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Clinical medicine

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https://www.readbyqxmd.com/read/28450367/atrial-fibrillation-epidemiology-pathophysiology-and-clinical-outcomes
#1
REVIEW
Laila Staerk, Jason A Sherer, Darae Ko, Emelia J Benjamin, Robert H Helm
The past 3 decades have been characterized by an exponential growth in knowledge and advances in the clinical treatment of atrial fibrillation (AF). It is now known that AF genesis requires a vulnerable atrial substrate and that the formation and composition of this substrate may vary depending on comorbid conditions, genetics, sex, and other factors. Population-based studies have identified numerous factors that modify the atrial substrate and increase AF susceptibility. To date, genetic studies have reported 17 independent signals for AF at 14 genomic regions...
April 28, 2017: Circulation Research
https://www.readbyqxmd.com/read/24275173/toxicologic-acid-base-disorders
#2
REVIEW
Sage W Wiener
Acid-base disorders may complicate the presentation of patients with poisoning. This article summarizes an approach to acid-base disorders from a toxicologic perspective. It aims to assist the reader in identifying underlying acid-base processes, generating a differential diagnosis for each, and approaching that differential diagnosis in a systematic fashion. Understanding these processes will help to guide management and interventional strategies.
February 2014: Emergency Medicine Clinics of North America
https://www.readbyqxmd.com/read/21814173/critical-care-nephrology-management-of-acid-base-disorders-with-crrt
#3
REVIEW
Jorge Cerdá, Ashita J Tolwani, David G Warnock
Normal acid-base homeostasis is severely challenged in the intensive care setting. In this review, we address acid-base disturbances, with a special focus on the use of continuous (rather than intermittent) extracorporeal technologies in critical ill patients with acute kidney injury. We consider hypercapnic acidosis and lactic acidosis as examples in which continuous modalities may have different roles and indications than the traditional intermittent approaches to renal replacement therapy. Hypercapnic acidosis develops as a consequence of alveolar hypoventilation...
July 2012: Kidney International
https://www.readbyqxmd.com/read/26011230/acid-base-disturbance-in-patients-with-cirrhosis-relation-to-hemodynamic-dysfunction
#4
Jens H Henriksen, Flemming Bendtsen, Søren Møller
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. RESULTS: Hyperventilatory hypocapnia was present in all patients with cirrhosis and progressed from Child class A to C (P<0.01). Arterial pH increased significantly from class A to C (P<0...
August 2015: European Journal of Gastroenterology & Hepatology
https://www.readbyqxmd.com/read/23884137/whole-body-acid-base-and-fluid-electrolyte-balance-a-mathematical-model
#5
Matthew B Wolf
A cellular compartment was added to our previous mathematical model of steady-state acid-base and fluid-electrolyte chemistry to gain further understanding and aid diagnosis of complex disorders involving cellular involvement in critically ill patients. An important hypothesis to be validated was that the thermodynamic, standard free-energy of cellular H(+) and Na(+) pumps remained constant under all conditions. In addition, a hydrostatic-osmotic pressure balance was assumed to describe fluid exchange between plasma and interstitial fluid, including incorporation of compliance curves of vascular and interstitial spaces...
October 15, 2013: American Journal of Physiology. Renal Physiology
https://www.readbyqxmd.com/read/17656477/use-of-the-deltaag-deltahco3-ratio-in-the-diagnosis-of-mixed-acid-base-disorders
#6
REVIEW
Asghar Rastegar
When a strong acid is added to plasma, one expects a quantitative relationship between excess anion gap (DeltaAG) and bicarbonate deficit (DeltaHCO(3)(-)) with the DeltaAG/DeltaHCO(3)(-) ratio close to unity. If true, then this ratio could be used to diagnose mixed acid-base disorders in patients with metabolic acidosis. Although the mean ratio in selected patients is close to unity, this ratio also has a wide range, making its use in individual patients problematic. The ratio should therefore be used cautiously in making a diagnosis of mixed acid-base disorders...
September 2007: Journal of the American Society of Nephrology: JASN
https://www.readbyqxmd.com/read/25370778/drug-induced-acid-base-disorders
#7
REVIEW
Daniel Kitterer, Matthias Schwab, M Dominik Alscher, Niko Braun, Joerg Latus
The incidence of acid-base disorders (ABDs) is high, especially in hospitalized patients. ABDs are often indicators for severe systemic disorders. In everyday clinical practice, analysis of ABDs must be performed in a standardized manner. Highly sensitive diagnostic tools to distinguish the various ABDs include the anion gap and the serum osmolar gap. Drug-induced ABDs can be classified into five different categories in terms of their pathophysiology: (1) metabolic acidosis caused by acid overload, which may occur through accumulation of acids by endogenous (e...
September 2015: Pediatric Nephrology: Journal of the International Pediatric Nephrology Association
https://www.readbyqxmd.com/read/26410149/understanding-acid-base-disorders
#8
REVIEW
Hernando Gomez, John A Kellum
The concentration of hydrogen ions is regulated in biologic solutions. There are currently 3 recognized approaches to assess changes in acid base status. First is the traditional Henderson-Hasselbalch approach, also called the physiologic approach, which uses the relationship between HCO3(-) and Pco2; the second is the standard base excess approach based on the Van Slyke equation. The third approach is the quantitative or Stewart approach, which uses the strong ion difference and the total weak acids. This article explores the origins of the current concepts framing the existing methods to analyze acid base balance...
October 2015: Critical Care Clinics
https://www.readbyqxmd.com/read/22874469/acid-base-status-and-progression-of-chronic-kidney-disease
#9
REVIEW
Nimrit Goraya, Donald E Wesson
PURPOSE OF REVIEW: Most patients with reduced glomerular filtration rate (GFR) have progressive GFR decline despite currently recommended kidney-protective interventions. Recent studies support that dietary acid reduction with Na(+)-based alkali or food types that yield base when metabolized provides kidney protection that is additive to currently recommended interventions. We review these recent studies in light of current kidney-protective recommendations for chronic kidney disease (CKD)...
September 2012: Current Opinion in Nephrology and Hypertension
https://www.readbyqxmd.com/read/23833313/the-serum-anion-gap-in-the-evaluation-of-acid-base-disorders-what-are-its-limitations-and-can-its-effectiveness-be-improved
#10
REVIEW
Jeffrey A Kraut, Glenn T Nagami
The serum anion gap has been utilized to identify errors in the measurement of electrolytes, to detect paraproteins, and, most relevant to the nephrologist, to evaluate patients with suspected acid-base disorders. In regard to the latter purpose, traditionally an increased anion gap is identified when it exceeds the upper limit of normal for a particular clinical laboratory measurement. However, because there is a wide range of normal values (often 8-10 mEq/L), an increase in anion concentration can be present in the absence of an increased anion gap...
November 2013: Clinical Journal of the American Society of Nephrology: CJASN
https://www.readbyqxmd.com/read/17893626/disorders-of-acid-base-balance
#11
REVIEW
John A Kellum
BACKGROUND: Intensivists spend much of their time managing problems related to fluids, electrolytes, and blood pH. Recent advances in the understanding of acid-base physiology have resulted from the application of basic physical-chemical principles of aqueous solutions to blood plasma. All changes in blood pH, in health and in disease, occur through changes in three variables: carbon dioxide, relative electrolyte concentrations, and total weak acid concentrations. However, while this quantitative approach has enjoyed widespread use among researchers, clinicians are reluctant to employ it...
November 2007: Critical Care Medicine
https://www.readbyqxmd.com/read/25592251/evaluation-of-acid-base-status-in-patients-admitted-to-ed-physicochemical-vs-traditional-approaches
#12
Elvira-Markela Antonogiannaki, Ioanna Mitrouska, Vassilis Amargianitakis, Dimitris Georgopoulos
BACKGROUND: The aim of this study is to evaluate the value of physicochemical, base excess (BE), and plasma bicarbonate concentration ([HCO3(-)]) approaches on the assessment of acid-base status in patients presented to the emergency department (ED). METHODS: Upon presentation at ED, patients whose arterial blood was deemed in need of analysis were studied. Arterial blood gases, serum electrolytes, and proteins were measured and used to derive [HCO3(-)], BE, anion gap (AG), AG adjusted for albumin (AGadj), strong ion difference, strong ion gap (SIG) and SIG corrected for water excess/deficit (SIGcor)...
March 2015: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28114143/electrolyte-and-acid-base-disorders-in-chronic-kidney-disease-and-end-stage-kidney-failure
#13
REVIEW
Tsering Dhondup, Qi Qian
The kidneys play a pivotal role in the regulation of electrolyte and acid-base balance. With progressive loss of kidney function, derangements in electrolytes and acid-base inevitably occur and contribute to poor patient outcomes. As chronic kidney disease (CKD) has become a worldwide epidemic, medical providers are increasingly confronted with such problems. Adequate diagnosis and treatment will minimize complications and can potentially be lifesaving. In this review, we discuss the current understanding of the disease process, clinical presentation, diagnosis and treatment strategies, integrating up-to-date knowledge in the field...
2017: Blood Purification
https://www.readbyqxmd.com/read/27229644/management-of-acute-kidney-injury-and-acid-base-balance-in-the-septic-patient
#14
REVIEW
Paul D Weyker, Xosé L Pérez, Kathleen D Liu
Acute kidney injury (AKI) is an abrupt decrease in kidney function that takes place over hours to days. Sepsis is the leading cause of AKI and portends a particularly high morbidity and mortality, although the severity may vary from a transient rise in serum creatinine to end-stage renal disease. With regard to acid-base management in septic AKI, caution should be used with hyperchloremic crystalloid solutions, and dialysis is often used in the setting of severe acidosis. In the future, biomarkers may help clinicians identify AKI earlier and allow for potential interventions before the development of severe AKI...
June 2016: Clinics in Chest Medicine
https://www.readbyqxmd.com/read/26825098/american-society-of-nephrology-quiz-and-questionnaire-2015-electrolytes-and-acid-base-disorders
#15
Mitchell H Rosner, Mark A Perazella, Michael J Choi
The Nephrology Quiz and Questionnaire remains an extremely popular session for attendees of the annual Kidney Week meeting of the American Society of Nephrology. During the 2015 meeting the conference hall was once again overflowing with eager quiz participants. Topics covered by the experts included electrolyte and acid-base disorders, glomerular disease, end-stage renal disease and dialysis, and kidney transplantation. Complex cases representing each of these categories together with single-best-answer questions were prepared and submitted by the panel of experts...
April 7, 2016: Clinical Journal of the American Society of Nephrology: CJASN
https://www.readbyqxmd.com/read/22362904/molecular-mechanisms-of-acid-base-sensing-by-the-kidney
#16
REVIEW
Dennis Brown, Carsten A Wagner
A major function of the kidney is to collaborate with the respiratory system to maintain systemic acid-base status within limits compatible with normal cell and organ function. It achieves this by regulating the excretion and recovery of bicarbonate (mainly in the proximal tubule) and the secretion of buffered protons (mainly in the distal tubule and collecting duct). How proximal tubular cells and distal professional proton transporting (intercalated) cells sense and respond to changes in pH, bicarbonate, and CO(2) status is a question that has intrigued many generations of renal physiologists...
May 2012: Journal of the American Society of Nephrology: JASN
https://www.readbyqxmd.com/read/27001688/beyond-bicarbonate-complete-acid-base-assessment-in-patients-receiving-intermittent-hemodialysis
#17
Marco Marano, Stefano Marano, F John Gennari
Background: Acid-base assessments in hemodialysis patients have been limited almost entirely to measurements of total CO 2 concentration, and assumptions have been made about the presence of acid-base disorders. To gain a fuller understanding of the acid-base status of stable hemodialysis patients, we analyzed measurements of pCO 2 , pH and HCO 3 - obtained in a cohort of chronic stable hemodialysis patients over a 5-year period. Methods: We reviewed acid-base measurements taken pre-dialysis from fistula blood in 53 outpatients receiving hemodialysis thrice weekly between 2008 and 2012...
March 1, 2017: Nephrology, Dialysis, Transplantation
https://www.readbyqxmd.com/read/27590096/assessing-acid-base-status-physiologic-versus-physicochemical-approach
#18
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
https://www.readbyqxmd.com/read/28031171/whole-body-acid-base-modeling-revisited
#19
REVIEW
Troels Ring, Søren Nielsen
The textbook account of whole body acid-base balance in terms of endogenous acid production, renal net acid excretion, and gastrointestinal alkali absorption, which is the only comprehensive model around, has never been applied in clinical practice or been formally validated. To improve understanding of acid-base modeling, we managed to write up this conventional model as an expression solely on urine chemistry. Renal net acid excretion and endogenous acid production were already formulated in terms of urine chemistry, and we could from the literature also see gastrointestinal alkali absorption in terms of urine excretions...
April 1, 2017: American Journal of Physiology. Renal Physiology
https://www.readbyqxmd.com/read/25820346/acid-base-and-electrolyte-abnormalities-in-heart-failure-pathophysiology-and-implications
#20
REVIEW
Caterina Urso, Salvatore Brucculeri, Gregorio Caimi
Electrolyte and acid-base abnormalities are a frequent and potentially dangerous complication in subjects with congestive heart failure. This may be due either to the pathophysiological alterations present in the heart failure state leading to neurohumoral activation (stimulation of the renin-angiotensin-aldosterone system, sympathoadrenergic stimulation), or to the adverse events of therapy with diuretics, cardiac glycosides, and ACE inhibitors. Subjects with heart failure may show hyponatremia, magnesium, and potassium deficiencies; the latter two play a pivotal role in the development of cardiac arrhythmias...
July 2015: Heart Failure Reviews
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