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Excess Anion Gap

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161. Toxicity, Iron (Overview)

cardiac output, and increased pulmonary vascular resistance. The decrease in cardiac output may be related to a decrease in myocardial contractility exacerbated by the acidosis and hypovolemia. Free radicals from the iron absorption may induce damage and play a role in the impaired cardiac function. The systemic iron poisoning in phase 3 is associated with a positive anion gap metabolic acidosis. The following explanations for the acidosis have been proposed: Conversion of free plasma iron to ferric (...) mucosa and can affect the heart, lungs, and liver. Excess free iron is a mitochondrial toxin that leads to derangements in energy metabolism. Although iron poisoning is a clinical diagnosis, serum iron levels are useful in predicting the clinical course of the patient. In treatment of iron poisoning, consider both bowel decontamination with whole bowel irrigation and chelation using intravenous deferoxamine. In addition, chronic iron overload may develop in pediatric cancer patients who receive

2014 eMedicine Pediatrics

162. Toxicity, Isoniazid (Overview)

toxicity Acute INH overdose predominantly involves the brain and may cause prolonged seizures, anion gap metabolic acidosis, and coma. Note the following: Patients who are affected may present with active tonic-clonic seizures and thus may be unable to give a history of INH use; this often makes rapid identification of acute INH toxicity difficult without third-party input. The amount ingested is also often difficult to ascertain, making accurate antidote (pyridoxine) dosing challenging. Clinical (...) in the central nervous system (CNS), as well as a relative increase in the amounts of glutamate, the primary excitatory neurotransmitter. INH metabolites directly inhibit pyridoxine phosphokinase. This enzyme converts pyridoxine (vitamin B-6) to its active form, pyridoxal-5'-phosphate, a key cofactor in the production of GABA. This functional depletion of pyridoxine causes a disruption of glutamate and GABA homeostasis and leads to an excessive excitatory milieu in the brain. Chronic toxicity Chronic INH

2014 eMedicine Pediatrics

163. Tumor Lysis Syndrome (Overview)

and a high anion gap acidosis (see the calculator). Acidemic states can worsen the many electrolyte imbalances already present in tumor lysis syndrome; intracellular uptake of potassium is hindered, uric acid solubility is decreased, and extracellular shift of phosphate is promoted. Calcium phosphate solubility, however, improves in acidic conditions. The myriad of metabolic disorders must be assessed and treated rapidly. Proper fluid management, alkalinization of the urine, correction of acidosis (...) and hypocalcemia, predispose patients to cardiac arrhythmia and seizures. Iatrogenic complications, such as pulmonary edema from overly vigorous hydration or metabolic alkalosis from excess exogenous administration of bicarbonate, can also occur and are life threatening if not immediately addressed. Acute kidney injury Renal tubule precipitation of uric acid, calcium phosphate, or hypoxanthine causes acute kidney injury. This is often oliguric (< 400 mL daily) in nature, leading to volume overload

2014 eMedicine Pediatrics

164. Electrolytes

be asked to have regular testing to determine how well the treatment has worked and to make sure the imbalance does not reoccur. Anion gap (AG) is a value calculated using the results of an electrolyte panel. It is used to help distinguish between anion-gap and non-anion-gap metabolic acidosis. Acidosis refers to an excess of acid in the body; this can disturb many cell functions and should be recognised as quickly as possible, when present. AG is frequently used in the hospital and/or accident (...) of unmeasured anions increases, indicating a state of anion-gap metabolic acidosis, but it does not tell the doctor what is causing the imbalance. The metabolic acidosis must be treated to restore the , but the underlying condition must also be identified and treated. Causes can include uncontrolled , starvation, kidney damage, and ingestion of potentially toxic substances such as antifreeze, excessive amounts of aspirin, or methanol. A low anion gap can also occur; this is most commonly seen when albumin

2012 Lab Tests Online UK

165. An Adaptive Phase II Study to Evaluate the Efficacy, Pharmacodynamics, Safety and Tolerability of GSK2586184

as the last Pre-treatment value observed. Change from Baseline in anion gap, calcium, cholesterol, chloride, carbon dioxide, glucose, HDL cholesterol, potassium, LDL cholesterol, magnesium, phosphate, soidium, triglycerides, urea, VLDL cholesterol at the indicated time points up to Week 16 [ Time Frame: Baseline (Day 1), Weeks 2, 3, 4, 5, 6, 8, 10, 12 and 16 ] Change from Baseline in the anion gap, calcium, ionised calcium, cholesterol, chloride, carbon dioxide, glucose, high density lipoprotein (HDL (...) result in donation of blood or blood products in excess of 500 mL within a 56 day period. Contacts and Locations Go to Information from the National Library of Medicine To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor. Please refer to this study by its identifier (NCT number): NCT01777256 Sponsors and Collaborators GlaxoSmithKline Investigators Layout table for investigator information

2013 Clinical Trials

166. Experimental Determination of Atot en Ka in the Critically Ill

. For application in the bicarbonate and base excess centred frameworks, Atot and Ka values will be related to albumin and protein content to update the correction factor for the anion gap in critically ill. Condition or disease Sepsis CABG Study Design Go to Layout table for study information Study Type : Observational Actual Enrollment : 30 participants Observational Model: Cohort Time Perspective: Prospective Official Title: Experimental Determination of Atot en Ka in the Critically Ill Study Start Date (...) University Medical Center Study Details Study Description Go to Brief Summary: To diagnose acid base disturbances using blood gas analysis, multiple approaches are currently in use. These include the classic Henderson-Hasselbach bicarbonate approach and the physiochemical approach by Stewart1. All have shown to be mathematically compatible2. Diagnosing the metabolic component of acid base disturbances relies on the assessment of the so called ion gaps: the anion gap for the classic acid-base approach

2013 Clinical Trials

167. Blood glucose, acid-base and electrolyte changes during loading doses of alphaâ‚‚-adrenergic agonists followed by constant rate infusions in horses. Full Text available with Trip Pro

-adrenergic agonists. Chloride concentration ([Cl(-)]B) and anion-gap (AG) decreased significantly compared to baseline. The decrease in sodium concentration ([Na(+)]B) was only significant with xylazine. From 1h after starting the CRI onwards, [Glu]B was significantly higher with romifidine compared to xylazine. Except [Glu]B, SIDest, and Pv¯CO2, all variables returned to normal values 1h after discontinuing xylazine. After stopping romifidine, all variables except pH remained altered for at least 1h (...) (1mg/kg) or romifidine (80 μg/kg) was administered followed by an IV CRI of xylazine (0.69 mg/kg/h) or romifidine (30 μg/kg/h) for 2h. Blood samples were collected from the pulmonary artery before and after loading doses, during the CRI, and for 1h after discontinuing drugs. Blood glucose, base excess (BE), pH, partial pressure of carbon dioxide (Pv¯CO2), strong ion difference (SIDest) and bicarbonate concentration ( [Formula: see text] ) increased significantly during the CRI with both alpha2

2013 Veterinary journal (London, England : 1997) Controlled trial quality: uncertain

169. 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

2015 FP Notebook

170. 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

2015 FP Notebook

171. Comparison of Hb-200 and 6% hetastarch 450/0.7 during initial fluid resuscitation of 20 dogs with gastric dilatation-volvulus. (Abstract)

color, strong femoral pulse quality; (2) heart rate (HR) ≤ 150/min; or (3) indirect arterial systolic blood pressure (SBP) > 90 mm Hg. HR, SBP, packed cell volume, hemoglobin, glucose, venous pH, bicarbonate, base excess, anion gap, and colloid osmotic pressure were compared at hospital entry and within 30 minutes post-resuscitation. Compared to the HES group, the Hb-200 group required significantly less colloid (4.2 versus 18.4 mL/kg) and crystalloid (31.3 versus 48.1 mL/kg) to reach resuscitation

2012 Journal of veterinary emergency and critical care (San Antonio, Tex. : 2001) Controlled trial quality: uncertain

172. Delirium in Diabetic Ketoacidosis: A Case Report Full Text available with Trip Pro

Delirium in Diabetic Ketoacidosis: A Case Report A 15-year-old female patient with known type 1 diabetes mellitus was referred because of abdominal pain. On admission, she was alert but dehydrated with marked Kussmaul breathing. Blood glucose was 414 mg/dL (23 mmol/L). Blood gas analysis revealed severe metabolic acidosis (pH: 6.99) with an elevated anion gap (29.8 mmol/L) and an increased base excess (-25.2 mmol/L). At the sixth hour of treatment with intravenous fluids and insulin

2012 Journal of clinical research in pediatric endocrinology

173. Chloride: the queen of electrolytes? (Abstract)

review the function of chloride in man, data for this review include searches of MEDLINE, PubMed, and references from relevant articles including the search terms "chloride," "HCl," "chloride channel" "acid-base," "acidosis," "alkalosis," "anion gap" "strong anion gap" "Stewart," "base excess" and "lactate." In addition, internal medicine, critical care, nephrology and gastroenterology textbooks were evaluated on topics pertaining the assessment and management of acid-base disorders, including

2012 European journal of internal medicine

174. Ringer's Lactate Versus Normal Saline in Caesarean Section

or disease Intervention/treatment Phase Normal Anion Gap Metabolic Acidosis Drug: 0.9% Normal Saline Drug: Ringer's Lactate Not Applicable Detailed Description: Fluid therapy in caesarean section surgery in Mulago Hospital is done mostly with 0.9% normal saline (NS). Several studies have highlighted the complications associated with large infusion of normal saline. Few studies have compared the effects of an alternative crystalloid, Ringer's Lactate (RL), on perinatal pH and postoperative morbidity (...) Outcome Measures : Neonatal pH [ Time Frame: Within 30 seconds of umbilical cord ligature ] A sample of umbilical arterial cord blood will be drawn after ligating the cord to measure neonatal pH Change in maternal base excess from preoperative baseline [ Time Frame: Intraoperatively ] The aim is to study the effect of the study fluid on maternal base excess. Base excess will be measured preoperatively and immediately postoperatively before the patient leaves the recovery room. Number of mothers

2012 Clinical Trials

175. Acid-base and biochemical stabilization and quality of recovery in male cats with urethral obstruction and anesthetized with propofol or a combination of ketamine and diazepam. Full Text available with Trip Pro

excess, anion gap, sodium, potassium, and partial pressure of carbon dioxide in mixed venous blood (pvCO2) were measured before urethral obstruction, at start of fluid therapy (0 h), and at subsequent intervals. The quality of recovery and time to standing were respectively 4 and 75 min in the KD group and 5 and 16 min in the P group. The blood urea nitrogen values were increased at 0, 2, and 8 h in both groups. Serum creatinine increased at 0 and 2 h in cats administered KD and at 0, 2, and 8 h

2012 Canadian journal of veterinary research = Revue canadienne de recherche vétérinaire Controlled trial quality: uncertain

176. A recognition primed decision model approach to the BMP problem

4.2 25 1.3 Monday morning 142 112 5 93 3.4 17 0.8 The task for you is to explain the bicarbonate drop from 25 to 17. The albumin is normal – this patient does not have an increased anion gap. What caused the bicarbonate drop? My explanation: In the RPDM (proposed by Gary Klein a major thought leader in naturalistic decision making), we start with system 1. I have presented this problem to many internists and they have all made the same mistake – using system 1 and then not proceeding to test (...) the past 5 years. Most residents and attendings stop at system 1 when they see a decreased bicarbonate and a normal anion gap. As this patient story illustrates, system 1 can induce cognitive errors. We may have figured out the problem approaching from a different angle, but in the patient the BMP stimulated a quicker understanding of the need for oxygen and the new pleural effusions. Share this: Like this: Like Loading... Comments (3) Stefan Kertesz said on 11-08-2015 can you comment further on what

2015 db's Medical Rants blog

177. NephMadness 2014 Part 7 - Electrolyte Bracket

findings given that these patients are the sickest and probably most acidemic you will encounter! Despite this entire blurb I went for serum anion gap in this bracket!Very useful equation. Posted by Unknown at Labels: , , , , No comments: Subscribe to: Interested in Contributing to the Renal Fellow Network? Email Matt or Gearoid NSMC Founding Member Get notified of new RFN posts by email Partner A nice repository of landmark articles and reviews in the field of nephrology at . are also included (...) not significantly different. No patients in the no HCO3 group had hypernatremia (sodium [Na]+ greater than 150), whereas four patients (2%) in the HCO3 group were hypernatremic. Eight patients (14%) in the no HCO3 group and 37 patients (17%) in theHCO3 group were alkalotic with pH values greater than 7.49 (P = NS). Six patients (10%) of the no HCO3 group and 24 patients (11%) of the HCO3 group had a metabolic component to the alkalosis as defined by a positive base excess value (P = NS). These are interesting

2014 Renal Fellow Network

178. Hyperammonemia in Myeloma: Dialyze?

requiring intubation for airway protection. His initial arterial blood gas at the time of intubation revealed a pH of 7.35, an undetectably low pCO2, and a bicarbonate of 14 (on concurrent labs) with an anion gap of 14. Mechanical ventilation was initiated with a minimal amount of pressure support. All subsequent blood gases demonstrated a pH greater than 7.55 with ongoing respiratory alkalosis. The anion gap normalized. Intensive work-up of the altered mental status resulted in the sole finding (...) off of chemotherapy. Hyperammonemic encephalopathy in multiple myeloma In vitro , myeloma cell lines secrete ammonia into culture medium in greater amounts than other hematological malignant cells. This may be due to excess protein synthesis in myeloma cells. In vivo , the exact mechanism for hyperammonemia in multiple myeloma patients is unknown. It is important to rule out hypercalcemia and hyperviscosity as causes of altered mental status in patients with multiple myeloma before encephalopathy

2012 Renal Fellow Network

179. Acute Kidney Injury

, sodium polystyrene sulfonate , diuretics, dialysis). Although correction of an anion gap metabolic acidosis with sodium bicarbonate is controversial, correction of the nonanion gap portion of severe metabolic acidosis (pH < 7.20) is less controversial. The nonanion gap portion may be treated with IV sodium bicarbonate in the form of a slow infusion ( ≤ 150 mEq sodium bicarbonate in 1 L of 5% D/W at a rate of 50 to 100 mL/h). Using the delta delta gradient calculation, a normal-anion gap metabolic (...) acidosis plus a high anion-gap metabolic acidosis yields a negative delta delta gradient; sodium bicarbonate is given to raise the serum bicarbonate until the delta delta gradient reaches zero. Because variations in body buffer systems and the rate of acid production are hard to predict, calculating the amount of bicarbonate needed to achieve a full correction is usually not recommended. Instead, bicarbonate is given via continuous infusion and the anion gap is monitored serially. or is initiated when

2013 Merck Manual (19th Edition)

180. Diabetic Ketoacidosis (DKA)

mostly in type 1 diabetes mellitus (DM). It causes nausea, vomiting, and abdominal pain and can progress to cerebral edema, coma, and death. DKA is diagnosed by detection of hyperketonemia and anion gap metabolic acidosis in the presence of hyperglycemia. Treatment involves volume expansion, insulin replacement, and prevention of hypokalemia. (See also and .) Diabetic ketoacidosis (DKA) is most common among patients with type 1 diabetes mellitus and develops when insulin levels are insufficient (...) Pa co 2 at presentation appear to be at greatest risk. Delays in correction of hyponatremia and the use of bicarbonate during DKA treatment are additional risk factors. Diagnosis Arterial pH Serum ketones Calculation of anion gap In patients suspected of having diabetic ketoacidosis, serum electrolytes, BUN and creatinine, glucose, ketones, and osmolarity should be measured. Urine should be tested for ketones. Patients who appear significantly ill and those with positive ketones should have

2013 Merck Manual (19th Edition)

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