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Open Heart Oct 2021
Topics: Acidosis; Cardiovascular Diseases; Chronic Disease; Humans; Public Health; Severity of Illness Index
PubMed: 34702776
DOI: 10.1136/openhrt-2021-001730 -
Journal of Medical Toxicology :... Apr 2022Severe metabolic acidosis with elevated anion and osmol gap is suggestive of toxic alcohol ingestion. The absence of detectable methanol or ethylene glycol in the serum...
INTRODUCTION
Severe metabolic acidosis with elevated anion and osmol gap is suggestive of toxic alcohol ingestion. The absence of detectable methanol or ethylene glycol in the serum could mean that metabolism is complete or that other hypotheses have to be considered. Ingestion of less common alcohol or alcoholic ketoacidosis should be investigated as illustrated by the present observation.
CASE REPORT
A 46-year-old woman was admitted with altered consciousness in the Emergency Department. In the presence of a high anion gap (peak value 39 mEq/L) metabolic acidosis with mildly increased osmol gap (peak value 19 mOsm/kg), there was a high suspicion of toxic alcohol ingestion in an individual with alcohol use disorder (AUD). Serum arterial lactate concentration was particularly high at 27 mmol/L. Urinalysis failed to reveal the presence of ketone bodies or oxalate crystals. The results of the serum determination of ethanol, methanol, ethylene glycol, and isopropanol were obtained within 2 h and were negative. Due to the severity of lactic metabolic acidosis and the persisting suspicion of intoxication by a less common toxic alcohol, antidotal therapy with ethanol was initiated together with hemodialysis. Correction of lactic metabolic acidosis was obtained. Results of urinalysis obtained later revealed the presence not only of propylene glycol and D-lactate but also of significant concentrations of ß-hydroxybutyrate as a marker of alcoholic ketoacidosis.
DISCUSSION
The combination of propylene glycol ingestion and alcoholic ketoacidosis may have contributed to the severity of lactic acidosis.
Topics: Acidosis; Acidosis, Lactic; Ethanol; Ethylene Glycol; Female; Humans; Ketosis; Lactic Acid; Methanol; Middle Aged; Propylene Glycol
PubMed: 35043364
DOI: 10.1007/s13181-022-00876-5 -
Indian Journal of Pediatrics Feb 2023Extremely preterm neonates (< 28 wk) are at risk of metabolic complications like hypocalcemia, hypophosphatemia, hyponatremia, and metabolic acidosis. Many of these...
Extremely preterm neonates (< 28 wk) are at risk of metabolic complications like hypocalcemia, hypophosphatemia, hyponatremia, and metabolic acidosis. Many of these complications are often the result of prematurity per se, while some of them may be the result of prolonged parenteral nutrition. Most of the complications occur in the initial few weeks of hospital stay, but hyponatremia, hypocalcemia, and hypophosphatemia may persist for longer periods of time. Optimizing enteral nutrition along with fortification helps in promoting optimal growth and overcoming the aforementioned problems. The authors report one such extremely preterm neonate with hyperchloremic metabolic acidosis, the cause of which is uncommon and not reported previously in the literature.
Topics: Infant, Newborn; Humans; Infant, Extremely Premature; Hyponatremia; Hypocalcemia; Hypophosphatemia; Acidosis; Anions
PubMed: 36482234
DOI: 10.1007/s12098-022-04402-x -
Canadian Journal of Anaesthesia =... Mar 2009Metabolic acid-base disorders are common in critically ill patients. Clinicians may have difficulty recognizing their presence when multiple metabolic acid-base... (Review)
Review
PURPOSE
Metabolic acid-base disorders are common in critically ill patients. Clinicians may have difficulty recognizing their presence when multiple metabolic acid-base derangements are present in a single patient. Clinicians should be able to identify the components of complex metabolic acid-base disorders since metabolic acidoses due to unmeasured anions are associated with increased mortality in critically ill patients. This review presents the derivation of three commonly used methods of acid-base analysis, which include the anion gap, Stewart physiochemical, and modified base excess. Clinical examples are also provided to demonstrate the subtleties of the different methods and to demonstrate their application to real patient data.
PRINCIPAL FINDINGS
A comparison of these methods shows that each one is equally adept at identifying a metabolic acidosis due to unmeasured anions; however, the Stewart physiochemical and the modified base excess methods better evaluate complex metabolic acid-base disorders.
CONCLUSIONS
While all three methods correctly identify metabolic acidosis due to unmeasured anions, which is a predictor of mortality, it remains unclear if further delineation of complex metabolic acid-base disorders using the Stewart physiochemical or the modified base excess methods is clinically beneficial.
Topics: Acid-Base Equilibrium; Acid-Base Imbalance; Acidosis; Algorithms; Anions; Critical Illness; Humans; Reference Standards
PubMed: 19247746
DOI: 10.1007/s12630-008-9037-y -
Kidney International. Supplement May 1998There is growing interest in quantitative physical chemical analysis of acid-base physiology among intensivists. Acid-base dilemmas seen in the intensive care unit are... (Review)
Review
There is growing interest in quantitative physical chemical analysis of acid-base physiology among intensivists. Acid-base dilemmas seen in the intensive care unit are not always well addressed by the traditional approaches. Quantitative physical chemical analysis also allows for the exploration of unexplained anion-induced acidosis where the familiar anion gap is insufficient or inaccurate. This approach emphasizes the application of accepted physical chemical principles and identification of independent and dependent acid-base variables. In aqueous solutions, water dissociation is the major source of free hydrogen ions.
Topics: Acid-Base Equilibrium; Acidosis; Acidosis, Lactic; Carbon Dioxide; Chemical Phenomena; Chemistry, Physical; Critical Illness; Humans; Hydrogen-Ion Concentration; Lactic Acid; Solutions; Water
PubMed: 9573580
DOI: No ID Found -
The Veterinary Clinics of North... May 2008This article serves as a quick reference for metabolic acidosis. Guidelines for analysis and causes, signs, and a stepwise approach are presented. (Review)
Review
This article serves as a quick reference for metabolic acidosis. Guidelines for analysis and causes, signs, and a stepwise approach are presented.
Topics: Acidosis; Animals; Blood Gas Analysis; Carbonates; Hydrogen-Ion Concentration; Partial Pressure; Reference Values
PubMed: 18402865
DOI: 10.1016/j.cvsm.2008.01.019 -
Heart & Lung : the Journal of Critical... 2020The use of sodium bicarbonate in the treatment of metabolic acidosis in critically ill subjects has long been a subject of debate. Despite empiric use in the setting of... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
The use of sodium bicarbonate in the treatment of metabolic acidosis in critically ill subjects has long been a subject of debate. Despite empiric use in the setting of severe acidemia in critically ill patients, there is little data looking into the role of sodium bicarbonate in the treatment of severe metabolic acidosis in the intensive care unit (ICU) setting.
METHODS
We conducted a comprehensive search of Pubmed and Cochrane Central Register of Controlled Trials addressing bicarbonate use in the metabolic acidosis in the intensive care unit (ICU) setting. We examined mortality as end point. Pooled odds ratios (OR) and their 95% confidence intervals (CI) were calculated for all outcomes using a random-effect model.
RESULTS
The final search yielded 202 articles of which all were screened individually. A total of 11 studies were identified but 6 studies were excluded due to irrelevance in mortality outcome and methodology. Analysis was done separately for observational studies and randomized controlled trials. The pooled OR [95% CI] for mortality with bicarbonate use in the observational studies was 1.5 [0.62-3.67] with heterogeneity of 67%, while pooled OR for mortality in the randomized trials was 0.72 [0.49-1.05] (figure 2). In combining all studies, the pooled odds ratio was 0.93 95% [0.69-1.25] but with heterogeneity of 63%. After sensitivity analysis with removing the study done by Kim et al. 2013, heterogeneity was 0% with OR 0.8 [0.59-1.10].
CONCLUSION
There is no significant difference in mortality in the use of bicarbonate among critically ill patients with high anion gap metabolic acidosis predominantly driven by lactic acidosis.
Topics: Acidosis; Critical Illness; Humans; Intensive Care Units; Randomized Controlled Trials as Topic; Sodium Bicarbonate
PubMed: 31733880
DOI: 10.1016/j.hrtlng.2019.10.007 -
Nephrology, Dialysis, Transplantation :... Nov 2016Metabolic acidosis is common in advanced chronic kidney disease and has been associated with a range of physiological derangements of importance to the health of older... (Review)
Review
Metabolic acidosis is common in advanced chronic kidney disease and has been associated with a range of physiological derangements of importance to the health of older people. These include associations with skeletal muscle weakness, cardiovascular risk factors, and bone and mineral disorders that may lead to fragility fractures. Although metabolic acidosis is associated with accelerated decline in kidney function, end-stage renal failure is a much less common outcome in older, frail patients than cardiovascular death. Correction of metabolic acidosis using bicarbonate therapy is commonly employed, but the existing evidence is insufficient to know whether such therapy is of net benefit to older people. Bicarbonate is bulky and awkward to take, may impose additional sodium load with effects on fluid retention and blood pressure, and may cause gastrointestinal side effects. Trial data to date suggest potential benefits of bicarbonate therapy on progression of renal disease and nutrition, but trials have not as yet been published examining the effect of bicarbonate therapy across a range of domains relevant to the health of older people. Fortunately, a number of trials are now underway that should allow us to ascertain whether bicarbonate therapy can improve physical function, quality of life, and vascular, bone and kidney health in older people, and hence decide whether any benefits seen outweigh adverse effects and additional treatment burden in this vulnerable group of patients.
Topics: Acidosis; Disease Progression; Humans; Renal Insufficiency, Chronic
PubMed: 26420895
DOI: 10.1093/ndt/gfv344 -
The American Journal of Case Reports Jan 2022BACKGROUND Chronic acetaminophen toxicity has been known to cause an anion gap metabolic acidosis (AGMA) due to accumulation of 5-oxoproline metabolites. This diagnosis... (Review)
Review
BACKGROUND Chronic acetaminophen toxicity has been known to cause an anion gap metabolic acidosis (AGMA) due to accumulation of 5-oxoproline metabolites. This diagnosis requires a high index of suspicion when evaluating a patient with AGMA as occasional acetaminophen use is very common among patients, whom oftentimes are not entirely truthful about the extent of ingestion and have multiple comorbid conditions complicating diagnosis. CASE REPORT A 68-year-old male with multiple medical comorbidities presented to the emergency room with recurrent generalized weakness. On all occasions the patient denies focal weakness or infectious symptoms. The patient also denies ingestions other than his routine prescribed medications, including acetaminophen 325mg as needed, which he describes taking "a couple times" a day. His prior visits were notable for profound anion-gap metabolic acidosis, hypernatremia, acute kidney injury, and positive urine ketones. As the patient's blood urea nitrogen (BUN), blood sugar, liver function tests, lactic acid, and serum osmolality were normal, the patient received a diagnosis of "starvation ketosis" and received supportive care each time. Further investigation at his final admission revealed an extremely elevated 5-oxoproline level revealing a delayed diagnosis of chronic acetaminophen toxicity CONCLUSIONS This report emphasizes the need for a high index of suspicion related to chronic acetaminophen toxicity and other ingestions contributing to a metabolic acidosis in at-risk populations, even when routine history is unrevealing. Furthermore, severe acidosis should prompt more extensive investigation when out of proportion to obvious routine etiologies.
Topics: Acetaminophen; Acid-Base Equilibrium; Acidosis; Aged; Analgesics, Non-Narcotic; Humans; Ketosis; Male
PubMed: 35034948
DOI: 10.12659/AJCR.934410 -
Clinical Journal of the American... Aug 2019
Topics: Acidosis; Female; Humans; Middle Aged; Renal Insufficiency, Chronic
PubMed: 31018936
DOI: 10.2215/CJN.00600119