¿Bicarbonato de sodio en terapia intensiva es útil o no?

La acidosis metabólica se ha convertido en un problema muy serio, tanto en las áreas críticas, como de medicina interna y emergencias, sobre todo por la innumerable cantidad de patologías que la presentan; que ha encaminado a muchos profesionales a usar el bicarbonato de Na (NaHCO3-), que definitivamente tiene un efecto en el ascenso del pH y el HCO3-, asociado a un sosiego inverosímil del profesional médico y probablemente a un escaso beneficio por parte de los pacientes; este estudio trata de explicar en forma concisa a la etiología de la acidosis metabólica y la real indicación de esta droga, que hasta el momento podría tener más perjuicios que beneficios.

Metabolic acidosis has become a very serious problem, both in critical areas, such as internal medicine and emergencies, especially due to the innumerable number of pathologies that present it; which has led many professionals to use Na bicarbonate (NaHCO3-), which definitely has an effect on the rise in pH and HCO3-, associated with an unlikely calmness of the medical professional and probably with little benefit on the part of the patients. patients; This study tries to concisely explain the etiology of metabolic acidosis and the real indication of this drug, which up to now could have more harm than good.

Effect of different hypoxic and hypobaric interventions on blood gas and erythrocyte-related indicators in rats / 浙江大学学报·医学版

OBJECTIVES@#To explore the effects of hypoxic and hypobaric conditions on blood gas and erythrocyte-related indicators in rats.@*METHODS@#SD male rats were exposed to low-pressure hypoxic conditions simulating an altitude of 6500 m in a small or a large experimental cabin. Abdominal aortic blood samples were collected and blood gas indicators, red blood cells (RBCs) count, and hemoglobin (Hb) content were measured. The effects of exposure to different hypoxia times, different hypoxia modes, normal oxygen recovery after hypoxia, and re-hypoxia after hypoxia preconditioning on blood gas indicators, RBCs count and Hb content were investigated.@*RESULTS@#The effect of blood gas indicators was correlated with the length of exposure time of hypoxia and the reoxygenation after leaving the cabin. Hypoxia caused acid-base imbalance and its severity was associated with the duration of hypoxia; hypoxia also led to an increase in RBCs count and Hb content, and the increase was also related to the time exposed to hypoxia. The effects of reoxygenation on acid-base imbalance in rats caged in a small animal cabin were more severe that those in a large experimental cabin. Acetazolamide alleviated the effects of reoxygenation after leaving the cabin. Different hypoxia modes and administration of acetazolamide had little effect on RBCs count and Hb content. Normal oxygen recovery can alleviate the reoxygenation and acid-base imbalance of hypoxic rats after leaving the cabin and improve the increase in red blood cell and hemoglobin content caused by hypoxia. The improvement of hypoxia preconditioning on post hypoxia reoxygenation is not significant, but it can alleviate the acid-base imbalance caused by hypoxia in rats and to some extent improve the increase in red blood cell and hemoglobin content caused by hypoxia.@*CONCLUSIONS@#Due to excessive ventilation and elevated RBCs count and Hb content after hypoxia reoxygenation, oxygen partial pressure and other oxygenation indicators in hypoxic rats are prone to become abnormal, while blood gas acid-base balance indicators are relatively stable, which are more suitable for evaluating the degree of hypoxia injury and related pharmacological effects in rats.

Alteraciones del estado ácido básico en pacientes adultos con insuficiencia renal crónica / Acid-base status alterations in adult patients with chronic renal failure

RESUMEN Introducción: el portador de insuficiencia renal crónica puede presentar diversas alteraciones del estado ácido básico, siendo la acidosis metabólica la más frecuente. Objetivos: describir las características demográficas y clínicas y las alteraciones del estado ácido básico de pacientes adultos que ingresan con insuficiencia renal crónica en dos centros hospitalarios del Paraguay. Metodología: se aplicó un diseño observacional, descriptivo, transversal. Se incluyó a sujetos adultos de ambos sexos, portadores de insuficiencia renal crónica, que acudieron al Hospital Nacional (Itauguá) y Hospital Militar (Asunción) entre abril y noviembre del 2021. Se midieron variables antropométricas, clínicas y laboratoriales al ingreso. Los datos se sometieron a estadística descriptiva con el programa Epi Info 7™. El estudio contó con la aprobación del Comité de Ética de la Universidad Privada del Este, Paraguay. Resultados: se incluyó a 148 sujetos, siendo 78 (52,7 %) varones con edad media 58 ± 16 años y 70 (47,3 %) mujeres con edad media 54 ± 17 años. Las etiologías más frecuentes de la insuficiencia renal crónica fueron la diabetes mellitus e hipertensión arterial (44,5 %). Se detectó 12 sujetos (8,1 %) con gasometría normal. La alteración del estado ácido básico más frecuente fue la acidosis metabólica (87,2 %), predominando en este grupo los casos con brecha aniónica normal. Conclusiones: las alteraciones del estado ácido básico predominantes en pacientes con insuficiencia renal crónica fue la acidosis metabólica con brecha aniónica normal. Se sugiere aplicar los cálculos de los mecanismos compensadores para llegar al diagnóstico certero de estas alteraciones metabólicas.

ABSTRACT Introduction: the carrier of chronic renal failure can present various alterations of the basic acid state, being the metabolic acidosis the most frequent. Objectives: to describe the demographic and clinical characteristics and alterations in the acid-base status of adult patients admitted with chronic renal failure in two hospitals in Paraguay. Methodology: an observational, descriptive, cross-sectional design was applied. Adult subjects of both sexes, carriers of chronic renal failure, who attended the National Hospital (Itauguá) and the Military Hospital (Asunción) between April and November 2021 were included. Anthropometric, clinical and laboratory variables were measured at admission. The data was submitted to descriptive statistics with the Epi Info 7™ program. The study was approved by the Ethics Committee of the Universidad Privada del Este, Paraguay. Results: 148 subjects were included, being 78 (52.7 %) men with a mean age of 58 ± 16 years and 70 (47.3 %) women with a mean age of 54 ± 17 years. The most frequent etiologies of chronic renal failure were diabetes mellitus and arterial hypertension (44.5 %). 12 subjects (8.1 %) with normal blood gases were detected. The most frequent alteration of the acid-base status was metabolic acidosis (87.2 %), with cases with normal anion gap predominating in this group. Conclusions: the predominant acid-base status alterations in patients with chronic renal failure was metabolic acidosis with normal anion gap. It is suggested to apply the calculations of the compensatory mechanisms to arrive at the accurate diagnosis of these metabolic alterations.

A comparison of dietary acid load between team, endurance, and strength sports

ABSTRACT Purpose: Since the dietary acid load (PRAL) may affect the acid-base balance of the body, there is an increasing interest in its role in sports performance. Typical nutritional requirements of different sports, associated with its physiological demands, might be reflected in the acid load of their diet. Thus, the purpose of this study is to compare the dietary acid load between team, endurance, and strength athletes and to determine the associations between PRAL and hydration status. Methods: Fifty-one healthy recreational male athletes (age: 18-39 yrs) from team, endurance, and strength sports participated in the study. A 3-day food diary was recorded and dietary PRAL values (mEq/day) were calculated. Urine pH and specific gravity were measured. One-way ANOVA with Bonferroni post-hoc analysis and Pearson correlation coefficient (r) were used for data analysis. Results: PRAL in endurance athletes (25.34 mEq/day) was lower compared to team and strength athletes (46.12 and 46.47 mEq/day, respectively) (p= 0.023). Percentage of high PRAL diet (≥15 (mEq/day)) was highest in team sports (89.5%), followed by strength (83.3%) and endurance sports (60%). PRAL was not associated with hydration status. Conclusion: Typical nutritional requirements of sport disciplines are reflected in the PRAL, thus PRAL should be considered when preparing nutritional strategies to improve performance.

RESUMEN Objetivo: Dado que la carga ácida de la dieta (PRAL) puede afectar el equilibrio ácido-base del cuerpo, existe un interés creciente en su papel en el rendimiento deportivo. Los requerimientos nutricionales típicos de diferentes deportes, asociados con sus demandas fisiológicas, pueden reflejarse en la carga ácida de su dieta. Por lo tanto, el propósito de este estudio fue comparar la carga ácida de la dieta entre atletas de equipo, de resistencia y de fuerza, y determinar las asociaciones entre PRAL y el estado de hidratación. Métodos: Participaron en el estudio 51 atletas masculinos sanos (edad: 18-39 años) de deportes de equipo, de resistencia y de fuerza. Se registró un diario de alimentación de 3 días y se calcularon los valores de PRAL dietético (mEq/día). Se midieron el pH y la gravedad específica de la orina. Para el análisis de datos se utilizó ANOVA de una vía con análisis post-hoc de Bonferroni y coeficiente de correlación de Pearson (r). Resultados: PRAL en los atletas de resistencia (25,34 mEq/día) fue menor en comparación con los atletas de equipo y de fuerza (46,12 y 46,47 mEq/día, respectivamente) (p= 0,023). El porcentaje de dieta alta en PRAL (≥15 mEq/día) fue más alto en los deportes de equipo (89,5%), seguido de los deportes de fuerza (83,3%) y de resistencia (60%). PRAL no se asoció con el estado de hidratación. Conclusión: Los requerimientos nutricionales típicos de las disciplinas deportivas se reflejan en el PRAL, por lo que se debe considerar el PRAL al preparar estrategias nutricionales para mejorar el rendimiento.

Iatrogenic alkalosis in goats with the use of intravenous electrolyte solution containing 84 mEq/L of lactate / Alcalose iatrogênica em cabras após infusão intravenosa de solução eletrolítica contendo 84mEq/L de lactato

ABSTRACT: This study investigated the alkalinizing potential of an intravenous polyionic solution containing 84 mEq/L of lactate on hydroelectrolyte and acid-base balances in healthy goats.Four solutions, containing 28 and 84 mEq/L of lactate (L28 and L84) or bicarbonate (B28 and B84), were formulated. Six healthy Saanen goats were used. All four solutions were infused intravenously in each animal, one at a time, with an interval of 4-5 days between the infusions, at a speed of 33.3 mL/kg/h and totaling a volume equivalent to 10% of their body weight, in 3 h of continuous administration. Samples of venous blood and urine were collected at 0h (start of the infusion), 1.5h (middle of the infusion), 3h (end of the infusion), and 4.5h, 6h, and 24 h from the start of the infusion. The laboratory tests includeddetermination of blood pH, pCO2,HCO3 -, base excess (BE), Na+, K+, Cl-, total plasmatic protein, L-lactate, and creatinine. In urine samples, pH, Na+, K+, Cl-, L-lactate, and creatinine were measured. The L28 solution, equivalent to lactated Ringer's solution, caused a slight increase in the alkaline reserve and did not change the electrolyte balance. The L84 solution resulted in a greater increase in the alkaline reserve, equivalent to the B84 solution, with return to baseline values within 24 h from the start of the infusion.The L84 solution proved to be safe and produced iatrogenic alkalization when infused into healthy goats, without causing side effects.

RESUMO: O objetivo deste trabalho foi investigar o potencial alcalinizante de uma solução poli-iônica intravenosa contendo 84mEq/L de lactato no equilíbrio hidroeletrolítico e ácido base de cabras saudáveis. Quatro soluções contendo 28 e 84 mEq/L de lactato (L28 e L84) ou bicarbonato (B28 e B84) foram formuladas. Seis cabras, adultas, da raça Saanen, saudáveis receberam as quatro soluções por via intravenosa, uma de cada vez, com intervalo de quatro a cinco dias entre as infusões, a velocidade de 33,3 ml/kg/h, totalizando um volume equivalente a 10% do seu peso corporal, em três horas de administração contínua. Foram coletadas amostras de sangue venoso e urina antes do início da infusão (0h), na metade (1,5h), no fim (3h) e às 4,5h, 6h e 24h após o início da infusão. Os exames laboratoriais consistiram na determinação do pH sanguíneo, pCO2, HCO3 -, BE, Na+, K+, Cl-, proteína plasmática total, lactato L e creatinina. Nas amostras de urina foram medidos o pH, Na+, K+, Cl-, lactato L e creatinina. A solução L28, equivalente à solução de Ringer com lactato, causou um aumento leve na reserva alcalina e não alterou o equilíbrio eletrolítico. A solução L84 resultou em maior aumento da reserva alcalina, equivalente à solução B84, com retorno dos parâmetros avaliados aos valores basais em até 24 horas após o início da infusão. A solução L84 provou-se segura e produziu alcalose iatrogência em cabras sadias, sem causar qualquer efeito colateral.

Experimental protocol for metabolic acidosis induction by intravenous administration of hydrochloric acid in sheep / Protocolo de indução experimental de acidose metabólica por administração intravenosa de ácido clorídrico em ovinos

The aim of this study was to assess the magnitude and duration of blood and urine changes and the side effects of hyperchloremic acidosis induced by the intravenous administration of hydrochloric acid in sheep. Five healthy, crossbred adult ewes, with a mean body weight of 44±2.9kg were used. The hydrochloric acid solution was administered intravenously at a rate of 25mL/kg/h for 4 hours continuously. Venous blood and urine samples were collected and pH values, blood carbon dioxide partial pressure, bicarbonate, base excess, strong ion difference, anion gap, total concentration of nonvolatile buffers, creatinine, plasma L-lactate, plasma and urine sodium, potassium, and chloride were determined. The experimental protocol induced severe hyperchloremic acidosis at the end of the infusion, with a decreased plasma strong ion difference. The fractional excretion of sodium and chloride remained increased during 4 hours after the infusion. Aciduria was observed at approximately 24 hours. Twenty-four hours after the infusion, the animals showed mild and compensated metabolic acidosis. This protocol was effective in inducing severe and long-lasting hyperchloremic acidosis and did not cause serious side effects. Therefore, this protocol can be used safely in adult sheep for studies on the treatment of this condition.(AU)

O objetivo deste estudo foi avaliar a magnitude e a duração das alterações sanguíneas e urinárias, bem como os efeitos colaterais da acidose hiperclorêmica induzida por administração intravenosa de ácido clorídrico, em ovinos. Foram utilizadas cinco ovelhas mestiças, adultas, sadias, com peso médio de 44±2,9kg. A solução de ácido clorídrico foi administrada por via intravenosa, na velocidade de 25mL/kg/h, totalizando quatro horas de administração contínua. Amostras de sangue venoso e de urina foram colhidas, e determinaram-se os valores de pH, pressão parcial de dióxido de carbono, bicarbonato, excesso de bases, diferença dos íons fortes, ânion-gap, creatinina, lactato L, sódio, potássio e cloro. O protocolo de indução experimental foi capaz de induzir acidose hiperclorêmica grave ao término da infusão, com diminuição da diferença dos íons fortes plasmáticos. Houve aumento da excreção fracionada de sódio e cloro por até quatro horas após o término da infusão. A acidúria foi observada por cerca de 24 horas. Após 24 horas do início da infusão, os animais apresentaram acidose metabólica leve e compensada. Esse protocolo foi eficaz na indução da acidose hiperclorêmica grave e duradoura e não causou efeitos colaterais. Conclui-se que o protocolo pode ser usado com segurança em ovelhas adultas, para estudos sobre tratamento dessa condição.(AU)

Approximation of bicarbonate concentration using serum total carbon dioxide concentration in patients with non-dialysis chronic kidney disease

BACKGROUND: We investigated the relationship between serum total carbon dioxide (CO₂) and bicarbonate ion (HCO₃⁻) concentrations in pre-dialysis chronic kidney disease (CKD) patients and devised a formula for predicting low bicarbonate (HCO₃⁻< 24 mmol/L) and high bicarbonate (HCO₃⁻ ≥ 24 mmol/L) using clinical parameters. METHODS: In total, 305 samples of venous blood collected from 207 pre-dialysis patients assessed by CKD stage (G1 + G2, 46; G3, 50; G4, 51; G5, 60) were investigated. The relationship between serum total CO₂ and HCO₃⁻ concentrations was analyzed using Pearson’s correlation coefficient. An approximation formula was developed using clinical parameters correlated independently with HCO₃⁻ concentration. Diagnostic accuracy of serum total CO₂ and the approximation formula was evaluated by receiver operating characteristic curve analysis and a 2 × 2 table. RESULTS: Serum total CO₂ correlated strongly with HCO₃⁻ concentration (r = 0.91; P < 0.001). The following approximation formula was obtained by a multiple linear regression analysis: HCO₃⁻ (mmol/L) = total CO₂ − 0.5 × albumin − 0.1 × chloride − 0.01 × (estimated glomerular filtration rate + blood glucose) + 15. The areas under the curves of serum total CO₂ and the approximation formula for detection of low bicarbonate and high bicarbonate were 0.981, 0.996, 0.993, and 1.000, respectively. This formula had superior diagnostic accuracy compared with that of serum total CO₂ (86.6% vs. 81.3%). CONCLUSION: Serum total CO₂ correlated strongly with HCO₃⁻ concentration in pre-dialysis CKD patients. An approximation formula including serum total CO₂ showed superior diagnostic accuracy for low and high bicarbonate compared with serum total CO₂.

Effect of calcium sources in the diets of adult cats on urinary parameters and acid-base balance / Efeitos das fontes de cálcio na dieta de gatos adultos sobre parâmetros urinários e equilíbrio ácido-básico

Calcium is a macroelement that is part of the mineral composition of the diet of companion animals, and is considered a cation of strong alkalizing power, increasing urinary pH. Calcium salts have different solubilities and depending on the anion to which calcium is associated with, it can be more or less absorbed, modifying the pH of the urine. The aim of this study was to evaluate the efficiency of calcium sources on alkalinization of urinary pH, as well as excretion of urinary electrolytes and acid-base balance of adult cats. An extruded diet for cats was selected, and had 160mEq/kg of calcium from the sources of either calcium carbonate (CaCO3) or calcium gluconate (C12H22CaO14) added. In the control treatment there was no addition of calcium sources, resulting in three treatments. Nine adult cats were used, mixed breed, in two experimental periods, with six replicates per treatment. Animal average age was 4±1.3 years old and average weight was 3.96±0.71kg. The cats remained in metabolic cages for an adaptation period of seven days, followed by six days of urine total collection, with volume, density, pH and calcium concentration (g/d) measurements. The acid-base balance was studied by blood gas analysis of venous blood. The two sources of calcium alkalinized the urine (P<0.001). However, calcium gluconate had less alkalinization power compared to the calcium carbonate (P<0.05). Urinary calcium was not affected by treatments, and represented less than 0.5% of calcium intake. The experiment showed that calcium, although an alkaline cation and considered strong influencer of the EB of the diet, cannot be evaluated individually, because depending on its associated anion it may have greater or lesser influence on cats urine pH.(AU)

O cálcio (Ca) é um macroelemento que faz parte da composição mineral da dieta de animais de companhia. Este macroelemento é considerado um cátion de forte capacidade alcalinizante e, de acordo com a fonte e quantidade inclusa, pode aumentar o pH urinário. Os sais de cálcio têm diferentes solubilidades e dependendo do ânion ao qual o cálcio está associado, pode ser mais ou menos absorvido e assim, alterar o pH da urina. O objetivo deste estudo foi avaliar os efeitos de duas fontes de cálcio na alcalinização do pH urinário, bem como a excreção de eletrólitos urinários e o equilíbrio ácido-básico de felinos. Foi selecionada uma dieta extrusada para gatos e adicionados 160mEq/kg de cálcio das fontes carbonato de cálcio (CaCO3) ou gluconato de cálcio (C12H22CaO14). No tratamento controle, não houve adição de fontes de cálcio. Foram utilizados nove gatos adultos, de raças mistas, em dois períodos experimentais, com seis repetições por tratamento. Os animais apresentavam idade média de 4,0±1,3 anos e peso corporal médio de 3,96±0,71kg. Estes permaneceram em gaiolas metabólicas em período de adaptação durante sete dias, seguido de coleta total de urina durante seis dias. Nestas amostras foram aferidos o volume, densidade, pH e concentração de cálcio (g/d). O equilíbrio ácido-básico foi avaliado por hemogasometria em amostras de sangue venoso. As duas fontes de cálcio alcalinizaram a urina (P<0,001). No entanto, o gluconato de cálcio apresentou menor potencial de alcalinização em comparação ao carbonato de cálcio (P<0,05). O cálcio urinário não foi afetado pelos tratamentos e representou menos de 0,5% da ingestão de Ca. O experimento demonstrou que o cálcio, apesar de ser um cátion alcalinizante e influenciador do EB da dieta, não pode ser avaliado individualmente, porque dependendo do ânion associado, pode apresentar maior ou menor influência no pH da urina de gatos.(AU)

A velocidade de infusão da solução poli-iônica intravenosa contendo 84mEq/L de lactato determina a intensidade do efeito alcalinizante em equinos / The intravenous polyionic solution with 84mEq/L of lactate infusion rate determines the intensity of the alkalizing effect in horses

O objetivo deste trabalho foi verificar os efeitos da solução poli-iônica intravenosa contendo 84mEq/L de lactato (L84) sobre os equilíbrios hidroeletrolítico e ácido-base de equinos, quando administrada de forma rápida ou lenta. Cinco equinos sadios adultos receberam a infusão contínua intravenosa da L84, em volume correspondente a 10% do peso corporal, em duas ocasiões: a) infusão rápida (16,66mL/kg/h) durante seis horas; b) infusão lenta (8,33mL/kg/h) durante 12 horas. Amostras de sangue venoso foram colhidas ao início da infusão (hora zero) e três, seis, nove, 12 e 24 horas após, e amostras de urina nas horas zero, seis, 12 e 24. Determinaram-se pH (sanguíneo e urinário), pCO2, HCO3 -, BE, PPT, lactato L, Na+, K+, Cl-, AG, SID, Atot, VVP, densidade urinária e excreções fracionadas urinárias de lactato L, Na+, K+ e Cl-. A L84 provoca efeito alcalinizante iatrogênico de menor magnitude quando administrada de forma lenta, porque os mecanismos renais, atuantes durante o período de infusão, promovem a correção gradativa do desequilíbrio. Pode-se concluir que a infusão de forma lenta da solução L84 em equinos é recomendável nos casos em que se suspeite de acidose metabólica e não seja possível quantificar o grau do desequilíbrio.(AU)

The aim of this study was to investigate the effects of an intravenous polyionic solution containing 84mEq/L of lactate (L84) on the hydroelectrolyte and acid-base balances when administered quickly or slowly in horses. Five healthy adult horses received the L84 solution, in a volume corresponding to 10% of BW, by continuous intravenous infusion, in two instants: a) rapid infusion (16.66mL/kg/h) during 6 hours; b) slow infusion (8.33mL/kg/h) during 12 hours. Venous blood samples were taken at the beginning of the infusion (hour 0) and 3, 6, 9, 12, and 24 hours after. Urine samples were taken at 0, 6, 12, and 24h. pH (blood and urine), pCO2, HCO3-, BE, TPP, L-lactate, Na+, K+, Cl-, AG, SID, Atot, PVV, urine specific gravity, and L-lactate, Na+, K+, and Cl- renal fractional clearance were determined. The L84 solution causes lower magnitude alkalizing effect when administered slowly, due to the gradual correction of the iatrogenic imbalance by the kidneys during the infusion period. The L84 solution infused at a low rate in horses could be recommended in cases where metabolic acidosis is suspected and it is not possible to quantify the imbalance degree.(AU)

Efeitos da corticoterapia materna nos valores hemogasométricos de cordeiros nascidos a termo e prematuros / Effects of maternal blood gas values corticotherapy of Lambs born at term and premature

O objetivo do estudo foi avaliar as variáveis hemogasométricas de cordeiros nascidos a termo e prematuros do nascimento às 48 horas de vida. Foram constituídos quatros grupos experimentais: PN (cordeiros nascidos de parto normal, n=15, média de 146 dias de gestação); PNDEX (cordeiros nascidos de parto normal, cujas mães receberam 16 mg de dexametasona aos 141 de gestação, n=8, média de 143 dias de gestação); PRE (cordeiros prematuros nascidos de cesarianas aos 138 dias de gestação, n=10) e PREDEX (cordeiros prematuros nascidos de cesarianas aos 138 dias de gestação, cujas mães receberam 16 mg de dexametasona dois dias antes do parto, n=9). Imediatamente após o nascimento, os cordeiros de todos os grupos apresentaram quadro de acidose respiratória (pH baixo e pCO2 elevada), com maior ênfase nos animais prematuros. A concentração de HCO3 - diminuiu entre 15 e 60 minutos de vida, principalmente nos grupos PRE e PREDEX, com posterior aumento no M24h. Os valores de diferença de base foram menores nos cordeiros prematuros, os quais apresentaram respiração abdominal, intensa dispneia e grande quantidade de líquido pulmonar. A estabilização do equilíbrio ácidobase ocorreu em todos os animais ao longo das primeiras 24 horas de vida. A dexametasona teve influência positiva sobre a condição clínica dos animais prematuros, resultando em adequada ventilação e perfusão tecidual, o que garantiu maior taxa de sobrevivência.(AU)

The aim of the study was to evaluate blood gas parameters of full-term and premature lambs from birth to 48 hours of life. Four experimental groups were formed: NDG (normal delivery group - lambs vaginally delivered, n=15, average of 146-day gestation); NDEXG (normal delivery with dexamethasone group - lambs vaginally delivered whose mothers received 16 mg of dexamethasone at 141 days of gestation, n=8, average of 143-day gestation); PRE (premature lambs born by cesarean section at 138 days of gestation, n=10) and PREDEX (premature lambs born by cesarean section at 138 days gestation, whose mothers received 16mg of dexamethasone two days before, n=9). Immediately after birth, lambs from all groups showed respiratory acidosis (low pH and high pCO2), most obviously in premature animals. The concentration of HCO3 - was lower between 15 and 60 minutes of life, especially in PRE and PREDEX groups with subsequent increase in M24h. The values of base excess were lower in premature lambs, which showed abdominal breathing, severe dyspnea and lots of lung fluid. The stabilization of acid-base balance occurred in all animals during the first 24 hours of life. Dexamethasone had a positive effect on the clinical condition of the premature lambs, resulting in adequate ventilation and tissue perfusion, which guaranteed higher survival rate.(AU)

Brecha de iones fuertes y su cinética de aclaramiento como marcador de mortalidad en pacientes con choque séptico / Strong ion gap and its clearance kinetics as a mortality marker in septic shock patients / Hiato de íons fortes e sua cinética de aclaramento como marcador da mortalidade em pacientes com choque séptico

Resumen: Introducción: Existe evidencia clínica de que la brecha de iones fuertes obtenida por el método de Stewart de equilibrio ácido-base es mejor predictora de mortalidad que los parámetros tradicionales en algunos pacientes críticamente enfermos. Objetivo: Evaluar la cinética de depuración de la brecha de iones fuertes en individuos con choque séptico durante las primeras 48 horas de estancia en la unidad de cuidados intensivos. Material y métodos: Se trata de un estudio retrospectivo observacional, con datos obtenidos del expediente clínico, realizado en una unidad de cuidados intensivos adultos en un hospital privado de la ciudad de Monterrey, Nuevo León. Se evaluaron variables demográficas, así como datos obtenidos de gasometrías y química sanguínea al ingreso, a las 24 y 48 horas posteriores, para calcular parámetros tradicionales del equilibrio ácido-base y los obtenidos por el método de Stewart. Se calculó también la cinética de eliminación de dichos parámetros para evaluar sus cambios a través del tiempo y su relación con la mortalidad. Resultados: Se estudiaron 91 personas con choque séptico entre junio de 2014 y junio de 2016, con una mortalidad de 28.6%. La depuración de lactato, brecha aniónica corregida y brecha de iones fuertes a 48 horas no fueron capaces de predecir mortalidad, aunque sí los niveles individuales de dichos parámetros a las 48 horas. El mejor predictor de mortalidad fue AGCOR a 48, con un área bajo la curva ROC de 0.71805, contrario a la brecha de iones fuertes (SIG por sus siglas en inglés) a 48 horas, con un área bajo la curva ROC de 0.67367. Conclusiones: Los cambios a través de las primeras 48 horas de la brecha de iones fuertes son asociados a mortalidad, pero no aportan mayor beneficio que los parámetros tradicionales en sujetos con choque séptico.

Abstract: Introduction: There is clinical evidence that the strong ion gap obtained by Stewart's acid-base approach is a better predictor of mortality than those obtained by the traditional approach in some critically ill patients. Objective: To evaluate the strong ion gap clearance kinetics in patients with septic shock during the first 48 hours in the intensive care unit. Material and methods: A retrospective, observational study obtained from a patient database in a private intensive care unit in Monterrey, Nuevo León. Patient's demographics were analyzed, along with data collected from their laboratory work at admission and at 24 and 48 hours to calculate traditional acid-base parameters and parameters obtained by the Stewart's method. Clearance at 48 hours was also calculated to track their changes over time and to evaluate their relation to patient mortality. Results: Data from 91 patients with septic shock admitted between June 2014 and June 2016 were studied, with a 28.6% mortality rate. Lactate clearance, corrected anion gap clearance and strong ion gap clearance at 48 hours were not related to patient mortality, although their individual values at 48 hours were able to predict mortality. The best predictor of mortality was AGCOR at 48, with an area under the ROC curve of 0.71805, compared with an area under the ROC curve of 0.67367 for SIG at 48 hours. Conclusions: Strong ion gap changes over the first 48 hours were associated with mortality; however, they do not offer any advantage over traditional acid-base parameters in patients with septic shock.

Resumo: Introdução: Existe evidência clínica que o hiato de íons fortes, obtido pelo método de Stewart de ácido-base, é melhor preditor de mortalidade que os parâmetros tradicionais em alguns pacientes graves. Objetivo: Avaliar a cinética de depuração do hiato de íons fortes em pacientes com choque séptico durante as primeiras 48 horas de estadia na unidade de terapia intensiva. Material e métodos: Um estudo retrospectivo, observacional com dados obtidos a partir do prontuário médico. Realizado na UTI de um hospital particular na cidade de Monterrey, em Nuevo León. Foram avaliadas as variáveis ​​demográficas e os dados obtidos a partir da gasometria e química sanguínea na admissão, 24 horas e 48 horas posteriores para calcular os parâmetros tradicionais do equilíbrio ácido-base e os obtidos pelo método de Stewart. Calculou-se também as cinéticas de eliminação destes parâmetros e assim avaliar as alterações ao longo do tempo e a sua relação com a mortalidade. Resultados: Foram estudados 91 pacientes com choque séptico entre junho de 2014 e junho de 2016, com uma taxa de mortalidade de 28.6%. A depuração de lactato, hiato aniônico corrigido e hiato de íons fortes às 48 horas não foram capazes de prever a mortalidade, se bem que previram os níveis individuais de estes parâmetros às 48 horas. O melhor preditor de mortalidade foi AGCOR às 48 com uma área sob a curva ROC de 0.71805, contrário ao SIG às 48 horas com uma área sob a curva ROC de 0.67367. Conclusões: As alterações através das primeiras 48 horas do hiato de íons fortes está associada com a mortalidade, mas não fornecem maior benefício que os parâmetros tradicionais em pacientes com choque séptico.

Procedural analysis of acid-base balance disorder: case serials in 4 patents / 中华危重病急救医学

Objective To establish the standardization process of acid-base balance analysis, analyze cases of acid-base balance disorder with the aid of acid-base balance coordinate graph.Methods The acid-base balance theory were reviewed systematically on recent research progress, and the important concepts, definitions, formulas, parameters, regularity and inference in the analysis of acid-base balance were studied. The analysis of acid-base balance disordered processes and steps were figured. The application of acid-base balance coordinate graph in the cases was introduced.Results The method of four parameters-four steps analysis was put forward to analyze the acid-base balance disorders completely. Four parameters included pH, arterial partial pressure of carbon dioxide (PaCO2), HCO3- and anion gap (AG). Four steps were outlined by following aspects: ① according to the pH, PaCO2 and HCO3-, the primary or main types of acid-base balance disorder was determined; ② primary or main types of acid-base disorder were used to choose the appropriate compensation formula and to determine the presence of double mixed acid-base balance disorder; ③ the primary acid-base balance disorders were divided into two parts: respiratory acidosis or respiratory alkalosis, at the same time, the potential HCO3- should be calculated, the measured HCO3- should be replaced with potential HCO3-, to determine whether there were three mixed acid-base disorders; ④ based on the above analysis the data judged as the simple AG increased-metabolic acidosis was needed to be further analyzed. The ratio of ΔAG↑/ΔHCO3-↓ was also needed to be calculated, to determine whether there was normal AG metabolic acidosis or metabolic alkalosis. In the clinical practice, PaCO2 (as the abscissa) and HCO3- (as the ordinate) were used to establish a rectangular coordinate system, through origin (0, 0) and coordinate point (40, 24) could be a straight line, and all points on the straight line pH were equal to 7.40. The acid-base balance coordinate graph could be divided into seven areas by three straight lines [namely pH = 7.40 isoline, PaCO2 = 40 mmHg (1 mmHg = 0.133 kPa) line and HCO3- = 24 mmol/L line]: main respiratory alkalosis area, main metabolic alkalosis area, respiratory+ metabolic alkalosis area, main respiratory acidosis area, main metabolic acidosis area, respiratory+ metabolic acidosis area and normal area. It was easier to determine the type of acid-base balance disorders by identifying the location of the (PaCO2, HCO3-) or (PaCO2, potential HCO3-) point on the acid-base balance coordinate graph.Conclusions Four parameters-four steps method is systematic and comprehensive. At the same time, by using the acid-base balance coordinate graph, it is simpler to estimate the types of acid-base balance disorders. It is worthy of popularizing and generalizing.

Balanced Fluid Versus Saline-Based Fluid in Post-operative Severe Traumatic Brain Injury Patients: Acid Base and Electrolytes Assessment

Background: Normal saline (NS) is a common fluid of choice in neurosurgery and neurointensive care unit (ICU), but it does not contain other electrolytes and has the potential to cause hyperchloremic metabolic acidosis with prolonged infusion. These problems may be reduced with the availability of balanced fluid (BF), which becomes a more physiological isotonic solution with the presence of complete electrolyte content. This study aimed to compare the changes in electrolytes and acid–base between NS and BF (Sterofundin® ISO) therapy for post-operative severe traumatic brain injury (TBI) patients in neuro-ICU. Methods: Sixty-six severe TBI patients who required emergency craniotomy or craniectomy and were planned for post-operative ventilation were randomised into NS (n = 33) and BF therapy groups (n = 33). The calculation of maintenance fluid given was based on the Holliday-Segar method. The electrolytes and acid–base parameters were assessed at an 8 h interval for 24 h. The data were analysed using repeated measures ANOVA. Results: The NS group showed a significant lower base excess (-3.20 versus -1.35, P = 0.049), lower bicarbonate level (22.03 versus 23.48 mmol/L, P = 0.031), and more hyperchloremia (115.12 versus 111.74 mmol/L, P < 0.001) and hypokalemia (3.36 versus 3.70 mmol/L, P < 0.001) than the BF group at 24 h of therapy. The BF group showed a significantly higher level of calcium (1.97 versus 1.79 mmol/L, P = 0.003) and magnesium (0.94 versus 0.80 mmol/L, P < 0.001) than the NS group at 24 h of fluid therapy. No significant differences were found in pH, pCO2, lactate, and sodium level. Conclusion: BF therapy showed better effects in maintaining higher electrolyte parameters and reducing the trend toward hyperchloremic metabolic acidosis than the NS therapy during prolonged fluid therapy for postoperative TBI patients.

Acute but not chronic metabolic acidosis potentiates the acetylcholine-induced reduction in blood pressure: an endothelium-dependent effect

Metabolic acidosis has profound effects on vascular tone. This study investigated the in vivo effects of acute metabolic acidosis (AMA) and chronic metabolic acidosis (CMA) on hemodynamic parameters and endothelial function. CMA was induced by ad libitum intake of 1% NH4Cl for 7 days, and AMA was induced by a 3-h infusion of 6 M NH4Cl (1 mL/kg, diluted 1:10). Phenylephrine (Phe) and acetylcholine (Ach) dose-response curves were performed by venous infusion with simultaneous venous and arterial blood pressure monitoring. Plasma nitrite/nitrate (NOx) was measured by chemiluminescence. The CMA group had a blood pH of 7.15±0.03, which was associated with reduced bicarbonate (13.8±0.98 mmol/L) and no change in the partial pressure of arterial carbon dioxide (PaCO2). The AMA group had a pH of 7.20±0.01, which was associated with decreases in bicarbonate (10.8±0.54 mmol/L) and PaCO2 (47.8±2.54 to 23.2±0.74 mmHg) and accompanied by hyperventilation. Phe or ACh infusion did not affect arterial or venous blood pressure in the CMA group. However, the ACh infusion decreased the arterial blood pressure (ΔBP: -28.0±2.35 mm Hg [AMA] to -4.5±2.89 mmHg [control]) in the AMA group. Plasma NOx was normal after CMA but increased after AMA (25.3±0.88 to 31.3±0.54 μM). These results indicate that AMA, but not CMA, potentiated the Ach-induced decrease in blood pressure and led to an increase in plasma NOx, reinforcing the effect of pH imbalance on vascular tone and blood pressure control.

Clinical and blood gasometric parameters during Vaquejada competition / Parâmetros clínicos e hemogasométricos de equinos durante prova de vaquejada

Clinical and complementary analysis are good alternatives to evaluate physiological demand in performance horses. The aim of this study was to assess whether the physical effort variation of the three-day Vaquejada competition (a Brazilian form of bullfighting) reflected in clinical and blood gasometric changes. During the competition eight sprints have been performed on the first day (D1), eight on the second (D2) and three on the last one (D3). Ten horses were evaluated by checking heart and respiratory rates and collecting blood samples for use in portable chemistry analyzer. Through that, it was assessed potential of hydrogen ion (pH), carbon dioxide pressure (pCO2), bicarbonate (HCO3-) and titratable base concentration (cBase). Evaluations were carried with resting of at least twenty hours, before physical activity (D0), as control parameter, and up to thirty minutes after each sprint. Clinical parameters have increased on D1, D2 and D3, when compared to D0, which demonstrated the increased demand for substrate and oxygen to the cells.. Blood gasometric trial showed reductions of all variables, most marked between D1 and D2. It was verified less alteration of all clinical and blood gasometric parameters in D3 against D0. We concluded that the change effort between days of competition influenced the clinical and blood gas parameters, demonstrating appropriate physiological response. The data were presented as mean and standard error of the mean (mean ± SEM) obtained in different days. Normality was confirmed by the Kolmogorov-Sminov test and data were compared by one-way ANOVA, followed by post-test Holm-Sidak (GraphPad Prism 2.6 for Windows, GraphPad Software, San Diego, CA, USA). P≤0.05 was considered as statistically significant...

As análises clínica e complementar são boas alternativas para avaliar a demanda fisiológica de equinos atletas. O objetivo deste estudo foi avaliar se a variação do esforço entre os três dias de competição de vaquejada refletiu em alterações clínicas e hemogasométricas. Durante a competição foram realizados oito sprints no primeiro dia (D1), oito no segundo (D2) e três no ultimo (D3). Dez equinos foram avaliados através de aferição das frequências cardíaca, frequência respiratória e coleta de amostra de sangue para uso em analisador químico portátil. Foi determinado o potencial hidrogênionico (pH), pressão de dióxido de carbono (pCO2), bicarbonato (HCO3-) e concentração de base titulável (cBASE). As avaliações foram realizadas em repouso de pelo menos vinte horas, antes do exercício (D0), considerado como parâmetro de controle, e até três minutos após cada sprint. Os parâmetros clínicos aumentaram em D1, D2 e D3, quando comparados a D0, o que demonstrou a maior demanda de substrato e oxigênio para as células. A avaliação hemogasométrica demonstrou redução de todas as variáveis, mais acentuada entre D1 e D2. Em D3, verificou-se menor alteração de todos os parâmetros clínicos e hemogasométricos em comparação a D0. Foi possível concluir que a variação de esforço entre os dias de competição influenciou os parâmetros clínicos e hemogasométricos, demonstrando resposta fisiológica adequada. Os dados foram apresentados como média e erro padrão da média (mean ± SEM) obtidos nos diferentes dias. A normalidade foi comprovada pelo teste de Kolmogorov-Sminov e dados foram comparados através do teste one-way ANOVA, seguido pelo pós-teste de Holm-Sidak (GraphPad Prism 6.02 for Windows, GraphPad Software, San Diego, CA, USA). Foi considerado p≤0.05, como estatisticamente significativo...

Efeito alcalinizante da solução de Ringer com lactato em ovelhas sadias e acidóticas / Alkalinizing effect of lactated Ringer's solution in healthy and acidotic sheep

O estudo teve o objetivo de testar a hipótese de que o efeito alcalinizante da solução de Ringer com lactato (SRL) pode ser maior nos animais portadores de acidose metabólica do que nos sadios, como consequência da necessidade de retorno ao equilíbrio. Seis ovelhas receberam a SRL em volume correspondente a 10% do peso corporal, administrada por infusão contínua intravenosa, durante quatro horas, em duas condições definidas: enquanto eram saudáveis e após a indução experimental de acidose láctica ruminal aguda (ALRA). Amostras de sangue venoso e de urina foram colhidas em quatro momentos: antes do início da infusão, na metade do volume infundido, ao término da infusão e duas horas após. Foram determinados valores de pH sanguíneo e urinário, de pCO2, HCO3 - e BE no sangue, de Na+, K+, Cl-, SID, AG, PPT, Atot e lactato L no plasma, e das excreções fracionadas urinárias de Na+, K+, Cl- e lactato L. A SRL provocou hemodiluição, mas não interferiu nos equilíbrios eletrolítico e acidobase das ovelhas sadias. Apesar de eficaz para reverter a desidratação, não foi capaz de corrigir a acidose metabólica presente após a indução da ALRA.

The aim of this study was to investigate if the alkalinizing effect of lactated Ringer's solution (LRS) is greater in animals with metabolic acidosis than in healthy ones, as a result of the need to restore acid-base balance. LRS was intravenously infused in a volume corresponding to 10% of body weight, continously during four hours, in two definite conditions in the same six ewes: when they were healthy and after experimentally induced acute rumen lactic acidosis (ARLA). Venous blood and urine samples were taken in four moments: before the beginning, in the middle, at the end of the infusion and two hours after. Blood and urine pH, blood pCO2, HCO3 - and BE, and plasma Na+, K+, Cl-, TP and L lactate were measured. Na+, K+, Cl- and L lactate fractional clearance and plasma SID, AG, and Atot were calculated. LRS caused hemodilution but didn't change electrolyte and acid-base balances in healthy ewes. When ewes were affected by ARLA, the infusion of this solution was effective for dehydration reversion but was unable to correct metabolic acidosis.

Efeito da suplementação de cloreto de amônio sobre os equilíbrios eletrolítico e ácido-básico e o pH urinário de ovinos confinados / Effect of supplementation of ammonium chloride on electrolyte and acid-base balances and urinary pH of feedlot sheep

A incidência da urolitíase obstrutiva em ovinos é elevada, principalmente em machos confinados, tanto para produção de carne, quanto reprodutores de alto valor genético. A acidificação urinária é um dos métodos para prevenção desta enfermidade e pode ser realizada de forma eficaz com a suplementação de cloreto de amônio na dieta, que pode propiciar a instalação de acidose metabólica. A hemogasometria avalia o equilíbrio ácido-básico sanguíneo de forma prática e fácil. Neste trabalho, avaliou-se o efeito do cloreto de amônio sobre o equilíbrio ácido-básico e eletrolítico de ovinos em confinamento para quantificar a acidose metabólica desenvolvida. Utilizaram-se 100 ovinos, machos, confinados, com idade aproximada de três meses. Constituíram-se três grupos experimentais: Grupo I (n=40), recebeu 400mg/kg/PV de cloreto de amônio/animal/dia por 21 dias consecutivos, momento da interrupção da administração do acidificante urinário (M3) e continuidade do acompanhamento clinico até o final do experimento (M6); Grupo II (n=40), 400mg/kg/PV de cloreto de amônio/animal/dia por 42 dias consecutivos; Grupo III (n=20), não recebeu cloreto de amônio durante todo o período do experimento. Os Momentos (M) de colheita de amostras e avaliação clínica foram estabelecidos com intervalo de sete dias, sendo M0 (imediatamente antes do início do tratamento com cloreto de amônio), M1 (sete dias após), M2, M3, M4, M5 e M6, totalizando 56 dias de confinamento. A alimentação consistiu de ração total, composta por 15% de feno triturado e 85% de concentrado, água e sal mineral ad libitum. Após adaptação de 15 dias à dieta de confinamento, colheram-se de todos os animais amostras de urina para mensuração do pH, e sangue venoso para hemogasometria, nos diferentes momentos...

The incidence of obstructive urolithiasis in sheep is high, especially in feedlot males, both for meat production, or the breeder of high genetic value. The urinary acidification is one way to prevent this disease and can be performed effectively supplementation with ammonium chloride in the diet, which may facilitate the installation of metabolic acidosis. The blood gas analysis evaluates the acid-base balance of blood in a practical and easy way. In this study, it was evaluated the effect of ammonium chloride on acid-base and electrolyte in feedlot sheep blood gas analysis to determine the occurrence of metabolic acidosis. It was used 100 male lambs, in a feedlot, aged approximately three months. It was constituted three groups: Group I (n=40) that received 400mg/kg/PV of ammonium chloride/animal/day for 21 consecutive days, the time of discontinuation of the urinary acidifiers (M3) and continued clinical follow until the end of the experiment (M6); Group II (n=40), that received 400mg/kg/PV of ammonium chloride/animal/day for 42 consecutive days, Group III (n=20), that did not receive ammonium chloride throughout the experimental period. The moments (M) of samples and clinical assessment were established on seven days of interval, M0 (immediately before the beginning of the treatment with ammonium chloride), M1 (seven days after), M2, M3, M4, M5 and M6, totalizing 56 days of feedlot. The feed consisted of a total mixed ration consisting of 15% of ground hay and 85 % of concentrate, water and mineral salt ad libitum. After 15 days of adaptation to the diet of feedlot, urine samples for measurement of pH, and venous blood for blood gas analysis were collected from all animals at different moments. The urinary acidification was maintained as was the administration of ammonium chloride in GI and GII. The values of Na+ and K+ remained within the normal range for the species...

Equilíbrio ácido-básico de embriões e pintos de corte em momentos críticos da incubação e submetidos a diferentes períodos de transferência para o nascedouro / Acid-base balance of embryos and broiler chicks in critical moments of incubation and submitted to different periods of transfer to the hatcher

Foram analisados os níveis de pCO2, pO2, pH e HCO3 - de embriões e pintos de corte provenientes de matrizes novas e velhas, nos momentos anteriores à bicagem interna e externa da casca e ao nascimento, submetidos a diferentes períodos de transferência para as condições ambientais dos nascedouros. Os tratamentos foram definidos pela idade da matriz (33 e 63 semanas) e pela transferência para o nascedouro (aos 15, 17 e 19 dias). O delineamento experimental foi em parcelas subdivididas, sendo a parcela os três momentos de transferência e a subparcela as duas idades das matrizes. Foram utilizadas seis repetições para cada tratamento, e o embrião ou o pinto foi considerado uma repetição. Os dados normais e homogêneos foram submetidos às análises de variância, e as médias comparadas pelos testes F, de Tukey e SNK. Embriões cujos ovos foram transferidos aos 15 dias para o nascedouro apresentaram melhor equilíbrio ácido-básico durante as fases pré-natal e perinatal. Durante o último terço da incubação, independentemente das diferentes condições ambientais às quais os embriões são submetidos e da idade da matriz, há capacidade de resposta fisiológica que permite uma estabilidade no equilíbrio ácido-básico dos pintos após a eclosão...

We analyzed the levels of pCO2, pO2, pH and HCO3 - in embryos and chicks from young and older breeders, in the moments before internal pipping, external pipping and at hatch and submitted to different periods in the environmental conditions of hatchers. The treatments were defined by breeder age (33 and 63 weeks) and transfer to the hatcher (at 15, 17 and 19 days). The experimental design was split plots with three periods in the hatcher and the plots were the two breeder ages. We used six replicates per treatment and the embryo or chick was considered a repetition. The normal data forms were submitted to analysis of variance and means were compared by F, Tukey and SNK tests. Embryos transferred at 15 days to the hatcher had better acid-base balance during the pre-and perinatal phases. During the last third of incubation, regardless of the different environmental conditions which the embryos are subjected and breeder age, there is physiological responsiveness that allows for stability in acid-base balance of the chicks after hatching...

Blood gas analysis, anion gap, and strong ion difference in horses treated with polyethylene glycol balanced solution (PEG 3350) or enteral and parenteral electrolyte solutions / Hemogasometria, anion gap e diferença de íons fortes em equinos tratados com solução balanceada contendo polietilenoglicol (PEG 3350) ou soluções eletrolíticas enteral e parenteral

Large volumes of different electrolytes solutions are commonly used for ingesta hydration in horses with large colon impaction, but little is known about their consequences to blood acid-base balance. To evaluate the effects of PEG 3350 or enteral and parenteral electrolyte solutions on the blood gas analysis, anion gap and strong ion difference, five adult female horses were used in a 5x5 latin square design. The animals were divided in five groups and distributed to each of the following treatments: NaCl (0.9% sodium chloride solution); EES (enteral electrolyte solution), EES+LR (EES plus lactated Ringer's solution); PEG (balanced solution with PEG 3350) and PEG+LR (PEG plus lactated Ringer's solution). Treatments PEG or PEG + LR did not change or promoted minimal changes, while the EES caused a slight decrease in pH, but its association with lactated Ringer's solution induced increase in AG and SID values, as well as caused hypernatremia. In turn, the treatment NaCl generated metabolic acidosis. PEG 3350 did not alter the acid-base balance. Despite it's slight acidifying effect, the enteral electrolyte solution (EES) did not cause clinically relevant changes.

Grandes volumes de diferentes soluções eletrolíticas são comumente usados na hidratação da ingesta em equinos com compactação, mas pouco se sabe sobre suas consequências sobre o equilíbrio ácido base sanguíneo. Para avaliar os efeitos do PEG 3350 e soluções eletrolíticas enterais e parenterais sobre a hemogasometria, anion gap e diferença de íons fortes, foram utilizadas cinco fêmeas adultas em um quadrado latino 5x5. Os animais foram distribuídos em cinco grupos e submetidos a cada um dos seguintes tratamentos: solução NaCl (cloreto de sódio 0,9%); EES (solução eletrolítica enteral); EES + RL (solução eletrolítica enteral mais Ringer lactato); PEG 3350 (solução balanceada com PEG 3350) e PEG + RL (PEG 3350 mais Ringer lactato). Os tratamentos PEG ou PEG + RL não alteraram ou promoveram alterações mínimas, enquanto a EES ocasionou discreta diminuição no pH, mas sua associação com Ringer lactato induziu o aumento nos valores do AG e DIF, além de ocasionar hipernatremia. Por sua vez, o tratamento NaCl resultou em acidose metabólica hiperclorêmica. O PEG 3350 não alterou o equilíbrio ácido base. Apesar do seu discreto efeito acidificante, a solução eletrolítica enteral (EES) não promoveu alteração clínica relevante.

Physiology and metabolism in perioperative blood transfusion therapy in pediatric patients / 中华实用儿科临床杂志

Blood transfusion therapy is widerly used in pediatric surgery as it's validity in many acute and chronic pediatric diseases.Compared to adults,pediatric perioperative transfusion therapy,particularly the approach to massive blood transfusion can be quite complex because of the unique physiologic characteristics.Perioperative transfusion therapy in children can cause significant metabolic disturbance,and further,cause severe complications.This paper presents an overview of the physiologic characteristics which related to pediatric perioperative transfusion therapy.And also the metabolisms related to massive perioperative blood transfusion in children.These may accordingly primarily useful to treat the pediatric patients.