ABSTRACT
BACKGROUND: Lactic acidosis (LA) is the most common form of metabolic acidosis, defined by lactate values greater than 5 mmol/L and pH<7.34. The pathogenesis of LA involves hypoxic causes (type A) and non-hypoxic (type B), often coexisting. Identification and removal of the trigger are mandatory in the therapeutic management of LA. The case: A 38 years-old male patient entered the Emergency Ward for dyspnea, fever, vomiting and hyporexia. An important respiratory distress with hyperventilation due to severe LA was found, together with severe hypoglicemia, without renal impairment. Past medical history unremarkable, except for reported episodic hypoglicemia in the childhood, with fructose "intolerance", without any other data. No evidence of intoxications, septic shock or significant cytolysis. No drugs causing LA. The patient underwent orotracheal intubation, glucose infusion, and continuous haemodiafiltration for 36-hrs. A rapid general improvement was obtained with stabilization of acid-base balance. A diagnosis of fructose-1,6-diphosphatase deficiency was made. It is an autosomical recessive gluconeogenesis abnormality, with recurrent episodes of hypoglicemia and lactic acidosis after fasting, potentially lethal. The therapy is based on avoiding prolonged fasts, glucose infusion, and a specific diet, rich in glucose without fructose intake. CONCLUSIONS: The presence of not-otherwise-explained lactic acidosis in young patients has to place the suspect of an underlying and unknown metabolic derangement; in these cases, the involvement of the nephrologist appears to be pivotal for the differential diagnosis of the abnormalities of the acid-base balance, and for setting the best treatment.
Subject(s)
Acidosis, Lactic/therapy , Fructose-1,6-Diphosphatase Deficiency/diagnosis , Hemodiafiltration , Acidosis, Lactic/etiology , Adult , Fructose/adverse effects , Fructose-1,6-Diphosphatase Deficiency/blood , Fructose-1,6-Diphosphatase Deficiency/complications , Fructose-1,6-Diphosphatase Deficiency/diet therapy , Fructose-Bisphosphatase/blood , Genes, Recessive , Gluconeogenesis , Humans , Hypoglycemia/complications , MaleABSTRACT
BACKGROUND: Whether convective therapies allow better control of serum phosphate (P) is still undefined, and no data are available concerning on-line haemofiltration (HF). The objectives of the study are to evaluate the effect of convective treatments (CTs) on P levels in comparison with low-flux haemodialysis (HD) and to evaluate the correlates of serum phosphate in a post hoc analysis of a randomized clinical trial. METHODS: This analysis was performed in the database of a multicentre, open label and randomized controlled study in which 146 chronic HD patients from 27 Italian centres were randomly assigned to HD (70 patients) or CTs: on-line pre-dilution HF (36 patients) or on-line pre-dilution haemodiafiltration (40 patients). RESULTS: CTs did not affect P (P = 0.526), calcium (Ca) (P = 0.849) and parathyroid hormone levels (P = 0.622). P levels were associated with the use of phosphate binders including aluminium-based phosphate binders (P < 0.001) and sevelamer (P < 0.001), pre-dialysis bicarbonate levels (P < 0.001) and pre-dialysis blood K levels (P < 0.001). On multivariate analysis (generalized linear model), serum P was again largely unassociated with CTs (P = 0.631). Notably, participating centres were by far the strongest independent correlate of serum P, explaining 45.3% of the variance of serum P over the trial and this association was confirmed at multivariate analysis. Bicarbonate (P < 0.001) and, to a weaker extent, serum K (P = 0.032) were independently related to serum P. CONCLUSIONS: In comparison with low-flux HD, CTs did not significantly affect serum P levels. Participating centres were the main source of P variability during the trial followed by treatment with phosphate binders, serum bicarbonate and, to a weak extent, serum potassium levels (ClinicalTrials.gov Identifier: NCT011583309).
Subject(s)
Kidney Failure, Chronic/blood , Phosphates/blood , Renal Replacement Therapy , Aged , Bicarbonates/blood , Calcium/blood , Female , Hemodiafiltration/adverse effects , Hemofiltration , Humans , Kidney Failure, Chronic/therapy , Male , Middle Aged , Parathyroid Hormone/blood , Renal DialysisABSTRACT
Desarrollada con EPrints, un software que facilita la creación de repositorios virtuales, la biblioteca virtual de la Facultad de Matemática y Computación de la Universidad de La Habana es un recurso útil, tanto a profesores e investigadores como a los estudiantes de dicha institución. Se exponen brevemente la organización del trabajo en el repositorio, así como las principales opciones disponibles para la gestión de los documentos: almacenamiento, navegación y búsqueda.
Developed with EPrints, software that facilitates the creation of virtual repositories, the Virtual Library of the Information Science and Mathematics Faculty of the University of Havana is a very useful resource for its professors, researchers and students. The organization of the work at the repository is exposed, as well as the main options available for document management: storing, navigation and search.
ABSTRACT
Desarrollada con EPrints, un software que facilita la creación de repositorios virtuales, la biblioteca virtual de la Facultad de Matemática y Computación de la Universidad de La Habana es un recurso útil, tanto a profesores e investigadores como a los estudiantes de dicha institución. Se exponen brevemente la organización del trabajo en el repositorio, así como las principales opciones disponibles para la gestión de los documentos: almacenamiento, navegación y búsqueda(AU)
Developed with EPrints, software that facilitates the creation of virtual repositories, the Virtual Library of the Information Science and Mathematics Faculty of the University of Havana is a very useful resource for its professors, researchers and students. The organization of the work at the repository is exposed, as well as the main options available for document management: storing, navigation and search(AU)
