Electrolyte Disturbances and Acid-Base Imbalance

2021 ◽  
pp. 1141-1146
Author(s):  
Sara E. Hocker ◽  
Ali Daneshmand
Keyword(s):  
Heart Failure ◽  
Differential Diagnosis ◽  
Fluid Management ◽  
Kidney Injury ◽  
Electrolyte Disorders ◽  
Electrolyte Disturbances ◽  
Severe Burns ◽  
Muscle Tissues ◽  
Electrolyte Homeostasis ◽  
Clinical Problems

Electrolyte disorders are among the most common clinical problems encountered in critically ill patients. Disorders such as severe burns, trauma, sepsis, acute brain injury, and heart failure lead to disturbances in fluid and electrolyte homeostasis through complex mechanisms involving deregulation or activation of hormonal systems and ischemic or nephrotoxic kidney injury. Inappropriate fluid management should also be considered in the differential diagnosis of electrolyte disturbances in patients in intensive care units. Electrolyte imbalances produce both central and peripheral neurologic dysfunction because electrochemical membrane potentials in brain, nerve, and muscle tissues are particularly sensitive to chemical, ionic, and osmolar shifts.

Kidney Disease in the Cancer Patient

2014 ◽  
Author(s):  
Colm Magee ◽  
Lynn Redahan
Keyword(s):  
Kidney Disease ◽  
Cancer Patient ◽  
Tumor Lysis Syndrome ◽  
Interleukin 2 ◽  
Kidney Injury ◽  
Vascular Diseases ◽  
Electrolyte Disorders ◽  
Laboratory Findings ◽  
Hematopoietic Stem ◽  
Electrolyte Disturbances

The spectrum of kidney disease in the cancer patient is wide. Kidney dysfunction can result from the cancer itself or its treatment. The presentation in this population is varied and may manifest as acute kidney injury (AKI) or chronic kidney disease. In addition, other manifestations of kidney disease can include proteinuria, hypertension, and electrolyte disturbances. As new cancer treatments emerge, the range of therapy-associated renal syndromes increases. This chapter deals predominantly with causes and management of renal dysfunction that are specific to the cancer patient, including those caused by hypercalcemia; hepatorenal syndrome; the use of interleukin-2 (IL-2) and bisphosphonate; glomerular, tubular, interstitial, and vascular diseases; multiple myeloma (MM); and tumor infiltration. The chapter also examines postrenal causes of AKI, electrolyte disorders, and hematopoietic stem cell transplantation (HSCT). Tables provide the features of kidney disease in the cancer patient, the pathogenesis of hypercalcemia, strategies for preventing and managing AKI with IL-2 therapy, laboratory findings with hemolytic-uremic syndrome/thrombocytopenic purpura, the causes of acute tubular necrosis in MM, a summary of electrolyte disturbances in the cancer patient, indications for HSCT, and a summary of the management of patients with post-HSCT AKI. The chapter is also enhanced by ultrasound and computed tomographic scans, histology images, and an illustration of tumor lysis syndrome. This chapter contains 105 references, 8 tables, 4 highly rendered figures, and 5 MCQs.

Kidney Disease in the Cancer Patient

2014 ◽  
Author(s):  
Colm Magee ◽  
Lynn Redahan
Keyword(s):  
Kidney Disease ◽  
Cancer Patient ◽  
Tumor Lysis Syndrome ◽  
Interleukin 2 ◽  
Kidney Injury ◽  
Vascular Diseases ◽  
Electrolyte Disorders ◽  
Laboratory Findings ◽  
Hematopoietic Stem ◽  
Electrolyte Disturbances

The spectrum of kidney disease in the cancer patient is wide. Kidney dysfunction can result from the cancer itself or its treatment. The presentation in this population is varied and may manifest as acute kidney injury (AKI) or chronic kidney disease. In addition, other manifestations of kidney disease can include proteinuria, hypertension, and electrolyte disturbances. As new cancer treatments emerge, the range of therapy-associated renal syndromes increases. This chapter deals predominantly with causes and management of renal dysfunction that are specific to the cancer patient, including those caused by hypercalcemia; hepatorenal syndrome; the use of interleukin-2 (IL-2) and bisphosphonate; glomerular, tubular, interstitial, and vascular diseases; multiple myeloma (MM); and tumor infiltration. The chapter also examines postrenal causes of AKI, electrolyte disorders, and hematopoietic stem cell transplantation (HSCT). Tables provide the features of kidney disease in the cancer patient, the pathogenesis of hypercalcemia, strategies for preventing and managing AKI with IL-2 therapy, laboratory findings with hemolytic-uremic syndrome/thrombocytopenic purpura, the causes of acute tubular necrosis in MM, a summary of electrolyte disturbances in the cancer patient, indications for HSCT, and a summary of the management of patients with post-HSCT AKI. The chapter is also enhanced by ultrasound and computed tomographic scans, histology images, and an illustration of tumor lysis syndrome. This chapter contains 105 references, 8 tables, 4 highly rendered figures, and 5 MCQs.

Evaluation of simplified fluid intake and output recording schemes for the self-management in patients with heart failure: a randomized controlled trial

2020 ◽  
Author(s):  
Na Lin ◽  
Xiaohuan Chen ◽  
Xiufang Huang ◽  
Donghui Liu ◽  
Zhiyong Wu ◽  
...  
Keyword(s):  
Heart Failure ◽  
Fluid Intake ◽  
Controlled Trial ◽  
Fluid Management ◽  
Allocation Concealment ◽  
The Self ◽  
Self Management ◽  
Random Allocation ◽  
Electrolyte Disturbances ◽  
Clinical Stability

Abstract Background Fluid management plays a pivotal role for heart failure (HF) patients. Medical fluid intake and output recording scheme by health care professional is complicated, which is not easily conducive to carry out by HF patients for self-management at home. This study aimed to optimize the professional fluid records for the self-management of HF patients and evaluate the effectiveness of this simplified recording scheme of fluid intake and output. Methods A randomized, non-blinded, non-inferiority trial with allocation concealment was conducted. Participants meeting the diagnostic criteria for HF were randomly assigned to professional recording group (PRG) and simplified recording group (SRG) according to the random allocation sequence generated by online tool. Days from admission to clinical stability (primary outcome), clinical congestion score (CCS), Minnesota Living with Heart Failure Questionnaire (MLHFQ) and frequency of electrolyte disturbances (secondary outcomes) were collected. The outcomes judges were blinded to group assignment.Results A total of 140 HF patients were enrolled and randomly divided into PRG (n=70) and SRG (n=70). Ultimately, 129 HF patients (PRG, n=65, and SRG, n=64) completed these experiments. Compared to PRG patients, SRG patients also improved their HF symptoms (including shortness of breath and fluid retention), and did not show the prolonged hospitalization time after similar intravenous diuretic treatment. Additionally, the parameters of clinical stability, CCS, MLHFQ, electrolyte disturbances and body weight in SRG patients were not inferior to that of PRG patients ( P >0.05). Conclusions This simplified fluid intake and output recording scheme was safe, efficient and non-inferior to the professional mode, which might effectively enhance their feasibility of self-management, and improve their quality of life in HF patients.

The kidney in systemic disease

2021 ◽  
pp. 185-284
Keyword(s):  
Systemic Disease ◽  
High Capacity ◽  
Kidney Injury ◽  
Autoimmune Disorders ◽  
Pathological Response ◽  
Electrolyte Disorders ◽  
Excretory Function ◽  
Renal Lesions ◽  
Organ Systems ◽  
Electrolyte Homeostasis

The kidneys are frequently involved in several systemic conditions, including autoimmune disorders, vasculitides, haematological conditions, malignancy, and disorders of other organ systems. Moreover, drugs used to treat these conditions could have an effect on the kidneys, presenting as acute kidney injury (AKI), electrolyte disorders due to disruption of the absorptive function of the kidneys, or as a form of glomerulonephritis. Due to the high vasculature and volume of blood flow in the kidneys, autoimmune disorders and vasculitides have been reported to cause immune-complex mediated disorders and inflammatory lesions of both glomeruli and tubulointerstitium. Likewise, monoclonal gammopathies have a propensity for the kidneys, with several reported phenotypes causing characteristic renal lesions. Due to the high capacity for glomerular filtration and excretory function, the kidneys are often the insult of disorders of cellular breakdown such as pigment disorders or tumour lysis syndrome, where AKI is common, resulting in a reduced ability for electrolyte homeostasis. Finally, both cardiorenal and hepatorenal syndromes have been well described, highlighting the interdependency of various organ systems and the pathological response of the kidneys to disorders of heart and liver.

Use of locally prepared peritoneal dialysis (PD) fluid for acute PD in children and infants in Africa

2020 ◽  
Vol 40 (5) ◽  
pp. 441-445 ◽  
Author(s):  
Mignon I McCulloch ◽  
Peter Nourse ◽  
Andrew C Argent
Keyword(s):  
Intensive Care Unit ◽  
Overall Survival ◽  
Acute Kidney Injury ◽  
Intensive Care ◽  
Peritoneal Dialysis ◽  
Kidney Injury ◽  
Electrolyte Disorders ◽  
Infusion Solution ◽  
Electrolyte Disturbances ◽  
Intravenous Solution

Background: In less well-resourced countries, the high cost of commercially available peritoneal dialysis (PD) fluid limits its use. The major concerns regarding bedside-prepared PD fluid is peritonitis as well as electrolyte disorders. The aim of this study was to review our experience with the use of PD fluids prepared at the bedside using the intravenous infusion solution Balsol (Fresenius Kabi). Methods: This was a retrospective review of all patients who received PD for acute kidney injury (AKI) using a bedside-prepared PD solution adapted from the intravenous solution Balsol in our intensive care unit. Results: In total, 49 cases of acute PD were performed. Of the 49 children, 21 (43%) were male. The ages of the patients ranged from newborn to 10.2 years (median 0.33 years). The weight of children ranged from 1.3 kg to 50 kg (median 4.1 kg). The type of PD catheters used: Cook catheters, 41 patients; Kimal peel-away, 10 patients; and surgical inserted Tenckhoff type of catheter, 2 patients. The duration of PD was 1–17 days (median 3 days) Complications included peritonitis in 2 of 49 patients and blocked catheter in 6 of 49 patients. There were no electrolyte disturbances as a result of the PD. Overall survival was 43% of patients. Conclusions: Locally prepared PD solutions at the bedside adapted from intravenous solutions can be used safely and effectively. This has important relevance for centres in less well-resourced countries, where commercially produced PD fluid is not available for the management of AKI.

scholarly journals Renal Complications Related to Checkpoint Inhibitors: Diagnostic and Therapeutic Strategies

Diagnostics ◽  
2021 ◽  
Vol 11 (7) ◽  
pp. 1187
Author(s):  
Julie Belliere ◽  
Julien Mazieres ◽  
Nicolas Meyer ◽  
Leila Chebane ◽  
Fabien Despas
Keyword(s):  
Checkpoint Inhibitors ◽  
Treatment Strategies ◽  
Kidney Injury ◽  
Immunosuppressive Drugs ◽  
Peripheral Tolerance ◽  
Electrolyte Disorders ◽  
Glomerular Diseases ◽  
Renal Complications ◽  
Lower Baseline ◽  
Low Incidence

Immune checkpoint inhibitors (ICI) targeting CTLA-4 and the PD-1/PD-L1 axis have unprecedentedly improved global prognosis in several types of cancers. However, they are associated with the occurrence of immune-related adverse events. Despite their low incidence, renal complications can interfere with the oncologic strategy. The breaking of peripheral tolerance and the emergence of auto- or drug-reactive T-cells are the main pathophysiological hypotheses to explain renal complications after ICI exposure. ICIs can induce a large spectrum of renal symptoms with variable severity (from isolated electrolyte disorders to dialysis-dependent acute kidney injury (AKI)) and presentation (acute tubule-interstitial nephritis in >90% of cases and a minority of glomerular diseases). In this review, the current trends in diagnosis and treatment strategies are summarized. The diagnosis of ICI-related renal complications requires special steps to avoid confounding factors, identify known risk factors (lower baseline estimated glomerular filtration rate, proton pump inhibitor use, and combination ICI therapy), and prove ICI causality, even after long-term exposure (weeks to months). A kidney biopsy should be performed as soon as possible. The treatment strategies rely on ICI discontinuation as well as co-medications, corticosteroids for 2 months, and tailored immunosuppressive drugs when renal response is not achieved.

scholarly journals A simple nomogram to predict contrast-induced acute kidney injury in patients with congestive heart failure undergoing coronary angiography

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
L Lei ◽  
Y He ◽  
Z Guo ◽  
B Liu ◽  
J Liu ◽  
...  
Keyword(s):  
Heart Failure ◽  
Congestive Heart Failure ◽  
Acute Kidney Injury ◽  
Coronary Angiography ◽  
Prediction Models ◽  
Validation Cohort ◽  
Kidney Injury ◽  
Class Ii ◽  
Functional Class ◽  
Killip Class

Abstract Background Patients with congestive heart failure (CHF) are vulnerable to contrast-induced acute kidney injury (CI-AKI), but few prediction models are currently available. Objectives We aimed to establish a simple nomogram for CI-AKI risk assessment for patients with CHF undergoing coronary angiography. Methods A total of 1876 consecutive patients with CHF (defined as New York Heart Association functional class II-IV or Killip class II-IV) were enrolled and randomly (2:1) assigned to a development cohort and a validation cohort. The endpoint was CI-AKI defined as serum creatinine elevation of ≥0.3 mg/dL or 50% from baseline within the first 48–72 hours following the procedure. Predictors for the nomogram were selected by multivariable logistic regression with a stepwise approach. The discriminative power was assessed using the area under the receiver operating characteristic (ROC) curve and was compared with the classic Mehran score in the validation cohort. Calibration was assessed using the Hosmer–Lemeshow test and 1000 bootstrap samples. Results The incidence of CI-AKI was 9.06% (n=170) in the total sample, 8.64% (n=109) in the development cohort and 9.92% (n=61) in the validation cohort (p=0.367). The simple nomogram including four predictors (age, intra-aortic balloon pump, acute myocardial infarction and chronic kidney disease) demonstrated a similar predictive power as the Mehran score (area under the curve: 0.80 vs 0.75, p=0.061), as well as a well-fitted calibration curve. Conclusions The present simple nomogram including four predictors is a simple and reliable tool to identify CHF patients at risk of CI-AKI, whereas further external validations are needed. Figure 1 Funding Acknowledgement Type of funding source: None

scholarly journals Unusual Presentation of Kratom Overdose With Rhabdomyolysis, Transient Hearing Loss, and Heart Failure

2021 ◽  
Vol 9 ◽  
pp. 232470962110050
Author(s):  
Vikram Sangani ◽  
Naseem Sunnoqrot ◽  
Kurdistan Gargis ◽  
Akshay Ranabhotu ◽  
Abbas Mubasher ◽  
...  
Keyword(s):  
Heart Failure ◽  
Hearing Loss ◽  
Cardiac Death ◽  
Multidisciplinary Approach ◽  
Kidney Injury ◽  
Lethal Effect ◽  
Limited Information ◽  
Emergency Physicians ◽  
Behavioral Impairment ◽  
Elevated Creatinine

Kratom mainly grows in Southeast Asia. It is widely used for pain management and opioid withdrawal, which is available online for cheaper prices. Alkaloids extracted from kratom such as mitragynine and 7-hydroxy mitragynine exhibit analgesic properties by acting through µ receptors. Commonly reported side effects of kratom include hypertension, tachycardia, agitation, dry mouth, hallucinations, cognitive and behavioral impairment, cardiotoxicity, renal failure, cholestasis, seizures, respiratory depression, coma, and sudden cardiac death from cardiac arrest. Rhabdomyolysis is a less commonly reported lethal effect of kratom. Limited information is available in the literature. In this article, we present a case of a 45-year-old female who is overdosed with kratom and presented with lethargy, confusion, transient hearing loss, and right lower extremity swelling and pain associated with weakness who was found to have elevated creatinine phosphokinase. She was diagnosed with rhabdomyolysis, compartment syndrome, multiorgan dysfunction including acute kidney injury, liver dysfunction, and cardiomyopathy. She underwent emergent fasciotomy and required hemodialysis. Her renal and liver function subsequently improved. We described the case and discussed pharmacology and adverse effects of kratom toxicity with a proposed mechanism and management. We conclude that it is essential for emergency physicians, internists, intensivists, cardiologists, and nephrologists to be aware of these rare manifestations of kratom and consider a multidisciplinary approach.

scholarly journals Adverse clinical outcomes associated with RAAS inhibitor discontinuation: analysis of over 400 000 patients from the UK Clinical Practice Research Datalink (CPRD)

2021 ◽  
Author(s):  
Toby J L Humphrey ◽  
Glen James ◽  
Eric T Wittbrodt ◽  
Donna Zarzuela ◽  
Thomas F Hiemstra
Keyword(s):  
Heart Failure ◽  
Acute Kidney Injury ◽  
Clinical Practice ◽  
Clinical Outcomes ◽  
Kidney Injury ◽  
Practice Research ◽  
Clinical Practice Research Datalink ◽  
Ckd Stage ◽  
First Occurrence ◽  
Baseline Characteristics

Abstract Background Users of guideline-recommended renin–angiotensin–aldosterone system (RAAS) inhibitors may experience disruptions to their treatment, e.g. due to hyperkalaemia, hypotension or acute kidney injury. The risks associated with treatment disruption have not been comprehensively assessed; therefore, we evaluated the risk of adverse clinical outcomes in RAAS inhibitor users experiencing treatment disruptions in a large population-wide database. Methods This exploratory, retrospective analysis utilized data from the UK’s Clinical Practice Research Datalink, linked to Hospital Episodes Statistics and the Office for National Statistics databases. Adults (≥18 years) with first RAAS inhibitor use (defined as angiotensin-converting enzyme inhibitors or angiotensin receptor blockers) between 1 January 2009 and 31 December 2014 were eligible for inclusion. Time to the first occurrence of adverse clinical outcomes [all-cause mortality, all-cause hospitalization, cardiac arrhythmia, heart failure hospitalization, cardiac arrest, advancement in chronic kidney disease (CKD) stage and acute kidney injury] was compared between RAAS inhibitor users with and without interruptions or cessations to treatment during follow-up. Associations between baseline characteristics and adverse clinical outcomes were also assessed. Results Among 434 027 RAAS inhibitor users, the risk of the first occurrence of all clinical outcomes, except advancement in CKD stage, was 8–75% lower in patients without interruptions or cessations versus patients with interruptions/cessations. Baseline characteristics independently associated with increased risk of clinical outcomes included increasing age, smoking, CKD, diabetes and heart failure. Conclusions These findings highlight the need for effective management of factors associated with RAAS inhibitor interruptions or cessations in patients for whom guideline-recommended RAAS inhibitor treatment is indicated.

Critical care management of hydrofluoric acid burns with a negative outcome

2021 ◽  
Vol 14 (6) ◽  
pp. e242187
Author(s):  
Aalekh Prasad ◽  
Heba Ibrahim ◽  
Katherine Mortimore ◽  
Rohan Vandabona
Keyword(s):  
Hydrofluoric Acid ◽  
Care Management ◽  
Vital Role ◽  
Severe Metabolic Acidosis ◽  
Fluoride Ions ◽  
Subcutaneous Injections ◽  
Electrolyte Disturbances ◽  
Severe Burns ◽  
Systemic Reactions ◽  
Critical Care Management

Hydrofluoric acid is a highly corrosive acid widely used in various industries. When in contact with skin it causes local and systemic reactions due to the generation of fluoride ions. Severe burns are associated with high mortality rates, approaching 100%. We present a 21-year-old man with 15% full thickness burns, severe metabolic acidosis, hypoxia and electrolyte disturbances. The burns were treated with topical and subcutaneous injections of calcium gluconate, and the patient was given intravenous fluid, calcium chloride, magnesium and insulin-glucose infusions. Continuous renal replacement therapy was initiated due to the severity of the systemic toxicity. Extracorporeal membrane oxygenation was considered as it plays a vital role when conventional therapies fail. Our patient suffered multiple cardiac arrests and cardiopulmonary resuscitation was conducted several times but despite extensive efforts, he did not survive.

Sign in / Sign up

Export Citation Format

Share Document