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Fractional Excretion of Bicarbonate


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181. 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)

182. 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)

183. 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)

184. Pharmacokinetic and Pharmacodynamic (PK and PD) Study of Fluticasone Propionate and Salmeterol Combination Product Delivered in a Capsule-based Inhaler and in a Multi-dose Dry Powder Inhaler in Moderate Asthma Patients and Moderate to Severe Chronic Obstr

the maximum concentration of the drug. Mean Urine Cortisol Excretion Over 0 to 24 Hours Post Dose for FP [ Time Frame: 0-24 hours post dose on Day 10 of each study period (P): Study Day (SD) 10 (reference day is SD 1 or Randomization day), 20, 30, and 40 (+/-1) for P 1, 2, 3, and 4, respectively ] Urine samples of participants were collected to evaluate urine cortisol excretion over 0-24 hours post treatment dose. A 24-hour urine cortisol sample was used to measure the total amount of cortisol excreted (...) in urine in 24 hours. Any differences in systemic exposure as a result of the absorbed steroid component of the two differing inhaled devices should also result in differences in the amount of cortisol excreted in the urine. Serum Cortisol Minimum (Cmin) for FP [ Time Frame: Day 10 of each study period (Periods 1-4); Study Day 10 (+/-1) (reference day is Study Day 1 or Randomization day), Period 1; Study Day 20 (+/-1), Period 2; Study Day 30 (+/-1), Period 3; Study Day 40 (+/-1), Period 4 ] Blood

2011 Clinical Trials

185. Safety & Efficacy of Zirconium Silicate in Chronic Kidney Disease or Moderate Kidney Dysfunction With Mild Hyperkalemia

[ Time Frame: 24 and 48 hours post study drug dose ] Serum sodium compared between the combined placebo-treated controls and the ZS-treated subjects (measured at 24 & 48 hours post dose on Study Days 2 and 3). Serum Bicarbonate (HCO3) Levels [ Time Frame: 24 and 48 hours post study drug dose ] Serum bicarbonate compared between the combined placebo-treated controls and the ZS-treated subjects (measured at 24 & 48 hours post dose on Study Days 2 and 3). 24-hour Urinary Excretion of Potassium [ Time (...) Placebo (silicified microcrystalline cellulose) randomized to mimic escalating doses of experimental drug administered three times daily (TID) with meals. Drug: Placebo Randomized to mimic escalating doses of experimental drug administered 3 times daily (tid) with meals. Other Name: silicified microcrystalline cellulose Experimental: Zirconium silicate (ZS) Randomized escalating doses (0.3g, 3g and 10g) of ZS (fractionated, protonated, microporous zirconium silicate, an oral sorbent) administered 3

2011 Clinical Trials

186. Idiopathic recurrent calcium urolithiasis (IRCU): pathophysiology evaluated in light of oxidative metabolism, without and with variation of several biomarkers in fasting urine and plasma - a comparison of stone-free and -bearing male patients, emphasizing Full Text available with Trip Pro

of markers.1) In SB vs. SF unstratified OM biomarkers were statistically unchanged, but the majority of patients was overweight; despite, in SB vs. SF urine pH, total and non-albumin protein concentration were elevated, fractional urinary uric acid excretion and blood bicarbonate decreased, whereas urine volume, sodium, supersaturation with CaOx and CaPi (as hydroxyapatite) were unchanged; 2) upon variation of OM markers (strata below and above median) numerous stone parameters differed significantly (...) , among others urine volume, total protein, Ca/Pi ratio, pH, sodium, potassium, plasma Ca/Pi ratio and parathyroid hormone, blood pressure, renal excretion of non-albumin protein and other substances; 3) a significant shift from SF to SB patients occurred with increase of urine pH, decrease of blood bicarbonate, and increase of diastolic blood pressure, whereas increase of plasma uric acid impacted only marginally; 4) in both SF and SB patients a strong curvilinear relationship links a rise of urine

2011 European Journal Of Medical Research

187. Mechanisms mediating the diuretic and natriuretic actions of the incretin-hormone glucagon-like peptide-1. Full Text available with Trip Pro

established. This study aimed to define the cellular and molecular mechanisms mediating the renal effects of GLP-1. GLP-1 (1 μg·kg(-1)·min(-1)) was intravenously administered in rats for the period of 60 min. GLP-1-infused rats displayed increased urine flow, fractional excretion of sodium, potassium, and bicarbonate compared with those rats that received vehicle (1% BSA/saline). GLP-1-induced diuresis and natriuresis were also accompanied by increases in renal plasma flow and glomerular filtration rate (...) . Real-time RT-PCR in microdissected rat nephron segments revealed that GLP-1 receptor-mRNA expression was restricted to glomerulus and proximal convoluted tubule. In rat renal proximal tubule, GLP-1 significantly reduced Na(+)/H(+) exchanger isoform 3 (NHE3)-mediated bicarbonate reabsorption via a protein kinase A (PKA)-dependent mechanism. Reduced proximal tubular bicarbonate flux rate was associated with a significant increase of NHE3 phosphorylation at the PKA consensus sites in microvillus

2011 American Journal of Physiology. Renal physiology

188. Potassium Full Text available with Trip Pro

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

189. Altitude sickness Full Text available with Trip Pro

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

190. Effects of high altitude on humans Full Text available with Trip Pro

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 available with Trip Pro

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. Urine electrolytes in metabolic alkalosis

with passage of concentrated small amount of urine, the concentration of chloride may be high too. The ideal way of eliminating this error is by doing a fractional excretion of chloride!! It probably is the ideal way of assessing volume status. 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 (...) Urine electrolytes in metabolic alkalosis Renal Fellow Network: Urine electrolytes in metabolic alkalosis | | | | | Tuesday, February 8, 2011 Urine electrolytes in metabolic alkalosis No time like the present for a quick review of urine electrolytes. Is there any such thing as a ‘normal’ urine sodium? Not really – like all great answers in medicine, ‘it depends’. In general, in patients who are euvolaemic, the urine sodium excretion will directly correlate with the degree of dietary sodium

2011 Renal Fellow Network

193. The Diet Pill and the Deadly Acidosis

and serum bicarbonate of 7 mmol/L). She was initially suspected as having diabetic ketoacidosis due to miscalculation of the anion gap by the admitting team who used the corrected serum sodium and not the actual sodium, and as expected, her acidosis did not resolve despite the correction of hyperglycemia with intravenous fluids and insulin. Her urine pH was 6.2, urine anion gap was 12 (no ketonuria) and fractional excretion of bicarbonate was 17% suggesting the possibility of mixed renal tubular (...) fractional excretion of bicarbonate with elevated B2 microglobulinuria suggesting proximal tubular impairment. Besides metabolic acidosis, topimarate use has been associated with 10 fold increased risk of and is largely due to hypocitraturia that develops in these patients with failure of renal acidification. These patients are also at risk for for the same reasons. Non ambulatory patients, ketogenic diets, hypovolemia and higher dosage (400mg/d) is associated with an increased risk of renal

2011 Renal Fellow Network

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. 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 available with Trip Pro

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

196. 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

197. Potassium bicarbonate attenuates the urinary nitrogen excretion that accompanies an increase in dietary protein and may promote calcium absorption. Full Text available with Trip Pro

Potassium bicarbonate attenuates the urinary nitrogen excretion that accompanies an increase in dietary protein and may promote calcium absorption. Protein is an essential component of muscle and bone. However, the acidic byproducts of protein metabolism may have a negative impact on the musculoskeletal system, particularly in older individuals with declining renal function.We sought to determine whether adding an alkaline salt, potassium bicarbonate (KHCO3), allows protein to have a more (...) ) or placebo was administered for 41 d.We measured 24-h urinary nitrogen excretion, IGF-I, 24-h urinary calcium excretion, and fractional calcium absorption.KHCO3 reduced the rise in urinary nitrogen excretion that accompanied an increase in protein intake (P = 0.015) and was associated with higher IGF-I levels on the low-protein diet (P = 0.027) with a similar trend on the high-protein diet (P = 0.050). KHCO3 was also associated with higher fractional calcium absorption on the low-protein diet (P = 0.041

2009 The Journal of clinical endocrinology and metabolism Controlled trial quality: uncertain

198. 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

199. 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 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

200. 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

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