Fractional excretion of electrolytes and paradoxical aciduria in dairy cows with left displaced abomasum / Excreção fracionada de eletrólitos em acidúria paradoxal em vacas leiteiras com deslocamento de abomaso à esquerda

The fractional excretion of electrolytes is used to assess renal function and interpret electrolyte and acid-base imbalances. Left displaced abomasum is a common disorder in dairy cows, which causes hypokalemic, hypochloremic metabolic alkalosis. There is limited information on fractional excretion of electrolytes in cows with displaced abomasum. This study aimed to measure the fractional excretion of sodium, potassium, and chloride and paradoxical aciduria in dairy cows with displaced abomasum. Blood and urine samples were collected from 30 dairy cows before and 24, 48, and 72 h after surgery. The cows were divided into two groups (G1: laparoscopy and G2: laparotomy) with 15 cows each. The concentrations of chloride, sodium, potassium, and creatinine were measured in serum and urine. Urinary pH and packed cell volume were measured. Fractional excretion of sodium, potassium, and chloride and urinary strong ion difference [SID]urine were calculated using published formulas. Cows in both groups showed hypokalemic, metabolic alkalosis before surgery; however, hypochloremia was observed only in G2. Potassium concentration significantly increased 24, 48, and 72 h after surgery in G1 and 48 and 72 h after surgery in G2. There were no significant changes in fractional excretion of sodium, chloride, and potassium and urinary pH and [SID]urine between treatments and time points. Paradoxical aciduria was observed before and 24 h following surgery in G1. Fractional excretion and urinary SID are valuable tools to understand hypochloremic, hypokalemic alkalosis in dairy cows with displaced abomasum, as well as paradoxical aciduria and return of abomasal flux.(AU)

A excreção fracionada de eletrólitos é calculada para verificar a função renal e auxiliar na interpretação de distúrbios eletrolíticos e ácido-base. O deslocamento de abomaso à esquerda é frequente em vacas leiteiras, ocasionado alcalose hipoclorêmica e hipocalêmica. Há pouca informação na literatura sobre excreção fracionada de eletrólitos em vacas com deslocamento de abomaso. Este estudo objetivou mensurar a excreção fracionada de sódio, potássio e cloro e a acidúria paradoxal em vacas leiteiras com deslocamento abomasal. Amostras sanguíneas e urinárias foram coletadas de 30 vacas antes e 24, 48 e 72 horas após operação. As vacas foram divididas em dois grupos (G1: laparoscopia e G2: laparotomia) com 15 animais cada. As concentrações de cloro, sódio, potássio e creatinina foram dosadas no soro e urina. Mensurou-se pH urinário e o hematócrito. A excreção fracionada e diferença de íons fortes urinário [SID]urina foram calculados utilizando fórmulas publicadas. Vacas de ambos os grupos apresentaram alcalose hipocalêmica antes da operação. Não houve alterações significativas na excreção fracionada de sódio, potássio e cloro, no pH urinário e na [SID]urina entre os tratamentos e momentos. Acidúria paradoxal foi observada no G1 antes e 24h após operação. A excreção fracionada e [SID]urina são ferramentas importantes para interpretar a alcalose hipoclorêmica e hipocalêmica em vacas leiteiras com deslocamento de abomaso, como também a acidúria paradoxal e o retorno do fluxo abomasal.(AU)

Trastornos ácido base en la Unidad de Cuidados Intensivos del hospital "Víctor Lazarte Echegaray":: incidencia, estancia hospitalaria y mortalidad / Acid base disturbances in the Intensive Care Unit of "Víctor Lazarte Echegaray" hospital:: incidence, length of stay and mortality

Introducción: Los trastornos Acido Base (TAB) son una patología Frecuente de los pacientes de las Unidades de Cuidados Intensivos (UCIs), por ello es importante evaluar la morbimortalidad de este trastorno en estas unidades. Objetivo: determinar la incidencia de los Trastornos Acido Base (TAB) y su relación con la estancia hospitalaria y mortalidad en la Unidad de Cuidados Intensivos (UCI). Material y métodos: Resultados: durante el período del estudio se hospitalizaron 131 pacientes. En 100 la edad promedio fue 66.9 ± 18, 9 años, el puntaje APACHE II promedio fue 18,07 ± 7,62 puntos, la estancia hospitalaria en UCI fue 6,42 ± 7,78 días y la mortalidad dentro de la UCI fue del 24% (24 pacientes). Los valores gasométricos fueron pH 7,39 ± 0.11, paCO2 37.79 ± 10,08 mmHg. BE- 1,40 ± 6,93 mEq/Lt y bicarbonato 23.78 ± 5,92 mEq/Lt. Los TAB más frecuentes fueron acidosis metabólica (21%) y los trastornos mixtos primariamente metabólicos (20%). No se encontró TAB en 14% de los pacientes. El TAB con mayor estancia hospitalaria en UCI fue la acidosis respiratoria (9,14 ± 6,1 días) y los trastornos mixtos primariamente respiratorios (9,75 ± 8,0 días). El mayor porcentaje de mortalidad se observó en los grupos con acidosis metabólica (28,6%) y acidosis respiratoria (27%). Conclusiones: la incidencia de los TAB fue alta (86%). Los trastornos metabólicos (acidosis y mixto) fueron los de mayor incidencia; los trastornos respiratorios (acidosis y mixto) estuvieron asociados a mayor estancia en UCI y la acidosis (metabólica y respiratoria) estuvieron asociadas a mayor mortalidad.

Introducction: Acid-Base(A - B) alterations are a frequent problem of patients in Intensive Care Units (ICUs); therefore, it’s important to evaluate morbidity and mortality of this pathology in the ICUs Objetive: to determine the incidence of Acid Base (A-B) disorders and their relationship with lenght of hospitalization and mortality in the Intensive Care Unit (ICU). Material and methods: Results: during the period of the study of 131 pacients were hospitalized. In 100 the mean age was 66.9 ± 18,9 years, the mean APACHE II score was 18,07 7,62 points; the mean hospital stay in ICU was 6,42 ± 7,78 days and the mortality within the ICU was 24% (24 patients). The gasometric mean values were pH 7,39 ± 0.11, paCO2 37.79 ± 10,08 mmHg. BE- 1,40 ± 6,93 mEQ/Lt. The more frequent A-B disorders were metabolic acidosis (21%) and mixed primary metabolic alterations (20%). No A-B disorder was found in 14% of the patients. The A-B disorders with longer hospital stays in ICU were respiratory acidosis (9,14 6,1 days) and mixed primary metabolic alterations (9,75 ± 8,0 days). Greater mortality was observed in the groups with metabolic acidosis (28,6%) and respiratory acidosis (27%). Conclusions: the incidence of A-B disorders was high (86%). Metabolic alterations (acidosis and mixed) had a greater incidence; the respiratory alterations (acidosisand mixed) were associated with longer ICU stays and the acidoses (metabolic and respiratory) were associated with greater mortality.

Avaliação da acidose metabólica em pacientes graves: método de Stewart-Fencl-Figge versus a abordagem tradicional de henderson-hasselbalch / Assessment of metabolic acidosis in critically ill patients: method of Stewart-Fencl-Figge versus the traditional henderson-hasselbalch approach

JUSTIFICATIVA E OBJETIVOS: Rever estratégias de avaliação da acidose metabólica dando ênfase ao método de Stewart-Fencl-Figge versus a abordagem tradicional de Henderson-Hasselbalch. CONTEÚDO: A acidose metabólica é um distúrbio comum em pacientes criticamente enfermos, sendo importante causa de depressão da função miocárdica e sensível indicador de má perfusão tissular. Tradicionalmente, é avaliada através do método de Henderson-Hasselbalch no qual a gasometria arterial fornece informações sobre a existência e o tipo de distúrbio ácido-básico. Porém, nem sempre, esse método é capaz de explicar os seus mecanismos causais e, por isso, muitos estudos têm sido feitos na tentativa de melhorar sua interpretação. O método de Stewart-Fencl-Figge, calculado através de fórmula matemática, em que além da gasometria arterial, são utilizados níveis séricos de vários eletrólitos, lactato e albumina, nos fornece informações mais fidedignas permitindo detectar anormalidades metabólicas mistas e estimar a magnitude de cada componente, principalmente na presença de múltiplas disfunções orgânicas. Nesses pacientes, a presença de ânions não mensurados no plasma é importante mecanismo de acidose metabólica e sua detecção precoce é fundamental para se evitar efeitos deletérios sobre o organismo. CONCLUSÕES: A abordagem tradicional de Henderson-Hasselbalch falha em analisar os mecanismos da acidose metabólica e possui muitas variáveis que interferem no seu resultado, principalmente no paciente criticamente enfermo. O método de Stewart-Fencl-Figge proporciona abordagem mais completa para avaliação da acidose metabólica, sugerindo seus mecanismos e orientando a terapêutica. Como alternativa, o anion gap corrigido pela albumina e lactato parece ser tão eficiente em identificar a presença de anions não mensurados quanto o método de Stewart.

BACKGROUND AND OBJECTIVES: To review strategies of assessment of metabolic acidosis giving emphasis to the of Stewart-Fencl-Figge method versus the traditional method of Henderson-Hasselbalch. CONTENTS: Metabolic acidosis is a common issue in critically ill patients, an important cause of myocardial contractility depression and sensible marker of impaired tissue oxygenation. Traditionally, is evaluated by the Henderson-Hasselbalch approach in which an arterial blood sample provides information about the presence and type of acid base disturbance. However, this method is not always capable to explain the causes of the metabolic acidosis and, therefore, several studies have explored mechanisms to improve its interpretation. The Stewart-Fencl-Figge method calculated through a mathematical formula, where in addition to arterial blood gas levels, serum levels of electrolytes, lactate and albumin are used, supplies trustworthy information allowing detection of mixed metabolic abnormalities and quantification of the magnitude of each component, mainly in patients with multiple organic dysfunctions. In these individuals, the presence of unmeasured anions in the plasma is an important mechanism of metabolic acidosis and its early detection fundamental to avoid deleterious effect on the organism. CONCLUSIONS: The traditional Henderson-Hasselbalch approach fails in analyzing the underlying mechanisms of metabolic acidosis and possesses many variables that intervene with its result especially in the critically ill patient. The Stewart-Fencl-Figge method offers a broader analysis of metabolic acidosis, indicating its mechanisms and guiding a better therapeutically strategy. As an alternative, the albumin-corrected and lactate-corrected anion gap seems to be as useful as the Stewart approach in identifying the unmeasured anions.

Analysis of Acid-Base Disturbance Caused by Severe Pneumonia in Newbern Infants / 实用儿科临床杂志

Objective To analyze the type of acid-base disturbance caused by severe pneumonia in newborn infants .Methods Venous blood of neonate with severe pneumonia(SP group) were collected to detect serum electrolyte and blood gas analysis 12 hours before and after oxygen therapy .The results of serum electrolyte and blood gas were compared 12 hours before and after oxygen therapy ,and the results of acid-base disturbance between SP group and control groups were compared.Results There were mostly metabolic acidosis incorporated respiratory acidosis in all neonate in SP group,which were with increased anion gap (AG) and obviously higher than that of control group(t=1.27 P

MULTIPLE-PARAMETER DIAGNOSIS OF ACID-BASE DISTURBANCE IN PATIENTS WITH SEVERE VIRAL HEPATITIS / 解放军医学杂志

In order 10 correctly evaluate acid-base disturbances (ABD) in patients with severe viral hepatitis, 274 measurements of blood gases and electrolytes are analysed by the combination of ABD-PCF, AG, potential bicarbonate and chlorine (Cl~). According to the results of ABD-PCF, 142 times (51.8%) were diagnosed as simple ABD and 132 times (48.2%) as double ABD. When AG, potential bicarbonate and Cl- were used to analyse further, simple ABD was diagnosed 78 times only, double ABD 100 times, triple ABD 94 times, and quartet ABD 2 times only. Increased 64 times (48.5%) of mixed ABD were diagnosed by the combined method. This results suggests that the latter was important for correct evaluation of mixed ABD, especially for triple and quartet ABD. The incidences of complications and mortality were significantly higher in patients with mixed ABD than those with simple ABD.

Acid-base Disturbance in Hepatic Encephalopathy: An Analysis of 33 Cases / 第三军医大学学报

In order to evaluate the clinical significance of the acid-base disturbance complicating hepatic encephalopathy, arterial blood gas and electrolyte levels were determined in 33 patients with encephalopathy due to various hepatic disorders. It was found the respiratory alkalosis occurred in 31 cases(93.9%) and respiratory acidosis complicated with metabolic acidosis in 2 cases (6.06%). In the 31 cases of respiratory alkalosis, there were 4 cases(12.12%) of simple respiratory alkalosis, 18 cases(54.55%) complicated with metabolic alkalosis, 3 cases(9.09%) complicated with metabolic acidosis, and 6 cases complicated with both metabolic alkalosis and acidosis. In addition, the arterial blood pH of 29 cases (87.87%) was above the normal value of 7.45. The main type of acid-base disturbance found in hepatic encephalopathy was alkalosis. Its occurrence was closely related to hypoxemia, hyperammonemia, and elevated blood level of progesterone in the case of respiratory alkalosis and to salt-limited diet and improper administration of diuretics and alkalite drugs in the case of metabolic alkalosis. Metabolic acidosis was usually the result of severe complitions. In alkalosis, there was frequently an elevation of blood free ammonia, which could penetrate the blood-brain barrier easily and induce coma and encephalopathy. Therefore energetic correction of alkalosis would be valuable to prevent hepatic encephalopathy. Effective treatment of the primary disease, correction of hyperventilation.correction of disturbances of blood electrolytes, and administration of arginine hydrochloride and potasium chloride would be appropriate measures in dealing with alkalosis.