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Acid base

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21 papers 0 to 25 followers
https://www.readbyqxmd.com/read/25669331/the-assessment-of-acid-base-analysis-comparison-of-the-traditional-and-the-modern-approaches
#1
Jasna Todorović, Jelena Nešovic-Ostojić, Aleksandar Milovanović, Predrag Brkić, Mihailo Ille, Dušan Čemerikić
Three distinct approaches are currently used in assessing acid-base disorders: the traditional - physiological or bicarbonate-centered approach, the base-excess approach, and the "modern" physicochemical approach proposed by Peter Stewart, which uses the strong ion difference (particularly the sodium chloride difference) and the concentration of nonvolatile weak acids (particularly albumin) and partial pressure of carbon dioxide (pCO(2)) as independent variables in the assessment of acid-base status. The traditional approach developed from the pioneering work of Henderson and Hasselbalch and the base-excess are still most widely used in clinical practice, even though there are a number of problems identified with this approach...
February 2015: Medicinski Glasnik
https://www.readbyqxmd.com/read/27229644/management-of-acute-kidney-injury-and-acid-base-balance-in-the-septic-patient
#2
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/26410149/understanding-acid-base-disorders
#3
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/18289237/metabolic-acidosis-in-the-critically-ill-part-1-classification-and-pathophysiology
#4
REVIEW
C G Morris, J Low
Metabolic acidaemia (pH < 7.35 not primarily related to hypoventilation) is common amongst the critically ill and it is essential that clinicians caring for such patients have an understanding of the common causes. The exclusive elimination routes of volatile (carbon dioxide), organic (lactic and ketone) and inorganic (phosphate and sulphate) acids mean compensation for a defect in any one is limited and requires separate provision during critical illness. We discuss the models available to diagnose metabolic acidosis including CO2/HCO3(-) and physical chemistry-derived (Stewart or Fencl-Stewart) approaches, but we propose that the base excess and anion gap, corrected for hypoalbuminaemia and iatrogenic hyperchloraemia, remain most appropriate for clinical usage...
March 2008: Anaesthesia
https://www.readbyqxmd.com/read/19812535/assessing-acid-base-disorders
#5
REVIEW
Horacio J Adrogué, F John Gennari, John H Galla, Nicolaos E Madias
Effective management of acid-base disorders depends on accurate diagnosis. Three distinct approaches are currently used in assessing acid-base disorders: the physiological approach, the base-excess approach, and the physicochemical approach. There are considerable differences among the three approaches. In this review, we first describe the conceptual framework of each approach, and comment on its attributes and drawbacks. We then highlight the application of each approach to patient care. We conclude with a brief synthesis and our recommendations for choosing an approach...
December 2009: Kidney International
https://www.readbyqxmd.com/read/26597304/acid-base-homeostasis
#6
REVIEW
L Lee Hamm, Nazih Nakhoul, Kathleen S Hering-Smith
Acid-base homeostasis and pH regulation are critical for both normal physiology and cell metabolism and function. The importance of this regulation is evidenced by a variety of physiologic derangements that occur when plasma pH is either high or low. The kidneys have the predominant role in regulating the systemic bicarbonate concentration and hence, the metabolic component of acid-base balance. This function of the kidneys has two components: reabsorption of virtually all of the filtered HCO3(-) and production of new bicarbonate to replace that consumed by normal or pathologic acids...
December 7, 2015: Clinical Journal of the American Society of Nephrology: CJASN
https://www.readbyqxmd.com/read/23903783/the-role-of-venous-blood-gas-in-the-emergency-department-a-systematic-review-and-meta-analysis
#7
REVIEW
Benjamin M Bloom, Johann Grundlingh, Jonathan P Bestwick, Tim Harris
The aim of this study is to provide a systematic review of the literature reporting agreement between arterial and venous pH, partial pressure of carbon dioxide (PCO2), bicarbonate (HCO3⁻), base excess and lactate; and to perform a meta-analysis of the differences. Medline and Embase searches using Eduserv Athens from 1950 to present were conducted using the terms 'VBG', 'ABG', 'arterial', 'venous', 'blood', 'gas', 'lactate', 'emergency' and 'department'. References of the published papers were hand searched and full-text versions of those deemed helpful to the question were obtained...
April 2014: European Journal of Emergency Medicine: Official Journal of the European Society for Emergency Medicine
https://www.readbyqxmd.com/read/26363848/approach-to-the-patient-with-a-negative-anion-gap
#8
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
https://www.readbyqxmd.com/read/25552544/can-vbg-analysis-replace-abg-analysis-in-emergency-care
#9
REVIEW
Anne-Maree Kelly
Blood gas analysis is an integral part of the assessment of emergency department (ED) patients with acute respiratory or metabolic disease. Traditionally ABG analyses have been used, but increasingly, emergency clinicians are using venous blood gas (VBG) analyses. This has been challenged, especially by respiratory physicians, as being too inaccurate. This clinical review, using case examples, summarises the evidence supporting use of VBG to guide management decisions. Arteriovenous agreement for pH is such that values are clinically interchangeable and agreement for bicarbonate is also close...
February 2016: Emergency Medicine Journal: EMJ
https://www.readbyqxmd.com/read/25685724/has-stewart-approach-improved-our-ability-to-diagnose-acid-base-disorders-in-critically-ill-patients
#10
REVIEW
Fabio D Masevicius, Arnaldo Dubin
The Stewart approach-the application of basic physical-chemical principles of aqueous solutions to blood-is an appealing method for analyzing acid-base disorders. These principles mainly dictate that pH is determined by three independent variables, which change primarily and independently of one other. In blood plasma in vivo these variables are: (1) the PCO2; (2) the strong ion difference (SID)-the difference between the sums of all the strong (i.e., fully dissociated, chemically nonreacting) cations and all the strong anions; and (3) the nonvolatile weak acids (Atot)...
February 4, 2015: World Journal of Critical Care Medicine
https://www.readbyqxmd.com/read/26856640/is-arterial-base-deficit-still-a-useful-prognostic-marker-in-trauma-a-systematic-review
#11
REVIEW
I Ibrahim, W P Chor, K M Chue, C S Tan, H L Tan, F J Siddiqui, M Hartman
BACKGROUND: Arterial base deficit (BD) has been widely used in trauma patients since 1960. However, trauma management has also evolved significantly in the last 2 decades. The first objective of this study was to systematically review the literature on the relationship between arterial BD as a prognostic marker for trauma outcomes (mortality, significant injuries, and major complications) in the acute setting. The second objective was to evaluate arterial BD as a prognosis marker, specifically, in the elderly and in patients with positive blood alcohol levels...
March 2016: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/27755508/sex-differences-in-inflammatory-response-and-acid-base-balance-in-prepubertal-children-with-severe-sepsis
#12
Nicolas Lefèvre, Benjamin Noyon, Dominique Biarent, Francis Corazza, Jean Duchateau, Georges Casimir
PURPOSE AND METHODS: The severity and prognosis of various acute inflammatory conditions, such as sepsis, differ between males and females. The mechanisms underlying these sex differences probably involve both hormonal and genetic factors. In order to evaluate a possible genetic influence, we reviewed clinical signs and biological inflammatory markers of prepubertal children with severe sepsis admitted to the pediatric intensive care unit (PICU). FINDINGS: A total of 142 prepubertal children, 66 girls and 76 boys, suffering from severe sepsis and admitted to the PICU were included...
October 17, 2016: Shock
https://www.readbyqxmd.com/read/15069420/primer-on-clinical-acid-base-problem-solving
#13
REVIEW
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
https://www.readbyqxmd.com/read/22403272/differential-diagnosis-of-nongap-metabolic-acidosis-value-of-a-systematic-approach
#14
REVIEW
Jeffrey A Kraut, Nicolaos E Madias
Nongap metabolic acidosis is a common form of both acute and chronic metabolic acidosis. Because derangements in renal acid-base regulation are a common cause of nongap metabolic acidosis, studies to evaluate renal acidification often serve as the mainstay of differential diagnosis. However, in many cases, information obtained from the history and physical examination, evaluation of the electrolyte pattern (to determine if a nongap acidosis alone or a combined nongap and high anion gap metabolic acidosis is present), and examination of the serum potassium concentration (to characterize the disorder as hyperkalemic or hypokalemic in nature) is sufficient to make a presumptive diagnosis without more sophisticated studies...
April 2012: Clinical Journal of the American Society of Nephrology: CJASN
https://www.readbyqxmd.com/read/22871240/evaluation-and-treatment-of-respiratory-alkalosis
#15
Biff F Palmer
Respiratory alkalosis is the most frequent acid-base disturbance encountered in clinical practice. This is particularly true in critically ill patients, for whom the degree of hypocapnia directly correlates with adverse outcomes. Although this acid-base disturbance often is considered benign, evidence suggests that the alkalemia of primary hypocapnia can cause clinically significant decreases in tissue oxygen delivery. Mild respiratory alkalosis often serves as a marker of an underlying disease and may not require therapeutic intervention...
November 2012: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
https://www.readbyqxmd.com/read/27639981/impact-of-chloride-and-strong-ion-difference-on-icu-and-hospital-mortality-in-a-mixed-intensive-care-population
#16
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
https://www.readbyqxmd.com/read/25295502/physiological-approach-to-assessment-of-acid-base-disturbances
#17
REVIEW
Kenrick Berend, Aiko P J de Vries, Rijk O B Gans
New England Journal of Medicine, Volume 371, Issue 15, Page 1434-1445, October 2014.
October 9, 2014: New England Journal of Medicine
https://www.readbyqxmd.com/read/25372090/integration-of-acid-base-and-electrolyte-disorders
#18
REVIEW
Julian L Seifter
No abstract text is available yet for this article.
November 6, 2014: New England Journal of Medicine
https://www.readbyqxmd.com/read/25213433/acid-base-disturbances-in-intensive-care-patients-etiology-pathophysiology-and-treatment
#19
REVIEW
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
https://www.readbyqxmd.com/read/27587638/acid-base-disorders
#20
Benson S Hsu, Saquib A Lakhani, Michael Wilhelm
No abstract text is available yet for this article.
September 2016: Pediatrics in Review
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