ABSTRACT
Introducción. La cetoacidosis diabética (CAD) se caracteriza por acidosis metabólica (AM) con anión restante (AR) elevado, aunque, ocasionalmente, puede presentar hipercloremia. Se postuló que la presencia de hipercloremia inicial podría reflejar un mejor estado de hidratación; sin embargo, su prevalencia y su impacto en el tratamiento de la CAD se desconoce. Objetivos. Determinar la prevalencia de AM con componente hiperclorémico previo al inicio del tratamiento y evaluar si su presencia se asocia con mejor estado de hidratación y con menor tiempo de salida de la CAD, en comparación con los pacientes con AR elevado exclusivo. Pacientes y métodos. Se agruparon los pacientes internados con CAD (período entre enero de 2014 y junio de 2016) según presentaran, al ingresar, AM con AR elevado exclusivo o con hipercloremia y se compararon sus variables clínicas, de laboratorio y la respuesta al tratamiento. Resultados. Se incluyeron 40 pacientes -amp;#91;17 varones, mediana de edad: 14,5 años (2,4-18)-amp;#93;, 22 con AM con componente hiperclorémico (prevalencia de 55%) y 18 con AR elevado exclusivo. La presencia de hipercloremia no se asoció con mejor estado de hidratación (porcentaje de déficit de peso en ambos grupos: 4,9%; p= 0,81) ni con una respuesta terapéutica más rápida (con componente hiperclorémico: 9,5 horas; con AR elevado exclusivo: 11 horas; p= 0,64). Conclusiones. En niños con CAD, la prevalencia de AM con componente hiperclorémico fue del 55% y no se asoció con un mejor estado de hidratación ni con una salida más temprana de la descompensación metabólica.
Introduction. Diabetic ketoacidosis (DKA) is characterized by metabolic acidosis (MA) with a high anion gap (AG), although, occasionally, it can present with hyperchloremia. It has been postulated that the early presence of hyperchloremia could reflect a better hydration status; however, its prevalence and impact on DKA treatment remain unknown. Objectives. To determine the prevalence of the hyperchloremic component in MA prior to treatment and to assess whether it is associated with a better hydration status and a shorter recovery time from DKA compared to patients with high AG only. Patients and Methods. Patients hospitalized with DKA (between January 2014 and June 2016) were grouped according to whether they were admitted with MA with high AG only. or with hyperchloremia, and clinical and laboratory outcome measures and response to treatment were compared. Results. Forty patients (17 males, median age: 14.5 years -amp;#91;2.4-18-amp;#93;) were included; 22 with hyperchloremic metabolic acidosis (prevalence of 55%) and 18 with metabolic acidosis with high AG only. The presence of hyperchloremia was not associated with a better hydration status (weight loss percentage in both groups: 4.9%; p= 0.81) nor with a faster treatment response (MA with a hyperchloremic component: 9.5 hours; MA with high AG only: 11 hours; p= 0.64). Conclusions. The prevalence of MA with a hyperchloremic component among children with DKA was 55% and was not associated with a better hydration status nor with a faster recovery from the metabolic decompensation.
Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Child , Adolescent , Acid-Base Equilibrium/physiology , Acidosis/therapy , Chlorides/blood , Diabetic Ketoacidosis/therapy , Acidosis/physiopathology , Water-Electrolyte Imbalance , Prevalence , Cross-Sectional Studies , Diabetic Ketoacidosis/physiopathology , Organism Hydration Status/physiologyABSTRACT
Abstract Metabolic acidosis is highly prevalent in hemodialysis patients. The disorder is associated with increased mortality and its deleterious effects are already present in the predialysis phase of chronic kidney disease. Metabolic acidosis has been linked to progression of chronic kidney disease, changes in protein and glucose metabolism, bone and muscle disorders and cardiovascular disease. At present, the control of metabolic acidosis in hemodialysis is mainly focused on the supply of bicarbonate during dialysis session, but further studies are needed to set the optimum target serum bicarbonate and the best concentration of the bicarbonate dialysate. The present study reviews pathophysiological and epidemiological aspects of metabolic acidosis in hemodialysis patients and also addresses its adverse effects and treatment.
Resumo A acidose metabólica é altamente prevalente em pacientes em hemodiálise. A doença está associada com mortalidade aumentada e os seus efeitos deletérios já estão presentes na fase pré-diálise da doença renal crônica. A acidose metabólica tem sido associada a progressão da doença renal crônica, alterações no metabolismo das proteínas e da glicose, doenças ósseas e musculares e enfermidades cardiovasculares. Atualmente, o controle da acidose metabólica em hemodiálise está voltado principalmente para o suprimento de bicarbonato durante a sessão de diálise, porém, mais estudos são necessários para definir o bicarbonato sérico alvo ideal e a melhor concentração de bicarbonato do banho. O artigo revisa os aspectos fisiopatológicos e epidemiológicos da acidose metabólica em pacientes em hemodiálise e também aborda seus efeitos adversos e tratamento.
Subject(s)
Humans , Acidosis/etiology , Acidosis/therapy , Renal Dialysis , Kidney Failure, Chronic/therapy , Kidney Failure, Chronic/complications , Kidney Failure, Chronic/metabolismSubject(s)
Humans , Emergency Medical Services/methods , Emergency Treatment/methods , Acidosis/therapy , Hemorrhage/therapy , Hypothermia/therapy , Vascular System Injuries/therapy , Pelvis/injuries , Resuscitation , Kidney/injuries , Blood Coagulation Disorders/therapy , Abdominal Injuries/surgery , Thoracic Injuries/surgeryABSTRACT
In patients undergoing surgery, acid-base imbalance during general anesthesia causes disruption in the function of cardiovascular, respiratory, musculoskeletal and the central nervous system. Since the potential complications of acid-base disturbances are serious, we decided to explore these changes and related causes so that prevention and compensation would be feasible. In this study, acid-base disruption and its causes during general anesthesia were studied in 60 patients. The patients were divided into three groups based on the location of surgery: abdominal [I], extremities [II], and head and neck [III]. Body central temperature, type, and volume of injected fluids and bicarbonate [as needed] were recorded. In the second, third, and fourth hours of surgery, arterial blood gases and pH were measured. The incidence and degree of metabolic acidosis in all patients were significantly related to the duration of the surgery. The number of patients with acidosis and the number of patients requiring treatment were also greater in groups I and II than in group III. Although all patients became hypothermic during the surgery, there was no significant relationship with development of acidosis. No relationship was found between the type and volume of the solution administered and development of acidosis. In our opinion, monitoring of acid-base status in prolonged surgeries especially in abdominal and extremity operations seems necessary
Subject(s)
Humans , Male , Female , Acid-Base Imbalance/complications , Acid-Base Imbalance/prevention & control , Anesthesia, General/complications , Blood Gas Analysis , Acidosis/etiology , Acidosis/therapy , Body Temperature , Bicarbonates , Surgical Procedures, Operative/complicationsABSTRACT
Na prática médica, o distúrbio do equilíbrio ácido-básico possui grande relevância. Muitas funções metabólicas e fisiológicas dependem do pH. Alterações no pH em geral, decorrem de patologias concomitantes (EX: sepse, insuficiência renal, pneumonia, etc...) e, dependendo do grau de alteração, representam um risco eminente de vida ao paciente,O equilíbrio ácido básico é um assunto de importância para todas as especialidades. Porém, seu entendimento prático é revestido de diversos graus de dificuldade.
Subject(s)
Acidosis/etiology , Acidosis/therapy , Alkalosis, Respiratory/ethnology , Alkalosis, Respiratory/therapy , Acid-Base Imbalance , Acid-Base Equilibrium/physiology , Hydrogen-Ion Concentration , Metabolism , Kidney/metabolismABSTRACT
Isoniazid [INH] overdose can be effectively treated, only if, suspected. Seizures and coma are due to INH unless proved otherwise in patients with access to the drug. Acute INH intoxication is characterized by a clinical triad consisting of metabolic acidosis resistant to treatment with sodium bicarbonate, seizure which may be fatal and refractory to standard anticonvulsant therapy, and coma. Pyridoxine is the specific antidote for INH overdose. We report a case of a 25-yr-old lady, who in a suicidal attempt ingested a toxic dose of INH resulting in status epilepticus and was successfully treated with pyridoxine [Vit B6]
Subject(s)
Humans , Female , Isoniazid/antagonists & inhibitors , Pyridoxine , Acidosis/etiology , Acidosis/therapy , Seizures/chemically induced , Seizures/drug therapy , Pyridoxine/administration & dosage , Prognosis , Treatment OutcomeABSTRACT
Foram utilizados seis novilhos, providos de cânula ruminal, em delineamento experimental cross-over, para comparar a eficiência de soluções de bicarbonato de sódio e lactato-L de sódio na correção da acidose metabólica sistêmica (AMS), causada pela acidose láctica ruminal (ALR). Vinte horas após, quando apresentavam intensa AMS, os animais foram distribuídos aleatoriamente e tratados com cinco litros de 150mMol/l de bicarbonato de sódio ou de lactato-L de sódio, infundidas por via intravenosa, nas quatro horas seguintes. Amostras de sangue, para hemogasometria, foram coletadas no decorrer da infusão a zero, 1, 2, 3, 4, 6 e 8 horas. Ambos os tratamentos elevaram o pH sangüíneo já na primeira hora pós-infusão, corrigindo adequadamente a AMS. O tratamento com lactato-L de sódio aumentou as concentrações de bicarbonato, TCO2 e EAB sangüíneos já na segunda hora pós-infusão; com o bicarbonato essa elevação ocorreu a partir da terceira hora. Não houve diferenças entre tratamentos para pH sangüíneo, bicarbonato, TCO2 e excesso de base. Vinte e quatro horas após o tratamento todos os novilhos apresentaram plena recuperação. O lactato-L pode substituir o bicarbonato na correção da AMS em novilhos com ALR
The efficiency of sodium bicarbonate or l-lactate for correcting systemic metabolic acidosis (SMA) caused by rumen lactic acidosis (RLA) was evaluated using six rumen-cannulated steers in a cross-over experimental design. RLA was induced by administration of sucrose, intraruminally. Twenty hours later when the animals developed an intense SMA, the steers were randomly distributed and treated intravenously either with 5l of 15 mMol/l sodium bicarbonate or L-lactate solution, infused throughout 4h. Blood samples were colleted throughout the infusion at zero, 1, 2, 3, 4, 6 and 8h, for blood gas analysis. After 1hour, both sodium bicarbonate and L-lactate solutions increased blood pH and corrected adequately the SMA. Blood bicarbonate, TCO2 and base excess concentrations were also increased at the 2nd hour with L-lactate and at the 3rd hour with bicarbonate. No differences between treatments were observed for blood pH, bicarbonate, TCO2 and base excess concentrations. Treated steers after twenty-four hours showed an effective clinical recovery. L-lactate can adequately replace bicarbonate in the correction of SMA in steers with RLA
Subject(s)
Animals , Cattle , Acidosis, Lactic/metabolism , Acidosis, Lactic/veterinary , Acidosis/metabolism , Acidosis/therapy , Sodium Bicarbonate/therapeutic use , Cattle/metabolismABSTRACT
Neutropenia exists when the neutrophil counts is less than 1000/mm3 in infants between 2 weeks and 1 year of age and less than 1500/mm3 beyond 1 year of age (1). Severe infections occur when the absolute neutrophil count is below 500/mm3 with perirectal abscesses, pneumonia, and sepsis being common. Granulocyte Colony-Stimulating Factor (G-CSF) produces a sustained neutrophil recovery in patients with severe neutropenia, reduces the incidence and severity of infection, and improves the quality of life. Various cytopenias, including neutropenia, thrombocytopenia and pancytopenia, have been reported in association with inborn errors of branched aminoacid metabolism such as methylmalonic, propionic and isovaleric acidemia. We report an infant with methylmalonic acidemia who presented severe neutropenia
Subject(s)
Humans , Male , Infant, Newborn , Infant , Methylmalonic Acid/blood , Acidosis/complications , Amino Acid Metabolism, Inborn Errors/complications , Neutropenia/etiology , Acidosis/blood , Acidosis/therapy , Amino Acid Metabolism, Inborn Errors/blood , Amino Acid Metabolism, Inborn Errors/therapy , Granulocyte Colony-Stimulating Factor/therapeutic use , Infant, Premature , Neutropenia/blood , Treatment OutcomeABSTRACT
O objetivo do presente estudo foi descrever algumas alteraçöes metabólicas em 109 pacientes adultos, recém-admitidos no Centro de Terapia Intensiva do Hospital Escola da Faculdade de Medicina do Triângulo Mineiro, Uberaba, MG. Os principais diagnósticos foram: traumatismo craniano, sépsis, politraumatismo, pós-operatório de grandes cirurgias, acidente vascular cerebral, encefalopatia anóxica pós-parada cardíaca e intoxicaçäo barbitúrica. Sessenta por cento dos pacientes estavam sob assistência respiratória e 15,6 por cento tinham história de alcoolismo. As alteraçöes mais frequentes foram: hiperglicemia (76,4 por cento), hipomagnesemia (63,4 por cento), hipoalbunemia (56,4 por cento), hipocalcemia (47,6 por cento), hipopotassemia (45,9 por cento), níveis de creatinina sérica superiores ao normal (32,2 por cento), hipofosfatemia (28,7 por cento), acidose (28,3 por cento), hipernatremia (23,9 por cento) e hiponatremia (22,0 por cento). Houve correlaçäo estatística (p<0,05) entre níveis séricos do potássio com fósforo e com o cálcio, do magnésio com o cálcio e do sódio com o cálcio. Estas alteraçöes metabólicas provavelmente refletem distúrbios no metabolismo de carboidratos, água e eletrólitos secundários ao estresse, bem como a má perfusäo tecidual.
Subject(s)
Humans , Adult , Water-Electrolyte Balance , Intensive Care Units , Metabolism , Fluid Therapy , Acidosis/therapy , Hypophosphatemia/therapy , Hyperglycemia/therapy , Hypernatremia/therapy , Hypocalcemia/therapy , Hypokalemia/therapy , Hyponatremia/therapyABSTRACT
Embora a hipobicarbonaterapia seja a caracteristica principal das acidoses matabólicas,nao se deve considerar como consequencia natural a sua administraçao. As vezes,tal administraçao pode provocar complicaçoes,alem de nao solucionar o distúrbio ácido-basico.No presente trabalho,sao analisdas as razoes do seu uso,as consequências,boas ou más,que provoca e a maneira que empregamos para calcular a quantidade a ser infundida,quando houver razao para o seu uso.
Subject(s)
Humans , Sodium Bicarbonate/administration & dosage , Sodium Bicarbonate , Acidosis/therapyABSTRACT
O artigo é uma revisäo suscinta de aspectos da fisiopatologia, do diagnóstico e do tratamento dos desvios do equilíbrio ácido-básico. Concentramos o texto nos aspectos relativos a classificaçäo, formas de compensaçäo, causas, sintomatologia, diagnóstico laboratorial, fundamentos da terapêutica e tratamento farmacológico. Mantivemos a classificaçäo de ASTRUP-SIGGAARD-ANDERSEN-JORGENSEN, 1960 que divide os transtornos do equilíbrio ácido-básico em respiratórios e näo-respiratórios (compensados, näo -compensados e parcialmente compensados) e os critérios de diagnóstico baseados na equaçäo de HENDERSON-HASSELBALCH, 1908
Subject(s)
Acidosis/therapy , Alkalosis/therapy , Acid-Base Imbalance , Diagnosis, Differential , Acid-Base Imbalance/diagnosis , Acid-Base Imbalance/physiopathology , Acid-Base Imbalance/therapyABSTRACT
Se les realizaron estudios del equilibrio ácido-básico a 60 pacientes pediátricos antes de la anestesia; 3 pacientes presentaron alcalosis metabólica, los cuales no requirieron tratamiento, los 57 restantes no mostraron alteraciones ácido-básicas. A 30 pacientes se les efectuaron toracotomía, tripleligadura y cección del ductus arterioso persistente y a los otros 30 cirugía pulmonar (26) o pleural (4). Todos se anestesiaron con tiopental 2,5 %, succinilcolina 2 %, intubación endotrawqueal y el mantenimiento se realizó con oxígeno-óxido nitroso y halotano y como relajante muscular succinilcolina al 0,2 %, vía intravenosa. Los 60 estudios del equilibrio ácido-básico realizados a los pacientes una vez recuperados de la anestesia dieron por resultado que 14 presentaron acidosis, de los cuales sólo 6 necesitaron tratamiento con bicarbonato de sodio al 4 % y 4 pacientes necesitaron medidas para mejorar la ventilación alveolar
Subject(s)
Infant , Child, Preschool , Child , Adolescent , Humans , Male , Female , Acidosis/therapy , Alkalosis , Anesthesia/adverse effects , Bicarbonates/therapeutic use , Acid-Base Equilibrium , Postoperative Care , Respiration, Artificial , Sodium/therapeutic use , Thoracic SurgeryABSTRACT
Estudio de 18 lactantes con acidosis metabólica grave (pH sérico menor de siete) tratados con diálisis peritoneal. En cada paciente se determinó pH, EB (exceso de base) y HCO3 previos al procedimiento quirúrgico; posteriormente, control al quinto baño de diálisis y a las seis horas de evolución. En siete pacientes se determinó lactato sérico y líquido de diálisis. Se correlacionaron número de baños de diálisis y pH sérico; r=0.89 y p<0.01. Se demuestra diferencia significativa entre el inicio y la evolución a las seis horas para el pH,t=13.42 y p<0.001, EB con t=7.99 y p<0.001, y para HCO3, t=5.67 y p<0.001; lactado sérico de 23.2 mg%, lactado en líquido de diálisis promedio, de 23.23 mg%. No hubo complicaciones. Se considera que la acidosis metabólica grave es mortal o deja secuelas neurales irreversibles. Consideramos que todo pacientes con acidosis metabólica con pH menor de siete debe recibir el beneficio de la diálisis