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electrolyte and acid-base abnormalities

Francesco Caccetta, Maurizio Caroppo, Fernando Musio, Anna Mudoni, Antonella Accogli, Maria Dolores Zacheo, Domenica Burzo, Rolando Mangia, Michele Accogli, Vitale Nuzzo
Takotsubo cardiomyopathy (CT) is a syndrome characterized by an acute and transient left ventricular dysfunction, electrocardiographic abnormalities suggestive of acute coronary syndrome, chest pain and/or dyspnea, left ventricular mid-apical segments akinesia and normal coronary angiography. It is mainly observed in postmenopausal women after an intense physical or mental stress. The course is usually favourable but sometimes severe complications occur. The recurrence rate is 2-10%. We present the case of a recurrence of CT in a female, 79 years old, with hypertension, diabetes, chronic kidney disease (CKD) stage 3 who was admitted to the emergency room for dyspnea and vomiting...
November 2016: Giornale Italiano di Nefrologia: Organo Ufficiale Della Società Italiana di Nefrologia
Dagmara Hering, Pawel J Winklewski
Acute kidney injury (AKI) is a rapid loss of kidney function resulting in accumulation of end metabolic products and associated abnormalities in fluid, electrolyte and acid-base homeostasis. The pathophysiology of AKI is complex and multifactorial involving numerous vascular, tubular and inflammatory pathways. Neurohumoral activation with heightened activity of the sympathetic nervous system and renin-angiotensin-aldosterone system play a critical role in this scenario. Inflammation and/or local renal ischaemia are underlying mechanisms triggering renal tissue hypoxia and resultant renal microcirculation dysfunction; a common feature of AKI occurring in numerous clinical conditions leading to a high morbidity and mortality rate...
February 2017: Clinical and Experimental Pharmacology & Physiology
Niels Van Regenmortel, Walter Verbrugghe, Tim Van den Wyngaert, Philippe G Jorens
BACKGROUND: Abnormal chloride levels are commonly observed in critically ill patients, but their clinical relevance remains a matter of debate. We examined the association between abnormal chloremia and ICU and hospital mortality. To further refine findings and integrate them into the ongoing discussion on the detrimental effects of chloride-rich solutions, the impact of strong ion difference (SID) on the same end points was assessed. METHODS: Retrospective cohort study in an academic tertiary intensive care unit on 8830 adult patients who stayed at least 24 h in the ICU was carried out...
December 2016: Annals of Intensive Care
C Urso, B Canino, S Brucculeri, A Firenze, G Caimi
About 50% of deaths from heart failure (HF) are sudden, presumably referable to arrhythmias. Electrolyte and acid-base abnormalities are a frequent and potentially dangerous complication in HF patients. Their incidence is almost always correlated with the severity of cardiac dysfunction; furthermore leading to arrhythmias, these imbalances are associated with a poor prognosis. The frequency of ventricular ectopic beats and sudden cardiac death correlate with both plasma and whole body levels of potassium, especially in alkalemia...
July 2016: La Clinica Terapeutica
Naohiro Shioji, Masao Hayashi, Hiroshi Morimatsu
Kidneys play an important role to maintain human homeostasis. They contribute to maintain body fluid, electrolytes, and acid-base balance. Especially in fluid control, we, physicians can intervene body fluid balance using fluid resuscitation and diuretics. In recent years, one type of fluid resuscitation, hydroxyl ethyl starch has been extensively studied in the field of intensive care. Although their effects on fluid resuscitation are reasonable, serious complications such as kidney injury requiring renal replacement therapy occur frequently...
May 2016: Masui. the Japanese Journal of Anesthesiology
Justin L Grodin
Electrolyte abnormalities are common in heart failure and can arise from a variety of etiologies. Neurohormonal activation from ventricular dysfunction, renal dysfunction, and heart failure medications can perturb electrolyte homeostasis which impact both heart failure-related morbidity and mortality. These include disturbances in serum sodium, chloride, acid-base, and potassium homeostasis. Pharmacological treatments differ for each electrolyte abnormality and vary from older, established treatments like the vaptans or acetazolamide, to experimental or theoretical treatments like hypertonic saline or urea, or to newer, novel agents like the potassium binders: patiromer and zirconium cyclosilicate...
August 2016: Current Heart Failure Reports
Antonios I Vezakis, Eirini V Pantiora, Elissaios A Kontis, Vasileios Sakellariou, Dimitrios Theodorou, Georgios Gkiokas, Andreas A Polydorou, Georgios P Fragulidis
BACKGROUND: Ingestion of caustic substances is a medical emergency in both the adult and pediatric population and is associated with high morbidity and mortality. The extent of injuries after ingestion of caustic substances depends on the nature, amount, and concentration of the agent and on the exposure time. Acutely, caustic substances may cause massive hemorrhage and gastrointestinal tract perforation; the most markedly affected cases require urgent surgical treatment. Patients surviving the initial event may present with aorto-enteric or gastrocolic fistulae, esophageal strictures, dysphagia, and increased risk of esophageal cancer as long term sequelae...
May 20, 2016: American Journal of Case Reports
Onur Cil, Peter M Haggie, Puay-Wah Phuan, Joseph-Anthony Tan, Alan S Verkman
Pendrin is a Cl(-)/HCO3(-) exchanger expressed in type B and non-A, non-B intercalated cells in the distal nephron, where it facilitates Cl(-) absorption and is involved in Na(+) absorption and acid-base balance. Pendrin-knockout mice show no fluid-electrolyte abnormalities under baseline conditions, although mice with double knockout of pendrin and the Na(+)/Cl(-) cotransporter (NCC) manifest profound salt wasting. Thus, pendrin may attenuate diuretic-induced salt loss, but this function remains unconfirmed...
December 2016: Journal of the American Society of Nephrology: JASN
Clara D M van Karnebeek, Sylvia A Tiebout, Jikkemien Niermeijer, Bwee Tien Poll-The, Aisha Ghani, Curtis R Coughlin, Johan L K Van Hove, Jost Wigand Richter, Hans Juergen Christen, Renata Gallagher, Hans Hartmann, Sylvia Stockler-Ipsiroglu
BACKGROUND: Pyridoxine-dependent epilepsy is a rare autosomal recessive epileptic encephalopathy caused by antiquitin (ALDH7A1) deficiency. In spite of adequate seizure control, 75% of patients suffer intellectual developmental disability. Antiquitin deficiency affects lysine catabolism resulting in accumulation of α-aminoadipic semialdehyde/pyrroline 6' carboxylate and pipecolic acid. Beside neonatal refractory epileptic encephalopathy, numerous neurological manifestations and metabolic/biochemical findings have been reported...
June 2016: Pediatric Neurology
Yichu Deng, Liping Zeng, Wen Bao, Pinghua Xu, Gongrong Zhong
OBJECTIVE: Zika virus disease is an acute infectious disease caused by Zika virus transmitted through Aedes mosquitoes. To explore the therapeutic effect of integrated traditional Chinese and Western Medicine for Zika virus disease, the treatment process of the first imported case in China was reviewed. METHODS: The first imported Zika virus disease in China was admitted to Ganxian People's Hospital in Jiangxi Province on February 6th, 2016, and the patient received isolation treatment for 9 days and cured later...
February 2016: Zhonghua Wei Zhong Bing Ji Jiu Yi Xue
Gherardo Finocchiaro, Sanjay Sharma
The cardiomyopathies are a heterogeneous group of primary myocardial diseases characterized by a propensity to fatal arrhythmias and are the leading cause of sudden cardiac death in young athletes. Apart from the underlying pathologic substrate, a combination of neurohormonal, mechanical, and oxidative stressors; dehydration; electrolyte abnormalities; and acid-base disturbances may trigger fatal arrhythmias during intensive exercise. Current consensus-based documents recommend that affected athletes abstain from most competitive sports, with the exception of those involving minimal dynamic or static components, to minimize the risk of sudden cardiac death...
April 2016: Canadian Journal of Cardiology
Philip S Mehler, Kristine Walsh
OBJECTIVE: Eating disorders that are associated with purging behaviors are complicated by frequent blood electrolyte and acid-base abnormalities. Herein, we review the major electrolyte and acid-base abnormalities and their treatment methods. The body of rigorous, eating disorder-specific literature on this topical area is not robust enough to perform a systematic review as defined by PRISMA guidelines. Therefore, a qualitative review of mostly medical literature was conducted. RESULTS: Hypokalemia, hyponatremia, and sodium chloride-responsive metabolic alkalosis are the most common serum changes that occur as a result of purging behaviors...
March 2016: International Journal of Eating Disorders
Anna Bertini, Gregorio P Milani, Giacomo D Simonetti, Emilio F Fossali, Pietro B Faré, Mario G Bianchetti, Sebastiano A G Lava
Guidelines on the diagnosis and management of urinary tract infections in childhood do not address the issue of abnormalities in Na(+), K(+), Cl(-) and acid-base balance. We have conducted a narrative review of the literature with the aim to describe the underlying mechanisms of these abnormalities and to suggest therapeutic maneuvers. Abnormalities in Na(+), K(+), Cl(-) and acid-base balance are common in newborns and infants and uncommon in children of more than 3 years of age. Such abnormalities may result from factitious laboratory results, from signs and symptoms (such as excessive sweating, poor fluid intake, vomiting and passage of loose stools) of the infection itself, from a renal dysfunction, from improper parenteral fluid management or from the prescribed antimicrobials...
September 2016: Pediatric Nephrology: Journal of the International Pediatric Nephrology Association
Charlotte E Thiessen, Kyle L Tofflemire, Kelly M Makielski, Gil Ben-Shlomo, R David Whitley, Rachel A Allbaugh
OBJECTIVE: To describe the occurrence of hypokalemia, metabolic acidosis, and suspected renal tubular acidosis associated with the administration of topical ophthalmic carbonic anhydrase inhibitor (CAI) in a cat. CASE SUMMARY: A 2-year-old, 5.3 kg, male, castrated, domestic short-haired cat developed hyporexia 6 weeks after starting topical ophthalmic dorzolamide 2% therapy for treatment of ocular hypertension. Two weeks later, the cat was evaluated for severe weakness, cervical ventroflexion, and anorexia...
November 2016: Journal of Veterinary Emergency and Critical Care
Martino Marangella, Cristina Marcuccio, Corrado Vitale
Nephrolithiasis (NL) has high and increasing prevalence in western countries. Most renal stones contain calcium and/or uric acid and often occur as idiopathic stones, while seldom are caused by genetic disorders. Conversely, cystinuria, xantinuria, 2-8 dihydroxyadeninuria only occur in patients with mutations of corresponding genes. Inherited NL must be suspected in case of early onset, positive family history, severe recurrence rate, associated biochemical disorders, abnormal urinary sediment, renal insufficiency, involvement of other organs or apparatus...
2015: Giornale Italiano di Nefrologia: Organo Ufficiale Della Società Italiana di Nefrologia
Jun Ye, Weiming Mo, Yan Chen, Aiping Yang
OBJECTIVE: To explore the role of parameters of organ function during heat stroke ( HS ) on the prognosis, and to form the treatment strategy through an analysis of parameters of organ function during HS. METHODS: A retrospective study was conducted. Thirty-seven patients with HS ( HS group ) and 54 patients with mild-to-moderate stroke ( stroke group ) admitted to Zhejiang Xiaoshan Hospital from 2011 to 2014 were enrolled. The experimental results of organs function indicators for patients were recorded including: (1) cardiac markers: troponin I ( TnI ); (2) myocardium zymogram: creatine kinase ( CK ), MB isoenzyme of creatine kinase ( CK-MB ), lactate dehydrogenase ( LDH ), and aspartate aminotransferase ( AST ); (3) renal function indexes: blood urea nitrogen ( BUN ), uric acid ( UA ), and serum creatinine ( SCr ); (4) electrolyte: serum K(+), Na(+), and Cl(-); (5)coagulation function: prothrombin time ( PT ), international normalized ratio ( INR ), activated partial thromboplastin time ( APTT ), thrombin time ( TT ), fibrinogen ( FIB ), and D-dimer; (6) blood gas analysis: pH value, arterial partial pressure of carbon dioxide ( PaCO(2)), base excess ( BE ), standard bicarbonate ( SB ), and actual bicarbonate ( AB ); (7) routine blood test: blood platelet count ( PLT ); (8) hepatic function: alanine aminotransferase ( ALT )...
August 2015: Zhonghua Wei Zhong Bing Ji Jiu Yi Xue
Francesco Caccetta, Maurizio Caroppo, Fernando Musio, Anna Mudoni, Antonella Accogli, Maria Dolores Zacheo, Domenica Burzo, Daniele Bramato, Giancamillo Carluccio, Vitale Nuzzo
The horseshoe kidney is a congenital anatomical defect of the kidney that occurs in 0,25% of the population and is generally characterized by the fusion of the lower poles of the two kidneys through an isthmus and to which may be associated with urogenital and renal vascular anomalies. Asymptomatic in 1/3 of the cases and, most of time, accidentally discovered during a radiological examination, promotes nephrolithiasis, ureteropelvic junction obstruction, hydronephrosis, vesicoureteral reflux and pyelonephritis...
July 2015: Giornale Italiano di Nefrologia: Organo Ufficiale Della Società Italiana di Nefrologia
Carlo Basile, Carlo Lomonte
The intended function of dialysate fluid is to correct the composition of uraemic blood to physiologic levels, both by reducing the concentration of uraemic toxins and correcting electrolyte and acid-base abnormalities. This is accomplished principally by formulating a dialysate whose constituent concentrations are set to approximate normal values in the body. Sodium balance is the cornerstone of intradialysis cardiovascular stability and good interdialytic blood pressure control; plasma potassium concentration and its intradialytic kinetics certainly play a role in the genesis of cardiac arrhythmias; calcium is related to haemodynamic stability, mineral bone disease and also cardiac arrhythmias; the role of magnesium is still controversial; lastly, acid buffering by means of base supplementation is one of the major roles of dialysis...
August 2015: Clinical Kidney Journal
Arieh Riskin, Corina Hartman, Raanan Shamir
Parenteral nutrition (PN) must be initiated as soon as possible after delivery in very low birth weight (VLBW) preterm infants in order to prevent postnatal growth failure and improve neurodevelopmental outcome. When administered early, high levels of parenteral amino acids (AA) are well tolerated and prevent negative nitrogen balance. Although proteins are the driving force for growth, protein synthesis is energy-demanding. Intravenous lipid emulsions (ILE) constitute a good energy source because of their high energy density and provide essential fatty acids (FA) along with their long-chain polyunsaturated fatty acid (LC-PUFA) derivatives necessary for central nervous system and retinal development...
May 2015: Israel Medical Association Journal: IMAJ
Robert Krysiak, Agnieszka Kędzia, Joanna Krupej-Kędzierska, Beata Kowalska, Bogusław Okopień
The kidneys play a crucial role in maintaining homeostasis of fluids and electrolytes, acid-base balance, and volume regulation. In subjects with chronic renal failure, particularly at its later stages, these adaptive responses are impaired and some of these alterations are of clinical relevance. The ways in which chronic renal failure affects function of endocrine organs include impaired secretion of kidney-derived hormones, altered peripheral hormone metabolism, disturbed binding to carrier proteins, accumulation of hormone inhibitors, as well as abnormal target organ responsiveness...
May 2015: Polski Merkuriusz Lekarski: Organ Polskiego Towarzystwa Lekarskiego
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