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Fractional Excretion of Bicarbonate


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161. 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

162. 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

163. Does Acetazolamide Prevent Altitude Sickness?

is a carbonic anhydrase inhibitor and works by stimulating renal bicarbonate excretion. The increased blood acidity serves as a central stimulus to increase ventilation, thus facilitating adaptation to hypoxic conditions. Show me the data! Here are a few trials: Basnyat et al, looked at the efficacy of low-dose acetazolamide for the prophylaxis of AMS.1 In this prospective, double-blind, randomized, placebo-controlled trial, acetazolamide at 125mg bid or placebo was given to approximately 200 healthy (...) . The result is a rise in arterial oxygen content and a respiratory alkalosis which is only partially compensated by kidneys. Acetazolamide effectively mimics this normal acclimatization response, by inducing a respiratory acidosis (impaired cellular delivery of CO2 to the lungs) and a metabolic acidosis (enhanced renal bicarbonate excretion), thus stimulating alveolar ventilation. It also prevents two commonly encountered phenomena in acclimatizing individuals: periodic breathing and accentuated hypoxemia

2009 Clinical Correlations

164. Proteomic Profiling and Pathway Analysis of the Response of Rat Renal Proximal Convoluted Tubules to Metabolic Acidosis. (Full text)

Proteomic Profiling and Pathway Analysis of the Response of Rat Renal Proximal Convoluted Tubules to Metabolic Acidosis. Metabolic acidosis is a relatively common pathological condition that is defined as a decrease in blood pH and bicarbonate concentration. The renal proximal convoluted tubule responds to this condition by increasing the extraction of plasma glutamine and activating ammoniagenesis and gluconeogenesis. The combined processes increase the excretion of acid and produce (...) bicarbonate ions that are added to the blood to partially restore acid-base homeostasis. Only a few cytosolic proteins, such as phosphoenolpyruvate carboxykinase, have been determined to play a role in the renal response to metabolic acidosis. Therefore, further analysis was performed to better characterize the response of the cytosolic proteome. Proximal convoluted tubule cells were isolated from rat kidney cortex at various times after onset of acidosis and fractionated to separate the soluble cytosolic

2013 American Journal of Physiology. Renal physiology

165. Arterial Blood Gases

to haemoglobin 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 (...) oxygen in your 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

2012 Lab Tests Online UK

166. Phase 1 Study of CC-486 in Japanese Subjects With Hematological Neoplasms

and urine concentration) excreted in subsequent collection intervals Pharmacokinetics - fet [ Time Frame: On day 1 and day 8 ] Cumulative fraction of dose excreted in the urine from time zero to time t (%), calculated as Ae t divided by dose Pharmacokinetics - Renal Clearance [ Time Frame: On day 1 and day 8 ] Renal clearance (mL/min), calculated as Aet divided by AUCt Investigator's response assessment [ Time Frame: Up to 4 years ] Number of participants who demonstrate response by investigator's (...) : t1/2 = 0.693/λz Pharmacokinetics - Total Clearance [ Time Frame: On day 1 and day 8 ] Apparent total clearance, calculated as Dose/AUC∞ Pharmacokinetics - Volume of distribution [ Time Frame: On day 1 and day 8 ] Apparent volume of distribution will be calculated according to the equation: Vz/F = (CL/F)/λz Pharmacokinetics - Aet [ Time Frame: On day 1 and day 8 ] Cumulative amount excreted from time zero to time t (ng), calculated as the summation of the amounts (Aet, product of urine volume

2013 Clinical Trials

167. 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)

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

168. Comparison of clinical and biochemical markers of dehydration with the clinical dehydration scale in children: a case comparison trial. (Full text)

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

169. Serum level of fibroblast growth factor 23 in maintenance renal transplant patients. (Full text)

and FGF23 (r = -0.487; P < 0.001), PTH (r = -0.444; P < 0.001), serum phosphate levels (r = -0.315; P < 0.001) and fractional excretion of magnesium (r = -0.503; P < 0.001). Multivariable analysis showed that increased time on corticosteroids (P < 0.001), PTH (P < 0.001), serum phosphate (P = 0.003), decreased serum calcitriol (P = 0.049) and estimated glomerular filtration (P = 0.003) rate were associated with high FGF23 levels. In contrast with pre-transplant patients and first year post-transplant (...) patients, higher FGF23 values were not correlated with increased phosphate excretion. An elevated phosphate reabsorption rate was associated with decreased PTH (P < 0.001) and calciuria (P = 0.028) and increased serum calcitriol (P = 0.009), plasma bicarbonate (P = 0.024) and estimated glomerular filtration (P = 0.003).Serum FGF23 concentrations remain increased in long-term kidney graft recipients, even in the early stages of CKD. It remains to be seen whether measures aimed at reducing serum levels

2012 Transplantation

170. 3 Month PHI PAD PoM Study

clinical concern included albumin, calcium, creatinine, glucose, magnesium, phosphorus, potassium, sodium and bicarbonate. Number of participants with clinical chemistry abnormalities of potential clinical importance are presented. Number of Participants With Clinical Hematology Abnormalities of Potential Clinical Importance [ Time Frame: Up to 67 days ] Hematology parameters included platelet count, red blood cell (RBC) count, white blood cell WBC count (absolute), hemoglobin, hematocrit, Mean (...) with the lowest ABI. Claudication symptoms with stable severity for at least 3 months prior to screening. The patient is able to provide written informed consent to participate in this study. AST and ALT < 2xULN; alkaline phosphatase and bilirubin greater than or equal too 1.5xULN (isolated bilirubin >1.5xULN is acceptable if bilirubin is fractionated and direct bilirubin <35%). Confirmed QTcB or QTcF < 450 msec; or QTc < 480 msec in subjects with bundle branch block. Subjects must be able to perform

2012 Clinical Trials

171. A Study to Assess the Effect of Repeat Doses of GSK962040 on the Pharmacokinetics of L-DOPA in Subjects With Parkinson's Disease Exhibiting Delayed Gastric Emptying

of a 13C-labelled test meal. The test meal was consumed approximately 80 minutes 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 hours (...) , and GGT measurements were taken at pre-dose on Day 1 (Baseline), Day 4, and Day 8. 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. Change From Baseline in Calcium, Chloride, Carbon Dioxide Content (CO2)/Bicarbonate (BC), Glucose, Potassium, Sodium, Urea/Blood Urea Nitrogen (BUN), and Uric Acid (UA) at Day 4 and Day 8 [ Time Frame: Baseline, Day 4, and Day 8 ] Calcium, chloride, CO2/BC

2012 Clinical Trials

172. Dose-Optimization, Adjunctive Treatment Study of Ezogabine/Retigabine Immediate Release in Partial-onset Seizures

, there was not sufficient data to summarize or evaluate this endpoint. Change From Baseline in Calcium, Chloride, Potassium, Sodium, Glucose, Magnesium, Phosphorus Inorganic, Bicarbonate and Urea/Blood Urea Nitrogen (BUN) [ Time Frame: Screening, Week 0 (end of Baseline Phase), Week 10 (end of Dose-Optimization Phase), Week 18 (end of Maintenance Phase) and Week 21 (end of Taper Phase) ] The change from Baseline in the indicated chemistry tests were to be assessed. Due to the study being prematurely terminated (...) that in the investigator's judgment could potentially affect subject safety. Have an average corrected QT interval (QTc), using Bazett's QT correction (QTcB), ≥450msec or ≥480msec for subjects with bundle branch block at the time of the Screening Visit Liver function tests: alanine aminotransferase (ALT) is ≥2 times the upper limit of normal (ULN); alkaline phosphatase and bilirubin are >1.5 × ULN (isolated bilirubin >1.5 × ULN is acceptable if bilirubin is fractionated and direct bilirubin is <35%). Are suffering from

2012 Clinical Trials

173. A Study Of Pregabalin (Lyrica) Drug Levels In Urine, Plasma And Breast Milk Of Healthy Lactating Women

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 the blood. Area Under the Curve From Time Zero to End of Dosing Interval for Breast Milk (AUCtau [Breast Milk]) [ Time Frame: Pre-dose on Day 3; 0 to 2, 2 to 4, 4 to 8, 8 to 12 hours post-dose on Day 3 ] AUCtau (breast milk) was the area under the curve for breast milk, from (...) ) is based on the terminal elimination phase time points from this timeframe. Average Breast Milk Concentration During the Dosing Interval (Cav) [ Time Frame: Pre-dose on Day 3; 0 to 2, 2 to 4, 4 to 8, 8 to 12 hours post-dose on Day 3 ] Average breast milk concentration during the dosing interval (Cav) was calculated by dividing AUCtau (breast milk) with tau, where tau was the dosing interval of 12 hours. Amount Excreted in Breast Milk Over the Dosing Interval Tau (Aetaubm) [ Time Frame: Pre-dose on Day

2012 Clinical Trials

174. A Phase 2 Multi-Center Study To Evaluate The Efficacy And Safety Of A Chemokine CCR2/5 Receptor Antagonist In Adults With Type 2 Diabetes And Overt Nephropathy

] Serum creatinine is an indicator of kidney function. Creatinine is a substance formed from the metabolism of creatine, commonly found in blood, urine, and muscle tissue. It is removed from the blood by the kidneys and excreted in urine. Normal adult blood levels of creatinine=45 to 90 micromoles per liter (mcmol/L) for females, 60 to 110 mcmol/L for males, however normal values are age-dependent. Change from baseline=creatinine level at Week 1, 4, 8, 12 or 16 minus baseline level where higher scores (...) the average plasma glucose concentration over prolonged periods of time. As the average amount of plasma glucose increases, the fraction of HbA1c increases in a predictable way. Summary of Plasma PF-04634817 Pharmacokinetic (PK) Concentrations at Day 1 and Weeks 1, 4, 8 and 12 [ Time Frame: 1, 2, 4 hours post-dose on Day 1; 2 hours post-dose on Weeks 1, 4, 8 and 12 ] Other Outcome Measures: Change From Baseline in Systolic Blood Pressure (SBP) and Diastolic Blood Pressure (DBP) at Weeks 1, 4, 8, 12 and 16

2012 Clinical Trials

175. 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

176. 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

177. 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)

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

178. Mechanisms mediating the diuretic and natriuretic actions of the incretin-hormone glucagon-like peptide-1. (Full text)

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

179. Clarification of the site of action of chlorothiazide in the rat nephron. (Full text)

on chloride transport in the nephron. The effect of chlorothiazide on chloride transport was studied because chlorothiazide's effectiveness as a saluretic is largely due to its ability to enhance sodium chloride excretion; if only changes in sodium transport are examined, it would be then difficult to determine if sodium as bicarbonate or as chloride is affected, since chlorothiazide can inhibit carbonic anhydrase. One group of rats was studied before and after 15 mg/kg per h chlorothiazide (...) . Fractional chloride excretion in the urine increased from 0.29 to 3.44%, P less than 0.001, after chlorothiazide, but did not change after benzolamide. The influence of chlorothiazide on proximal chloride transport presumably is related to its ability to inhibit renal carbonic anhydrase. However, it is not the effect of chlorothiazide in the proximal convolution but rather its effect in the distal convoluted tubule which is primarily responsible for its ability to be an effective saliuretic.

1975 Journal of Clinical Investigation

180. Effects of Acetazolamide on Proximal Tubule Cl, Na, and HCO3 Transport in Normal and Acidotic Dogs during Distal Blockade (Full text)

of acetazolamide (20 mg/kg i.v.), there was a significant increase in urine flow, absolute and fractional excretion of sodium, bicarbonate, and chloride in all animals. Associated with these effects, urine/plasma osmolality and urine/plasma sodium remained unchanged but urine/plasma chloride decreased significantly to 1.15+/-0.01 in normal and to 1.19+/-0.01 in acidotic dogs. In acidotic dogs there was a significant correlation between the increase in bicarbonate, sodium, or chloride excretion after (...) water and electrolyte excretion were examined in 6 normal dogs and 10 chronic ammonium chloride-loaded dogs during distal blockade produced by ethacrynic acid and chlorothiazide administration. During distal blockade control urine/plasma osmolality and urine/plasma sodium were close to unity in all experiments. Urine/plasma chloride and urine/plasma bicarbonate were 1.21+/-0.02 and 0.75+/-0.07 in normal and 1.24+/-0.01 and 0.04+/-0.01 in acidotic dogs, respectively. After the administration

1977 Journal of Clinical Investigation

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