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By Varun Shetty A Med-Peds resident
William L Whittier, Gregory W Rutecki
Acid-base problem solving has been an integral part of medical practice in recent generations. Diseases discovered in the last 30-plus years, for example, Bartter syndrome and Gitelman syndrome, D-lactic acidosis, and bulimia nervosa, can be diagnosed according to characteristic acid-base findings. Accuracy in acid-base problem solving is a direct result of a reproducible, systematic approach to arterial pH, partial pressure of carbon dioxide, bicarbonate concentration, and electrolytes. The 'Rules of Five' is one tool that enables clinicians to determine the cause of simple and complex disorders, even triple acid-base disturbances, with consistency...
March 2004: Disease-a-month: DM
Richard D Vaughan-Jones, Walter F Boron
No abstract text is available yet for this article.
January 22, 2015: New England Journal of Medicine
Julian L Seifter
No abstract text is available yet for this article.
November 6, 2014: 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
Mohammad Hassan Murad, Victor M Montori, John P A Ioannidis, Roman Jaeschke, P J Devereaux, Kameshwar Prasad, Ignacio Neumann, Alonso Carrasco-Labra, Thomas Agoritsas, Rose Hatala, Maureen O Meade, Peter Wyer, Deborah J Cook, Gordon Guyatt
Clinical decisions should be based on the totality of the best evidence and not the results of individual studies. When clinicians apply the results of a systematic review or meta-analysis to patient care, they should start by evaluating the credibility of the methods of the systematic review, ie, the extent to which these methods have likely protected against misleading results. Credibility depends on whether the review addressed a sensible clinical question; included an exhaustive literature search; demonstrated reproducibility of the selection and assessment of studies; and presented results in a useful manner...
July 2014: JAMA: the Journal of the American Medical Association
Lakhmir S Chawla, Paul W Eggers, Robert A Star, Paul L Kimmel
No abstract text is available yet for this article.
July 3, 2014: New England Journal of Medicine
Thomas G DeLoughery
New England Journal of Medicine, Volume 371, Issue 14, Page 1324-1331, October 2014.
October 2, 2014: New England Journal of Medicine
Luciano Gattinoni, Eleonora Carlesso, Paolo Cadringher, Pietro Caironi
The plasmatic strong ion difference (SID) is the difference between positively and negatively charged strong ions. At pH 7.4, temperature 37 degrees C and partial carbon dioxide tension 40 mmHg, the ideal value of SID is 42 mEq/l. The buffer base is the sum of negatively charged weak acids ([HCO3(-)], [A-], [H2PO4(-)]) and its normal value is 42 mEq/l. According to the law of electroneutrality, the amount of positive and negative charges must be equal, and therefore the SID value is equal to the buffer base value...
2006: Critical Care: the Official Journal of the Critical Care Forum
Mohammed Al-Jaghbeer, John A Kellum
Acid-base disturbances are very common in critically ill and injured patients as well as contribute significantly to morbidity and mortality. An understanding of the pathophysiology of these disorders is vital to their proper management. This review will discuss the etiology, pathophysiology and treatment of acid-base disturbances in intensive care patients--with particular attention to evidence from recent studies examining the effects of fluid resuscitation on acid-base and its consequences.
July 2015: Nephrology, Dialysis, Transplantation
Robert J Unwin, Friedrich C Luft, David G Shirley
Potassium (K(+)) ions are the predominant intracellular cations. K(+) homeostasis depends on external balance (dietary intake [typically 100 mmol per day] versus excretion [95% via the kidney; 5% via the colon]) and internal balance (the distribution of K(+) between intracellular and extracellular fluid compartments). The uneven distribution of K(+) across cell membranes means that a mere 1% shift in its distribution can cause a 50% change in plasma K(+) concentration. Hormonal mechanisms (involving insulin, β-adrenergic agonists and aldosterone) modulate K(+) distribution by promoting rapid transfer of K(+) across the plasma membrane...
February 2011: Nature Reviews. Nephrology
Agata Bielecka-Dabrowa, Dimitri P Mikhailidis, Linda Jones, Jacek Rysz, Wilbert S Aronow, Maciej Banach
Maintenance of normal potassium (K(+)) homeostasis has become an increasingly important limiting factor in the therapy of heart failure (HF). With the application of loop diuretics and digoxin, hypokalemia has become a frequent and feared side effect of treatment. Low serum K(+) in HF may be also a marker of increased neurohormonal activity and disease progression. To gain the maximum benefit from treatment, we need to individualize drug use and carefully monitor electrolytes. Symptomatic HF patients (New York Heart Association class III-IV) should be prescribed the lowest dose of diuretic necessary to maintain euvolemia...
June 28, 2012: International Journal of Cardiology
Abdo Asmar, Rajesh Mohandas, Charles S Wingo
Hypokalemia is common and can be associated with serious adverse consequences, including paralysis, ileus, cardiac arrhythmias, and death. As a result, the body maintains serum potassium concentration within very narrow limits by tightly regulated feedback and feed-forward systems. Whereas the consequences of symptomatic hypokalemia and severe potassium depletion are well appreciated, chronic mild hypokalemia can accelerate the progression of chronic kidney disease, exacerbate systemic hypertension, and increase mortality...
September 2012: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
Jack C Salerno, Stephen P Seslar
Supraventricular tachycardia is the most common rhythm disturbance in children. We reviewed the spectrum of this common rhythm disorder from symptom recognition and epidemiology to management, with special attention to advancements in the available treatment options.
March 2009: Archives of Pediatrics & Adolescent Medicine
Syed K Haque, Gema Ariceta, Daniel Batlle
Proximal renal tubular acidosis (RTA) (Type II RTA) is characterized by a defect in the ability to reabsorb HCO(3) in the proximal tubule. This is usually manifested as bicarbonate wastage in the urine reflecting that the defect in proximal tubular transport is severe enough that the capacity for bicarbonate reabsorption in the thick ascending limb of Henle's loop and more distal nephron segments is overwhelmed. More subtle defects in proximal bicarbonate transport likely go clinically unrecognized owing to compensatory reabsorption of bicarbonate distally...
December 2012: Nephrology, Dialysis, Transplantation
Daniel Batlle, Syed K Haque
The primary or hereditary forms of distal renal tubular acidosis (dRTA) have received increased attention because of advances in the understanding of the molecular mechanism, whereby mutations in the main proteins involved in acid-base transport result in impaired acid excretion. Dysfunction of intercalated cells in the collecting tubules accounts for all the known genetic causes of dRTA. These cells secrete protons into the tubular lumen through H(+)-ATPases functionally coupled to the basolateral anion exchanger 1 (AE1)...
October 2012: Nephrology, Dialysis, Transplantation
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