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Fractional Excretion of Bicarbonate


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161. Hypocalcemia (Overview)

: 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 Emergency Medicine

162. Altitude Illness - Pulmonary Syndromes (Overview)

, triggered by oxygen-sensing cells in the carotid body. Increased ventilation produces a higher alveolar PO 2. Concurrently, a lowered alveolar PCO 2 results in a respiratory alkalosis and so acts as to limit the increase in ventilation. Renal compensation, through excretion of bicarbonate ion, gradually brings the blood pH back toward normal and allows further increase in ventilation. This process, termed ventilatory acclimatization, requires approximately 4 days at a given altitude and is greatly (...) Hypoxia is the primary physiological insult on ascent to high altitude. The fraction of oxygen in the atmosphere remains constant (0.21), but the partial pressure of oxygen decreases along with barometric pressure on ascent to altitude. The inspired partial pressure of oxygen (PiO 2 ) is lower still because of water vapor pressure in the airways. At the altitude of La Paz, Bolivia (4000 m; 13,200 ft), PiO 2 is 86.4 mm Hg, which is equivalent to breathing 12% oxygen at sea level. The response

2014 eMedicine Emergency Medicine

163. Altitude Illness - Cerebral Syndromes (Overview)

important immediate response of the body to hypoxia is an increase in minute ventilation, called the hypoxic ventilatory response (HVR), and is triggered by oxygen sensing cells in the carotid bodies. Increased ventilation produces a higher alveolar PO 2. Concurrently, a lowered alveolar PCO 2 produces a respiratory alkalosis, acting as a brake on the respiratory center of the brain and subsequently limiting further increases in ventilation. Renal compensation, through excretion of bicarbonate ions (...) physiological insult on ascent to high altitude. The fraction of oxygen in the atmosphere remains constant (0.21) at all altitudes, but the partial pressure of oxygen decreases along with barometric pressure on ascent to altitude. The inspired partial pressure of oxygen (PiO 2 ) is lower still because of water vapor pressure in the airways. At the altitude of International Airport at La Paz, Bolivia (4062 m; 13,327 ft), PiO 2 is 98.18 mm Hg, which is equivalent to breathing 12.8% oxygen at sea level. See

2014 eMedicine Emergency Medicine

164. 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

165. 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

166. Proteomic Profiling and Pathway Analysis of the Response of Rat Renal Proximal Convoluted Tubules to Metabolic Acidosis. Full Text available with Trip Pro

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

167. 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

168. 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

169. 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

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 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

172. Serum level of fibroblast growth factor 23 in maintenance renal transplant patients. Full Text available with Trip Pro

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

173. Clarification of the site of action of chlorothiazide in the rat nephron. Full Text available with Trip Pro

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

174. On the mechanism of renal potassium wasting in renal tubular acidosis associated with the Fanconi syndrome (type 2 RTA) Full Text available with Trip Pro

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

175. A Micropuncture Study of HCO3 Reabsorption by the Hypertrophied Proximal Tubule Full Text available with Trip Pro

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

176. Effects of Acetazolamide on Proximal Tubule Cl, Na, and HCO3 Transport in Normal and Acidotic Dogs during Distal Blockade Full Text available with Trip Pro

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

177. Micropuncture study of nephron function in the rhesus monkey Full Text available with Trip Pro

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

178. 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

179. 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)

180. 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)

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