One-step laparoscopic abomasopexy versus abomasopexy via right paralumbar fossa to treat left abomasal displacement in dairy cows / Abomasopexia por laparoscopia em um passo em comparação à abomasopexia via laparotomia pelo flanco direito no tratamento do deslocamento de abomaso à esquerda em vacas leiteiras

This study aimed to compare the clinical and metabolic results obtained by use of one-step laparoscopic abomasopexy and right paralumbar fossa abomasopexy for the treatment of left displaced abomasum in dairy cows. Thirty Holstein-Friesian dairy cows were randomly placed in two groups: G1, with 15 animals treated by one-step laparoscopic abomasopexy; and G2, with 15 animals treated by right paralumbar fossa ventral abomasopexy. Concentrations of sodium, potassium, chloride, bicarbonate, base excess (BE), pH, partial pressure of carbon dioxide (pCO2) strong ion difference (SID), anion gap (AG), glucose, β-hydroxybutyrate (BHBA) and non-esterified fatty acids (NEFA) were measured before (M0) and 24 (M1), 48 (M2) and 72 (M3) hours following surgery. Laparotomy was statistically faster than laparoscopy. Hypochloremia was observed only in G2 at M0. Hypokalemia and hypocalcemia were observed in both groups at M0, increasing after surgery. Metabolic alkalosis in both groups before surgery was characterized by high bicarbonate, pCO2, and BE, which decreased in subsequent time points, as well as blood pH. Glucose was statistically increased and NEFA and BHBA were statistically decreased in G2 compared to G1. In G1, NEFA and BHBA decreased significantly following surgery. Both surgical techniques restored abomasal flow and feed intake in both groups. Based in acid-base status, one-step laparoscopy showed no additional advantage in comparison with abomasopexy via right paralumbar fossa.(AU)

Este estudo objetivou comparar as técnicas de abomasopexia por laparoscopia em um passo e abomasopexia por laparotomia pelo flanco direito, no tratamento do deslocamento de abomaso à esquerda (DAE) em vacas leiteiras quanto a recuperação clínica no pós-operatório, utilizando parâmetros clínicos, metabólicos e eletrolíticos. Trinta vacas Holandesas preto e brancas foram distribuídas de forma aleatória em dois grupos: G1 com 15 animais tratados pela técnica de abomasopexia em um passo; e G2, com 15 animais tratados pela abomasopexia por laparotomia pelo flanco direito. Foram mensuradas as concentrações séricas de sódio, potássio, cloro, bicarbonato, excesso de base (BE), pH sanguíneo, pressão parcial de gás carbônico (pCO2), diferença de íons fortes (SID), ânion gap AG), glicose, β-hidroxibutirato (BHBA) e ácidos graxos não esterificados (NEFA). As variáveis foram mensuradas antes da operação e 24, 48 e 72 horas após operação. A laparotomia foi estatisticamente mais rápida do que a laparoscopia no tratamento do DAE. Hipocloremia foi observada somente nas vacas do G2 antes da cirurgia. Alcalose metabólica em ambos os grupos antes da operação foi caracterizada pelo aumento do bicarbonato, pCO2 e BE, os quais diminuíram significativamente nos momentos subsequentes, assim como o pH sanguíneo. A concentração de glicose apresentou aumento significativo no G2 em comparação ao G1, enquanto o BHBA e o NEFA estavam estatisticamente diminuídos. Ambas as técnicas restauraram o fluxo abomasal e o consumo de alimentos em ambos os grupos. Baseado no equilíbrio ácido-base, a técnica de laparoscopia não demonstrou vantagens sobre a técnica cirúrgica tradicional.(AU)

Alcalosis metabólica hipoclorémica o alcalosis de iones fuertes: una revisión / Hypochloremic metabolic alkalosis or strong ion alkalosis: A review / Alcalose metabólica hipoclorêmica ou alcalose de íons fortes: uma revisão

Durante los últimos 100 años se han realizado diferentes investigaciones en busca de dilucidar los mecanismos del equilibrio ácido base en humanos y animales. A partir de estas investigaciones se han desarrollado diferentes abordajes, de los cuales el modelo propuesto por Henderson-Hasselbalch (H-H) es el más difundido en la comunidad médica y médico-veterinaria. En los últimos años ha cobrado gran importancia otro método propuesto por Stewart y es el correspondiente a la diferencia de iones fuertes, el cual pretende dar una mirada más amplia para entender los diferentes procesos que intervienen en dicho equilibrio. Tanto en medicina humana como en medicina veterinaria en las unidades de cuidados intensivos uno de los disturbios ácido base más común es la alcalosis metabólica hipoclorémica que en humanos resulta principalmente del vómito y en animales rumiantes de disturbios abomasales. Este estado puede llegar a permanecer por periodos largos, en los cuales se desarrolla el fenómeno de una orina ácida conocida como aciduria paradójica. El presente artículo pretende revisar los diferentes mecanismos fisiopatológicos que ocurren durante este trastorno ácido base y los diferentes abordajes para explicar su ocurrencia.

Over the past 100 years numerous studies sought to elucidate the mechanisms of acid-base balance in humans and animals. Based on these investigations, different approaches have been developed; among them, the model proposed by Henderson-Hasselbalch (H-H) is the most widespread in the medical and medical-veterinary community. In recent years, another method proposed by Stewart has gained importance, and it corresponds to the strong ion difference, which aims to take a broader look in order to understand the different processes involved in acid-base balance. Both in human and veterinary medicine, one of the most common acid-base disorder in ICUs is hypochloremic metabolic alkalosis, which results from vomiting in humans and from abomasal disorders in ruminants. This disorder can remain for long periods during which acidic urine occurs and it is known as paradoxical aciduria develops. This article reviews the different pathophysiological mechanisms occurring during this acid-base disorder and the different approaches to explain its occurrence.

Durante os últimos 100 anos têm se realizado diferentes pesquisas em busca de dilucidar os mecanismos do equilíbrio ácido base em humanos e animais. A partir destas pesquisas se desenvolveram diferentes abordagens, das quais o modelo proposto por Henderson-Hasselbalch (H-H) é o mais difundido na comunidade médica e médico-veterinária. Nos últimos anos adquiriu grande importância outro método proposto por Stewart e é o correspondente à diferença de íons fortes, o qual pretende dar uma visão mais ampla para entender os diferentes processos que intervêm neste equilíbrio. Tanto em medicina humana como em medicina veterinária nas unidades de cuidados intensivos um dos distúrbios ácido base mais comum é a alcalose metabólica hipoclorêmica que em humanos é causado principalmente do vômito e em animais ruminantes de distúrbios abomasais. Este estado pode chegar a permanecer por períodos longos, nos quais se desenvolve o fenômeno de uma urina ácida conhecida como acidúria paradoxal. O presente artigo pretende revisar os diferentes mecanismos fisiopatológicos que ocorrem durante este transtorno ácido base e as diferentes abordagens para explicar sua ocorrência.

Relación entre el intervalo de nacimiento entre gemelos y el pH de cordón umbilical: ¿existe asociación entre la acidosis del primer gemelo y el segundo? / Relationship between the birth interval between twins and umbilical cord pH: is there an association between acidosis of the first twin and the second?

OBJETIVOS: Determinar si el intervalo de nacimiento vía vaginal entre gemelos, se relaciona con un descenso de pH arterial/venoso de cordón umbilical del segundo gemelo respecto al primero, y establecer si el pH acidótico del primer gemelo predice la acidosis del segundo. MÉTODO: Estudio de cohortes retrospectivo en 77 pares de gemelos realizado en el Hospital de Getafe, España, en el periodo 2008-2013. Se relacionó el tiempo transcurrido entre el nacimiento de los gemelos con el resultado del pH de cordón y el exceso de bases. Estudiamos la correlación entre el tiempo transcurrido entre ambos nacimientos y la diferencia entre los valores de pH del primer y segundo gemelo, y la correlación con la diferencia de exceso de base. RESULTADOS: Hubo correlación lineal significativa entre el tiempo transcurrido entre el nacimiento de los gemelos y la diferencia de pH venoso del segundo gemelo respecto del primero (R=0,560; p=0,0001), así como con el pH arterial (R=0,502; p=0,0001). El pH <7,20 del primer gemelo se asoció con acidosis en el cordón del 2° gemelo (<7,20, p=0,000; <7,15, p=0,0001; <7,10, p=0,0001; <7,05, p=0,001; <7,00, p=0,0001). CONCLUSIONES: El pH del segundo gemelo siempre fue igual o menor que el del primer gemelo, hubo una correlación lineal entre el intervalo de nacimiento entre gemelos y el descenso del pH venoso y arterial del segundo gemelo respecto al primero. El pH acidótico del primer gemelo predice la acidosis del segundo.

OBJETIVOS: Determinate if the twin-to-twin vaginal delivery time interval, is related with a decline of the arterio-venous cord blood pH of the second twin regarding to the first twin, and to evaluate if the acidotic pH of first twin can predict the acidosis status of the second one. METHOD: A retrospective descriptive cohort study was performed at the Hospital of Getafe, Spain, in the period 2008-2013, with 77 pairs of twins that were registered and met the inclusion criteria. The twin-to-twin delivery time interval and the cord blood status results were registered. A statistical analysis was performed to study the relation of the twin-to-twin delivery time interval with the pH value differences between first and second twins, and with the base excess. RESULTS: A positive linear correlation between the twin-to-twin delivery time interval and the difference of venous pH of the second twin respect to the first one was found (R=0.560; p=0.0001), and also with the difference on arterial pH (R=0.502; p=0.0001). A pH value <7.20 of the first twin was associated with blood cord acidosis of the second twin (<7.20, p=0.000; <7.15, p=0.0001; <7.10, p=0.0001; <7.05, p=0,001; <7.00, p=0.0001). CONCLUSIONS: The second twin pH was equal to or less than the first twin pH in all cases. There is a linear relation between twin-to-twin delivery time interval and the decrease of the pH value of the second twin regarding to the first one. The acidosis of first twin could predict the acidosis status of the second twin.

Avaliação da terapia com fluido no período perioperatório da ovariossalpingohisterectomia, em cadelas com piometra e insuficiência renal aguda / Avaliation of perioperative conservative treatment in pyometra ovariohysterectomy bitches of in acute renal failure

A insuficiência renal aguda foi avaliada em 351 cadelas com piometra, selecionando-se 132 pelos critérios: creatinina > 2,4 mg/dL e/ou ureia > 80 mg/dL e/ou aumentos relativos de 100% de creatinina e/ou ureia séricas, no diagnóstico, 24 horas após a ovariossalpingohisterectomia e na retirada dos pontos. Foi administrado Ringer lactato de sódio até 90 mL/kg/h, durante quatro horas, ou três dias. Os parâmetros avaliados antes e após cada terapia foram: peso, pressão arterial sistólica (PAS), frequência cardíaca, função renal, hemogasimetria arterial, bioquímica sérica e urinária, unidade de remoção de ureia, fração de excreção de eletrólitos e clearance de creatinina. A análise univariada detectou diferença significante (p < 0,05) para: PAS, pH urinário, peso corpóreo, ureia e creatinina séricas, fração de excreção de eletrólitos e clearance da creatinina. Comparadas as sobreviventes (79,6%) com as não sobreviventes (20,4%), respectivamente, detectou-se creatinina sérica de 2,38 ± 1,33 mg/dL (média ± desvio padrão) e mediana 2,2 mg/dL e de 5,54 ± 3,0 mg/dL (média ± desvio padrão) e mediana 4,4 mg/dl, com diferença significante (p < 0,0001). Quanto ao clearance da creatinina endógena nas sobreviventes, 1,82 ± 1,74 mL/kg/min (média ± desvio padrão) e mediana 1,34 mg/dL e as não sobreviventes 0,36 ± 0,38 mg/dL (média ± desvio padrão) e mediana 0,23 mg/dL, com diferença significativa (p < 0,0001). Conclui-se que o critério de inclusão pode auxiliar na seleção dos animais em estado grave e o clearance da creatinina, considerado relevante quando observados valores > 1 mL/kg/min; negativo com valores < 1 mL/kg/min e indicador de falência renal grave e ou morte para valores < 0,5 ml/kg/min.

Acute renal failure (ARF) was evaluated prospectively in 351 female dogs with piometra, 132 animals were selected for this study, fulfilling the following criteria, measured in three moments (immediately after the diagnosis, 24 hours after the hysterectomy and when the suture was removed): creatinine > 2.4 mg/dL and/or urea > 80 mg/dL and/or relative increases of 100% in comparison with values previously obtained. The animals selected for the prospective study received conservative treatment consisting in lactated Ringer solution, with the maximum dose of 90 mL/kg/hr, during four hours. The factors evaluated before and after the therapy were: weight, systolic arterial pressure, heart rate, renal function, arterial hemogasometry, serum and urinary biochemistry and the endogenous renal creatinine clearance. The evaluated parameters showed significant statistical differences (p < 0.05) when companing: PAS (systolic arterial pressure), urinary pH, wheigt, serum urea and creatinine, excretion electrolyte rate and creatinine clearance. Howerer, the survining animals (79.6%) that received the treatment described above showed decresead levels of serum creatinine- 2,38 ± 1,33mg/dL and median 2.2 mg/dL – when compared to the non-survining animals (20.4%) that received the same treatment – 5.54 ± 3.0mg/dL and median 4.4mg/dL – (p < 0.0001). When comparing the endogenous creatinine clearance, the survining animals had higher values – 1.82 ± 1.74mL/kg/min and median 1.34 mL/kg/min – than the non-survining animals – 0.36 ± 0.38 mL/kg/min and median 0.23 mL/kg/min – (p < 0.0001). Concluding: the criteria used to include the animals in this study can help to select the severely affected animals. Values higher than 1mL/kg/min are considered as a good prognosis while values lower than 1mL/kg/min are considered as a restricted prognosis. Values lower than 0.5 mL/kg/min are considered as strong predictors of severe renal failure or death.

Relationship between Twin-to-twin Delivery Interval and Umbilical Artery Acid-base Status in the Second Twin

The purpose of this study was to determine the effect of twin-to-twin delivery interval on umbilical artery acid-base status of the second twin at birth. This was a retrospective cohort study of all live-born twins with measured acid-base status in umbilical arterial blood who were delivered after 34 weeks' gestation from June 2003 to February 2006. Twins with any maternal or fetal complications were excluded. Subjects were divided into two groups based on the mode of delivery of the first twin: normal cephalic vaginal deliveries (n=40) or cesarean deliveries (n=67). The inter-twin differences in umbilical arterial blood pH, PCO2, PO2, and base excess in twin newborns born vaginally were significantly greater than the corresponding differences in those born by cesarean section. A significant positive correlation was found between twin-to-twin delivery interval and inter-twin difference in umbilical arterial blood pH in twin newborns born vaginally. The umbilical arterial blood pH of the second twin was less than 7.0 in 14% (2/14) in cases delivered more than 20 min after the first twin. The umbilical arterial blood gas status of the second twin worsened with increasing twin-to-twin delivery interval, and pathologic fetal acidemia (pH<7.0) might develop in the second twin when the twin-to-twin delivery interval was greater than 20 min.

Relationship between fetal biophysical profile and fetal cord blood acid-base status obtained by cordocentesis / 대한산부인과학회잡지

OBJECTIVE: Fetal biophysical profile is widely used antenatal test for fetal wellbeing, but its biochemical background is not well known. The purpose of this study is to examine the relationship of fetal biophysical profile and cord blood acid base status including gas analysis using cord blood obtained by cordocentesis, by which the biochemical background of fetal biophysical profile can be understood. STUDY DESIGN: 121 pregnant women received cordocentesis for various indication, of whom the fetuses were evaluated with fetal biophysical profile just before the cordocentesis. Cord blood obtained by cordocentesis was analyzed for acid-base and gas status. The results of both tests were compared by appropriate statistical method. RESULTS: Fetal biophysical profile showed definite correlation with the results of cord blood acid-base and gas analysis (p<0.001). Fetal biophysical profile was not a sensitive study for the diagnosis of fetal acidemia, but the test could be used for the diagnosis of severe fetal acidemia. Variables of fetal biophysical profile responded to acidemia differently and there were gradual changes among the variables according to the degree of acidemia. Gestational age was important factor for the normality of nonstress test, even after adjustment of pH level. Anomaly did not affect the fetal biophysical profile and fetal biophysical profile was determined mainly by fetal metabolic status. CONCLUSION: Fetal biophysical profile score is a useful noninvasive antenatal test reflecting fetal acid base status, effective for the diagnosis of severe acidemia, probably affected by fetal gestational age, but not by fetal anomaly.

Acid-base Balance of Korean CAPD Patients: Incidence of Metabolic Acidosis and Factors Affecting the Acid-base Status / 대한신장학회잡지

OBJECTIVES: Any form of dialysis must provide a sufficient replenishment of buffer. Lactate with a con- centration of 35 to 40mM/L is now the only buffer routinely used in CAPD. Buffer balance using lactate solutions will be governed essentially by the balance between the H+ generated, the amount of bicarbonate lost into the peritoneal effluent, and the lactate absorbed from the dialysate. Factors affecting buffer balance in CAPD patients will therefore include dietary protein intake which determine H+ generation and ultrafiltration which can affect bicarbonate loss. Although several studies reported a different prevalence of metabolic acidosis in their CAPD patients, it is uncertain whether the same prevalence of metabolic acidosis(MA) or the similar characteristics of acid-base status of Western CAPD patients can be found in Asian patients with smaller body size and relatively less amount of dietary animal protein intake. This study was undertaken to know the current acid-base status of CAPD patients in Korea with the exact information about buffer balance. We will also investigate the factors affecting acid-base homeostasis in CAPD patients such as dietary protein intake, the individual membrane characteristics and the various indices of dialysis adequacy and nutritional status of patients. METHODS: The acid-base status of Korean CAPD patients was assessed based on arterial blood gas analysis along with various nutritional parameters including subjective global assessment(SGA), anthropometric measurements and standard peritoneal equilibration test in 198 clinically stable patients main- tained on CAPD for more than 6 months using 35- 40mM/L of lactate-based dialysate(M:F 106:92, mean age 47.9 years, mean duration 45.3 months). RESULTS: Mean arterial bicarbonate concentration was 24.6+/-3.4mM/L with a range of 16.2-36.7mM/L and mean dialytic base gain was 29.4+/-15.2mM/day. Only 28(14.1%) patients showed MA while 52(26.3%) patients had a various degree of metabolic alkalosis. Normal acid-base status was observed in 75 patients(37.9%). The rest showed mixed acid-base abnormalities of respiratory origin. Patients with MA (mean HCO3 19.5+/-1.9mM/L) showed significantly higher serum albumin(4.01+/-0.38 vs. 3.59+/-0.46 g/dl, P<0.001) & protein equivalent of nitrogen appearance (NPNA, 1.2+/-0.1 vs. 0.9+/-0.2 g/kg/day, P<0.05) compared to the metabolic alkalosis group(mean HCO3 28.1+/-1.9mM/L). Dialytic protein loss(6.39+/-1.86 vs. 7.64+/-2.71 g/day, P<0.01) and D/PCr(0.60+/-0.09 vs. 0.71+/-0.13, P<0.05) were significantly lower in MA group. There were no significant differences in residual renal function, KT/VUrea, number of malnourished patients by SGA and other anthropometric parameters according to the acid-base status of patients. There were significant inverse correlations of arterial HCO3 with serum albumin and NPNA while HCO3 was positively correlated with duration of dialysis, ultrafiltration volume, dialytic lactate gain and dialytic protein loss. CONCLUSION: Our results on the acid-base status of Korean CAPD patients including a generally lower incidence of MA appear to be quite different from other reports based on the Western population. The peritoneal membrane transport characteristics can be one of the important factors determining the acid- base status of peritoneal dialysis patients. Duration of dialysis and protein catabolic rate also influence arterial bicarbonate level independently.