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1.
A A Pract ; 15(10): e01535, 2021 Oct 20.
Artigo em Inglês | MEDLINE | ID: mdl-34673660

RESUMO

Olanzapine is increasingly used as a sleep aid in hospitalized patients. Although thought to have less extrapyramidal effects, known side effects include oversedation, arrythmias, and hypotension. We present the unusual case of hyperventilation with respiratory alkalosis after the administration of olanzapine for insomnia in an elderly postoperative patient. This led to a second admission to the intensive care unit with invasive interventions including mechanical ventilation and vasopressor support. Caution must be exercised in prescribing antipsychotics for off-label use, especially in a population whose baseline characteristics can affect the pharmacokinetics of second-generation antipsychotics.


Assuntos
Alcalose Respiratória , Antipsicóticos , Hiperventilação , Olanzapina , Distúrbios do Início e da Manutenção do Sono , Idoso , Alcalose Respiratória/induzido quimicamente , Antipsicóticos/efeitos adversos , Humanos , Hiperventilação/induzido quimicamente , Olanzapina/efeitos adversos , Distúrbios do Início e da Manutenção do Sono/tratamento farmacológico
2.
Respir Physiol Neurobiol ; 294: 103740, 2021 12.
Artigo em Inglês | MEDLINE | ID: mdl-34256173

RESUMO

We tested the hypothesis that increasing the respiratory control systems' arterial PCO2 equilibrium point via induced acute metabolic alkalosis by ingestion of sodium bicarbonate (NaHCO3, 0.3 g/kg) would decrease the ventilatory equivalent for CO2 (V̇E/V̇CO2) at its lowest point ("nadir") during constant-load cycle exercise testing performed at 80 % of peak power output in 18 healthy young adults. Compared to the sodium chloride (4 g) control condition, ingestion of NaHCO3: increased arterialized venous pH, HCO3- and PCO2 at rest by 0.05 ± 0.01 units (mean ± SE), 6.4 ± 0.4 mEq/L and 4.3 ± 0.7 mmHg, respectively (all p < 0.0001); and decreased the V̇E/V̇CO2 nadir during exercise by 9.4 % (p < 0.0001) secondary to a 4.7 ± 1.8 L/min decrease in V̇E (p = 0.019). In conclusion, induced acute metabolic alkalosis by ingestion of NaHCO3 decreased the V̇E/V̇CO2 response to strenuous exercise in healthy adults.


Assuntos
Alcalose Respiratória/induzido quimicamente , Alcalose Respiratória/fisiopatologia , Dióxido de Carbono/metabolismo , Exercício Físico/fisiologia , Ventilação Pulmonar/fisiologia , Bicarbonato de Sódio/farmacologia , Adulto , Humanos , Bicarbonato de Sódio/administração & dosagem , Adulto Jovem
3.
Chest ; 156(5): e95-e98, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31699235

RESUMO

CASE PRESENTATION: An 82-year-old man presented with 6 months of difficulties of falling asleep. He described a feeling of fading breath culminating in breathing arrest when he becomes drowsy. These recurrent events prevented him from falling asleep. Symptoms would only appear when he went to sleep but not during wakefulness. Medical history comprised several episodes of acute decompensated heart failure due to supraventricular tachyarrhythmia with need for hospitalization during the last 2 years. He additionally had two-vessel coronary artery disease with myocardial infarction, pulmonary hypertension, chronic atrial fibrillation, peripheral arterial disease, and chronic kidney disease (stage 3). Medication included diuretics, sodium bicarbonate, angiotensin II receptor antagonist, beta-blocker, statin, clopidogrel, and phenprocoumon without sedatives or analgesics.


Assuntos
Insuficiência Cardíaca/diagnóstico , Apneia do Sono Tipo Central/diagnóstico , Distúrbios do Início e da Manutenção do Sono/diagnóstico , Bicarbonato de Sódio/efeitos adversos , Idoso de 80 Anos ou mais , Alcalose Respiratória/induzido quimicamente , Humanos , Masculino
4.
Am J Ther ; 23(6): e1929-e1932, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-26938763

RESUMO

The large availability of salicylic acid products makes them an often encountered source of poisoning in the emergency department. Even though in most cases the prognosis is good, with a low incidence of long-term morbidity and mortality, complications do occur, and some of those can be life threatening. We present an unusual case of salicylate intoxication in an adolescent in which several uncommon complications (severe coagulopathy, pulmonary edema, and pancreatitis) conjoined together. We review the literature and discuss the complications pathogenesis and differential diagnosis. We suggest that these potentially life-threatening complications be acknowledged, investigated, and rapidly treated.


Assuntos
Transtornos da Coagulação Sanguínea/induzido quimicamente , Pancreatite/induzido quimicamente , Edema Pulmonar/induzido quimicamente , Ácido Salicílico/intoxicação , Acidose/induzido quimicamente , Adolescente , Alcalose Respiratória/induzido quimicamente , Alcalose Respiratória/terapia , Antifibrinolíticos/uso terapêutico , Azotemia/induzido quimicamente , Azotemia/terapia , Transtornos da Coagulação Sanguínea/terapia , Feminino , Hidratação , Humanos , Hipocalcemia/induzido quimicamente , Hiponatremia/induzido quimicamente , Hiponatremia/terapia , Hipóxia/induzido quimicamente , Hipóxia/terapia , Oxigenoterapia , Plasma , Vitamina K/uso terapêutico
6.
J Emerg Med ; 45(2): 206-9, 2013 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-23522957

RESUMO

BACKGROUND: Flunexin is a nonsteroidal anti-inflammatory drug approved for veterinary use in horses and cattle. Acepromazine is a phenothiazine derivative used in horses, dogs, and cats. Human exposure to these substances is rare. CASE REPORT: We report a case of a human injection of two equine medications, flunixin and acepromazine, which resulted in altered mental status, respiratory alkalosis, gastrointestinal bleeding, and elevation of liver transaminases in a 43-year-old woman who worked as a horse trainer. The patient intentionally self-injected these medications and subsequently presented to the Emergency Department with altered mental status and lethargy. The patient required hospitalization for metabolic abnormalities, including respiratory alkalosis, and suffered a gastrointestinal bleed requiring blood transfusion. The patient ultimately recovered with supportive measures. We believe this to be the first case of concomitant injection of flunixin and acepromazine in a human. CONCLUSIONS: This report explains a case of parenteral administration of two equine medications and the subsequent complications in a patient that presented to the Emergency Department. Human exposure to veterinary medications cannot be predicted by their effect in animals due to variations in absorption, distribution, and metabolism. Physicians should be aware that individuals who work with animals may have access to large quantities of veterinary medicine. This case also exemplifies the challenges that Emergency Physicians face on a daily basis, and generates additional consideration for overdoses and intoxications from medications that are not considered commonplace in humans.


Assuntos
Acepromazina/intoxicação , Alcalose Respiratória/induzido quimicamente , Clonixina/análogos & derivados , Antagonistas de Dopamina/intoxicação , Doenças Metabólicas/induzido quimicamente , Síndromes Neurotóxicas/etiologia , Antagonistas de Prostaglandina/intoxicação , Doença Aguda , Adulto , Clonixina/intoxicação , Feminino , Humanos
7.
Anesthesiology ; 115(4): 791-803, 2011 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-21934407

RESUMO

BACKGROUND: Although accumulating evidence suggests that arousal pathways in the brain play important roles in emergence from general anesthesia, the roles of monoaminergic arousal circuits are unclear. In this study, the authors tested the hypothesis that methylphenidate (an inhibitor of dopamine and norepinephrine transporters) induces emergence from isoflurane general anesthesia. METHODS: Using adult rats, the authors tested the effect of intravenous methylphenidate on time to emergence from isoflurane general anesthesia. They then performed experiments to test separately for methylphenidate-induced changes in arousal and changes in minute ventilation. A dose-response study was performed to test for methylphenidate-induced restoration of righting during continuous isoflurane general anesthesia. Surface electroencephalogram recordings were performed to observe neurophysiological changes. Plethysmography recordings and arterial blood gas analysis were performed to assess methylphenidate-induced changes in respiratory function. Intravenous droperidol was administered to test for inhibition of methylphenidate's actions. RESULTS: Methylphenidate decreased median time to emergence from 280 to 91 s. The median difference in time to emergence without methylphenidate compared with administration of methylphenidate was 200 [155-331] s (median, [95% CI]). During continuous inhalation of isoflurane, methylphenidate induced return of righting in a dose-dependent manner, induced a shift in electroencephalogram power from delta (less than 4 Hz) to theta (4-8 Hz), and induced an increase in minute ventilation. Administration of intravenous droperidol (0.5 mg/kg) before intravenous methylphenidate (5 mg/kg) largely inhibited methylphenidate-induced emergence behavior, electroencephalogram changes, and changes in minute ventilation. CONCLUSIONS: Methylphenidate actively induces emergence from isoflurane general anesthesia by increasing arousal and respiratory drive, possibly through activation of dopaminergic and adrenergic arousal circuits. The authors' findings suggest that methylphenidate may be useful clinically as an agent to reverse general anesthetic-induced unconsciousness and respiratory depression at the end of surgery.


Assuntos
Período de Recuperação da Anestesia , Anestesia Geral , Estimulantes do Sistema Nervoso Central/farmacologia , Metilfenidato/farmacologia , Adjuvantes Anestésicos/farmacologia , Algoritmos , Alcalose Respiratória/sangue , Alcalose Respiratória/induzido quimicamente , Anestésicos Inalatórios , Animais , Nível de Alerta/efeitos dos fármacos , Gasometria , Pressão Sanguínea/efeitos dos fármacos , Droperidol/farmacologia , Eletroencefalografia/efeitos dos fármacos , Frequência Cardíaca/efeitos dos fármacos , Hemodinâmica/efeitos dos fármacos , Isoflurano , Masculino , Pletismografia , Equilíbrio Postural/efeitos dos fármacos , Ratos , Ratos Sprague-Dawley , Mecânica Respiratória/efeitos dos fármacos
9.
Pediatr Emerg Care ; 26(2): 134-8, 2010 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-20145505

RESUMO

We present a 19-month-old boy with a history of asthma who presented to the pediatric emergency department with noisy breathing and tachypnea partially responsive to albuterol. He was discharged to routine care at home. His parents brought him back the next day for persistent respiratory distress despite routine home albuterol. A check of electrolytes showed a low bicarbonate level.


Assuntos
Aspirina/intoxicação , Asma/complicações , Hiperventilação/induzido quimicamente , Equilíbrio Ácido-Base , Albuterol/uso terapêutico , Alcalose Respiratória/sangue , Alcalose Respiratória/induzido quimicamente , Asma/tratamento farmacológico , Bicarbonatos/sangue , Mordeduras Humanas/complicações , Maus-Tratos Infantis , Cloretos/sangue , Deficiências do Desenvolvimento/complicações , Emergências , Humanos , Hiperventilação/sangue , Lactente , Masculino , Intoxicação/sangue , Intoxicação/diagnóstico , Recidiva , Salicilatos/sangue
11.
Nat Med ; 12(7): 817-23, 2006 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-16819552

RESUMO

Febrile seizures are frequent during early childhood, and prolonged (complex) febrile seizures are associated with an increased susceptibility to temporal lobe epilepsy. The pathophysiological consequences of febrile seizures have been extensively studied in rat pups exposed to hyperthermia. The mechanisms that trigger these seizures are unknown, however. A rise in brain pH is known to enhance neuronal excitability. Here we show that hyperthermia causes respiratory alkalosis in the immature brain, with a threshold of 0.2-0.3 pH units for seizure induction. Suppressing alkalosis with 5% ambient CO2 abolished seizures within 20 s. CO2 also prevented two long-term effects of hyperthermic seizures in the hippocampus: the upregulation of the I(h) current and the upregulation of CB1 receptor expression. The effects of hyperthermia were closely mimicked by intraperitoneal injection of bicarbonate. Our work indicates a mechanism for triggering hyperthermic seizures and suggests new strategies in the research and therapy of fever-related epileptic syndromes.


Assuntos
Alcalose Respiratória/fisiopatologia , Febre/fisiopatologia , Convulsões Febris/fisiopatologia , Alcalose Respiratória/induzido quimicamente , Animais , Bicarbonatos , Temperatura Corporal , Encéfalo/crescimento & desenvolvimento , Encéfalo/fisiopatologia , Dióxido de Carbono/uso terapêutico , Modelos Animais de Doenças , Feminino , Febre/prevenção & controle , Gravidez , Ratos , Ratos Wistar
12.
Toxicol Rev ; 24(3): 195-204, 2005.
Artigo em Inglês | MEDLINE | ID: mdl-16390221

RESUMO

Experimental studies suggest that both alkalinisation and sodium loading are effective in reducing cardiotoxicity independently. Species and experimental differences may explain why sodium bicarbonate appears to work by sodium loading in some studies and by a pH change in others. In the only case series, the administration of intravenous sodium bicarbonate to achieve a systemic pH of 7.5-7.55 reduced QRS prolongation, reversed hypotension (although colloid was also given) and improved mental status in patients with moderate to severe tricyclic antidepressant poisoning. This clinical study supports the use of sodium bicarbonate in the management of the cardiovascular complications of tricyclic antidepressant poisoning. However, the clinical indications and dosing recommendations remain to be clarified. Hypotension should be managed initially by administration of colloid or crystalloid solutions, guided by central venous pressure monitoring. Based on experimental and clinical studies, sodium bicarbonate should then be administered. If hypotension persists despite adequate filling pressure and sodium bicarbonate administration, inotropic support should be initiated. In a non-randomised controlled trial in rats, epinephrine resulted in a higher survival rate and was superior to norepinephrine both when the drugs were used alone or when epinephrine was used in combination with sodium bicarbonate. Sodium bicarbonate alone resulted in a modest increase in survival rate but this increased markedly when sodium bicarbonate was used with epinephrine or norepinephrine. Clinical studies suggest benefit from norepinephrine and dopamine; in an uncontrolled study the former appeared more effective. Glucagon has also been of benefit. Experimental studies suggest extracorporeal circulation membrane oxygenation is also of potential value. The immediate treatment of arrhythmias involves correcting hypoxia, electrolyte abnormalities, hypotension and acidosis. Administration of sodium bicarbonate may resolve arrhythmias even in the absence of acidosis and, only if this therapy fails, should conventional antiarrhythmic drugs be used. The class 1b agent phenytoin may reverse conduction defects and may be used for resistant ventricular tachycardia. There is also limited evidence for benefit from magnesium infusion. However, class 1a and 1c antiarrhythmic drugs should be avoided since they worsen sodium channel blockade, further slow conduction velocity and depress contractility. Class II agents (beta-blockers) may also precipitate hypotension and cardiac arrest.


Assuntos
Antidepressivos Tricíclicos/intoxicação , Arritmias Cardíacas/tratamento farmacológico , Hipotensão/tratamento farmacológico , Intoxicação/tratamento farmacológico , Bicarbonato de Sódio/uso terapêutico , Alcalose Respiratória/induzido quimicamente , Alcalose Respiratória/tratamento farmacológico , Alcalose Respiratória/fisiopatologia , Antiarrítmicos/uso terapêutico , Arritmias Cardíacas/induzido quimicamente , Arritmias Cardíacas/fisiopatologia , Humanos , Hipotensão/induzido quimicamente , Hipotensão/fisiopatologia , Intoxicação/complicações , Intoxicação/fisiopatologia , Bicarbonato de Sódio/farmacologia
14.
J Physiol ; 559(Pt 1): 85-101, 2004 Aug 15.
Artigo em Inglês | MEDLINE | ID: mdl-15194736

RESUMO

Previous reports suggest that an important characteristic of chemosensitive neurones is an unusually large change of steady-state intracellular pH in response to a change in extracellular pH (DeltapH(i)/DeltapH(o)). To determine whether such a correlation exists between neurones from the medullary raphe (a chemosensitive brain region) and hippocampus (a non-chemosensitive region), we used BCECF to monitor pH(i) in cultured neurones subjected to extracellular acid-base disturbances. In medullary raphe neurones, respiratory acidosis (5%--> 9% CO(2)) caused a rapid fall in pH(i) (DeltapH(i) approximately 0.2) with no recovery and a large DeltapH(i)/DeltapH(o) of 0.71. Hippocampal neurones had a similar response, but with a slightly lower DeltapH(i)/DeltapH(o) (0.59). We further investigated a possible link between pH(i) regulation and chemosensitivity by following the pH(i) measurements on medullary raphe neurones with an immunocytochemistry for tryptophan hydroxylase (a marker of serotonergic neurones). We found that the DeltapH(i)/DeltapH(o) of 0.69 for serotonergic neurones (which are stimulated by acidosis) was not different from either the DeltapH(i)/DeltapH(o) of 0.75 for non-serotonergic neurones (most of which are not chemosensitive), or from the DeltapH(i)/DeltapH(o) of hippocampal neurones. For both respiratory alkalosis (5%--> 3% CO(2)) and metabolic alkalosis (22 mm--> 35 mm HCO(3)(-)), DeltapH(i)/DeltapH(o) was 0.42-0.53 for all groups of neurones studied. The only notable difference between medullary raphe and hippocampal neurones was in response to metabolic acidosis (22 mm--> 14 mm HCO(3)(-)), which caused a large pH(i) decrease in approximately 80% of medullary raphe neurones (DeltapH(i)/DeltapH(o)= 0.71), but relatively little pH(i) decrease in 70% of the hippocampal neurones (DeltapH(i)/DeltapH(o)= 0.09). Our comparison of medullary raphe and hippocampal neurones indicates that, except in response to metabolic acidosis, the neurones from the chemosensitive region do not have a uniquely high DeltapH(i)/DeltapH(o). Moreover, regardless of whether neurones were cultured from the chemosensitive or the non-chemosensitive region, pH(i) did not recover during any of the acid-base stresses.


Assuntos
Líquido Extracelular/fisiologia , Hipocampo/fisiologia , Líquido Intracelular/fisiologia , Bulbo/fisiologia , Neurônios/fisiologia , Núcleos da Rafe/fisiologia , Acidose Respiratória/induzido quimicamente , Acidose Respiratória/fisiopatologia , Alcalose Respiratória/induzido quimicamente , Alcalose Respiratória/fisiopatologia , Animais , Bicarbonatos/farmacologia , Dióxido de Carbono/farmacologia , Células Cultivadas , Líquido Extracelular/efeitos dos fármacos , Hipocampo/efeitos dos fármacos , Concentração de Íons de Hidrogênio , Líquido Intracelular/efeitos dos fármacos , Bulbo/efeitos dos fármacos , Neurônios/efeitos dos fármacos , Núcleos da Rafe/efeitos dos fármacos , Ratos , Ratos Sprague-Dawley
15.
Am J Ther ; 11(3): 236-7, 2004.
Artigo em Inglês | MEDLINE | ID: mdl-15133541

RESUMO

We present an 84-year-old man with a history of chronic obstructive pulmonary disease, type 2 diabetes, hypertension, glaucoma, and bladder cancer who presented to the emergency department after the police found him disoriented and confused. Metformin therapy began 3 days before, and he denied any overdose or suicidal ideation. Other daily medications included glipizide, fluticasone, prednisone, aspirin, furosemide, insulin, and potassium supplements. In the emergency department, his vital signs were significant for hypertension (168/90), tachycardia (120 bpm), and Kussmaul respirations at 24 breaths per minute. Oxygen saturation was 99% on room air, and a fingerstick glucose was 307 mg/dL. He was disoriented to time and answered questions slowly. Metformin was discontinued, and by day 3, the patient's vital signs and laboratory test results normalized. He has been asymptomatic at subsequent follow-up visits. Metformin-associated lactic acidosis is a well-known phenomenon. Respiratory alkalosis may be an early adverse event induced by metformin prior to the development of lactic acidosis.


Assuntos
Alcalose Respiratória/induzido quimicamente , Hipoglicemiantes/efeitos adversos , Metformina/efeitos adversos , Idoso , Idoso de 80 Anos ou mais , Alcalose Respiratória/fisiopatologia , Humanos , Masculino
17.
Ann Pharmacother ; 34(3): 335-7, 2000 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-10917381

RESUMO

OBJECTIVE: To describe a case of hyperventilation associated with the administration of quetiapine. CASE SUMMARY: A 69-year-old African-American woman admitted to a psychiatric hospital for treatment of major depression with psychotic features was treated and successfully discharged with quetiapine, along with metronidazole and miconazole to treat bacterial/monilial vaginitis. Three days after discharge, the patient presented to a community hospital with shortness of breath and hyperventilation. The patient was admitted and treated for tachypnea and acute respiratory alkalosis. During this hospitalization, the patient was noted to have increased respiratory rate following the administration of quetiapine. DISCUSSION: Hyperventilation was reported during the clinical trials of quetiapine; however, this is the first published report to date. Serotonin is involved both centrally and peripherally in the regulation of respiration. A contributing factor in this case may have been the concomitant administration of metronidazole, which inhibits the cytochrome P450 enzyme (CYP3A4) also responsible for the metabolism of quetiapine. CONCLUSIONS: The development of hyperventilation and respiratory alkalosis was associated with the administration of quetiapine.


Assuntos
Antipsicóticos/efeitos adversos , Transtorno Depressivo/complicações , Dibenzotiazepinas/efeitos adversos , Hiperventilação/induzido quimicamente , Idoso , Alcalose Respiratória/sangue , Alcalose Respiratória/induzido quimicamente , Antipsicóticos/uso terapêutico , Antitricômonas/efeitos adversos , Transtorno Depressivo/tratamento farmacológico , Dibenzotiazepinas/uso terapêutico , Interações Medicamentosas , Feminino , Humanos , Metronidazol/efeitos adversos , Fumarato de Quetiapina
18.
Crit Care Med ; 27(9): 1838-42, 1999 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-10507607

RESUMO

OBJECTIVES: After an initial vasodilator response to alkalosis, many children with pulmonary hypertension exhibit marked pulmonary vascular reactivity despite continued alkalosis therapy. This study sought to a) identify the mediator of alkalosis-induced pulmonary vasodilation in isolated lamb lungs; b) determine whether alkalosis-induced pulmonary vasodilation decreases over time in this model; and c) determine whether alkalosis enhanced vascular reactivity to subsequent pressor stimuli. DESIGN: Prospective, interventional study. SUBJECTS: Isolated perfused lungs from 1-month-old lambs. INTERVENTIONS: Hypocarbic alkalosis, hypoxia, and infusion of the thromboxane mimetic agent U46619 MEASUREMENTS AND MAIN RESULTS: Pulmonary artery pressure was measured at constant flow, so a change in pressure reflects change in resistance. Hypoxic pulmonary artery pressure was compared after 20 and 100 mins of hypocarbic alkalosis or normocarbia in control and cyclooxygenase-inhibited lungs. Pulmonary artery dose responses to U46619 were then measured in control lungs. Responses to hypoxia and U46619 were also compared after 60-80 mins of hypocarbic or normocarbic normoxia. Hypocarbic alkalosis acutely reduced hypoxic pulmonary vascular resistance, and this was sustained for at least 100 mins. Cyclooxygenase inhibition blocked this vasodilation, suggesting that it was mediated by dilator prostaglandins. However, subsequent reactivity to U46619 was enhanced in hypoxic alkalotic lungs, and both hypoxia and U46619 caused significant vasoconstriction in normoxic alkalotic lungs. CONCLUSIONS: Alkalosis caused sustained vasodilation when pulmonary vascular resistance was high but either failed to attenuate or enhanced vascular reactivity to subsequent pressor stimuli.


Assuntos
Alcalose Respiratória , Hipertensão Pulmonar/tratamento farmacológico , Circulação Pulmonar , Resistência Vascular , Vasodilatação , Ácido 15-Hidroxi-11 alfa,9 alfa-(epoximetano)prosta-5,13-dienoico/farmacologia , Alcalose Respiratória/induzido quimicamente , Alcalose Respiratória/fisiopatologia , Animais , Inibidores de Ciclo-Oxigenase/farmacologia , Hipertensão Pulmonar/fisiopatologia , Hipóxia/fisiopatologia , Técnicas In Vitro , Indometacina/farmacologia , Estudos Prospectivos , Circulação Pulmonar/efeitos dos fármacos , Distribuição Aleatória , Ovinos , Fatores de Tempo , Resistência Vascular/efeitos dos fármacos , Vasoconstritores/farmacologia , Vasodilatação/efeitos dos fármacos
19.
J Clin Endocrinol Metab ; 84(6): 1997-2001, 1999 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-10372700

RESUMO

Menopause is associated with an increase in venous bicarbonate concentrations that is reversible with hormone replacement therapy (HRT). However, the mechanism underlying this effect is not known. To address this question, we studied the changes in acid-base indexes in the arterialized venous blood of normal postmenopausal women commencing conjugated equine estrogen (0.625 mg/day), medroxyprogesterone acetate (MPA; 5 mg/day), their combination, or placebo, in a double blind randomized controlled study over 3 months. Serum bicarbonate concentrations decreased significantly in the groups receiving either MPA or estrogen plus MPA (P = 0.008). This trend was apparent as early as 2 days and reached 2.7 and 2.3 mmol/L in the respective groups by 3 months. Similar changes were seen with partial pressure of carbon dioxide (P = 0.04); a change of -0.7 kPa occurred in the estrogen plus MPA group at 3 months. There were no changes in bicarbonate concentrations or partial pressure of carbon dioxide in those receiving estrogen alone or placebo. Accompanying changes in blood pH were apparent in the estrogen plus MPA group, where there was an upward trend at 1 week (P = 0.056) and a significant change from baseline (+0.013) at 3 months (P = 0.03). In the whole group, the changes in pH were inversely correlated with those in urinary excretion of hydroxyproline (r = -0.44; P = 0.01). We conclude that HRT using conjugated estrogens and MPA produces small, but sustained, changes in acid-base status. These may contribute to the effects of HRT and menopause on many tissues and disease processes, including the development of osteoporosis.


Assuntos
Alcalose Respiratória/induzido quimicamente , Terapia de Reposição de Estrogênios/efeitos adversos , Pós-Menopausa/metabolismo , Equilíbrio Ácido-Base/efeitos dos fármacos , Cálcio/metabolismo , Cálcio/urina , Método Duplo-Cego , Quimioterapia Combinada , Estrogênios/efeitos adversos , Estrogênios/uso terapêutico , Feminino , Humanos , Acetato de Medroxiprogesterona/efeitos adversos , Acetato de Medroxiprogesterona/uso terapêutico , Pessoa de Meia-Idade , Congêneres da Progesterona/efeitos adversos , Congêneres da Progesterona/uso terapêutico
20.
Anaesthesist ; 48(2): 89-96, 1999 Feb.
Artigo em Alemão | MEDLINE | ID: mdl-10093649

RESUMO

UNLABELLED: Seeing as gamma-hydroxybutyrate (GHB) and benzodiazepines interact with the GABA-transmitter system, we investigated whether GHB can replace the conventional therapy, which uses benzodiazepines in the treatment of alcohol withdrawal syndrome in ICU settings. METHODS: 42 chronic alcoholics were included in this prospective and randomized study. Following the development of alcohol withdrawal syndrome, the patients were randomly allocated to the GHB or to the flunitrazepam group. In addition to this, clonidine was administered in order to treat autonomic signs of withdrawal. In cases were hallucinations occurred, haloperidol was administered. RESULTS: There was no significant difference in the efficacy of treatment used in the duration of mechanical ventilation and intensive care unit stay between groups. The patients in the GHB-group required significantly higher dosages of haloperidol and significantly lower dosages of clonidine. 14 out of 21 patients from the GHB-group developed hypernatriaemia and 15 out of 21 developed a metabolic alkalosis. CONCLUSIONS: Symptoms of the autonomic nervous system were more effectively prevented by GHB as evident in the lower dosage requirement of clonidine. However, GHB may not sufficiently block the hyperactivity of the dopaminergic system or may have an hallucinogenic effect itself. This may be evident from the higher dosages of haloperidol which were necessary. Due to the latter fact, the administration of GHB cannot be recommended in all patients suffering from AWS in ICU settings.


Assuntos
Etanol/efeitos adversos , Oxibato de Sódio/uso terapêutico , Síndrome de Abstinência a Substâncias/tratamento farmacológico , Agonistas alfa-Adrenérgicos/efeitos adversos , Agonistas alfa-Adrenérgicos/uso terapêutico , Idoso , Alcalose Respiratória/induzido quimicamente , Alcalose Respiratória/terapia , Ansiolíticos/uso terapêutico , Antipsicóticos/uso terapêutico , Clonidina/efeitos adversos , Clonidina/uso terapêutico , Cuidados Críticos , Feminino , Flunitrazepam/uso terapêutico , Haloperidol/uso terapêutico , Humanos , Hipernatremia/induzido quimicamente , Hipernatremia/terapia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Oxibato de Sódio/efeitos adversos
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