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By Isabel Acosta-Ochoa Nephrology senior staff. Valladolid. Spain
Horacio J Adrogué, Nicolaos E Madias
The physiologic approach has long been used in assessing acid-base status. This approach considers acids as hydrogen ion donors and bases as hydrogen ion acceptors and the acid-base status of the organism as reflecting the interaction of net hydrogen ion balance with body buffers. In the physiologic approach, the carbonic acid/bicarbonate buffer pair is used for assessing acid-base status and blood pH is determined by carbonic acid (ie, Paco2) and serum bicarbonate levels. More recently, the physicochemical approach was introduced, which has gained popularity, particularly among intensivists and anesthesiologists...
November 2016: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
Bernard C Rossier
Vertebrates control the osmolality of their extra- and intra-cellular compartments despite large variations in salt and water intake. Aldosterone-dependent sodium reabsorption and vasopressin-dependent water transport in the distal nephron and collecting duct play a critical role in the final control of sodium and water balance. Long-term fasting (no eating, no drinking) represents an osmotic challenge for survival. Evolution has found very different solutions to meet this challenge. To illustrate this point, I will discuss osmoregulation of a mammal (elephant seal pup) and of a fish (lungfish) that are able to survive long-term fasting for months or even years...
2016: Nephron
Pedro A Jose, Zhiwei Yang, Chunyu Zeng, Robin A Felder
What is the topic of this review? Sensing the amount of ingested sodium is one mechanism by which sodium balance is regulated. This review describes the role of gastrin in the cross-talk between the stomach and the kidney following the ingestion of sodium. What advances does it highlight? Neural mechanisms and several gut hormones, including cholecystokinin and uroguanylin, have been suggested to mediate the natriuresis after an oral sodium load. It is proposed that gastrin produced by G-cells via its receptor, cholecystokinin B receptor, interacts with renal D1 -like dopamine receptors to increase renal sodium excretion...
April 2016: Experimental Physiology
Peter H Hinderling
Potassium is critical for maintaining cellular tonicity, propagation of nerve impulses, contraction of cardiac, skeletal, and smooth muscles, and normal renal function. The focus of this review is on the pharmacokinetics of potassium, K(+) , after administration of liquid and solid formulations of potassium chloride, KCl, to healthy subjects. Potassium can be considered an endogenous and exogenous compound. The amounts of endogenous K(+) are kept constant by balancing intake and loss of exogenous K(+) . Food and ingestion of KCl-containing medicines are sources for exogenous K(+) ...
October 2016: Journal of Clinical Pharmacology
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
Susan Mayor
No abstract text is available yet for this article.
January 14, 2016: BMJ: British Medical Journal
Bhavna Bhasin, Juan Carlos Q Velez
Polyuria, defined as daily urine output in excess of 3.0 to 3.5L/d, can occur due to solute or water diuresis. Solute-induced polyuria can be seen in hospitalized patients after a high solute load from exogenous protein administration or following relief of urinary obstruction. Similar clinical scenarios are rarely encountered in the outpatient setting. We describe a case of polyuria due to high solute ingestion and excessive water intake leading to a mixed picture of solute and water diuresis. Restriction of the daily solute load and water intake resulted in complete resolution of polyuria...
March 2016: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
Michael L Moritz, Juan C Ayus
No abstract text is available yet for this article.
October 2015: New England Journal of Medicine
(no author information available yet)
No abstract text is available yet for this article.
September 24, 2015: New England Journal of Medicine
David A Bushinsky, Gordon H Williams, Bertram Pitt, Matthew R Weir, Mason W Freeman, Dahlia Garza, Yuri Stasiv, Elizabeth Li, Lance Berman, George L Bakris
Patients with chronic kidney disease (CKD) have a high risk of hyperkalemia, which increases mortality and can lead to renin-angiotensin-aldosterone system inhibitor (RAASi) dose reduction or discontinuation. Patiromer, a nonabsorbed potassium binder, has been shown to normalize serum potassium in patients with CKD and hyperkalemia on RAASi. Here, patiromer's onset of action was determined in patients with CKD and hyperkalemia taking at least one RAASi. After a 3-day potassium- and sodium-restricted diet in an inpatient research unit, those with sustained hyperkalemia (serum potassium 5...
December 2015: Kidney International
Michael Emmett
When anion gap calculation generates a very small or negative number, an explanation must be sought. Sporadic (nonreproducible) measurement errors and systematic (reproducible) laboratory errors must be considered. If an error is ruled out, 2 general possibilities exist. A true anion gap reduction can be generated by either reduced concentrations of unmeasured anions such as albumin or increased concentrations of unmeasured cations such as magnesium, calcium, or lithium. This teaching case describes a patient with aspirin (salicylate) poisoning whose anion gap was markedly reduced (-47 mEq/L)...
January 2016: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
Biff F Palmer, Deborah J Clegg
No abstract text is available yet for this article.
August 6, 2015: New England Journal of Medicine
Michelle L Gumz, Lawrence Rabinowitz, Charles S Wingo
New England Journal of Medicine, Volume 373, Issue 1, Page 60-72, July 2015.
July 2, 2015: New England Journal of Medicine
David Severs, Maarten B Rookmaaker, Ewout J Hoorn
Infusion fluids are often given to restore blood pressure (volume resuscitation), but may also be administered to replace ongoing losses, match insensible losses, correct electrolyte or acid-base disorders, or provide glucose. The development of new infusion fluids has provided clinicians with a wide range of products. Although the choice for a certain infusion fluid is often driven more by habit than by careful consideration, we believe it is useful to approach infusion fluids as drugs and consider their pharmacokinetic and pharmacodynamic characteristics...
July 2015: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
Mark A Knepper, Tae-Hwan Kwon, Soren Nielsen
New England Journal of Medicine, Volume 372, Issue 14, Page 1349-1358, April 2015.
April 2, 2015: New England Journal of Medicine
Richard H Sterns
New England Journal of Medicine, Volume 372, Issue 1, Page 55-65, January 2015.
January 1, 2015: New England Journal of Medicine
Jeffrey A Kraut, Nicolaos E Madias
New England Journal of Medicine, Volume 371, Issue 24, Page 2309-2319, December 2014.
December 11, 2014: New England Journal of Medicine
Jens Titze
PURPOSE OF REVIEW: Textbook theory holds that extracellular fluids readily equilibrate, electrolyte concentrations in the extracellular fluid compartments are constant, and the kidney is solely responsible for controlling the body sodium content. RECENT FINDINGS: Investigation of salt and water balance traditionally relies on short-term studies of bodily responses to extremes in salt intake. Ultra-long-term sodium balance studies instead studied the kidney's response to constant salt intake...
January 2015: Current Opinion in Nephrology and Hypertension
Julian L Seifter
No abstract text is available yet for this article.
November 6, 2014: New England Journal of Medicine
Francesco Trepiccione, Giovambattista Capasso, Giuseppe Lippi
Clinical practice is frequently challenged by limited funding and resources, which finally limit both clinical effectiveness and safety of some therapies. Electrolyte disorders represent serious problems in the clinical management. Nonetheless the osmometer, that is the reference instrument for routine assessment of osmolality, it is only available in a limited number of healthcare facilities. The diagnosis of the leading electrolyte disorders relies therefore on indirect criteria, frequently inaccurate, especially when inappropriately used...
September 2014: Giornale Italiano di Nefrologia: Organo Ufficiale Della Società Italiana di Nefrologia
2014-10-17 19:39:43
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