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Journal of the American Society of... Sep 2009
Topics: Acidosis; Animals; Disease Progression; Humans; Renal Insufficiency, Chronic
PubMed: 19696222
DOI: 10.1681/ASN.2009070710 -
Critical Care (London, England) 2006In the critically ill, metabolic acidosis is a common observation and, in clinical practice, the cause of this derangement is often multi-factorial. Various measures are... (Review)
Review
In the critically ill, metabolic acidosis is a common observation and, in clinical practice, the cause of this derangement is often multi-factorial. Various measures are often employed to try and characterise the aetiology of metabolic acidosis, the most popular of which is the anion gap. The purpose of the anion gap can be perceived as a means by which the physician is alerted to the presence of unmeasured anions in plasma that contribute to the observed acidosis. In many cases, the causative ion may be easily identified, such as lactate, but often the causative ion(s) remain unidentified, even after exclusion of the 'classic' causes. We describe here the various attempts in the literature that have been made to address this observation and highlight recent studies that reveal potential sources of such hitherto unmeasured anions.
Topics: Acidosis; Animals; Anions; Humans
PubMed: 16879718
DOI: 10.1186/cc4954 -
Kidney International. Supplement Oct 1997Based on work performed in many laboratories including our own, we suggest the following schematic shown in Figure 4 to explain metabolic acidosis and the effects of... (Review)
Review
Based on work performed in many laboratories including our own, we suggest the following schematic shown in Figure 4 to explain metabolic acidosis and the effects of alkalinization therapy. Metabolic acidosis induces prompt and substantial decreases in cardiac functional performance. This is mediated by an intracellular acidosis which impairs cardiac function directly as well as leads to an impairment of cardiac energy metabolism which further impairs cardiac function. Attempts to alkalinize the cell with sodium bicarbonate therapy lead to a paradoxical intracellular acidosis and further impairment of cardiac function, whereas Carbicarb may correct the intracellular acidosis and improve physiological function. However, at the time which this paper was written, Carbicarb was not available for clinical use in the United States.
Topics: Acidosis; Animals; Carbonates; Drug Combinations; Energy Metabolism; Heart; Humans; Sodium Bicarbonate
PubMed: 9328965
DOI: No ID Found -
Medicina Clinica Apr 2022
Topics: Acidosis; Alcoholism; Diabetic Ketoacidosis; Humans; Ketosis
PubMed: 34465450
DOI: 10.1016/j.medcli.2021.06.020 -
American Family Physician Apr 1989Determining the cause of metabolic acidosis with a high anion gap may present a diagnostic challenge. Possible causes include ketoacidosis, certain toxic ingestions,... (Review)
Review
Determining the cause of metabolic acidosis with a high anion gap may present a diagnostic challenge. Possible causes include ketoacidosis, certain toxic ingestions, renal failure and lactic acidosis. Many of these entities present with nausea, vomiting and changes in mental status; however, there are specific hallmarks in the signs, symptoms and laboratory findings that help to differentiate among them.
Topics: Acid-Base Equilibrium; Acidosis; Acute Kidney Injury; Adult; Diagnosis, Differential; Humans; Ketosis; Male; Poisoning
PubMed: 2650500
DOI: No ID Found -
Annals of Neurology Jan 2021
Topics: Acidosis; Basal Ganglia; Brain; Brain Diseases, Metabolic; Humans; Male; Middle Aged
PubMed: 32893882
DOI: 10.1002/ana.25896 -
Human & Experimental Toxicology Jun 19961. A chronic alcoholic with severe metabolic acidosis presents a difficult diagnostic problem. The most common cause is alcoholic ketoacidosis, a syndrome with a typical... (Comparative Study)
Comparative Study Review
1. A chronic alcoholic with severe metabolic acidosis presents a difficult diagnostic problem. The most common cause is alcoholic ketoacidosis, a syndrome with a typical history but often misleading laboratory findings. This paper will focus on this important and probably underdiagnosed syndrome. 2. The disorder occurs in alcoholics who have had a heavy drinking-bout culminating in severe vomiting, with resulting dehydration, starvation, and then a beta-hydroxybutyrate dominated ketoacidosis. 3. Awareness of this syndrome, thorough history-taking, physical examination and routine laboratory analyses will usually lead to a correct diagnosis. 4. The treatment is simply replacement of fluid, glucose, electrolytes and thiamine. Insulin or alkali should be avoided. 5. The most important differential diagnoses are diabetic ketoacidosis, lactic acidosis and salicylate, methanol or ethylene glycol poisoning, conditions which require quite different treatment. 6. The diagnostic management of unclear cases should always include toxicological tests, urine microscopy for calcium oxalate crystals and calculation of the serum anion and osmolal gaps. 7. It is suggested here, however, that the value of the osmolal gap should be considered against a higher reference limit than has previously been recommended. An osmolal gap above 25 mosm/kg, in a patient with an increased anion gap acidosis, is a strong indicator of methanol or ethylene glycol intoxication.
Topics: Acidosis; Alcoholism; Diagnosis, Differential; Fluid Therapy; Humans
PubMed: 8793530
DOI: 10.1177/096032719601500604 -
Journal of Cardiothoracic and Vascular... Feb 2022
Topics: Acidosis; Cardiac Surgical Procedures; Heart; Humans; Sodium Bicarbonate
PubMed: 34776352
DOI: 10.1053/j.jvca.2021.10.021 -
Critical Care Medicine May 2004
Review
Topics: Acid-Base Equilibrium; Acidosis; Critical Care; Humans; Multivariate Analysis; Prognosis; ROC Curve; Reproducibility of Results; Survival Analysis
PubMed: 15190979
DOI: 10.1097/01.ccm.0000125513.26170.d2 -
American Journal of Kidney Diseases :... Feb 2014Metabolic acidosis is a common complication of chronic kidney disease and is believed to contribute to a number of sequelae, including bone disease, altered protein... (Review)
Review
Metabolic acidosis is a common complication of chronic kidney disease and is believed to contribute to a number of sequelae, including bone disease, altered protein metabolism, skeletal muscle wasting, and progressive glomerular filtration rate loss. Small trials in animal models and humans suggest a role for alkali therapy to lessen these complications. Recent studies support this notion, although more definitive evidence is needed on the long-term benefits of alkali therapy and the optimal serum bicarbonate level. The role of dietary modification also should be given greater consideration. In addition, potential adverse effects of alkali treatment must be taken into consideration, including sodium retention and the theoretical concern of promoting vascular calcification. This teaching case summarizes the rationale for and benefits and complications of base therapy in patients with chronic kidney disease.
Topics: Acidosis; Animals; Feeding Behavior; Humans; Male; Middle Aged; Renal Insufficiency, Chronic; Treatment Outcome
PubMed: 23932089
DOI: 10.1053/j.ajkd.2013.06.017