Spurious Low Serum Bicarbonate Level Due to Severe Hypertriglyceridemia: A Clinical Challenge

2020 ◽  
Vol 133 (6) ◽  
pp. e306-e307
Author(s):  
Ali Pardis Dana ◽  
Amir Kazory
Keyword(s):  
Bicarbonate Level ◽  
Serum Bicarbonate ◽  
Clinical Challenge ◽  
Severe Hypertriglyceridemia ◽  
Serum Bicarbonate Level ◽  
Low Serum

scholarly journals Short-term and long-term effects of low serum bicarbonate level at admission in hospitalised patients

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Sung Yoon Lim ◽  
Youngmi Park ◽  
Ho Jun Chin ◽  
Ki Young Na ◽  
Dong-Wan Chae ◽  
...  
Keyword(s):  
Bicarbonate Level ◽  
Serum Bicarbonate ◽  
Long Term Effects ◽  
Short Term ◽  
Hospitalised Patients ◽  
Serum Bicarbonate Level ◽  
Low Serum

scholarly journals A Leukocyte Score to Improve Clinical Outcome Predictions in Bacteremic Pneumococcal Pneumonia in Adults

2014 ◽  
Vol 1 (2) ◽  
Author(s):  
Mathieu Blot ◽  
Delphine Croisier ◽  
André Péchinot ◽  
Ameline Vagner ◽  
Alain Putot ◽  
...  
Keyword(s):  
Pneumococcal Pneumonia ◽  
Pneumonia Severity Index ◽  
Adult Patients ◽  
Bicarbonate Level ◽  
Serum Bicarbonate ◽  
Risk Of Death ◽  
Pneumonia Severity Index Score ◽  
Serum Bicarbonate Level ◽  
Bacteremic Pneumococcal Pneumonia ◽  
Low Serum

Abstract Background.  Bacteremic pneumococcal pneumonia (BPP) is associated with high and early mortality. A simple procedure to predict mortality is crucial. Methods.  All adult patients with BPP admitted from 2005 through 2013 to the University Hospital of Dijon, France, were enrolled to study 30-day mortality and associated factors, particularly leukocyte counts. A simple leukocyte score was created by adding 1 point each for neutropenia (<1500 cells/mm3), lymphopenia (<400), and monocytopenia (<200). Results.  One hundred and ninety-two adult patients (mean age, 69 years; standard deviation [SD], 19 years) who had developed and were hospitalized for BPP (58% community-acquired) were included. The 30-day crude mortality rate was 21%. The mean Pneumonia Severity Index score was high at 127.3 (SD = 41.3). Among the 182 patients who had a white blood cell count, 34 (19%) had a high leukocyte score (≥2). Multivariate analysis revealed that mortality was significantly associated with a high leukocyte score (odds ratio, 6.28; 95% confidence interval, 2.35–16.78), a high respiratory rate, a low serum bicarbonate level, and an altered mental status (all P < .05). The leukocyte score was not significantly dependent on the previous state of immunosuppression, alcoholism, or viral coinfection, but it did correlate with an acute respiratory distress syndrome and a low serum bicarbonate level. Conclusions.  This new leukocyte score, in combination with the well known predictive factors, seems of interest in predicting the risk of death in BPP. A high score correlated with organ dysfunction and probably reflects the level of immunoparalysis. Its predictive value has to be confirmed in other cohorts.

Is Serum Bicarbonate Level Associated With Negative Outcomes in Pediatric Patients?

2017 ◽  
Vol 33 (11) ◽  
pp. e108-e113
Author(s):  
Naveen Poonai ◽  
David Mainprize ◽  
Carolyn Travers ◽  
Lilian Lee Yan Vivas ◽  
Peter Tryphonopoulos ◽  
...  
Keyword(s):  
Pediatric Patients ◽  
Bicarbonate Level ◽  
Serum Bicarbonate ◽  
Negative Outcomes ◽  
Serum Bicarbonate Level

scholarly journals Low Serum Bicarbonate and CKD Progression in Children

2020 ◽  
Vol 15 (6) ◽  
pp. 755-765 ◽  
Author(s):  
Denver D. Brown ◽  
Jennifer Roem ◽  
Derek K. Ng ◽  
Kimberly J. Reidy ◽  
Juhi Kumar ◽  
...  
Keyword(s):  
Lower Risk ◽  
Glomerular Disease ◽  
Bicarbonate Level ◽  
Serum Bicarbonate ◽  
Ckd Progression ◽  
Hazard Ratios ◽  
Alkali Therapy ◽  
Therapy Treatment ◽  
Low Serum

Background and objectivesStudies of adults have demonstrated an association between metabolic acidosis, as measured by low serum bicarbonate levels, and CKD progression. We evaluated this relationship in children using data from the Chronic Kidney Disease in Children study.Design, setting, participants, & measurementsThe relationship between serum bicarbonate and a composite end point, defined as 50% decline in eGFR or KRT, was described using parametric and semiparametric survival methods. Analyses were stratified by underlying nonglomerular and glomerular diagnoses, and adjusted for demographic characteristics, eGFR, proteinuria, anemia, phosphate, hypertension, and alkali therapy.ResultsSix hundred and three participants with nonglomerular disease contributed 2673 person-years of follow-up, and 255 with a glomerular diagnosis contributed 808 person-years of follow-up. At baseline, 39% (237 of 603) of participants with nonglomerular disease had a bicarbonate level of ≤22 meq/L and 36% (85 of 237) of those participants reported alkali therapy treatment. In participants with glomerular disease, 31% (79 of 255) had a bicarbonate of ≤22 meq/L, 18% (14 of 79) of those participants reported alkali therapy treatment. In adjusted longitudinal analyses, compared with participants with a bicarbonate level >22 meq/L, hazard ratios associated with a bicarbonate level of <18 meq/L and 19–22 meq/L were 1.28 [95% confidence interval (95% CI), 0.84 to 1.94] and 0.91 (95% CI, 0.65 to 1.26), respectively, in children with nonglomerular disease. In children with glomerular disease, adjusted hazard ratios associated with bicarbonate level ≤18 meq/L and bicarbonate 19–22 meq/L were 2.16 (95% CI, 1.05 to 4.44) and 1.74 (95% CI, 1.07 to 2.85), respectively. Resolution of low bicarbonate was associated with a lower risk of CKD progression compared with persistently low bicarbonate (≤22 meq/L).ConclusionsIn children with glomerular disease, low bicarbonate was linked to a higher risk of CKD progression. Resolution of low bicarbonate was associated with a lower risk of CKD progression. Fewer than one half of all children with low bicarbonate reported treatment with alkali therapy. Long-term studies of alkali therapy’s effect in patients with pediatric CKD are needed.

scholarly journals 0675 Nocturnal Oxygen Supplementation With Positive Airway Pressure Therapy For Obesity Hypoventilation Syndrome: Clinical Predictors And Liberation From Oxygen

SLEEP ◽  
2020 ◽  
Vol 43 (Supplement_1) ◽  
pp. A257-A258
Author(s):  
A Quintos ◽  
R Grewal ◽  
A Lee
Keyword(s):  
Positive Airway Pressure ◽  
Supplemental Oxygen ◽  
Bicarbonate Level ◽  
Serum Bicarbonate ◽  
Obesity Hypoventilation Syndrome ◽  
Clinical Predictors ◽  
Oxygen Supplementation ◽  
Serum Bicarbonate Level ◽  
Hypoventilation Syndrome ◽  
Obesity Hypoventilation

Abstract Introduction Obesity hypoventilation syndrome (OHS) is associated with a high morbidity and mortality. Many patients require nocturnal supplemental oxygen on top of positive airway pressure (PAP) therapy for hypoxemia independent of apneic events. We need to clinically identify patients likely to require nocturnal oxygen supplementation. Follow up is essential as with adequate control of sleep apnea, hypoxia improves and liberation from nocturnal oxygen supplementation may be achievable. Methods Researchers obtained a list of patients with coding diagnosis of OHS, seen at the Jefferson Sleep Center between November 2016 and September 2019. Patients with BMI of ≥ 30 and evidence of hypoventilation were included. Hypoventilation was defined as an elevated CO2 level of ≥ 45 mmHg on blood gas analysis, elevated serum bicarbonate level of ≥ 27 mmol/L or by evidence of nocturnal hypoventilation by AASM criteria on polysomnography. Patients with pulmonary and neuromuscular disorders were excluded Results Out of 189 patients reviewed, 36 met the inclusion and exclusion criteria. Nineteen patients (53%) required nocturnal oxygen supplementation. A higher serum bicarbonate level of 33 mmol/L against 30 mmol/L (p=0.0078) and a lower resting awake SaO2 of 89% versus 95% (p &lt;0.01) were observed in the oxygen supplementation group. In polysomnographic data, the oxygen supplementation group had lower SaO2 nadir of 67% versus 73% (p=0.026) and had a longer time with SaO2 &lt;88% at 238.2 minutes versus 65.5 minutes (p &lt;0.01). Nine out of the 19 patients (47%) underwent nocturnal oximetry on PAP and room air. Of these, 4 patients (44%) were liberated from oxygen. Conclusion Fifty three percent of patients with OHS required nocturnal oxygen supplementation on top of PAP therapy. Higher serum bicarbonate level and lower resting awake SaO2 are potential clinical predictors of nocturnal oxygen supplementation. After nocturnal oximetry on PAP, 44% were successfully liberated from supplemental oxygen. Support  

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