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acidosis metabolic [keywords]
- Transient Acidosis during Early Reperfusion Attenuates Myocardium Ischemia Reperfusion Injury via PI3k-Akt-eNOS Signaling Pathway. [Journal Article]
- Oxid Med Cell Longev 2013.:126083.
In this paper, we concluded that transient acidosis reperfusion conferred cardioprotection against myocardial ischemia reperfusion injury in isolated rat hearts through activating PI3K-Akt-eNOS pathway.
- Treatment of life-threatening hypercapnia with isoflurane in an infant with status asthmaticus. [JOURNAL ARTICLE]
- J Anesth 2013 Dec 6.
We encountered a 2-year-old child with life-threatening hypercapnia, with a PaCO2 of 238 mm Hg and severe respiratory and metabolic acidosis, due to status asthmaticus that was refractory to steroid and bronchodilator therapy. Suspecting ventilatory failure and excessive ventilation-induced obstructive shock, we started respiratory physiotherapy in synchrony with her respiration, to facilitate exhalation from her over-inflated lungs. Isoflurane inhalation was commenced in preparation for extracorporeal circulation, to reduce the hypercapnia. The combination of respiratory physiotherapy and isoflurane inhalation resulted in a rapid decrease in ventilatory resistance and PaCO2 levels within a few minutes, with recovery of consciousness within 60 min. Isoflurane inhalation was gradually discontinued and steroid and aminophylline therapy were commenced. The patient recovered completely without any recurrence of her bronchospasm and without any residual neurological deficits. In our patient with a severe asthmatic attack, decreased exhalation secondary to asthma and overventilation during artificial ventilation resulted in overinflation of the lungs, which in turn led to cerebral edema and obstructive cardiac failure. The favorable outcome in this case was due to the short duration of hypercapnia. Hence, we conclude that the duration of hypercapnia is an important determinant of the morbidity and mortality of status asthmaticus-induced severe hypercapnia.
- Unusual Clinical Presentation of Ethylene Glycol Poisoning: Unilateral Facial Nerve Paralysis. [JOURNAL ARTICLE]
- Case Rep Med 2013.:460250.
Ethylene glycol (EG) may be consumed accidentally or intentionally, usually in the form of antifreeze products or as an ethanol substitute. EG is metabolized to toxic metabolites. These metabolites cause metabolic acidosis with increased anion gap, renal failure, oxaluria, damage to the central nervous system and cranial nerves, and cardiovascular instability. Early initiation of treatment can reduce the mortality and morbidity but different clinical presentations can cause delayed diagnosis and poor prognosis. Herein, we report a case with the atypical presentation of facial paralysis, hematuria, and kidney failure due to EG poisoning which progressed to end stage renal failure and permanent right peripheral facial nerve palsy.
- Regional perfusion during venoarterial extracorporeal membrane oxygenation: a case report and educational modules on the concept of dual circulations. [Journal Article]
- J Extra Corpor Technol 2013 Sep; 45(3):187-94.
A challenging aspect of managing patients on venoarterial extracorporeal membrane oxygenation (V-A ECMO) is a thorough understanding of the relationship between oxygenated blood from the ECMO circuit and blood being pumped from the patient's native heart. We present an adult V-A ECMO case report, which illustrates a unique encounter with the concept of "dual circulations." Despite blood gases from the ECMO arterial line showing respiratory acidosis, this patient with cardiogenic shock demonstrated regional respiratory alkalosis when blood was sampled from the right radial arterial line. In response, a sample was obtained from the left radial arterial line, which mimicked the ECMO arterial blood but was dramatically different from the blood sampled from the right radial arterial line. A retrospective analysis of patient data revealed that the mismatch of blood gas values in this patient corresponded to an increased pulse pressure. Having three arterial blood sampling sites and data on the patient's pulse pressure provided a dynamic view of blood mixing and guided proper management, which contributed to a successful patient outcome that otherwise may not have occurred. As a result of this unique encounter, we created and distributed graphics representing the concept of "dual circulations" to facilitate the education of ECMO specialists at our institution. Keywords: ECMO, education, cardiopulmonary bypass, cannulation.
- Use of central venous saturation monitoring in a patient with pediatric cardiac beriberi. [JOURNAL ARTICLE]
- World J Clin Cases 2013 Sep 16; 1(6):205-207.
The patient was a 1-year-and-4-mo-old boy. He had drunk about 1 L of an isotonic drink for infants daily since about 10 mo after birth. He was examined by a local doctor due to anorexia and vomiting, found to have cardiomegaly, and transported to our hospital with suspected myocarditis. After admission, the patient showed polypnea, a decreased level of consciousness, and marked metabolic acidosis and lapsed into circulatory insufficiency, requiring catecholamine administration, endotracheal intubation, and extracorporeal membrane oxygenation. Initially, low-output heart failure due to acute myocarditis was suspected, but the central venous oxygen saturation was high, at 82%. Considering high-output heart failure to be more likely, we evaluated its cause and noted, by urinary organic acid analysis, increases in lactate, pyruvate, 3-OH-butyrate, acetoacetate, metabolic products of branched-chain amino acids, 2-ketoglutarate, 2-OH-glutarate, 2-keto-adipate, and 2-OH-adipate. Since the vitamin B1 level was reduced to 12 ng/mL (normally 20-50 ng/mL), a diagnosis of cardiac beriberi due to vitamin B1 deficiency was made. When unexplained heart failure is observed in children, cardiac beriberi must be excluded as a differential diagnosis of myocarditis and cardiomyopathy. The measurement of the central venous oxygen saturation may be useful for the diagnosis.
- Ribosome profiling reveals features of normal and disease-associated mitochondrial translation. [Journal Article]
- Nat Commun 2013 Dec 3.:2886.
Mitochondria are essential cellular organelles for generation of energy and their dysfunction may cause diabetes, Parkinson's disease and multi-systemic failure marked by failure to thrive, gastrointestinal problems, lactic acidosis and early lethality. Disease-associated mitochondrial mutations often affect components of the mitochondrial translation machinery. Here we perform ribosome profiling to measure mitochondrial translation at nucleotide resolution. Using a protocol optimized for the retrieval of mitochondrial ribosome protected fragments (RPFs) we show that the size distribution of wild-type mitochondrial RPFs follows a bimodal distribution peaking at 27 and 33 nucleotides, which is distinct from the 30-nucleotide peak of nuclear RPFs. Their cross-correlation suggests generation of mitochondrial RPFs during ribosome progression. In contrast, RPFs from patient-derived mitochondria mutated in tRNA-Tryptophan are centered on tryptophan codons and reduced downstream, indicating ribosome stalling. Intriguingly, long RPFs are enriched in mutated mitochondria, suggesting they characterize stalled ribosomes. Our findings provide the first model for translation in wild-type and disease-triggering mitochondria.
- Malignant Hyperthermia in Children: An Analysis of the North American Malignant Hyperthermia Registry. [JOURNAL ARTICLE]
- Anesth Analg 2013 Dec 2.
Clinical characteristics of malignant hyperthermia (MH) in pediatric patients have not been elucidated. In this study, we used the North American Malignant Hyperthermia Registry to determine differences in clinical characteristics of acute MH across pediatric age groups. We hypothesized that there are differences in clinical presentation, clinical course, and outcomes, which correlate with age. A secondary aim was to determine the types of preexisting medical conditions associated with pediatric MH.We performed a retrospective review of the North American Malignant Hyperthermia Registry to identify pediatric subjects (up to and including 18 years) with an MH clinical grading score at or above 35 indicating "very likely" or "almost certain" MH. Preoperative patient characteristics, perianesthetic factors, and outcome data were compared for 3 cohorts based on age: 0 to 24 months, 25 months to 12 years, and 13 to 18 years. We used statistical analysis to determine differences among the groups.We analyzed 264 records: 35 in the youngest age group, 163 in the middle age group, and 66 in the oldest group. There was no indication of any predisposing risk factors for MH based on family history or physical examination. Sinus tachycardia, hypercarbia, and rapid temperature increase were the most common signs of acute MH (observed in 73.1%, 68.6%, and 48.5%, respectively) and were more common in the oldest age cohort. Higher maximum temperatures and higher peak potassium values were seen in the oldest age cohort. Masseter spasm was more common in the middle age cohort. The youngest age cohort was more likely to develop skin mottling and was approximately half as likely to develop muscle rigidity. The youngest age group also demonstrated significantly higher peak lactic acid levels and lower peak creatine kinase values. Treatments were similar across age cohorts. There were 10 MH-associated deaths, 6 in the middle age group and 4 in the oldest age group. Recrudescence of symptoms after initial treatment occurred in 14.4% of subjects, with no difference across age cohorts. Two of these subjects, 1 in the middle age group and 1 in the oldest age group, died after the recrudescence event.There are differences in clinical characteristics of acute MH among different age cohorts in childhood. Older subjects demonstrated higher body temperatures and higher potassium levels, and the youngest subjects had greater levels of metabolic acidosis. Most children in each age group were phenotypically normal before developing MH.
- Lactic acidosis induced metformin in a chronic hemodialysis patient with diabetes mellitus tip 2. [JOURNAL ARTICLE]
- Hemodial Int 2013 Dec 3.
Metformin is a biguanide group oral antidiabetic drug used for the treatment of type 2 diabetes mellitus. Nausea, vomiting, diarrhea, abdominal pain, and anorexia are the most common adverse effects encountered during treatment. Lactic acidosis is a serious side effect seen with metformin use, and while the incidence of lactic acidosis is similar to other oral antidiabetics, metformin is not recommended to patients with certain risk factors, such as cardiovascular, pulmonary, and renal and liver failure. We describe a chronic hemodialysis patient treated with metformin, presenting to the nephrology department with altered mental status.
- Identification of a deletion in the NDUFS4 gene using Array-Comparative Genomic Hybridization in a patient with suspected mitochondrial respiratory Disease. [JOURNAL ARTICLE]
- Gene 2013 Nov 29.
We evaluated a patient, born after a normal 38-week pregnancy, with psychomotor retardation, poor coordination of ocular movements, recurrent vomiting and severe lactic acidosis. The patient was admitted to hospital at 2months of age because of a mitochondrial-like syndrome and died at the age of 4.5months. Array-comparative genomic hybridization (a-CGH) analysis revealed a homozygous deletion in 5q11.2 involving NADH dehydrogenase (ubiquinone) Fe-S protein 4, 18kDa (NADH-coenzyme Q reductase; NDUFS4). Both parents were heterozygous for the mutation. The array revealed a deletion of~32 Kb that includes exon 2 of NDUFS4 subsequently confirmed by real time-PCR and multiplex PCR. NDUFS4 was previously correlated to Leigh syndrome since mutations in this gene block the assembly of complex I. This result demonstrates the relevance of a-CGH screening in patients affected by metabolic disorders of unknown etiology.
- Transabdominal ultrasonography of the ruminal mucosa as a tool to diagnose subacute ruminal acidosis in adult dairy bulls: a pilot study. [Journal Article]
- Vet Q 2013 Sep; 33(3):139-47.
Subacute rumen acidosis (SARA) is frequently encountered in ruminants on high-concentrate rations and characterized by mild to moderate rumen pH depression. Although the measurement of rumen pH is considered as a gold standard approach to diagnose SARA, rumen fluid collection is conceived as a cumbersome and invasive procedure. In the present study, the suitability of transabdominal ultrasonography to identify structural changes of the rumen mucosa associated with SARA was explored. Five adult rumen canulated bulls previously adjusted to a roughage-based ration were switched in 10-day intervals to rations with increasing concentrate content. Seven rations with a concentrate content ranging from 5% to 95% were fed. The rumen pH and rumen mucosal thickness were measured at the end of each 10-d feeding period. The left flank was divided into 12 acoustic windows and the mean rumen mucosal thickness for each acoustic window determined for each ration. Repeated measure ANOVA and stepwise regression analyses were conducted. Increasing the dietary concentrate content resulted in thickening of rumen mucosa which was most pronounced in the upper part of the ventral rumen sac and the least pronounced in the uppermost and lowermost parts of the rumen. The intersection of a horizontal line going through the costochondral junction and a vertical line coming from the third lumbar vertebra was found to be most suitable to identify animals with rumen pH < 5.5 at 4 h post feeding. We conclude that transabdominal ultrasonography of the rumen mucosa has the potential to be a suitable, non-invasive diagnostic tool to identify adult ruminants with SARA.