen bonds in T-state Hb models of P. erythrurus. Based on the present data, we suggest that P. erythrurus have evolved an efficient oxygen transport system under the unremitting hypobaric hypoxia.

  14. Pediatric ECMO outcomes: comparison of centrifugal versus roller blood pumps using propensity score matching.

    Science.gov (United States)

    Barrett, Cindy S; Jaggers, James J; Cook, E Francis; Graham, Dionne A; Yarlagadda, Vasmi V; Teele, Sarah A; Almond, Christopher S; Bratton, Susan L; Seeger, John D; Dalton, Heidi J; Rycus, Peter T; Laussen, Peter C; Thiagarajan, Ravi R

    2013-01-01

    Centrifugal blood pumps are being increasingly utilized in children supported with extracorporeal membrane oxygenation (ECMO). Our aim was to determine if survival and ECMO-related morbidities in children supported with venoarterial (VA) ECMO differed by blood pump type.Children aged less than 18 years who underwent VA ECMO support from 2007 to 2009 and reported to the Extracorporeal Life Support Organization registry were propensity score matched (Greedy 1:1 matching) using pre-ECMO characteristics.A total of 2,656 (centrifugal = 2,231, roller = 425) patients were identified and 548 patients (274 per pump type) were included in the propensity score-matched cohort. Children supported with centrifugal pumps had increased odds of hemolysis (odds ratio [OR], 4.03 95% confidence interval [CI], 2.37-6.87), hyperbilirubinemia (OR, 5.48; 95% CI, 2.62-11.49), need for inotropic support during ECMO (OR, 1.54; 95% CI, 1.09-2.17), metabolic alkalosis (blood pH > 7.6) during ECMO (OR, 3.13; 95% CI, 1.49-6.54), and acute renal failure (OR, 1.61; 95% CI, 1.10-2.39). Survival to hospital discharge did not differ by pump type.In a propensity score-matched cohort of pediatric ECMO patients, children supported with centrifugal pumps had increased odds of ECMO-related complications. There was no difference in survival between groups.

  15. [Is physiological saline really physiological? Hyponatreamia treatment--small deviations from the rules of appropriate therapy create serious complications and side effects].

    Science.gov (United States)

    Krotkiewski, Marcin

    2015-10-01

    Physiological saline can hardly be treated as physiological as it contains qualitatively and quantitatively different amounts of electrolytes. In particular, it contains 50% more chlorine ions than serum. Physiological saline can cause metabolic acidosis and in diabetic patients hyperchloremic acidosis. In comparison with Ringer solution and plasma-lyte, physiological saline is causing higher number of untoward effects and mortality associated with surgery. Ringer solution should be used in the situations requiring expansion of extracellular fluid. Physiological saline is a solution of choice in hypochloremic alkalosis in the case of brain injuries quite unfavourable is unnecessary rapid correction with physiological saline which can lead to serious sequelae in form of brain oedema and central extrapontine myelinolysis (osmotic demyelinisation) and permanent brain lesions. The hyponatremia's treatment depends on severity of symptoms, neurological deficit motivates immediate 4-6 mmol/l infusion, but further correction should be prolonged to 24-hrs; cautious correction corresponds to 8-mmol/l for 24 hrs. The modern treatment encompasses the introduction of vasopressin receptors antagonist--vaptans.

  16. Effect of Modified Alkaline Supplementation on Syngenic Melanoma Growth in CB57/BL Mice

    Science.gov (United States)

    Spugnini, Enrico Pierluigi; Canese, Rossella; Gugliotta, Alessio; Fidanza, Stefano; Fais, Stefano

    2016-01-01

    Tumor extracellular acidity is a hallmark of malignant cancers. Thus, in this study we evaluated the effects of the oral administration of a commercially available water alkalizer (Basenpulver®) (BP) on tumor growth in a syngenic melanoma mouse model. The alkalizer was administered daily by oral gavage starting one week after tumor implantation in CB57/BL mice. Tumors were calipered and their acidity measured by in vivo MRI guided 31P MRS. Furthermore, urine pH was monitored for potential metabolic alkalosis. BP administration significantly reduced melanoma growth in mice; the optimal dose in terms of tolerability and efficacy was 8 g/l (p< 0.05). The in vivo results were supported by in vitro experiments, wherein BP-treated human and murine melanoma cell cultures exhibited a dose-dependent inhibition of tumor cell growth. This investigation provides the first proof of concept that systemic buffering can improve tumor control by itself and that this approach may represent a new strategy in prevention and/or treatment of cancers. PMID:27447181

  17. Pulmonary gas exchange and acid-base state at 5,260 m in high-altitude Bolivians and acclimatized lowlanders

    DEFF Research Database (Denmark)

    Wagner, Hans Peter; Araoz, Mauricio; Boushel, Robert Christopher;

    2002-01-01

    exchange and acid-base balance at rest and during peak exercise when breathing room air and 55% O2. Despite 9 wk at 5,260 m and considerable renal bicarbonate excretion (arterial plasma HCO3- concentration = 15.1 meq/l), resting arterial pH in L was 7.48 +/- 0.007 (significantly greater than 7......Pulmonary gas exchange and acid-base state were compared in nine Danish lowlanders (L) acclimatized to 5,260 m for 9 wk and seven native Bolivian residents (N) of La Paz (altitude 3,600-4,100 m) brought acutely to this altitude. We evaluated normalcy of arterial pH and assessed pulmonary gas...... hyperoxic work, capacity was 73% greater in N. Buffering of lactic acid was greater in N, with 20% less increase in base deficit per millimole per liter rise in lactate. These data show in L persistent alkalosis even after 9 wk at 5,260 m. In N, the data show 1) insignificant reduction in exercise capacity...

  18. The Importance of the Ionic Product for Water to Understand the Physiology of the Acid-Base Balance in Humans

    Directory of Open Access Journals (Sweden)

    María M. Adeva-Andany

    2014-01-01

    Full Text Available Human plasma is an aqueous solution that has to abide by chemical rules such as the principle of electrical neutrality and the constancy of the ionic product for water. These rules define the acid-base balance in the human body. According to the electroneutrality principle, plasma has to be electrically neutral and the sum of its cations equals the sum of its anions. In addition, the ionic product for water has to be constant. Therefore, the plasma concentration of hydrogen ions depends on the plasma ionic composition. Variations in the concentration of plasma ions that alter the relative proportion of anions and cations predictably lead to a change in the plasma concentration of hydrogen ions by driving adaptive adjustments in water ionization that allow plasma electroneutrality while maintaining constant the ionic product for water. The accumulation of plasma anions out of proportion of cations induces an electrical imbalance compensated by a fall of hydroxide ions that brings about a rise in hydrogen ions (acidosis. By contrast, the deficiency of chloride relative to sodium generates plasma alkalosis by increasing hydroxide ions. The adjustment of plasma bicarbonate concentration to these changes is an important compensatory mechanism that protects plasma pH from severe deviations.

  19. Forebrain-independent generation of hyperthermic convulsions in infant rats.

    Science.gov (United States)

    Pospelov, Alexey S; Yukin, Alexey Y; Blumberg, Mark S; Puskarjov, Martin; Kaila, Kai

    2016-01-01

    Febrile seizures are the most common type of convulsive events in children. It is generally assumed that the generalization of these seizures is a result of brainstem invasion by the initial limbic seizure activity. Using precollicular transection in 13-day-old rats to isolate the forebrain from the brainstem, we demonstrate that the forebrain is not required for generation of tonic-clonic convulsions induced by hyperthermia or kainate. Compared with sham-operated littermate controls, latency to onset of convulsions in both models was significantly shorter in pups that had undergone precollicular transection, indicating suppression of the brainstem seizure network by the forebrain in the intact animal. We have shown previously that febrile seizures are precipitated by hyperthermia-induced respiratory alkalosis. Here, we show that triggering of hyperthermia-induced hyperventilation and consequent convulsions in transected animals are blocked by diazepam. The present data suggest that the role of endogenous brainstem activity in triggering tonic-clonic seizures should be re-evaluated in standard experimental models of limbic seizures. Our work sheds new light on the mechanisms that generate febrile seizures in children and, therefore, on how they might be treated. PMID:26547277

  20. Measurements of myocardial flow vs. extraction of rubidium under varying physiological conditions

    Energy Technology Data Exchange (ETDEWEB)

    Budinger, T.F.; Yano, Y.; Moyer, B.R.; Twitchell, J.A.; Brennan, K.M.; Huesman, R.H.

    1984-01-01

    The relationship between myocardial rubidium extraction (E) and flow (F) are well described by the single capillary model E = (1-exp(-PS/F)) with a permeability surface product PS = 0.87 cc/min/gm. Some effects of alkalosis and acidosis have been reported. Here the authors investigate the effects of dipyridamole, norepinephrine-atropine, exsanguination, pacing, ouabain and calcium on extraction using Rb-82 PET and Rb-86 acute studies with microspheres in dogs. Thoracotomies were performed for left atrial microsphere infusion. Anesthesia was by N/sub 2/O and methoxyflurane. The degree of exsanguination, drug levels administered and pacing rates were sufficient to produce flow modifications. Extraction was calculated by dividing FE from Rb observations by F from microsphere data. These results of extraction vs. flow do not show a significant dependence on the method used for flow modification. There was less than a 20% change in FE after an infusion of 0.04 mg/kg ouabain over 5 minutes in 3 replicate studies each on 4 dogs. An important finding not previously explained in flow vs. extraction studies is the occurrence of extraction values greater than 1.0 which is possible only if the distribution opportunities of small cations are greater than that of microspheres. This is equivalent to the well known hematocrit effect in small channels.

  1. Mineralocorticoid hypertension

    Directory of Open Access Journals (Sweden)

    Vishal Gupta

    2011-01-01

    Full Text Available Hypertension affects about 10 - 25% of the population and is an important risk factor for cardiovascular and renal disease. The renin-angiotensin system is frequently implicated in the pathophysiology of hypertension, be it primary or secondary. The prevalence of primary aldosteronism increases with the severity of hypertension, from 2% in patients with grade 1 hypertension to 20% among resistant hypertensives. Mineralcorticoid hypertension includes a spectrum of disorders ranging from renin-producing pathologies (renin-secreting tumors, malignant hypertension, coarctation of aorta, aldosterone-producing pathologies (primary aldosteronism - Conns syndrome, familial hyperaldosteronism 1, 2, and 3, non-aldosterone mineralocorticoid producing pathologies (apparent mineralocorticoid excess syndrome, Liddle syndrome, deoxycorticosterone-secreting tumors, ectopic adrenocorticotropic hormones (ACTH syndrome, congenitalvadrenal hyperplasia, and drugs with mineraocorticoid activity (locorice, carbenoxole therapy to glucocorticoid receptor resistance syndromes. Clinical presentation includes hypertension with varying severity, hypokalemia, and alkalosis. Ratio of plasma aldosterone concentraion to plasma renin activity remains the best screening tool. Bilateral adrenal venous sampling is the best diagnostic test coupled with a CT scan. Treatment is either surgical (adrenelectomy for unilateral adrenal disease versus medical therapy for idiopathic, ambiguous, or bilateral disease. Medical therapy focuses on blood pressure control and correction of hypokalemia using a combination of anti-hypertensives (calcium channel blockers, angiotensin converting enzyme inhibitors, or angiotensin receptor blockers and potassium-raising therapies (mineralcorticoid receptor antagonist or potassium sparing diuretics. Direct aldosterone synthetase antagonists represent a promising future therapy.

  2. Bartter syndrome in a patient with type 2 diabetes mellitus and literatures review%Bartter综合征合并2型糖尿病1例报道并文献复习

    Institute of Scientific and Technical Information of China (English)

    李汇; 李京艳; 李淑英; 李鸿梅; 刘蕾; 冀秋娣; 冯凭

    2012-01-01

    Bartter sydrome(BS) is a hereditary disorder that has been characterized by the combination of hypokalemia,alkalosis,and the hypertrophy of the juxtaglomerular complicated with secondary hyperaldosteronism and normal blood pressure.It is believed that BS is familial and more common in children,relatively rare in adult.Only 5 cases with diabetes mellitus(DM) were reported worldwide in the past 50 years.It is important to investigate the relationship between BS and DM and hyperlipidemia and also the treatment and prognosis of BS,which might be helpful for the clinical therapy of BS.%Bartter综合征(BS)是低血钾、碱中毒、肾小球旁器增生继发高醛固酮血症,但血压正常的一种临床综合征.目前认为BS多见于儿童,有家族性,成人发病较少见,近50年国内、外仅有5例BS合并糖尿病的报道.探讨BS与糖尿病、高脂血症的关系及其治疗及预后,有助于临床对该类疾病的诊治.

  3. Cerebral circulation, metabolism, and blood-brain barrier of rats in hypocapnic hypoxia

    Energy Technology Data Exchange (ETDEWEB)

    Beck, T.; Krieglstein, J.

    1987-03-01

    The effects of hypoxic hypoxia on physiological variables, cerebral circulation, cerebral metabolism, and blood-brain barrier were investigated in conscious, spontaneously breathing rats by exposing them to an atmosphere containing 7% O/sub 2/. Hypoxia affected a marked hypotension, hypocapnia and alkalosis. Cortical tissue high-energy phosphates and glucose content were not affected by hypoxia, glucose 6-phosphate lactate, and pyruvate levels were significantly increased. Blood-brain barrier permeability, regional brain glucose content and lumped constant were not changed by hypoxia. Local cerebral glucose utilization (LCGU) rose by 40-70% of control values in gray matter and by 80-90% in white matter. Under hypoxia, columns of increased and decreased LCGU and were detectable in cortical gray matter. Color-coded (/sup 14/C)2-deoxy-D-glucose autoradiograms of rat brain are shown. Local cerebral blood flow (LCBF) increased by 50-90% in gray matter and by up to 180% in white matter. Coupling between LCGU and LCBF in hypoxia remained unchanged. The data suggests a stimulation of glycolysis, increased glucose transport into the cell, and increased hexokinase activity. The physiological response of gray and white matter to hypoxia obviously differs. Uncoupling of the relation between LCGU and LCBF does not occur.

  4. 自动化酸碱平衡图在急诊社区获得性肺炎诊治中的应用%Study of automated acid-base mapping on diagnose and treatment of community acquired pneumonia in emergency department

    Institute of Scientific and Technical Information of China (English)

    杨旭峰; 王海嵘; 顾金花; 姜坚; 潘曙明

    2012-01-01

    Objective To analyze the value of automated acid-base mapping on diagnose and treatment of patients with community acquired pneumonia (CAP) in emergency department.Methods According to medical history,pulmonary function test,diagnosing guideline of chronic obstructive pulmonary disease (COPD),111 patients with CAP were divided into two groups:single CAP group (n=56) and COPD complicated with CAP group [acute exacerbation of chronic obstructive pulmonary disease (AECOPD) group,n =55].After enquiring medical history,arterial blood samples were drawn for blood gas analysis and automated acid-base mapping was analyzed.Results Arterial blood gas analysis showed arterial carbondioxide partial pressure (PaCO2,kPa),HC03- (mmol/L),base excess (BE,mmol/L) of AECOPD group were obviously higher than those in CAP group (PaCO2:7.714 ± 2.414 vs.5.896 ±1.308,HCO3-:30.767 ± 7.185 vs.25.014 ± 3.043,BE:4.345 ± 5.371 vs.-0.354 ± 3.180,all P<0.01 ).Automated acid-base mapping showed acid-base disturbance of AECOPD group was 89.1% and CAP group was 66.1%.Chi-square analysis were done for patients of normal ( 10.9%,33.9%),acute respiratory acidosis (12.7%,14.3% ),chronic respiratory acidosis (49.1%,10.7%),respiratory alkalosis (7.3%,14.3%),metabolic acidosis ( 12.7%,17.9%),metabolic alkalosis ( 12.7%,8.9%) between AECOPD group and CAP group,and statistical significance was found between AECOPD group and single CAP group ( x2=24.421,P=0.001 ).Advanced Chi-square analysis for patients of normal,acute respiratory acidosis,respiratory alkalosis,metabolic acidosis,metabolic alkalosis were done and showed no statistical difference ( x2=5.280,P=0.260).It is indicated chronic respiratory acidosis occurrences rate in AECOPD patients was higher than single CAP patients.Conclusions Our study demonstated that automated acid-base mapping may be helpful for emergency physician to rapidly recognize multi-acid-base disturbance in patients with CAP,and to promptly

  5. Myocardial perfusion with rubidium-82. II. Effects of metaolic and pharmacologic interventions. [Dogs

    Energy Technology Data Exchange (ETDEWEB)

    Goldstein, R.A.; Mullani, N.A.; Marani, S.K.; Fisher,D.J.; Gould, K.L.; O' Brien, H.A. Jr.

    1983-10-01

    In order to validate a new method for quantifying coronary blood flow, a bolus of rubidium-82 (Rb-82) was injected intravenously into 28 open-chested dogs under a wide range of flow and physiologic conditions, using beta probes to monitor myocardial radioactivity. Extraction fraction and perfusion were measured using a functional model that separates the data into the free and trapped myocardial rubidium. Extraction and uptake of rubidium were lower during acidosis than during alkalosis and were unchanged by glucose-insulin, digoxin, or propranolol. Myocardial flow, as indicated by rubidium, correlated linearly with simultaneous measurements of flow by microspheres in the same sample volume over a wide range of flow (r = 0.97, n = 106, range 0.02 to 7.75 ml/min/g). Regional myocardial blood flow can be accurately determined using generator-produced Rb-82. Studies using current state-of-the-art, fast positron-emission tomographic cameras are required to determine the utility of this approach in man.

  6. 1例糖尿病合并异位ACTH综合征病例分析%Analysis of 1 case of diabetes mellitus patients with ectopic ACTH syndrome

    Institute of Scientific and Technical Information of China (English)

    缪洪芸; 任伟; 张素华; 刘隆田; 龚莉琳; 罗成; 李斌

    2013-01-01

    异位ACTH综合征因其发病率低、尤因部分自然病程短的显性肿瘤所致的患者因其临床表现不典型易漏诊.但其因高皮质醇血症引起的高血压、低钾碱中毒等是患者死亡的直接原因.本文报道1例糖尿病合并由肺小细胞癌所引起异位ACTH综合征并进行文献复习,旨在引起对异位ACTH早期诊断及治疗的重视.%Ectopic ACTH syndrome might be missed in the patients because of its low incidence and atypical clinical manifestations,especially the part caused by dominant tumor with nature of short duration. Hypertension and hy-pokalemic alkalosis caused by high coritsol might be the direct cause of patients' death. This paper reports 1 case of diabetes mellitus with ectopic ACTH syndrome caused by lung small cell carcinoma and literature review to make attention of early diagnosis and treatment of ectopic ACTH syndrome.

  7. Modulation of erythropoietin concentrations by manipulation of hypercarbia

    Energy Technology Data Exchange (ETDEWEB)

    Miller, M.E.; Howard, D.

    1979-01-01

    The present studies were done to determine whether preventing the respiratory alkalosis, which is known to occur with acute hypoxic stimuli, would lead to alterations in plasma concentrations of erythropoietin (Ep). Rats were subjected to two acute stresses, hypoxia and blood loss, separately and in combination, with and without the added stress of hypercarbia. Hypercarbia in all experimental groups was associated with a decrease in plasma concentrations of Ep. This reduction in plasma Ep with hypercarbia could not be fully explained by the higher arterial pO/sub 2/s or p50s of the hypercarbic rats. Hypercarbia may have indirectly suppressed Ep production by increasing blood flow to the site of Ep production. Alternatively, the cell of origin of Ep could be sensitive to changes in pH and/or pCO/sub 2/. It was further demonstrated that neither the onset nor the degree of reticulocytosis could be predicted by the plasma Ep concentrations. It is likely that the removal of red blood cells led to a decrease in marrow transit time with the early emergence of reticulocytes after acute blood loss.

  8. Clinical observation and nursing of pregnancy complicated with Gitleman syndrome%妊娠合并Gitleman综合征的临床观察和护理

    Institute of Scientific and Technical Information of China (English)

    陈晓芬

    2012-01-01

    目的 探讨妊娠合并Gitleman综合征的临床特点及其护理.方法 回顾性分析3例妊娠合并Gitleman综合征的临床资料和护理体会.结果 3例患者均表现为怀孕后引起疾病,主要表现为低血钾碱中毒,血浆肾素活性增高而血压正常.并根据尿钙明显减少及低血镁,诊断为妊娠合并Gitleman综合征.结论 通过护士全面细致的观察病情,做出预见性的评估,实施全面整体的护理措施,促进了患者的康复.%Objective To explore the clinical features and nursing of pregnancy complicated with Giteman syndrome. Methods The clinical data and nursing of 3 cases of pregnancy complicated with Giteman syndrome were retrospectively analyzed. Results The symptoms of three pregnant women mainly included hypokalemic alkalosis,hyperreninemia with normal blood pressure,decreasing urine calcium and hypomagnesemia. Those women were diagnosed as Giteman syndrome. Conclusion Nurses can make a foreseeing evaluation carefully observing the progression of disease and implement overall nursing measure to promote the recovery of patients.

  9. Novel molecular variants of the Na-Cl cotransporter gene are responsible for Gitelman syndrome

    Energy Technology Data Exchange (ETDEWEB)

    Mastroianni, N.; De Fusco, M.; Casari, G. [Univsersita` di Milano (Italy)] [and others

    1996-11-01

    A hereditary defect of the distal tubule accounts for the clinical features of Gitelman syndrome (GS), an autosomal recessive disease characterized by hypokalemia, hypomagnesemia, metabolic alkalosis, and hypocalciuria. Recently, we cloned the cDNA coding for the human Na-Cl thiazide-sensitive cotransporter (TSC; also known as {open_quotes}NCCT{close_quotes} or {open_quotes}SLC12A3{close_quotes}) as a possible candidate for GS, and Simon et al., independently, described rotation in patients with GS. Now, we show 12 additional mutations consistent with a loss of function of the Na-Cl cotransporter in GS. Two missense replacements, R09W and P349L, are common to both studies and could represent ancient mutations. The other mutations include three deletions, two insertions, and six missense mutations. When all mutations from both studies are considered, missense mutations seem to be more frequently localized within the intracellular domains of the molecule, rather than in transmembrane or extracellular domains. One family, previously reported as a GS form with dominant inheritance, has proved to be recessive, with the affected child being a compound heterozygote. A highly informative intragenic tetranucleotide marker, useful for molecular diagnostic studies, has been identified at the acceptor splice site of exon 9. 12 refs., 3 figs., 2 tabs.

  10. Is CO2 gas unsufflator necessary for laparoscopic training in animals?

    Directory of Open Access Journals (Sweden)

    Tiraboshi Ricardo Brianezi

    2003-01-01

    Full Text Available OBJECTIVE: To verify the efficacy and safety of compressed air to produce pneumoperitoneum for laparoscopic surgery in pigs for a training program of residence. METHODS: Dalland pigs weighing 15-17kg underwent general anethesia and mechanical ventilation. They were divided in 3 groups: A - (38 the pneumoperitnoneum was established with an automatic CO2 insufflator, B - (7 as in A except the CO2 gas was changed by compressed air, and C - (11 abdomen insufflation was obtained with compressed air directly from hospital pipe network system. Intra-abdominal pressure in all groups was kept between 12 and 15 mmHg. The laparoscopic procedures performed were distributed proportionally among groups: 20 bilateral nephrectomy, 20 dismembered pyeloplasty and 16 partial nephrectomy. Arterial blood sampling for gasometry was obtained before and 2h after establishment of pneumoperitoneum in 5 pigs of group C. RESULTS: The cost of 25 4,5kg CO2 container used in group A was R$ 3,150.00 (U$ 1,050.00. The mean length time of surgeries in groups A, B and C were respectively: 181±30min, 196±39min e 210±47min (p>0.05. Respiratory alkalosis occurred in 3 out of 5 pigs of group C. No animal exhibited signs of gas embolism or died during surgery. CONCLUSION: The use of compressed air for laparoscopy in pigs was safe, reduced costs and did not require the use of an automatic gas insufflator.

  11. Modulation of erythropoietin levels by manipulation of hypercarbia. [Carbon dioxide levels in blood plasma

    Energy Technology Data Exchange (ETDEWEB)

    Miller, M E; Howard, D

    1978-01-01

    The present studies were done in order to determine if preventing the respiratory alkalosis which is known to occur with acute ''hypoxic'' stimuli would lead to alterations in plasma levels of Ep. Rats were subjected to two acute stresses, hypoxia and acute blood loss, separately and in combination, with and without the added stress of hypercarbia. Hypercarbia in all experimental groups was associated with a decrease in plasma levels of Ep. This reduction in plasma Ep with hypercarbia could not be fully explained by the higher arterial PO/sub 2/'s or P50's of the hypercarbic rats. Hypercarbia may have indirectly suppressed Ep production by increasing blood flow to the site of Ep production. Alternatively, the cell of origin of EP could be sensitive to changes in pH and/or pCO/sub 2/. It was further demonstrated that neither the onset nor the degree of reticulocytosis could be predicted by the plasma Ep levels. It is likely that the removal of red blood cells lead to a decrease in marrow transit time with the early emergence of reticulocytes after acute blood loss.

  12. 肺心病患者三重酸碱紊乱的临床分析

    Institute of Scientific and Technical Information of China (English)

    杨培文

    2003-01-01

    目的探讨慢性肺心病三重酸碱紊乱(TABD)的临床诊断方法.方法对112例慢性肺心病患者的血气分析、血清电解质及血乳酸含量(L)进行同步测定研究.以酸碱失衡预测代偿公式,结合AG值和潜在HC03-进行酸碱失衡类型判断.结果112例慢性肺心病患者中有11例诊断为TABD(triple acid-base disorders),其中呼碱型(respiratory alkalosis)7例(6 3.6%),死亡7例(6 3.6%).结论慢性肺心病患者急性加重期呼吸衰竭出现多种类型酸碱失衡,AG值及潜在HCO3-对TABD判断有重要意义.

  13. Congenital Chloride Diarrhea: Diagnosis by Easy-Accessible Chloride Measurement in Feces

    Directory of Open Access Journals (Sweden)

    C. Gils

    2016-01-01

    Full Text Available Background. Congenital chloride diarrhea (CCD is an autosomal recessive disorder caused by mutations in the genes encoding the intestinal Cl−/HCO3- exchanger and is clinically characterized by watery, profound diarrhea, electrolyte disturbances, and metabolic alkalosis. The CCD diagnosis is based on the clinical symptoms and measurement of high chloride concentration in feces (>90 mmol/L and is confirmed by DNA testing. Untreated CCD is lethal, while long-term clinical outcome improves when treated correctly. Case Presentation. A 27-year-old woman had an emergency caesarian due to pain and discomfort in gestational week 36 + 4. The newborn boy had abdominal distension and yellow fluid per rectum. Therapy with intravenous glucose and sodium chloride decreased his stool frequency and improved his clinical condition. A suspicion of congenital chloride diarrhea was strongly supported using blood gas analyzer to measure an increased chloride concentration in the feces; the diagnosis was confirmed by DNA testing. Discussion. Measurement of chloride in feces using an ordinary blood gas analyzer can serve as a preliminary analysis when congenital chloride diarrhea is suspected. This measurement can be easily performed with a watery feces composition. An easy-accessible chloride measurement available will facilitate the diagnostics and support the initial treatment if CCD is suspected.

  14. Milk alkali syndrome in an infant with chronic kidney disease

    Directory of Open Access Journals (Sweden)

    Kari JA

    2012-06-01

    Full Text Available Jameela A Kari, Sherif M El DesokyDepartment of Pediatrics and Pediatric Nephrology Unit, King Abdulaziz University, Jeddah, Kingdom of Saudi ArabiaAbstract: We report a case of milk alkali syndrome in a 15-month-old infant who had chronic kidney disease. His kidney function worsened, with creatinine raised from 1.11 mg/dL (98 µmol/L to 3.98 mg/dL (350.3 µmol/L, normal 0.4–1.0 mg/dL (35–91 µmol. He had hypercalcemia, serum calcium level 3.11 (normal 2.1–2.6 mmol/L, and metabolic alkalosis, HCO3 48.7 (normal 21–26 mmol/L. His kidney function returned to its base level and his calcium and bicarbonate levels normalized with adjustment of calcium carbonate and sodium bicarbonate doses. We report this case to highlight an unusual complication and to review the literature on milk alkali syndrome which is rare in children.Keywords: milk alkali syndrome, infants, chronic kidney disease

  15. Nephrocalcinosis and Placental Findings in Neonatal Bartter Syndrome

    Directory of Open Access Journals (Sweden)

    Hidehiko Maruyama

    2013-05-01

    Full Text Available Neonatal Bartter syndrome (NBS is an inherited renal tubular disorder associated with hypokalemic alkalosis. Here we report a case of genetically diagnosed NBS. Polyhydramnios was noted at 26 weeks. A boy was born at 31 weeks and 1 day, weighed 1344 g, and had an Apgar score of 8/8. We initiated indomethacin (IND at a dose of 0.2 mg/kg/d on day 31, and increased it to approximately 3 mg/kg/d. However, his urinary calcium (Ca levels remained unchanged. At 4 months of age, nephrocalcinosis was detected by ultrasound. The placenta weighed 700 g (+2.7 standard deviations. Although the proportion of terminal villi was consistent with the gestational age, many of them exhibited poorly dilated capillaries. Hemosiderin pigment was seen throughout the amniochorionic connective tissue and along about 50% of the trophoblast basement membrane (TBM. Von Kossa stain revealed the corresponding area of mineralization along the TBM. In our opinion, urinary Ca levels were high and did not change after IND initiation, indicating that nephrocalcinosis may be inevitable. Enhanced inflow of maternal plasma through the basement membrane would cause Ca deposition, given that the same finding was obtained in the case with polyhydramnios. The same mechanism would also explain the hemosiderin pigment distribution.

  16. EFEITOS DA SUPLEMENTAÇÃO DE BICARBONATO DE SÓDIO EM UM TESTE ERGOMÉTRICO DE ESFORÇO CRESCENTE EM HOMENS RECREACIONALMENTE ATIVOS

    Directory of Open Access Journals (Sweden)

    Everton Marcio Derisso

    2014-02-01

    Full Text Available The supplementation of sodium bicarbonate (NaHCO3 is being used as a way to induce blood alkalosis and increase the buffering chemical capacity. The literature shows a need for studies that use supplemental NaHCO3 at high intensities lasting more than 5 minutes. This study compares the effect of supplementation of NaHCO3 in speed corresponding to maximum working speed (vMAX and the respiratory compensation point (vRCP during an incremental treadmill test. We evaluate six recreationally active males (22.00 ± 2.00 years, 81.80 ± 9.90 kg, 1.81 ± 0.06 m and BMI 25 ± 2 kg/m2 and previously trained. The volunteers presented to the laboratory on two different days. They ingested 0.1 g/kg body weight of NaHCO3 (Group B or placebo with calcium carbonate (CaCO3 (Group P and performed an incremental test on a treadmill with 1km/h increments every 2 minutes until volitional exhaustion maximum. There was no significant difference in the velocities corresponding to vPCR and vMAX with supplementation of NaHCO3 and in any respiratory parameter. The ingestion of NaHCO3 at a concentration of 0.1 g/kg body weight does not improve performance in an incremental test on a treadmill.

  17. Differences in Hematological Traits between High- and Low-Altitude Lizards (Genus Phrynocephalus.

    Directory of Open Access Journals (Sweden)

    Songsong Lu

    Full Text Available Phrynocephalus erythrurus (Lacertilia: Agamidae is considered to be the highest living reptile in the world (about 4500-5000 m above sea level, whereas Phrynocephalus przewalskii inhabits low altitudes (about 1000-1500 m above sea level. Here, we report the differences in hematological traits between these two different Phrynocephalus species. Compared with P. przewalskii, the results indicated that P. erythrurus own higher oxygen carrying capacity by increasing red blood cell count (RBC, hemoglobin concentration ([Hb] and hematocrit (Hct and these elevations could promote oxygen carrying capacity without disadvantage of high viscosity. The lower partial pressure of oxygen in arterial blood (PaO2 of P. erythrurus did not cause the secondary alkalosis, which may be attributed to an efficient pulmonary system for oxygen (O2 loading. The elevated blood-O2 affinity in P. erythrurus may be achieved by increasing intrinsic O2 affinity of isoHbs and balancing the independent effects of potential heterotropic ligands. We detected one α-globin gene and three β-globin genes with 1 and 33 amino acid substitutions between these two species, respectively. Molecular dynamics simulation results showed that amino acids substitutions in β-globin chains could lead to the elimination of hydrogen bonds in T-state Hb models of P. erythrurus. Based on the present data, we suggest that P. erythrurus have evolved an efficient oxygen transport system under the unremitting hypobaric hypoxia.

  18. Citrate Anticoagulation for CRRT in Children: Comparison with Heparin

    Directory of Open Access Journals (Sweden)

    Sara Nicole Fernández

    2014-01-01

    Full Text Available Regional anticoagulation with citrate is an alternative to heparin in continuous renal replacement therapies, which may prolong circuit lifetime and decrease hemorrhagic complications. A retrospective comparative cohort study based on a prospective observational registry was conducted including critically ill children undergoing CRRT. Efficacy, measured as circuit survival, and secondary effects of heparin and citrate were compared. 12 patients on CRRT with citrate anticoagulation and 24 patients with heparin anticoagulation were analyzed. Median citrate dose was 2.6 mmol/L. Median calcium dose was 0.16 mEq/kg/h. Median heparin dose was 15 UI/kg/h. Median circuit survival was 48 hours with citrate and 31 hours with heparin (P=0.028. 66.6% of patients treated with citrate developed mild metabolic alkalosis, which was directly related to citrate dose. There were no cases of citrate intoxication: median total calcium/ionic calcium index (CaT/I of 2.16 and a maximum CaT/I of 2.33, without metabolic acidosis. In the citrate group, 45.5% of patients developed hypochloremia and 27.3% hypomagnesemia. In the heparin group, 27.8% developed hypophosphatemia. Three patients were moved from heparin to citrate to control postoperatory bleeding. In conclusion citrate is a safe and effective anticoagulation method for CRRT in children and it achieves longer circuit survival than heparin.

  19. Necessity Of ABG Analysis In HPS

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    Kalantari M

    2005-06-01

    Full Text Available Background: The purpose of this study is to determine the incidence of electrolyte and ABG abnormalities in infants with HPS and also we evaluate other parameters of the study. ‎ Materials and Methods: This descriptive study covers 161 infants with HPS hospitalized in children Medical center of Tehran university underwent surgical repair from march 1996 to march 2002 . ‎ Results & Conclusion: The results indicated that Hypokalemic metabolic alkalosis had occurred in 40% of patients. ‎The sex ratio was 3/1 =M/F and the most time of presentation was between 15t and 5st week and the most presenting sign was vomiting. Clinical icter happened to be found in 15% of patients. The incidence of accompanying anomalies was 9% and olive sign was palpable in 40%. ‎The best way for evaluating and diagnosis was sonography. ‎The mean period to begin postoperative feeding was 30 hours' no complication related to option was reported after operation.

  20. Changes of arterial blood pressure, heart rate, internal body temperature, and blood acido-basic balance in the unanaesthetized rabbit following whole-body gamma irradiation at a mean absorbed dose of 250 rads

    Energy Technology Data Exchange (ETDEWEB)

    Dufour, R.; Court, L.

    1973-09-01

    The general effects of whole-body gamma -irradiation at a mean absorbed dose of 250 rads were studied simultaneously in the unanaesthetized rabbit for 48 hours. They occurred early, with the following characteristics: arterial blood pressure decreased steadily as early as the 2nd hour and reached its minimum value on the 5th hour with a decrease of about 14%; it remained low during the following two days. Heart rate increased during the first hour, was the highest by the end of the second hour, and resumed normal value on the 24th hour. Internal body temperature increased during the 1st hour and was maximum by the end of the 2nd hour, with a mean increase of 1.2 deg C; hyperthermia steadily decreased between the 4th and the 6th hours and had completely disappeared by the 24th hour. Respiratory alkalosis is shown in the acido-basic balance by a raise of pH, a decrease of PCO/sub 2/ and arterial blood bicarbonates. These various changes seem to indicate a double origin, both central and peripheral. (FR)

  1. Comparison of (/sup 125/I)HIPDm and (/sup 125/I)iodoantipyrine in quantifying regional cerebral blood flow in rats

    Energy Technology Data Exchange (ETDEWEB)

    Albright, R.E. Jr.; Friedman, A.H.; Fram, E.K.; Harbury, O.L.; Molter, B.A.; Skatoff, J.H.; Harris, C.C.; Coleman, R.E.; Drayer, B.P.

    1988-11-01

    We determined regional cerebral blood flow (rCBF) using (/sup 125/I)HIPDm (N,N,N'-trimethyl-N'-(2-hydroxy-3-methyl-5-iodobenzyl)-1,3-propanediamin e) and (/sup 125/I)iodoantipyrine autoradiography under control and pathologic conditions (hypercapnia (acidosis), hypocapnia (alkalosis), and disrupted blood-brain barrier) conditions in 35 rats. In control rats, HIPDm rCBF (indicator fractionation method, n = 5) was lower than the corresponding IAP rCBF (diffusible indicator method, n = 4), most notably in the infratentorial regions and subcortical nuclei. In hypercapnia, rCBF increased by 100% and 37% in the HIPDm (n = 5) and IAP (n = 5) groups, respectively. In hypocapnia, IAP rCBF (n = 4) decreased 34% but HIPDm rCBF (n = 4) did not change. Following disruption of the blood-brain barrier by intracarotid infusion of mannitol in eight rats, both radiotracers (HIPDm n = 4, IAP n = 4) showed decreased rCBF to regions of disruption as defined by trypan blue extravasation. Our work indicates that modeling HIPDm uptake to quantify rCBF using the indicator fractionation method will underestimate blood flow and that HIPDm kinetics are influenced by compartmental pH dynamics that will limit the accuracy of this method in quantifying rCBF in pathologic conditions.

  2. Reduced red cell membrane potential and acidification of the plasma in response to contrast materials: time course of the alteration in plasma pH

    Energy Technology Data Exchange (ETDEWEB)

    Lichtman, M.A.; Murphy, M.S.

    1976-11-01

    Radiographic contrast materials added to blood reduce the red cell membrane potential by balancing the internal impenetrable anions, hemoglobin and organic phosphates. In so doing, a redistribution of protons occurs such that plasma is acidified. The time course of acidification of plasma is measured in seconds, with a nadir of pH occurring 12 to 15 seconds after addition of Hypaque (1.5 to 3.0 ml/10 ml blood) and a half-time of acidification requiring about 6 seconds. The acidification process is slowed in part by an initial alkalosis due to Hypaque. The acidification of blood is more rapid after addition of Renografin (1.5 to 3.0 ml/10 ml blood) than after addition of Hypaque since the former solution is slightly acidic. The time course of plasma acidification indicates that a maximal reduction in blood pH may not occur in the capillaries of a regional circulation following injection of contrast materials into its afferent vessel, since the transit time of the contrast material may be less than the time required for maximal acidification of plasma.

  3. The Measurement of Maximal (Anaerobic Power Output on a Cycle Ergometer: A Critical Review

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    Tarak Driss

    2013-01-01

    Full Text Available The interests and limits of the different methods and protocols of maximal (anaerobic power ( assessment are reviewed: single all-out tests versus force-velocity tests, isokinetic ergometers versus friction-loaded ergometers, measure of during the acceleration phase or at peak velocity. The effects of training, athletic practice, diet and pharmacological substances upon the production of maximal mechanical power are not discussed in this review mainly focused on the technical (ergometer, crank length, toe clips, methodological (protocols and biological factors (muscle volume, muscle fiber type, age, gender, growth, temperature, chronobiology and fatigue limiting in cycling. Although the validity of the Wingate test is questionable, a large part of the review is dedicated to this test which is currently the all-out cycling test the most often used. The biomechanical characteristics specific of maximal and high speed cycling, the bioenergetics of the all-out cycling exercises and the influence of biochemical factors (acidosis and alkalosis, phosphate ions… are recalled at the beginning of the paper. The basic knowledge concerning the consequences of the force-velocity relationship upon power output, the biomechanics of sub-maximal cycling exercises and the study on the force-velocity relationship in cycling by Dickinson in 1928 are presented in Appendices.

  4. A dangerous mixture

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    Anna Piva

    2014-03-01

    Full Text Available A 59-year old woman was admitted for fatigue and arm paresthesias with Trousseau sign. Her medical history included thyroidectomy and hypercholesterolemia recently treated with simvastatin. Laboratory tests showed severe hypokalemia and hypocalcemia, severe increase in muscle enzymes, metabolic alkalosis; low plasma renin activity, increased thyroid-stimulating hormone, normal free thyroxine, increased parathyroid hormone, decreased vitamin D3; alterations in electrolyte urinary excretion, cortisol and aldosterone were excluded. Hypothesizing a statin-related myopathy, simvastatin was suspended; the patient reported use of laxatives containing licorice. Electrolytes normalized with intravenous supplementation. Among many biochemical alterations, none stands out as a major cause for muscular and electrolyte disorders. All co-factors are inter-connected, starting with statin-induced myopathy, worsened by hypothyroidism, secondary hyperaldosteronism and vitamin D deficiency, leading to hypocalcemia and hypokalemia, perpetrating muscular and electrolyte disorders. The importance of considering clinical conditions as a whole emerges with multiple co-factors involved. Another issue concerns herbal products and their potential dangerous effects.

  5. Hypophosphatemia. From retrospective analysis to the analysis of the potential role of phosphatemia in panic disorders

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    Alessandro Riccardi

    2010-09-01

    Full Text Available The detection of a low serum phosphate level is not unusual in an Emergency Department, especially in clinical conditions linked to hyperventilation and subsequent respiratory alkalosis, asthma, sepsis, severe pain, anxiety. Symptoms of hypophosphatemia are typically not specific when the imbalance is not particularly severe, but if hyphophosphatemia does not resolve rhabdomyolisis, hemolysis, decreased tissue oxygenation and respiratory failure can be observed. Only recently some authors have pointed out that the level of serum phosphate in patient with anxiety and panic disorders can give information on the severity of the attacks as well on the clinical course of the disease. In a retrospective analysis on 599 case of hypophosphatemia observed in our ED, the percentage of case of panic disorders was particularly high among patients with lower phosphatemia. Therefore, we decided to examine this aspect closely, assessing if the determination of serum phosphate could be useful in the management of panic attacks at first approach in emergency room. Our observation are consistent with the statement that hypophosphatemia is one of the main clinical aspect of panic attack, and strongly support the hypothesis that hypophosphatemia correlates with the most severe symptoms of panic attack and should be itself considered as one of the most important aspect of this syndrome. Serum phosphate levels appear to mirror its clinical course, and can be used in the clinical setting of an Emergency Department, for the confirmation of a diagnosis of anxiety-panic disorder and as marker of the response to therapy

  6. Physiologic and Pharmacokinetic Changes in Pregnancy

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    Maged eCostantine

    2014-04-01

    Full Text Available Physiologic changes in pregnancy induce profound alterations to the pharmacokinetic properties of many medications. These changes affect distribution, absorption, metabolism, and excretion of drugs, and thus may impact their pharmacodynamic properties during pregnancy. Pregnant women undergo several adaptations in many organ systems. Some adaptations are secondary to hormonal changes in pregnancy, while others occur to support the gravid woman and her developing fetus. Some of the changes in maternal physiology during pregnancy include, for example, increased maternal fat and total body water, decreased plasma protein concentrations, especially albumin, increased maternal blood volume, cardiac output and blood flow to the kidneys and uteroplacental unit, and decreased blood pressure. The maternal blood volume expansion occurs at a larger proportion than the increase in red blood cell mass, which results in physiologic anemia and hemodilution. Other physiologic changes include increased tidal volume, partially compensated respiratory alkalosis, delayed gastric emptying and gastrointestinal motility, and altered activity of hepatic drug metabolizing enzymes. Understating these changes and their profound impact on the pharmacokinetic properties of drugs in pregnancy is essential to optimize maternal and fetal health.

  7. Anticoagulation Strategies in Venovenous Hemodialysis in Critically Ill Patients: A Five-Year Evaluation in a Surgical Intensive Care Unit

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    Christoph Sponholz

    2014-01-01

    Full Text Available Renal failure is a common complication among critically ill patients. Timing, dosage, and mode of renal replacement (RRT are under debate, but also anticoagulation strategies and vascular access interfere with dialysis success. We present a retrospective, five-year evaluation of patients requiring RRT on a multidisciplinary 50-bed surgical intensive care unit of a university hospital with special regard to anticoagulation strategies and vascular access. Anticoagulation was preferably performed with unfractionated heparin or regional citrate application (RAC. Bleeding and suspected HIT-II were most common causes for RAC. In CVVHD mode filter life span was significantly longer under RAC compared to heparin or other anticoagulation strategies (P=0.001. Femoral vascular access was associated with reduced filter life span (P=0.012, especially under heparin anticoagulation (P=0.015. Patients on RAC had higher rates of metabolic alkalosis (P=0.001, required more transfusions (P=0.045, and showed higher illness severity measured by SOFA scores (P=0.001. RRT with unfractionated heparin represented the most common anticoagulation strategy in this study population. However, patients with bleeding risk and severe organ dysfunction were more likely placed on RAC. Citrate provided longer filter life spans regardless of vascular access site. Attention has to be paid to metabolic disturbances.

  8. Renal transplantation in a patient with Bartter syndrome and glomerulosclerosis

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    Se Eun Lee

    2011-01-01

    Full Text Available Bartter syndrome (BS is a clinically and genetically heterogeneous inherited renal tube disorder characterized by renal salt wasting, hypokalemic metabolic alkalosis and normotensive hyperreninemic hyperaldosteronism. There have been several case reports of BS complicated by focal segmental glomerulosclerosis (FSGS. Here, we have reported the case of a BS patient who developed FSGS and subsequent end-stage renal disease (ESRD and provided a brief literature review. The patient presented with classic BS at 3 months of age and developed proteinuria at 7 years. Renal biopsy performed at 11 years of age revealed a FSGS perihilar variant. Hemodialysis was initiated at 11 years of age, and kidney transplantation was performed at 16 years of age. The post-transplantation course has been uneventful for more than 3 years with complete disappearance of BS without the recurrence of FSGS. Genetic study revealed a homozygous p.Trp(TGG610Stop(TGA mutation in the CLCNKB gene. In summary, BS may be complicated by secondary FSGS due to the adaptive response to chronic salt-losing nephropathy, and FSGS may progress to ESRD in some patients. Renal transplantation in patients with BS and ESRD results in complete remission of BS.

  9. Congenital chloride diarrhea: a review of twelve Arabian children

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    Elrefae F

    2013-06-01

    Full Text Available Fawaz Elrefae,1 Ahmed Farag Elhassanien,2 Hesham Abdel-Aziz Alghiaty3 1Pediatric Gastroenterology, Al-Adan Hospital, Kuwait; 2Faculty of Medicine, Elmansoura University, El Mansoura, El Dakahleya, Egypt; 3Faculty of Medicine, Benha University, Egypt Background: Congenital chloride diarrhea (CCD, a rare autosomal recessive disorder, is characterized by sustained watery diarrhea (due to defect of active Chloride/HCO3 exchange in the ileum and colon with high fecal chloride. Objective: To spotlight the common presentation of CCD for early management and prevention of complications. Subjects and methods: This is a retrospective case series study of patients diagnosed as CCD who were followed up in the pediatric department of Al-Adan Hospital, Kuwait. Results: Twelve patients diagnosed with CCD were born to consanguineous parents; had antenatal history of intrauterine growth retardation (IUGR; polyhydramnios; and distended hypoechoic fetal bowel; and presented with abdominal distension, hypotonia and muscle wasting. 90% of patients had maternal hypertension and 75% of patients had absence of normal meconium at birth. Our patients showed a decrease in serum sodium, potassium, chloride and urine chloride. Conclusion: A high level of suspicion for an early diagnosis of CCD should be considered for any infant presenting with chronic diarrhea, especially in the presence of consanguineous marriage, and the characteristic features in antenatal ultrasound. Thus, allowing for early investigations and appropriate management. Keywords: congenital chloride diarrhea, children, chronic diarrhea, metabolic alkalosis, prenatal diagnosis

  10. Antenatal Bartter Syndrome: A Review

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    Y. Ramesh Bhat

    2012-01-01

    Full Text Available Antenatal Bartter syndrome (ABS is a rare autosomal recessive renal tubular disorder. The defective chloride transport in the loop of Henle leads to fetal polyuria resulting in severe hydramnios and premature delivery. Early onset, unexplained maternal polyhydramnios often challenges the treating obstetrician. Increasing polyhydramnios without apparent fetal or placental abnormalities should lead to the suspicion of this entity. Biochemical analysis of amniotic fluid is suggested as elevated chloride level is usually diagnostic. Awareness, early recognition, maternal treatment with indomethacin, and amniocentesis allow the pregnancy to continue. Affected neonates are usually born premature, have postnatal polyuria, vomiting, failure to thrive, hypercalciuria, and subsequently nephrocalcinosis. Hypokalemia, metabolic alkalosis, secondary hyperaldosteronism and hyperreninaemia are other characteristic features. Volume depletion due to excessive salt and water loss on long term stimulates renin-angiotensin-aldosterone system resulting in juxtaglomerular hyperplasia. Clinical features and electrolyte abnormalities may also depend on the subtype of the syndrome. Prenatal diagnosis and timely indomethacin administration prevent electrolyte imbalance, restitute normal growth, and improve activity. In this paper, authors present classification, pathophysiology, clinical manifestations, laboratory findings, complications, and prognosis of ABS.

  11. 经典型Bartter综合征合并代谢综合征的临诊应对%Approach to the patient with typical Bartter′s syndrome and metabolic syndrome:diagnosis and treatment

    Institute of Scientific and Technical Information of China (English)

    黄启亚; 杨彩娴; 李绍清; 苏云清; 曾龙驿

    2015-01-01

    Bartter 综合征(Bartter syndrome, BS)是一种罕见的肾小管疾病,为常染色体隐性遗传病,以肾性低钾,代谢性碱中毒,高肾素、高醛固酮血症为主要临床特点,Bartter 综合征合并代谢综合征临床未见报道。本文详细介绍1例经典型 Bartter 综合征合并代谢综合征的诊治经过,以使临床医师重视 Bartter 综合征合并代谢综合征的诊治。%Bartter′s syndrome(BS) is a rare renal tubular diseases and an autosomal recessive hereditary disease. The characteristic findings are hypokalemia, metabolic alkalosis, and raised serum renin and aldosterone levels. Combination of metabolic syndrome with Bartter′s syndrome has not been reported so far. Here in, we report a case in order to call attention to the diagnosis and treatment of typical Bartter′s syndrome combined with metabolic syndrome.

  12. Intracellular pH and inorganic phosphate content of heart in vivo: A sup 31 P-NMR study

    Energy Technology Data Exchange (ETDEWEB)

    Katz, L.A.; Swain, J.A.; Portman, M.A.; Balaban, R.S. (National Heart, Lung, and Blood Institute, Bethesda, MD (USA))

    1988-07-01

    Studies were performed to determine the contribution of red blood cells to the {sup 31}P-nuclear magnetic resonance (NMR) spectrum of the canine heart in vivo and the feasibility of measuring myocardial intracellular phosphate and pH. This was accomplished by replacing whole blood with a perfluorochemical perfusion emulsion blood substitute, Oxypherol, and noting the difference in the {sup 31}P-NMR spectrum of the heart. NMR data were collected with a NMR transmitter-receiver coil on the surface of the distal portion of the left ventricle. These studies demonstrated that a small contribution from 2,3-diphosphoglycerate (2,3-DPG) and phosphodiesters in the blood could be detected. The magnitude and shift of these blood-borne signals permitted the relative quantification of intracellular inorganic phosphate (P{sub i}) content as well as intracellular pH. Under resting conditions, the intracellular ATP/P{sub i} was 7.0 {plus minus} 0.08. This corresponds to a free intracellular P{sub 1} content of {approx} 0.8 {mu}mol./g wet wt. The intracellular pH was 7.10 {plus minus} 0.01. Acute respiratory alkalosis and acidosis, with the arterial pH ranging from {approximately}7.0 to 7.7, resulted in only small changes in the intracellular pH. These latter results demonstrate an effective myocardial intracellular proton-buffering mechanism in vivo.

  13. The importance of the ionic product for water to understand the physiology of the acid-base balance in humans.

    Science.gov (United States)

    Adeva-Andany, María M; Carneiro-Freire, Natalia; Donapetry-García, Cristóbal; Rañal-Muíño, Eva; López-Pereiro, Yosua

    2014-01-01

    Human plasma is an aqueous solution that has to abide by chemical rules such as the principle of electrical neutrality and the constancy of the ionic product for water. These rules define the acid-base balance in the human body. According to the electroneutrality principle, plasma has to be electrically neutral and the sum of its cations equals the sum of its anions. In addition, the ionic product for water has to be constant. Therefore, the plasma concentration of hydrogen ions depends on the plasma ionic composition. Variations in the concentration of plasma ions that alter the relative proportion of anions and cations predictably lead to a change in the plasma concentration of hydrogen ions by driving adaptive adjustments in water ionization that allow plasma electroneutrality while maintaining constant the ionic product for water. The accumulation of plasma anions out of proportion of cations induces an electrical imbalance compensated by a fall of hydroxide ions that brings about a rise in hydrogen ions (acidosis). By contrast, the deficiency of chloride relative to sodium generates plasma alkalosis by increasing hydroxide ions. The adjustment of plasma bicarbonate concentration to these changes is an important compensatory mechanism that protects plasma pH from severe deviations.

  14. Physiologic and pharmacokinetic changes in pregnancy.

    Science.gov (United States)

    Costantine, Maged M

    2014-01-01

    Physiologic changes in pregnancy induce profound alterations to the pharmacokinetic properties of many medications. These changes affect distribution, absorption, metabolism, and excretion of drugs, and thus may impact their pharmacodynamic properties during pregnancy. Pregnant women undergo several adaptations in many organ systems. Some adaptations are secondary to hormonal changes in pregnancy, while others occur to support the gravid woman and her developing fetus. Some of the changes in maternal physiology during pregnancy include, for example, increased maternal fat and total body water, decreased plasma protein concentrations, especially albumin, increased maternal blood volume, cardiac output, and blood flow to the kidneys and uteroplacental unit, and decreased blood pressure. The maternal blood volume expansion occurs at a larger proportion than the increase in red blood cell mass, which results in physiologic anemia and hemodilution. Other physiologic changes include increased tidal volume, partially compensated respiratory alkalosis, delayed gastric emptying and gastrointestinal motility, and altered activity of hepatic drug metabolizing enzymes. Understating these changes and their profound impact on the pharmacokinetic properties of drugs in pregnancy is essential to optimize maternal and fetal health. PMID:24772083

  15. Effect of Modified Alkaline Supplementation on Syngenic Melanoma Growth in CB57/BL Mice.

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    Tommaso Azzarito

    Full Text Available Tumor extracellular acidity is a hallmark of malignant cancers. Thus, in this study we evaluated the effects of the oral administration of a commercially available water alkalizer (Basenpulver® (BP on tumor growth in a syngenic melanoma mouse model. The alkalizer was administered daily by oral gavage starting one week after tumor implantation in CB57/BL mice. Tumors were calipered and their acidity measured by in vivo MRI guided 31P MRS. Furthermore, urine pH was monitored for potential metabolic alkalosis. BP administration significantly reduced melanoma growth in mice; the optimal dose in terms of tolerability and efficacy was 8 g/l (p< 0.05. The in vivo results were supported by in vitro experiments, wherein BP-treated human and murine melanoma cell cultures exhibited a dose-dependent inhibition of tumor cell growth. This investigation provides the first proof of concept that systemic buffering can improve tumor control by itself and that this approach may represent a new strategy in prevention and/or treatment of cancers.

  16. Splicing Defect in Mitochondrial Seryl-tRNA Synthetase Gene Causes Progressive Spastic Paresis Instead of HUPRA Syndrome.

    Science.gov (United States)

    Linnankivi, Tarja; Neupane, Nirajan; Richter, Uwe; Isohanni, Pirjo; Tyynismaa, Henna

    2016-09-01

    Mitochondrial aminoacyl-tRNA synthetases are an important group of disease genes typically underlying either a disorder affecting an isolated tissue or a distinct syndrome. Missense mutations in the mitochondrial seryl-tRNA synthetase gene, SARS2, have been identified in HUPRA syndrome (hyperuricemia, pulmonary hypertension, renal failure in infancy, and alkalosis). We report here a homozygous splicing mutation in SARS2 in a patient with progressive spastic paresis. We show that the mutation leads to diminished levels of the synthetase in patient's fibroblasts. This has a destabilizing effect on the tRNASer(AGY) isoacceptor, but to a lesser degree than in HUPRA syndrome patients. tRNASer(UCN) is largely unaffected in both phenotypes. In conclusion, the level of tRNASer(AGY) instability may be a factor in determining tissue manifestation in patients with SARS2 mutations. This finding exemplifies the sensitivity of the nervous system to partially reduced aminoacylation, which is sufficient in other tissues to maintain respiratory chain function. PMID:27279129

  17. Glucose concentration and blood acid-basis status in high-yielding dairy cows during heat stress

    Directory of Open Access Journals (Sweden)

    Vujanac Ivan

    2011-01-01

    Full Text Available The objective of this work was to examine the effect of heat stress on glucose and pH values in blood of high-yielding dairy cows in the early stage of lactation, as well as to determine whether the changes in these parameters are interdependent under such conditions. An experiment was performed on high-yielding dairy cows during the summer and the spring periods. Forty cows were selected, twenty each for the two periods under investigation. In the course of the experiment, the temperature humidity index (THI was determined for the entire period of investigations, and then also the average daily THI, nightmorning THI (average value of hourly THI measured from 22h on the previous day until 10h of the current day, as well as the day-night THI (average value of hourly THI measured during the period from 10h to 22h of the current day. The pH and glucose concentration were determined in blood samples taken in the morning and afternoon of days 30, 60, and 90 of lactation during the spring and summer periods of the investigations. Based on the results for the THI, it was established that the animals were not exposed to the effect of extreme heat stress during the spring period of investigations, while they were periodically exposed to moderate but also extreme heat stress during the summer, in particular in the afternoon hours. It can be concluded from the results obtained for the blood pH that the cows were in respiratory alkalosis during the summer in the morning and afternoon hours on day 30, in the afternoon hours of days 60 and 90 of lactation, as well as in the afternoon on day 90 of lactation during the spring period of investigations. During the summer period, there were no statistically significant differences between the pH value determined in the morning and afternoon hours on day 30 of lactation, while the pH value was significantly higher in the afternoon hours than in the morning hours on days 60 and 90 of lactation. There were no

  18. Determinação de eletrólitos, gases sanguíneos, osmolalidade, hematócrito, hemoglobina, base titulável e anion gap no sangue venoso de equinos destreinados submetidos a exercício máximo e submáximo em esteira rolante Determination of electrolytes, hemogasometry, osmalility, hematocrit, hemoglobin, base concentration, and anion gap in detrained equines submitted a maximum and submaximum exercise on treadmill

    Directory of Open Access Journals (Sweden)

    M.A.G. Silva

    2009-10-01

    Base, SatvO2, and PvO2. So, maximum exercises can lead equines to present metabolic acidosis with respiratory alkalosis as response, hypercalemia and increase in hematocrit and hemoglobin, values. Submaximum exercises can present hypochloremic metabolic alkalosis but no alterations in the hydroelectrolitic balance.

  19. 《关于国外渗透性脱髓鞘综合征部分文献之重新分析:反思》英文摘要与说明

    Institute of Scientific and Technical Information of China (English)

    张海鹏; 王荣明; 杨子军; 闫四梅; 陈萌; 崔松; 张力; 杜长生; 陈宗羡; 曾伏虎; 翟所鑫; 李玉清; 刘庆梅; 朱玉忠

    2015-01-01

    Objectives: To explore the main etiological factors of central pontine myelinolysis (CPM) and of the “osmotic demyelination syndrome(ODS)”that occurs after hepatic transplantation, to explore the differential diagnosing the manifestation consisting of dysarthria, dysphagia and quadriplegia presented after vomiting for a number of times, and to explore which fraction to be mainly involved by the “ODS”, what to be the pathological mechanism of the “ODS”, and how to prevent the “ODS”.Methods: Physiopathological principles are applied on the base of the clinical certificates, the diagnostic results differring from those in the case reports (that have been analyzed again by us).Results and Conclusions: It could be suggested that (1) CPM based mainly on alcoholism should result mainly from beriberi, as was mentioned by HUANG Ke-wei, the well-known Chinese neurologist, before or in 1960; (2) The coma secondary to hepatic transplantation could be often caused by Wernicke encephalopathy(WE, one of beriberi), which could be asscociated with the postoperative elevated corticosteroid or/and high-starch food for liver cirrhosis, which complicated by hepatic encephalopathy; (3)The case that was in 1995 reported by Kabeer et al, of possiblity of the earliest reported CPM due to cyclosporine, appeared to be the bilateral type of pontine lower paracentral hematal syndrome, a bilateral uncomplete Foville syndrome. It should be considerable whether an epileptic attack related to both cyclosporine and corticosteroid could result from reverible posterior leukoencephalopath syndrome with negative MRI owing to the effect of corticosteroid; (4) It is cerebral cortex that could be mainly involved by the “ODS” following a number of times of vomiting, of which one of evidences has been the 2 cases reported by Tomlinson et al in 1976.The kind of “ODS” following the encephalopathy of alkalosis yet without hypoxemic hypoxia, is possibly preventable not only if the

  20. Clinical analysis of the relationship between 56 cases of chronic obstructive pulmonary disease with re-spiratory failure and hyponatremia%56例慢性阻塞性肺疾病合并呼吸衰竭与低钠血症关系的临床分析

    Institute of Scientific and Technical Information of China (English)

    石屏屏

    2016-01-01

    目的:探讨慢性阻塞性肺疾病合并呼吸衰竭的发生与低钠血症的关系。方法:选取56例患者,分为A、B、C三组,观察其血钠情况,并分析其中关系。结果:三组血钠相比,差异有显著统计学意义( P﹤0.01),B、C两组相比,差异有显著统计学意义( P﹤0.05)。慢性阻塞性肺疾病合并呼吸衰竭患者发生低血钠与下列因素有关,且Ⅱ型呼吸衰竭引起低血钠的原因较I型呼吸衰竭明显,差异有统计学意义( P﹤0.05)。低钠血症患者往往伴随酸碱失衡,特别是碱中毒,慢性阻塞性肺疾病合并呼吸衰竭患者呼酸并代碱及代碱发生率较高,差异有统计学意义( P﹤0.05)。结论:慢性阻塞性肺疾病合并呼吸衰竭与低钠血症关系密切,且其发病原因复杂,与疾病的发展程度及医源性因素有关,需要定期对其血电解质进行检测并给予及时处理,使患者的死亡率降低。%Objective To investigate the relationship between chronic obstructive pulmonary disease with respiratory failure and hyponatremia. Method 56 cases of patients were divided into A group,B group,C group,to observe the serum sodium,and analyzes the relationship between them. Results The three groups were compared,the difference was significant( P ﹤0. 01 ), compared to B,C two groups,there was significant difference(P﹤0. 05). Hyponatremia was related to the following factors in pa-tients with chronic obstructive pulmonary disease complicated with respiratory failure,and type Ⅱ respiratory failure caused by hyponatremia with typeⅠ respiratory failure significantly,the difference was statistically significant( P﹤0. 05 ). Hyponatremia often accompanied by acid-base imbalance,especially alkali poisoning,chronic obstructive pulmonary disease with respiratory failure in patients with respiratory acidosis and metabolic alkalosis and metabolic alkalosis were higher,the difference was

  1. Clinical analysis of 6 cases of Bartter syndrome%巴特综合征临床分析

    Institute of Scientific and Technical Information of China (English)

    殷方美; 郑方遒; 张鑫; 吴梅筠; 卫红艳; 马中书; 卢飚; 邱明才

    2011-01-01

    Objective To summarize the clinical characteristics of Bartter syndrome and investigate its pathogenesis. Methods The clinical data of 6 cases of Bartter syndrome at our hospital from November 2006 to May 2010 were analyzed retrospectively. Results The onset age of Bartter syndrome was 13-35years old. The main symptoms included weakness (6/6), paralysis ( 1/6 ), numbness ( 5/6 ) and tetany (4/6). All patients had normal blood pressure. The biochemical tests showed persistent hypokalemia, metabolic alkalosis (6/6) and hyperreninemia. The pathological examination of deltoid muscle biopsy showed the swelling, degeneration and necrosis of myocytes and the deposition of immunocomplex in myolemma. And the pathological examination of renal biopsy showed the hyperplasia of juxtaglomerular apparatus (5/6) and the deposition of immunocomplex.All symptoms were relieved after a therapy of potassium supplementation or a combination of indomethacin, spironolactone and immunosuppressant.Conclusion When such clinical features as weakness, paralysis, tetany, hypokalemic alkalosis and normotension are encountered, Bartter syndrome should be suspected. Serum electrolytes, blood gas analysis and activation of the renin-angiotensin-aldosterone system should be examined for a definite diagnosis. The treatment of choice includes potassium and magnesium supplementation or in combination with prostaglandin synthetase inhibitor, aldosterone antagonist and immunosuppressant. Immunologic mechanism may participate in the course of Bartter syndrome.%目的 总结巴特综合征的临床特点,探讨其发病机制.方法 回顾性分析天津医科大学总医院内分泌科2006年11月至2010年5月的6例巴特综合征病例.结果 6例患者发病年龄13~35岁,男女比例为5∶1.临床上以乏力(6/6)、发作性四肢软瘫(1/6)、肢体麻木(5/6)、手足搐搦(4/6)等为主要表现;血压正常;实验室检查出现持续性低血钾、代谢性碱中毒(6/6),有血浆肾

  2. Effect of continuous hemofiltration on internal environment and survival rate of severe heatstroke dogs with shock

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    Guang-ming CHEN

    2011-08-01

    Full Text Available Objective To explore the effect of continuous hemofiltration(CHF on internal environment and survival rate of severe heatstroke dogs with shock.Methods Sixteen healthy male dogs were randomly divided into heatshock group(HS group,n=8 and continuous hemofiltration group(CHF group,n=8.Severe heatstroke model was established by applying high temperature to whole body,and then the animals were removed from the heating cabin as soon as they presented manifestations of shock.Dogs of HS group were put into an ordinary environment,while dogs of CHF group received CHF treatment.The core temperature(Tc,mean arterial pressure(MAP,blood gas analysis,serum electrolytes and survival rate of dogs in two groups were observed.Results The time from heat exposure to shock was 107.0±28.5min and 111.4±22.2min in HS group and CHF group respectively(t=-0.354,P=0.729.The Tc in CHF group declined to normal level 15 to 30 minitues after CHF treatment,while the Tc in HS group remained at a level higher than that before heat exposure at 90min after shock.The Tc of two groups showed significant difference at each time point after shock(P < 0.01.The MAP of both groups was obviously lowered than that before heatstroke.The MAP of CHF group raised gradually 30 min after treatment,while the MAP of HS group rose very slowly,and it was significantly lower than that of CHF group at each time point after 45min(P < 0.05,P < 0.01.All the dogs in both groups manifested hyperventilation and respiratory alkalosis when shock appeared.After shock,respiratory alkalosis in HS group gradually became metabolic acidosis,with some animals manifested combined metabolic and respiratory acidosis because of respiratory decompensation,while the blood gas levels in CHF group recovered to normal gradually.The blood gas levels of two groups showed significant difference at each time point after shock(P < 0.05,P < 0.01.Hypernatremia,hyperchloraemia and hyperpotassaemia were found in all animals of both

  3. Analysis of 15 case with Bartter syndrome and literature review%儿童Bartter综合征15例临床分析

    Institute of Scientific and Technical Information of China (English)

    杨雪钧; 李秋

    2014-01-01

    目的:探讨儿童Bartter综合征的临床表现、诊断及治疗。方法回顾性分析15例Bartter综合征患儿的临床资料。结果15例患儿中表现为生长发育迟滞14例(93.3%),纳差12例(80.0%),呕吐7例(46.7%),腹泻5例(33.3%),多饮多尿5例(33.3%),乏力4例(26.7%)。15例患儿均有低氯血症、低钾血症,其中重度低钾血症10例,12例患儿出现代谢性碱中毒。15例患儿中经典型Bartter综合征10例、新生儿型Bartter综合征3例、变异型Bartter综合征(Gitelman综合征)2例。15例患儿均给予大剂量补钾等纠正水电解质酸碱平衡紊乱,口服螺内酯、布洛芬悬液及卡托普利后,症状基本控制。结论儿童出现不明原因持续性低钾低氯性代谢性碱中毒及生长发育迟滞时需警惕该病可能,结合临床表现及氢氯噻嗪试验基本可诊断,基因诊断是最可靠的方法。目前主要以补钾、补镁、醛固酮拮抗剂、前列腺素拮抗剂等综合治疗为主,需终生治疗。%Objective To investigate the clinical manifestations, diagnosis and treatment of Bartter syndrome in children. Methods Clinical data of 15 patients with Bartter syndrome in Children`s Hospital Afifliated to Chongqing Medical University was analyzed, and pertinent literatures were reviewed. Results Bartter syndrome is an autosomal recessive inherited renal disorder characterized by hypokalemia, hypochloremia, metabolic alkalosis, vomiting, growth retardation, the activation of the renin-aldosterone axis, normal blood pressure. Genetic analysis is the most reliable way for diagnosis. Comprehensive therapy with antisterone, indomethacin, catopril and potassium have remarkable effect. Conclusions Bartter syndrome should be considered when children have unreasonable continuous hypokalemia, hypochloremia, metabolic alkalosis and growth retardation. It can be clinically diagnosed by clinical manifestation and hydrochlorothiazide test, and genetic

  4. The role of hyperventilation: hypocapnia in the pathomechanism of panic disorder O papel da hiperventilação: a hipocapnia no patomecanismo do distúrbio de pânico

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    Andras Sikter

    2007-12-01

    Full Text Available OBJECTIVE: The authors present a profile of panic disorder based on and generalized from the effects of acute and chronic hyperventilation that are characteristic of the respiratory panic disorder subtype. The review presented attempts to integrate three premises: hyperventilation is a physiological response to hypercapnia; hyperventilation can induce panic attacks; chronic hyperventilation is a protective mechanism against panic attacks. METHOD: A selective review of the literature was made using the Medline database. Reports of the interrelationships among panic disorder, hyperventilation, acidosis, and alkalosis, as well as catecholamine release and sensitivity, were selected. The findings were structured into an integrated model. DISCUSSION: The panic attacks experienced by individuals with panic disorder develop on the basis of metabolic acidosis, which is a compensatory response to chronic hyperventilation. The attacks are triggered by a sudden increase in (pCO2 when the latent (metabolic acidosis manifests as hypercapnic acidosis. The acidotic condition induces catecholamine release. Sympathicotonia cannot arise during the hypercapnic phase, since low pH decreases catecholamine sensitivity. Catecholamines can provoke panic when hyperventilation causes the hypercapnia to switch to hypocapnic alkalosis (overcompensation and catecholamine sensitivity begins to increase. CONCLUSION: Therapeutic approaches should address long-term regulation of the respiratory pattern and elimination of metabolic acidosis.OBJETIVO: Os autores apresentam um modelo de transtorno do pânico que se baseia nos efeitos da hiperventilação aguda e crônica, característicos do subtipo respiratório de transtorno do pânico. O modelo é generalizado a partir desses efeitos. Ele integra três características da hiperventilação: a hiperventilação é uma resposta fisiológica à hipercapnia; a hiperventilação pode induzir ataques de pânico; a hiperventila

  5. Molecular and biochemical studies on bovine ephemeral fever

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    Nahed S. Thabet; Emad W. Ghazy; Mohamed A. Nayel; Mohamed Abo-Elkhair

    2011-05-01

    Full Text Available Bovine ephemeral fever (BEF in cattle has been reported to be associated with a range of biochemical changes which are similar to those seen in milk fever. This study aimed to clarify the biochemical alterations that associate infection of cattle with BEF with special references to the mechanisms involved in the development of hypocalcemia. The study was conducted on 30 cases of cattle infected with BEF based on the characteristic clinical signs which were confirmed by isolation of virus and RT-PCR. Another 6 healthy cows were used in the study as control. The evaluated parameters included biochemical variables such as serum values of total protein (TP, albumin (Alb, glucose (Glu, total calcium (tCa, ionized calcium (iCa, inorganic phosphorus (P, magnesium (Mg, sodium (Na, potassium (K, chloride (Cl, creatinine (Cr, blood urea nitrogen (BUN and serum activity of alkaline phosphatase (ALP. Hormonal profile included parathyroid hormone (PTH, insulin (Ins, and cortisol (Cor. The results showed that BEF-infected animals demonstrated a significant decrease (P<0.05 in serum concentrations of TP, Glo, iCa, P, Na, K, BUN and ALP while the mean values of serum levels of Glu and Cl were significantly increased (P<0.05. The mean values of serum levels of PTH were significantly decreased (P<0.05 while serum concentrations of Ins and Cor showed a significant increase. It was concluded that the clinical signs of bovine ephemeral fever are related to the hypocalcemia resulting from suppression of parathyroid hormone which seems to be mediated by respiratory alkalosis caused by the disease. This explanation needs future studies to provide a direct link between measurement of blood indicators of acid-base status, blood biochemical parameters and urine analysis. However, this work can provide a good knowledge about the pathogenesis of the disease that can lead to better management and proper treatment.

  6. Pseudo-Bartter syndrome in an infant with congenital chloride diarrhoea

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    Igrutinović Zoran

    2011-01-01

    Full Text Available Introduction. Pseudo-Bartter syndrome encompasses a heterogenous group of disorders similar to Bartter syndrome. We are presenting an infant with pseudo-Bartter syndrome caused by congenital chloride diarrhoea. Case Outline. A male newborn born in the 37th gestational week (GW to young healthy and non-consanguineous parents. In the 35th GW a polyhydramnios with bowel dilatation was verified by ultrasonography. After birth he manifested several episodes of hyponatremic dehydration with hypochloraemia, hypokalaemia and metabolic alkalosis, so as Bartter syndrome was suspected treatment with indomethacin, spironolactone and additional intake of NaCl was initiated. However, this therapy gave no results, so that at age six months he was rehospitalized under the features of persistent watery diarrhoea, vomiting, dehydration and acute renal failure (serum creatinine 123 μmol/L. The laboratory results showed hyponatraemia (123 mmol/L, hypokalaemia (3.1 mmol/L, severe hypochloraemia (43 mmol/L, alcalosis (blood pH 7.64, bicarbonate 50.6 mmol/L, high plasma renin (20.6 ng/ml and aldosterone (232.9 ng/ml, but a low urinary chloride concentration (2.1 mmol/L. Based on these findings, as well as the stool chloride concentration of 110 mmol/L, the patient was diagnosed congenital chloride diarrhoea. In further course, the patient was treated by intensive fluid, sodium and potassium supplementation which resulted in the normalization of serum electrolytes, renal function, as well as his mental and physical development during 10 months of follow-up. Conclusion. Persistent watery diarrhoea with a high concentration of chloride in stool is the key finding in the differentiation of congenital chloride diarrhoea from Bartter syndrome. The treatment of congenital chloride diarrhoea consists primarily of adequate water and electrolytes replacement.

  7. Sarcomere neutralization in inherited cardiomyopathy: small-molecule proof-of-concept to correct hyper-Ca2+-sensitive myofilaments.

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    Thompson, Brian R; Martindale, Joshua; Metzger, Joseph M

    2016-07-01

    The sarcomere is the functional unit of the heart. Alterations in sarcomere activation lead to disease states such as hypertrophic and restrictive cardiomyopathy (HCM/RCM). Mutations in many of the sarcomeric genes are causal for HCM/RCM. In most cases, these mutations result in increased Ca(2+) sensitivity of the sarcomere, giving rise to altered systolic and diastolic function. There is emerging evidence that small-molecule sarcomere neutralization is a potential therapeutic strategy for HCM/RCM. To pursue proof-of-concept, W7 was used here because of its well-known Ca(2+) desensitizer biochemical effects at the level of cardiac troponin C. Acute treatment of adult cardiac myocytes with W7 caused a dose-dependent (1-10 μM) decrease in contractility in a Ca(2+)-independent manner. Alkalosis was used as an in vitro experimental model of acquired heightened Ca(2+) sensitivity, resulting in increased live cell contractility and decreased baseline sarcomere length, which were rapidly corrected with W7. As an inherited cardiomyopathy model, R193H cardiac troponin I (cTnI) transgenic myocytes showed significant decreased baseline sarcomere length and slowed relaxation that were rapidly and dose-dependently corrected by W7. Langendorff whole heart pacing stress showed that R193H cTnI transgenic hearts had elevated end-diastolic pressures at all pacing frequencies compared with hearts from nontransgenic mice. Acute treatment with W7 rapidly restored end-diastolic pressures to normal values in R193H cTnI hearts, supporting a sarcomere intrinsic mechanism of dysfunction. The known off-target effects of W7 notwithstanding, these results provide further proof-of-concept that small-molecule-based sarcomere neutralization is a potential approach to remediate hyper-Ca(2+)-sensitive sarcomere function. PMID:27199134

  8. KCNJ10 gene mutations causing EAST syndrome (epilepsy, ataxia, sensorineural deafness, and tubulopathy) disrupt channel function

    Science.gov (United States)

    Reichold, Markus; Zdebik, Anselm A.; Lieberer, Evelyn; Rapedius, Markus; Schmidt, Katharina; Bandulik, Sascha; Sterner, Christina; Tegtmeier, Ines; Penton, David; Baukrowitz, Thomas; Hulton, Sally-Anne; Witzgall, Ralph; Ben-Zeev, Bruria; Howie, Alexander J.; Kleta, Robert; Bockenhauer, Detlef; Warth, Richard

    2010-01-01

    Mutations of the KCNJ10 (Kir4.1) K+ channel underlie autosomal recessive epilepsy, ataxia, sensorineural deafness, and (a salt-wasting) renal tubulopathy (EAST) syndrome. We investigated the localization of KCNJ10 and the homologous KCNJ16 in kidney and the functional consequences of KCNJ10 mutations found in our patients with EAST syndrome. Kcnj10 and Kcnj16 were found in the basolateral membrane of mouse distal convoluted tubules, connecting tubules, and cortical collecting ducts. In the human kidney, KCNJ10 staining was additionally observed in the basolateral membrane of the cortical thick ascending limb of Henle's loop. EM of distal tubular cells of a patient with EAST syndrome showed reduced basal infoldings in this nephron segment, which likely reflects the morphological consequences of the impaired salt reabsorption capacity. When expressed in CHO and HEK293 cells, the KCNJ10 mutations R65P, G77R, and R175Q caused a marked impairment of channel function. R199X showed complete loss of function. Single-channel analysis revealed a strongly reduced mean open time. Qualitatively similar results were obtained with coexpression of KCNJ10/KCNJ16, suggesting a dominance of KCNJ10 function in native renal KCNJ10/KCNJ16 heteromers. The decrease in the current of R65P and R175Q was mainly caused by a remarkable shift of pH sensitivity to the alkaline range. In summary, EAST mutations of KCNJ10 lead to impaired channel function and structural changes in distal convoluted tubules. Intriguingly, the metabolic alkalosis present in patients carrying the R65P mutation possibly improves residual function of KCNJ10, which shows higher activity at alkaline pH. PMID:20651251

  9. Hypercalcemia Associated with Calcium Supplement Use: Prevalence and Characteristics in Hospitalized Patients

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    Machado, Maria C.; Bruce-Mensah, Araba; Whitmire, Melanie; Rizvi, Ali A.

    2015-01-01

    Background: The ingestion of large amounts of milk and antacids to treat peptic ulcer disease was a common cause of hypercalcemia in the past (the “milk-alkali syndrome”). The current popularity of calcium and supplements has given rise to a similar problem. Objectives: To evaluate the prevalence and characteristics of hypercalcemia induced by calcium intake (“calcium supplement syndrome”; or CSS) in hospitalized patients. Methods: We conducted a retrospective; electronic health record (EHR)-based review of patients with hypercalcemia over a 3-year period. Diagnosis of CSS was based on the presence of hypercalcemia; a normal parathyroid hormone (PTH) level; renal insufficiency; metabolic alkalosis; a history of calcium intake; and documented improvement with treatment. Results: Of the 72 patients with non-PTH mediated hypercalcemia; 15 (20.8%) satisfied all the criteria for the diagnosis of CSS. Calcium; vitamin D; and multivitamin ingestion were significantly associated with the diagnosis (p values < 0.0001; 0.014; and 0.045 respectively); while the presence of hypertension; diabetes; and renal insufficiency showed a trend towards statistical significance. All patients received intravenous fluids; and six (40%) received calcium-lowering drugs. The calcium level at discharge was normal 12 (80%) of patients. The mean serum creatinine and bicarbonate levels decreased from 2.4 and 35 mg/dL on admission respectively; to 1.6 mg/dL and 25.6 mg/dL at discharge respectively. Conclusion: The widespread use of calcium and vitamin D supplementation can manifest as hypercalcemia and worsening of kidney function in susceptible individuals. Awareness among health care professionals can lead to proper patient education regarding these health risks. PMID:26239247

  10. Erythrocytosis in a Patient with Type 1 Diabetes Mellitus and Concomitant Gitelman’s Syndrome

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    Müge Keskin

    2016-06-01

    Full Text Available Gitelman’s syndrome (GS is characterized by hypokalemia, hypomagnesaemia, hypocalciuria, metabolic alkalosis, and neurological symptoms. The association of GS with type 1 diabetes is rare, described only in a few case reports. We report a patient with an unusual combination of GS and type 1 diabetes mellitus with erythrocytosis. A 26-year-old male with GS and type 1 diabetes, who was on intensive insulin therapy with poor compliance, presented with the complaint of headache. On physical examination, his blood pressure was 120/70 mmHg and there was no neurological deficit or proximal muscle weakness. He had no previous medical history of obstructive sleep apnea, heart or lung disease. He had negative smoking history. His laboratory tests revealed erythrocytosis with a hemoglobin level of 18.9 g/dL (13.6-17.2 g/dL and a hematocrit level of 54.8% (39.5-50.3%. Cranial magnetic resonance imaging was normal. He had no evidence of hypovolemia. Hematological workout excluded polycythemia vera and chronic myeloid neoplasm. A bone marrow aspiration revealed a hypercellular marrow with increased erythroid precursors, megakaryocytes and granulocytes. The reticulin stain grade was zero. There was no iron accumulation with iron stain. There was no radiologic evidence of any kind of erythropoietin-producing tumors. His echocardiography was normal. Serum insulin-like growth factor-1 levels and endogenous androgens were within normal limits. After 2 therapeutic phlebotomies, his symptoms improved and his hemoglobin was 16.1 mg/dL. Our patient, besides having GS and type 1 diabetes, was complicated with idiopathic erythrocytosis, all having deleterious effects on hemodynamic status of the patient.

  11. Respiratory, acid-base, and metabolic responses of the Christmas Island blue crab, Cardisoma hirtipes (Dana), during simulated environmental conditions.

    Science.gov (United States)

    Dela-Cruz, J; Morris, S

    1997-01-01

    The dependency of the Christmas Island blue crab, Cardisoma hirtipes, on fresh water for respiratory gas exchange and transport was investigated in laboratory simulations. The gas exchange rates of air-breathing C. hirtipes were similar to those of other land crabs but decreased to 20% in submerged crabs. Crabs with access to air maintained arterial and pulmonary O2 content (CO2) and partial pressure (PO2), while in submerged crabs the PO2 and CO2 rapidly decreased (by 50%). There was no anaerobiosis, but haemolymph glucose concentration and cardiac output decreased when crabs were submersed, which suggests a hypometabolic state. Submersion induced a metabolic rather than a respiratory alkalosis, and since respiratory gas exchange was low, CO2 excretion to water was unimportant. Cardisoma hirtipes haemocyanin (Hc) has high O2 affinity but low pH sensitivity, which facilitates O2 uptake from hypoxic environments. The high Hc-O2 affinity supports O2 loading but may prevent access to a venous O2 reserve. Calcium, magnesium, and urate, but not L-lactate, were effectors of Hc-O2 affinity. In submerged crabs increased circulating urate maintained haemolymph O2 content. The CO2 capacitance and nonbicarbonate buffering of the haemolymph were relatively low. A significant Haldane effect seemed important for CO2 excretion but would require CO2 and O2 exchange to occur at the same organ (gills or lungs). Submersion interferes with respiration and is not needed for haemolymph acid-base balance; thus; C. hirtipes is an air-breathing crab.

  12. [Effects of breathing high concentrations of oxygen on changes in blood indices during bicycle exercise].

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    Nagata, A; Yoshida, M; Fuke, T; Miyazato, I; Shiba, K

    1990-01-01

    The purpose of this study is to examine effects of hyperoxic gas mixtures on changes of blood indices during bicycle exercise of human. Oxygen-enriched gases (30% O2) were inspired during the ramp load exercise of 25 watt/min. Changes of blood indices were analyzed with Sequential Multiple Analyzer with the computer (SMAC). The improvement of exercise performance were discussed about relationship between function of hyperoxic gas and physiological mechanism. Three experimental conditions were set as follows (I) 30% O2 +N2 gases balance, (II) air (21% O2), and (III) 30% O2 +2% CO2 +N2 gases balance. Arterial blood were sampled from the radial artery of the forearm in order to analyze following items; 1) pH level, PaO2, PaCO2, and HCO3 of these blood gases, 2) Blood sugar, TG, and F-CH of the blood contents, 3) red blood corpuscle, white blood corpuscle, Hb, and Ht values, 4) LDH, CK, GOT, and GPT of the blood enzymes, 5) TP, ALB, Na, K, Ca and Cl of the electric ions. In the case of inspiring hyperoxic gases, the recovery rate of blood indices increased after this ramp load exercise remarkably, and the whole exercise metabolism were removed from acidosis tendency to alkalosis value of the resting condition significantly. At hyperoxic experimental conditions, the blood sugar and oxygen consumption were much more decreased than these at normal oxygen content one during both states of exercise and recovery times. These data of the blood indices would support strongly to the hypothesis that improvement of oxygen delivery should be depended upon the enhanced performance with the hyperoxic gases. There might be effects of the hyperoxia on the cellular metabolism and on function of the vascular muscle during those aerobic exercise.

  13. Effects of xylazine on acid-base balance and arterial blood-gas tensions in goats under different environmental temperature and humidity conditions

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    E.G.M. Mogoa

    2000-07-01

    Full Text Available The effects of acute exposure to 3 different temperature and humidity conditions on arterial blood-gas and acid-base balance in goats were investigated after intravenous bolus administration of xylazine at a dose of 0.1 mg/kg. Significant (P < 0.05 changes in the variables occurred under all 3 environmental conditions. Decreases in pH, partial pressure of oxygen and oxyhaemoglobin saturation were observed, and the minimum values for oxygen tension and oxyhaemoglobin saturation were observed within 5 min of xylazine administration. The pH decreased to its minimum values between 5 and 15 min. Thereafter, the variables started to return towards baseline, but did not reach baseline values at the end of the 60 min observation period. Increases in the partial pressure of carbon dioxide, total carbon dioxide content, bicarbonate ion concentration, and the actual base excess were observed. The maximum increase in the carbon dioxide tension occurred within 5 min of xylazine administration. The increase in the actual base excess only became significant after 30 min in all 3 environments, and maximal increases were observed at 60 min. There were no significant differences between the variables in the 3 different environments. It was concluded that intravenous xylazine administration in goats resulted in significant changes in arterial blood-gas and acid-base balance that were associated with hypoxaemia and respiratory acidosis, followed by metabolic alkalosis that continued for the duration of the observation period. Acute exposure to different environmental temperature and humidity conditions after xylazine administration did not influence the changes in arterial blood-gas and acid-base balance.

  14. Acute respiratory failure induced by mechanical pulmonary ventilation at a peak inspiratory pressure of 40 cmH2O.

    Science.gov (United States)

    Tsuno, K; Sakanashi, Y; Kishi, Y; Urata, K; Tanoue, T; Higashi, K; Yano, T; Terasaki, H; Morioka, T

    1988-09-01

    The effects of high pressure mechanical pulmonary ventilation at a peak inspiratory pressure of 40 cmH(2)O were studied on the lungs of healthy newborn pigs (14-21 days after birth). Forty percent oxygen in nitrogen was used for ventilation to prevent oxygen intoxication. The control group (6 pigs) was ventilated for 48 hours at a peak inspiratory pressure less than 18 cmH(2)O and a PEEP of 3-5 cmH(2)O with a normal tidal volume, and a respiratory rate of 20 times/min. The control group showed few deleterious changes in the lungs for 48 hours. Eleven newborn pigs were ventilated at a peak inspiratory pressure of 40 cmH(2)O with a PEEP of 3-5 cmH(2)O and a respiratory rate of 20 times/min. To avoid respiratory alkalosis, a dead space was placed in the respiratory circuit, and normocarbia was maintained by adjusting dead space volume. In all cases in the latter group, severe pulmonary impairments, such as abnormal chest roentgenograms, hypoxemia, decreased total static lung compliance, high incidence of pneumothorax, congestive atelectasis, and increased lung weight were found within 48 hours of ventilation. When the pulmonary impairments became manifest, 6 of the 11 newborn pigs were switched to the conventional medical and ventilatory therapies for 3-6 days. However, all of them became ventilator dependent, and severe lung pathology was found at autopsy. These pulmonary insults by high pressure mechanical pulmonary ventilation could be occurring not infrequently in the respiratory management of patients with respiratory failure. PMID:15236077

  15. Capsiate supplementation reduces oxidative cost of contraction in exercising mouse skeletal muscle in vivo.

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    Kazuya Yashiro

    Full Text Available Chronic administration of capsiate is known to accelerate whole-body basal energy metabolism, but the consequences in exercising skeletal muscle remain very poorly documented. In order to clarify this issue, the effect of 2-week daily administration of either vehicle (control or purified capsiate (at 10- or 100-mg/kg body weight on skeletal muscle function and energetics were investigated throughout a multidisciplinary approach combining in vivo and in vitro measurements in mice. Mechanical performance and energy metabolism were assessed strictly non-invasively in contracting gastrocnemius muscle using magnetic resonance (MR imaging and 31-phosphorus MR spectroscopy (31P-MRS. Regardless of the dose, capsiate treatments markedly disturbed basal bioenergetics in vivo including intracellular pH alkalosis and decreased phosphocreatine content. Besides, capsiate administration did affect neither mitochondrial uncoupling protein-3 gene expression nor both basal and maximal oxygen consumption in isolated saponin-permeabilized fibers, but decreased by about twofold the Km of mitochondrial respiration for ADP. During a standardized in vivo fatiguing protocol (6-min of repeated maximal isometric contractions electrically induced at a frequency of 1.7 Hz, both capsiate treatments reduced oxidative cost of contraction by 30-40%, whereas force-generating capacity and fatigability were not changed. Moreover, the rate of phosphocreatine resynthesis during the post-electrostimulation recovery period remained unaffected by capsiate. Both capsiate treatments further promoted muscle mass gain, and the higher dose also reduced body weight gain and abdominal fat content. These findings demonstrate that, in addition to its anti-obesity effect, capsiate supplementation improves oxidative metabolism in exercising muscle, which strengthen this compound as a natural compound for improving health.

  16. Diagnosis and Treatment of Cerebral Salt Wasting Syndrome With Cryptococcal Meningitis in HIV Patient.

    Science.gov (United States)

    Lee, Sunggeun; Collado, Anitsira; Singla, Montish; Carbajal, Roger; Chaudhari, Ashok; Baumstein, Donald

    2016-01-01

    Hyponatremia is one of the most common electrolyte imbalances in HIV patients. The differential diagnosis may include hypovolemic hyponatremia, syndrome of inappropriate antidiuretic hormone secretion (SIADH), and adrenal insufficiency. Here, we describe a case of hyponatremia secondary to cerebral salt wasting syndrome (CSWS) in an HIV patient with cryptococcal meningitis. A 52-year-old man with a history of diabetes and HIV was admitted for headache and found to have cryptococcal meningitis. He was also found to have asymptomatic hyponatremia. He had signs of hypovolemia, such as orthostatic hypotension, dry mucosa, decreased skin turgor, hemoconcentration, contraction alkalosis, and high BUN/Cr ratio. The laboratory findings revealed sodium of 125 mmol/L, potassium of 5.5 mmol/L, urine osmolality of 522 mOsm/kg, urine sodium of 162 mmol/L, and urine chloride of 162 mmol/L. We started normal saline for hypovolemia, each 1 L prior and after amphotericin therapy. However, hypovolemia did not improve significantly despite IV fluid. Cosyntropin stimulation test was negative, and renin level was 0.25 ng·mL·h, with the aldosterone level of <1 ng/dL, the serum brain natriuretic peptide of 15 pg/mL, and serum uric acid of 2.8 mg/dL. The diagnosis of CSWS was suspected, fludrocortisone was tried, and hypovolemia and hyponatremia improved. Cryptococcal meningitis in HIV patients can present with CSWS, and the distinction between CSWS and SIADH is important because the treatment for CSWS is different than that of SIADH. Both share a similar clinical picture except that CSWS presents with constant hypovolemia despite volume replacement. Salt tablets, normal saline, or fludrocortisone can be used for treatment.

  17. Generalized glucocorticoid resistance accompanied with an adrenocortical adenoma and caused by a novel point mutation of human glucocorticoid receptor gene

    Institute of Scientific and Technical Information of China (English)

    ZHU Hui-juan; GONG Feng-ying; DAI Yu-fei; WANG Ou; LI Mei; LU Lin; ZHAO Wei-gang; XING Xiao-ping; PAN Hui; LI Nai-shi

    2011-01-01

    Background Generalized glucocorticoid resistance syndrome is a rare familial or sporadic condition characterized by generalized, partial, target-tissue insensitivity to glucocorticoids. This syndrome is partially caused by mutations in human glucocorticoid receptor (hGR) gene. The clinical spectrum of generalized glucocorticoid resistance is broad, ranging from fatigue or no symptoms to severe hypertension with hypokalemic alkalosis. The purpose of this study was to explore the genetic disorder of glucocorticoid resistance syndrome.Methods We identified a 56-year-old male patient diagnosed with generalized glucocorticoid resistance syndrome accompanied with an adrenocortical adenoma. This asymptomatic patient referred to Peking Union Medical College Hospital for treatment of his adrenal incidentaloma. Endocrinological evaluation consistently revealed his elevated serum cortisol level. Total RNA was extracted from the patient's peripheral blood mononuclear leukocytes (PBMLs) and entire coding region of hGR alpha was amplified by reverse transcription (RT)-PCR. To confirm the possible mutation identified by sequencing RT-PCR products, genomic DNA sequence of hGR gene from the patient and 50 healthy controls was analyzed by PCR and directly sequencing.Results A heterozygotic (C→T) substitution at nucleotide position of 1667 (exon 5) in GR alpha gene was found in this patient by sequencing of RT-PCR products of hGR gene. This substitution was also identified at genomic DNA level and it was absent in 100 chromosomes from 50 unrelated health controls. This substitution resulted in a threonine to isoleucine substitution (ACT→ATT) at amino acid 556 in the ligand-binding domain of GR alpha. Conclusion Generalized glucocorticoid resistance in this patient might be caused by a novel heterozygotic mutation in the ligand-binding domain of the GR alpha.

  18. Treating Experience of Acute Arsenic Poisoning:Report of 11 Cases%急性砷中毒11例救治体会

    Institute of Scientific and Technical Information of China (English)

    屈银宗; 余贻汉; 郭玉飞; 汪毅; 凌瑞杰

    2011-01-01

    Objective To investigate the clinical characteristics of acute arsenic poisoning and to improve the level of treatment. Methods Clinical data of 11 cases in our hospital with acute arsenic poisoning through digestive tract route were analyzed. Results Nausea, vomiting and diarrhea were commonly found as the first symptoms. Multiple system symptoms and impairment were also common. Arsenic concentrations in the urine were increased in all cases. Abnormality of blood routine, liver function and renal function, hypokalemia, and metabolic acidosis with complicated respiratory alkalosis were also common among these patients. All cases recovered after intensive treatment. Conclusion The success rate of therapy depends on cooperative, timely and effective treatment.%目的 分析急性砷中毒临床特点,提高其救治水平.方法 对本院收治的11例通过消化道途径急性砷中毒患者的临床资料进行分析.结果 急性砷中毒消化道症状是首发表现,可出现多系统症状,尿砷均增高,血常规、肝肾功能异常、低钾血症、代谢性酸中毒并呼吸性碱中毒常见,经过积极救治均治愈出院.结论 多学科协作、及时有效的治疗,能提高其治疗成功率.

  19. [Intractable vomiting, convulsions and megaloblastic anemia: anamnesis, key to diagnosis].

    Science.gov (United States)

    Schlaeppi, M; Humair, L; de Torrenté, A

    1999-07-01

    In July 1996 a 43-year-old illiterate Hispanic woman presented with uncontrollable vomiting, palpitations and confusion. In 1994, despite several hospitalisations in other medical centres where a cerebral CT-scan, oesogastroduodenoscopy, colonoscopy and abdominal ultrasound were performed, no satisfactory diagnosis could be found. A psychiatric origin was finally considered. On admission, the laboratory findings showed severe metabolic alkalosis with associated hypokalaemia, confirmatory evidence of vomiting. The ECG showed tremendous P waves (5 mV) in the standard derivations, which can be explained by the hypokalaemia, with multiple supraventricular extrasystoles. Echocardiography and pulmonary scintigraphy ruled out pulmonary hypertension and a pulmonary embolus. After additional discussion with her daughter we discovered that the patient had been treating chronic headaches for years with 4-5 Cafergot-PB suppositories per day. This drug contains 2 mg ergotamine tartrate, 100 mg butalbital, 100 mg caffeine and 0.25 mg belladona alkaloids. As is known, vomiting is a classical symptom of ergotamine intoxication. After rehydration we discovered a megaloblastic anaemia with a folate deficiency compatible with chronic barbiturate intoxication. Folate and iron supplementation allowed a rapid normalisation of the haemoglobin values. Five months after having stopped the Cafergot-PB, the patient was well and did not vomit anymore. The headaches were treated with chlorpromazine with a good result. Despite sophisticated technical means, the diagnosis could only be established after a thorough history taking. This message should be heard in times when high tech medicine tends to obscure the place of a good history taking! PMID:10431323

  20. Etiological Analysis of Pulmonary Heart Disease Combined with Disturbance of Consciousness in the Acute Exacerbation Period%肺心病急性加重期合并意识障碍病因分析

    Institute of Scientific and Technical Information of China (English)

    金洋; 王颖; 王凯权; 王金叶

    2014-01-01

    目的:分析肺心病急性加重期患者合并意识障碍的发病因素、临床特点及防治措施。方法:对46例肺心病急性加重期出现意识障碍患者的临床资料进行回顾性分析。结果:肺心病急性加重期合并意识障碍原因以肺性脑病最常见,其次为低渗性脑病,其它如感染中毒性脑病、代谢性碱中毒及脑梗死等次之。结论:肺心病急性加重期合并意识障碍的原因是多方面的,需及时完善相关检查,避免误诊。%Objective:To analyse the risk factors,clinical features and prevention measures in the patients with pulmonary heart disease combined with acute exacerbation of consciousness disturbance. Methods:The clinical data of 46 cases of pulmo-nary heart disease combined with disturbance of consciousness were retrospectively analyzed. Results:Pulmonary encephalopathy is the most common cause for disturbance of consciousness in the patients with pulmonary heart disease,and then hypotonic en-cephalopathy,followed by other issues such as infectious toxic encephalopathy,metabolic alkalosis and cerebral infarction. Con-clusion:There are many reasons for acute exacerbation of pulmonary heart disease combined with disturbance of consciousness and the relevant checks need to be timely perfected so as to avoid misdiagnosis.

  1. MRI and MRS studies on acute effects of ethanol in the rat brain

    Energy Technology Data Exchange (ETDEWEB)

    Hirakawa, Keiko; Uekusa, Kyoko; Nihira, Makoto; Sato, Shigeru (Nippon Medical School, Tokyo (Japan))

    1994-04-01

    Using magnetic resonance (MR) imaging and MR spectroscopy, the effects of intoxicating doses of ethanol on the rat brain and the dynamic changes in the cerebral tissues were examined. After ethanol treatment, the cerebral hemispheres, especially the cortex, were shown as high signal intensities on T1-weighted images and low signal intensities on T2-weighted images. Four hr after ethanol treatment, the T1 values significantly decreased in the thalamus and hypothalamus, as compared with the control animals. At one hr, the T2 values significantly decreased in the cortex of the ethanol treated rats. At 4 and 24 hr, the T2 values significantly decreased in the cerebral hemispheres in the ethanol treated rats. In vivo [sup 31]P-MR spectroscopy showed a slight decrease in ATP and phosphocreatine after ethanol treatment. Intracellular pH levels decreased, but returned to normal by 4 hr. In highly sedated animals, early occurrence of acidosis was associated with heavy alkalosis. In vitro [sup 1]H-MR spectra of brain tissue and blood samples revealed many kinds of metabolites. Blood and brain levels of ethanol rose to the peak one 1 hr after ethanol treatment; and no ethanol was detected at 24 hr. Brain levels of acetate were almost unchanged. Blood levels of lactate significantly decreased at 0.5 hr; and brain levels of lactate slightly increased and rose to the peak at 2 hr. Brain N-acetylaspartic acid significantly increased at 0.5 hr and decreased at 4 hr. Electron microscopic findings were edema in both neuronal and glial cells after ethanol treatment, severe congestion, and swelling of mitochondria in capillary endothelial cells. In conclusion, high doses of ethanol may cause circulatory disorders in the rat brain and disturb water balance in the cerebral tissues, resulting in changes in the structure of intracellular water molecules. Ethanol also causes confusion without depletion of high energy phosphate metabolites. (N.K.) 44 refs.

  2. 12例大剂量输血患者的并发症及处理对策分析%Analysis of complications and countermeasures in 12 patients with large-dose transfusion

    Institute of Scientific and Technical Information of China (English)

    朱美英; 陈春雷

    2012-01-01

    Objective:To discuss the complications and countermeasures of patients with massive blood transfusion. Methods: Clinical data of 12 patients who had received massive blood transfusion from January to December in 2009 in our hospital were analyzed retrospectively. Results; It was found 10 cases of coagulation disorders, 2 cases of upper gastrointestinal hemorrhage with cutaneous purpura, 3 eases of early DIC and 1 case of typical DIC in the 12 patients. 9 cases were survived and 3 were dead, in which 2 cases died of hemorrhagic shock and 1 died from typical DIC. 4 cases were complicated by metabolic alkalosis and 1 was hyponatremia and hypochloremia. Conclusion : Large dose transfusion can cause dysfunction of coagulation, water electrolyte acid -base balance disorder, low temperature and other complications.%目的:探讨大剂量输血患者的并发症及相应处理对策.方法:回顾性分析2009年1月-2009年12月我院收治的12例大剂量输血患者临床资料.结果:12例患者并发凝血功能障碍10例;上消化道出血伴皮肤紫斑2例;出现早期DIC 3例,出现典型DIC 1例.本组生存9例,死亡3例.直接死于失血性休克2例,典型DIC 1例死亡.并发代谢性酸中毒4例,低钠低氯1例.结论:大剂量输血可以引起凝血功能障碍,水电解质酸碱平衡紊乱,低体温等并发症.

  3. Mesenteric microcirculatory dysfunctions and translocation of indigenous bacteria in a rat model of strangulated small bowel obstruction

    Directory of Open Access Journals (Sweden)

    Fernando Luiz Zanoni

    2009-01-01

    Full Text Available PRUPOSE: Bacterial translocation has been shown to occur in critically ill patients after extensive trauma, shock, sepsis, or thermal injury. The present study investigates mesenteric microcirculatory dysfunctions, the bacterial translocation phenomenon, and hemodynamic/metabolic disturbances in a rat model of intestinal obstruction and ischemia. METHODS: Anesthetized (pentobarbital 50 mg/kg, i.p. male Wistar rats (250-350 g were submitted to intestinal obstruction or laparotomy without intestinal obstruction (Sham and were evaluated 24 hours later. Bacterial translocation was assessed by bacterial culture of the mesenteric lymph nodes (MLN, liver, spleen, and blood. Leukocyte-endothelial interactions in the mesenteric microcirculation were assessed by intravital microscopy, and P-selectin and intercellular adhesion molecule (ICAM-1 expressions were quantified by immunohistochemistry. Hematocrit, blood gases, lactate, glucose, white blood cells, serum urea, creatinine, bilirubin, and hepatic enzymes were measured. RESULTS: About 86% of intestinal obstruction rats presented positive cultures for E. coli in samples of the mesenteric lymph nodes, liver, and spleen, and 57% had positive hemocultures. In comparison to the Sham rats, intestinal obstruction induced neutrophilia and increased the number of rolling (~2-fold, adherent (~5-fold, and migrated leukocytes (~11-fold; this increase was accompanied by an increased expression of P-selectin (~2-fold and intercellular adhesion molecule-1 (~2-fold in the mesenteric microcirculation. Intestinal obstruction rats exhibited decreased PaCO2, alkalosis, hyperlactatemia, and hyperglycemia, and increased blood potassium, hepatic enzyme activity, serum urea, creatinine, and bilirubin. A high mortality rate was observed after intestinal obstruction (83% at 72 h vs. 0% in Sham rats. CONCLUSION: Intestinal obstruction and ischemia in rats is a relevant model for the in vivo study of mesenteric microcirculatory

  4. Hypercalcemia Associated with Calcium Supplement Use: Prevalence and Characteristics in Hospitalized Patients

    Directory of Open Access Journals (Sweden)

    Maria C. Machado

    2015-03-01

    Full Text Available Background: The ingestion of large amounts of milk and antacids to treat peptic ulcer disease was a common cause of hypercalcemia in the past (the “milk-alkali syndrome”. The current popularity of calcium and supplements has given rise to a similar problem. Objectives: To evaluate the prevalence and characteristics of hypercalcemia induced by calcium intake (“calcium supplement syndrome”; or CSS in hospitalized patients. Methods: We conducted a retrospective; electronic health record (EHR-based review of patients with hypercalcemia over a 3-year period. Diagnosis of CSS was based on the presence of hypercalcemia; a normal parathyroid hormone (PTH level; renal insufficiency; metabolic alkalosis; a history of calcium intake; and documented improvement with treatment. Results: Of the 72 patients with non-PTH mediated hypercalcemia; 15 (20.8% satisfied all the criteria for the diagnosis of CSS. Calcium; vitamin D; and multivitamin ingestion were significantly associated with the diagnosis (p values < 0.0001; 0.014; and 0.045 respectively; while the presence of hypertension; diabetes; and renal insufficiency showed a trend towards statistical significance. All patients received intravenous fluids; and six (40% received calcium-lowering drugs. The calcium level at discharge was normal 12 (80% of patients. The mean serum creatinine and bicarbonate levels decreased from 2.4 and 35 mg/dL on admission respectively; to 1.6 mg/dL and 25.6 mg/dL at discharge respectively. Conclusion: The widespread use of calcium and vitamin D supplementation can manifest as hypercalcemia and worsening of kidney function in susceptible individuals. Awareness among health care professionals can lead to proper patient education regarding these health risks.

  5. Acid-base and ionic fluxes in rainbow trout (Oncorhynchus mykiss) during exposure to chloramine-T

    Energy Technology Data Exchange (ETDEWEB)

    Powell, M.D.; Perry, S.F. [Department of Biology, University of Ottawa, 30 Marie Curie Ottawa, Ontario, K1N 6N5 (Canada)

    1998-09-01

    The effects of chloramine-T and its degradation products, sodium hypochlorite (NaOCl) and para-toluenesulphonamide (pTSA), on whole body acid-base and branchial and renal ion (Na{sup +}and Cl{sup -}) fluxes were examined in rainbow trout (Oncorhynchus mykiss). Exposure to chloramine-T (3.5 h, 18 mg l{sup -1}) resulted in increases in plasma total CO{sub 2} but no coincident rise in P{sub a}CO{sub 2} or reduction in blood pH. Exposure of fish to 2, 9 or 18 mg l{sup -1} chloramine-T (3.5 h duration) resulted in a reduction in net acid uptake suggesting the development of a metabolic alkalosis. Exposure to the chloramine-T breakdown product pTSA (dissolved in DMSO) resulted in increased net acid uptake (decreased acid excretion) suggesting a metabolic acidosis. Whole body ion fluxes demonstrated increases in the losses of both Na{sup +}and Cl{sup -} with chloramine-T, NaOCl and pTSA. However, the effect of DMSO alone could not be isolated. Confirmatory studies using fish in which the urinary bladder (to allow collection of urine) and dorsal aorta (to allow injection of [{sup 14}C]polyethylene glycol 4000 ([{sup 14}C]PEG), an extracellular fluid marker) were catheterised, revealed that changes in whole body ion fluxes during chloramine-T exposure could not be explained by increased renal efflux through urine flow, glomerular filtration or renal clearance. Branchial effluxes of [{sup 14}C]PEG were not significantly affected by chloramine-T exposure suggesting that the changes in whole body ionic fluxes were caused by transcellular rather than paracellular processes. (Copyright (c) 1998 Elsevier Science B.V., Amsterdam. All rights reserved.)

  6. EAST综合征一例并文献复习%EAST syndrome:a case report and literature review

    Institute of Scientific and Technical Information of China (English)

    石汝婷; 杨作成

    2015-01-01

    ObjectiveTo report a case of EAST syndrome and describe the clinical and pathological characteristics of EAST syndrome (epilepsy, ataxia, sensorineural deafness, and tubulopathy syndrome).Methods One case was retrospectively analyzed. The case was confirmed to have EAST syndrome by clinical manifestations and laboratory examination.Results A boy of eight years old who has primary renal tubular hypokalemia alkalosis, recurrent seizure, ataxia and sensorineural deafness can be diagnosed with EAST syndrome.Conlusions EAST syndrome was uncommon. It is necessary to perform long-term follow-up and to further investigate the mechanisms. Early diagnosis and treatment may improve the prognosis.%目的:报告1例儿童EAST综合征,描述EAST综合征的临床和病理特征。方法回顾性分析一例病例,通过其临床特点及实验室检查诊断为 EAST 综合征。结果患儿男,8岁,有原发性肾小管性低钾血症性碱中毒表现、反复惊厥发作、共济失调、感音神经性耳聋,可诊断为EAST综合征。结论 EAST 综合征发病率低,需要进行长期的随访和对其发病机制更深入的研究,早期诊断及治疗可能改善其预后。

  7. Clinical and diagnostic methods for evaluation of sharp foreign body syndrome in buffaloes

    Directory of Open Access Journals (Sweden)

    Nasr-Eldin M. Aref

    2013-06-01

    Full Text Available Aim: The present study was designed to evaluate clinically and under laboratory condition the sharp foreign body syndrome (SFBS in buffaloes with special emphasis on the diagnostic value of radiography, ultrasonography and blood gases and acidbase balance. Materials and Methods: 196 buffaloes with a history of anorexia, reduction of milk production and no response to previous medical treatment were included in the present study. These animals were subjected to clinical and radiographical examinations. Positive cases for SFBS were further evaluated by sonography, hemato-biochemical and blood gas and acid base balance analysis.Results: Out of 196 admitted cases, 49 (25% cases were confirmed as SFBS by clinical and radiographical examination. Positive cases were subsequently divided into two main categories (complicated and non complicated according to radiographical and sonographical findings. SFBS with no complication was diagnosed in 16 cases while 33 cases showed various degrees of complication including reticular adhesion (abdominal and diaphragmatic, n= 23, diaphragmatic hernia (n = 6 and traumatic pericarditis (n = 4. Leukocytosis, hyperprotenemia and increased activity of AST and ALT were of additional values in the diagnosis of SFBS. A consistent finding of primary metabolic alkalosis was recorded in all cases except one with advanced traumatic pericarditis that showed metabolic acidosis. Conclusion: While there is no substitution for clinical examination, using of ultrasonography and radiography simultaneously are essential for proper evaluation and differentiation between various sequelae of SFBS in buffaloes. Radiography is an efficient tool for visualization of metallic foreign body while ultrasonography is an excellent device in assessing fibrinous deposits. Hemato-biochemical and blood gases and acid base balance are of additional values in discriminating between various outcomes of SFBS.

  8. 钙代谢紊乱的临床治疗分析%Clinical Treatment of Calcium Metabolism Disorders

    Institute of Scientific and Technical Information of China (English)

    王鹤辉

    2015-01-01

    Objective To investigate the calcium metabolism disorder clinical treatment effect.Methods The clinical treatment of disorders of calcium metabolism data from March 2014 to June 2015 were treated for analysis.Results The clinical treatment of clinical symptoms, results were satisfactory.Conclusion Hypocalcemia remove the cause, correct alkalosis. Asymptomatic, oral calcium and vitamin D2. There are symptoms, should intravenous calcium. Patients need long-term calcium, calcium lactate can be taken orally. There are obvious symptoms or serum calcium up 3.5 to 3.75 mmol/L (ie, 14 to 15 mg/L), regardless of symptoms, should immediately press the accident and emergency treatment.%目的:探讨钙代谢紊乱的临床治疗方法效果。方法选取2014年3月~2015年6月收治的钙代谢紊乱的临床治疗方法资料进行分析。结果经临床治疗临床症状改善,效果满意。结论低钙血症去除病因,纠正碱中毒。无症状者,可口服钙和维生素D2。有症状者,应静脉补钙。对需要长期补钙的患者,可口服乳酸钙。有明显症状或血清钙高达3.5~3.75 mmol/L(即14~15 mg/L),不论有无症状,均应立即按急症治疗。

  9. 浅谈分娩镇痛%Discussion on labor analgesia

    Institute of Scientific and Technical Information of China (English)

    雷道琴

    2015-01-01

    分娩是每个女性都需要经历的一个特殊生理过程,而大多数产妇在分娩过程中都会有分娩痛。分娩痛不仅会造成过度换气,使产妇出现呼吸性碱中毒,而且会影响产妇的胃肠道及膀胱动力,影响分娩过程的顺利进行。同时,分娩痛还会升高剖宫产率、升高新生儿窒息率,会对产妇日后的心理状态造成影响,影响胎儿的身体健康。因此,对产妇进行分娩镇痛至关重要。本文结合实际情况分析分娩镇的方法,以供参考。%Birth is a special physiological process of each female friends to experience, but most mothers in childbirth process will have labor pains.Labor pains will not only cause hyperventilation, easy to make maternalrespiratory alkalosis, and will influence the maternal gastrointestinal andbladder power, influence of delivery process. At the same time, labor painalso increased cesarean section rate, neonatal asphyxia rate rise, will affect the psychological status of pregnant women in the future, affect fetal health. Therefore, it was crucial to labor analgesia for parturient. In this paper, combined with the actual, talk about some views, for labor analgesia, in order to offer reference.

  10. Surfactant secretion is stimulated by decreased alveolar CO/sub 2/

    Energy Technology Data Exchange (ETDEWEB)

    Chander, A.; Dodia, C.R.; Gullo, J.; Fisher, A.B.

    1986-03-05

    The authors investigated the hypothesis that altered intracellular pH may modulate lung surfactant secretion. They have used isolated perfused lung preparation to investigate release of (/sup 3/H)choline labeled phosphatidylcholine (PC) in the alveolar space of rat lungs ventilated with 5%, 2.5%, or 0% CO/sub 2/ in air. Adult rats were injected i.p. 40uCi of (/sup 3/H-methyl) choline and lungs removed after 45 min. Lungs were perfused for 15 or 60 min. with KRB plus 25 mM HEPES. At the end of perfusion lungs were lavaged five times with 7 ml of ice cold saline. Lavage fluid, was centrifuged, lyophilized, and both lung and lavage fluid extracted for lipids. Lipid choline label in lavage fluid, expressed as percent of that in lung lipids, from control lungs (5% CO/sub 2/) showed 0.6 +/- 0.1 % at 15 min and 1.1 +/- 0.3% (mean +/- SE, n=6) label at 60 min. When perfused with 50 ..mu..M 1-isoproterenol, the label after 60 min perfusion increased to 2.76 +/- 0.33 (n=3). Ventilation with air containing 2.5% CO/sub 2/ and 0% CO/sub 2/ showed 6.1 +/- 2.1 % (n=4) and 6.4 +/- 1.8% (n=4) label in lavage fluid. Addition of 25mM sodium acetate in the perfusion medium and ventilation with 0% CO/sub 2/ in air lowered release of label to 4.2 +/- 1.4% (n=4). These results show that low pCO/sub 2/ increases surfactant PC secretion in lung and suggest that intracellular alkalosis triggers surfactant release.

  11. The Effect of Sodium Bicarbonate in Sports Drink on the Metabolism of Athletes

    Directory of Open Access Journals (Sweden)

    Yanchun Liu

    2015-05-01

    Full Text Available It is known that sodium bicarbonate (NaHCO3 is used by athletes before exercise to delay fatigue and improve performance based on the knowledge that it removes H+ ions from the body through the creation of a metabolic alkalosis state. In this study, the effects of 0.3 g/kg NaHCO3 given orally to athletes and non-athletes before a 600 m race were compared. After resting for 48 h, 0.3 g/kg NaHCO3 was given orally as a 500 mL fruit juice and the same determinations made under the same conditions 2 h later. In the study, the time taken to complete race after the administration of NaHCO3 fell compared to that before its administration in the athletes. The level of HCO3- before the administration of NaHCO3 in the athletes was observed to be higher than after the administration of NaHCO3. A rise in the HLa levels was observed after exercising following the administration of NaHCO3 ’ in the athletes. The differences in the other parameters apart from that in pH were not statistically significant (p<0.01, (p<0.05. In conclusion, it can be said that, use of NaHCO3 at doses low enough not to cause gastrointestinal disturbances is one of the factors that positively affect anaerobic performance in athletes, but this effect is lower than that observed in individuals leading sedentary lives.

  12. Exogenous sphingosine-1-phosphate boosts acclimatization in rats exposed to acute hypobaric hypoxia: assessment of haematological and metabolic effects.

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    Sonam Chawla

    Full Text Available BACKGROUND: The physiological challenges posed by hypobaric hypoxia warrant exploration of pharmacological entities to improve acclimatization to hypoxia. The present study investigates the preclinical efficacy of sphingosine-1-phosphate (S1P to improve acclimatization to simulated hypobaric hypoxia. EXPERIMENTAL APPROACH: Efficacy of intravenously administered S1P in improving haematological and metabolic acclimatization was evaluated in rats exposed to simulated acute hypobaric hypoxia (7620 m for 6 hours following S1P pre-treatment for three days. MAJOR FINDINGS: Altitude exposure of the control rats caused systemic hypoxia, hypocapnia (plausible sign of hyperventilation and respiratory alkalosis due to suboptimal renal compensation indicated by an overt alkaline pH of the mixed venous blood. This was associated with pronounced energy deficit in the hepatic tissue along with systemic oxidative stress and inflammation. S1P pre-treatment improved blood oxygen-carrying-capacity by increasing haemoglobin, haematocrit, and RBC count, probably as an outcome of hypoxia inducible factor-1α mediated erythropoiesis and renal S1P receptor 1 mediated haemoconcentation. The improved partial pressure of oxygen in the blood could further restore aerobic respiration and increase ATP content in the hepatic tissue of S1P treated animals. S1P could also protect the animals from hypoxia mediated oxidative stress and inflammation. CONCLUSION: The study findings highlight S1P's merits as a preconditioning agent for improving acclimatization to acute hypobaric hypoxia exposure. The results may have long term clinical application for improving physiological acclimatization of subjects venturing into high altitude for occupational or recreational purposes.

  13. Potentiation of the effect of thiazide derivatives by carbonic anhydrase inhibitors: molecular mechanisms and potential clinical implications.

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    Kamyar Zahedi

    Full Text Available BACKGROUND: Carbonic anhydrase inhibitors (CAI are mild diuretics, hence not widely used in fluid overloaded states. They are however the treatment of choice for certain non-kidney conditions. Thiazides, specific inhibitors of Na-Cl cotransport (NCC, are mild agents and the most widely used diuretics in the world for control of mild hypertension. HYPOTHESIS: In addition to inhibiting the salt reabsorption in the proximal tubule, CAIs down-regulate pendrin, therefore leaving NCC as the major salt absorbing transporter in the distal nephron, and hence allowing for massive diuresis by the inhibitors of NCC in the setting of increased delivery of salt from the proximal tubule. EXPERIMENTAL PROTOCOLS AND RESULTS: Daily treatment of rats with acetazolamide (ACTZ, a known CAI, for 10 days caused mild diuresis whereas daily treatment with hydrochlorothiazide (HCTZ for 4 days caused hardly any diuresis. However, treatment of rats that were pretreated with ACTZ for 6 days with a combination of ACTZ plus HCTZ for 4 additional days increased the urine output by greater than 2 fold (p<0.001, n = 5 compared to ACTZ-treated animals. Sodium excretion increased by 80% in the ACTZ plus HCTZ group and animals developed significant volume depletion, metabolic alkalosis and pre-renal failure. Molecular studies demonstrated ∼75% reduction in pendrin expression by ACTZ. The increased urine output in ACTZ/HCTZ treated rats was associated with a significant reduction in urine osmolality and reduced membrane localization of AQP-2 (aquaporin2. CONCLUSIONS: These results indicate that ACTZ down-regulates pendrin expression and leaves NCC as the major salt absorbing transporter in the distal nephron in the setting of increased delivery of salt from the proximal tubule. Despite being considered mild agents individually, we propose that the combination of ACTZ and HCTZ is a powerful diuretic regimen.

  14. Established and potential physiological roles of bicarbonate-sensing soluble adenylyl cyclase (sAC) in aquatic animals.

    Science.gov (United States)

    Tresguerres, Martin; Barott, Katie L; Barron, Megan E; Roa, Jinae N

    2014-03-01

    Soluble adenylyl cyclase (sAC) is a recently recognized source of the signaling molecule cyclic AMP (cAMP) that is genetically and biochemically distinct from the classic G-protein-regulated transmembrane adenylyl cyclases (tmACs). Mammalian sAC is distributed throughout the cytoplasm and it may be present in the nucleus and inside mitochondria. sAC activity is directly stimulated by HCO3(-), and sAC has been confirmed to be a HCO3(-) sensor in a variety of mammalian cell types. In addition, sAC can functionally associate with carbonic anhydrases to act as a de facto sensor of pH and CO2. The two catalytic domains of sAC are related to HCO3(-)-regulated adenylyl cyclases from cyanobacteria, suggesting the cAMP pathway is an evolutionarily conserved mechanism for sensing CO2 levels and/or acid/base conditions. Reports of sAC in aquatic animals are still limited but are rapidly accumulating. In shark gills, sAC senses blood alkalosis and triggers compensatory H(+) absorption. In the intestine of bony fishes, sAC modulates NaCl and water absorption. And in sea urchin sperm, sAC may participate in the initiation of flagellar movement and in the acrosome reaction. Bioinformatics and RT-PCR results reveal that sAC orthologs are present in most animal phyla. This review summarizes the current knowledge on the physiological roles of sAC in aquatic animals and suggests additional functions in which sAC may be involved. PMID:24574382

  15. A neglected requirement for optimizing treatment of age-related osteoporosis: Replenishing the skeleton's base reservoir with net base-producing diets.

    Science.gov (United States)

    Sebastian, Anthony; Frassetto, Lynda A

    2016-06-01

    Osteoporosis is a disorder of bone in which the mass of the bone is reduced and the bone's architecture at the microscopic level is disordered. Together those abnormalities predispose affected individuals to experience fractures despite only minimal trauma (i.e., fragility fractures). Age related osteoporosis is a common type of osteoporosis that occurs with aging in both men and women usually beginning after the age of peak bone mass. Research has found that the disorder can be partially reversed by reducing the net amount of acid that is produced when consuming typical Western diets. However, the amelioration that results has not been so dramatic or so consistent that physicians have adopted the procedure as part of the standard treatment for age-related osteoporosis. We propose that reducing the net acid load from the diet is not sufficient to reverse age related osteoporosis because it fails to supply base needed to restore the large amount of base in bone that had been lost by reacting with the net acid load of the diet that had been consumed for years or decades. Reducing the net acid load from the diet might be expected to have little ameliorative effect or merely slow the progression of the disorder. We hypothesize that both to restore osteoporotic bone to, or nearly to, its pre-disease state, as well as to eliminate the risk of fragility fractures, requires consuming diets that produce net amounts of base to restore the base lost from years to decades of consuming diets that produce net amounts of acid. We hypothesize also that the excess base and attendant subclinical metabolic alkalosis will both stimulate the cellular process of bone formation and suppress the cellular process of bone resorption, and thereby implement the restorative process.

  16. Multum in Parvo: Explorations with a Small Bag of Carbon Dioxide

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    EJM Campbell

    2001-01-01

    Full Text Available A collection of 12 papers published between 1957 and 1972 are revisited. The papers had a common theme of the use of rebreathing carbon dioxide and explored a variety of topics in respiratory physiology. The first study established a method for the noninvasive and indirect estimation of arterial carbon dioxide pressure that was suitable for the routine clinical monitoring of respiratory failure and whose clinical utility remains to this day, but which also provided observations that were the stimulus for the studies that followed. The rate of rise in the partial pressure of carbon dioxide (PCO2 during rebreathing led to an analysis of body carbon dioxide storage capacity. Knowledge of carbon dioxide storage led to a method for quantifying lactate production in exercise without the need for blood sampling. The changes in ventilation that accompanied the increase in PCO2 provided the basis for a rapid method for measuring aspects of breathing control (Read's method, which was later modified to measure the ventilatory response to hypoxia. The physiology of breath-holding was explored through observations of the fall in breath-holding time as PCO2 climbed. Rebreathing also allowed increases in voluntary ventilation to be achieved without the development of alkalosis, leading to studies of maximal voluntary ventilation and respiratory muscle fatigue. Equilibration of PCO2 during rebreathing was used to measure mixed venous PCO2 during exercise and develop an integrated approach to the physiology of exercise in health and disease; alveolar-arterial disequilibrium in PCO2 during exercise was uncovered. Equilibration of PCO2, as well as PO2, during rebreathing of carbon dioxide and nitrogen gas mixtures showed different time courses of venous gases at the onset of exercise. Starting with the rebreathing of carbon dioxide in oxygen mixtures in a small rubber bag, an astonishing range of topics in respiratory physiology was explored, with observations

  17. Alterations of proteins in MDCK cells during acute potassium deficiency.

    Science.gov (United States)

    Peerapen, Paleerath; Ausakunpipat, Nardtaya; Chanchaem, Prangwalai; Thongboonkerd, Visith

    2016-06-01

    Chronic K(+) deficiency can cause hypokalemic nephropathy associated with metabolic alkalosis, polyuria, tubular dilatation, and tubulointerstitial injury. However, effects of acute K(+) deficiency on the kidney remained unclear. This study aimed to explore such effects by evaluating changes in levels of proteins in renal tubular cells during acute K(+) deficiency. MDCK cells were cultivated in normal K(+) (NK) (K(+)=5.3 mM), low K(+) (LK) (K(+)=2.5 mM), or K(+) depleted (KD) (K(+)=0 mM) medium for 24 h and then harvested. Cellular proteins were resolved by two-dimensional gel electrophoresis (2-DE) and visualized by SYPRO Ruby staining (5 gels per group). Spot matching and quantitative intensity analysis revealed a total 48 protein spots that had significantly differential levels among the three groups. Among these, 46 and 30 protein spots had differential levels in KD group compared to NK and LK groups, respectively. Comparison between LK and NK groups revealed only 10 protein spots that were differentially expressed. All of these differentially expressed proteins were successfully identified by Q-TOF MS and/or MS/MS analyses. The altered levels of heat shock protein 90 (HSP90), ezrin, lamin A/C, tubulin, chaperonin-containing TCP1 (CCT1), and calpain 1 were confirmed by Western blot analysis. Global protein network analysis showed three main functional networks, including 1) cell growth and proliferation, 2) cell morphology, cellular assembly and organization, and 3) protein folding in which the altered proteins were involved. Further investigations on these networks may lead to better understanding of pathogenic mechanisms of low K(+)-induced renal injury.

  18. Surfactant secretion is stimulated by decreased alveolar CO2

    International Nuclear Information System (INIS)

    The authors investigated the hypothesis that altered intracellular pH may modulate lung surfactant secretion. They have used isolated perfused lung preparation to investigate release of [3H]choline labeled phosphatidylcholine (PC) in the alveolar space of rat lungs ventilated with 5%, 2.5%, or 0% CO2 in air. Adult rats were injected i.p. 40uCi of [3H-methyl] choline and lungs removed after 45 min. Lungs were perfused for 15 or 60 min. with KRB plus 25 mM HEPES. At the end of perfusion lungs were lavaged five times with 7 ml of ice cold saline. Lavage fluid, was centrifuged, lyophilized, and both lung and lavage fluid extracted for lipids. Lipid choline label in lavage fluid, expressed as percent of that in lung lipids, from control lungs (5% CO2) showed 0.6 +/- 0.1 % at 15 min and 1.1 +/- 0.3% (mean +/- SE, n=6) label at 60 min. When perfused with 50 μM 1-isoproterenol, the label after 60 min perfusion increased to 2.76 +/- 0.33 (n=3). Ventilation with air containing 2.5% CO2 and 0% CO2 showed 6.1 +/- 2.1 % (n=4) and 6.4 +/- 1.8% (n=4) label in lavage fluid. Addition of 25mM sodium acetate in the perfusion medium and ventilation with 0% CO2 in air lowered release of label to 4.2 +/- 1.4% (n=4). These results show that low pCO2 increases surfactant PC secretion in lung and suggest that intracellular alkalosis triggers surfactant release

  19. Hereditary coproporphyria from clinician’s point of view: A case report

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    Savić Željka

    2013-01-01

    Full Text Available Introduction. Acute hepatic porphyrias can mimic a range of unrelated diseases and conditions that may occur independently of porphyria and trigger their initial manifestations and further attacks. Case Report. A 46-year-old female patient was subjected to cholecystectomy for biliary colic. Histopathological analysis revealed acute purulent exacerbation of chronic cholecystitis. On the 8th day post surgery, the patient was rehospitalized for nausea, abdominal pain, weakness and faintness, poor general condition, hypertension, tachycardia, apathy and profuse sweating. Laboratory findings revealed hyponatremia, hypokalemia, and metabolic alkalosis. Exploratory laparotomy did not detect a pathomorphological substrate. The patient was transferred to surgery department of the tertiary care institution. Due to metabolic imbalance, she was transferred to the Department of Endocrinology with signs of paleness, profuse sweating, tachycardia, and tachydyspnoea. The cardiologist performed echocardiography. The patient was diagnosed to have acute left ventricular failure and sub-acute myocardial infarction and transferred to the Department of Cardiology. Coronarography findings were normal. Cramps and pain in the legs with sensory loss, general weakness, apathy and mental confusion suggested acute hepatic porphyria. Thus, hereditary coproporphyria was diagnosed in the second month of illness. The treatment was continued at the Department of Gastroenterology. Clinical manifestations included polyneuropathy, flaccid paraparesis and acute brain syndrome, precordial oppressions and tachycardia. Haem arginate and hypertonic glucose were applied. The condition of the patient gradually improved. Conclusion. Porphyrias should always be taken into consideration in doubtful, frequently dramatic clinical pictures characterized by neurovisceral symptoms and precipitating factors of acute porphyria attacks must never be neglected.

  20. Role of tolvaptan in the management of hyponatremia in patients with lung and other cancers: current data and future perspectives.

    Science.gov (United States)

    Thajudeen, Bijin; Salahudeen, Abdulla K

    2016-01-01

    Hyponatremia is the most frequently observed electrolyte abnormality in clinical practice, and its frequency is almost double in hospitalized cancer patients. As a subset of cancer, hyponatremia is quite common in lung cancer patients, and it is often coupled with the diagnosis of syndrome of inappropriate antidiuretic hormone secretion. The presence of hyponatremia is consequential in that its presence adversely affects cancer patients' prognosis and outcomes. Limited data suggest that correcting hyponatremia in lung cancer patients can increase response to anticancer treatment, may help reduce length of hospital stay and cost, and reduce morbidity and mortality. The type of treatment for hyponatremia depends on several factors; the key factors are the duration and severity of neurological symptoms of hyponatremia and the status of extracellular volume. When hyponatremia is caused by syndrome of inappropriate antidiuretic hormone, hypertonic saline is indicated for acute symptomatic cases, whereas fluid restriction is recommended in chronic asymptomatic hyponatremia. The latter allows a slower rate of correction, thus avoiding the dreaded complication of osmotic demyelination syndrome. Fluid restriction is, however, insufficient or impractical, and often the use of pharmacological therapy such as antidiuretic hormone receptor antagonists becomes necessary. Availability of these antagonists as an effective treatment in the management of hyponatremia has been a major breakthrough, and furthermore, its clinical or investigational use in cancer-related hyponatremia may offer a potential opportunity to gain further insights into the prognostic impact of hyponatremia correction on cancer patients' outcomes. Tolvaptan is a prototype of ADH receptor antagonists that acts at renal tubular levels to increase free water excretion without inducing major systemic electrolyte abnormalities such as hypokalemia or alkalosis. The aim of this paper is to provide a brief review

  1. Clinical features and SLC26A3 genetic mutation analysis of a kindred with congenital chloride diarrhea%先天性失氯性腹泻一家系临床及SLC26A3基因突变分析

    Institute of Scientific and Technical Information of China (English)

    宋福英; 陈晓波; 刘颖; 叶雪; 邱明芳; 刘子勤

    2015-01-01

    included polyhydramnios,preterm,normal birth weight,watery diarrhea,low weight and severe electrolyte disturbances with hypochloremia,hypokalemia,hyponatremia and metabolic alkalosis.Renin angiotensin and aldosterone were high.His urine chloride concentration was low and fecal chloride concentration was high (> 90mmol/L).After oral salt substitution therapy with KCl and NaCl [3 mmol/(kg · d),4 mmol/(kg · d)],the electrolyte was better,alkalosis was alleviated,and growth and development were improved.The gene analysis revealed that the patient carried nt1631T > A homozygous mutation on exon 15 which lead to Ile544Asn mutation in the predicted SLC26A3 transmembrane protein sequence,which was considered to be responsible for the functional abnormality of the Cl-/HCO3-protein.His parents were carriers of SLC26A3 gene and their clinical phenotype was normal.Conclusions Congenital chloride diarrhea is a rare autosomal recessive disorder and easily misdiagnosed.The patient of early postnatal diarrhea with persistent hypochloremia,hypokalemia,hyponatremia and metabolic alkalosis should be thought about this disease.Genetic analysis can help make the diagnosis.The prognosis is good if a patient has an early diagnosis and appropriate management.

  2. 碳酸氢钠水化预防心肌梗死急诊经皮冠状动脉介入术后发生造影剂肾病分析%Effect of sodium bicarbonate on preventing contrast-induced nephropathy in patients with myocardial infarction undergoing primary percutaneous coronary interventions

    Institute of Scientific and Technical Information of China (English)

    谢刚; 曹树军; 张银; 胡硕强; 王峙峰

    2015-01-01

    Objective To investigate whether hydration with sodium bicarbonate reduces the incidence of contrast-induced nephropathy (CIN) in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary interventions (PCI). Methods From October 1, 2013 to October 1, 2014, 87 STEMI patients undergoing primary PCI in Daxing Hospital of Capital Medical University were consecutively enrolled in this study. All patients were randomly divided into sodium bicarbonate hydration (SB) group and control (NSB) group. The serum creatinine (SCr), estimated glomerular filtration rate (eGFR), serum potassium, N-terminal pro brain natriureic peptide (NT-pro BNP) levels and the pH value, the concentration of standard bicarbonate in arterial blood sample were measured on admission and at 24 h, 48 h and 72 h after primary PCI. The incidences of CIN, hypokalemia and metabolic alkalosis were analyzed in each group. Results Forty-three patients were included in SB group while the other forty-four patients were included in NSB group. The average intake volume of 1.4%sodium bicarbonate solution in SB group was (583.2±87.7) ml. There was no significant difference in contrast volume administered during the process of primary PCI between two groups (SB:237±95 ml vs. NSB:249±102 ml, P>0.05). Within 72 h after primary PCI, the incidence of CIN in SB group was significantly lower than that in NSB group (2/43;4.7%vs 10/44;22.7%, P0.05), the incidences of hypokalemia (SB:6/43;14.0%vs NSB:4/44;9.1%, P>0.05) and metabolic alkalosis (SB:5/43;11.6%vs NSB:3/44;6.8%, P>0.05). Conclusion This study shows that using standard hydration regimen of sodium bicarbonate can effectively reduce the incidence of CIN in STEMI patients undergoing primary PCI without increasing incidences of hypokalemia and metabolic alkalosis, and additional intake of sodium bicarbonate solution does not worsen the heart function further in STEMI patients.%目的:评价标准碳酸氢钠水化

  3. The Lazarus Syndrome%拉撒路综合征

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    付阳阳; 徐军; 于学忠

    2016-01-01

    拉撒路综合征,是指在心肺复苏失败停止所有抢救措施后,包括停止胸外按压、停止呼吸机辅助通气、停止输液及抢救药物应用等,无原因自主循环恢复,所以又被称为迟发的自主循环恢复.自首例报道于1982年,目前已经有53例个案报告.拉撒路综合征的病理生理及其发生机制,目前医学界并没有一个确切的定论.呼气末正压释放假说、高血钾堆积、碱中毒、肾上腺素等药物堆积效应等假说纷纷被提出.大多数的病例报告中拉撒路综合征发生在心肺复苏停止10 min之内,所以大多数文献中建议在心肺复苏停止后,对患者的积极监护至少应该持续10 min,以此来确定是患者是否真的死亡.但这一建议仍需要更多的研究支持.%The Lazarus phenomenon is defined as delayed ROSC,or ROSC after failure of CPR and cessation of all the emergency medical care,including the cessation of chest compression,mechanical ventilation,and venous fluid resuscitation.It was first reported in 1982 and 53 cases of Lazarus phenomenon have been reported in the medical literature so far.Even though Lazarus phenomenon is rare and the pathophysiological mechanisms are poorly understood,several possible mechanisms are still proposed,which could be rational to explain this phenomenon,such as auto-PEEP,hyperkalemia,alkalosis,delayed action of drugs,etc.In most cases,it was reported that ROSC occurred within 10 minutes after cessation of medical effort.Therefore,before the announcement of death of patient,it is mandatory to monitor those patients for at least 10 minutes after the cessation of CPR.However,more explicit studies seem to be necessary to gain a better understanding of this phenomenon.

  4. Experimental study on the role of endotoxin in the development of hepatopulmonary syndrome

    Institute of Scientific and Technical Information of China (English)

    Hui-Ying Zhang; De-Wu Han; Xin-Guo Wang; Yuan-Chang Zhao; Xin Zhou; Hai-Zhen Zhao

    2005-01-01

    AIM: To evaluate the role of intestinal endotoxemia in the genesis of hepatopulmonary syndrome.METHODS: A rat model of cirrhosis was prepared with the method of compound factors. At the end of the eighth week, rats with cirrhosis were treated with 300 μg LPS/100 g body weight, and 1 g/rat of glycine about four h prior to LPS. After three h of LPS treatment, blood and tissues were collected for various measurements. Kupffer cells were isolated from male Wistar rats and cultured, and divided into five groups. Supernatant was harvested at 3 h after treatment with LPS for measurement of tumor necrosis factor-alpha (TNF-α).RESULTS: Our results showed that in rats with cirrhosis, zslowed and deepened breath with occasional pause was.PaO2, PaCO2 and standard bicarbonate (SB) in arterial blood were decreased. Arterial O2 and actual bicarbonate (AB) were markedly decreased. There was a close correlation between decreased O2 and endotoxin. Metabolic acidosis accompanying respiratory alkalosis was the primary type of acid-base imbalance. The alveolar-arterial oxygen gradient was sharply widened. Massive accumulation of giant macrophages in the alveolar spaces and its wall and widened alveolar wall architecture were observed. The number of bacterial translocations in mesenteric lymph nodes increased. The ratio of TC99M-MAA brain-over-lung radioactivity rose. Endotoxin, and TNF-α, endothelin-1 (ET-1), nitric oxide (NO) in plasma and ET-1, carbon monoxide (CO) in lung homogenates increased. After administration of a given dosage of LPS in rats with cirrhosis, various pathological parameters worsened.Plasma level of endotoxin was related to TNF-α, ET-1, NO in plasma and ET-1, NO, CO in lung homogenates. TNF-α level was related to ET-1 and NO in plasma and lung homogenates and CO in lung homogenate as well. The level of TNF-α increased after infusion of LPS into culture supernatant of Kupffer cells in vitro. However, TNF-α significantly decreased after pretreatment with

  5. Cetoacidosis alcohólica y complicaciones neurológicas reversibles de la hipofosfatemia Alcoholic ketoacidosis and reversible neurological complications due to hypophosphataemia

    Directory of Open Access Journals (Sweden)

    M.ª T. Fernández López

    2012-06-01

    hypophosphataemia, hypomagnesemia, hypocalcemia, hypokalemia, metabolic acidosis and respiratory alkalosis. Disturbance of consciousness in alcoholic patients is observed in several disorders, such drunkenness, Wernicke encephalopathy, alcohol withdrawal syndrome, central pontine myelinolysis, hepatic encephalopathy, hypoglucemia and electrolyte disorders.

  6. Locomotion, respiratory physiology, and energetics of amphibious and terrestrial crabs.

    Science.gov (United States)

    Adamczewska, A M; Morris, S

    2000-01-01

    metabolism of G. natalis are strongly implied, including variations in hyperglycaemic hormone, variable basal metabolic rates, and a diel alkalosis present only in migrating crabs. The persistent dependence on water for reproduction is a determining factor in the biology of air-breathing crabs. The annual migrations include costs other than locomotion, for example, burrow construction and intermale competition. Estimates of costs that consider walking alone will underestimate the metabolic and stored fuel requirements for successful reproduction.

  7. Effect of an isoflavones-containing red clover preparation and alkaline supplementation on bone metabolism in ovariectomized rats

    Directory of Open Access Journals (Sweden)

    S Kawakita

    2009-02-01

    /body weight ratio observed in untreated post-ovariectomy group. Untreated ovariectomy caused about 48% decrease of cancellous bone mass in the femoral neck while this abnormality was prevented at similar extent by both RCE and RCE + BP treatments. Ovariectomy determined an over 80% increase of bone alkaline phosphatase (BALP level but both RCE and RCE + BP treatments significantly mitigated such variable. The BALP decrease yielded by the combined RCE + BP treatment was statistically lower than RCE alone. Taken together these data show that red clover preparation in dosages amenable to clinical practice do improve OVX-induced osteoporosis while a mild metabolic alkalosis might further synergize some therapeutic aspects. Keywords: red clover, alkaline supplementation, osteoporosis, ovariectomy

  8. Red blood cell pH, the Bohr effect, and other oxygenation-linked phenomena in blood O2 and CO2 transport.

    Science.gov (United States)

    Jensen, F B

    2004-11-01

    RBC volume and pHi regulation. Blood O2 transport shows several adaptive changes during exposure to environmental hypoxia. The Bohr effect is involved via the respiratory alkalosis induced by hyperventilation, and also via the pHi change that results from modulation of RBC organic phosphate content. In teleost fish, beta-adrenergic activation of Na+/H+ exchange rapidly elevates pHi and O2 affinity, particularly under low O2 conditions. PMID:15491402

  9. Role of tolvaptan in the management of hyponatremia in patients with lung and other cancers: current data and future perspectives

    Directory of Open Access Journals (Sweden)

    Thajudeen B

    2016-08-01

    ADH receptor antagonists that acts at renal tubular levels to increase free water excretion without inducing major systemic electrolyte abnormalities such as hypokalemia or alkalosis. The aim of this paper is to provide a brief review while focusing on cancer hyponatremia; (1 of the epidemiology of hyponatremia and its pathophysiology and diagnostic approaches and (2 of the pharmacokinetics of tolvaptan and its clinical efficacy, safety, and compliance. Keywords: treatment, pharmacology, safety, tolerability, efficacy, adherence

  10. Pathophysiological aspects of malignant brain tumors studied with positron emission tomography

    International Nuclear Information System (INIS)

    To further understand the control of brain tumor fluid balance and pH, the following studies were undertaken. The transport of a water soluble molecule across the brain and tumor capillary endothelium was studied during glucocorticoid and radiation treatment. The brain and brain-tumor acidity (pH) was evaluated as a single measurement in patients receiving a low maintenance dose of glucocorticoid. Transport changes and pH were measured in 61 patients with cerebral tumors using 82Rubidium (82Rb) and 11C-Dimethyloxa-zolidindione (11C-DMO), respectively, and Positron Emission Tomography (PET). Supplementary studies of tumor and contralateral brain blood flow and blood volume using the C15O2/PET and C15O/PET technique, respectively, were included to validate the 82Rb/PET model and obtain further information. A total of 125 PET scans were performed. Supplementary studies were undertaken to estimate delay of blood registration and form distribution of arterial blood isotope activity curves. Blood-to-tumor barrier transport was outlined at baseline and at 6 and 24 hours after the start of glucocorticoid treatment, finding a significant decrease in the transpfort. Radiation treatment (2-6 gray) did not alter the blood-to-tumor barrier transport when restudied within one hour in patients receiving glucocorticoid. The pH in brain tumors was as high as 6.88-7.26, suggesting that tumors are more alkalotic than the normal brain. The permeability surface area product and the permeability coefficient were determined form the 82Rb/PET transport and C15O2/PET flow studies. Baseline permeability values were comparable to the literature values both for 82Rb and potassium. No difference in tissue blood volume was seen between 82Rb/PET and C15O/PET models and was of the same magnitude in the tumor and the contralateral tissue. Aspects of tumor alkalosis, tumor edema production, glucocorticoid edema clearance, and relationship between the anti-edema effect of glucocorticoid and the

  11. Analysis and physiological implications of renal 2-oxoglutaramate metabolism.

    Science.gov (United States)

    Nissim, I; Wehrli, S; States, B; Nissim, I; Yudkoff, M

    1991-07-01

    The relative significance of the flux through the glutamine aminotransferase (glutaminase II) pathway to renal ammoniagenesis is poorly understood. A basic and unresolved question is whether 2-oxoglutaramate (2-OGM), a product of the glutaminase II reaction, is deamidated to yield 2-oxoglutarate and NH3, or whether 2-OGM accumulates as an unreactive lactam, depending on the environmental pH. In the current studies we utilized 13C n.m.r. as well as 15N n.m.r. as well as 15N n.m.r. to demonstrate that 2-OGM occurs as a lactam, i.e. 5-hydroxypyroglutamate, regardless of the environmental pH. Our additional aims were to determine whether human kidney cells (HK cells) in culture can produce 2-OGM and to ascertain a pH-dependent relationship between NH3 and 2-OGM production from glutamine. We therefore developed an isotope dilution assay for 2-OGM utilizing 5-hydroxy[4-13C,1-15N]pyroglutamate as the labelled species. Incubations of HK cells in minimal essential medium supplemented with 1 mM-[2-15N]glutamine demonstrated significantly higher production of 2-OGM at pH 6.8 and lower production at pH 7.6 compared with pH 7.4. Similarly both 15NH3 and [15N]alanine formation were significantly higher in acute acidosis (pH 6.8) and lower in acute alkalosis (pH 7.6) compared with that at physiological pH. Addition of 1 mM-amino-oxyacetate to the incubation medium at pH 7.4 significantly diminished [15N]alanine and 2-OGM production, but the production of 15NH3 via the glutamate dehydrogenase pathway was significantly stimulated. The current observations indicate that the glutaminase II pathway plays a minor role and that flux through glutamate dehydrogenase is the predominant site for regulation of ammoniagenesis in human kidney.

  12. 局部枸椽酸钠抗凝法与肝素抗凝法在CRRT中的应用比较%Comparative study on regional citrate anticoagulation and the heparin law used in the application of CRRT

    Institute of Scientific and Technical Information of China (English)

    刘锦全; 郑志忠; 罗文晓; 蔡洧丹

    2013-01-01

    目的 比较局部枸椽酸钠抗凝法与肝素抗凝法在CRRT中的应用效果.方法 将我院2011年11月至2012年12月行CRRT治疗的126例患者随机分为两组,肝素抗凝组患者采用常规肝素抗凝方式治疗,局部枸椽酸钠抗凝组患者采用局部枸椽酸钠抗凝方式治疗.结果 治疗后局部枸椽酸钠抗凝组患者未出现高钠血症和代谢性碱中毒情况;治疗后肝素抗凝组患者的体内钙离子浓度明显下降,局部枸椽酸钠抗凝组明显上升,两组比较差异有统计学意义(P<0.05).结论 在CRRT治疗中,局部枸椽酸钠抗凝比常规肝素抗凝更有效、更安全.%Objective To compare the clinical effects of regional citrate anticoagulation with heparin sodium anticoagulation method in the application of continuous renal replacement therapy (CRRT).Methods In our hospital from November 2011 to December 2012,126 cases of C RRT were randomly divided into 2 groups,namely regional citrate anticoagulation group and heparin group.Heparin group was treated with conventional heparin anticoagulation therapy,regional citrate anticoagulation group was treated by regional citrate anticoagulation treatment.Results After treatment of regional citrate anticoagulation group patients did not appear hypernatremia and metabolic alkalosis; after treatment with heparin patients with total body calcium concentration decreased significantly,regional citrate anticoagulation group increased obviously.With comparison of the two groups,the difference was statistically significant (P<0.05).Conclusion In the treatment of CRRT,regional citrate anticoagulation is more effective and safer than heparin anticoagulation

  13. Co-Regulated Pendrin and Aquaporin 5 Expression and Trafficking in Type-B Intercalated Cells under Potassium Depletion

    Directory of Open Access Journals (Sweden)

    Giuseppe Procino

    2013-12-01

    Full Text Available Background: We recently reported that aquaporin 5 (AQP5, a water channel never identified in the kidney before, co-localizes with pendrin at the apical membrane of type-B intercalated cells in the kidney cortex. Since co-expression of AQP5 and pendrin in the apical membrane domain is a common feature of several other epithelia such as cochlear and bronchial epithelial cells, we evaluated here whether this strict membrane association may reflect a co-regulation of the two proteins. To investigate this possibility, we analyzed AQP5 and pendrin expression and trafficking in mice under chronic K+ depletion, a condition that results in an increased ability of renal tubule to reabsorb bicarbonate, often leads to metabolic alkalosis and is known to strongly reduce pendrin expression. Methods: Mice were housed in metabolic cages and pair-fed with either a standard laboratory chow or a K+-deficient diet. AQP5 abundance was assessed by western blot in whole kidney homogenates and AQP5 and pendrin were localized by confocal microscopy in kidney sections from those mice. In addition, the short-term effect of changes in external pH on pendrin trafficking was evaluated by fluorescence resonance energy transfer (FRET in MDCK cells, and the functional activity of pendrin was tested in the presence and absence of AQP5 in HEK 293 Phoenix cells. Results: Chronic K+ depletion caused a strong reduction in pendrin and AQP5 expression. Moreover, both proteins shifted from the apical cell membrane to an intracellular compartment. An acute pH shift from 7.4 to 7.0 caused pendrin internalization from the plasma membrane. Conversely, a pH shift from 7.4 to 7.8 caused a significant increase in the cell surface expression of pendrin. Finally, pendrin ion transport activity was not affected by co-expression with AQP5. Conclusions: The co-regulation of pendrin and AQP5 membrane expression under chronic K+-deficiency indicates that these two molecules could cooperate as an

  14. 枸橼酸钠在血液滤过中的效果观察%Effect observation of sodium citrate in hemofiltration

    Institute of Scientific and Technical Information of China (English)

    刘国英; 熊科俊; 赵琳

    2014-01-01

    目的::观察局部运用低浓度枸橼酸抗凝在行血液滤过中的疗效及安全性。方法:多脏器功能衰竭伴高危出血患者,即行4%枸橼酸钠在体外抗凝。观察血滤器、管路动静脉壶、动脉压、静脉压及跨膜压等情况。结果:20例(76次)高危出血患者在行血液滤过中未出现原有出血症状加重现象,也未出现滤器或管路凝血而终止;未出现低钙高钠代谢性碱中毒等并发症,均达到预期效果。结论:局部枸橼酸钠抗凝行血液滤过技术是一种安全有效的、简单的技术,易于掌握,并且禁忌症少,值得推行。%Objective: To observe efficacy and safety of local use of low concentrations sodium citrate anticoagulation in hemo-filtration. Methods: MOF patients with high-risk bleeding were given 4% sodium citrate for extracorporeal anticoagulation in hemofil-tration. The hemofilter, pipeline artery and vein pots, artery pressure and vein pressure, and transmembrane pressure were observed. Results: 20 cases with high-risk bleeding had no aggravated bleeding during the hemofiltration, and the filter and pipeline did not stop due to coagulation. No complications like low calcium high sodium metabolic alkalosis were found. Therefore, the treatment had the ex-pected effects. Conclusions: The technology of the local use of low concentrations sodium citrate anticoagulation in hemofiltration is safe and effective, easy to learn, and is worth being popularized.

  15. Treatment of singultus following craniocerebral injury Intranasal cavity drip infusion versus Intramuscular injection of aminazine

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    BACKGROUND: Craniocerebral injury always accompanies with singultus, while frequent singultus may cause increased intracranial pressure. Simultaneously, respiratory alkalosis and cerebral hypoxia induced by respiratory disorder may aggravate craniocerebral injury.OBJECTIVE: To observe the therapeutic effects of intranasal cavity drip infusion of aminazine and intramuscular injection on singultus following craniocerebral injury.DESIGN: Contrast observation.SETTING: Department ofNeurosurgery, Xi'an Aerospace General Hospital.PARTICIPANTS: A total of 102 patients with singultus following craniocerebral injury were selected from the Department of Neurosurgery, Xi'an Aerospace General Hospital from June 2001 to June 2006. Patients with craniocerebral injury were diagnosed with CT examination and randomly divided into nasal cavity medication group (n =62) and intramuscular injection group (n =40). There were 44 males and 18 females in the nasal cavity medication group and their mean age was (33±4) years; while, there were 26 males and 14 females in the intramuscular injection group and their mean age was (29±4) years. All patients and their relatives provided the confirmed consent.METHODS: Patients in the nasal cavity medication group were slowly dripped aminazine solution into bilateral nasal cavity with the dosage of 12.5 mg (0.5 mL). Patients who had no obvious effect or had mild improvement received the treatment once every 6 hours. The treatment was stopped if symptoms were also observed after the fifth medication. In addition, patients in the intramuscular injection group received intramuscular injection of 50 mg aminazine. Patients who had no obvious effect or had mild improvement received the treatment once every 6 hours. The treatment was changed if symptoms were also observed after the fifth medication.MAIN OUTCOME MEASURES: Therapeutic effects of different medications in the two groups.RESULTS: All 102 patients were involved in the final analysis. Effective

  16. To study the clinical feature of Bartter syndrome (Attached 3 cases report)%儿童巴特(Bartter)综合征的临床特征研究(附3例临床报告)

    Institute of Scientific and Technical Information of China (English)

    王成月; 赵忠礼; 江亮亮; 叶小飞; 杨斌; 张志明

    2011-01-01

    目的 总结儿童巴特综合征的临床特征及预后.方法 复习国内外巴特综合征相关的文献并结合我院明确诊断的3例巴特综合征,总结儿童巴特综合征的临床表现、实验室检查特点及预后.结果 儿童巴特综合征在治疗前均有营养不良及生长发育落后,并伴有长期腹泻、呕吐、多饮、多尿等非特异性临床表现.我院3例巴特综合征中有2例以抽搐为首发症状.实验室检查可见高肾素血症、高醛固酮血症、低钾血症、低钠血症、低氯血症及代谢性碱中毒.经积极治疗,预后大多良好,未经治疗患儿可致死亡.结论 巴特综合征临床症状多样,经积极治疗大多预后良好.%Objective; It was to summarize the clinical feature and prognosis of Bartter syndrome in children. Methods; The domestic and international reference correlated with Bartter syndrome was reviewed, and the characteristics of clinical manifestation, laboratory examination and prognosis were drawn from 3 cases of Bartter syndrome of definite diagnosis in our hospital. Results: Children with Bartter syndrome always manifest dystrophy and growth retardation, accompanied by non - specificity clinical situation such as chronic diarrhea and vomiting, polydipsia and hyperdiuresis, if without effective treatment. 2 in 3 of our cases show convulsion as the first symptom laboratory examination often shows hyperreninemia, hyperaldosteronemia, hypokalemia hyponatremia, hypochloraemia and metabolic alkalosis. Untreated Bartter syndrome can lead to death of the sick children. But after vigorous management, the prognosis of patient of Bartter syndrome was usually favorable. Conclusion; Symptoms of Bartter syndrome vary, but with rather favorable prognosis after proper treatment.

  17. 急诊室对非器质性呼吸困难的临床分析%A Clinical Analysis of Nonorganic Dyspnea in Emergency Department

    Institute of Scientific and Technical Information of China (English)

    罗昌彬; 章成

    2011-01-01

    目的 总结非器质性呼吸困难患者的急诊诊治经验,提高急诊医生对心理-生理性疾病的认识.方法 对2005年- 2009年急诊科32例非器质性呼吸困难患者的诊治经过进行回顾性分析.结果 32例患者发病前均有精神创伤或过度劳累、精神紧张、或应急等心因性诱因;有典型的临床症状;过度通气激发试验阳性;血气分析提示呼吸性碱中毒;Nijmegen问卷积分≤23分者18例(56.2%);辅助检查未见其他原发性疾病.结论 随着现代社会身心压力的增大,非器质性呼吸困难患者明显增加,临床医生应加强对社会心理-生理性疾病的认识,提高诊断率,对减轻患者的精神压力及避免过度医疗具有重要的临床意义.%Objective To summarize the medical experiences of treating nonorganic dyspnea in the emergency department and raise physicians' awareness of psychological-physiological diseases. Methods The clinical data of 32 patients with nonorganic dyspnea between 2005 and 2009 in the emergency department of our hospital were analyzed retrospectively. Results All the 32 patients had psychogenic incentives before onset of the disease, such as mental injury, over-exhaustion, nervousness or emergency. All of them had typical clinical manifestations. The results of hyperventilation provocation test were positive. Arterial blood gas analysis implied respiratory alkalosis. Eighteen of them (56. 2%) had a mark ≤23 on the Nijmegen questionnaire. Auxiliary examinations showed no other primary diseases. Conclusions With the increase of emotional stress in the modern society, the number of patients with nonorganic dyspnea have markedly increased. Clinicians should strengthen the awareness of social psychology-physiological diseases, and improve diagnostic accuracy, which will have an obvious clinical value in relieving patients ' mental stress and avoiding excessive medical treatment

  18. Do anesthetics and sampling strategies affect transcription analysis of fish tissues?

    Directory of Open Access Journals (Sweden)

    Hevrøy Ernst M

    2007-06-01

    Full Text Available Abstract Background The aim of the current examination was to evaluate if sedation and anesthetic treatment techniques affect the quality of RNA extracted from liver, gill, head kidney and brain tissues in Atlantic salmon Salmo salar L. Blood parameters were measured and tissue specimens sampled in six groups of fish; one control group (0 minutes, two groups kept in pure seawater in 90 liter tanks for 30 and 120 minutes, two groups treated with the anesthetic isoeugenol for 30 and 120 minutes, and one group kept in pure seawater for 105 minutes and then anaesthetized with metacaine for 15 minutes. RNA quality was assessed with the NanoDrop ND-1000 spectrophotometer (260/280 and 260/230 nm ratios and with the Agilent Bioanalyzer (28S/18S ratio and RIN data in samples either preserved in liquefied nitrogen (N2 or in RNAlater. In addition, the transcriptional levels of two fast-responding genes were quantified in gill and brain tissues. Results The results show that physiological stress during sampling does not affect the quality of RNA extracted from fish specimens. However, prolonged sedation (2 hours resulted in a metabolic alkalosis that again affected the transcriptional levels of genes involved in ionoregulation and respiration. In gills, Na+-K+-ATPase α1b was significantly downregulated and hypoxia inducible factor 1 (HIF1 significantly upregulated after two hours of treatment with isoeugenol, suggesting that this commonly used sedative affects osmo-regulation and respiration in the fish. The results also suggest that for tissue preservation in general it is better to flash-freeze fish specimens in liquefied N2 than to use RNAlater. Conclusion Prolonged sedation may affect the transcription of fast-responding genes in tissues of fish. Two hours of sedation with isoeugenol resulted in downregulation of the Na+-K+-ATPase α1b gene and upregulation of the HIF1 gene in gills of Atlantic salmon. The quality of RNA extracted from tissue specimens

  19. 难治性Gitelman综合征1例及临床诊疗体会%Experience in clinical diagnosis and treatment of refractory Gitelman syndrome:a case report

    Institute of Scientific and Technical Information of China (English)

    孙璐; 唐咸玉; 赵晓华; 范冠杰; 危建安

    2016-01-01

    Objective To analyze the clinical characteristics of refractory Gitelman syndrome and summarize the experience in diagnosis and treatment. Methods A cases of Gitelman syndrome was studied. The relevant examinations, kidney pathology and SLC12A 3 gene analysis were completed. Results The patient got the disease when he was young. The clinical manifestations included recurrent heart palpitations, seizures, limb convulsions and fatigue. Laboratory examinations revealed low potassium, low magnesium and metabolic alkalosis. Renal pathology showed juxtaglomerular hyperplasia. Gene analysis revealed compound heterozygous mutation of SLC12A 3 gene. After supplement of potassium and magnesium, the condition was alleviated but easy to relapse. Conclusions Hypokalemia of the patients was difficult to correct and easy to relapse. The patient had obvious clinical symptoms, and was worthy of long-term attention.%目的:分析1例难治性Gitelman综合征的临床特点并总结其诊疗体会。方法以1例Gitelman综合征患者为研究对象,完善相关检验检查以及肾脏病理、123基因分析。结果该患者青年起病,临床表现为反复心悸、发作性四肢抽搐、乏力,检查提示低钾、低镁、代谢性碱中毒,肾穿病理提示肾小球旁器增生,基因分析提示SLC12A3的复合杂合突变。治疗上予补钾、补镁及保钾,病情可缓解但易反复。结论本例患者低钾更难纠正,极易复发,临床症状明显,值得长期关注。

  20. 干燥综合征合并获得性Gitelman综合征二例并文献复习%Acquired Gitelman syndrome associated with primary Sj(o)gren syndrome: two cases report and review of literature

    Institute of Scientific and Technical Information of China (English)

    刘旭东; 刘海娜; 方芳; 田百玲; 杨娉婷; 肖卫国

    2012-01-01

    目的 提高对干燥综合征(SS)合并获得性Gitelman综合征的认识,了解其特点及治疗.方法 报告2例SS合并获得性Gitelman综合征病例的临床资料,并结合相关文献进行分析.结果 2例患者均为首次就诊的老年女性,临床以低钾血症及相关肌炎症状、肌酶学改变为特点入院.虽口干、眼干症状不典型,但查体及实验室等相关检查诊断SS明确,伴低血镁、代谢性碱中毒、高肾素-血管紧张素-醛固酮,且无高血压,符合Gitelman综合征改变,因此考虑为SS合并获得性Gitelman综合征.结论 在符合Gitelman综合征临床特点基础上,诊断应完善肾活检.SS患者合并的Gitelman综合征少见,其发生机制与SS的关系有待进一步探讨.%Objective To better understand the clinical features and the diagnosis of acquired Gitelman syndrome associated with primary Sj(o)gren syndrome (SS).Methods Two cases of acquired Gitelman syndrome associated with primary SS were investigated.Literature were reviewed.Results Two women with sicca complex presented to our clinic with intermittent muscle cramping and weakness involving both lower extremities for several months.Laboratory findings showed hypokalemic metabolic alkalosis, hypomagnesemia, and hypocalciuria,all these met the criteria for Gitelman syndrome.Diagnostic evaluation identified primary SS as the cause of the acquired Gitelman syndrome.Conclusion Acquired Gitelman syndrome associated with SS is rare.Kidney biopsy is necessary for the diagnosis of Gitelman syndrome.Further studies are needed.

  1. 药物致假性巴特综合征五例临床分析%Clinical analysis of drug-induced Pseudo-Bartter's syndrome: a report of five cases

    Institute of Scientific and Technical Information of China (English)

    李凤翱; 卫红艳; 林珊; 韩红玲; 邱明才

    2012-01-01

    Objective To summarize the clinical characteristics and outcomes of Pseudo-Bartter's syndrome and explore its pathogenesis.Methods The clinical data of 5 cases of Pseudo-Bartter's syndrome at our ward from May 2008 to December 2010 was analyzed retrospectively.Results All patients were female. Long-term regimen of purgative or diuretics was prescribed. The clinical features included normotension,hypokalemic alkalosis and activation of renin-angiotensin-aldosterone.The pathological results of 3 cases of kidney biopsy showed the hyperplasia of juxtaglomerular apparatus,thickness of arteriole,infiltration of lymphocytes and monocytes and degeneration of renal tubule. Upon a definitive diagnosis,purgative or diuretics was discontinued and supplement therapy of potassium chloride initiated.The results of laboratory tests reverted to normal ranges within 4 weeks.Conclusion Purgative or diuretics should be prescribed appropriately to avoid the occurrence of Pseudo-Bartter's syndrome.%目的 总结5例药物致假性巴特综合征的临床特点和治疗转归,探讨发病机制.方法 回顾性分析天津医科大学总医院内分泌科2008年5月至2010年12月5例药物致假性巴特综合征患者病历资料.结果 患者均为中青年女性,有长期服用泻剂和利尿剂史.临床上以正常血压、低钾代谢性碱中毒、肾素-血管紧张素-醛同酮系统的激活为特点.3例患者肾穿刺病理活检均可见球旁器增生,小动脉管壁增厚.间质可见淋巴、单核细胞浸润.肾小管可见不同程度的退行性变.早期诊断,及时停用致病性药物配合补充氯化钾治疗.实验室检查在4周内恢复正常范围.结论 临床合理应用利尿剂和泻剂可减少假性巴特综合征的发生.

  2. Congenital chloride diarrhea:one case report%先天性失氯性腹泻一家系临床和基因诊断

    Institute of Scientific and Technical Information of China (English)

    张文; 李希红

    2015-01-01

    ObjectiveTo discuss the clinical diagnosis, treatment and genetic diagnosis of congenital chloride diarrhea (CCD), a rare autosomal recessive disease.Methods One month old boy with persistent diarrhea, hypochloremia, hyponatremia, hypokalemia and metabolic alkalosis, his stool electrolyte testing, clinical treatment and follow-up, as well as his and his parents’ SLC26A3 gene mutation analysis were retrospectively analyzed.Results The fecal electrolyte testing showed that the levels of Cl- and K+ were increased and the level of Cl- was much higher than the sum of Na+ and K+. After replacement therapy with NaCl and KCl, the blood electrolyte recovered to normal. Follow-up 4 years, the boy had a normal growth and development. Mutation analysis onSLC26A3 gene showed there was a homozygous mutation of 239G>A and both his father and mother carried the same heterozygous mutation. This mutation was ifrst discovered in China.Conclusions The sequencing analysis ofSLC26A3 mutation may help to diagnosis CCD.%目的:探讨先天性失氯性腹泻(CCD)的临床诊治及基因诊断。方法回顾性分析1例表现为持续腹泻、低氯血症、低钠血症、低钾血症和代谢性碱中毒的男性、1月龄患儿的大便电解质检测、临床治疗随访以及患儿及其父母SLC26A3基因突变分析的资料。结果患儿大便电解质Cl-、K+明显升高,Cl->Na+和K+之和;经氯化钠和氯化钾替代治疗,血电解质恢复正常。随访4年,患儿生长发育尚可。患儿为SLC26A3基因c.239G>A(p.Gly80Asp纯合突变,父母该位点均为相同的杂合突变,该突变首次在国内发现。结论 SLC26A3基因分析有助于CCD的诊断。

  3. Prostaglandin-E2 Mediated Increase in Calcium and Phosphate Excretion in a Mouse Model of Distal Nephron Salt Wasting.

    Directory of Open Access Journals (Sweden)

    Manoocher Soleimani

    Full Text Available Contribution of salt wasting and volume depletion to the pathogenesis of hypercalciuria and hyperphosphaturia is poorly understood. Pendrin/NCC double KO (pendrin/NCC-dKO mice display severe salt wasting under basal conditions and develop profound volume depletion, prerenal renal failure, and metabolic alkalosis and are growth retarded. Microscopic examination of the kidneys of pendrin/NCC-dKO mice revealed the presence of calcium phosphate deposits in the medullary collecting ducts, along with increased urinary calcium and phosphate excretion. Confirmatory studies revealed decreases in the expression levels of sodium phosphate transporter-2 isoforms a and c, increases in the expression of cytochrome p450 family 4a isotypes 12 a and b, as well as prostaglandin E synthase 1, and cyclooxygenases 1 and 2. Pendrin/NCC-dKO animals also had a significant increase in urinary prostaglandin E2 (PGE-2 and renal content of 20-hydroxyeicosatetraenoic acid (20-HETE levels. Pendrin/NCC-dKO animals exhibit reduced expression levels of the sodium/potassium/2chloride co-transporter 2 (NKCC2 in their medullary thick ascending limb. Further assessment of the renal expression of NKCC2 isoforms by quantitative real time PCR (qRT-PCR reveled that compared to WT mice, the expression of NKCC2 isotype F was significantly reduced in pendrin/NCC-dKO mice. Provision of a high salt diet to rectify volume depletion or inhibition of PGE-2 synthesis by indomethacin, but not inhibition of 20-HETE generation by HET0016, significantly improved hypercalciuria and salt wasting in pendrin/NCC dKO mice. Both high salt diet and indomethacin treatment also corrected the alterations in NKCC2 isotype expression in pendrin/NCC-dKO mice. We propose that severe salt wasting and volume depletion, irrespective of the primary originating nephron segment, can secondarily impair the reabsorption of salt and calcium in the thick ascending limb of Henle and/or proximal tubule, and reabsorption of

  4. Career perspective: John B West.

    Science.gov (United States)

    West, John B

    2012-11-07

    I have been fortunate to work in two areas of extreme physiology and medicine: very high altitude and the microgravity of spaceflight. My introduction to high altitude medicine was as a member of Sir Edmund Hillary's Silver Hut Expedition in 1960-1961 when a small group of physiologists spent the winter and spring at an altitude of 5,800 m just south of Mt. Everest. The physiological objective was to obtain a better understanding of the acclimatization process of lowlanders during exposure to a very high altitude for several months. As far as we knew, no one had ever spent so long at such a high altitude before. The success of this expedition prompted me to organize the 1981 American Medical Research Expedition to Everest where the scientific objective was to determine the physiological changes that allow humans to survive in the extreme hypoxia of the highest point on earth. There is good evidence that this altitude is very near the limit of human tolerance to oxygen deprivation. Much novel information was obtained including an extraordinary degree of hyperventilation which reduced the alveolar partial pressure of carbon dioxide (Pco2) to about 8 mmHg (1.1 kPa) on the summit, and this in turn allowed the alveolar partial pressure of oxygen, PO2, to be maintained at a viable level of about 35 mmHg (4.7 kPa). The low Pco2 caused a severe degree of respiratory alkalosis with an arterial pH exceeding 7.7. These were the first physiological measurements to be made on the Everest summit, and essentially, none has been made since. The second extreme environment is microgravity. We carried out an extensive series of measurements on astronauts in the orbiting laboratory known as SpaceLab in the 1990s. Many aspects of pulmonary function are affected by gravity, so it was not surprising that many changes were found. However, overall gas exchange remained efficient. Some of the findings such as an anomalous behavior of inhaled helium and sulfur hexafluoride have still not

  5. Patterns of unexpected in-hospital deaths: a root cause analysis

    Directory of Open Access Journals (Sweden)

    Curry J Paul

    2011-02-01

    Full Text Available Abstract Background Respiratory alarm monitoring and rapid response team alerts on hospital general floors are based on detection of simple numeric threshold breaches. Although some uncontrolled observation trials in select patient populations have been encouraging, randomized controlled trials suggest that this simplistic approach may not reduce the unexpected death rate in this complex environment. The purpose of this review is to examine the history and scientific basis for threshold alarms and to compare thresholds with the actual pathophysiologic patterns of evolving death which must be timely detected. Methods The Pubmed database was searched for articles relating to methods for triggering rapid response teams and respiratory alarms and these were contrasted with the fundamental timed pathophysiologic patterns of death which evolve due to sepsis, congestive heart failure, pulmonary embolism, hypoventilation, narcotic overdose, and sleep apnea. Results In contrast to the simplicity of the numeric threshold breach method of generating alerts, the actual patterns of evolving death are complex and do not share common features until near death. On hospital general floors, unexpected clinical instability leading to death often progresses along three distinct patterns which can be designated as Types I, II and III. Type I is a pattern comprised of hyperventilation compensated respiratory failure typical of congestive heart failure and sepsis. Here, early hyperventilation and respiratory alkalosis can conceal the onset of instability. Type II is the pattern of classic CO2 narcosis. Type III occurs only during sleep and is a pattern of ventilation and SPO2 cycling caused by instability of ventilation and/or upper airway control followed by precipitous and fatal oxygen desaturation if arousal failure is induced by narcotics and/or sedation. Conclusion The traditional threshold breach method of detecting instability on hospital wards was not

  6. 婴幼儿严重低钾血症11例疗效分析%Analysis of the curative effect of 11 infants with severe hypokalemia

    Institute of Scientific and Technical Information of China (English)

    姚华; 钱苗红

    2014-01-01

    Objective To analyze the diagnose , treatment and prognosis of infants with severe hypokalemia , so as to provide reference for clinical medication for infants with severe hypokalemia .Methods Retrospective analysis was conducted on the clinical data of 11 infants with severe hypokalemia admitted during the period of January 2010 to March 2013.They were divided into 3 groups according to different fluid infusion methods, 1/2 tension GNS, 1/3 tension GNS, and 1/4 tension GNS.The concentration of potassium supplement liquid was 0.3%.Three groups were compared in the concentrations of sodium of fluid infusion , the speed of potassium rise , the clinical progress and prognosis.Results All of the three cases with 1/2 tension GNS were improved at the first day .At the second day one case was given 1/4 tension GNS for report of severe hypokalemia , and it died.The other two cases recovered day after day .Four cases received 1/3 tension GNS, among which two cases were improved while the other two cases did not change at the first day .At the second and third day three cases were improved while the other one was not .Four cases were given 1/4 tension GNS, and they were not improved in three days .There was significant difference in curative effect among three groups , and the curative effect of the group with 1/2 tension GNS was best (χ2 =13.636,P<0.05).Conclusion Severe hypokalemia is usually complicated with metabolic alkalosis , so liquid with more sodium should be given for accelerating the correction of metabolic alkalosis and recovering of low potassium .%目的:分析婴幼儿严重低钾血症的诊治及其预后,为婴幼儿严重低钾血症的临床治疗提供参考。方法回顾性分析2010年1月至2013年3月收治的11例婴幼儿严重低钾血症患儿的临床资料,根据补液治疗方法的不同分为3组,分别用以下液体补钾:1/2张含钠糖盐水、1/3张含钠糖盐水、1/4张含钠糖盐水。补钾浓度为0.3

  7. Application of acid citrate dextrose in contiunous veno-venous hemofiltration%血液保存液在连续性血液滤过中的应用

    Institute of Scientific and Technical Information of China (English)

    宋锴; 张田杰; 姜山; 詹周兵; 石永兵

    2013-01-01

    Objective To assess the effectiveness and safety of acid citrate dextrose (ACD) solution in contiunous veno-venous hemofiltration (CWH). Methods A total of 77 patients with bleeding risk was divided into two groups of A( treated with regional heparin anticoagulation,31 cases) and B( treated with regional ACD anticoagulation, 46 cases). ACD was taken as anticoagulant to maintenance post-filter ionized calcium(iCa2+ ) 0. 25-0. 35 mmol/L. The dialyzer lifespan, anticoagulation effectiveness, adverse effects and costs were compared. Results The mean dialyzer lifespan in group A was shorter than that in group B[(17. 3±1. 4) h vs. (41. 5 ± 4. 6) h](P<0. 01). Compared with before, the prothrombin time and activated partial thromboplastin time were not obvioulsy changed after treatment in groups of A and B,but platelet count was decreased in group A[(130. 50± 58. 20) ×109/L vs. (111. 10±45. 40) × 109/L](P<0. 01). The amount of blood transfusion and cost in group B were less than those in group A[(7. 4±2. 3) ml/h vs. (23. 4±4. 8) ml/h and (3371±249) RMB vs. (4334±1107) RMB](P<0. 05 or P<0. 01). The metabolic alkalosis occurred in 13 cases of group B, which was corrected by decreasing the concentration of sodium bicarbonate to 28 mmol/L in the hemofiltration solution. Conclusion ACD anticoagulation in CWH treatment is safe, effective, cheap and easy for clinical application. Metabolic alkalosis can be prevented by adjusting the concentration of sodium bicarbonate in replacement solution.%目的 评价血液保存液用于连续性血液滤过(CVVH)治疗的效果和安全性.方法 77例有出血倾向的重症患者行CVVH治疗,分为局部肝素抗凝组(A组,31例)和局部枸橼酸葡萄糖(ACD)抗凝组(B组,46例).B组用ACD作抗凝剂,维持滤器后离子钙(iCa2+)0.25-0.35 mmol/L.比较两组滤器的寿命、抗凝效果和不良反应,并进行经济学评价.结果 A组滤器使用寿命短于B组[(17.3±1.4)h vs.(41.5±4.6) h](P<0.01).两组治疗

  8. Estresse térmico durante o pré-abate em frangos de corte Heat stress during the pre-slaughter on broiler chicken

    Directory of Open Access Journals (Sweden)

    Camila Brossi

    2009-07-01

    to become very susceptible to heat stress. When the environment temperature rises above the thermoneutrality zone, the bird is submitted to a stress condition, which can generate acute hyperthermia, respiratory alkalosis, electrolyte imbalance, reduction in food consumption, lower growth rate, increased mortality rate and even negative effects on meat quality due to the incidence of pale meat and dark in other cases, interfering in properties such as industrial yield, water holding capacity, color and tenderness. The results of the evaluation of quality parameters observed in literature showed that the heat stress, chronic or acute, suffered by broiler chickens, generates negative consequences on the functional properties of meat. Further studies with this research line should be conducted, mainly in Brazil, for being a tropical country with high temperatures in the summer in order to understand, prevent and overcome the extent or intensity of this stress, avoiding problems and damages to the meat chain.

  9. Analysis of Clinical Characteristics of Cushing's Syndrome in Patients with Different Serumal Potassium Levels and Its Complications%不同血钾水平库欣综合症患者的临床特点及并发症分析

    Institute of Scientific and Technical Information of China (English)

    王旭红; 张之农; 刘元志; 杨伟光; 林杨

    2015-01-01

    目的:分析不同血钾水平的库欣综合症患者的临床特点及并发症发生趋势。方法筛选2013年12月-2015年1月该院收治的库欣综合症患者156例,作为研究对象。根据患者血钾水平将其分为正常组与低血钾组,正常组62例,低血钾组94例,比较两组患者的临床特点,分析两组患者并发症发生特点。结果与正常组比较低血钾组患者男性构成比高于女性,同时低血钾组男性患者病程、血压、血脂与正常组比较,差异有统计学意义(P<0.05);低血钾组紫纹、瘀斑、碱中毒和下肢水肿发生率明显高于正常组;低血钾组并发症发生率明显高于正常组,并且以心律失常最为常见。结论库欣综合症合并低血钾者常见于男性患者,患者表现为病程短、代谢异常加重、体征突出等,库欣综合症发生心脑血管并发症发生率较高,而低血钾患者发生率更高。%Objective To analyze the clinical characteristics of Cushing's syndrome in patients with different serumal potassium levels and its complications. Methods 156 patients with Cushing's syndrome admitted to our hospital from December 2013 to Jan-uary 2015 were selected as the research object and divided into normal group (n=62) and hypokalemia group (n=94) according to potassium levels. The clinical characteristics and complications of the two groups were analyzed. Results Constituent ratio of male patients in the hypokalemia group was higher than that in the normal group, and there were statistically significant differences be-tween the duration of disease, blood pressure, blood lipid of the male patients in the hypokalemia group and those in the normal group (P<0.05). The incidences of purple striae, ecchymosis, alkalosis, lower extremity edema, and the complications (arrhythmias and so on) rate of the hypokalemia group were obviously higher than those of the normal group. Conclusion Hypokalemia is more common in male

  10. 0.9% saline is neither normal nor physiological%0.9%盐水既不正常也不生理

    Institute of Scientific and Technical Information of China (English)

    Heng LI; Shi-ren SUN; John Q YAP; Jiang-hua CHEN; Qi QIAN

    2016-01-01

    folowing saline infusion. Clinically, saline infusion for patients post abdominal and cardiovascular surgery is associated with a greater number of adverse effects including more frequent blood product transfusion and bicarbonate therapy, reduced gastric blood flow, delayed recovery of gut function, impaired cardiac contractility in response to inotropes, prolonged hospital stay, and possibly increased mortality. In critically il patients, saline infusion, compared to balanced fluid infusions, in-creases the occurrence of acute kidney injury. In summary, saline is a highly acidic fluid. With the exception of saline infusion for patients with hypochloremic metabolic alkalosis and volume depletion due to vomiting or upper gastroin-testinal suction, indiscriminate use, especialy for acutely il patients, may cause unnecessary complications and should be avoided. More education regarding saline-related effects and adequate electrolyte management is needed.

  11. Urea cycle disorders in Thai infants: a report of 5 cases.

    Science.gov (United States)

    Wasant, Pornswan; Srisomsap, Chantragan; Liammongkolkul, Somporn; Svasti, Jisnuson

    2002-08-01

    Urea Cycle Disorders (UCD) is an inborn error of urea synthesis in which ammonium and other nitrogenous precursors of urea accumulate leading to episodic coma and a high mortality rate. Therapy with peritoneal dialysis, essential amino acids or their nitrogen-free analogues has increased survival. The authors report 5 cases of urea cycle disorders, all of whom developed and were rescued from hyperammonemic coma. However, the eventual outcome was quite variable. Argininosuccinate lyase deficiency (ALD) Case 1. A 2 month old male infant, a product of a consanguineous marriage (Suphanburi province); developed poor feeding on day 7, lethargy, convulsion, hepatomegaly and respiratory alkalosis leading to respiratory failure and coma. Hyperammonemia, elevation of glutamic acid and argininosuccinic acid and its anhydrides confirmed the diagnosis of ALD. He is now 9 years old and severely retarded. Case 2. A male infant with history of lethargy, poor feeding on day 3, treated as sepsis and required respiratory support for 6 days; subsequently readmitted at age 2 weeks with vomitting, lethargy, seizure activity and hyperammonemia, and was treated by a local pediatrician in Songkhla province. There was a history of parental consanguinity and he was referred to Siriraj Hospital on day 64 with severe essential amino acid deficiency and acrodermatitis enteropathica with markedly elevated plasma citrulline level. In spite of aggressive treatment; the patient developed sepsis and he expired on day 78. Ornithine transcarbamylase deficiency (OTC) Case 3. An eleven-month-old male infant, the product of a non-consanguineous marriage, developed neonatal onset of hyperammonemia on day 5 after poor feeding, lethargy, hypothermia, seizure, apnea and coma. He was rescued from neonatal hyperammonemic coma on day 9 after aggressive treatment, but expired at eleven months of age after overwhelming sepsis. Case 4. A male infant, sibling of case 3 was referred to Siriraj Hospital on day 8 with

  12. Estudo da capacidade alcalinizante de tampões metabolizáveis em bovinos sadios The alkalinizing effects of different metabolizable buffers in healthy steers

    Directory of Open Access Journals (Sweden)

    M.L.R. Leal

    2007-08-01

    generate a discrete metabolic alkalosis compensated organically by a small retention of CO2. Best alkalinizing effects are obtained by bicarbonate and L-lactato infusions. Bicarbonate infusions causes a high urinary pH.

  13. Blood gas profile of copper-poisoned in sheep treated with ammonium tetrathiomolybdatePerfil de gases sanguíneos de ovinos intoxicados por cobre e tratados com tetratiomolibidato de amônio

    Directory of Open Access Journals (Sweden)

    Maria Claudia Araripe Sucupira

    2012-05-01

    Full Text Available The aim of this study was to evaluate the blood gas profile of experimentally copper-poisoned sheep (in the pre-hemolytic, hemolytic and post-hemolytic phases that have been treated or not treated with ammonium tetrathiomolybdate. Ten lambs of the Santa Ines breed were divided into two groups: control and ATTM (treated (ammonium tetrathiomolibydate. The animals were submitted to increasing doses of copper sulfate until macroscopic hemoglobinuria was detected.All of the control animals from died within four days of hemolytic crisis, and one sheep from ATTM died during the treatment. There was no difference in blood gas parameters between experimental groups. Higher values of pCO2 were observed during the hemolytic crisis (HC in both groups. The control group had higher mean values of hCO3 in the times HC and 2 days after hemolytic crisis (dA when compared with the time 15 before hemolytic crises (dB. The sheep that were treated with ATTM presented lower values of hCO3 at 7dB and higher levels at the HC. The control and ATTM groups exhibited higher values of BE during the HC. Poisoning resulted in disorder in the acid-base equilibrium, characterized by metabolic alkalosis and respiratory acidosis. Treatment with ATTM was able to reverse the changes in acid-base balance in copper poisoning sheep. O objetivo desse estudo foi avaliar o perfil de gases sanguineos em ovinos experimentalmente intoxicados com cobre (fases: pré-hemoltica, hemolitica e pós-hemolitica tratados ou não com tetratiomolibidato de amônio (ATTM. Dez cordeiros da raça Santa Inês foram divididos em dois grupos:controle (tratados com solução fisiologica a 0,9% e ATTM (tratados com 3,4 mg/kg de tetratiomolibidato de amonio. Os animais foram submetidos a doses crescentes de sulfato de cobre até a observação de hemoglobinúria macroscópica. Todos os animais do grupo controle morreram dentro de quatro dias após observação da hemoglobinúria, e um cordeiro do grupo ATTM

  14. Regulation of [15N]urea synthesis from [5-15N]glutamine. Role of pH, hormones, and pyruvate.

    Science.gov (United States)

    Nissim, I; Yudkoff, M; Brosnan, J T

    1996-12-01

    stimulation of [15N]urea synthesis in acute alkalosis is mediated via increased flux through PDG and subsequent increased utilization of [5-15N] of glutamine for [15N]citrulline synthesis and/or increased synthesis of NAG from glutamate and pyruvate. The opposite may have occurred in acute acidosis. Glucagon, but not insulin, stimulated [15N]urea synthesis via increased flux through PDG and synthesis of NAG. Pyruvate stimulated urea synthesis via increased availability of aspartate and/or increased synthesis of NAG. The formation of NAG and aspartate from pyruvate are both pH-sensitive processes.

  15. 一例维吾尔族Gitelman综合征患者的临床与基因突变分析%Clinical and Genetic Analysis of a Uyghur Patient with Gitelman's Syndrome

    Institute of Scientific and Technical Information of China (English)

    努荣古丽买买提; 张化冰; 邢小平

    2015-01-01

    Objective To analyze the clinical manifestations and molecular basis of a Uyghur patient with Gitelman's syndrome ( GS ) . Methods Clinical features, laboratory data, and imaging results of this patient were collected. Genomic DNA was extracted from leukocytes of peripheral blood of the patient. Twenty-six exons of the GS gene and their boundaries with introns were amplified by polymerase chain reaction ( PCR) . The muta-tions of the SLC12A3 gene were identified by direct sequencing. Results GS was diagnosed based on compre-hensive consideration of clinical presentations, laboratory test results, and imaging findings. Gene mutation test revealed a nucleotide substitution of adenine for guanine at the position 1964 of cDNA sequence of SLC12 A3 gene (c. 1964 G>A), which caused a missense mutation of arginine to histidine at codon 655 (p. Arg655His). It oc-curred at the 16 th exon of SLC12 A3 . Conclusions SLC12 A3 gene mutation analysis confirms the diagnosis of GS in this Uyghur patient from the aspect of molecular genetics. GS should be suspected in patients with per-sisting hypokalemia, renal potassium loss, metabolic alkalosis, normal or low-than-normal blood pressure, and hypocalcuria. Genetic analysis of SLC12A3 may be helpful to confirm the diagnosis.%目的 探讨1例维吾尔族Gitelman综合征 (Gitelman's syndrome, GS) 患者的临床表现及其分子生物学基础. 方法 详细收集患者的临床资料、 生化检查及影像学检查结果, 抽取外周静脉血, 提取基因组DNA, 聚合酶链反应 ( poly-merase chain reaction, PCR) 扩增SLC12A3基因的26个外显子及其与内含子的交界区, 测序确定突变情况. 结果 患者临床表现、 实验室检查和影像学检查符合GS诊断. 基因突变分析显示, 患者SLC12A3基因cDNA序列的第1964位鸟嘌呤G纯合突变为腺嘌呤A (c. 1964 G>A), 造成第655位氨基酸由精氨酸改变为组氨酸 (p. Arg655His), 该突变位于SLC12A3的第16外显子. 结论

  16. Acid-Base Disturbance in Patients with Emergent Critical Diseases:Clinical Study of 115 Cases%急诊危重患者酸碱平衡紊乱115例临床研究

    Institute of Scientific and Technical Information of China (English)

    何炳泉; 龙雄; 舒萧

    2014-01-01

    Objective To investigate the types of acid-base disturbance in patients with emergent critical diseases. Methods The types of acid-base disturbance in 115 patients with emergent critical diseases were analyzed. All cases were divided into death group (n=35) and surviving group (n=80), and the results of blood gas analysis were compared between two groups. Results ①Among 115 cases, there were 78 cases (67.83%) of single acid-base disturbance, 36 cases (31.30%) of double acid-base disturbance and one case (0.87%) of triple acid-base disturbance; Metabolic acidosis was the most frequent and occurred in 28 patients (24.35%), followed by respiratory alkalosis, which occurred in 24 patients (20.87%).②There was statistical difference in the blood gas values at last time between the two groups (P<0.05). Conclusions For the treatment and diagnosis of patients with emergent critical diseases, we should understand patients' medical history in detail, conduct blood gas analysis and correct acid-base disturbance actively, so as to ensure success rate of first aid and prognosis.%目的:探讨酸碱平衡紊乱急诊危重患者的类型。方法分析115例酸碱平衡紊乱急诊危重患者的不同类型,并根据治疗情况将其分为死亡组35例及生存组80例,对比两组血气分析测定的结果。结果①115例酸碱平衡紊乱危重者中,仅存有一种酸碱平衡紊乱者78例(67.83豫),两重紊乱者36例(31.30豫),三重紊乱者1例(0.87豫)。115例酸碱平衡紊乱患者中,发生最多的为中代谢性酸中毒28例(24.35豫),其次为呼吸性碱中毒者24例(20.87豫)。②死亡组最后一次血气分析值与生存组相比具有明显差异(孕<0.05)。结论针对急诊危重症者进行处理与诊断时,应详细了解患者的病史,做好血气分析检测,积极纠正酸碱平衡紊乱情况,以此保障患者的急救成功率及预后质量。

  17. Low-salt diet and hyponatremia in chronic congestive heart failure%慢性充血性心力衰竭低盐饮食与低钠血症

    Institute of Scientific and Technical Information of China (English)

    姚亚丽; 李俨; 秦建茹; 张博

    2009-01-01

    目的 探讨慢性充血性心力衰竭(CHF)患者合并低钠血症的病因、后果及治疗措施.方法 120例慢性CHF患者,心功能NYHA分级Ⅲ~Ⅳ级,按就诊先后随机分为观察组60例和对照组60例.观察组给予常规抗心力衰竭治疗和低盐饮食,对照组给予常规抗心力衰竭治疗和正常饮食,观察期3个月.结果 观察组中有32例发生轻度低钠血症,8例出现严重低钠血症,2例因严重低钠血症合并碱中毒和严重低钠血症致心功能恶化死亡;对照组中有2例发生轻度低钠血症,没有发生严重低钠血症及死亡.结论 对于心功能Ⅲ~Ⅳ级慢性CHF患者需长期或间断服用利尿剂,适当补充钠盐或者放宽钠盐的摄入,可有效防止低钠血症及并发症的发生,对已发生低钠血症患者口服钠盐安全有效.%Objective To investigate the causes,prognosis and treatments of chronic congestive heart failure (CHF) with hyponatremia. Methods 120 patients with chronic CHF at Ⅲ~Ⅳ heart function levels were randomly divided into study group and control group with 60 cases in each. The study group received standard heart failure therapy along with low-salt diet while the control group received standard heart failure therapy along with normal diet. All cases were observed for 3 months. Results In the study group,32 cases had mild hyponatremia,8 cases had severe hyponatremia,and 2 cases died of severe hyponatremia with alkalosis and deterioration of heart function. In the control group,2 cases suffered from mild hyponatremia but no cases had sever hyponatremia and died. Conclusion For CHF at Ⅲ~Ⅳ heart function levels,long-term or intermittent diuretic administration accompanied by proper sodium salt supply or loosening the restriction of sodium salt intake may effectively prevent hyponatremia and its complications. For the patients with hyponatremia,oral administration of sodium salt is safe and effective.

  18. 简化局部枸橼酸抗凝在连续性静-静脉血液滤过中的应用%The use of simplified regional citrate anticoagulation in continuous veno-venous hemofiltration

    Institute of Scientific and Technical Information of China (English)

    陈珊莹; 万建新; 吴彼得

    2010-01-01

    .After treatment, the blood volume in the filter was higher than 80% of the original volume.The life span of the filter was (14.79±5.98) hours on the average.Twelve hours after infusing citrate, there was a marked shortening of prothrombin time [PT, (12.2±1.2) s vs.(14.0±3.3) s], while plasma total calcium was increased markedly [(2.46±0.30) mmol/L vs.(2.07±0.36) mmol/L, both P2 000 ml/h of CVVH without complications of hypernatremia and metabolic alkalosis caused by sodium citrate anticoagulation.

  19. 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

    Institute of Scientific and Technical Information of China (English)

    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

  20. 60例重症肺结核合并呼吸衰竭临床分析%THE CLINICAL ANALYSIS ON 60 CASES OF INTENSIVE TUBERCULOSIS COMBINED WITH RESPIRATORY FAILURE

    Institute of Scientific and Technical Information of China (English)

    龚惠莉

    2012-01-01

    [目的]探讨并分析重症肺结核合并呼吸衰竭的临床特征,以较早预防该病的发生,并采取相应的治疗措施.[方法]选取某院60例重症肺结核合并呼吸衰竭的患者,对其临床资料进行分析.[结果] 60例患者经治疗后有3例患者死亡,同时对所有患者的临床资料进行分析,发现有肺部感染42例,占70%;Ⅰ型呼吸衰竭有17例,占28.33%,Ⅱ型呼吸衰竭有43例,占71.67%;酸碱紊乱以呼吸性酸中毒合并代谢性碱中毒为主,有48例,占80%.经治疗后患者的血气分析变化较治疗前差异均有统计学意义(P<0.05).[结论]重症肺结核并发呼吸衰竭的可能诱因为呼吸道感染及接触过敏原等,积极控制感染,避免接触过敏原,积极采取有效的治疗措施,可以有效控制病情的继续进展.%[Objective] To study and analyze the clinical characteristics of intensive tuberculosis combined with respiratory failure, in order to prevent the incidence of the disease early, and take the corresponding treatment measures. [Methods] Chose 60 patients of intensive tuberculosis combined with respiratory failure and analyzed their clinical data. [ Results j 3 patients were died in 60 patients after the treatment Through analyzing the clinical data, it found there were 42 patients with pulmonary infection, accounting for 70%; type I respiratory failure in 17 cases, accounting for 28.33%, type 0 respiratory lail-ure in 43 patients, accounting for 71.67%; respiratory acidosis combined with metabolic alkalosis primarily happened in acid-base disturbances, there were 48 cases, accounting for 80%. After the therapy, the changes of patients' blood gas analysis were statistically significant compared with that before treatment (P < 0.05). [Conclusion] Severe tuberculosis and respiratory failure may cause respiratory infections and contact allergens, such as positive controlling infection and avoiding to contact with allergens, actively adopting effective

  1. 高原地区严重创伤患者动脉血气指标监测分析%Analysis the blood gas of serious trauma patients in plateau

    Institute of Scientific and Technical Information of China (English)

    史连胜; 陶媛; 李瑛; 陈永红; 孙胜; 靳琦琛; 潘春光; 李晔; 黄海涛; 席文雁; 张晓荣; 杜媛媛

    2014-01-01

    Objective:To monitor the index characters of acid-base and oxidation of serious trauma patients in plateau. Meth-ods:90 trauma patients (ISS≥16) were treated in emergence department since Jan 2011 to July 2013,and pH,PaO2,PaCO2,AB,SaO2, P(A-a)O2 were immediately monitored just as they were hospitalized. Results:pH 7.44 ± 0.01,PaO2(mmHg)61.92 ± 1.57,PaCO2 (mmHg) 28.00±0.82 , AB(mmol/L) 19.06±0.31, SaO2(%) 89.27±1.22, P(A-a)O2 (mmHg) 48.10±1.52. Except the PH, the total aver-ages of acid-base and oxidation of the serious trauma patients had statistic differences from those of the plain (P<0.05). Conclusion:In plateau, the serious trauma patients were encountered different hypoxemia and dysfunction of gas exchange, the style of acid-base were characterized of respiratory alkalosis with normal PH and compensatory metabolic acidosis with decreased AB.%目的:监测高原地区严重创伤患者酸碱及氧合指标特点。方法:入选2011年1月—2013年7月来我院急诊科就诊的创伤患者90例(ISS≥16分)。监测动脉血气指标:pH值、动脉血氧分压(PaO2)、动脉血CO2分压(PaCO2)、实际碳酸氢盐(AB)、动脉血氧饱和度(SaO2)、肺泡-动脉氧分压差[P(A-a)O2)]变化特点。结果:pH值7.44±0.01;PaO2(61.92±1.57)mmHg;PaCO2(28.00±0.82)mmHg;AB(19.06±0.31)mmol/L;SaO2(%)89.27±1.22;P(A-a)O2(48.10±1.52)mmHg。高原地区严重创伤后酸碱及氧合各指标与平原地区对比所有酸碱及氧合指标总体均数估计值(除pH值外),差异显著(P<0.05)。结论:高原地区严重创伤发生后,所有患者均存在不同程度的低氧血症及换气功能障碍,酸碱类型特点是以pH值正常范围的呼吸性碱中毒及以AB降低为主的代偿性代谢性酸中毒。

  2. Synchronous cirtric acid anticoagulation and without-heparin anticoagulation in continuous blood purification for patients at high risk of bleeding%同步枸橼酸抗凝与无肝素抗凝在连续性血液净化中的应用及护理

    Institute of Scientific and Technical Information of China (English)

    杨洛; 刁永书; 陈志文; 林丽

    2012-01-01

    目的 探讨连续性血液净化中高危出血患者采用同步枸橼酸抗凝与无肝素抗凝的应用及护理.方法 选择21例高危出血倾向的患者随机分为2组,A组10例采用同步枸橼酸抗凝,行血液净化23例次;B组11例采用无肝素抗凝,行血液净化21例次,监测全血活化凝血时间(WBACT)和PH值、碱剩余(BE)、滤器和管路等指标,比较两种方法的差异,在治疗中怎样对护理问题进行观察及处理.结果 A组患者滤后WBACT较滤前明显延长,而治疗前后WBACT并无明显差异(P>0.05);两组患者滤后与滤前WBACT的延长时间,A组WBACT在2、4及6h的延长时间均明显大于B组(P<0.05);而A组较B组管路使用寿命较长,更换频次较低,肌酐下降率较高(P<0.05),治疗后无碱中毒出现.结论 同步枸橼酸抗凝对患者全身凝血状态无明显影响,不加重出血倾向,管路中抗凝效果好,节约了医疗耗材,适用于高危出血患者的治疗.%Objective To discuss the application and nursing of continuous blood purification using synchronous cirtric acid anticoagulation and without-heparin anticoagulation for patients at high risk of bleeding. Methods Patients were divided into two groups. Group A using synchronous cirtric acid anticoagulation, group B using without-heparin anticoagulation. Clinical indice including whole blood activated clotting time (WBACT), PH value, base excess (BE), higher serum creatinine decrease rate, service life of the hemofilter and pipelines were compared between the two groups during therapy. Results The WBACT before hemofilter was much longer than that after hemofilter (P0. 05). Group A had longer pipeline life service time, lower replace frequency and higher serum creatinine decrease rate than group B (P<0. 05). No alkalosis was found in the cohort. Conclusion Synchronous cirtric acid anticoagulation has no effect on the patients' systemic coagulation, and would not increase bleeding risk, has better

  3. The Anticoagulant Effects of Local Sodium Citrate versus Unfractionated Heparin in Continuous Veno-venous Hemofiltration: A Systematic Analysis%局部枸橼酸钠与普通肝素在连续性静静脉血液滤过中抗凝效果的系统评价

    Institute of Scientific and Technical Information of China (English)

    杜兴; 马成; 杜娟

    2014-01-01

    Objective To assess the efficacy and safety of local citrate anticoagulation in the process of continuous veno-venous hemofiltration(CVVH) for acute kidney injury(AKI) patients in ICU.Methods We searched the Pubmed,EMBASE,CNKI,VIP,CBM,and Cochrane library for randomized controlled trials(RCTs) that comparing the anticoagulate effects of local citrate and unfractionated heparin in CVVH up to April 2014.The RCTs were selected and assessed based on the inclusion and exclusion criteria,then the data was extracted for meta-analysis.Results Finally 4 RCTs with 258 patients met the inclusion criteria.The meta-analysis showed that local sodium citrate obviously decreased the incidence of bleeding(RR =0.25,95 % CI =0.09 ~ 0.68,P =0.006) and prolonged the service life of filter (M D =14.36,95 % CI =1.11 ~ 27.61,P =0.03),but the incidence of metabolic alkalosis (RR =0.89,95 % CI =0.16 ~ 4.96,P =0.90) and hypocalcemia (RR =4.44,95 % CI =0.76 ~ 25.83,P =0.10) was no significant differences between two groups.Conclusion Based on the current clinical evidence,local citrate may be more suitable for the patients with higher risk of bleeding and the treatment of CVVH,because of its advantages of reducing the rate of hemorrhage and extending the service life of filter.%目的:系统评价局部枸橼酸盐抗凝在ICU急性肾损伤患者进行连续性静静脉血液滤过(CVVH)过程中的有效性和安全性.方法:计算机检索PubMed、EMBASE、CNKI、VIP、CBM和Cochrane图书馆,纳入比较枸橼酸盐与普通肝素在CVVH过程中抗凝效果的随机对照试验(RCT),检索日期截止至2014年4月.按照纳入排除标准选择试验并评价其质量,而后提取有效数据进行Meta分析.结果:共纳入4个RCTs,包括258例患者.Meta分析显示:局部枸橼酸钠抗凝能降低出血事件的发生率(RR=0.25,95%CI =0.09 ~0.68,P=0.006),且具有较长的滤器使用寿命(MD=14.36,95%CI=1.11 ~27.61,P=0.03),但代谢性碱中毒(RR =0

  4. Clinical analysis of 103 case of influenza A(H1N1)%103例甲型H1N1流感临床分析

    Institute of Scientific and Technical Information of China (English)

    万瑾; 朱晨曦; 王凯; 刘双; 陈吉祥; 何林林; 夏静鸿; 刘海波; 王珊; 张雪冬; 石秀梅

    2012-01-01

    be double infection, coagulation disorder,respiratory alkalosis and hypoxemia or respiratory failure, which happen easily in existence of chronic underlying diseases.

  5. The clinical features of ectopic ACTH syndrome: a report of 16 cases%16例异位ACTH综合征的临床特点分析

    Institute of Scientific and Technical Information of China (English)

    杨彦; 李春霖; 母义明; 田慧; 陆菊明; 潘长玉

    2010-01-01

    目的 通过分析异位ACTH综合征的临床特点,加深对其的认识,提高诊治水平.方法 回顾性分析解放军总医院2000-2009年确诊的16例异位ACTH综合征患者的临床资料.结果 (1)异位ACTH综合征最常见的病因为肺部肿瘤及胸腺类癌;(2)临床表现以糖代谢异常、高血压、低血钾、下肢水肿最为突出;(3)实验室检查提示血皮质醇、促肾上腺皮质激素(ACTH)及24 h尿游离皮质醇(24hUFC)水平显著升高及严重的低血钾碱中毒;(4)大剂量地塞米松抑制试验、促肾上腺皮质激素释放激素(CRH)兴奋试验及岩下窦取血测定岩下静脉血ACTH与外周静脉血ACTH的比值对定性诊断具有较高价值;(5)X线胸片、胸部CT能发现大多数原发病灶;(6)手术切除原发肿瘤病灶是首选治疗方法.结论 异位ACTH综合征诊断困难,其治疗应首选手术切除原发肿瘤.%Objectives To improve the diagnostic and therapeutic ability of ectopic ACTH syndrome by analysing its clinical features.Methods Sixteen cases of ectopic ACTH syndrome diagnosed in Chinese PLA General Hospital from 2000 to 2009 were analyzed retrospectively.Results ( 1 ) The main causes of ectopic ACTH syndrome were lung tumor and thymic carcinoid;(2) Abnormal glucose metabolism, hypertension, hypokalemia and edema of both lower limbs were the most common clinical symptoms;(3) Laboratory examination showed a significant increase of serum cortisol, adrenocorticotropic hormone(ACTH) and 24 h urinary free cortisol (24hUFC) together with severe hypokalemia and alkalosis;(4) High dose dexamethasone suppressing test, corticotrophin-releasing hormone(CRH) stimulating test and petrosal sinus sampling were the most meaningful diagnostic methods;(5) Most of the primary lesions might be detected with chest film and CT;(6) Resection of the primary lesion was the treatment of first choice.Conclusion The diagnosis of ectopic ACTH syndrome is very hard.Resection of the primary lesion is

  6. CHANGES ELECTROLYTES AND BLOOD GASES IN ARABIAN HORSES DURING TO 60 KM ENDURANCE RACE ALTERAÇÕES HEMOGASOMÉTRICAS E ELETROLÍTICAS DE CAVALOS DA RAÇA ÁRABE DURANTE PROVA DE ENDURO DE 60 KM

    Directory of Open Access Journals (Sweden)

    José Corrêa de Lacerda Neto

    2009-09-01

    Full Text Available Changes in venous blood pH, pCO2, pO2, HCO-3 and cBase, and in serum concentrations of sodium, potassium, ionized calcium and chloride were studied in eight Arabian horses during endurance ride of 60km, with controlled speed of 12km/h-. The blood samples were collected prior to the beginning (M0 of the exercise, immediately after the ride (M1 and one hour after the ride (M2, with the animals resting. Immediately after the end of the exercise (M1 the animals presented higher values for pH which, added to the increase of cHCO3- and cBase, characterized the metabolic alkalosis, probably due to losses of chloride ions in the sweat. The metabolic changes observed in M1 were quickly corrected by respiratory changes, characterized by increased pCO2 or hypoventilation. Additionally, the horses presented dehydration, hypocalcemia and hypokalemia. The metabolic disturbances observed were not associated with clinical changes.

    KEY WORDS: Acid-base, electrolytes, endurance, equine
    Avaliaram-se as alterações do pH, pCO2, pO2, HCO-3 e da cBase do sangue venoso e das concentrações séricas de sódio, potássio, cálcio ionizado e cloreto de oito cavalos adultos da raça Árabe, durante prova de enduro de 60 km de extensão, com velocidade média de 12km h-1. As amostras de sangue foram coletadas antes do início da prova (M0, imediatamente após o seu término (M1 e sessenta minutos após a realização da prova (M2, com os animais já em repouso. Imediatamente após o término do exercício (M1, os animais apresentaram aumento nos valores do pH o qual, associado ao aumento da cHCO3- e da cBase, caracterizou a alcalose metabólica, que teve como provável origem a perda de cloro no suor. As alterações metabólicas observadas no M1 foram rapidamente corrigidas por modificações respiratórias, caracterizadas pelo aumento da pCO2 ou hipoventilação. Adicionalmente, apresentaram desidratação, hipocalemia e hipocalcemia. Não se

  7. 不同病因的库欣综合征患者心脑血管并发症和临床特点的比较%Cardiovascular and cerebrovascular complications and clinical characteristics in patients with Cushing's syndrome of different aetiologies

    Institute of Scientific and Technical Information of China (English)

    唐志清; 朱笑笑; 王先令; 杜锦; 杨国庆; 欧阳金芝; 谷伟军; 郭清华; 金楠

    2013-01-01

    Objective To compare the cardiovascular and cerebrovascular complications and clinical characteristics in patients with Cushing's syndrome of various aetiologies.Methods Two hundred and eighty-four consecutive patients with Cushing's syndrome were included and divided into three groups according to aetiologies:Cushing's disease group (CD),adrenal adenoma group (AA),ectopic ACTH syndrome group (EAS).Results (1) Of the 284 patients,the mean age was(37.7 ± 12.3) years(16-76 years),while in EAS group it was(45.1 ±16.4) years (16-68 years,P <0.05).Patients in EAS group had shorter duration of illness (1-3 months).Hypokalemia was present in 44.9%,32.3%,100% of patients in CD group,AA group,and EAS group respectively.(2) Patients in EAS group were more susceptible to alkalosis and edema of lower limbs,and had lower prevalence of striae (P<0.05) ; AA group had lower prevalence of pigmentation and acne(P<0.01).(3) Patients in EAS group had significantly higher baseline plasma ACTH,cortisol,and 24 h urine free cortisol levels than those in CD group and AA group.(4) Patients in EAS group and CD group had similar prevalences of overall vascular complications(68.8% vs 59.2%,P>0.05),which were significantly higher than that in AA group(43.4%,P<0.05).Compared with AA group,patients in CD group had higher prevalence of cardiovascular complications (43.8% vs 31.3%) and cerebrovascular complications (13.1% vs 6.1%,P<0.05),manifesting as cardiac arrhythmia(33.7% vs 22.2%) and cerebral infarction (13.1% vs 5.1%,P <0.05).No significant difference in the prevalence of impaired renal function in three groups was found (P > 0.05).Multivariate logistic regression analysis revealed that the incidence of hypokalemia was positively correlated with vascular complication in group CD,but serum potassium level was negatively correlated with vascular complication.Conclusion Patients in EAS group were older and had shorter duration of illness,and higher

  8. 连续性血液滤过对重症中暑休克犬内环境和生存率的影响%Effect of continuous hemofiltration on internal environment and survival rate of severe heatstroke dogs with shock

    Institute of Scientific and Technical Information of China (English)

    陈光明; 卢金福; 王文睿; 陈建

    2011-01-01

    group, n=8) and continuous hemofiltration group (CHF group, n= 8). Severe heatstroke model was established by applying high temperature to whole body, and then the animals were removed from the heating cabin as soon as they presented manifestations of shock. Dogs of HS group were put into an ordinary environment, while dogs of CHF group received CHF treatment. The core temperature (Tc), mean arterial pressure (MAP), blood gas analysis, serum electrolytes and survival rate of dogs in two groups were observed. Results The time from heat exposure to shock was 107.0±28.5min and 111.4±22.2min in HS group and CHF group respectively (t= -0.354, P=0.729).The Tc in CHF group declined to normal level 15 to 30 minitues after CHF treatment, while the Tc in HS group remained at a level higher than that before heat exposure at 90min after shock. The Tc of two groups showed significant difference at each time point after shock (P<0.01). The MAP of both groups was obviously lowered than that before heatstroke. The MAP of CHF group raised gradually 30 min after treatment, while the MAP of HS group rose very slowly, and it was significantly lower than that of CHF group at each time point after 45min (P<0.05, P<0. 01). All the dogs in both groups manifested hyperventilation and reapiratory alkalosis when shock appeared.After shock, respiratory alkalosis in HS group gradually became metabolic acidosis, with some animals manifested combined metabolic and respiratory acidosis because of respiratory decompensation, while the blood gas levels in CHF group recovered to normal gradually. The blood gas levels of two groups showed significant difference at each time point after shock (P<0.05, P<0.01). Hypernatremia,hyperehloraemia and hyperpotassaemia were found in all animals of both groups. In CHF group the electrolyte disturbance recovered gradually and reached normal level at 180min after shock, while it did not recover in HS group. The levels of serum sodium, chlorine and

  9. [Clinical studies of pediatric malabsorption syndromes].

    Science.gov (United States)

    Hosoyamada, Takashi

    2006-11-01

    -intestinal tract. 4. In two cases of heterozygous familial hypobetalipoproteinemia, serum total cholesterol and betalipoprotein levels were very low. The subjects presented with symptoms and signs of acanthocytosis and fat malabsorption. Further, one subject had neurological abnormalities such as mental retardation and severe convulsions. Treatment with MCT formula diet corrected the lipid malabsorption. 5. A 5-year-old girl presented with pellagra-like rashes, mental retardation and cerebellar ataxia. An oral tryptophan (Trp) and dipeptide (Trp-Phe) loading test were conducted and the renal clearance of amino acids was also evaluated in this patient and in controls. Following the oral Trp loading test, plasma levels of Trp indicated a lower peak in the case, reaching a maximum at 60 minutes. On the other hand, the oral dipeptide (Trp-Phe) loading test in the Hartnup patient showed the peak Trp plasma level was the same as the control subjects. The renal clearance of neutral amino acids in this case increased to levels 5 to 35 times normal. 6. In the case of congenital chloride diarrhea, the subject had secondary lactose intolerance, dehydration, hyponatremia, hypokalemia, hypochloremia, hyperreninemia and metabolic alkalosis. The chloride content of her fecal fluid was very high. The concentrations were 89-103 mEq/l. In contrast, her urine was chloride-free. The subject's growth and development improved after treatment with lactose free formura and oral replacement of the fecal loses of water, NaCl and KCl. Unfortunately, the patient died of a small bowel intussusception. The kidney histopathological finding was juxtaglomerular hyperplasia by a necropsy. 7. In the case of acrodermatitis enteropathica, the subject had characteristic skin lesions, low serum zinc levels and ALPase activity. An oral ZnSO4 loading test and intestinal mucosal histology by a peroral biopsy were conducted. The serum zinc peak level was 2 hours after the oral ZnSO4 loading test. Infant formula alone could

  10. Application of sodium citrate combined with modified dialysate in continuous venous-venous hemodialysis%枸橼酸钠抗凝联合透析液配方改良在连续性静脉-静脉血液透析中的应用

    Institute of Scientific and Technical Information of China (English)

    兰洋; 齐华林; 庄守纲; 严海东

    2012-01-01

    Objective To investigate the effectiveness and safety of sodium citrate combined with modified dialysate in continuous venous-venous hemodialysis (CVVHD). Methods Sixty-one patients with acute kidney injury (AKI) underwent CVVHD therapy in this study. 4% sodium citrate and modified bicarbonate dialysate were used in 39 patients at high risk of bleeding and active bleeding. Heparin was applied in 22 patients without active bleeding or high risk of bleeding. Calcium and magnesium were continuously supplied during the treatment periods. Initial flow of blood, dialysate, 4% sodium citrate and calcium chloride were adjusted according to the body weight. Arterial blood gas, calcium ion concentration in peripheral blood and dialyser, serum total calcium ion concentration, the blood coagulation of tube pathways and blood filters were recorded. Adverse reaction was observed during the treatment. Results Vital signs kept stable in all patients. No convulsion or muscular spasm happened. The blood filter for sodium citrate was more durable than that for sodium heparin ([74 ± 42] h vs. [32±26] h, P<0.01). Twenty-two patients (56.4%) developed metabolic alkalosis. Of them, acid-base balance were corrected in 21 patients (95.5%) within 48 h by increasing the dialysate blow (250-500 mL/h). Conclusion Ideal therapeutic effects and low hemorrhagic tendency can be achieved in AKI patients at high risk of bleeding or active bleeding by using sodium citrate substitution fluid during CVVHD. (Shanghai Med J, 2012, 35: 585-587)%目的 探讨枸橼酸钠抗凝联合透析液配方改良在连续性静脉-静脉血液透析(CVVHD)中应用的有效性和安全性.方法 共入选61例急性肾损伤( AKI)患者均行CVVHD治疗,其中39例合并活动性出血或高危出血患者(RCA组)给予4%枸橼酸钠抗凝和配方改良过的碳酸氢钠透析液,持续补钙;22例无活动性出血或高危出血患者行肝素抗凝(肝素组).开始治疗时,根据患者的体重调整

  11. 小儿幽门管溃疡36例%Pyloric Canal Ulcer in 36 Children

    Institute of Scientific and Technical Information of China (English)

    陈昌斌; 游洁玉; 陈志勇; 欧阳文献; 罗艳红; 赵红梅; 段柏萍

    2011-01-01

    目的 探讨小儿幽门管溃疡的临床特点、诊断及治疗方法.方法 回顾性分析36例(男22例,女14例;年龄6个月~12岁)幽门管溃疡的的临床表现、胃镜和钡餐检查特点及其治疗和预后.结果 以呕吐为首发表现的患儿33例(占91.7%),伴食欲减退30例,腹痛20例,黑便、消瘦各12例,面色苍黄、腹上区包块各10例;合并不同程度贫血29例,代谢性碱中毒27例,低钠、低钾、低氯血症各18例.胃镜首次检查能通过幽门并发现幽门管溃疡9例,并幽门梗阻且胃镜前端不能通过者27例;对胃镜不能通过者行稀钡餐检查,结果显示幽门管溃疡6例,幽门不完全性梗阻21例.23例(63.9%)经内科保守治疗治愈,13例(36.1%)经手术治疗治愈.结论 小儿幽门管溃疡的首发表现为呕吐,胃镜和钡餐检查是确诊幽门管溃疡的主要手段.治疗方面以内科保守治疗为主,幽门管溃疡由于其解剖位置特异,其抑酸治疗的疗程适当延长,主张以4~6周为1个疗程抑酸治疗,患儿不易复发;对少数难以控制的大出血者、幽门完全性梗阻经保守治疗72 h无效者及易复发的多发性幽门管溃疡者应选择手术治疗.%Objective To explore the clinical features,diagnosis and treatment of children with pyloric canal ulcer.Methods Medical records of the clinical performance, the characteristics of electronic endoscopy and barium meal examination of 36 hospitalized cases ( with the pyloric canal ulcer) including 22 male and 14 female,aged 6 months to 12 years old and its treatment and prognosis were analyzed retrospectively.Results Vomiting was the first symptom in 33 cases of the 36 children (91.7%) ,30 cases with loss of appetite,abdominal pain in 20 cases,melena in 12 cases,weight loss in 12 cases looking greenish yellow on the face in 10 cases;upper abdominal mass in 10 cases;different degrees of anemia in 29 cases, metabolic alkalosis in 27 cases,low sodium and low potassium and low

  12. 低分子肝素钠联合枸橼酸钠在血浆吸附灌流中的抗凝效果%Anticoagulant effects of low-molecular-weight heparin combined with citrate in plasma perfusion patients

    Institute of Scientific and Technical Information of China (English)

    李国强; 燕朋波; 刘阳; 魏路清; 孙亮

    2013-01-01

    Objective To observe the anticoagulant effects and safety of the low-molecular-weight heparin combined with citrate in plasma perfusion patients with high risk of bleeding.Methods A total of 24 patients of poisoning associated with upper gastrointestinal bleeding were treated with plasma perfusion treatment and the low molecular weight heparin combined with citrate was used to anticoagulate.The changes of arterial pH,serum ionized sodium,bicarbonate and gastric juice occult blood were observed before and after 2,4,6,8 hours of plasma perfusion.The filter pressure,venous pressure and heart rate were observed after 30 minutes and 1 hour,2,4,6,8 hours of plasma perfusion.Results Among the total of 24 patients,20 cases completed plasma perfusion successfully,3 cases generated plasma separator coagulation and 1 case occurred acute left ventricular failure.Compared with plasma perfusion after 30 rain,the filter pressure in the upper 2 hours of plasma perfusion continued to increase (P < 0.05),but after 2 hours the filter pressure began to decrease,after 6 hours the filter pressure was stable;the venous pressure and heart rate continued to decline after 2、4、6、8 hours of plasma perfusion (P < 0.05),after 4hours and 6 hours the venous pressure and heart rate were stable.At 2,4,6,8 hours after plasma perfusion,the serum sodium,bicarbonate and pH increased consistently,at 8 hours after plasma perfusion,the pH value,serum sodium and bicarbonate increased significantly compared with before plasma perfusion(P <0.05).Gastric juice occult blood had no significant changes at 2,4,6,8 hours of after plasma perfusion.Conclusion The low molecular weight heparin combined with citrate anticoagulant in plasma perfusion has a good anticoagulant effects,and doesn't aggravate the bleeding,but in earlier period,plasma separator coagulation will be generated easily,and with the extension of the treatment time,alkalosis and hypernatremia will happen.%目的 观察低分子肝素钠

  13. 胃镜下幽门肌切开术治疗先天性肥厚性幽门狭窄%Treatment of congenital hypertrophic pyloric stenosis with endoscopic pyloromyotomy

    Institute of Scientific and Technical Information of China (English)

    张又祥; 聂玉强; 肖雪; 喻宁芬; 黎庆宁; 邓礼

    2008-01-01

    目的 探讨胃镜下幽门肌切开术治疗先天性肥厚性幽门狭窄(CHPS).方法 具有典型临床表现,结合B超、胃肠造影和胃镜确诊为CHPS的9例患儿,男7例,女2例,年龄26~70 d,体重2.65~6.10 kg.在胃镜室,经苯巴比妥钠和咪达唑仑镇静后,直径5.9 mm电子胃镜经口入胃,通过幽门达十二指肠降段.在胃镜直视下,使用弓形乳头肌切开刀和针式切开刀,按球部→胃窦方向,电切狭窄幽门管前壁和后壁肥厚的黏膜及环形肌,以暴露纵形肌为标志,深度2~4 mm.术中使用吸引和去泡剂.结果 术后胃镜容易通过幽门.B超及造影显示液体顺利通过幽门.术后2~10 h喂养,呕吐次数和呕吐量均显著减少,8例在1周内消失,1例呕吐持续1个月.无胃肠道穿孔、大出血等严重并发症.随访2~9个月,8例经1次治疗痊愈,1例呕吐停止1个月后复发,经第2次治疗痊愈.结论 胃镜下幽门肌切开术治疗CHPS是有效而安全的.该方法不用开腹手术,操作简便,不良反应少,恢复喂养快.%Objective To evaluate the effect of the treatment of congenital hypertrophic pyloric stenosis (CHPS) with endoscopic pyloromyotomy.Method Nine consecutive infants(7 boys,2 girls;age range 26-70 days:weight range 2.65-6.10 kg),with a diagnosis of CHPS according to typical clinical manifestations,transabdominal uhrasound(US),gastroenterography and gastroscope.All the cases had accompanying malnutrition,anaemia,metabolic alkalosis,and some were complicated with congenital heart disease.In gastroscope operating room,all the patients were given pentobarbital and midazolam intravenously.A gastroscope with an outer diameter of 5.9 mm was passed through mouth,stomach,pylorus to the descending segment of duodenum.Under gastroscopy,two incisions were made along the anterior and posterior wall of pylorus from the duodenal bulb to the antrum by using endoscopic electrosurgical needle knife and an arch sDhincter sarcotom. Incisions were

  14. Clinical analysis on 9 cases of nervous system disorder caused by Heat stroke%热射病致神经系统损害9例临床分析

    Institute of Scientific and Technical Information of China (English)

    王美红; 鞠小宁; 周庆博; 孙琳; 尚伟; 许继平; 毕建忠

    2015-01-01

    temperature were 39.8℃~42.5℃. Patients had disturbance of consciousness and multi⁃ple organ dysfunction including acute cerebral infarct in 2 cases, peripheral neuropathy in 3 cases, acute respiratory fail⁃ure in 2 cases, pulmonary infection in 9 cases, disseminated intravascular coagulation in 1 case ,acute myocardial injury in 8 cases, arrhythmia in 3 cases, rhabdomyolysis in 3 cases, acute liver damage in 8 cases, of acute kidney injury in 6 cases, upper gastrointestinal bleeding in 4 cases, metabolic acidosis in 1 case, metabolic alkalosis in 2 cases , electrolyte disorder in 9 cases and quadriplegia in 3 cases. Brain magnetic resonance imaging showed diffuse brain swelling in 6 cas⁃es and the acute asymmetric lacunar infarction in 2 cases. All patients are treated with cooling , rehydration , anticoagula⁃tion , reduction of the intracranial pressure and symptomatic treatment. One case died and the condition of remaining cas⁃es were improved. At one-year follow-up, the symptoms were almost cured in 2 cases, significantly improved in 4 cases with disability degree in grade 1~2, moderately improved in 1 case with disability degree in grade 3, remained unchanged in 1 case with disability degree of grade 5. Conclusion Heat stroke can cause conscious disorder and multiple organ fail⁃ure .The central nervous system lesions are often presented with diffuse swelling or/and lacunar infarction and presented with peripheral nerve injury in some cases, leaving persistent neurological deficits .

  15. The safety and efficacy of regional citrate anticoagulation in sustained low efficiency dialysis%枸橼酸抗凝在持续缓慢低效血液透析中的疗效和安全性

    Institute of Scientific and Technical Information of China (English)

    张凌; 王婷立; 赵宇亮; 陈志文; 唐怡; 杨莹莹; 廖宇捷; 付平

    2013-01-01

    ,thrombocytopenia,cardiac arrhythmia,hypernatremia,metabolic alkalosis or hypotension was observed.Conclusion SLED under regional citrate anticoagulation is safe and effective.Citrate achieves satisfying regional anticoagulation effect without interfering systemic clotting function,thus this study provides a new option of SLED anticoagulation for clinicians.%目的 观察枸橼酸抗凝应用于持续缓慢低效血液透析(SLED)的安全性及有效性.方法 前瞻性观察四川大学华西医院2011年8月至2012年9月收治的45例急性肾损伤或终末期肾病患者.所有患者血管通路均采用颈/股静脉留置双腔导管,采用费森尤斯4008sARrTplus透析机进行SLED,治疗时间为8h.4%枸橼酸钠以130 ml/h由动脉端泵入,血流量150 ml/min,无钙透析液流量200 ml/min,10%葡萄糖酸钙以40 ml/h静脉端泵入.分别在0、2、5h测定枸橼酸浓度,并观察外周血及透析器后血清游离钙水平.结果 45例患者行SLED治疗162例次,除2例次患者分别在治疗4h及6h时出现1次透析器Ⅲ°凝血需更换透析管路外,余160例次(98.8%)SLED均顺利完成.0h枸橼酸浓度为(0.14 ±0.06) mmol/L,虽然2h及5h外周血枸橼酸浓度轻度升高,但两组间差异无明显统计学意义[(1.08±0.12) mmol/L比(1.11 ±0.17) mmol/L,P>0.05].0、2、5h的外周血游离钙水平分别为(1.04±0.13)mmol/L、(1.07±0.23) mmol/L及(1.04±0.24) mmol/L,组间差异无统计学意义(P>0.05).2h及5h滤器后游离钙水平分别为(0.31±0.04) mmo1/L及(0.29±0.03) mmol/L.2h和5h的跨膜压分别为(104.5±17.8) mm Hg(1 mm Hg=0.133 kPa)和(109.3±20.1)mm Hg,两组间差异无统计学意义(P>0.05).5h测定外周血凝血酶原时间及活化部分凝血活酶时间与治疗前比较差异无统计学意义(P>0.05).在SLED治疗过程中未出现出血、血小板减少、心律失常、高钠血症、代谢性碱中毒及低血压事件.结论 枸橼酸抗凝在SLED应用中安全有效,在保证有效的局部抗凝过程下不影响

  16. Selected Abstracts of the 1st Congress of joint European Neonatal Societies (jENS 2015; Budapest (Hungary; September 16-20, 2015; Session “Brain & Development”

    Directory of Open Access Journals (Sweden)

    Various Authors

    2015-09-01

    PERINATAL ASPHYXIA REVEALS LASTING BEHAVIORAL DEFICITS • A. Kerenyi, E. Sipos, P. Bakos, K. Demeter, P. Pottyondi, J. Haller, M. Szabo, K. Kaila, E. Mikics, A. Denes, A. FeketeABS 28. EFFECT OF EARLY NUTRITION ON PRETERM CEREBRAL MATURATION AND BRAIN INJURY REFLECTED BY MR-IMAGING AT TERM • L. Beauport, J. Schneider, P. Hagmann, M. Faouzi, C.J. Fischer Fumeaux, A.C. TruttmannABS 29. NEURITE OUTGROWTH IN RESPONSE TO CEREBROSPINAL FLUID DERIVED FROM NEC-SENSITIVE PRETERM PIGS • J. Sun, S. Pankratova, D.E.W. Chatterton, P.T. SangildABS 30. URINARY NEUTROPHIL GELATINASE-ASSOCIATED LIPOCALIN (NGAL AFTER GLOBAL HYPOXIA-ISCHEMIA IN NEWBORN PIGLETS • H.T. Garberg, M.U. Huun, G. Dyrhaug, R. Solberg, O.D. SaugstadABS 31. CEREBRAL DEEP GREY MATTER ALKALOSIS IN BABIES WITH NEONATAL ENCEPHALOPATHY IS ASSOCIATED WITH AN INCREASED SEIZURE BURDEN • C. Uria-Avellanal, D. Price, M. Sokolska, S. Mitra, A. Bainbridge, X. Golay, N. RobertsonABS 32. THE PROGNOSTIC VALUE OF NIRS DURING THERAPEUTIC HYPOTHERMIA IN TERM ASPHYXIATED NEWBORNS • P. Costa, A. Graça, I. Sampaio, C. MonizABS 33. EEG DISCONTINUITY PREDICTS CEREBRAL TISSUE INJURY AND ADVERSE NEURODEVELOPMENT IN COOLED NEWBORNS • J. Dunne, D. Wertheim, P. Clarke, O. Kapellou, P. Chisholm, J. Boardman, D. ShahABS 34. A RANDOMIZED CONTROLLED TRIAL OF COOLING COMBINED WITH INHALED XENON FOR PERINATAL ASPHYXIAL ENCEPHALOPATHY WITH CEREBRAL MAGNETIC RESONANCE ENDPOINTS – THE TOBY-Xe TRIAL • D. Azzopardi, N. Robertson, A. Bainbridge, E. Cady, A. Deierl, G. Fagiolo, N. Franks, J. Griffiths, J. Hajnal, E. Juszczak, B. Kapetanakis, L. Linsell, M. Maze, O. Omar, B. Strohm, N. Tusor, A.D. EdwardsABS 35. MULTIORGAN DYSFUNCTION IN NEWBORNS WITH HYPOXIC-ISCHEMIC ENCEPHALOPATHY IN THE HYPOTERMIA ERA • M. Alsina, A. Martin-Ancel, P. Alamillo, M. Leon, A Garcia-AlixABS 36. HYPOXIC-ISCHAEMIC BRAIN INJURY: DELIVERY BEFORE INTRAPARTUM EVENTS • D. Odd, A. Heep, K. Luyt, T. DraycottABS 37. IS NEONATAL ESTABLISHED HEARING LOSS PERMANENT IN