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acidosis metabolic [keywords]
- Neuroblastoma accompanied by hyperaldosteronism. [Journal Article]
- J Renal Inj Prev 2014; 3(3):79-82.
Tumors known derived from kidneys which take place in secondary hyperaldosteronism etiology are juxtaglomerular cell tumor and Wilms' tumor. Neuroblastoma presenting with hyperaldosteronism is rare.A 15-month-old girl who had been having diarrhea and fever for 2 weeks presented with a 3 day history of bilious vomiting, metabolic acidosis and severe hypokalemia. She was referred to our hospital with the pre-diagnosis of unknown manifest hypertension etiology, diarrhea, and paralytic ileus after having therapy-resistant hypokalemia and severe resistant acidosis. On her examination after being admitted to our clinic, she was weak, unwell and lethargic with a blood pressure of 140/93 mmHg. Due to the hypertension and severe hypokalemia, the patient was considered to be hyperaldosteronism. Serum aldosterone level, plasma renin activity and cortisol level were elevated. Radiologic findings were compatible with neuroblastoma. The patient underwent an abdominal surgery and the mass excision. The histopathological examination was proved neuroblastoma.Hyperaldosteronism can be presented by unexpected atypical forms as in our patient.
- Atrial fibrillation in the acute, hypercapnic exacerbations of COPD. [Journal Article]
- Eur Rev Med Pharmacol Sci 2014 Oct; 18(19):2908-17.
Chronic obstructive pulmonary disease (COPD) has been associated with a high frequency of arrhythmias. Atrial fibrillation (AF) is one of the most common arrhythmias and causes substantial morbidity and mortality. Emerging risk factors for the development of AF include a variety of breathing disorders like COPD. Few studies have analyzed the role of reduced lung function and respiratory acidosis in predicting AF. Aim of the current study was to investigate the role of hypercapnia, pulmonary systolic hypertension and lung function impairment in COPD patients, as risk factors for atrial fibrillation development.We evaluated a population of individuals consecutively hospitalized for COPD exacerbation and hypercapnic respiratory failure between January 2012 and January 2013; among them we selected a subgroup of patients presenting a paroxysmal episode of atrial fibrillation. All patients underwent pulmonary function tests, haemogasanalysis, electrocardiogram and transthoracic echocardiography.Among the 193 subjects evaluated, 35 individuals with AF and COPD were enrolled in the study. Risk of new AF was higher in those subjects with lower FEV1 and higher PaCO2 values, also there was a significantly increased prevalence of AF in patients with higher value of Pulmonary Artery Systolic Pressure (PASP), obtained by transthoracic echocardiography. Linear correlation between variables revealed a direct relationships between hypercapnia and PASP and left and right atrial areas.Impaired pulmonary function, hypercapnia and high values of PASP are independent predictors of incident AF.
- Swift recovery of severe acute hypoxemic respiratory failure under non-invasive ventilation. [JOURNAL ARTICLE]
- Anaesthesiol Intensive Ther 2014 Oct 23.
Background : In the setting of severe acute respiratory distress syndrome (ARDS; PaO2/FiO2<100), the cut-off point for switching from non-invasive ventilation to intubation combined to mechanical ventilation is poorly defined. Results : The swift resolution over 10 h of a severe acute hypoxemic respiratory failure (P/F=57) caused by aspiration following heroin overdose, using non-invasive ventilation (NIV)-high PEEP (15-20 cm H2O)-low pressure support (8 cm H20) is reported. The success in treating non-invasively severe hypoxia was presumably linked to a highly restricted subset : healthy young patient, minimal alteration of consciousness, non-combativeness, absence of severe metabolic acidosis, quick resolution of supraventricular arrhythmia, one-to-one supervision by the intensivist in the critical care unit. Conclusion : Given the complications associated with tracheal intubation and mechanical ventilation on the one hand and with delayed intubation on the other hand, high PEEP-NIV may warrant study in a restricted set of patients closely monitored in a critical care environment.
- Role of iron, zinc and reduced glutathione in oxidative stress induction by low pH in rat brain synaptosomes. [Journal Article]
- Springerplus 2014.:560.
Brain ischemia leads to a decrease in pHo. We have shown previously in synaptosomes that the extracellular acidification induces depolarization of mitochondria followed by synthesis of superoxide anions and oxidative stress. Here, we investigated the effects of lowered pHo on oxidative stress and membrane potentials in synaptosomes treated by the iron chelator deferoxamine and zinc chelator TPEN. We demonstrated that chelating of metals has no impact on superoxide anion synthesis and intrasynaptosomal mitochondria depolarization. Meanwhile, deferoxamine was able to inhibit oxidative stress induced by low pHo and hydrogen peroxide application. Compared to deferoxamine, TPEN was less effective but it decreased the DCF fluorescence induced by pHo 6.0 which had no effects in other oxidative stress models. We found that the chelators were able to inhibit slightly plasma membrane depolarization. Synaptosomes preincubation at low pHo caused no effects on the reduced glutathione level. Depletion of glutathione by CDNB produced no additional increase in the DCF fluorescence induced by pHo 7.0. Our results suggest that free iron is crucial for the development of oxidative stress elicited by acidification in synaptosomes. Chelating of this metal seems to be a promising strategy for protecting the neuronal presynaptic terminals against oxidative stress developed at stroke.
- Randomised prospective study compares efficacy of five different stomach tubes for rumen fluid sampling in dairy cows. [JOURNAL ARTICLE]
- Vet Rec 2014 Oct 20.
The objective of the study was to compare the performance of five types of stomach tubes for rumen fluid sampling. Rumen fluid was sampled in rumen fistulated cows assigned to a 5×5 Latin square study design. The pH values of samples taken by stomach tubes and via fistulas were measured; the results were compared with indwelling sensor measurements. The practicability of the stomach tubes for regular use was tested in the field. Rumen fluid samples were obtained rapidly. Volumes for transfaunation could be obtained. The pH-values of samples taken with the four out of the five tubes (Dirksen, Geishauser, tube 4 and a simple water hose used with a gag) did not show significant differences to samples taken via rumen fistulas. Mean differences ranged between -0.02 and +0.09. Samples taken with tube 4 and the water hose showed also no significant differences to pH-sensor measurements. This study demonstrates that stomach tubes are suitable for rumen fluid sampling. Tube 4 seems to be the best probe for work in the field. It was well tolerated by the animals, saliva contamination is negligible. We, therefore, conclude that the evaluation of rumen acid base status in the field is possible.
- Evaluation of the Potential of Tedizolid and Linezolid to Affect Mitochondrial Function Using Nonclinical and Pharmacokinetic Assessments. [JOURNAL ARTICLE]
- Antimicrob Agents Chemother 2014 Oct 20.
Prolonged treatment with the oxazolidinone linezolid is associated with myelosuppression, lactic acidosis, and neuropathies, toxicities likely caused by impairment of mitochondrial protein synthesis (MPS). To evaluate the potential of the novel oxazolidinone tedizolid to cause similar side effects, nonclinical and pharmacokinetic assessments were conducted. In isolated rat heart mitochondria, tedizolid inhibited MPS more potently than linezolid (average concentrations that inhibit 50% [IC50]MPS of 0.31±0.02 μM vs. 6.4±1.2 μM, respectively). However, a rigorous 9-month rat study comparing placebo and high-dose tedizolid (resulting in steady-state area under the plasma concentration time curve values about 8-fold greater than those with the standard therapeutic dose in humans) showed no evidence of neuropathy. Additional studies explored why prolonged, high-dose tedizolid did not cause these mitochondriopathic side effects despite potent MPS inhibition by tedizolid. Murine macrophage (J774) cell fractionation studies found no evidence of stable association of tedizolid with eukaryotic mitochondria. Monte Carlo simulations based on population pharmacokinetics models showed that over the course of a dosing interval using standard therapeutic doses, free plasma concentrations fell below the respective MPS IC50 in 84% of tedizolid-treated patients (for a median duration of 7.94 h) and 38% of linezolid-treated patients (for a median duration of 0 h). Therapeutic doses of tedizolid, but not linezolid, may therefore allow for mitochondrial recovery during antibacterial therapy. The overall results suggest that tedizolid has less potential to cause myelosuppression and neuropathy than linezolid during prolonged treatment courses. This, however, remains a hypothesis that must be confirmed in clinical studies.
- [Extracorporeal membrane oxygenation treatment for a patient with life-threatening asthma.] [JOURNAL ARTICLE]
- Ugeskr Laeger 2014 Oct 6; 176(41)
This is a case report of a young male with life-threatening asthma presenting hypercapnia and respiratory acidosis despite mechanical ventilation and intense broncholytic medication. He was treated with venovenous extracorporeal membrane oxygenation (VV-ECMO) through a double-lumen catheter placed in the right jugular vein. This patient, as well as two other comparable patients, improved respiratory and circulatory within 3 h of VV-ECMO treatment. Smaller low-flow ECMO devices for CO₂ removal are emerging but attention should be kept on the fact, that they are not capable of oxygenation.
- Suicide Case Due to Phosphoric Acid Ingestion: Case Report and Review of Literature. [JOURNAL ARTICLE]
- J Forensic Sci 2014 Oct 20.
Ingesting caustic substances represents a common event which may result in serious injuries of the gastrointestinal system. Severity of injury depends on the type of ingested substance: Caustic burns are more frequently associated with acid ingestion and their severity depends on type, concentration, time of exposure, and amount of the ingested substance. We report a case of phosphoric acid ingestion leading to death in a patient with depressive disorder. While reports ingestion of other acids and organophosphates can be found in the literature, there are no reports detailing a death due to phosphoric acid ingestion. We hope that presenting the findings in this case can aid death investigators in future cases that may involve ingestion of such a substance. After autopsy pH, phosphate and calcium ions concentration in the blood were analyzed. The cause of death was due to systemic effects: metabolic acidosis, hypophosphatemia, hypocalcemia, and hyperkalemia.
- Airway tissue plasminogen activator prevents acute mortality due to lethal sulfur mustard inhalation. [JOURNAL ARTICLE]
- Toxicol Sci 2014 Oct 20.
Rationale: Sulfur mustard (SM) is a chemical weapon stockpiled today in volatile regions of the world. SM inhalation causes a life-threatening airway injury characterized by airway obstruction from fibrin casts, that can lead to respiratory failure and death. Mortality in those requiring intubation is >80%. No therapy exists to prevent mortality after SM exposure. Our previous work using the less toxic analog of SM, 2-chloroethyl ethyl sulfide, identified tissue plasminogen activator (tPA) an effective rescue therapy for airway cast obstruction (Veress et al., 2013). It is not known if exposure to neat SM vapor, the primary agent used in chemical warfare, will also cause death due to airway casts, and if tPA could be used to improve outcome. Methods: Adult rats were exposed to SM, and when oxygen saturation reached <85% (median: 6.5h), intratracheal tPA or placebo was given under isoflurane anesthesia every 4h for 48h. Oxygen saturation, clinical distress and arterial blood gases were assessed. Microdissection was done to assess airway obstruction by casts. Results: Intratracheal tPA treatment eliminated mortality (0% at 48 h) and greatly improved morbidity after lethal SM inhalation (100% death in controls). tPA normalized SM-associated hypoxemia, hypercarbia, and lactic acidosis, and improved respiratory distress. Moreover, tPA treatment resulted in greatly diminished airway casts, preventing respiratory failure from airway obstruction. Conclusions: tPA given via airway >6h after exposure prevented death from lethal SM inhalation, and normalized oxygenation and ventilation defects, thereby rescuing from respiratory distress and failure. Intra-airway tPA should be considered as a life-saving rescue therapy after a significant SM inhalation exposure incident.
- [Genetic diagnosis of fructose-1, 6-bisphosphatase deficiency: a case report]. [English Abstract, Journal Article]
- Beijing Da Xue Xue Bao 2014 Oct 18; 46(5):681-5.
To report the first case of fructose-1,6-bisphosphatase (FBPase) deficiency diagnosed by genetic sequencing in China, and to improve the cognition of this rare disease.The clinical and laboratory characteristics of FBPase deficiency were reviewed, and the findings of direct sequencing of genomic DNA described, and published literature on FBPase deficiency reviewed.A 23-month-old boy was repeatedly admitted for 5 times with recurrent onset of lethargy and drowsiness every time after diarrhea and vomiting for 2-3 days during the last 7 months after being weaned, and he had convulsion this time. On admission, his physical examination showed tachypnea, and mild hepatomegaly, and he had normal physical and mental development. His paternal-grandparents had cousinship, and his parents were collateral relatives in the fifth generation. The laboratory findings revealed severe hypoglycemia, lacticacidemia, metabolic acidosis, ketonemia and hyperuricacidemia. After intravenous infusion of glucose, bicarbonate and antibiotics, there was a dramatic clinical improvement in a short time. Urine organic acids analyses ever showed an elevation of gluconeogenetic substrates including lactic acid, ketone and glycerol. The molecular analysis of liver fructose-1, 6-bisphosphatase (FBP1) gene showed a homozygous mutation with one G residue insertion at base 961 in exon 7(c.960/961insG), resulting in a reading frame shift mutation of 320th amino acid and premature termination at 333th amino acid. This mutation had been reported to be the most common mutation among patients with FBPase deficiency. Frequent feeding by avoiding taking in too much sweet food, restriction of food with high protein and fat, and the use of uncooked starch had been taken after our patient was discharged from the hospital. There had been no attack in the last 9 months.Clinicians must consider the diagnosis of FBPase deficiency when confronted with the patient who has episodes of severe hypoglycemia and lacticacidemia, especially accompanied by metabolic acidosis and ketonemia, which are typically triggered by infection and fasting. Early diagnosis, urgent treatment of hypoglycemia and appropriate diet control can prevent death, improve growth and quality of life of these children.