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Molecules (Basel, Switzerland) Apr 2019The aim of this paper was to review recent literature (from 2000 onwards) and summarize the newest findings on fluctuations in the concentration of some essential macro-...
The aim of this paper was to review recent literature (from 2000 onwards) and summarize the newest findings on fluctuations in the concentration of some essential macro- and microelements in those patients with a history of chronic alcohol abuse. The focus was mainly on four elements which the authors found of particular interest: Iron, magnesium, copper, and manganese. After independently reviewing over 50 articles, the results were consistent with regard to iron and magnesium. On the other hand, data were limited, and in some cases contradictory, as far as copper and manganese were concerned. Iron overload and magnesium deficiency are two common results of an excessive and prolonged consumption of alcohol. An increase in the levels of iron can be seen both in the serum and within the cells, hepatocytes in particular. This is due to a number of factors: Increased ferritin levels, lower hepcidin levels, as well as some fluctuations in the concentration of the TfR receptor for transferrin, among others. Hypomagnesemia is universally observed among those suffering from alcoholism. Again, the causes for this are numerous and include malnutrition, drug abuse, respiratory alkalosis, and gastrointestinal problems, apart from the direct influence of excessive alcohol intake. Unfortunately, studies regarding the levels of both copper and manganese in the case of (alcoholic) liver disease are scarce and often contradictory. Still, the authors have attempted to summarize and give a thorough insight into the literature available, bearing in mind the difficulties involved in the studies. Frequent comorbidities and mutual relationships between the elements in question are just some of the complications in the study of this topic.
Topics: Alcoholism; Biomarkers; Brain; Copper; Disease Susceptibility; Energy Metabolism; Humans; Iron; Liver; Magnesium; Manganese; Organ Specificity
PubMed: 30959950
DOI: 10.3390/molecules24071361 -
Paediatric Anaesthesia Jul 2020Infantile hypertrophic pyloric stenosis (IHPS) leads to excessive vomiting and metabolic alkalosis, which may subsequently cause apnea. Although it is generally assumed... (Review)
Review
BACKGROUND
Infantile hypertrophic pyloric stenosis (IHPS) leads to excessive vomiting and metabolic alkalosis, which may subsequently cause apnea. Although it is generally assumed that metabolic derangements should be corrected prior to surgery to prevent apnea, the exact incidence of perioperative apneas in infants with IHPS and the association with metabolic alkalosis are unknown. We performed this systematic review to assess the incidence of apnea in infants with IHPS and to verify the possible association between apnea and metabolic alkalosis.
METHODS
We searched MEDLINE, Embase, and Cochrane library to identify studies regarding infants with metabolic alkalosis, respiratory problems, and hypertrophic pyloric stenosis. We conducted a descriptive synthesis of the findings of the included studies.
RESULTS
Thirteen studies were included for analysis. Six studies described preoperative apnea, three studies described postoperative apnea, and four studies described both. All studies were of low quality or had other research questions. We found an incidence of 27% of preoperative and 0.2%-16% of postoperative apnea, respectively. None of the studies examined the association between apnea and metabolic alkalosis in infants with IHPS.
CONCLUSIONS
Infants with IHPS may have a risk to develop perioperative apnea. However, the incidence rates should be interpreted with caution because of the low quality and quantity of the studies. Therefore, further studies are required to determine the incidence of perioperative apnea in infants with IHPS. The precise underlying mechanism of apnea in these infants is still unknown, and the role of metabolic alkalosis should be further evaluated.
Topics: Apnea; Humans; Incidence; Infant; Pyloric Stenosis, Hypertrophic
PubMed: 32298502
DOI: 10.1111/pan.13879 -
The International Journal of Eating... Mar 2016Eating disorders that are associated with purging behaviors are complicated by frequent blood electrolyte and acid-base abnormalities. Herein, we review the major... (Review)
Review
OBJECTIVE
Eating disorders that are associated with purging behaviors are complicated by frequent blood electrolyte and acid-base abnormalities. Herein, we review the major electrolyte and acid-base abnormalities and their treatment methods. The body of rigorous, eating disorder-specific literature on this topical area is not robust enough to perform a systematic review as defined by PRISMA guidelines. Therefore, a qualitative review of mostly medical literature was conducted.
RESULTS
Hypokalemia, hyponatremia, and sodium chloride-responsive metabolic alkalosis are the most common serum changes that occur as a result of purging behaviors. They vary depending on the mode and frequency of purging behaviors. They can all potentially cause dangerous medical complications and are in need of definitive medical treatment.
DISCUSSION
Eating disorders that are associated with purging behaviors are associated with a number of electrolyte and acid-base changes which are complex in their origin, documented to be medically dangerous and this definitive treatment is necessary to help achieve a successful treatment outcome, and in need of definitive treatment as described herein.
Topics: Alkalosis; Electrolytes; Feeding and Eating Disorders; Humans; Hypokalemia; Hyponatremia
PubMed: 26876281
DOI: 10.1002/eat.22503 -
Journal of Sports Sciences Apr 2019The aim of this study was to perform a systematic review and meta-analysis on the acute and chronic effects of sodium bicarbonate (NaHCO) ingestion on Wingate... (Meta-Analysis)
Meta-Analysis
The aim of this study was to perform a systematic review and meta-analysis on the acute and chronic effects of sodium bicarbonate (NaHCO) ingestion on Wingate performance. Following a search through PubMed, Scopus and Web of Science, 9 studies were found meeting inclusion criteria (6 acute and 3 chronic). Random-effects meta-analysis of standardized mean difference (SMD) for peak and mean power was performed. Study quality was assessed using the QualSyst. Results of the meta-analysis showed that acute ingestion of NaHCO did not improve Wingate test peak (weighted average effect size Hedges's g = 0.02, 95%CI: - 0.19 to 0.23, P = 0.87) or mean power (weighted average effect size Hedges's g = 0.15, 95%CI: -0.06 to 0.36, P = 0.92). However, chronic ingestion of NaHCO improved Wingate test peak (weighted average effect size Hedges's g = 1.21, 95%CI: 0.83 to 1.42, P = 0.001) and mean power (weighted average effect size Hedges's g = 1.26, 95%CI: 0.96 to 1.56, P = 0.001). Quality assessment of selected articles was classified as strong. This meta-analysis provides evidence that chronic, but not acute, ingestion of NaHCO increases both Wingate test peak and mean power.
Topics: Acidosis; Administration, Oral; Athletic Performance; Drug Administration Schedule; Energy Metabolism; Exercise Test; Humans; Muscle Fatigue; Sodium Bicarbonate
PubMed: 30319077
DOI: 10.1080/02640414.2018.1524739 -
Journal of Critical Care Oct 2016The concept of fluid resuscitation with balanced solutions containing acetate is relatively new. The knowledge about acetate mostly originates from nephrological... (Review)
Review
INTRODUCTION
The concept of fluid resuscitation with balanced solutions containing acetate is relatively new. The knowledge about acetate mostly originates from nephrological research, as acetate was primarily used as a dialysis buffer where much higher doses of acetate are infused. The aim of this review is to give an overview of the advantages and disadvantages of an acetate-buffered crystalloid fluid when compared with other crystalloid infusates.
METHODS
We report trials with the primary object of comparing an acetate-buffered infusion solute to another crystalloid infusate. A systematic literature search of MEDLINE and the Cochrane Controlled Clinical trials register was conducted to identify suitable studies.
RESULTS
The search strategy used produced 1205 potential titles. After eliminating doubles, 312 titles and abstracts were screened, and 31 references were retrieved for full-text analysis. A total of 27 scientific studies were included in the study.
CONCLUSION
Acetate-buffered crystalloid solutes do have a favorable influence on microcirculation. To what extent the acetate-buffered crystalloids influence kidney function is controversially discussed and not yet clear. Metabolic alkalosis did not occur in a single study in humans after an acetate-buffered infusate; potassium levels stayed stable in all studies. Cardiac output and contractility seem to be positively influenced; nonetheless, data on maintenance of a target blood pressure remain inconclusive. Whether acetate-buffered crystalloid fluids lead to lower rates of acute kidney injury and increased survival when compared with normal saline is yet unclear and may depend on the amount of fluid administered.
Topics: Acetates; Buffers; Critical Care; Crystalloid Solutions; Fluid Therapy; Humans; Isotonic Solutions; Shock, Septic
PubMed: 27481742
DOI: 10.1016/j.jcrc.2016.05.006 -
Aviation, Space, and Environmental... Oct 2012Unpressurized aircraft routinely operate at altitudes where hypoxia may be of concern. A systematic literature review was conducted regarding hypoxic impairment,... (Review)
Review
Unpressurized aircraft routinely operate at altitudes where hypoxia may be of concern. A systematic literature review was conducted regarding hypoxic impairment, including mental functions, sensory deficits, and other pertinent research findings that may affect aviation-related duties at moderate altitude (8000 to 15,000 ft/2438 to 4572 m). The results of this review suggest that cognitive and psychomotor deficits may include learning, reaction time, decision-making, and certain types of memory. However, results are difficult to quantify and reliably reproduce. Inconsistency of results may be related to the subtlety of deficits compared to high altitude, differences among individual compensatory mechanisms, variation in methodology or sensitivity of metrics, presence or absence of exercise, heterogeneous neuronal central nervous system (CNS) response, and interindividual variation. Literature regarding hypoxic visual decrements is more consistent. Rod photoreceptors are more susceptible to hypoxia; visual degradation has been demonstrated at 4000 to 5000 ft (1219 to 1524 m) under scotopic and 10,000 ft (3048 m) under photopic conditions. Augmented night vision goggle resolution demonstrates more resilience to mild hypoxic effects than the unaided eye under starlight conditions. Hypocapnia enhances visual sensitivity and contrast discrimination. Hyperventilation with resulting respiratory alkalosis and cerebral vasoconstriction may confound both cognitive/ psychomotor and visual experimental results. Future research should include augmentation of validated neuropsychological metrics (surrogate investigational end points) with actual flight metrics, investigation of mixed gas formulations, contribution of hypocapnic vasoconstrictive effects on hypoxic performance, and further investigation into cellular- and systems-level approaches for heterogeneous CNS response. Research is also required into the contribution of mild-moderate hypoxia in human factors- and spatial disorientation-related mishaps.
Topics: Aerospace Medicine; Altitude; Cognition Disorders; Humans; Hyperventilation; Hypocapnia; Hypoxia; Psychomotor Performance; Reproducibility of Results; Vision Disorders
PubMed: 23066620
DOI: 10.3357/asem.3315.2012 -
Pediatric Nephrology (Berlin, Germany) Jun 2014Cystic fibrosis per se can sometimes lead to hyponatremia, hypokalemia, hypochloremia or hyperbicarbonatemia. This tendency was first documented 60 years ago and has... (Review)
Review
BACKGROUND
Cystic fibrosis per se can sometimes lead to hyponatremia, hypokalemia, hypochloremia or hyperbicarbonatemia. This tendency was first documented 60 years ago and has subsequently been confirmed in single case reports or small case series, most of which were retrospective. However, this issue has not been addressed analytically. We have therefore systematically reviewed and analyzed the available literature on this subject.
METHODS
This was a systematic review of the literature.
RESULTS
The reports included in this review cover 172 subacute and 90 chronic cases of electrolyte imbalances in patients with cystic fibrosis. The male:female ratio was 1.57. Electrolyte abnormalities were mostly associated with clinically inapparent fluid volume depletion, mainly affected patients aged ≤2.5 years, frequently tended to recur and often were found before the diagnosis of cystic fibrosis was established. Subacute presentation often included an history of heat exposure, vomiting, excessive sweating and pulmonary infection. History of chronic presentation, in contrast, was often inconspicuous. The tendency to hypochloremia, hypokalemia and metabolic alkalosis was similar between subacute and chronic patients, with hyponatremia being more pronounced (P < 0.02) in subacute compared to chronic presentations. Subacute cases were treated parenterally; chronic ones were usually managed with oral salt supplementation. Retention of urea and creatinine was documented in 38 % of subacute cases.
CONCLUSIONS
The findings of our review suggest that physicians should be aware that electrolyte abnormalities can occur both as a presenting and a recurring feature of cystic fibrosis.
Topics: Child; Cystic Fibrosis; Female; Humans; Male; Water-Electrolyte Balance; Water-Electrolyte Imbalance
PubMed: 24326787
DOI: 10.1007/s00467-013-2712-4 -
American Journal of Kidney Diseases :... Jun 2012Anticoagulation of the extracorporeal circuit is required in continuous renal replacement therapy (CRRT). Heparin is the classic choice for anticoagulation, although it... (Comparative Study)
Comparative Study Meta-Analysis Review
BACKGROUND
Anticoagulation of the extracorporeal circuit is required in continuous renal replacement therapy (CRRT). Heparin is the classic choice for anticoagulation, although it may increase the risk of bleeding. Regional citrate anticoagulation reduces the risk of bleeding, but may cause hypocalcemia and metabolic disturbances.
STUDY DESIGN
Systematic review and meta-analysis of randomized controlled trials (RCTs).
SETTING & POPULATION
Patients admitted to the intensive care unit with acute kidney injury that required CRRT.
SELECTION CRITERIA FOR STUDIES
RCTs regardless of publication status or language.
INTERVENTION
Regional citrate versus heparin anticoagulation in CRRT.
OUTCOMES
The primary outcomes were circuit survival time, the occurrence of major bleeding defined as a site of gross bleeding with a decrease in blood pressure or requiring transfusion of 2 or more units of red blood cells, metabolic alkalosis, hypocalcemia, and thrombocytopenia. The secondary outcome was cost.
RESULTS
6 RCTs with 488 patients were identified. Citrate anticoagulation was associated with a significant decrease in bleeding (RR, 0.34; 95% CI, 0.17-0.65). Circuit survival time, the incidence of metabolic alkalosis, and thrombocytopenia showed no significant difference between groups. Hypocalcemia was more common in patients receiving citrate, although no clinical adverse event was reported in the included studies.
LIMITATIONS
Significant heterogeneity in the primary outcome.
CONCLUSION
The efficacy of citrate and heparin anticoagulation for CRRT was similar. However, citrate anticoagulation decreased the risk of bleeding with no significant increase in the incidence of metabolic alkalosis. We recommend citrate as an anticoagulation agent in patients who require CRRT but are at high risk of bleeding.
Topics: Acute Kidney Injury; Anticoagulants; Citrates; Critical Illness; Female; Hemorrhage; Heparin; Hospital Mortality; Humans; Intensive Care Units; Male; Prognosis; Randomized Controlled Trials as Topic; Renal Replacement Therapy; Risk Assessment; Survival Rate; Thrombosis; Treatment Outcome
PubMed: 22226564
DOI: 10.1053/j.ajkd.2011.11.030 -
Intensive Care Medicine Jan 2012Regional citrate anticoagulation (RCA) is an attractive anticoagulation mode in continuous renal replacement therapy (CRRT) because it restricts the anticoagulatory... (Review)
Review
PURPOSE
Regional citrate anticoagulation (RCA) is an attractive anticoagulation mode in continuous renal replacement therapy (CRRT) because it restricts the anticoagulatory effect to the extracorporeal circuit. In recent years, several randomized controlled trials have been conducted to investigate its superiority over other anticoagulation modes. Thus, we performed a systematic review of available evidence on the efficacy and safety of RCA.
METHODS
A systematic review of randomized controlled trials investigating the efficacy and safety of RCA was performed. PubMed, Current Contents, CINAHL, and EMBASE databases were searched to identify relevance articles. Data on circuit life span, bleeding events, metabolic derangement, and mortality were abstracted. Mean difference was used for continuous variables, and risk ratio was used for binomial variables. The random effects or fixed effect model was used to combine these data according to heterogeneity. The software Review Manager 5.1 was used for the meta-analysis.
RESULTS
Six studies met our inclusion criteria, which involved a total of 658 circuits. In these six studies patients with liver failure or a high risk of bleeding were excluded. The circuit life span in the RCA group was significantly longer than that in the control group, with a mean difference of 23.03 h (95% CI 0.45-45.61 h). RCA was able to reduce the risk of bleeding, with a risk ratio of 0.28 (95% CI 0.15-0.50). Metabolic stability (electrolyte and acid-base stabilities) in performing RCA was comparable to that in other anticoagulation modes, and metabolic derangements (hypernatremia, metabolic alkalosis, and hypocalcemia) could be easily controlled without significant clinical consequences. Two studies compared mortality rate between RCA and control groups, with one reported similar mortality rate and the other reported superiority of RCA over the control group (hazards ratio 0.7).
CONCLUSIONS
RCA is effective in maintaining circuit patency and reducing the risk of bleeding, and thus can be recommended for CRRT if and when metabolic monitoring is adequate and the protocol is followed. However, the safety of citrate in patients with liver failure cannot be concluded from current analysis. The metabolic stability can be easily controlled during RCA. Survival benefit from RCA is still controversial due to limited evidence.
Topics: Anticoagulants; Blood Coagulation; Citrates; Critical Illness; Female; Humans; Intensive Care Units; Male; Randomized Controlled Trials as Topic; Renal Replacement Therapy; Treatment Outcome
PubMed: 22124775
DOI: 10.1007/s00134-011-2438-3 -
European Journal of Sport Science Jun 2023This study aimed to investigate the isolated effects of NaHCO on cycling time-trial performance. Furthermore, we investigated whether the ingestion time of NaHCO,... (Meta-Analysis)
Meta-Analysis
This study aimed to investigate the isolated effects of NaHCO on cycling time-trial performance. Furthermore, we investigated whether the ingestion time of NaHCO, standardized or individualized based on time to peak, could be effective in improving cycling time-trial performance. A systematic review was carried out on randomized placebo-controlled studies. A random-effects meta-analysis assessed the standardized mean difference (SMD) between NaHCO and placebo conditions. Eighteen studies were qualitatively (systematic review) and quantitatively (meta-analysis) analysed concerning mean power output (W) ( = 182) and time performance ( = 201). The reviewed studies showed a low risk of bias and homogenous results for W (I = 0%) and performance time (I= 0%). Overall, when compared to placebo, the NaHCO ingestion improved the W (SMD: 0.42; 95% CI: 0.21-0.63; = 0.001) and performance time (SMD: 0.22; 95% CI: 0.02-0.43; = 0.03). Similarly, the NaHCO ingestion using a time-to-peak strategy improved the W (SMD: 0.39; 95% CI: 0.03-0.75; = 0.04; I= 15%) and performance time (SMD: 0.34; 95% CI: 0.07-0.61, = 0.01, I= 0%). The present findings reveal that NaHCO ingestion has the potential to increase the overall performance time and W in cycling time trials.NaHCO is an effective strategy to increase cycling time-trial performance.The standardized protocol did not improve the cycling time-trial performance parameters.The individualized time-to-peak NaHCO ingestion has a positive effect on time and W during cycling time-trial performance.
Topics: Humans; Sodium Bicarbonate; Randomized Controlled Trials as Topic; Bicycling; Eating
PubMed: 35633035
DOI: 10.1080/17461391.2022.2071171