ABSTRACT
BACKGROUND: Standard base excess (SBE) is an important parameter for guiding fluid management in postoperative metabolic acidosis. However, individual SBE components, notably the chloride effect (Cl(eff)), provide valuable additional information. Cl(eff) is the deviation of the strong ion difference (SID) from normal caused by chloride loss or increase and represents the effect on SBE of an abnormal chloride-sodium ratio. Many centers use normal saline (NS) for intravascular volume therapy. In this study, we examined the impact of NS infusion on SBE and its chloride-driven component (Cl(eff)) in postoperative children. METHODS: The study was conducted in 119 children who underwent post-heart surgery in a Swiss pediatric intensive care unit. The 72-h postoperative course was divided into six observation periods, during which NS input and its impact on SBE and Cl(eff) were measured per period in each patient, and the results compared between patients infused and not infused with NS during each period. RESULTS: Normal saline was infused in 168/625 observation periods if indicated by volume deficit. Postoperative metabolic acidosis and the acidifying Cl(eff) were aggravated in the first 12 postoperative hours. Over the 72 h, NS infusion simultaneously lowered SBE by -0.06 mm x ml(-1) x kg(-1) body weight infused and Cl(eff) by -0.07 mm. CONCLUSIONS: Implementing serial Cl(eff) assessment could improve postoperative management by disclosing or excluding hyperchloremia as a cause of acidosis undetectable from SBE alone. Calculating the chloride-driven acidifying side effect of NS infusion using Cl(eff) improves the interpretation of SBE values and can optimize fluid management in postoperative metabolic acidosis.
Subject(s)
Acidosis/etiology , Chlorides/blood , Postoperative Complications , Sodium Chloride/adverse effects , Acidosis/blood , Adolescent , Algorithms , Cardiopulmonary Bypass , Child , Child, Preschool , Humans , Infant , Infant, Newborn , Infusions, Intravenous , Intensive Care Units, Pediatric , Postoperative Complications/blood , Sodium Chloride/administration & dosage , Switzerland , Time Factors , Treatment OutcomeABSTRACT
Bullous pemphigoid (BP) is an autoimmune subepidermal blistering disease associated with autoantibodies against the transmembrane hemidesmosomal protein BP180/collagen type XVII and the intracellular plaque protein BP230. The aim of the present study was to develop an ELISA system for the detection of circulating autoantibodies to BP230. We generated five overlapping cDNA constructs covering the entire length of BP230 and expressed them in baculovirus-infected Sf21 insect cells. ELISA reactivity against BP230 was found in 63% of 56 BP patients' sera; the specificity of the ELISA was 93%. Epitope mapping studies showed that the fragment representing the C-terminal portion of BP230 was by far the most frequent target within the molecule. This ELISA provides a useful tool for the detection of autoantibodies to BP230 in BP and other diseases associated with an autoimmune response to this protein.
Subject(s)
Autoantibodies/blood , Autoantigens/immunology , Collagen/immunology , Enzyme-Linked Immunosorbent Assay/methods , Non-Fibrillar Collagens , Pemphigoid, Bullous/blood , Adult , Aged , Aged, 80 and over , Animals , Autoantibodies/immunology , Base Sequence , Cells, Cultured , DNA Primers , Epitope Mapping , Female , Humans , Immunoblotting , Keratinocytes/immunology , Male , Middle Aged , Molecular Sequence Data , Pemphigoid, Bullous/immunology , Polymerase Chain Reaction , Recombinant Proteins/immunology , Collagen Type XVIIABSTRACT
The mainstay of treatment of pemphigus vulgaris is systemic corticosteroids. Intravenous immunoglobulins have been reported as an adjuvant corticosteroid-sparing regimen in recalcitrant pemphigus vulgaris. The purpose of the study was to monitor disease activity, serum levels of autoantibodies and doses of oral corticosteroids in 4 patients with recalcitrant pemphigus vulgaris adjuvantly treated with intravenous immunoglobulins (2 g kg(-1) monthly). After initiation of intravenous immunoglobulins, all patients showed clinical improvement and a decrease in autoantibody serum levels, as detected by both indirect immunofluorescence microscopy and ELISA. Corticosteroids and immunosuppressants could be reduced and even discontinued in one patient. In 3 patients, intravenous immunoglobulins were discontinued after 12 cycles. Subsequently, new blisters developed and autoantibody levels rose again. After re-initiation of intravenous immunoglobulins, in 2 patients, the condition quickly improved again, along with a decrease in autoantibody serum levels. It is concluded that the administration of intravenous immunoglobulins was associated with a decrease in circulating autoantibodies and clinical improvement in our patients.
