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Emergency Medicine Practice Sep 2016Identifying patients with potential toxic alcohol exposure and initiating appropriate management is critical to avoid significant patient morbidity. Sources of toxic... (Review)
Review
Identifying patients with potential toxic alcohol exposure and initiating appropriate management is critical to avoid significant patient morbidity. Sources of toxic alcohol exposure include ethylene glycol, methanol, diethylene glycol, propylene glycol, and isopropanol. Treatment considerations include the antidotes fomepizole and ethanol, and hemodialysis for removal of the parent compound and its toxic metabolites. Additional interventions include adjunctive therapies that may improve acidosis and enhance clearance of the toxic alcohol or metabolites. This issue reviews common sources of alcohol exposure, basic mechanisms of toxicity, physical examination and laboratory findings that may guide rapid assessment and management, and indications for treatment.
Topics: 2-Propanol; Acidosis; Alcohols; Antidotes; Diagnosis, Differential; Disease Management; Emergency Service, Hospital; Ethylene Glycol; Ethylene Glycols; Humans; Methanol; Physical Examination; Poisoning; Propylene Glycol; Renal Dialysis
PubMed: 27538060
DOI: No ID Found -
International Journal of Molecular... May 2015Cancer cells preferentially utilize glycolysis, instead of oxidative phosphorylation, for metabolism even in the presence of oxygen. This phenomenon of aerobic... (Review)
Review
Cancer cells preferentially utilize glycolysis, instead of oxidative phosphorylation, for metabolism even in the presence of oxygen. This phenomenon of aerobic glycolysis, referred to as the "Warburg effect", commonly exists in a variety of tumors. Recent studies further demonstrate that both genetic factors such as oncogenes and tumor suppressors and microenvironmental factors such as spatial hypoxia and acidosis can regulate the glycolytic metabolism of cancer cells. Reciprocally, altered cancer cell metabolism can modulate the tumor microenvironment which plays important roles in cancer cell somatic evolution, metastasis, and therapeutic response. In this article, we review the progression of current understandings on the molecular interaction between cancer cell metabolism and the tumor microenvironment. In addition, we discuss the implications of these interactions in cancer therapy and chemoprevention.
Topics: Acidosis; Glycolysis; Humans; Hypoxia; Neoplasms; Protein Kinase Inhibitors; Tumor Microenvironment
PubMed: 25988385
DOI: 10.3390/ijms160511055 -
The American Journal of Emergency... May 2023Toxic alcohol ingestion is a rare but serious condition that carries with it a high rate of morbidity and mortality. (Review)
Review
INTRODUCTION
Toxic alcohol ingestion is a rare but serious condition that carries with it a high rate of morbidity and mortality.
OBJECTIVE
This review highlights the pearls and pitfalls of toxic alcohol ingestion, including presentation, diagnosis, and management in the emergency department (ED) based on current evidence.
DISCUSSION
Toxic alcohols include ethylene glycol, methanol, isopropyl alcohol, propylene glycol, and diethylene glycol. These substances can be found in several settings including hospitals, hardware stores, and the household, and ingestion can be accidental or intentional. Toxic alcohol ingestion presents with various degrees of inebriation, acidemia, and end-organ damage depending on the substance. Timely diagnosis is critical to prevent irreversible organ damage or death and is based primarily on clinical history and consideration of this entity. Laboratory evidence of toxic alcohol ingestion includes worsening osmolar gap or anion-gap acidemia and end organ injury. Treatment depends on the ingestion and severity of illness but includes alcohol dehydrogenase blockade with fomepizole or ethanol and special considerations for the initiation of hemodialysis.
CONCLUSIONS
An understanding of toxic alcohol ingestion can assist emergency clinicians in diagnosing and managing this potentially deadly disease.
Topics: Humans; Prevalence; Ethanol; Methanol; Fomepizole; Acidosis; Eating
PubMed: 36796238
DOI: 10.1016/j.ajem.2023.01.048 -
The Canadian Veterinary Journal = La... Nov 2023Metabolic acidosis (MA) is the most common acid-base disorder reported in horses with colitis but its association with survival is yet to be determined.
BACKGROUND
Metabolic acidosis (MA) is the most common acid-base disorder reported in horses with colitis but its association with survival is yet to be determined.
OBJECTIVE
Investigate the types of MA in horses with colitis to determine effects of various anions on fatality rates.
ANIMALS AND PROCEDURES
We studied 158 horses with colitis. Horses were classified into 4 groups depending on the anion contributing to MA: i) no MA, ii) lactic acidosis (LA), iii) unmeasured strong ion (USI) acidosis, and iv) hyperchloremic acidosis (HA).
RESULTS
Sixty percent (95/158) of horses had no MA, 22% (34/158) had LA, 12% (19/158) had HA, and 6% (10/158) had USI acidosis. The fatality rate of horses without MA was 20% (20/95), whereas the rates for those with LA, USI, and HA were 53% (18/34), 30% (3/10), and 16% (3/19), respectively. Horses with LA were more likely to die or be euthanized than horses without MA (OR: 4.2, 95% CI: 1.83 to 9.72, < 0.001) and HA (OR: 5.9, 95% CI: 1.47 to 24.4, < 0.01).
CONCLUSION AND CLINICAL RELEVANCE
Lactic acidosis was the most common type of MA in horses with colitis, and it was associated with non-survival.
Topics: Animals; Horses; Acidosis, Lactic; Acidosis; Colitis; Horse Diseases
PubMed: 37915775
DOI: No ID Found -
Journal of Renal Nutrition : the... May 2023Studies have shown that low or high serum bicarbonate levels (reflecting metabolic acidosis or alkalosis) are associated with increased all-cause mortality rates in...
OBJECTIVE
Studies have shown that low or high serum bicarbonate levels (reflecting metabolic acidosis or alkalosis) are associated with increased all-cause mortality rates in moderate and advanced chronic kidney disease (CKD) cases. Correction of presumed acidosis using sodium bicarbonate, targeting serum levels around 22 mmol/L, has proven to be beneficial in delaying the progression of the disease and provided mortality benefit. A similar prognostic association may exist between uncorrected metabolic acidosis in chronic liver disease. Correcting it with sodium-containing salts may require more interventions due to increased sodium/fluid load. In patients with liver failure, a naturally alkalotic state, where sodium load is a concern, the impact of this intervention is unclear.
DESIGN
This study aims to generate proof of concept through a retrospective chart review in individuals with CKD-related metabolic acidosis and liver cirrhosis.
RESULT
Our analysis revealed a statistically significant association between the need for paracentesis and bicarbonate therapy. Our study has multiple drawbacks, including a retrospective chart review and limitation of data due to single-center patients.
CONCLUSION
We extrapolate that lowering bicarbonate targets in other clinical scenarios like liver failure, pregnancy, and cardiac failure may be prudent and will lead to a lower sodium load.
Topics: Humans; Bicarbonates; Retrospective Studies; Acidosis; Chronic Disease; Renal Insufficiency, Chronic; Sodium; Liver Diseases; Kidney; Liver Failure
PubMed: 36736470
DOI: 10.1053/j.jrn.2022.12.008 -
Current Medicinal Chemistry 2017Drug resistance and therapeutic failure are important causes of disease relapse and progression and may be considered as major obstacles preventing cure of cancer... (Review)
Review
Drug resistance and therapeutic failure are important causes of disease relapse and progression and may be considered as major obstacles preventing cure of cancer patients. Tumors use a large number of molecular, biochemical and cellular mechanisms to evade chemotherapy and targeted therapy. Important determinants of drug efficacy are the intrinsic pharmacological characteristics of drugs which may be largely affected by the tumor physiology. One feature of solid tumors is the acidic extracellular pH, resulting from metabolic shift and increased metabolic rates combined with low tissue perfusion due to defective vasculature. Besides its role in tumor pathobiology promoting tumor growth and metastasis, the acidic tumor environment creates a chemical barrier for many anticancer drugs, thus limiting their activity. The content of this review will be focused on the pathobiology of tumor acidosis and on its role in therapeutic resistance.
Topics: Acidosis; Animals; Antineoplastic Agents; Humans; Neoplasms
PubMed: 28031009
DOI: 10.2174/0929867323666161228142849 -
Iranian Journal of Kidney Diseases Jul 2018Chronic kidney disease is defined as a glomerular filtration rate lower than 60 mL/min/1.73 m2, which is regarded as a public health priority and part of the growing... (Review)
Review
Chronic kidney disease is defined as a glomerular filtration rate lower than 60 mL/min/1.73 m2, which is regarded as a public health priority and part of the growing burden of noncommunicable diseases. Reduced kidney function is concomitant with high levels of inflammatory factors, abnormal lipid profile, and anemia, as well as bone abnormalities, calcium deposition outside the bones, endothelial dysfunction, and cardiomyopathy. Furthermore, metabolic acidosis is a common complication in chronic kidney disease that is associated with secondary hyperparathyroidism and faster kidney disease progression. Effective preventive approaches may slow progression of chronic kidney disease and reduce the risk of subsequent morbidity and mortality. It seems that correction of metabolic acidosis slows down the decline in glomerular filtration rate and is one of the noble approaches. A diet rich in fruits and vegetables instead of bicarbonate therapy is feasible and economical and appears to have a positive effect on kidney hemodynamic function.
Topics: Acid-Base Equilibrium; Acidosis; Animals; Diet, Healthy; Disease Progression; Fruit; Glomerular Filtration Rate; Humans; Hydrogen-Ion Concentration; Kidney; Renal Insufficiency, Chronic; Treatment Outcome; Vegetables
PubMed: 30087214
DOI: No ID Found -
The Journal of Surgical Research Oct 2023Very low-calorie diets (VLCDs) are used preoperatively in bariatric-metabolic surgery; however, this can lead to physiological ketosis. Euglycemic ketoacidosis is an... (Clinical Trial)
Clinical Trial
INTRODUCTION
Very low-calorie diets (VLCDs) are used preoperatively in bariatric-metabolic surgery; however, this can lead to physiological ketosis. Euglycemic ketoacidosis is an increasingly recognized complication in diabetic patients on sodium-glucose-cotransporter-2 inhibitors (SGLT2i) undergoing surgery and requires assessment of ketones for diagnosis and monitoring. VLCD induced ketosis may confound monitoring in this group. We aimed to evaluate the influence of VLCD, compared to standard fasting, on perioperative ketone levels and acid-base balance.
MATERIALS AND METHODS
Twenty-seven patients were prospectively recruited to the intervention group and 26 to the control group from two tertiary referral centres in Melbourne, Australia. Intervention group patients were severely obese (body mass index) (BMI) (≥35), undergoing bariatric-metabolic surgery, and prescribed 2 wk of VLCD preoperatively. Control group patients underwent general surgical procedures and prescribed standard procedural fasting only. Patients were excluded if diabetic or prescribed SGLT2i. Ketone and acid-base measurements were taken at regular intervals. Univariate and multivariate regression was utilised with significance defined as P < 0.005.
CLINICALTRIALS
gov ID: NCT05442918.
RESULTS
Patients on VLCD, compared to standard fasting, had an increased median preoperative (0.60 versus 0.21 mmol/L), immediate postoperative (0.99 versus 0.34 mmol/L) and day 1 postoperative (0.69 versus 0.21 mmol/L) ketone level (P < 0.001). Preoperative acid-base balance was normal in both groups, however VLCD patients were found to have a metabolic acidosis immediately postoperatively (pH 7.29 versus pH 7.35) (P = 0.019). Acid-base balance had normalized in VLCD patients on postoperative day 1.
CONCLUSIONS
Preoperative VLCD resulted in increased pre- and postoperative ketone levels with immediate postoperative values consistent with metabolic ketoacidosis. This should be considered particularly when monitoring diabetic patients prescribed SGLT2i.
Topics: Humans; Acidosis; Caloric Restriction; Diabetes Mellitus, Type 2; Ketones; Ketosis; Obesity
PubMed: 37271067
DOI: 10.1016/j.jss.2023.05.001 -
NeoReviews Mar 2024
Topics: Infant, Newborn; Humans; Bradycardia; Acidosis; Heart Rate
PubMed: 38425200
DOI: 10.1542/neo.25-3-e166 -
The Veterinary Clinics of North... Mar 2017High anion gap (AG) metabolic acidoses can be identified by a decrease in pH, decrease in HCO or base excess, and an increased AG. The AG represents the difference... (Review)
Review
High anion gap (AG) metabolic acidoses can be identified by a decrease in pH, decrease in HCO or base excess, and an increased AG. The AG represents the difference between unmeasured cations and unmeasured anions; it increases secondary to the accumulation of anions other than bicarbonate and chloride. The most common causes of high AG acidosis are renal failure, diabetic ketoacidosis, and lactic acidosis. Severe increases in concentration of phosphorus can cause hyperphosphatemic acidosis.
Topics: Acid-Base Equilibrium; Acidosis; Acidosis, Lactic; Algorithms; Animals; Diabetic Ketoacidosis
PubMed: 28017408
DOI: 10.1016/j.cvsm.2016.11.002