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Fractional Excretion of Bicarbonate

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181. A Micropuncture Study of HCO3 Reabsorption by the Hypertrophied Proximal Tubule (Full text)

A Micropuncture Study of HCO3 Reabsorption by the Hypertrophied Proximal Tubule In rats with renal failure produced by excision of one kidney and infarction of large portions of the other kidney, given a low calcium, high phosphorus diet for 2-3 weeks, GFR was reduced by 80 percent, the fractional excretion of sodium increased from 7 to 23 percent, that of bicarbonate from 16 to 23 percent and that of water from 4 to 13 percent. Single nephron GFR in the remaining nephrons was nearly doubled (...) hand, practically prevented the rise of the fractional excretion of sodium and of water and inverted the rise of the fractional excretion of bicarbonate to a fall. The data are interpreted to indicate that secondary hyperparathyroidism in renal failure impairs distal nephron bicarbonate and sodium reabsorption and, thus, contributes to the maintenance of sodium balance, but could possibly aggravate acidosis.

1978 The Yale journal of biology and medicine

182. Micropuncture study of nephron function in the rhesus monkey (Full text)

was administered animals excreted about one-third of the filtered sodium and water. Despite this diuresis, electrolyte and water reabsorption along the proximal tubule did not differ from values obtained in control animals. Osmolality and sodium concentration of fluid from the distal tubule approached those of plasma. 22% of the filtered sodium (twice the control values) reached the distal tubule, whereas the fraction of filtered water remaining was only slightly increased. These findings indicate that, after (...) the administration of this drug, inhibition of sodium reabsorption occurred in the water-impermeable segment of the nephron, rather than in the proximal tubule. After furosemide administration, all tubule fluid to plasma potassium concentration ratios in the distal tubule were equal to or greater than one, suggesting inhibition of active potassium reabsorption at or prior to this site.Fluid to plasma bicarbonate concentration ratios from the midportion of the proximal tubule were consistently less than one

1968 Journal of Clinical Investigation

183. On the mechanism of renal potassium wasting in renal tubular acidosis associated with the Fanconi syndrome (type 2 RTA) (Full text)

the plasma bicarbonate concentration ([HCO(3) (-)]p) was experimentally increased to normal levels in three patients with a fractional potassium excretion (C(K)/C(in)) of less than 1.0 during acidosis, C(K)/C(in) and urinary potassium excretion (U(K)V/C(in)) increased strikingly and concurrently with a striking increase in urinary sodium (U(Na)V/C(in)) and bicarbonate (U(HCO3-)V/C(in)) excretion. When [HCO(3) (-)]p was increased to normal levels in two patients with a C(K)/C(in) of greater than 1.0 (...) during acidosis and in whom U(Na)V/C(in) and U(HCO3-)V/C(in) were already markedly increased, C(K)/C(in) did not increase further. When [HCO(3) (-)]p was decreased to subnormal levels in a patient given ammonium chloride, U(K)V/C(in), C(K)/C(in), and U(HCO3-)V/C(in) decreased concurrently. In the six patients in whom [HCO(3) (-)]p was maintained at normal levels (oral alkali therapy) for 2 months or longer, C(K)/C(in) was directly related to the urinary excretion rates of sodium and bicarbonate

1971 Journal of Clinical Investigation

184. Volume Depletion

sodium. Thus, the urine sodium concentration is usually < 15 mEq/L; the fractional excretion of sodium (urine sodium/serum sodium divided by urine creatinine/serum creatinine) is usually < 1%; also, urine osmolality is often > 450 mOsm/kg. When is combined with volume depletion, urine sodium concentration may be high because large amounts of bicarbonate are spilled in the urine, obligating the excretion of sodium to maintain electrical neutrality. In this instance, a urine chloride concentration

2013 Merck Manual (19th Edition)

185. Hyponatremia

with ongoing renal fluid losses can also be distinguished from patients with extrarenal fluid losses because the urine sodium concentration is inappropriately high ( > 20 mEq/L). Urine sodium concentration may not help in differentiation when (as occurs with protracted vomiting) is present and large amounts of bicarbonate are spilled in the urine, obligating the excretion of sodium to maintain electrical neutrality. In metabolic alkalosis, urine chloride concentration frequently differentiates renal from (...) is considered. Patients with SIADH are usually euvolemic or slightly hypervolemic. BUN and creatinine values are normal, and serum uric acid is generally low. Urine sodium concentration is usually > 30 mmol/L, and fractional excretion of sodium is > 1% (for calculation, see ). In patients with hypovolemia and normal renal function, sodium reabsorption results in a urine sodium of < 20 mmol/L. Urine sodium > 20 mmol/L in hypovolemic patients suggests mineralocorticoid deficiency or salt-losing nephropathy

2013 Merck Manual (19th Edition)

186. Chronic Kidney Disease

). Urea and creatinine are not major contributors to the uremic symptoms; they are markers for many other substances (some not yet well defined) that cause the symptoms. Sodium and water Despite a diminishing GFR, sodium and water balance is well maintained by increased fractional excretion of sodium in urine and a normal response to thirst. Thus, the plasma sodium concentration is typically normal, and hypervolemia is infrequent unless dietary intake of sodium or water is very restricted or excessive (...) the remaining tissue increases its performance (renal functional adaptation). Decreased renal function interferes with the kidneys’ ability to maintain fluid and electrolyte homeostasis. The ability to concentrate urine declines early and is followed by decreases in ability to excrete excess phosphate, acid, and potassium. When renal failure is advanced (GFR ≤ 15 mL/min/1.73 m 2 ), the ability to effectively dilute or concentrate urine is lost; thus, urine osmolality is usually fixed at about 300 to 320

2013 Merck Manual (19th Edition)

187. Acute Kidney Injury

be attempted. For example, in hypovolemia, volume infusion can be tried, in heart failure, diuretics and afterload reducing drugs can be tried. Abatement of AKI confirms a prerenal cause. Table Urinary Diagnostic Indices in Prerenal Acute Kidney Injury and Acute Tubular Injury Index Prerenal Tubular Injury U/P osmolality > 1.5 1–1.5 Urine sodium (mmol/L) 10 > 40 Fractional excretion of sodium (FE Na )* 1% > 1% Renal failure index † 1 > 2 BUN/creatinine ratio > 20 10 *U/P Na ÷ U/P creatinine. † Urine Na ÷ U (...) develops because hydrogen ions cannot be excreted. With significant uremia, coagulation may be impaired, and pericarditis may develop. Urine output varies with the type and cause of AKI. Etiology Causes of AKI (see table ) can be classified as Prerenal Renal Postrenal Prerenal AKI is due to inadequate renal perfusion. The main causes are ECF (eg,due to inadequate fluid intake, diarrheal illness, ) Cardiovascular disease (eg, , ) Decompensated liver disease Prerenal conditions typically do not cause

2013 Merck Manual (19th Edition)

188. Renal Tubular Acidosis

is suspected: Type 1 RTA is confirmed by a urine pH that remains > 5.5 during systemic acidosis. The acidosis may occur spontaneously or be induced by an acid load test (administration of ammonium chloride 100 mg/kg po). Normal kidneys reduce urine pH to < 5.2 within 6 h of acidosis. Type 2 RTA is diagnosed by measurement of the urine pH and fractional bicarbonate excretion during a bicarbonate infusion ( sodium bicarbonate 0.5 to 1.0 mEq/kg/h [0.5 to 1.0 mmol/L] IV). In type 2, urine pH rises above 7.5 (...) , and the fractional excretion of bicarbonate is > 15%. Because IV bicarbonate can contribute to hypokalemia, potassium supplements should be given in adequate amounts before infusion. Type 4 RTA is confirmed by a history of a condition that could be associated with type 4 RTA, chronically elevated potassium, and normal or mildly decreased bicarbonate. In most cases plasma renin activity is low, aldosterone concentration is low, and cortisol is normal. Treatment Varies by type Often alkali therapy Treatment

2013 Merck Manual (19th Edition)

189. Potassium (Full text)

and vegetables are good dietary sources of potassium. The body responds to the influx of dietary potassium, which raises potassium levels, with a shift of potassium from outside to inside cells and an increase in potassium excretion by the kidneys. Most industrial applications of potassium exploit the high in water of potassium compounds, such as . Heavy crop production rapidly depletes the soil of potassium, and this can be remedied with agricultural fertilizers containing potassium, accounting for 95 (...) tone systemic blood pressure control gastrointestinal motility acid–base homeostasis glucose and insulin metabolism mineralocorticoid action renal concentrating ability fluid and electrolyte balance Homeostasis [ ] Potassium homeostasis denotes the maintenance of the total body potassium content, plasma potassium level, and the ratio of the intracellular to extracellular potassium concentrations within narrow limits, in the face of pulsatile intake (meals), obligatory renal excretion, and shifts

2012 Wikipedia

190. Effects of high altitude on humans (Full text)

weeks. Gradually, the body compensates for the respiratory alkalosis by renal excretion of bicarbonate, allowing adequate respiration to provide oxygen without risking alkalosis. It takes about four days at any given altitude and can be enhanced by drugs such as . Eventually, the body undergoes physiological changes such as lower production (because reduced glucose breakdown decreases the amount of lactate formed), decreased volume, increased ( ), increased mass, a higher concentration of in tissue (...) in . Atmospheric pressure decreases exponentially with altitude while the O 2 fraction remains constant to about 100 km, so pO 2 decreases exponentially with altitude as well. It is about half of its sea-level value at 5,000 m (16,000 ft), the altitude of the , and only a third at 8,848 m (29,029 ft), the summit of . When pO 2 drops, the body responds with . Mountain medicine recognizes three altitude regions that reflect the lowered amount of oxygen in the atmosphere: High altitude = 1,500–3,500 metres (4,900

2012 Wikipedia

191. Kidney (Full text)

is the maintenance of around a relatively stable value. The lungs contribute to acid-base homeostasis by regulating (CO 2 ) concentration. The kidneys have two very important roles in maintaining the acid-base balance: to reabsorb and regenerate bicarbonate from urine, and to excrete ions and fixed acids (anions of acids) into urine. Regulation of osmolality [ ] Maintaining water and salt level of the body. Any significant rise in is detected by the , which communicates directly with the . An increase (...) centimetres (4.3 in) in length. They receive blood from the paired ; blood exits into the paired . Each kidney is attached to a , a tube that carries excreted to the . The is the structural and functional unit of the kidney. Each human adult kidney contains around 1 million nephrons, while a mouse kidney contains only about 12,500 nephrons. The kidney participates in the control of the volume of various compartments, fluid , , various concentrations, and removal of . Filtration occurs in the : one-fifth

2012 Wikipedia

192. Altitude sickness

the following: ↑ Erythropoietin → ↑ hematocrit and hemoglobin ↑ (allows ↑ release of O 2 and a right shift on the Hb-O 2 disassociation curve) ↑ kidney excretion of bicarbonate (use of acetazolamide can augment for treatment) Chronic hypoxic pulmonary vasoconstriction (can cause right ventricular hypertrophy) People with high-altitude sickness generally have reduced hyperventilator response, impaired gas exchange, fluid retention or increased sympathetic drive. There is thought to be an increase in cerebral (...) (0.54 * 1.34 * 19.3g/dL) + (0.023 x 3.3kPa) = 14.0 ml O 2 / 100ml Blood (Sa O 2 * * Hb) + (Oxygen carriage in blood * Pa O 2 ) The hypoxia leads to an increase in minute ventilation (hence both low CO 2 , and subsequently bicarbonate), Hb increases through haemoconcentration and erythrogenesis. Alkylosis shifts the haemaglobin dissociation constant to the left, 2,3-DPG increases to counter this. Cardiac output increases through an increase in heart rate. The body's response to high altitude includes

2012 Wikipedia

193. Gitelman syndrome in Gypsy paediatric patients carrying the same intron 9 + 1 G>T mutation. Clinical features and impact on quality of life. (Full text)

symptoms. Biochemical data at diagnosis were serum K 2.76 ± 0.46 mEq/L, serum Mg 1.32 ± 0.28 mg/dL, blood pH 7.45 ± 0.06, serum bicarbonate 28.2 ± 2.9 mEq/L, urinary calcium/creatinine ratio 0.03 ± 0.04 mg/mg, fractional K excretion 24.4 ± 17.1% and fractional Mg excretion 8.9 ± 8.3%. During follow-up, Mg and K supplements were prescribed to 79 and 86% of patients, respectively; compliance with treatment was good in 35%. Hospital admission rate was 0.03/patient/month. Muscle cramps were the symptom

2010 Transplantation

194. Dose Response of 28 Days of Dosing of GSK962040 in Type I and II Diabetic Male and Female Subjects With Gastroparesis

of a 13C-labelled test meal. The test meal was consumed approximately 80 minutes(min) later. After consumption of the test meal, breath samples were collected at pre-specified time points over an approximately 4 hour period following the test meal. For the duration of the breath test, no food or drink were allowed. The 13C breath content was determined by isotope ratio mass spectrometry. GE t1/2 was determined by using the cumulative percentage of the administered dose of 13C excreted in breath over 4 (...) Chemistry : Albumin, Total Protein [ Time Frame: Baseline (Day 1 pre-dose) and Day 28 ] Albumin, Total Protein measurements were taken at Baseline (Day 1 pre-dose), and Day 28. The Baseline value was the Day 1 pre-dose value. Change from Baseline was calculated by subtracting the Baseline value from the individual post-Baseline value. Mean Change From Baseline in Clinical Chemistry : Calcium, Chloride, Glucose, Potassium, Sodium, Urea/BUN, Carbon Dioxide Content/Bicarbonate [ Time Frame: Baseline (Day 1

2010 Clinical Trials

195. A Clinical Study to Assess the Safety, Tolerability, and Activity of Oral SRT2104 Capsules Administered for 28 Days to Subjects With Type 2 Diabetes Mellitus

was collected at screening, Day -1, 14, 28 and 42. Data for participants with positive and negative urinalysis result was presented. Unscheduled and control assessments were not included in the analysis. Mean clinical chemistry parameters including calcium, chloride, magnesium, potassium, sodium, bicarbonate, phosphate, glucose, urea and blood urea [ Time Frame: Up to Day 42 ] Clinical chemistry assessment for calcium, chloride, magnesium, potassium, sodium, bicarbonate, phosphate, glucose, urea ,blood urea (...) , 29 and 43 during the HEGC procedure for four 30-minute sessions at time points -570 min to -540 min (baseline), -40 min to -10 min (end of blood glucose adjustment phase), 210 min to 240 min (end of SS1), 450 min to 480 min (end of SS2). Energy expenditure (indirect calorimetry) parameters-Urinary urea excretion rate (n) [ Time Frame: Up to Day 43 ] Urinary urea excretion rate was reported using indirect calorimetry. Indirect calorimetry was performed using Quark RMR (COSMED, Rome, Italy) on Day

2009 Clinical Trials

196. Baraclude (entecavir)

dose of 10 mg/kg, 14 C-label was initially highest in bladder, liver, kidney, lymph nodes, large intestine, prostate, and bone marrow. Label was also detected in the maternal cerebrum of pregnant rats and there were data showing that the compound may pass through the blood/brain barrier in mice, dogs and monkeys. Studies in pregnant rats showed passage across the placenta and substance was excreted in milk of lactating animals within 1 hour after oral administration. The in vitro red blood cell (...) (RBC) distribution of radioactivity of entecavir was 49 %, 1.6 %, 50 % and 52 % in rats, dogs, monkeys and humans respectively indicating that entecavir was uniformly distributed in plasma and RBCs except in dog blood. • Metabolism (in vitro/in vivo) Metabolism appeared limited in all species and seemed to proceed via sulphation and glucuronidation pathways. Overall, metabolites accounted for a limited fraction in plasma, urine and faeces in all species. The highest extent of metabolism was in rats

2007 European Medicines Agency - EPARs

197. ACC/AHA/ESC 2006 Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death

. . . 778 8.1.3. Treatment of ventricular ?brillation and cardiac arrest survivors. . 779 8.1.4. Primary prevention of sudden cardiac death. . 779 8.1.5. Use of implantable cardioverter- de?brillator for ventricular tachycardia in patients with normal or near normal left ventricular ejection fraction 779 8.2. Valvular heart disease . . 779 8.3. Congenital heart disease. 780 8.4. Metabolic and in?ammatory conditions 781 8.4.1. Myocarditis, rheumatic disease, and endocarditis 781 8.4.1.1. Myocarditis 782 (...) ) Theetiologyofthearrhythmiasubstrate(coronaryheart disease [CHD], cardiomyopathy, or other conditions). (5) The functional status of the patient (New York Heart Association [NYHA] functional class). (6) The state of left ventricular (LV) function (LV ejection fraction [LVEF]). (7) The speci?c arrhythmia concerned (e.g., sustained monomorphic VT, polymorphic VT, and ventricular ?bril- lation [VF]). Not all therapeutic combinations are clinically relevant, and many have no evidence base and probably will not have one in the future

2006 European Society of Cardiology

198. Care and Maintenance to Reduce Vascular Access Complications

organisms (e.g., bacteria, virus or fungus). Routine practices reduce the risk of exposure to: ¦ Blood, including blood products, and materials soiled with blood; ¦ All body fluids (secretions and excretions) except sweat, regardless of whether they contain blood (e.g., urine, feces, semen, vaginal and respiratory secretions, cerebral spinal fluid); ¦ Non-intact skin, weeping or draining lesions or wounds; and ¦ Mucous membranes: eyes, nose, mouth, rectum or vagina (PHAC, 1999). Routine practices

2005 Registered Nurses' Association of Ontario

199. Blood Gases

in the red blood cells and available to be carried through the arteries to nourish the body’s cells HCO 3 - ; (bicarbonate) is excreted and reabsorbed by the kidneys in response to pH imbalances and is directly related to the pH level; as the amount of HCO 3 - rises, so does the pH How is the sample collected for testing? Since arterial blood carries oxygen to the body and venous blood carries waste products to the lungs, the gas and pH levels will not be the same in both. Arterial blood is almost always (...) blood and whether or not your blood pH is balanced - not too acidic ( ) or too alkaline/basic ( ). Blood gas tests directly measure: pH – a measure of the level of hydrogen ion (H + ), which indicates the acid/alkali status of your blood. The pH of your blood decreases (becomes more acidic) with increased amounts of CO 2 and other acids, and the pH increases (blood becomes more alkaline) with decreased CO 2 or increased amounts of bases like bicarbonate (HCO 3 - ). PO 2 – the partial pressure of O 2

2004 Lab Tests Online UK

200. Effect of dietary cation-anion difference and dietary crude protein on milk yield, acid-base chemistry, and rumen fermentation. (Full text)

with high CP. Serum bicarbonate concentration, urinary bicarbonate excretion, blood pH, and serum Na were elevated for high DCAD compared with low DCAD. Fractional excretion of Na, K, Cl, and Ca increased for high DCAD. Blood urea N and urinary urea N were greater for high than for low CP diets. No differences due to DCAD were observed for these parameters. Results of this study suggest that, in early lactation cows, blood acid-base chemistry is altered by differences in DCAD that range between the high (...) in a randomized complete block design to provide 15 or 17% CP and DCAD of 25 or 50 mEq (Na + K - Cl)/100 g of feed dry matter [15 or 39 mEq (Na + K) - (Cl + S)/100 g of feed dry matter]. High DCAD improved dry matter intake, milk yield, and concentrations of milk fat and protein. An interaction of DCAD and CP was observed for uric acid excretion, an indicator of microbial protein yield. Uric acid excretion was higher for high DCAD than for low DCAD in low CP diets and was similar for low and high DCAD

2007 Journal of dairy science Controlled trial quality: uncertain

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