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Nutrients Nov 2020Metabolic alkalosis may develop as a consequence of urinary chloride (and sodium) wasting, excessive loss of salt in the sweat, or intestinal chloride wasting, among...
Metabolic alkalosis may develop as a consequence of urinary chloride (and sodium) wasting, excessive loss of salt in the sweat, or intestinal chloride wasting, among other causes. There is also a likely underrecognized association between poor salt intake and the mentioned electrolyte and acid-base abnormality. In patients with excessive loss of salt in the sweat or poor salt intake, the maintenance of metabolic alkalosis is crucially modulated by the chloride-bicarbonate exchanger pendrin located on the renal tubular membrane of type B intercalated cells. In the late 1970s, recommendations were made to decrease the salt content of foods as part of an effort to minimize the tendency towards systemic hypertension. Hence, the baby food industry decided to remove added salt from formula milk. Some weeks later, approximately 200 infants (fed exclusively with formula milks with a chloride content of only 2-4 mmol/L), were admitted with failure to thrive, constipation, food refusal, muscular weakness, and delayed psychomotor development. The laboratory work-up disclosed metabolic alkalosis, hypokalemia, hypochloremia, and a reduced urinary chloride excretion. In all cases, both the clinical and the laboratory features remitted in ≤7 days when the infants were fed on formula milk with a normal chloride content. Since 1982, 13 further publications reported additional cases of dietary chloride depletion. It is therefore concluded that the dietary intake of chloride, which was previously considered a "mendicant" ion, plays a crucial role in acid-base and salt balance.
Topics: Acid-Base Imbalance; Adult; Chlorides; Dietary Supplements; Humans; Infant; Infant Formula; Syndrome; Water-Electrolyte Imbalance
PubMed: 33182508
DOI: 10.3390/nu12113436 -
Pediatric Research Jul 2021Congenital chloride diarrhea (CLD) is a rare autosomal recessive disorder characterized by watery diarrhea with a high level of fecal Cl, metabolic alkalosis, and...
INTRODUCTION
Congenital chloride diarrhea (CLD) is a rare autosomal recessive disorder characterized by watery diarrhea with a high level of fecal Cl, metabolic alkalosis, and electrolyte alterations. Several intestinal and extraintestinal complications and even death can occur. An optimal knowledge of the clinical features and best therapeutic strategies is mandatory for an effective management.
METHODS
Articles published between 1 January 1965 and 31 December 2019, reported in PUBMED and EMBASE, were evaluated for a systematic review analyzing four categories: anamnestic features, clinical features, management, and follow-up strategies.
RESULTS
Fifty-seven papers reporting information on 193 CLD patients were included. The most common anamnestic features were positive family anamnesis for chronic diarrhea (44.4%), consanguinity (75%), polyhydramnios (98.3%), preterm delivery (78.6%), and failure to pass meconium (60.7%). Mean age at diarrhea onset was 6.63 days. Median diagnostic delay was 60 days. Prenatal diagnosis, based on molecular analysis, was described in 40/172 (23.3%). All patients received NaCl/KCl-substitutive therapy. An improvement of diarrhea during adulthood was reported in 91.3% of cases. Failure to thrive (21.6%) and chronic kidney disease (17.7%) were the most common complications.
CONCLUSIONS
This analysis of a large population suggests the necessity of better strategies for the management of CLD. A close follow-up and a multidisciplinary approach is mandatory to manage this condition characterized by heterogeneous and multisystemic complications.
IMPACT
In this systematic review, we describe data regarding anamnestic features, clinical features, management, and follow-up of CLD patients obtained from the largest population of patients ever described to date. The results of our investigation could provide useful insights for the diagnostic approach and the management of this condition.
Topics: Diarrhea; Feces; Humans; Infant, Newborn; Meconium; Metabolism, Inborn Errors; Mutation, Missense
PubMed: 33173177
DOI: 10.1038/s41390-020-01251-2 -
Journal of Dietary Supplements 2021The aim of this systematic review was to investigate the effects of sodium bicarbonate supplementation on electromyographic (EMG) muscle activity in healthy, physically...
AIM
The aim of this systematic review was to investigate the effects of sodium bicarbonate supplementation on electromyographic (EMG) muscle activity in healthy, physically active individuals.
METHODS
A systematic review of cross-sectional studies, crossover studies and randomized controlled trials was performed to investigate the effects of sodium bicarbonate supplementation on EMG muscle activity in healthy, physically active individuals. Potentially eligible for the systematic review were identified through searches conducted in the PubMed/MEDLINE, Science Direct and Scopus, considering publications from January 1980 to August 2019. The terms used in the search were: sodium bicarbonate, NaHCO, alkalosis, alkaloses, electromyography, surface electromyography, electromyographies, electromyogram and EMG. Two independent assessors extracted data from the selected articles. Bias analysis was conducted using the Cochrane Risk of Bias tool and methodological quality was appraised using a checklist created based on the guidelines of the Consolidated Standards of Reporting Trials and the International Society of Electrophysiology and Kinesiology.
RESULTS
A total of 67 studies were retrieved and seven were included in this review. Only two studies showed significant differences in muscle activity after sodium bicarbonate supplementation. The different EMG signal capturing, processing, and analysis methods used constitute an important limitation to the comparative analyses of the results reported in the studies selected for the present review.
CONCLUSION
The results found do not allow us to affirm whether EMG may or may not be a safe tool to assess the effects of sodium bicarbonate supplementation on muscle activity.
Topics: Cross-Sectional Studies; Dietary Supplements; Electromyography; Humans; Muscle, Skeletal; Randomized Controlled Trials as Topic; Sodium Bicarbonate
PubMed: 32449633
DOI: 10.1080/19390211.2020.1766633 -
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 -
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 -
Case Reports in Medicine 2019Gitelman syndrome is one of the few inherited causes of metabolic alkalosis due to salt losing tubulopathy. It is caused by tubular defects at the level of distal...
Gitelman syndrome is one of the few inherited causes of metabolic alkalosis due to salt losing tubulopathy. It is caused by tubular defects at the level of distal convoluted tubules, mimicking a thiazide-like tumor. It usually presents in late childhood or in teenage as nonspecific weakness, fatigability, polyuria, and polydipsia but very rarely with seizures. It is classically associated with hypokalemia, hypomagnesemia, hypocalciuria, hyperreninemia, and hyperaldosteronism. However, less frequently, it can present with normal magnesium levels. It is even rarer to find normomagnesemic patients of GS who develop seizures as the main complication since hypomagnesemia is considered the principal etiology of abnormal foci of seizure-related brain activity in GS cases. Interestingly, patients with GS are oftentimes diagnosed during pregnancy when the classic electrolyte pattern consistent with GS is noticed. Our case presents GS with normal serum magnesium in a patient, with seizures being the main clinical presentation. We also did a comprehensive literature review of 122 reported cases to show the prevalence of normal magnesium in GS cases and an overview of clinical and biochemical variability in GS. We suggest that further studies and in-depth analysis are required to understand the pathophysiology of seizures in GS patients with both normal and low magnesium levels.
PubMed: 30867665
DOI: 10.1155/2019/4204907 -
Critical Care (London, England) Jan 2019Regional citrate anticoagulation (RCA) is a widely used strategy for continuous renal replacement therapy (CRRT). Most of the current guidelines recommend liver failure... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Regional citrate anticoagulation (RCA) is a widely used strategy for continuous renal replacement therapy (CRRT). Most of the current guidelines recommend liver failure as one of the contraindications for citrate anticoagulation. However, some studies suggested that the use of citrate for CRRT in liver failure patients did not increase the risk of citrate-related complications. The purpose of this systematic review is to summarize the current evidences on the safety and efficacy of RCA for CRRT in liver failure patients.
METHODS
We performed a comprehensive search on PubMed, Embase, and the Cochrane Library databases from the inception to March 1, 2018. Studies enrolled adult (age > 18 years) patients with various levels of liver dysfunction underwent RCA-CRRT were included in this systematic review.
RESULTS
After the study screening, 10 observational studies with 1241 liver dysfunction patients were included in this systematic review. The pooled rate of citrate accumulation and bleeding was 12% [3%, 22%] and 5% [2%, 8%], respectively. Compared with the baseline data, the serum pH, bicarbonate, and base excess (BE), the rate of metabolic alkalosis, the serum ionized calcium (ionCa) and total calcium (totCa) level, and the ratio of total calcium/ionized calcium (totCa/ionCa) significantly increased at the end of observation. However, no significant increase was observed in serum citrate (MD - 65.82 [- 194.19, 62.55]), lactate (MD 0.49 [- 0.27, 1.26]) and total bilirubin concentration (MD 0.79 [- 0.70, 2.29]) at the end of CRRT. Compared with non-liver failure patients, the live failure patients showed no significant difference in the pH (MD - 0.04 [- 0.13, 0.05]), serum lactate level (MD 0.69 [- 0.26, 1.64]), and totCa/ionCa ratio (MD 0.03 [- 0.12, 0.18]) during CRRT. The median of mean filter lifespan was 55.9 h, with a range from 22.7 to 72 h.
CONCLUSIONS
Regional citrate anticoagulation seems to be a safe anticoagulation method in liver failure patients underwent CRRT and could yield a favorable filter lifespan. Closely monitoring the acid base status and electrolyte balance may be more necessary during RCA-CRRT in patients with liver failure.
Topics: Acid-Base Equilibrium; Adult; Anticoagulants; Citric Acid; Hemorrhage; Humans; Liver Failure; Renal Replacement Therapy
PubMed: 30678706
DOI: 10.1186/s13054-019-2317-9 -
Critical Care (London, England) Oct 2018Metabolic alkalosis is common in patients with respiratory failure and may delay weaning in mechanically ventilated patients. Carbonic anhydrase inhibitors block renal... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Metabolic alkalosis is common in patients with respiratory failure and may delay weaning in mechanically ventilated patients. Carbonic anhydrase inhibitors block renal bicarbonate reabsorption, and thus reverse metabolic alkalosis. The objective of this systematic review is to assess the benefits and harms of carbonic anhydrase inhibitor therapy in patients with respiratory failure and metabolic alkalosis.
METHODS
We searched the following electronic sources from inception to August 2017: the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, and SCOPUS. Randomized clinical trials were included if they assessed at least one of the following outcomes: mortality, duration of hospital stay, duration of mechanical ventilation, adverse events, and blood gas parameters. Teams of two review authors worked in an independent and duplicate manner to select eligible trials, extract data, and assess risk of bias of the included trials. We used meta-analysis to synthesize statistical data and then assessed the certainty of evidence using the GRADE methodology.
RESULTS
Six eligible studies were identified with a total of 564 participants. The synthesized data did not exclude a reduction or an increase in mortality (risk ratio (RR) 0.94, 95% confidence interval (CI) 0.57 to 1.56) or in duration of hospital stay (mean difference (MD) 0.42 days, 95% CI -4.82 to 5.66) with the use of carbonic anhydrase inhibitors. Carbonic anhydrase inhibitor therapy resulted in a decrease in the duration of mechanical ventilation of 27 h (95% CI -50 to -4). Also, it resulted in an increase in PaO (MD 11.37 mmHg, 95% CI 4.18 to 18.56) and a decrease in PaCO (MD -4.98 mmHg, 95% CI -9.66, -0.3), serum bicarbonate (MD -5.03 meq/L, 95% CI -6.52 to -3.54), and pH (MD -0.04, 95% CI -0.07 to -0.01). There was an increased risk of adverse events in the carbonic anhydrase inhibitor group (RR 1.71, 95% CI 0.98 to 2.99). Certainty of evidence was judged to be low for most outcomes.
CONCLUSION
In patients with respiratory failure and metabolic alkalosis, carbonic anhydrase inhibitor therapy may have favorable effects on blood gas parameters. In mechanically ventilated patients, carbonic anhydrase inhibitor therapy may decrease the duration of mechanical ventilation. A major limitation of this finding was that only two trials assessed this clinically important outcome.
Topics: Alkalosis; Carbonic Anhydrase Inhibitors; Humans; Metabolic Diseases; Odds Ratio; Randomized Controlled Trials as Topic; Respiratory Insufficiency; Ventilator Weaning
PubMed: 30371345
DOI: 10.1186/s13054-018-2207-6 -
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