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.

HD is beneficial for enzymatic conversion of some amino-acids in the elderly

Many different causes of abnormal amino acid profile in uremic patients including: inadequate nutritional intake, uremic disturbances in amino acid metabolism, loss or fibrosis of renal tissues, metabolic acidosis and hormonal derangement. Some of these factors; such as metabolic acidosis are particularly corrected with dialytic therapy; but others such as decreased intake or hormonal disturbances may persist or worsen after initiation of dialysis. This study was done to investigate the plasma amino acids profile in uremic elderly patients. The present study was carried out on three matched groups: [G1] on HD, [G2] CRF and a control. A significant uniform decrease of Threonine, Valine and Leucine in both HD and CRF. However, a peculiar situation of significant increase in phenylalanine in HD in comparison to CRF and to control. This is similar to the significant increase of Arginine in HD group in comparison to the others. In contrast, phenylalanine was significantly decreased in CRF in comparison to both HD group and the control. The latter was similar to the decrease of Leucine in CRF in comparison to the other two groups. Hence, Phenylalanine was the only AA that was found to be significantly increased in HD and significantly decreased in CRF in comparison to control. Moreover, only Phenylalanine and Arginine were significantly increased in HD group in contrast to the rest of the essential amino-acids, which showed either decrease or no change. Tyrosine and lysine were significantly lower in pre -dialysis CRF group in comparison to patients on HD and the control. This may imply that HD can correct the deficiency of tyrosine and lysine in uremic patients probably due to less inhibition of phenylalanine hydrorxylase. Inter-conversion of phenylalanine to tyrosine was reported to be impaired in CRF; whereas tyrosine metabolism per se does not seem to be grossly affected by uremia. However; Serine was significantly lower in both groups of uremic patients in the current study compared with the control group, with no significant difference in-between pre -dialysis patients and patients on HD. In conclusion, our study showed that HD may be beneficial in restoring the enzymatic turnover of certain amino-acids including: Phenylalanine hydroxylase to normalize tyrosine plasma level, Arginine synthetase to convert citrulline to Arginine. On the other hand, HD may be injurious to the production of other amino-acids like serine due to complete lost of the renal tissue that is responsible of its production from glycine

Assessment of metabolic and acid-base changes during trans-urethral resection of prostate

TURP patients are usually critically ill and suffer from multiple diseases. The use of irrigation fluid has its own risks. This study was carried out to detect if any acid base disorders develop in these patients. Thirty patients received general anesthesia with controlled ventilation to maintain normocarbia. Arterial blood gases, electrolytes and lactate were determined preoperatively, 30 minutes after the start of the procedure and after finishing the operation. The present study revealed mild acidosis that can be explained on the basis of the Stewart concept as a decreased strong ion difference acidosis. This may pay our attention to acid base monitoring in TURP patients when there is too much absorption of the irrigation fluid and in prolonged cases

Severe neutropenia in an infant with methylmalonic acidemia

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

Methanol poisoning: clinical manifestations, investigations, formic acid level, management, and outcome

The present work was carried out to study patients with acute methanol poisoning as regards severity of clinical manifestations, laboratory investigations, formic acid level and management and to correlate these with the outcome. The study included twenty patients diagnosed as acute methanol poisoning following consumption of wine. They were admitted to Alexandria Poison Center [APC] and critical care medicine department at Alexandria Main University Hospital during four months period [February-May] in the year 2001. Patients were interviewed and clinically examined. Blood samples were collected immediately after admission for estimation of serum formate, blood gases and acid-base status. Also, brain computed tomography scanning [CT] was done. The results revealed that acute methanol poisoning is more common in young age group from 15-35 years [70.0%]. The longer the latent period i.e. the time lapsed since intake of methyl alcohol and appearance of symptoms, the lowest were the pH and bicarbonate levels, the highest was serum formate level and the worst was the CT and outcome

Urinary net charge in hyperchloremic metabolic acidosis.

OBJECTIVE: (i) To examine the usefulness of urinary net charge (UNa + UK - UCl) in the evaluation of hyperchloremic metabolic acidosis secondary to diarrhea, distal RTA and proximal RTA and (ii) To characterize the type of distal RTA on the basis of the underlying defect. SETTING: Pediatrics division of a tertiary referral center. SUBJECTS: Thirty four children with hyperchloremic metabolic acidosis secondary to diarrhea (n = 16), distal RTA (n = 11) and proximal RTA (n = 7). Ten normal children with ammonium chloride induced acidosis were also studied. METHODS: All subjects underwent urine collection of 30-60 minutes duration for measurement of Na, K, Cl, pH and pCO2. The measurements were also made on the blood samples collected at the midpoint of urine collection. The urinary net charge was calculated by subtracting Cl values from the sum of the Na and K. RESULTS: Patients with proximal and distal RTA had a positive urine net charge. Patients with diarrhea and ammonium chloride induced acidosis showed negative urine net charge. Patients with diarrhea with extremely low urine sodium levels showed an inappropriately high urine pH despite persistent metabolic acidosis. All patients with distal RTA were found to have a secretory type of defect. CONCLUSION: Measurement of urine net charge is helpful in the initial evaluation of a patient with hyperchloremic metabolic acidosis.

The intraosseous route is a suitable alternative to intravenous route for fluid resuscitation in severely dehydrated children.

It is sometimes difficult to gain a rapid intravenous access in hypovolemic states. The suitability of intraosseous (IO) route for fluid infusion as an effective, safe and reliable alternative to intravenous (IV) route was explored. Sixty children (age range 3 months to 2 years) with severe dehydration were assigned alternately to receive resuscitating fluid through either IO or IV routes. The IO route was successfully secured in all cases within the first 5 minutes of attempt. On the other hand, the IV line could not be secured in 33% (10 out of 30) patients within 5 minutes. The time taken for IV cannulation when it was successful (129 +/- 13 seconds, 95% confidence interval 103-156 seconds) was significantly longer than the time taken for IO cannulation (67 +/- 7 seconds, 95% confidence interval 55-80 seconds). Fluid infusion through either routes was equally effective in stabilizing vital signs and normalizing laboratory abnormalities. No significant complication of IO route was noted on short term follow-up. We conclude that IO route is a safe, effective alternative for emergency fluid administration in severe dehydration when intravenous line cannot be secured rapidly.

Alteration in blood gases in tetanus.

Tetanus is an important cause of patient mortality. Hypoxia is an important determinant of poor prognosis in tetanus. Oxygen saturation (Sa02) determines effectiveness of muscle relaxants. We performed arterial blood gas (ABG) studies in 20 patients with tetanus and 20 controls. All patients had hypoxemia and metabolic acidosis at admission. The mortality rate in patients with admission PaO2 < 70mm Hg was higher compared to those with PaO2 > 70mm Hg (P < 0.01). Patient with pH < 7.2 had higher mortality compared to those with pH > 7.2 (p < 0.05). Severe hypoxemia and severe metabolic acidosis connoted poor prognosis.

Study of blood pH in ischemic heart disease

Intracellular acidosis acts as an important factor for causing cellular necrosis in patients of ischaemic heart disease. Blood pH and bicarbonate levels were determined in 85 patients of ischaemic heart disease. The patients were classified into myocardial infarction, intermediate coronary syndrome and angina on assessing the clinical and ECG findings. Blood pH was found to be significantly low in patients of myocardial infarction as compared to control. Our result indicated that patients of myocardial infarction developed metabolic acidosis. It is suggested that the acidosis should be corrected as early as possible to prevent myocardial necrosis and extension of infract in ischaemic patien

Reavaliaçäo da cardiotocografia basal, na gestaçäo de alto-risco, à luz da gasometria do sangue fetal obtido por cordocentese / Re-evaluation of basal cardiotocography, in high-risk pregnancy, by fetal blood gasometry obtained by cordocentesis

Em 57 pacientes de alto-risco foram realizados 60 exames de cardiotocografia (CTG) basal e determinado o equilíbrio cido-b sico do sangue da veia umbilical, obtido por cordocentese. Os resultados da CTG foram realcionados com os resultados do pH, pO2 e asfixia fetal. Observou-se relaçäo significante entre os parâmetros bioquímicos estudados do sangue da veia umbilical e os exames de CTG basal. Relevante é o comprometimento do concepto (asfixia) quando presente a CTG basal grave terminal (85 por cento).

Esvaziamento gástrico e acidose metabólica I. Estudo de um modelo experimental em ratos, empregando uma soluçäo de cloreto de amônio por via orogástrica / Gastric emptying and metabolic acidosis. I. Study of an experimental model in rats, using an ammonium chloride solution administered through the orogastric route

O objetivo do estudo foi o de obter um modelo de acidose metabólica, induzida por via orogástrica, que pudesse ser utilizado em estudos posteriores, os quais tivessem como objetivo relacionar esvaziamento gástrico (EG) e acidose metabólica. Para isto foram necessárias 141 ratas brancas, variedade Wistar, que foram utilizadas em três etapas: a primeira (n=27) tinha como objetivo definir o perfil da acidose metabólica induzida pela soluçäo de cloreto de amónio, por via orogástrica, na dose de 1 mEq/100 gramas de peso do animal; a segunda (n=60), com a finalidade de avaliar o EG da soluçäo de cloreto de amônio utilizada na primeira etapa e, a terceira (n=54), com o objetivo de verificar possível lesäo da mucosa gástrica pela soluçäo acidificante, através do estudo do ECG da água em ratos com acidose e em controles. Como grupo controle, foram utilizados animais aos quais era infundido soluçäo de cloreto de sódio (nas duas primeiras etapas) com a mesma concentraçäo e volume da soluçäo acidificante. Os resultados mostraram que o estabelecimento e manutençäo da acidose ocorreram em níveis considerados adequados a estudos experimentais. O EG da soluçäo de NH4Cl completou-se entre 4 e 6 horas após a infusäo da soluçäo, havendo, mesmo após este período, manutençäo de níveis moderados a graves de acidose metabólica. Desta forma, conclui-se que com o modelo empregado pode-se obter um intervalo de tempo (6-8 horas após a infusäo da soluçäo) adequado a estudos posteriores. O EG da água näo diferiu entre animais com acidose e controle

Curso temporal de la acidosis metabolica durante el para cardiorrespiratorio engatos: tratamiento por medio de bicarbonato de sodio / Temporal course of metabolic acidosis during cardiorespiratory arrest in cats: treatment with sodiun bicarbonate

La correlación entre el tiempo de paro cardiorrespiratorio (10 min.) inducido experimentalmente en gatos con las modificaciones concomitantes de pH (0.16 unidades/min), déficit de exceso de base (0.97 mEp/L/min) y otros componentes sanguíneos, así como el análisis de regresión de los valores del déficit del exceso de base durante el paro cardiorrespiratorio permitieron calcular la dosis de bicarbonato de sodio adecuada para la corrección inmediata de la acidosis metabólica durante los procedimientos de reanimación correspondientes tras cinco minutos de paro cardiorrespiratorio en gatos, aunque también provocó hipopotasemia y hiperosmolaridad. En condiciones similares, la dosis de bicarbonato de sodio calculada sin tomar en cuenta la relación entre tiempo de paro cardiorrespiratorio y déficit de exceso de base fue insuficiente para normalizar el pH. Los resultados indican la importancia de dichos factores y la posibilidad de predeterminar la dosis adecuada de bicarbonato de sodio para el tratamiento del paro cardiorrespiratorio

Concentraciones plasmáticas de magnesio en lactantes con diarrea aguda, deshidratación y acidosis / Plasma concentrations of magnesium in infants with acute diarrhea, dehydration and acidosis

La concentración de Mg en el plasma de 22 lactantes sanos fue en promedio de 23,90 + ou - 1,63 mg x 1, similar a la de otras publicaciones. En 20 lactantes con diarrea aguda y deshidratación con o sin acidosis, las concentraciones plasmáticas fueron leve pero significativamente elevadas con respecto a los controles sanos, promedio 26,75 + ou - 3,49 mg x 1.(p <0,01)