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Bicarbonate therapy in metabolic acidosis

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https://www.readbyqxmd.com/read/27876158/is-bicarbonate-therapy-useful
#1
REVIEW
Kate Hopper
Despite concerns about the negative effects of metabolic acidosis, there is minimal evidence that sodium bicarbonate administration is an effective treatment. In addition, sodium bicarbonate therapy is associated with many adverse effects, including paradoxic intracellular acidosis, hypokalemia, hypocalcemia, hypernatremia, and hyperosmolality. Definitive recommendations regarding bicarbonate therapy are challenging as there is little high-quality evidence available. In most clinical scenarios of metabolic acidosis, treatment efforts should focus on resolution of the underlying cause, and sodium bicarbonate therapy should be used with caution, if at all...
November 18, 2016: Veterinary Clinics of North America. Small Animal Practice
https://www.readbyqxmd.com/read/27770799/correction-of-metabolic-acidosis-improves-insulin-resistance-in-chronic-kidney-disease
#2
Antonio Bellasi, Lucia Di Micco, Domenico Santoro, Stefania Marzocco, Emanuele De Simone, Mario Cozzolino, Luca Di Lullo, Pasquale Guastaferro, Biagio Di Iorio
BACKGROUND: Correction of metabolic acidosis (MA) with nutritional therapy or bicarbonate administration is widely used in chronic kidney disease (CKD) patients. However, it is unknown whether these interventions reduce insulin resistance (IR) in diabetic patients with CKD. We sought to evaluate the effect of MA correction on endogenous insulin action in diabetic type 2 (DM2) CKD patients. METHODS: A total of 145 CKD subjects (83 men e 62 women) with DM2 treated with oral antidiabetic drugs were included in the study and followed up to 1 year...
October 22, 2016: BMC Nephrology
https://www.readbyqxmd.com/read/27599629/approach-to-the-treatment-of-diabetic-ketoacidosis
#3
Kamel S Kamel, Martin Schreiber, Ana P C P Carlotti, Mitchell L Halperin
Diabetic ketoacidosis (DKA), a common cause of severe metabolic acidosis, remains a life-threatening condition due to complications of both the disease and its treatment. This Acid-Base and Electrolyte Teaching Case discusses DKA management, emphasizing complications of treatment. Because cerebral edema is the most common cause of mortality and morbidity, especially in children with DKA, we emphasize its pathophysiology and implications for therapy. The risk for cerebral edema may be minimized by avoiding a bolus of insulin, excessive saline resuscitation, and a decrease in effective plasma osmolality early in treatment...
September 3, 2016: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
https://www.readbyqxmd.com/read/27542916/acute-kidney-injury-in-hiv-infected-children-comparison-of-patients-according-to-the-use-of-highly-active-antiretroviral-therapy
#4
Douglas de Sousa Soares, Malena Gadelha Cavalcante, Samille Maria Vasconcelos Ribeiro, Rayana Café Leitão, Ana Patrícia Freitas Vieira, Roberto da Justa Pires Neto, Geraldo Bezerra da Silva Junior, Elizabeth De Francesco Daher
OBJECTIVE: To assess clinical and laboratory data, and acute kidney injury (AKI) in HIV-infected children using and not using highly active antiretroviral therapy (HAART) prior to admission. METHODS: A retrospective study was conducted with HIV-infected pediatric patients (<16 years). Children who were using and not using HAART prior to admission were compared. RESULTS: Sixty-three patients were included. Mean age was 5.3±4.27 years; 55...
August 16, 2016: Jornal de Pediatria
https://www.readbyqxmd.com/read/27515860/effect-of-metabolic-acidosis-on-qt-intervals-in-patients-with-chronic-kidney-disease
#5
Ezgi Coskun Yenigun, Cenk Aypak, Didem Turgut, Mehmet Zafer Aydin, Fatih Dede
BACKGROUND: There is a strong association between chronic kidney disease (CKD) and cardiovascular events. Increased arrhythmia risk in kidney disease is one of the main predominant factors in increased mortality and sudden cardiac death. To estimate this risk, noninvasive measurement of repolarization abnormalities including QT interval and its heart rate-corrected value (QTc) with surface ECG, are commonly used parameters in clinical practice. The aim of this study is to examine the effect of CKD-related problems - mainly acidosis - on QT intervals...
August 19, 2016: International Journal of Artificial Organs
https://www.readbyqxmd.com/read/27495287/effect-of-oral-sodium-bicarbonate-on-fibroblast-growth-factor-23-in-patients-with-chronic-kidney-disease-a-pilot-study
#6
Wei Chen, Michal L Melamed, Thomas H Hostetter, Carolyn Bauer, Amanda C Raff, Anthony L Almudevar, Amy Lalonde, Susan Messing, Matthew K Abramowitz
BACKGROUND: The regulation of fibroblast growth factor-23 (FGF23) secretion in patients with chronic kidney disease (CKD) is incompletely understood. An in vitro study showed that metabolic acidosis increased FGF23 in mouse bone. The objective of this study is to evaluate the effect of oral sodium bicarbonate on circulating FGF23 levels in patients with CKD. METHODS: This was a single-blind pilot study. Twenty adults with estimated glomerular filtration rate between 15-45 mL/min/1...
2016: BMC Nephrology
https://www.readbyqxmd.com/read/27411724/con-higher-serum-bicarbonate-in-dialysis-patients-is-protective
#7
Philippe Chauveau, Claire Rigothier, Christian Combe
Metabolic acidosis is often observed in advanced chronic kidney disease, with deleterious consequences on the nutritional status, bone and mineral status, inflammation and mortality. Through clearance of the daily acid load and a net gain in alkaline buffers, dialysis therapy is aimed at correcting metabolic acidosis. A normal bicarbonate serum concentration is the recommended target in dialysis patients. However, several studies have shown that a mild degree of metabolic acidosis in patients treated with dialysis is associated with better nutritional status, higher protein intake and improved survival...
August 2016: Nephrology, Dialysis, Transplantation
https://www.readbyqxmd.com/read/27408343/fanconi-syndrome-a-rare-initial-presentation-of-acute-lymphoblastic-leukemia
#8
Kamal Kant Sahu, Arjun Datt Law, Nidhi Jain, Alka Khadwal, Vikas Suri, Pankaj Malhotra, Subhash Chander Varma
A-14-year old boy, presented with a short history of excessive thirst and increased urine output. Clinical examination showed pallor, generalized lymphadenopathy and hepatosplenomegaly. For evaluation of his polyuric state he underwent routine laboratory investigations, including renal function test, acid-base studies, urine analysis. Blood tests suggested hypokalemia, hypouricemia, hypocalcemia and hyperchloremia with normal liver and kidney function tests. The arterial blood gas analysis was suggestive of normal anion gap metabolic acidosis...
June 2016: Indian Journal of Hematology & Blood Transfusion
https://www.readbyqxmd.com/read/27366514/successful-management-of-aluminium-phosphide-poisoning-resulting-in-cardiac-arrest
#9
Sedat Hakimoğlu, İsmail Dikey, Ali Sarı, Leyla Kekeç, Kasım Tuzcu, Murat Karcıoğlu
Aluminum phosphide has high toxicity when it is ingested, and in case of contact with moisture, phosphine gas is released. Aluminum phosphide poisoning causes metabolic acidosis, arrhythmia, acute respiratory distress syndrome and shock, and there is no specific antidote. A 17-year-old male patient was referred to our hospital because of aluminum phosphide poisoning with 1500 mg of aluminum phosphide tablets. The patient's consciousness was clear but he was somnolent. Vital parameters were as follows: blood pressure: 85/56 mmHg, pulse: 88 beats/min, SpO2: 94%, temperature: 36...
August 2015: Turkish Journal of Anaesthesiology and Reanimation
https://www.readbyqxmd.com/read/27352175/a-comparison-between-two-dilute-citrate-solutions-15-vs-18-mmol-l-in-continuous-renal-replacement-therapy-the-base-excess-and-renal-substitution-solution-study
#10
Chris Anstey, Victoria Campbell, Alexander Richardson
BACKGROUND/AIMS: The study aimed to compare the changes in biochemistry occurring in patients undergoing continuous renal replacement therapy (CRRT) using 2 trisodium citrate solutions, Baxter hemofiltration fluid containing 18 mmol/l (C18) and Baxter NamSol, a custom manufactured solution containing 15 mmol/l (C15), both delivered as regional citrate anticoagulation (RCA) predilution fluids for hemofiltration. METHODS: This is a prospective randomized control trial conducted in a major regional adult intensive care unit...
2016: Blood Purification
https://www.readbyqxmd.com/read/27082665/american-association-of-clinical-endocrinologists-and-american-college-of-endocrinology-position-statement-on-the-association-of-sglt-2-inhibitors-and-diabetic-ketoacidosis
#11
Yehuda Handelsman, Robert R Henry, Zachary T Bloomgarden, Sam Dagogo-Jack, Ralph A DeFronzo, Daniel Einhorn, Ele Ferrannini, Vivian A Fonseca, Alan J Garber, George Grunberger, Derek LeRoith, Guillermo E Umpierrez, Matthew R Weir
AACE = American Association of Clinical Endocrinologists ACE = American College of Endocrinology DKA = diabetic ketoacidosis EMA = European Medicines Agency FDA = U.S. Food and Drug Administration SGLT-2 = sodium glucosecotransporter 2 T1D = type 1 diabetes T2D = type 2 diabetes.
June 2016: Endocrine Practice
https://www.readbyqxmd.com/read/26984838/0-9-saline-is-neither-normal-nor-physiological
#12
Heng Li, Shi-ren Sun, John Q Yap, Jiang-hua Chen, Qi Qian
The purpose of this review is to objectively evaluate the biochemical and pathophysiological properties of 0.9% saline (henceforth: saline) and to discuss the impact of saline infusion, specifically on systemic acid-base balance and renal hemodynamics. Studies have shown that electrolyte balance, including effects of saline infusion on serum electrolytes, is often poorly understood among practicing physicians and inappropriate saline prescribing can cause increased morbidity and mortality. Large-volume (>2 L) saline infusion in healthy adults induces hyperchloremia which is associated with metabolic acidosis, hyperkalemia, and negative protein balance...
March 2016: Journal of Zhejiang University. Science. B
https://www.readbyqxmd.com/read/26955212/impact-of-dialysis-practice-patterns-on-outcomes-in-acute-kidney-injury-in-intensive-care-unit
#13
Rajeev A Annigeri, Venkatappa Nandeesh, Ramanathan Karuniya, Sasikumar Rajalakshmi, Ramesh Venkataraman, Nagarajan Ramakrishnan
AIM: Recent advances in dialysis therapy have made an impact on the clinical practice of renal replacement therapy (RRT) in acute kidney injury (AKI) in Intensive Care Unit (ICU). We studied the impact of RRT practice changes on outcomes in AKI in ICU over a period of 8 years. SUBJECTS AND METHODS: AKI patients requiring RRT in ICU referred to a nephrologist during two different periods (period-1: Between May 2004 and May 2007, n = 69; period-2: Between August 2008 and May 2011, n = 93) were studied...
January 2016: Indian Journal of Critical Care Medicine
https://www.readbyqxmd.com/read/26915026/sodium-bicarbonate-infusion-in-patients-undergoing-orthotopic-liver-transplantation-a-single-center-randomized-controlled-pilot-trial
#14
Laurence Weinberg, Jeremy Broad, Param Pillai, Guangjun Chen, Micheline Nguyen, Glenn M Eastwood, Nick Scurrah, Mehrdad Nikfarjam, David Story, Larry McNicol, Rinaldo Bellomo
BACKGROUND: Liver transplantation-associated acute kidney injury (AKI) carries significant morbidity and mortality. We hypothesized that sodium bicarbonate would reduce the incidence and/or severity of liver transplantation-associated AKI. METHODS: In this double-blinded pilot RCT, adult patients undergoing orthotopic liver transplantation were randomized to an infusion of either 8.4% sodium bicarbonate (0.5 mEq/kg/h for the first hour; 0.15 mEq/kg/h until completion of surgery); (n = 30) or 0...
May 2016: Clinical Transplantation
https://www.readbyqxmd.com/read/26880451/treatment-of-hyperkalemia-something-old-something-new
#15
REVIEW
Richard H Sterns, Marvin Grieff, Paul L Bernstein
Treatment options for hyperkalemia have not changed much since the introduction of the cation exchange resin, sodium polystyrene sulfonate (Kayexalate, Covis Pharmaceuticals, Cary, NC), over 50 years ago. Although clinicians of that era did not have ready access to hemodialysis or loop diuretics, the other tools that we use today-calcium, insulin, and bicarbonate-were well known to them. Currently recommended insulin regimens provide too little insulin to achieve blood levels with a maximal kalemic effect and too little glucose to avoid hypoglycemia...
March 2016: Kidney International
https://www.readbyqxmd.com/read/26807262/pseudohypoaldosteronism-type-1-due-to-novel-variants-of-scnn1b-gene
#16
Yael R Nobel, Maya B Lodish, Margarita Raygada, Jaydira Del Rivero, Fabio R Faucz, Smita B Abraham, Charalampos Lyssikatos, Elena Belyavskaya, Constantine A Stratakis, Mihail Zilbermint
UNLABELLED: Autosomal recessive pseudohypoaldosteronism type 1 (PHA1) is a rare disorder characterized by sodium wasting, failure to thrive, hyperkalemia, hypovolemia and metabolic acidosis. It is due to mutations in the amiloride-sensitive epithelial sodium channel (ENaC) and is characterized by diminished response to aldosterone. Patients may present with life-threatening hyperkalemia, which must be recognized and appropriately treated. A 32-year-old female was referred to the National Institutes of Health (NIH) for evaluation of hyperkalemia and muscle pain...
2016: Endocrinology, Diabetes & Metabolism Case Reports
https://www.readbyqxmd.com/read/26776539/approach-to-the-treatment-of-chronic-metabolic-acidosis-in-ckd
#17
Kalani L Raphael
Chronic metabolic acidosis is not uncommon in patients with chronic kidney disease (CKD). Clinical practice guidelines suggest that clinicians administer alkali to maintain serum bicarbonate level at a minimum of 22 mEq/L to prevent the effects of acidosis on bone demineralization and protein catabolism. Small interventional studies support the notion that correcting acidosis slows CKD progression as well. Furthermore, alkaline therapy in persons with CKD and normal bicarbonate levels may also preserve kidney function...
April 2016: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
https://www.readbyqxmd.com/read/26477665/metabolic-acidosis-of-ckd-an-update
#18
REVIEW
Jeffrey A Kraut, Nicolaos E Madias
The kidney has the principal role in the maintenance of acid-base balance. Therefore, a decrease in renal ammonium excretion and a positive acid balance often leading to a reduction in serum bicarbonate concentration are observed in the course of chronic kidney disease (CKD). The decrease in serum bicarbonate concentration is usually absent until glomerular filtration rate decreases to <20 to 25mL/min/1.73 m(2), although it can develop with lesser degrees of decreased kidney function. Non-anion gap acidosis, high-anion gap acidosis, or both can be found at all stages of CKD...
February 2016: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
https://www.readbyqxmd.com/read/26420895/should-chronic-metabolic-acidosis-be-treated-in-older-people-with-chronic-kidney-disease
#19
REVIEW
Miles D Witham, Edmund J Lamb
Metabolic acidosis is common in advanced chronic kidney disease and has been associated with a range of physiological derangements of importance to the health of older people. These include associations with skeletal muscle weakness, cardiovascular risk factors, and bone and mineral disorders that may lead to fragility fractures. Although metabolic acidosis is associated with accelerated decline in kidney function, end-stage renal failure is a much less common outcome in older, frail patients than cardiovascular death...
November 2016: Nephrology, Dialysis, Transplantation
https://www.readbyqxmd.com/read/26345674/renal-tubular-acidosis-type-iv-as-a-complication-of-lupus-nephritis
#20
C Sánchez-Marcos, V Hoffman, S Prieto-González, J Hernández-Rodríguez, G Espinosa
Renal tubular acidosis (RTA) is a rare complication of renal involvement of systemic lupus erythematosus (SLE). We describe a 24-year-old male with type IV lupus nephropathy as a presenting manifestation of SLE. He presented with improvement of renal function following induction therapy with three pulses of methylprednisolone and 500 mg biweekly pulses of cyclophosphamide. However, a week after the first pulse of cyclophosphamide, the patient presented with a significant increase in legs edema and severe hyperkalemia...
March 2016: Lupus
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