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Fractional Excretion of Bicarbonate

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81. 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

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. PTHrP-related Hypercalcaemia in Infancy and Congenital Anomalies of the Kidney and Urinary Tract (CAKUT) (Full text)

, 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

84. 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

85. Azotemia (Overview)

for hypothalamic production of antidiuretic hormone, which exerts its effect in the medullary collecting duct for water reabsorption. Through unknown mechanisms, activation of the sympathetic nervous system leads to enhanced proximal tubular reabsorption of salt and water, as well as BUN, creatinine, calcium, uric acid, and bicarbonate. The net result of these 4 mechanisms of salt and water retention is decreased output and decreased urinary excretion of sodium (< 20 mEq/L). Intrarenal azotemia Intrarenal (...) Failure Study Group. Kidney Int . 1996 Sep. 50 (3):811-8. . . Prakash J, Singh TB, Ghosh B, Malhotra V, Rathore SS, Vohra R, et al. Changing epidemiology of community-acquired acute kidney injury 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

2014 eMedicine.com

86. Rhabdomyolysis (Follow-up)

Dehydration (hematocrit >50, serum sodium level >150 mEq/L, orthostasis, pulmonary wedge pressure < 5 mm Hg, urinary fractional excretion of sodium < 1%) Sepsis Hyperkalemia or hyperphosphatemia on admission Hypoalbuminemia AKI has occasionally developed in severely dehydrated patients with peak CK levels as low as 2000 IU/L. To prevent renal failure, many authorities advocate urinary alkalization, mannitol, and loop diuretics. Alkalization of urine is believed to be helpful and is based (...) . These invasive studies can assist in the assessment of the intravascular volume.) Repeat the CK assay every 6-12 hours to determine the peak CK level. Aggressive and early hydration with isotonic sodium chloride solution is important for the prevention of pigment-associated renal failure. The composition of repletion fluid is controversial and may also include sodium bicarbonate. Initial fluid use in young children has been recommended to be 20 mL/kg; in adolescents, 1-2 L/h has been recommended. Subsequent

2014 eMedicine Pediatrics

87. Fluid, Electrolyte, and Nutrition Management of the Newborn (Diagnosis)

output and a serum creatinine that does not decline postnatally or increases may have acute kidney injury (AKI). Urine electrolyte levels and specific gravity may be assessed. If the infant is being treated with diuretics, such as furosemide, results of these tests are difficult to interpret. Calculation of the fractional urinary excretion of sodium in relation to creatinine (FENa) and blood gas analysis may be indicated; metabolic acidosis may be a marker of inadequate tissue perfusion. Previous (...) + excretion and loss of bicarbonate. [ ] During the active growth period after the first week, the need for potassium may increase to 2-3mEq/kg/day, and the need for sodium and chloride may increase to 3-5mEq/kg/day. Some of the smallest preterm infants have sodium requirements of as much as 6-8mEq/kg/day because of the decreased capacity of the kidneys to retain sodium. Previous Next: Fluids and Electrolytes in Common Neonatal Conditions Infants with respiratory distress syndrome need appropriate fluid

2014 eMedicine Pediatrics

88. Acidosis, Respiratory (Diagnosis)

, bicarbonate, and protein bound. It diffuses freely across cell membranes, and this diffusion allows it to be efficiently transported from peripheral tissues to the lungs for excretion. When hypercapnia is present, this same property causes excess carbon dioxide to shift intracellularly and decrease intracellular pH. Carbon dioxide (CO 2 ) normally combines with water (H 2 O) to form carbonic acid (H 2 CO 3 ), which then dissociates to release hydrogen ion (H + ) and bicarbonate (HCO 3 (...) substantial changes in pH, and approximately 10% of carbon dioxide is bound to hemoglobin to form carbaminohemoglobin. Cellular buffering elevates plasma bicarbonate (HCO 3 – ) only slightly and causes plasma HCO 3 – to increase by 1 mEq/L for every 10-mm Hg increase in P a CO 2 . Renal compensation for sustained hypercapnia begins in 6-12 hours, but 3-5 days pass before maximal compensation occurs. The kidneys increase excretion of hydrogen ions (predominantly in the form of ammonium [NH 4

2014 eMedicine Pediatrics

89. Toxicity, Mushroom (Follow-up)

), Boletus edulis (king boletus), Leccinium versipelle (brown birch boletus), and Albatrellus ovinus (sheep polypore). Many of these are identified in field guides as edible. Treatment is with aggressive IV fluid resuscitation and consideration for IV sodium bicarbonate to alkalinize the urine. In rare cases, dialysis may be needed if renal failure occurs. Agitation, commonly observed with hallucinogenic mushrooms, is treated with benzodiazepines; phenothiazines are best avoided in this setting. Other (...) of them demonstrate an important decrease in hepatic necrosis histologically. [ ] A large human case series found an association between both silibinin and NAC and higher survival rates. [ ] Corticosteroids, vitamin C, kutkin, aucubin, and thioctic acid have been used in the past but have no proven benefit and are no longer recommended. Charcoal hemoperfusion and hemodialysis are also ineffective in removing toxins because once the toxin is formed, it is rapidly excreted by the kidneys. Plasma

2014 eMedicine.com

90. 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

91. Azotemia (Diagnosis)

for hypothalamic production of antidiuretic hormone, which exerts its effect in the medullary collecting duct for water reabsorption. Through unknown mechanisms, activation of the sympathetic nervous system leads to enhanced proximal tubular reabsorption of salt and water, as well as BUN, creatinine, calcium, uric acid, and bicarbonate. The net result of these 4 mechanisms of salt and water retention is decreased output and decreased urinary excretion of sodium (< 20 mEq/L). Intrarenal azotemia Intrarenal (...) Failure Study Group. Kidney Int . 1996 Sep. 50 (3):811-8. . . Prakash J, Singh TB, Ghosh B, Malhotra V, Rathore SS, Vohra R, et al. Changing epidemiology of community-acquired acute kidney injury 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

2014 eMedicine.com

92. Acute Renal Failure (Follow-up)

be harmful for the patient. Maintenance of volume homeostasis and correction of biochemical abnormalities remain the primary goals of treatment and may include the following measures: Correction of fluid overload with furosemide Correction of severe acidosis with bicarbonate administration, which can be important as a bridge to dialysis Correction of hyperkalemia Correction of hematologic abnormalities (eg, anemia, uremic platelet dysfunction) with measures such as transfusions and administration (...) agents, nonsteroidal anti-inflammatory drugs [NSAIDs]) should be avoided or used with extreme caution. Similarly, all medications cleared by renal excretion should be avoided, or their doses should be adjusted appropriately. A 2013 study indicated that triple therapy using nonsteroidal anti-inflammatory drugs (NSAIDs) with 2 antihypertensive medications—a diuretic along with an angiotensin-converting enzyme (ACE) inhibitor or an angiotensin-receptor blocker (ARB)—significantly increases the risk

2014 eMedicine.com

93. Acute Tubular Necrosis (Follow-up)

(red arrow). Finally, intratubular obstruction due to the denuded epithelium and cellular debris is evident (green arrow); note that the denuded tubular epithelial cells clump together because of rearrangement of intercellular adhesion molecules. of 2 Tables Table. Laboratory Findings Used to Differentiate Prerenal Azotemia From ATN Finding Prerenal Azotemia ATN and/or Intrinsic Renal Disease Urine osmolarity (mOsm/kg) >500 < 350 Urine sodium (mmol/d) < 20 >40 Fractional excretion of sodium (FENa (...) ) (%) < 1 >2 Fractional excretion of urea (%) < 35 >50 Urine sediment Bland and/or nonspecific May show muddy brown granular casts Contributor Information and Disclosures Author Nikhil A Shah, MBBS, DNB(Neph) Clinical Research Fellow in Home Dialysis, Nephrologist, University of Alberta Faculty of Medicine and Dentistry, Canada Nikhil A Shah, MBBS, DNB(Neph) is a member of the following medical societies: , , , Canadian Society of Nephrology, , Disclosure: Nothing to disclose. Coauthor(s) Mahendra

2014 eMedicine.com

94. 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

95. 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

96. Acute Tubular Necrosis (Treatment)

(red arrow). Finally, intratubular obstruction due to the denuded epithelium and cellular debris is evident (green arrow); note that the denuded tubular epithelial cells clump together because of rearrangement of intercellular adhesion molecules. of 2 Tables Table. Laboratory Findings Used to Differentiate Prerenal Azotemia From ATN Finding Prerenal Azotemia ATN and/or Intrinsic Renal Disease Urine osmolarity (mOsm/kg) >500 < 350 Urine sodium (mmol/d) < 20 >40 Fractional excretion of sodium (FENa (...) ) (%) < 1 >2 Fractional excretion of urea (%) < 35 >50 Urine sediment Bland and/or nonspecific May show muddy brown granular casts Contributor Information and Disclosures Author Nikhil A Shah, MBBS, DNB(Neph) Clinical Research Fellow in Home Dialysis, Nephrologist, University of Alberta Faculty of Medicine and Dentistry, Canada Nikhil A Shah, MBBS, DNB(Neph) is a member of the following medical societies: , , , Canadian Society of Nephrology, , Disclosure: Nothing to disclose. Coauthor(s) Mahendra

2014 eMedicine.com

97. Hypertension (Treatment)

[ , ] : (1) elevated BP, with a systolic pressure (SBP) between 120 and 129 mm Hg and diastolic pressure (DBP) less than 80 mm Hg, and (2) stage 1 hypertension, with an SBP of 130 to 139 mm Hg or a DBP of 80 to 89 mm Hg. In adults at increased risk of heart failure (HF), the optimal BP in those with hypertension should be less than 130/80 mm Hg. Adults with HFrEF (HF with reduced ejection fraction) and hypertension should be prescribed GDMT (guideline-directed management and therapy) titrated to attain

2014 eMedicine.com

98. Azotemia (Treatment)

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

99. Acute Renal Failure (Treatment)

be harmful for the patient. Maintenance of volume homeostasis and correction of biochemical abnormalities remain the primary goals of treatment and may include the following measures: Correction of fluid overload with furosemide Correction of severe acidosis with bicarbonate administration, which can be important as a bridge to dialysis Correction of hyperkalemia Correction of hematologic abnormalities (eg, anemia, uremic platelet dysfunction) with measures such as transfusions and administration (...) agents, nonsteroidal anti-inflammatory drugs [NSAIDs]) should be avoided or used with extreme caution. Similarly, all medications cleared by renal excretion should be avoided, or their doses should be adjusted appropriately. A 2013 study indicated that triple therapy using nonsteroidal anti-inflammatory drugs (NSAIDs) with 2 antihypertensive medications—a diuretic along with an angiotensin-converting enzyme (ACE) inhibitor or an angiotensin-receptor blocker (ARB)—significantly increases the risk

2014 eMedicine.com

100. Toxicity, Mushroom (Treatment)

), Boletus edulis (king boletus), Leccinium versipelle (brown birch boletus), and Albatrellus ovinus (sheep polypore). Many of these are identified in field guides as edible. Treatment is with aggressive IV fluid resuscitation and consideration for IV sodium bicarbonate to alkalinize the urine. In rare cases, dialysis may be needed if renal failure occurs. Agitation, commonly observed with hallucinogenic mushrooms, is treated with benzodiazepines; phenothiazines are best avoided in this setting. Other (...) of them demonstrate an important decrease in hepatic necrosis histologically. [ ] A large human case series found an association between both silibinin and NAC and higher survival rates. [ ] Corticosteroids, vitamin C, kutkin, aucubin, and thioctic acid have been used in the past but have no proven benefit and are no longer recommended. Charcoal hemoperfusion and hemodialysis are also ineffective in removing toxins because once the toxin is formed, it is rapidly excreted by the kidneys. Plasma

2014 eMedicine.com

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