RESUMO
Bladder rupture is a rare complication of transurethral resection of the prostate (TURP) or bladder (TURB). Both extra and in- traperitoneal perforation have an incidence of 1.3% in patients undergoing this procedure, and only 17% of these perforations turn out to be intraperitoneal[],[]. It is a serious complication that requires immediate treatment to prevent it from progressing to peritonitis uremia, acidosis, and compartment syndrome.
La rotura vesical es una complicación poco común de la resección transuretral de próstata (RTUP) o vejiga (RTUV). La perforación tanto extra como intraperitoneal tiene una incidencia de 1,3% en los pacientes sometidos a este procedimiento y solo el 17% de dichas perforaciones resultan ser intraperitoneales. Es una complicación grave que requiere tratamiento inmediato para evitar que progrese a peritonitis, uremia, acidosis y síndrome compartimental.
Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Bexiga Urinária/lesões , Ressecção Transuretral da Próstata/efeitos adversos , Complicações Intraoperatórias/etiologia , Peritonite/prevenção & controle , Acidose/prevenção & controle , Tomografia Computadorizada por Raios X , Hipertensão Intra-Abdominal/prevenção & controle , Complicações Intraoperatórias/terapia , Complicações Intraoperatórias/diagnóstico por imagemRESUMO
The aim of this study was to perform a systematic review and meta-analysis on the acute and chronic effects of sodium bicarbonate (NaHCO3) 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 NaHCO3 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 NaHCO3 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 NaHCO3 increases both Wingate test peak and mean power.
Assuntos
Acidose/prevenção & controle , Desempenho Atlético/fisiologia , Teste de Esforço/métodos , Bicarbonato de Sódio/administração & dosagem , Administração Oral , Esquema de Medicação , Metabolismo Energético/efeitos dos fármacos , Humanos , Fadiga Muscular/fisiologia , Bicarbonato de Sódio/sangueRESUMO
This study aimed to investigate the energetic and hormonal profiles of dairy goats fed diets supplemented with monensin during the peripartum period. Eleven pregnant Saanen goats were subdivided into two random groups, a control group (GC) and the monensin group (MG). The MG group received 40 mg sodium monensin per animal per day for 15 days before partum and throughout the subsequent experimental period. Clinical observations and sample collection were performed at 30, 15, and 7 days before birth; on the day of partum; and at 5, 15, and 30 days after birth. The following biochemical and hormonal profile variables analyzed were: cholesterol, triglycerides, glucose, fructosamine, non-esterified fatty acids (NEFAs) and β-hydroxybutyrate (BHB), cortisol, and insulin. The ruminal fluid pH, chloride content, and volatile fatty acids were also measured. Statistical analysis of the data was performed using repeated measures ANOVA (p < 0.05) and Pearson's correlation. At partum, the MG group had lower values of NEFAs and lower acetate/propionate ratio. MG had higher triglycerides during the entire experiment period. The administration of monensin generated benefits in terms of energy parameters, improving the metabolic status of the dairy goats during peripartum.(AU)
Objetivou-se estudar o perfil energético e hormonal em cabras leiteiras suplementadas com monensina sódica durante o periparto. Utilizou-se onze cabras Saanen gestantes subdivididas em dois grupos de forma aleatória; um grupo controle (GC) e o grupo monensina (GM); o GM recebeu na dieta 40 mg por animal/dia de monensina sódica. As coletas das amostras foram efetuadas nos períodos de -30, -15, e -7 dias do parto, no dia do parto, +5, +15 e +30 dias do parto. As variáveis bioquímicas e hormonais analisadas foram: colesterol, triglicerídeos, glicose, frutosamina, ácidos graxos não esterificados (AGNE) e β-hidroxibutirato (BHB), cortisol e insulina. Também foram mensurados no fluido ruminal o pH, o teor de cloretos e os ácidos graxos voláteis. A análise estatística dos dados foi realizada pelo método da ANOVA (p < 0,05) e foi realizado estudo de correlação de Pearson. No momento do parto, o GM apresentou em relação ao GC índices mais baixos de AGNEs e menor relação acético/propiônico (p < 0,05). Em relação aos triglicerídeos, o GM apresentou valores superiores ao GC (p < 0,008) ao longo do experimento. A administração de monensina gerou benefícios nos parâmetros energéticos, melhorando o status metabólico de cabras leiteiras no periparto.(AU)
Assuntos
Animais , Feminino , Cabras/metabolismo , Ionóforos , Ácidos Graxos Voláteis , Monensin/uso terapêutico , Lactação/metabolismo , Período Periparto , Acidose/veterinária , Acidose/prevenção & controleRESUMO
This study aimed to investigate the energetic and hormonal profiles of dairy goats fed diets supplemented with monensin during the peripartum period. Eleven pregnant Saanen goats were subdivided into two random groups, a control group (GC) and the monensin group (MG). The MG group received 40 mg sodium monensin per animal per day for 15 days before partum and throughout the subsequent experimental period. Clinical observations and sample collection were performed at 30, 15, and 7 days before birth; on the day of partum; and at 5, 15, and 30 days after birth. The following biochemical and hormonal profile variables analyzed were: cholesterol, triglycerides, glucose, fructosamine, non-esterified fatty acids (NEFAs) and β-hydroxybutyrate (BHB), cortisol, and insulin. The ruminal fluid pH, chloride content, and volatile fatty acids were also measured. Statistical analysis of the data was performed using repeated measures ANOVA (p < 0.05) and Pearson's correlation. At partum, the MG group had lower values of NEFAs and lower acetate/propionate ratio. MG had higher triglycerides during the entire experiment period. The administration of monensin generated benefits in terms of energy parameters, improving the metabolic status of the dairy goats during peripartum.
Objetivou-se estudar o perfil energético e hormonal em cabras leiteiras suplementadas com monensina sódica durante o periparto. Utilizou-se onze cabras Saanen gestantes subdivididas em dois grupos de forma aleatória; um grupo controle (GC) e o grupo monensina (GM); o GM recebeu na dieta 40 mg por animal/dia de monensina sódica. As coletas das amostras foram efetuadas nos períodos de -30, -15, e -7 dias do parto, no dia do parto, +5, +15 e +30 dias do parto. As variáveis bioquímicas e hormonais analisadas foram: colesterol, triglicerídeos, glicose, frutosamina, ácidos graxos não esterificados (AGNE) e β-hidroxibutirato (BHB), cortisol e insulina. Também foram mensurados no fluido ruminal o pH, o teor de cloretos e os ácidos graxos voláteis. A análise estatística dos dados foi realizada pelo método da ANOVA (p < 0,05) e foi realizado estudo de correlação de Pearson. No momento do parto, o GM apresentou em relação ao GC índices mais baixos de AGNEs e menor relação acético/propiônico (p < 0,05). Em relação aos triglicerídeos, o GM apresentou valores superiores ao GC (p < 0,008) ao longo do experimento. A administração de monensina gerou benefícios nos parâmetros energéticos, melhorando o status metabólico de cabras leiteiras no periparto.
Assuntos
Feminino , Animais , Cabras/metabolismo , Ionóforos , Monensin/uso terapêutico , Ácidos Graxos Voláteis , Acidose/prevenção & controle , Acidose/veterinária , Lactação/metabolismo , Período PeripartoRESUMO
Intramuscular acidosis is a contributing factor to fatigue during high-intensity exercise. Many nutritional strategies aiming to increase intra- and extracellular buffering capacity have been investigated. Among these, supplementation of beta-alanine (~3-6.4 g/day for 4 weeks or longer), the rate-limiting factor to the intramuscular synthesis of carnosine (i.e. an intracellular buffer), has been shown to result in positive effects on exercise performance in which acidosis is a contributing factor to fatigue. Furthermore, sodium bicarbonate, sodium citrate and sodium/calcium lactate supplementation have been employed in an attempt to increase the extracellular buffering capacity. Although all attempts have increased blood bicarbonate concentrations, evidence indicates that sodium bicarbonate (0.3 g/kg body mass) is the most effective in improving high-intensity exercise performance. The evidence supporting the ergogenic effects of sodium citrate and lactate remain weak. These nutritional strategies are not without side effects, as gastrointestinal distress is often associated with the effective doses of sodium bicarbonate, sodium citrate and calcium lactate. Similarly, paresthesia (i.e. tingling sensation of the skin) is currently the only known side effect associated with beta-alanine supplementation, and it is caused by the acute elevation in plasma beta-alanine concentration after a single dose of beta-alanine. Finally, the co-supplementation of beta-alanine and sodium bicarbonate may result in additive ergogenic gains during high-intensity exercise, although studies are required to investigate this combination in a wide range of sports.
Assuntos
Acidose/prevenção & controle , Suplementos Nutricionais , Exercício Físico/fisiologia , Músculo Esquelético/metabolismo , Compostos de Cálcio/administração & dosagem , Compostos de Cálcio/efeitos adversos , Compostos de Cálcio/metabolismo , Citratos/administração & dosagem , Citratos/efeitos adversos , Citratos/metabolismo , Suplementos Nutricionais/efeitos adversos , Metabolismo Energético , Líquido Extracelular/metabolismo , Humanos , Concentração de Íons de Hidrogênio , Líquido Intracelular/metabolismo , Lactatos/administração & dosagem , Lactatos/efeitos adversos , Lactatos/metabolismo , Fadiga Muscular , Bicarbonato de Sódio/administração & dosagem , Bicarbonato de Sódio/efeitos adversos , Bicarbonato de Sódio/sangue , Citrato de Sódio , Lactato de Sódio/administração & dosagem , Lactato de Sódio/efeitos adversos , Lactato de Sódio/metabolismo , beta-Alanina/administração & dosagem , beta-Alanina/efeitos adversos , beta-Alanina/metabolismoRESUMO
BACKGROUND: Being born preterm implies comorbidities, among them the risk of intraventricular hemorrhage (IVH). The use of sodium bicarbonate has been linked to the presence of IVH. The main purpose of this study was to determine if the infusion of sodium bicarbonate during the first 24 hours increases the risk of IVH in preterm infants. METHODS: Our study is a cohort; we analyzed the files of 160 patients and divided them into two groups: one in which sodium bicarbonate was not used and another in which it was; this latter group was subdivided into two considering if the use was therapeutic of prophylactic. RESULTS: In our total group of patients 10 % presented IVH; had a mean weight of 1500 g and 31 weeks of gestational age. The incidence of IVH was identical between both groups, although patients in which bicarbonate was used were more premature, unstable, and in worse clinical conditions. CONCLUSIONS: Our data indicate the need of large scale studies to determine if the clinical benefits of the use of sodium bicarbonate outweigh the risk of IVH.
Introducción: nacer prematuro conlleva riesgos, como la posibilidad de sufrir hemorragia intraventricular. El 90 % de los casos se presenta dentro de los primeros 4 a 7 días; Se ha relacionado el uso de bicarbonato de sodio con su aparición. El propósito de este estudio fue determinar si el uso de bicarbonato en infusión continua, en las primeras 24 horas, aumenta el riesgo de hemorragia intraventricular. Métodos: cohorte retrospectiva, se revisaron 160 expedientes formándose 2 grupos: uno sin y otro con uso de bicarbonato. Posteriormente, el grupo con uso se dividió en dos: uso terapéutico y profiláctico. Resultados: Del total de los prematuros, 10 % presentaron hemorragia intraventricular, tenían un peso promedio de 1,500 g y una edad gestacional promedio de 31 semanas. La incidencia fue idéntica entre los grupos, aunque en el grupo con bicarbonato había pacientes más prematuros, y clínicamente más inestables. Se realizó una regresión logística donde se observó asociación entre la incidencia de hemorragia intraventricular y el peso al nacimiento (OR de 0.99); así como en el caso del uso de bicarbonato de sodio con una OR 1.22. Conclusiones: Nuestros datos indican la necesidad de evaluación sistemática del uso de bicarbonato, con el fin de determinar si los beneficios sobrepasan el riesgo de hemorragia intraventricular.
Assuntos
Acidose/tratamento farmacológico , Hemorragia Cerebral/induzido quimicamente , Doenças do Prematuro/induzido quimicamente , Bicarbonato de Sódio/efeitos adversos , Acidose/prevenção & controle , Hemorragia Cerebral/epidemiologia , Feminino , Seguimentos , Humanos , Incidência , Recém-Nascido , Recém-Nascido Prematuro , Doenças do Prematuro/tratamento farmacológico , Doenças do Prematuro/epidemiologia , Infusões Intravenosas , Masculino , Estudos Retrospectivos , Bicarbonato de Sódio/uso terapêutico , Resultado do TratamentoRESUMO
In the acute care setting, the type and amount of fluid administered has a significant impact on patient outcomes. In particular, 0.9% saline infusions are known to cause or exacerbate hyperchloremia. The studies presented evaluate possible complications from 0.9% saline infusions. These studies compared administration of 0.9% saline with lactated ringer or plasmalyte in the acute care setting. In each trial, the patients who were randomized to receive 0.9% saline infusions had a more severe acidosis from increased serum chloride levels. From the available data, chloride-restrictive intravenous fluid such as plasmalyte appears to reduce acid-base disturbances and improve patient outcomes.
Assuntos
Acidose/induzido quimicamente , Cuidados Críticos/métodos , Hidratação/efeitos adversos , Solução Salina Hipertônica/efeitos adversos , Cloreto de Sódio/sangue , Acidose/prevenção & controle , Eletrólitos/administração & dosagem , Feminino , Hidratação/métodos , Humanos , Incidência , Soluções Isotônicas/administração & dosagem , Masculino , Prevenção Primária/métodos , Ensaios Clínicos Controlados Aleatórios como Assunto , Ressuscitação/métodos , Lactato de Ringer , Medição de Risco , Solução Salina Hipertônica/administração & dosagem , Resultado do Tratamento , Ferimentos e Lesões/terapiaRESUMO
We examined the isolated and combined effects of beta-alanine (BA) and sodium bicarbonate (SB) on high-intensity intermittent upper-body performance in judo and jiu-jitsu competitors. 37 athletes were assigned to one of four groups: (1) placebo (PL)+PL; (2) BA+PL; (3) PL+SB or (4) BA+SB. BA or dextrose (placebo) (6.4 g day⻹) was ingested for 4 weeks and 500 mg kg⻹ BM of SB or calcium carbonate (placebo) was ingested for 7 days during the 4th week. Before and after 4 weeks of supplementation, the athletes completed four 30-s upper-body Wingate tests, separated by 3 min. Blood lactate was determined at rest, immediately after and 5 min after the 4th exercise bout, with perceived exertion reported immediately after the 4th bout. BA and SB alone increased the total work done in +7 and 8 %, respectively. The co-ingestion resulted in an additive effect (+14 %, p < 0.05 vs. BA and SB alone). BA alone significantly improved mean power in the 2nd and 3rd bouts and tended to improve the 4th bout. SB alone significantly improved mean power in the 4th bout and tended to improve in the 2nd and 3rd bouts. BA+SB enhanced mean power in all four bouts. PL+PL did not elicit any alteration on mean and peak power. Post-exercise blood lactate increased with all treatments except with PL+PL. Only BA+SB resulted in lower ratings of perceived exertion (p = 0.05). Chronic BA and SB supplementation alone equally enhanced high-intensity intermittent upper-body performance in well-trained athletes. Combined BA and SB promoted a clear additive ergogenic effect.
Assuntos
Acidose/prevenção & controle , Desempenho Atlético , Carbonato de Cálcio/farmacologia , Artes Marciais , Fadiga Muscular/efeitos dos fármacos , Bicarbonato de Sódio/farmacologia , beta-Alanina/farmacologia , Acidose/tratamento farmacológico , Acidose/metabolismo , Adulto , Atletas , Carbonato de Cálcio/administração & dosagem , Carbonato de Cálcio/efeitos adversos , Suplementos Nutricionais , Método Duplo-Cego , Teste de Esforço , Humanos , Ácido Láctico/sangue , Masculino , Destreza Motora/efeitos dos fármacos , Tono Muscular/efeitos dos fármacos , Tono Muscular/fisiologia , Esforço Físico , Bicarbonato de Sódio/administração & dosagem , Bicarbonato de Sódio/efeitos adversos , Extremidade Superior/fisiologia , Adulto Jovem , beta-Alanina/administração & dosagem , beta-Alanina/efeitos adversosRESUMO
BACKGROUND: Early damage-control resuscitation (DCR) indicators have not been clearly discerned in patients with penetrating abdominal trauma. Our objective was to identify these clinical indicators that could standardize a DCR initiation policy in this subset of patients. METHODS: Prospective data collection from January 2003 to October 2010 at a Level I trauma center in Cali, Colombia. All adult (>15 years) patients with abdominal gunshot wounds (GSWs) were included. They were divided into two groups: those who underwent DCR and those who did not. Both groups were compared by demographics, clinical variables, severity scores, and overall mortality. Other scores were compared with our newly devised model using the area under the receiver operating characteristic curve (AUROC). RESULTS: There was a total of 331 abdominal GSWs. Of these, a total of 162 (49%) underwent DCR. The overall mortality was 11.2%. Multivariate analysis identified (A) acidosis (base deficit ≥ 8); (B) blood loss (hemoperitoneum > 1,500 mL); (C) cold (temperature < 35 °C); (D) damage (New Injury Severity Score > 35) as significant clinical indicators that aided in the decision process of early implementation of DCR. The Trauma-Associated Severe Hemorrhage (AUROC, 0.8333), McLaughlin (AUROC, 0.8148), ABC (AUROC, 0.7372) scores and our ABCD mnemonic (AUROC, 0.8745) were all good predictors of DCR, and the difference between them was statistically significant (p < 0.001). CONCLUSION: We have identified (A) acidosis (base deficit ≥ 8); (B) blood loss (hemoperitoneum > 1,500 mL); (C) cold (temperature < 35 °C); (D) damage (New Injury Severity Score > 35) as significant clinical indicators that aided in the decision process of early implementation of DCR for patients with abdominal GSWs. LEVEL OF EVIDENCE: Prognostic/epidemiologic study, level III.
Assuntos
Traumatismos Abdominais/terapia , Serviço Hospitalar de Emergência , Seleção de Pacientes , Ressuscitação , Triagem , Ferimentos por Arma de Fogo/terapia , Traumatismos Abdominais/complicações , Traumatismos Abdominais/diagnóstico , Acidose/diagnóstico , Acidose/etiologia , Acidose/prevenção & controle , Adulto , Protocolos Clínicos , Estudos de Coortes , Feminino , Hemoperitônio/diagnóstico , Hemoperitônio/etiologia , Hemoperitônio/prevenção & controle , Humanos , Hipotermia/diagnóstico , Hipotermia/etiologia , Hipotermia/prevenção & controle , Masculino , Índices de Gravidade do Trauma , Ferimentos por Arma de Fogo/complicações , Ferimentos por Arma de Fogo/diagnóstico , Adulto JovemRESUMO
Hyperchloremia is one of the multiple etiologies of metabolic acidosis in hemodialysis (HD) patients. The aim of the present study was to determine the influence of chloride dialysate on metabolic acidosis control in this population. We enrolled 30 patients in maintenance HD program with a standard base excess (SBE) ≤2 mEq/L and urine output of less than 100 mL/24 h. The patients underwent dialysis three times per week with a chloride dialysate concentration of 111 mEq/L for 4 weeks, and thereafter with a chloride dialysate concentration of 107 mEq/L for the next 4 weeks. Arterial blood was drawn immediately before the second dialysis session of the week at the end of each phase, and the Stewart physicochemical approach was applied. The strong ion gap (SIG) decreased (from 7.5 ± 2.0 to 6.2 ± 1.9 mEq/L, P = 0.006) and the standard base excess (SBE) increased after the use of 107 mEq/L chloride dialysate (from -6.64 ± 1.7 to -4.73 ± 1.9 mEq/L, P < 0.0001). ∆SBE was inversely correlated with ∆SIG during the phases of the study (Pearson r = -0.684, P < 0.0001) and there was no correlation with ∆chloride. When we applied the Stewart model, we demonstrated that the lower concentration of chloride dialysate interfered with the control of metabolic acidosis in HD patients, surprisingly, through the effect on unmeasured anions.
Assuntos
Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Acidose/prevenção & controle , Cloretos/administração & dosagem , Soluções para Hemodiálise/administração & dosagem , Diálise Renal/efeitos adversos , Equilíbrio Ácido-Base/efeitos dos fármacos , Acidose/etiologia , Bicarbonatos/administração & dosagem , Bicarbonatos/sangue , Falência Renal Crônica/sangue , Falência Renal Crônica/terapia , Diálise Renal/métodosRESUMO
Hyperchloremia is one of the multiple etiologies of metabolic acidosis in hemodialysis (HD) patients. The aim of the present study was to determine the influence of chloride dialysate on metabolic acidosis control in this population. We enrolled 30 patients in maintenance HD program with a standard base excess (SBE) ≤2 mEq/L and urine output of less than 100 mL/24 h. The patients underwent dialysis three times per week with a chloride dialysate concentration of 111 mEq/L for 4 weeks, and thereafter with a chloride dialysate concentration of 107 mEq/L for the next 4 weeks. Arterial blood was drawn immediately before the second dialysis session of the week at the end of each phase, and the Stewart physicochemical approach was applied. The strong ion gap (SIG) decreased (from 7.5 ± 2.0 to 6.2 ± 1.9 mEq/L, P = 0.006) and the standard base excess (SBE) increased after the use of 107 mEq/L chloride dialysate (from -6.64 ± 1.7 to -4.73 ± 1.9 mEq/L, P < 0.0001). ∆SBE was inversely correlated with ∆SIG during the phases of the study (Pearson r = -0.684, P < 0.0001) and there was no correlation with ∆chloride. When we applied the Stewart model, we demonstrated that the lower concentration of chloride dialysate interfered with the control of metabolic acidosis in HD patients, surprisingly, through the effect on unmeasured anions.
Assuntos
Acidose/prevenção & controle , Cloretos/administração & dosagem , Soluções para Hemodiálise/administração & dosagem , Diálise Renal/efeitos adversos , Equilíbrio Ácido-Base/efeitos dos fármacos , Acidose/etiologia , Bicarbonatos/administração & dosagem , Bicarbonatos/sangue , Feminino , Humanos , Falência Renal Crônica/sangue , Falência Renal Crônica/terapia , Masculino , Pessoa de Meia-Idade , Diálise Renal/métodosRESUMO
La acidosis metabólica es una alteración ácido-base frecuentemente observada en pacientes críticos. Aunque en situaciones extremas este desorden en sí mismo es amenazante para la vida, la presencia de una acidosis metabólica leve no siempre es nociva y puede ser un reflejo de la adaptación fisiológica del organismo a la injuria aguda. Diferentes autores han documentado el desarrollo de acidosis metabólica hiperclorémica asociada al aporte de grandes cantidades de solución salina 0,9 por ciento. Algunos consideran que se trata de una condición benigna y autolimitada, mientras otros sostienen que la acidosis hiperclorémica puede deteriorar la perfusión renal y esplácnica, sin embargo su relevancia clínica real es aún incierta. En un afán de evitar la aparición de acidosis hiperclorémica y sus potenciales efectos adversos, se han desarrollado cristaloides y coloides en formulaciones modificadas para que se asemejen más a la composición del plasma. En este artículo de revisión analizaremo slos mecanismos de producción de la acidosis metabólica hiperclorémica en base al abordaje físico-químico de Stewart; la evidencia existente sobre el impacto de este trastorno sobre las variables de desenlace de los pacientes críticos, y el rol clínico de las nuevas soluciones balanceadas.
Metabolic acidosis is an acid-base alteration frequently observed in critically ill patients. Even in extreme situations this disorder in itself is life threatening, the presence of a mild metabolic acidosis is not always harmful and may be the result of physiological adaptation of the organism to acute injury. Several authors have documented the development of hyperchloremic metabolic acidosis associated with the infusion of large amounts of 0.9 percent normal saline. Some consider this to be a benign and transient, while others argue that hyperchloremic acidosis can impair renal and splanchnic perfusion, but her real clinical relevance remains uncertain. In an effort to prevent the development of hyperchloremic acidosis and its potential adverse effects have been development formulations of crystalloid and colloid modified to more closely resemble the composition of the plasma. In this review article will discuss the mechanism of production of hyperchloremic metabolic acidosis by the physicochemical approach Stewart, the existing evidence on the impact of this disorder on the outcome variables in critically ill patients, and clinical role of new balanced solutions.
Assuntos
Humanos , Acidose/induzido quimicamente , Acidose/prevenção & controle , Cloreto de Sódio/efeitos adversos , Soluções Isotônicas/administração & dosagem , Substitutos do Plasma/administração & dosagem , Acidose/fisiopatologia , Estado Terminal , Cloretos/sangue , Equilíbrio Ácido-BaseRESUMO
AIM: To determine whether fetal intrauterine resuscitation using tocolysis and delayed delivery is better for the fetus than emergency delivery when fetal hypoxia is suspected because of a non-reassuring fetal heart-rate (FHR) pattern using conventional heart rate monitoring. METHODS: This was a prospective and randomized study, conducted between 2001 and 2004 at Pereira Rossell Hospital, Montevideo, Uruguay. The population consisted of 390 fetuses, in which intrauterine distress was diagnosed using electronic FHR monitoring. Of these, 197 were randomly assigned to the emergency delivery group and 193 to the fetal intrauterine resuscitation group. The inclusion criteria were: term singleton pregnancy, in labor, cephalic presentation, and no placental accidents. RESULTS: The time between randomization and birth was 16.9 +/- 7.6 min (mean +/- SD) for the emergency delivery group, and 34.5 +/- 11.7 min (mean +/- SD) for the resuscitation group. The relative risk (RR) of acidosis in the umbilical artery (pH < 7.1) in the emergency delivery group was 1.47 (0.95-2.27). The RR of base deficit < or =12 mEq/L in the emergency delivery group was higher than in the resuscitation group (RR = 1.48 [1.0-2.2], P = 0.04). When considering the need for admission to the neonatal care unit, the relative risk was higher in the emergency delivery group than in the resuscitation group (RR = 2.14 [1.23.3.74], P = 0.005). No maternal adverse effects were reported. CONCLUSION: Tocolysis and delayed delivery renders better immediate neonatal results than emergency delivery when fetal distress is suspected because of a non-reassuring fetal heart pattern. In addition, it may decrease the need for emergency delivery without increasing maternal and fetal adverse side-effects.
Assuntos
Parto Obstétrico , Fenoterol/uso terapêutico , Sofrimento Fetal/terapia , Tocólise , Tocolíticos/uso terapêutico , Descolamento Prematuro da Placenta/metabolismo , Acidose/metabolismo , Acidose/prevenção & controle , Índice de Apgar , Parto Obstétrico/efeitos adversos , Parto Obstétrico/estatística & dados numéricos , Feminino , Fenoterol/efeitos adversos , Sofrimento Fetal/metabolismo , Humanos , Recém-Nascido , Unidades de Terapia Intensiva Neonatal/estatística & dados numéricos , Gravidez , Estudos Prospectivos , Tocólise/efeitos adversos , Tocólise/estatística & dados numéricos , Tocolíticos/efeitos adversos , Falha de Tratamento , Artérias Umbilicais/metabolismoRESUMO
OBJECTIVE: To test the hypothesis that levosimendan increases systemic and intestinal oxygen delivery (DO(2)) and prevents intramucosal acidosis in septic shock. DESIGN: Prospective, controlled experimental study. SETTING: University-based research laboratory. SUBJECTS: Nineteen anesthetized, mechanically ventilated sheep. INTERVENTIONS: Endotoxin-treated sheep were randomly assigned to three groups: control (n=7), dobutamine (10 microg/kg/min, n=6) and levosimendan (100 microg/kg over 10 min followed by 100 microg/kg/h, n=6) and treated for 120 min. MEASUREMENTS AND MAIN RESULTS: After endotoxin administration, systemic and intestinal DO(2) decreased (24.6+/-5.2 vs 15.3+/-3.4 ml/kg/min and 105.0+/-28.1 vs 55.8+/-25.9 ml/kg/min, respectively; p<0.05 for both). Arterial lactate and the intramucosal-arterial PCO(2) difference (DeltaPCO(2)) increased (1.4+/-0.3 vs 3.1+/-1.5 mmHg and 9+/-6 vs 23+/-6 mmHg mmol/l, respectively; p<0.05). Systemic DO(2) was preserved in the dobutamine-treated group (22.3+/-4.7 vs 26.8+/-7.0 ml/min/kg, p=NS) but intestinal DO(2) decreased (98.9+/-0.2 vs 68.0+/-22.9 ml/min/kg, p<0.05) and DeltaPCO(2) increased (12+/-5 vs 25+/-11 mmHg, p<0.05). The administration of levosimendan prevented declines in systemic and intestinal DO(2) (25.1+/-3.0 vs 24.0+/-6.3 ml/min/kg and 111.1+/-18.0 vs 98.2+/-23.1 ml/min/kg, p=NS for both) or increases in DeltaPCO(2) (7+/-7 vs 10+/-8, p=NS). Arterial lactate increased in both the dobutamine and levosimendan groups (1.6+/-0.3 vs 2.5+/-0.7 and 1.4+/-0.4 vs. 2.9+/-1.1 mmol/l, p=NS between groups). CONCLUSIONS: Compared with dobutamine, levosimendan increased intestinal blood flow and diminished intramucosal acidosis in this experimental model of sepsis.
Assuntos
Acidose/prevenção & controle , Cardiotônicos/farmacologia , Hidrazonas/farmacologia , Piridazinas/farmacologia , Choque Séptico/tratamento farmacológico , Circulação Esplâncnica/efeitos dos fármacos , Análise de Variância , Animais , Cardiotônicos/uso terapêutico , Dobutamina/farmacologia , Endotoxemia/tratamento farmacológico , Hidrazonas/uso terapêutico , Ácido Láctico/sangue , Oxigênio/sangue , Estudos Prospectivos , Piridazinas/uso terapêutico , Distribuição Aleatória , Ovinos , SimendanaRESUMO
OBJECTIVES: Levosimendan is an inotropic and vasodilator drug that has proved to be useful in cardiogenic shock. Pretreatment with levosimendan in experimental hypodynamic septic shock in pigs has shown valuable effects in oxygen transport. Our goal was to assess the effects of levosimendan in a normodynamic model of endotoxaemia. METHODS: Twelve sheep were anaesthetized and mechanically ventilated. After taking basal haemodynamic and oxygen transport measurements, sheep were assigned to two groups during 120 min: (1) endotoxin (5 microg/kg endotoxin); (2) levosimendan (5 microg/kg endotoxin plus levosimendan 200 microg/kg followed by 200 microg/kg/h). Both groups received hydration of 20 ml/kg/h of saline solution. RESULTS: In the endotoxin group, cardiac output, intestinal blood flow and systemic and intestinal oxygen transports and consumptions (DO(2) and VO(2)) remained unchanged. In the levosimendan group, systemic and intestinal DO(2) were significantly higher than in the endotoxin group. Because stroke volume did not change (basal versus 120': 0.9+/-0.1 ml/kg versus 0.9+/-0.2 ml/kg, p=0.3749), the elevation in cardiac output by levosimendan (145+/-17 ml/min/kg versus 198+/-16 ml/min/kg, p=0.0096) was related to an increased heart rate (159+/-32 beats l/min versus 216+/-19 beats l/min, p=0.0037). Levosimendan precluded the development of gut intramucosal acidosis at 120' (endotoxin versus levosimendan, ileal intramucosal-arterial PCO(2) difference: 19+/-4 Torr versus 10+/-4 Torr, p=0.0025). However, levosimendan decreased mean arterial blood pressure (99+/-20 Torr versus 63+/-13 Torr, p=0.0235) and increased blood lactate levels (2.4+/-0.9 mmol/l versus 4.8+/-1.5 mmol/l, p=0.0479). All p-values are differences in specific points (paired or unpaired t-test with Bonferroni correction) after two-way repeated measures ANOVA. A p-value<0.05 was considered significant. CONCLUSIONS: Levosimendan improved oxygen transport and prevented the development of intramucosal acidosis in this experimental model of endotoxaemia. However, systemic hypotension and lactic acidosis occurred. Additional studies are needed to show if different doses and timing of levosimendan administration in septic shock might improve gut perfusion without adverse effects.
Assuntos
Endotoxemia/fisiopatologia , Infecções por Escherichia coli/fisiopatologia , Hemodinâmica/efeitos dos fármacos , Hidrazonas/farmacologia , Oxigênio/sangue , Piridazinas/farmacologia , Vasodilatadores/farmacologia , Acidose/metabolismo , Acidose/prevenção & controle , Animais , Modelos Animais de Doenças , Endotoxemia/sangue , Endotoxemia/tratamento farmacológico , Infecções por Escherichia coli/sangue , Infecções por Escherichia coli/tratamento farmacológico , Hidrazonas/uso terapêutico , Mucosa Intestinal/irrigação sanguínea , Mucosa Intestinal/metabolismo , Ácido Láctico/sangue , Oxigênio/metabolismo , Piridazinas/uso terapêutico , Ovinos , Simendana , Vasodilatadores/uso terapêuticoRESUMO
INTRODUCTION: Increased intramucosal-arterial carbon dioxide tension (PCO2) difference (DeltaPCO2) is common in experimental endotoxemia. However, its meaning remains controversial because it has been ascribed to hypoperfusion of intestinal villi or to cytopathic hypoxia. Our hypothesis was that increased blood flow could prevent the increase in DeltaPCO2. METHODS: In 19 anesthetized and mechanically ventilated sheep, we measured cardiac output, superior mesenteric blood flow, lactate, gases, hemoglobin and oxygen saturations in arterial, mixed venous and mesenteric venous blood, and ileal intramucosal PCO2 by saline tonometry. Intestinal oxygen transport and consumption were calculated. After basal measurements, sheep were assigned to the following groups, for 120 min: (1) sham (n = 6), (2) normal blood flow (n = 7) and (3) increased blood flow (n = 6). Escherichia coli lipopolysaccharide (5 microg/kg) was injected in the last two groups. Saline solution was used to maintain blood flood at basal levels in the sham and normal blood flow groups, or to increase it to about 50% of basal in the increased blood flow group. RESULTS: In the normal blood flow group, systemic and intestinal oxygen transport and consumption were preserved, but DeltaPCO2 increased (basal versus 120 min endotoxemia, 7 +/- 4 versus 19 +/- 4 mmHg; P < 0.001) and metabolic acidosis with a high anion gap ensued (arterial pH 7.39 versus 7.35; anion gap 15 +/- 3 versus 18 +/- 2 mmol/l; P < 0.001 for both). Increased blood flow prevented the elevation in DeltaPCO2 (5 +/- 7 versus 9 +/- 6 mmHg; P = not significant). However, anion-gap metabolic acidosis was deeper (7.42 versus 7.25; 16 +/- 3 versus 22 +/- 3 mmol/l; P < 0.001 for both). CONCLUSIONS: In this model of endotoxemia, intramucosal acidosis was corrected by increased blood flow and so might follow tissue hypoperfusion. In contrast, anion-gap metabolic acidosis was left uncorrected and even worsened with aggressive volume expansion. These results point to different mechanisms generating both alterations.
Assuntos
Acidose/prevenção & controle , Endotoxemia/complicações , Infecções por Escherichia coli/complicações , Mucosa Intestinal/irrigação sanguínea , Mucosa Intestinal/metabolismo , Equilíbrio Ácido-Base , Acidose/metabolismo , Animais , Dióxido de Carbono/sangue , Dióxido de Carbono/metabolismo , Interpretação Estatística de Dados , Modelos Animais de Doenças , Endotoxemia/sangue , Escherichia coli , Lipopolissacarídeos/administração & dosagem , Artéria Mesentérica Superior/fisiologia , Mesentério/irrigação sanguínea , Oxigênio/sangue , Oxigênio/metabolismo , Consumo de Oxigênio , OvinosRESUMO
Out-of-hospital cardiac arrests account for approximately 1000 sudden cardiac deaths per day in the United States. Since its introduction in 1960 closed-chest cardiac massage (CCCM) often takes place as an attempt at resuscitation, although its survival rates are low. Other resuscitation techniques are available to physicians such as open-chest cardiopulmonary resuscitation (OCCPR). OCCPR has been shown by several scientists to be hemodynamically superior to CCCM as it increases arterial pressures, cardiac output, coronary perfusion pressures, return of spontaneous circulation and cerebral blood flow. Improved neurological and cardiovascular outcome and an increase in survival rate compared to CCCM have been described. Timing is one of the key variables in determining patient outcome when performing OCCPR. The American Heart Association in association with the International Liaison Committee (ILCOR) has specific indications for the use of OCCPR. Some investigators recommend starting OCCPR in out-of-hospital cardiac arrests on arrival at the scene instead of CCCM. Surprisingly, the incidence of infectious complications after thoracotomy in an unprepared chest is low. The vast majority of the patients' families accept OCCPR as a therapeutic choice for cardiac arrests and it has been showed to be economically viable. This paper reviews some of the basic and advanced concepts of this evolving technique.
Assuntos
Reanimação Cardiopulmonar/métodos , Reanimação Cardiopulmonar/tendências , Parada Cardíaca/terapia , Acidose/etiologia , Acidose/prevenção & controle , Adulto , Animais , Reanimação Cardiopulmonar/história , Criança , Modelos Animais de Doenças , Cães , Epinefrina/uso terapêutico , Parada Cardíaca/complicações , Massagem Cardíaca/métodos , História do Século XIX , História do Século XX , Humanos , Seleção de Pacientes , Toracotomia/métodos , Resultado do TratamentoRESUMO
PURPOSE: To verify in an experimental model whether gastrocystoplasty may protect patients with chronic renal failure from acid loading associated acidosis a wedge-shaped portion of the middle stomach was used to improve bladder capacity in animals with chronic renal failure. MATERIALS AND METHODS: An experimental model was used to study 112 adult female Wistar rats (EPM-1) weighing between 156 and 259 gm. The animals were randomly assigned to groups, including 41 controls, 24 undergoing five-sixths nephrectomy to create chronic renal failure, 26 undergoing gastrocystoplasty and 21 undergoing gastrocystoplasty and five-sixths nephrectomy to create renal failure. To provide an acid overload a 5% NH(4)Cl diet was administered to a subgroup of each group. Two months after surgery 24-hour urine was collected, and volume and pH were measured as well as the amount of bicarbonate, ammonium, titratable acidity and chloride. The animals were then exsanguinated through an abdominal aorta puncture. The blood was used for blood gas analysis and to measure sodium, potassium, chloride, ionized calcium and creatinine. RESULTS: When undergoing an acid overload, the animals with gastrocystoplasty had no acidosis since acid radicals were eliminating in the urine as NH(4)Cl. When given the same acid overload, metabolic acidosis developed in the animals with gastrocystoplasty and chronic renal failure. CONCLUSIONS: Gastrocystoplasty protected healthy rats from acidosis when they were given an acid overload but failed to protect the rats with chronic renal failure under the same conditions.
Assuntos
Acidose/fisiopatologia , Cloreto de Amônio/metabolismo , Gastroplastia , Falência Renal Crônica/fisiopatologia , Estômago/cirurgia , Bexiga Urinária/cirurgia , Equilíbrio Ácido-Base , Acidose/prevenção & controle , Cloreto de Amônio/administração & dosagem , Animais , Modelos Animais de Doenças , Feminino , Concentração de Íons de Hidrogênio , Falência Renal Crônica/cirurgia , Testes de Função Renal , Nefrectomia , Probabilidade , Distribuição Aleatória , Ratos , Ratos Wistar , Valores de Referência , Estatísticas não Paramétricas , Urinálise , Derivação Urinária/métodosRESUMO
La monitorización electrónica de la frecuencia cardíaca fetal es el método más difundido de control de la salud fetal intraparto. Su valor predictivo negativo es excelente pero el valor predictivo de la prueba positiva es muy bajo. Esto lleva a un aumento innecesario del intervencionismo obstétrico con el consiguiente aumento de la morbimortalidad materna, además de incrementar los costos sanitarios. Con el propósito de mejorar el valor predictivo de la prueba positiva de la monitorización electrónica de la frecuencia cardíaca fetal intraparto, hemos desarrollado un estudio prospectivo de casos y controles analizando computarizadamente uno de los parámetros de la monitorización: la variabilidad de la frecuencia cardíaca fetal. Esta la evaluamos a través de medidas directas: variabilidad a corto plazo y variabilidad a largo plazo. Seleccionamos en el transcurso de un año en la maternidad del Centro Hospitalario Pereira Rossell una muestra de 323 pacientes en trabajo de parto. Dieciocho recién nacidos de estas pacientes desarrollaron acidosis al nacer. Fueron apareados a esta población 30 controles normales. Mediante un "software " especialmente diseñado se calcularon diferentes parámetros de la variabilidad de la frecuencia cardíaca fetal. Encontramos que en la población de recién nacidos acidóticos la variabilidad estaba disminuida, siendo en el período de los 30 minutos previos al fin del registro, antes del nacimiento, donde se encontraron los valores más significativos. En este período el valor predictivo de la prueba positiva fue de 56 por ciento para la variabilidad a corto plazo y de 50 por ciento para la variabilidad a largo plazo, con una p < o igual a 0,04 y 0,05 respectivamente. Concluimos entonces que el análisis computarizado de la variabilidad de la frecuencia cardíaca fetal en los últimos 30 minutos antes del nacimiento constituye un buen método para prever acidosis en el recién nacido