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Fractional Excretion of Bicarbonate

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81. PTHrP-related Hypercalcaemia in Infancy and Congenital Anomalies of the Kidney and Urinary Tract (CAKUT) Full Text available with Trip Pro

, and elevated PTHrP levels.Case report.The Victoria Hospital campus of the London Health Sciences Centre in London, Ontario, Canada.A child with congenital anomalies of the kidneys and urinary tract (CAKUT), stage 2 chronic kidney disease (CKD), and renal dysplasia who presented with severe hypercalcaemia.Weight, renal ultrasound, creatinine, cystatin C, eGFR, calcium, urea, bicarbonate, serum sodium, fractional sodium excretion, urine calcium to creatinine ratio, PTH, TSH, Free T4, AM cortisol, HMA, VMA

2015 Canadian journal of kidney health and disease

82. Gastrointestinal Complications

and discolors alkaline urine red. Bisacodyl must be excreted in bile to be active and is not effective with biliary obstruction or diversion. Avoid bisacodyl with known or suspected ulcerative lesions of the colon. These medications may cause cramping. Drug interactions: Avoid taking bisacodyl within 1 hour of taking antacids, milk, or cimetidine because they cause premature dissolving of the enteric coating, which results in gastric or duodenal stimulation. There is an increased absorption of danthron when (...) –20 g of lactulose). Polyethylene glycol and electrolytes (Golytely, Colyte) Five packets are mixed with 1 gallon (3.785 L) of tap water and contain the following: polyethylene glycol (227.1 g), sodium chloride (5.53 g), potassium chloride (2.82 g), sodium bicarbonate (6.36 g), and sodium sulfate (anhydrous, 21.5 g). Do not add flavorings. Serve chilled to improve palatability. Can be stored up to 48 hours in the refrigerator. Use: To clear bowel with minimal water and sodium loss or gain. Opioid

2012 PDQ - NCI's Comprehensive Cancer Database

83. Comparison of clinical and biochemical markers of dehydration with the clinical dehydration scale in children: a case comparison trial. Full Text available with Trip Pro

significant (p < 0.05) between the comparison group and the dehydrated group: difference in heart rate, diastolic blood pressure, urine sodium/potassium ratio, urine sodium, fractional sodium excretion, serum bicarbonate, and creatinine measurements. The best markers for dehydration were urine Na and serum bicarbonate (ROC AUC = 0.798 and 0.821, respectively). CDS was most closely correlated with serum bicarbonate (Pearson r = -0.3696, p = 0.002).Although serum bicarbonate is not the gold standard (...) of established markers of dehydration, making it an appropriate and easy-to-use clinical tool.This study was designed as a prospective double-cohort trial in a single tertiary care center. Children with diarrhea and vomiting, who clinically required intravenous fluids for rehydration, were compared with minor trauma patients who required intravenous needling for conscious sedation. We compared the CDS with clinical and urinary markers (urinary electrolytes, proteins, ratios and fractional excretions

2014 BMC Pediatrics

84. Physical and Functional Links between Anion Exchanger-1 and Sodium Pump. Full Text available with Trip Pro

kidney membrane proteins showed that the last 11 residues of AE1 are important for β1 binding. siRNA-induced knockdown of β1 in cell culture resulted in a significant reduction in kidney AE1 levels at the cell membrane, whereas overexpression of kidney AE1 increased cell surface sodium pump levels. Notably, membrane staining of β1 was reduced throughout collecting ducts of AE1-null mouse kidney, where increased fractional excretion of sodium has been reported. These data suggest a requirement of β1 (...) Physical and Functional Links between Anion Exchanger-1 and Sodium Pump. Anion exchanger-1 (AE1) mediates chloride-bicarbonate exchange across the plasma membranes of erythrocytes and, via a slightly shorter transcript, kidney epithelial cells. On an omnivorous human diet, kidney AE1 is mainly active basolaterally in α-intercalated cells of the collecting duct, where it is functionally coupled with apical proton pumps to maintain normal acid-base homeostasis. The C-terminal tail of AE1 has

2014 Journal of the American Society of Nephrology

85. A Study to Estimate the Effect of CYP3A4 Inhibitors (Itraconazole, Diltiazem or Verapamil) on the Pharmacokinetics of Single Dose PF- 00489791 in Healthy Volunteers

) is influenced by the fraction absorbed. Apparent Oral Clearance (CL/F) of PF-00489791 [ Time Frame: Pre-dose, 0.5, 1, 2, 3, 4, 6, 8 and 12 hours after PF-00489791 administration ] Clearance of a drug is a measure of the rate at which a drug is metabolized or eliminated by normal biological processes. Clearance obtained after oral dose (apparent oral clearance) is influenced by the fraction of the dose absorbed. Drug clearance is a quantitative measure of the rate at which a drug substance is removed from (...) , red blood cell [RBC] count, RBC morphology, platelet count, white blood cell [WBC] count, total neutrophils, eosinophils, monocytes, basophils, lymphocytes); blood chemistry (blood urea nitrogen [BUN], creatinine, glucose, calcium, sodium, potassium, chloride, total bicarbonate, aspartate aminotransferase [AST], alanine aminotransferase [ALT], total bilirubin, alkaline phosphatase, uric acid, albumin, and total protein; urinalysis (pH, glucose, protein, blood, ketones, nitrites, leukocyte esterase

2014 Clinical Trials

86. Prevalence and European AIDS Clinical Society (EACS) criteria evaluation for proximal renal tubular dysfunction diagnosis in patients under antiretroviral therapy in routine setting. Full Text available with Trip Pro

the utility of urinary samples in PRTD diagnosis.During two consecutive years, we collected annually blood and urine samples at the same time in our outpatient clinic. We assessed kidney function, plasma levels and fractional excretion of phosphate, uric acid, potassium, plasma glucose and proteinuria. PRTD was defined by the presence of at least two out of the five following criteria: fractional excretion (FE) of phosphate >20% (or >10% when serum phosphate <0.8 mmol/L), non-diabetic glycosuria (positive (...) urine glucose with plasma glucose <70 mg/dL), renal tubular acidosis (urinary pH >5.5 and serum bicarbonate <21 mmol/L), uric acid FE >10% or potassium FE >10%. After the first year, patients with TDF regimen who were diagnosed with PRTD were shifted to TDF-free regimen and included again in the study.For PRTD (first line), they are expressed in number of diagnoses/total number of patients in this group. The second line resumes the number of PRTD diagnose patients who should have been screened

2014 Journal of the International AIDS Society

87. Azotemia (Follow-up)

in developing countries: analysis of 2405 cases in 26 years from eastern India. Clin Kidney J . 2013 Apr. 6 (2):150-5. . . Carvounis CP, Nisar S, Guro-Razuman S. Significance of the fractional excretion of urea in the differential diagnosis of acute renal failure. Kidney Int . 2002 Dec. 62(6):2223-9. . . Faubel S, Patel NU, Lockhart ME, Cadnapaphornchai MA. Renal relevant radiology: use of ultrasonography in patients with AKI. Clin J Am Soc Nephrol . 2014 Feb. 9(2):382-94. . . Holmquist F, Hansson K (...) , Mele C, et al. Transvenous transjugular renal core biopsy with a redesigned biopsy set including a blunt-tipped needle. Cardiovasc Intervent Radiol . 2002 Mar-Apr. 25(2):155-7. . Fenske W, Stork S, Koschker AC, et al. Value of fractional uric acid excretion in differential diagnosis of hyponatremic patients on diuretics. J Clin Endocrinol Metab . 2008 Aug. 93(8):2991-7. . Liu KD, Matthay MA, Chertow GM. Evolving practices in critical care and potential implications for management of acute kidney

2014 eMedicine.com

88. Hyperkalemia (Diagnosis)

(eg, increased intake or inhibited excretion) In patients with severe hyperkalemia, treatment is as follows: IV calcium to ameliorate cardiac toxicity, if present Identify and remove sources of potassium intake IV glucose and insulin infusion to enhance potassium uptake by cells Correct severe metabolic acidosis with sodium bicarbonate Consider beta-adrenergic agonist therapy (eg, nebulized albuterol, 10 mg, administered by a respiratory therapist); preferred over alkali therapy in patients (...) delivery to the distal tubule (eg, diuretics) High urine flow (eg, osmotic diuresis) High serum potassium level Delivery of negatively charged ions to the distal tubule (eg, bicarbonate) Renal potassium excretion is decreased by the following: Absence, or very low levels, of aldosterone WNK1 and WNK4 mutations Low sodium delivery to the distal tubule Low urine flow Low serum potassium level Kidneys adapt to acute and chronic alterations in potassium intake. When potassium intake is chronically high

2014 eMedicine.com

89. Hyperchloremic Acidosis (Diagnosis)

, urinary loss of glucose, amino acids, phosphate, uric acid, and other organic anions, such as citrate, can also occur (Fanconi syndrome). A distinctive feature of type II pRTA is that it is nonprogressing, and when the serum bicarbonate is reduced to approximately 15 mEq/L, a new transport maximum for bicarbonate is established and the proximal tubule is able to reabsorb all of the filtered bicarbonate. A fractional excretion of bicarbonate (FE[HCO 3 - ]) greater than 15% when the plasma bicarbonate (...) is normal after bicarbonate loading is diagnostic of pRTA. In contrast, the fractional excretion of bicarbonate in low and normal bicarbonate levels is always less than 5% in distal RTA (dRTA). Another feature of pRTA is that the urine pH can be lowered to less than 5.5 with acid loading. The pathogenic mechanisms responsible for the tubular defect in persons with pRTA are not completely understood. Defective pump secretion or function, namely aberrations in the function of the proton pump ([H

2014 eMedicine.com

90. Respiratory Alkalosis (Diagnosis)

quantity of volatile acid (carbon dioxide) and nonvolatile acid. The metabolism of fats and carbohydrates leads to the formation of a large amount of carbon dioxide. [ ] The carbon dioxide combines with water to form carbonic acid. The lungs excrete the volatile fraction through ventilation, and acid accumulation does not occur. Significant alterations in ventilation can affect the elimination of carbon dioxide and lead to a respiratory acid-base disorder. PaCO 2 is normally maintained in the range (...) : Oct 03, 2018 Author: Ryland P Byrd, Jr, MD; Chief Editor: Zab Mosenifar, MD, FACP, FCCP Share Email Print Feedback Close Sections Sections Respiratory Alkalosis Overview Background Respiratory alkalosis is a disturbance in acid and base balance due to alveolar hyperventilation. Alveolar hyperventilation leads to a decreased partial pressure of arterial carbon dioxide (PaCO 2 ). In turn, the decrease in PaCO 2 increases the ratio of bicarbonate concentration to PaCO 2 and, thereby, increases the pH

2014 eMedicine.com

91. Respiratory Acidosis (Diagnosis)

elevates plasma bicarbonate values, but only slightly (approximately 1 mEq/L for each 10-mm Hg increase in PaCO 2 ). The second step is renal compensation that occurs over 3-5 days. With renal compensation, renal excretion of carbonic acid is increased, and bicarbonate reabsorption is increased. The expected change in serum bicarbonate concentration in respiratory acidosis can be estimated as follows: Acute respiratory acidosis – Bicarbonate increases by 1 mEq/L for each 10-mm Hg rise in PaCO 2 (...) . [ , ] Alveolar hypoventilation leads to an increased PaCO 2 (ie, hypercapnia). The increase in PaCO 2 , in turn, decreases the bicarbonate (HCO 3 – )/PaCO 2 ratio, thereby decreasing the pH. Hypercapnia and respiratory acidosis ensue when impairment in ventilation occurs and the removal of carbon dioxide by the respiratory system is less than the production of carbon dioxide in the tissues. Lung diseases that cause abnormalities in alveolar gas exchange do not typically result in alveolar hypoventilation

2014 eMedicine.com

92. Metabolic Alkalosis (Diagnosis)

tract. Vomiting or nasogastric (NG) suction generates metabolic alkalosis by the loss of gastric secretions, which are rich in hydrochloric acid (HCl). Whenever a hydrogen ion is excreted, a bicarbonate ion is gained in the extracellular space. Renal losses of hydrogen ions occur whenever the distal delivery of sodium increases in the presence of excess aldosterone, which stimulates the electrogenic epithelial sodium channel (ENaC) in the collecting duct. As this channel reabsorbs sodium ions (...) , the tubular lumen becomes more negative, leading to the secretion of hydrogen ions and potassium ions into the lumen. Shift of hydrogen ions into the intracellular space mainly develops with hypokalemia. As the extracellular potassium concentration decreases, potassium ions move out of the cells. To maintain neutrality, hydrogen ions move into the intracellular space. Administration of sodium bicarbonate in amounts that exceed the capacity of the kidneys to excrete this excess bicarbonate may cause

2014 eMedicine.com

93. Metabolic Acidosis (Diagnosis)

. Comparison of Types 1, 2, and 4 RTA Characteristics Proximal (Type 2) Distal (Type 1) Type 4 Primary defect Proximal HCO 3 - reabsorption Diminished distal H+ secretion Diminished ammoniagenesis Urine pH < 5.5 when serum HCO 3 - is low >5.5 < 5.5 Serum HCO 3 - >15 mEq/L Can be < 10 mEq/L >15 mEq/L Fractional excretion of HCO 3 - (FEHCO 3 ) >15-20% during HCO 3 - load < 5% (can be as high as 10% in children) < 5% Serum K + Normal or mild decrease Mild-to-severe decrease* High Associated features Fanconi (...) concentrations. On the basis of this law, the addition of H + or bicarbonate (HCO 3 - ) drives the reaction shown below to the left. H 2 CO 3 (acid)↔H + + HCO 3 - (base) In body fluids, the concentration of hydrogen ions ([H + ]) is maintained within very narrow limits, with the normal physiologic concentration being 40 nEq/L. The concentration of HCO 3 - (24 mEq/L) is 600,000 times that of [H + ]. The tight regulation of [H + ] at this low concentration is crucial for normal cellular activities because H

2014 eMedicine.com

94. Milk-Alkali Syndrome (Diagnosis)

and bicarbonate, for treatment of peptic ulcer disease. (See Pathophysiology, Etiology, Prognosis, Presentation, and Workup.) [ ] With the development of nonabsorbable alkali and histamine-2 blockers for treatment of peptic ulcer disease, milk-alkali syndrome became a rare cause of hypercalcemia; however, with the increased use and promotion of calcium carbonate for dyspepsia and for calcium supplementation, a resurgence of milk-alkali syndrome has occurred. (See Etiology and Epidemiology.) A few authors (...) . Adaptation of intestinal calcium absorption to oral intake may play a role and help to explain individual variability in the development of milk-alkali syndrome. Some persons maintain a high fractional absorption of calcium even with a high intake, while other persons decrease fractional absorption with a high intake. The former are likely at risk of developing milk-alkali syndrome. Calcium absorption is completed within 4 hours of intake. Avid absorption of large doses may lead to suppression

2014 eMedicine.com

95. Hypocalcemia (Diagnosis)

: Pathophysiology Ionized calcium is the necessary plasma fraction for normal physiologic processes. In the neuromuscular system, ionized calcium facilitates nerve conduction, muscle contraction, and muscle relaxation. Calcium is necessary for bone mineralization and is an important cofactor for hormonal secretion in endocrine organs. At the cellular level, calcium is an important regulator of ion transport and membrane integrity. Calcium turnover is estimated to be 10-20 mEq/day. Approximately 500 mg (...) of calcium is removed from the bones daily and replaced by an equal amount. Normally, the amount of calcium absorbed by the intestines is matched by urinary calcium excretion. Despite these enormous fluxes of calcium, the levels of ionized calcium remain stable because of the rigid control maintained by parathyroid hormone (PTH), vitamin D, and calcitonin through complex feedback loops. These compounds act primarily at bone, renal, and GI sites. Calcium levels are also affected by magnesium

2014 eMedicine.com

96. Hypocitraturia (Diagnosis)

filtration rate (GFR) decreases, there is a stepwise decrease in the amount of citrate that is filtered; however, in the early stages of CKD, the increased fractional excretion of citrate prevents an abrupt decline in urinary citrate, such that overt hypocitraturia is not usually observed until advanced stages of CKD. [ ] Primary Hyperaldosteronism In this disease entity, both hypercalciuria and hypocitraturia occur via Na-dependent volume expansion and chronic hypokalemia. [ ] Previous Next: US (...) . Urol Res . 2006 Aug. 34(4):231-8. . Kessler T, Hesse A. Cross-over study of the influence of bicarbonate-rich mineral water on urinary composition in comparison with sodium potassium citrate in healthy male subjects. Br J Nutr . 2000 Dec. 84(6):865-71. . Pinheiro VB, Baxmann AC, Tiselius HG, Heilberg IP. The effect of sodium bicarbonate upon urinary citrate excretion in calcium stone formers. Urology . 2013 Jul. 82(1):33-7. . Seltzer MA, Low RK, McDonald M. Dietary manipulation with lemonade

2014 eMedicine.com

97. Respiratory Alkalosis (Overview)

quantity of volatile acid (carbon dioxide) and nonvolatile acid. The metabolism of fats and carbohydrates leads to the formation of a large amount of carbon dioxide. [ ] The carbon dioxide combines with water to form carbonic acid. The lungs excrete the volatile fraction through ventilation, and acid accumulation does not occur. Significant alterations in ventilation can affect the elimination of carbon dioxide and lead to a respiratory acid-base disorder. PaCO 2 is normally maintained in the range (...) 03, 2018 Author: Ryland P Byrd, Jr, MD; Chief Editor: Zab Mosenifar, MD, FACP, FCCP Share Email Print Feedback Close Sections Sections Respiratory Alkalosis Overview Background Respiratory alkalosis is a disturbance in acid and base balance due to alveolar hyperventilation. Alveolar hyperventilation leads to a decreased partial pressure of arterial carbon dioxide (PaCO 2 ). In turn, the decrease in PaCO 2 increases the ratio of bicarbonate concentration to PaCO 2 and, thereby, increases the pH

2014 eMedicine.com

98. Respiratory Acidosis (Overview)

elevates plasma bicarbonate values, but only slightly (approximately 1 mEq/L for each 10-mm Hg increase in PaCO 2 ). The second step is renal compensation that occurs over 3-5 days. With renal compensation, renal excretion of carbonic acid is increased, and bicarbonate reabsorption is increased. The expected change in serum bicarbonate concentration in respiratory acidosis can be estimated as follows: Acute respiratory acidosis – Bicarbonate increases by 1 mEq/L for each 10-mm Hg rise in PaCO 2 (...) hypoventilation leads to an increased PaCO 2 (ie, hypercapnia). The increase in PaCO 2 , in turn, decreases the bicarbonate (HCO 3 – )/PaCO 2 ratio, thereby decreasing the pH. Hypercapnia and respiratory acidosis ensue when impairment in ventilation occurs and the removal of carbon dioxide by the respiratory system is less than the production of carbon dioxide in the tissues. Lung diseases that cause abnormalities in alveolar gas exchange do not typically result in alveolar hypoventilation. Often

2014 eMedicine.com

99. Milk-Alkali Syndrome (Overview)

and bicarbonate, for treatment of peptic ulcer disease. (See Pathophysiology, Etiology, Prognosis, Presentation, and Workup.) [ ] With the development of nonabsorbable alkali and histamine-2 blockers for treatment of peptic ulcer disease, milk-alkali syndrome became a rare cause of hypercalcemia; however, with the increased use and promotion of calcium carbonate for dyspepsia and for calcium supplementation, a resurgence of milk-alkali syndrome has occurred. (See Etiology and Epidemiology.) A few authors (...) . Adaptation of intestinal calcium absorption to oral intake may play a role and help to explain individual variability in the development of milk-alkali syndrome. Some persons maintain a high fractional absorption of calcium even with a high intake, while other persons decrease fractional absorption with a high intake. The former are likely at risk of developing milk-alkali syndrome. Calcium absorption is completed within 4 hours of intake. Avid absorption of large doses may lead to suppression

2014 eMedicine.com

100. Metabolic Alkalosis (Overview)

tract. Vomiting or nasogastric (NG) suction generates metabolic alkalosis by the loss of gastric secretions, which are rich in hydrochloric acid (HCl). Whenever a hydrogen ion is excreted, a bicarbonate ion is gained in the extracellular space. Renal losses of hydrogen ions occur whenever the distal delivery of sodium increases in the presence of excess aldosterone, which stimulates the electrogenic epithelial sodium channel (ENaC) in the collecting duct. As this channel reabsorbs sodium ions (...) , the tubular lumen becomes more negative, leading to the secretion of hydrogen ions and potassium ions into the lumen. Shift of hydrogen ions into the intracellular space mainly develops with hypokalemia. As the extracellular potassium concentration decreases, potassium ions move out of the cells. To maintain neutrality, hydrogen ions move into the intracellular space. Administration of sodium bicarbonate in amounts that exceed the capacity of the kidneys to excrete this excess bicarbonate may cause

2014 eMedicine.com

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