The relationship between umbilical artery acid-base status and umbilical artery levels of total creatine kinase and creatine kinase isoenzymes. A preliminary study

A safe neonatal transport system is an essential component in the regionalization of perinatal care. Despite efforts to provide continuous intensive care to sick infants during transport,1-5 several studies have revealed an increased morbidity and mortality among infants transported to newborn intensive care units (NICU) compared with those infants born at the NICU.6,7 There is little information available about the adequacy of monitoring and maintaining oxygenation and acid-base status during infant transport. In a preliminary study we examined the ability of a neonatal transport team to maintain an infant's Pao2 (46 to 100 torr), pH (7.25 to 7.55), and Paco2 (20 to 50 torr) in the "physiologic" range during transport.

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Left Lateral Table Tilt for Elective Cesarean Delivery under Spinal Anesthesia Has No Effect on Neonatal Acid–Base Status

Anesthesiology ◽

10.1097/aln.0000000000001737 ◽

2017 ◽

Vol 127 (2) ◽

pp. 241-249 ◽

Cited By ~ 34

Author(s):

Allison J. Lee ◽

Ruth Landau ◽

James L. Mattingly ◽

Margaret M. Meenan ◽

Beatriz Corradini ◽

...

Keyword(s):

Blood Pressure ◽

Spinal Anesthesia ◽

Cesarean Delivery ◽

Umbilical Artery ◽

Base Excess ◽

Elective Cesarean Delivery ◽

Acid Base ◽

Elective Cesarean ◽

Acid Base Status ◽

Phenylephrine Infusion

Abstract Background Current recommendations for women undergoing cesarean delivery include 15° left tilt for uterine displacement to prevent aortocaval compression, although this degree of tilt is practically never achieved. We hypothesized that under contemporary clinical practice, including a crystalloid coload and phenylephrine infusion targeted at maintaining baseline systolic blood pressure, there would be no effect of maternal position on neonatal acid base status in women undergoing elective cesarean delivery with spinal anesthesia. Methods Healthy women undergoing elective cesarean delivery were randomized (nonblinded) to supine horizontal (supine, n = 50) or 15° left tilt of the surgical table (tilt, n = 50) after spinal anesthesia (hyperbaric bupivacaine 12 mg, fentanyl 15 μg, preservative-free morphine 150 μg). Lactated Ringer’s 10 ml/kg and a phenylephrine infusion titrated to 100% baseline systolic blood pressure were initiated with intrathecal injection. The primary outcome was umbilical artery base excess. Results There were no differences in umbilical artery base excess or pH between groups. The mean umbilical artery base excess (± SD) was −0.5 mM (± 1.6) in the supine group (n = 50) versus −0.6 mM (± 1.5) in the tilt group (n = 47) (P = 0.64). During 15 min after spinal anesthesia, mean phenylephrine requirement was greater (P = 0.002), and mean cardiac output was lower (P = 0.014) in the supine group. Conclusions Maternal supine position during elective cesarean delivery with spinal anesthesia in healthy term women does not impair neonatal acid–base status compared to 15° left tilt, when maternal systolic blood pressure is maintained with a coload and phenylephrine infusion. These findings may not be generalized to emergency situations or nonreassuring fetal status.

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The importance of metabolism in acid–base regulation and acid–base methodology

Canadian Journal of Zoology ◽

10.1139/z89-423 ◽

1989 ◽

Vol 67 (12) ◽

pp. 3005-3017 ◽

Cited By ~ 17

Author(s):

Hans-Otto Pörtner

Keyword(s):

Integrated Control ◽

Feedback Regulation ◽

Urea Synthesis ◽

Acid Base ◽

Base Parameters ◽

Recent Developments ◽

Acid Base Status ◽

The Relationship ◽

Aerobic And Anaerobic

Metabolism not only affects the acid–base status of an animal by means of proton stoichiometries but, by feedback regulation, acid–base parameters (pH, [Formula: see text], bicarbonate) influence metabolic rates and the pathways used. This leads to a significant contribution of metabolism to acid–base regulation under both aerobic and anaerobic conditions. The relationship between amino acid metabolism, urea synthesis, and [Formula: see text] excretion is discussed as an example important for steady-state metabolic acid–base regulation during aerobiosis. Generally, acid–base relevant metabolism may be regulated through the effect of acid–base disturbances on hormonal mediation, allosteric modulation of enzyme proteins, pH optima, and the levels of substrates or products, some of these being acid–base relevant substances like bicarbonate, CO2, inorganic phosphate, and NH3. During functional or environmental anaerobiosis the same relationships prevail. Metabolic proton accumulation is counterbalanced by phosphagen depletion and ammonia accumulation in adenylate catabolism. In addition, in integrated control of metabolic and acid–base status, long-term (mitochondrial) anaerobiosis leads to reductions in metabolic rate and increased removal of acidic groups. The importance of metabolic processes in acid–base methodology is discussed in terms of traditional concepts and recent developments.

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Hypoproteinemia, strong-ion difference, and acid-base status in critically ill patients

Journal of Applied Physiology ◽

10.1152/jappl.1998.84.5.1740 ◽

1998 ◽

Vol 84 (5) ◽

pp. 1740-1748 ◽

Cited By ~ 87

Author(s):

Peter Wilkes

Keyword(s):

Total Protein ◽

Protein Concentration ◽

Total Concentration ◽

Weak Acid ◽

Strong Ion Difference ◽

Acid Base ◽

Arterial Blood Gas ◽

Arterial Blood ◽

Acid Base Status ◽

The Relationship

The present study was a prospective, nonrandomized, observational examination of the relationship among hypoproteinemia and electrolyte and acid-base status in a critical care population of patients. A total of 219 arterial blood samples reviewed from 91 patients was analyzed for arterial blood gas, electrolytes, lactate, and total protein. Plasma strong-ion difference ([SID]) was calculated from [Na+] + [K+] − [Cl−] − [La−]. Total protein concentration was used to derive the total concentration of weak acid ([A]tot). [A]tot encompassed a range of 18.7 to 9.0 meq/l, whereas [SID] varied from 48.1 to 26.6 meq/l and was directly correlated with [A]tot. The decline in [SID] was primarily attributable to an increase in [Cl−]. A direct correlation was also noted between[Formula: see text] and [SID], but not between [Formula: see text] and [A]tot. The decrease in [SID] and [Formula: see text] was such that neither [H+] nor [[Formula: see text]] changed significantly with [A]tot.

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The Relationship Between Antepartum Fetal Heart Rate, Intrapartum Fetal Heart Rate, and Fetal Acid-Base Status

Obstetric Anesthesia Digest ◽

10.1097/00132582-198612000-00016 ◽

1986 ◽

Vol 6 (4) ◽

pp. 304

Author(s):

J. A. Low ◽

M. J. McGrath ◽

S. J. Marshall ◽

A. Fischer-Fay ◽

E. J. Krechmar

Keyword(s):

Heart Rate ◽

Fetal Heart Rate ◽

Fetal Heart ◽

Acid Base ◽

Acid Base Status ◽

The Relationship

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In Reply: Pathogenesis of Intraventricular Hemorrhage

PEDIATRICS ◽

10.1542/peds.64.3.387a ◽

1979 ◽

Vol 64 (3) ◽

pp. 387-387

Author(s):

John D. Kenny ◽

Joseph A. Garcia-Prats

Keyword(s):

Premature Infants ◽

Intraventricular Hemorrhage ◽

Elevated Pco2 ◽

Acid Base ◽

Rapid Infusion ◽

Acid Base Status ◽

The Relationship ◽

Additional Role

Dr. Wible's comments are interesting and may indeed offer an explanation for the occurrence of IVH in some infants. Since our study pertained to the acid-base status of premature infants at birth this hypothesis does not apply to the infants we studied; nevertheless, it offers an additional role for elevated pCO2 in the etiology of this condition. The relationship between rapid infusion of bicarbonate and IVH has not been adequately established although it has been shown that slow infusions do not increase the risk of IVH.1

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