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Excess Anion Gap

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61. Comparison of acid-base and electrolyte changes following administration of 6% hydroxyethyl starch 130/0.42 in a saline and a polyionic solution in anaesthetized dogs. (Abstract)

anaesthesia for elective surgical procedures or diagnostic imaging.During anaesthesia, dogs were intravenously administered 15 mL kg-1 of either HES-SAL (n = 20) or HES-BAL (n = 20) over 30-40 minutes. Jugular blood samples were analysed before (T0) and 5 minutes (T5), 1 hour (T60) and 3 hours (T180) after fluid administration. Sodium, potassium, chloride, ionised calcium, phosphate, albumin, pH, venous pCO2, base excess (BE), bicarbonate and anion gap were determined and strong ion difference (SID

2018 Veterinary anaesthesia and analgesia Controlled trial quality: uncertain

62. Early pH Change Predicts Intensive Care Unit Mortality (Full text)

to <7.35 of presumed metabolic origin were included. Arterial blood gas parameters including pH, PaO2, PaCO2, HCO3-, Na+, K+, Cl-, anion gap (AG), base excess, and lactate at 0, 6, and 24 h along with other standard laboratory investigations were recorded. The primary outcome was to assess the impact of early pH changes on mortality at day 28 of ICU.A total of 104 patients with 60.6% males and 91.3% medical patients were included in the study. Sepsis of lung origin (60.6%) was the predominant etiology

2018 Indian journal of critical care medicine : peer-reviewed, official publication of Indian Society of Critical Care Medicine PubMed abstract

63. Efficacy, Safety and Tolerability of a New Bowel Cleansing Preparation (BLI800) in Adult Subjects Undergoing Colonoscopy

. Diarrhoea or constipation of unknown aetiology e. Inflammatory Bowel Disease (IBD) not in severe active phase In good clinical condition (physical exam and medical history) Adequate fluid balance, and adequate electrolyte balance (measured during screening K, Na, Cl, anion gap/bicarbonate/carbon dioxide content within normal/within ±10% of normal range) Exclusion Criteria: Abnormal baseline findings, any other medical condition(s) or laboratory findings that, in the opinion of the investigator, might (...) jeopardise the subject's safety or decrease the chance of obtaining satisfactory data needed to achieve the objective(s) of the study. Advanced carcinoma or any other colon disease leading to excessive mucosal fragility. Known or suspected gastrointestinal (GI) obstruction, gastric retention, gastroparesis, or disorder of gastric emptying. Known or suspected ileus. Contacts and Locations Go to Information from the National Library of Medicine To learn more about this study, you or your doctor may contact

2018 Clinical Trials

64. Alterations in Metabolic Status and Headshaking Behavior Following Intravenous Administration of Hypertonic Solutions in Horses with Trigeminal-Mediated Headshaking (Full text)

(HB). Horses were assessed for headshaking behavior changes at times T0 (baseline, before infusion) and T15, 30, 60, 120 min post infusion. Venous blood variables: pH, HCO₃−, standard base excess (SBE), Na⁺, Cl−, K⁺, Ca2+, Mg2+, total magnesium (tMg), glucose, and lactate were measured at T0 (baseline, before infusion) and T5, 15, 30, 60, 120 min post infusion. Strong ion difference (SID) and anion gap (AG) were calculated for each time point. With HB treatment, there was greater than

2018 Animals : an open access journal from MDPI Controlled trial quality: uncertain PubMed abstract

65. Clinical Practice guideline on the diagnosis and treatment of hyponatraemia

for every 10 mU/l rise in thyroid-stimulating hormone, indicating that only severe cases of clinically manifest hypothyroidism re- sulted in clinically important hyponatraemia. Development of hyponatraemia may be related to myxoedema, resulting from a reduction in cardiac output and glomerular ?ltration rate[51]. 5.8.4. High water and low solute intake. Under conditions of high water and low solute intake, the excess water intake is primarily responsible for hyponatraemia. Vasopressin activity is absent (...) and speci?city of a particular threshold. Physiologically, one would expect maximally dilute urine,in thepresence of hypotonic hypo- natraemia, unless hypo-osmolality fails to fully suppress vasopressin release. In hyponatraemia primarily caused by excess water intake, vasopressin release is suppressed re- sulting in urine osmolality usually 30 mmol/l for diagnosis of euvolaemia vs hypovolaemia [89, 103, 107, 108]. All found similarly high sensitivity esti- mates ranging from 0.87 to 1.0 but variable

2014 European Renal Best Practice

66. European Society of Endocrinology Clinical guideline for the management of hyponatraemia (Full text)

to be a detailed reference section. It was only meant to clarify some of the important concepts to enhance understanding of the rationale of the statements in the guideline. Hyponatraemia is primarily a disorder of water balance, with a relative excess of body water compared to total body sodium and potassium content. It is usually associated with a disturbance in the hormone that governs water balance, vasopressin (also called antidiuretic hormone). Even in disorders associated with (renal) sodium loss (...) , vasopressin activity is generally required for hyponatraemia to develop. Therefore, after describing common signs and symptoms, we detail the mechanisms involved in vasopressin release. Changes in serum osmolality are primarily determined by changes in the serum concentration of sodium and its associated anions. It is important to differentiate the concepts of total osmolality and effective osmolality or tonicity. Total osmolality is defined as the concentration of all solutes in a given weight of water

2014 European Society of Endocrinology PubMed abstract

68. The management of diabetic ketoacidosis (DKA) in adults

baseline respiratory function) ? Systolic BP below 90mmHg ? Pulse over 100 or below 60bpm ? Anion gap above 16 [Anion Gap = (Na + + K + ) – (Cl - + HCO3 - ) ] If the patient exhibits any of these signs they should be reviewed by a consultant physician and considered for referral to a Level 2/HDU (High Dependency Unit) environment 69 . It may also be necessary to consider a surgical cause for the deterioration. If surgery is required there will need to be an urgent senior multidisciplinary discussion (...) therapy will resolve the acidosis in DKA and the use of bicarbonate is not indicated 51-53 . The acidosis may be an adaptive response as it improves oxygen delivery to the tissues by causing a right shift of the oxygen dissociation curve. Excessive bicarbonate may cause a rise in the CO 2 partial pressure in the cerebrospinal fluid (CSF) and may lead to a paradoxical increase in CSF acidosis 51 . In addition, the use of bicarbonate in DKA may delay the fall in blood lactate: pyruvate ratio and ketones

2013 Association of British Clinical Diabetologists

69. Effects of dystocia on blood gas parameters, acid-base balance and serum lactate concentration in heavy draft newborn foals (Full text)

was defined as prolonged labor >30 min with strong fetal traction with or without fetal displacement. The dystocia group (n=13) showed lower mean values for pH (P<0.01), bicarbonate (P<0.01), total carbon dioxide (P<0.05), and base excess (P<0.01) and higher mean values for anion gap (P<0.05) and lactate (P<0.01) immediately after birth than the normal group (n=22). Remarkably high pCO2 values (>90 mmHg) were observed in three foals in the dystocia group but in none of the foals in the normal birth group

2017 Journal of Equine Science PubMed abstract

70. Blood Lactic Acid

intolerancia léphet fel. A plazmában bekövetkező L-lactat növekedés jellemzi. Az acidosis ritkán jelentős kivéve, ha a vér lactat túllépi a 5 mmol/l értéket. Klinikai prezentáció a B típusú lactat acidosisban: o Tünetek: hiperventilláció vagy dyspnea, kábultság vagy kóma, hányás, álmosság és hasi fájdalom o A tünetek és jelek kezdete általában gyors és az öntudat hanyatlásával társul. Definition (MDR) Lactic acidosis is a form of high anion gap metabolic acidosis - Intrinsic cardiac contractility may (...) · Caractérisée par une élévation plasmatique du L-lactate · L'acidose est rarement significative à moins que le lactate sanguin ne dépasse 5 mmol/l · Présentation clinique d'acidose lactique de type B : o Symptômes : hyperventilation ou dyspnée, stupeur ou coma, vomissements, somnolence et douleurs abdominales o L'apparition de symptômes et signes est généralement rapide et s'accompagne d'une détérioration du niveau de conscience Definition (MDRDUT) . Melkzuuracidose is een vorm van hoge anion-gap metabole

2018 FP Notebook

71. Metabolic Acidosis

: Metabolic Acidosis , Non-Anion Gap Metabolic Acidosis , Hypochloremic Metabolic Acidosis , Anion Gap Metabolic Acidosis , Metabolic Acidosis with Anion Gap From Related Chapters II. Types Elevated Anion Gap Metabolic Acidosis Hyperchloremic Metabolic Acidosis (normal ) See III. Causes: Common Most common causes of Anion Gap Metabolic Acidosis in seriously ill patients Most common causes of Non-Anion Gap Metabolic Acidosis Gastrointestinal or renal losses of bicarbonate Volume with IV. Causes: Metabolic (...) Acidosis and Elevated Anion Gap (Mnemonic: "MUD PILERS") , (DKA), ic ketoacidosis or starvation ketosis Paraldehyde, Phenformin (neither used in U.S. now) has been proposed as a replacement in mnemonic , Isopropyl , and (due to s) , s (do not miss ) Other Causes Hyperalbuminemia Administered anions V. Causes: Metabolic Acidosis and Normal Anion Gap (Hyperchloremia) with Metabolic Acidosis Ureteral diversion Uretero-sigmoidostomy Ileal Ileal ureter (proximal or distal) Mineralocorticoid Deficiency

2018 FP Notebook

72. Komboglyze - saxagliptin / metformin hydrochloride

of craniorachischisis was considered to be within historical control levels. These findings were not reproduced in a second rat study at saxagliptin/metformin doses of 25/600 mg/kg/day. As metformin showed no effect on fertility in previous studies, and for saxagliptin effects were only seen at doses far in excess of the recommended human dose, additional studies to assess toxicity of the fixed combination to fertility and early embryonic development, parturition, pre- and postnatal development, or on juvenile

2011 European Medicines Agency - EPARs

73. Acid-base and Electrolyte thoughts from Core IM Episode #14

adenoma that presented with acute quadriparesis. Recently they presented a patient who had excess licorice ingestion. The labs strongly suggest the diagnosis – 136/1.9/119/<10/31/1.2 Since we are considering a distal RTA, I would have liked to have the U/A also, but they did not report the U/A. The reason I wanted the U/A is that distal RTA patients do not acidify the urine. A high urine pH in the face of a normal gap acidosis makes the diagnosis of distal RTA. The reason for the acidosis stems from (...) the lack of sufficient acid to buffer the ammonia to ammonium. That lack explains the positive urine anion gap. So the case is straightforward, until it was not. The patient had a phosphate of 1.5. Further urine studies showed increased phosphate excretion and glycosuria with a normal serum glucose. Thus the patient likely also had Fanconi’s syndrome. I did a quick literature search and found several case reports of Fanconi’s syndrome secondary to Sjogren’s and this one in particular of the combination

2018 db's Medical Rants blog

74. Acetazolamide Therapy for Metabolic Alkalosis in Pediatric Intensive Care Patients. (Abstract)

in respiratory patients. All patients received loop diuretics. A decrease in pH and PCO2 in the first 72 hours, a decrease in serum HCO3 (mean, 4.65 ± 4.83; p < 0.001), and an increase in anion gap values were observed. Urine output increased in cardiac postoperative patients (4.5 ± 2.2 vs 5.1 ± 2.0; p = 0.020), whereas diuretic treatment was reduced in cardiac patients. There was no significant difference in serum electrolytes, blood urea, creatinine, nor chloride after the administration of acetazolamide (...) acetazolamide.None.Demographic variables, diuretic treatment and doses of acetazolamide, urine output, serum electrolytes, urea and creatinine, acid-base excess, pH, and use of mechanical ventilation during treatment were collected. Patients were studied according to their pathology (postoperative cardiac surgery, decompensated heart failure, or respiratory disease). A total of 78 episodes in 58 patients were identified: 48 were carried out in cardiac postoperative patients, 22 in decompensated heart failure, and eight

2016 Pediatric Critical Care Medicine

75. A Patient With Alcoholic Ketoacidosis and Profound Lactemia. (Abstract)

A Patient With Alcoholic Ketoacidosis and Profound Lactemia. Alcoholic ketoacidosis (AKA) is a complex syndrome that results from disrupted metabolism in the setting of excessive alcohol use and poor oral intake. Dehydration, glycogen depletion, high redox state, and release of stress hormones are the primary factors producing the characteristic anion gap metabolic acidosis with an elevated β-hydroxybutyrate (β-OH) and lactate.We present the case of a 47-year-old man who presented (...) to the emergency department with metabolic acidosis and profoundly elevated lactate levels who had AKA. He recovered completely with intravenous fluids and parenteral glucose administration. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Emergency physicians should always consider the immediately life-threatening causes of a severe anion gap metabolic acidosis and treat aggressively based on the situation. This case highlights the fact that AKA can present with an impressively elevated lactate levels

2016 Journal of Emergency Medicine

76. Real-time urinary electrolyte monitoring after furosemide administration in surgical ICU patients with normal renal function (Full text)

[Cl(-)] and ammonium [NH4 (+)] concentrations were measured every 10 min for three to 8 h. Urinary anion gap (AG), electrolyte excretion rate, fractional excretion (Fe) and time constant of urinary [Na(+)] variation (τNa(+)) were calculated.Ten minutes after furosemide administration (12 ± 5 mg), urinary [Na(+)] and [Cl(-)], and their excretion rates, increased to similar levels (P < 0.001). After the first hour, urinary [Cl(-)] decreased less rapidly than [Na(+)], leading to a reduction (...) associated with a longer τNa(+) (P < 0.05). In patients receiving multiple administrations (n = 11), arterial pH, base excess and strong ion difference increased, due to a decrease in plasmatic [Cl(-)].Low-dose furosemide administration immediately modifies urinary electrolyte excretion rates, likely in relation to the ongoing proximal tubular activity, unveiled by its inhibitory action on Henle's loop. Such effects, when cumulative, found the bases for the long-term alterations observed. Real-time

2016 Annals of intensive care PubMed abstract

77. Clinical Evaluation of Use of Prismocitrate 18 in Patients Undergoing Acute Continuous Renal Replacement Therapy (CRRT)

to 120 hours post CRRT treatment initiation ] Serum Anion Gap [ Time Frame: Baseline and up to 120 hours post CRRT treatment initiation ] Serum Magnesium [ Time Frame: Baseline and up to 120 hours post CRRT treatment initiation ] Serum Phosphate [ Time Frame: Baseline and up to 120 hours post CRRT treatment initiation ] Serum Potassium [ Time Frame: Baseline and up to 120 hours post CRRT treatment initiation ] Serum Chloride [ Time Frame: Baseline and up to 120 hours post CRRT treatment initiation (...) , will be required to pass an assessment to demonstrate the understanding of how to use the solution. Serum Bicarbonate [ Time Frame: Baseline and up to 120 hours post CRRT treatment initiation ] pH [ Time Frame: Baseline and up to 120 hours post CRRT treatment initiation ] Base Excess [ Time Frame: Baseline and up to 120 hours post CRRT treatment initiation ] Blood Total Calcium Concentration [ Time Frame: Baseline and up to 120 hours post CRRT treatment initiation ] Serum Sodium [ Time Frame: Baseline and up

2016 Clinical Trials

78. Metabolic Acidosis Assessment in High-Risk Surgeries: Prognostic Importance. (Abstract)

/L and albumin-corrected anion gap ≤12 mmol/L (hyperchloremic), those with a base excess <-4 mmol/L and increased albumin-corrected anion gap >12 mmol/L, and those with a base excess <-4 mmol/L and hyperlactatemia >2 mmol/L. Furthermore, patients were reclassified 12 hours after admission to the ICU to verify the metabolic acidosis behavior and outcome differences among the groups.The study included 618 patients. The incidence of acidosis at ICU admission was 59.1%; 23.9% presented (...) with hyperchloremia, 21.3% with hyperlactatemia, 13.9% with increased anion gap, and 40.9% of the patients presented without metabolic acidosis. Patients whose metabolic acidosis persisted for 12 hours had an incidence of ICU complications rates in hyperlactatemia group of 68.8%, increased anion gap of 68.6%, hyperchloremic of 65.8%, and those without acidosis over 12 hours of 59.3%. A Cox regression model for postoperative 30-day mortality showed: in hyperlactatemic acidosis, hazard ratio (HR) = 1.74, 95

2016 Anesthesia and Analgesia

79. Metabolic and Hematological Consequences of Dietary Deoxynivalenol Interacting with Systemic Escherichia coli Lipopolysaccharide (Full text)

and electrolytes were not affected by DON and LPS. DON-feeding solely decreased portal glucose uptake (p < 0.05). LPS-decreased partial oxygen pressure (pO₂) overall (p < 0.05), but reduced pCO₂ only in arterial blood, and DON had no effect on either. Irrespective of catheter localization, LPS decreased pH and base-excess (p < 0.01), but increased lactate and anion-gap (p < 0.01), indicating an emerging lactic acidosis. Lactic acidosis was more pronounced in the group DON_LPSjugular-CONportal than in CON-fed

2015 Toxins PubMed abstract

80. Renal Tubular Acidosis is Highly Prevalent in Critically Ill Patients

subset calculation based on a physical-chemical approach on the first seven days after ICU admission was used to compare the effects of free water, chloride, albumin, and unmeasured anions on the standard base excess. Calculation of the urine osmolal gap (UOG) − as an approximate measure of the unmeasured urine cation ammonium − served as determinate between renal and extra-renal bicarbonate loss in the state of hyperchloremic acidosis. Study Design Go to Layout table for study information Study Type (...) of RTA has never been studied in critically ill patients. Therefore, we aimed to investigate the prevalence, type, and possible risk factors of RTA in critically ill patients using a physical-chemical approach. This prospective, observational trial was conducted in a medical ICU of a university hospital. 100 consecutive critically ill patients at the age ≥18, expected to stay in the ICU for ≥24h, with the clinical necessity for a urinary catheter and the absence of anuria were included. Base excess

2015 Clinical Trials

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