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 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 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 <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 <88% at 238.2 minutes versus 65.5 minutes (p <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  

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.

Effect of Bicarbonate-Buffered Dialysate on Ventricular Arrhythmias in Hemodialysis Patients

2019 ◽  
Vol 49 (1) ◽  
pp. 74-80 ◽  
Author(s):  
Ryan E. Krahn ◽  
Ryan Tulowitzki ◽  
Gregory D. Gudleski ◽  
Brian Murray ◽  
Bharath Rajagopalan ◽  
...  
Keyword(s):  
Ventricular Arrhythmia ◽  
Metabolic Alkalosis ◽  
Holter Monitoring ◽  
Serum Levels ◽  
Bicarbonate Level ◽  
Serum Bicarbonate ◽  
Premature Ventricular Contractions ◽  
Serum Total Calcium ◽  
Direct Association ◽  
Serum Bicarbonate Level

Background: The etiology of sudden cardiac death in patients with end-stage renal disease (ESRD) on hemodialysis (HD) is largely unknown, though there is evidence to suggest that metabolic alkalosis induced by HD with a high-bicarbonate dialysate/prescription may play a role. Methods: We investigated the effects of metabolic alkalosis induced by HD with an acetate-containing bicarbonate-buffered dialysate on frequency of ventricular arrhythmia in 47 patients with ESRD on chronic HD using 48-h Holter monitoring in 3 phases: intra-HD, post-HD day 1, and post-HD day 2. Serum levels of bicarbonate, calcium, and potassium along with hemodynamics were measured pre-HD, post-HD, 20-h post-HD, and 44-h post-HD. Correlations were performed to verify the association between bicarbonate prescription and change in serum bicarbonate levels post-HD and to determine if the HD-induced change in serum bicarbonate level (metabolic alkalosis) had any direct association with ambient ventricular arrhythmia (premature ventricular contractions per hour) or indirect associations with ambient ventricular arrhythmia by affecting electrolytes or hemodynamics that are known to increase the risk of ventricular arrhythmia. Results: Mean pre-HD serum bicarbonate level was 21.3 mEq/L. Dialysate bicarbonate prescription (mean of 36.4 mEq/L) correlated with changes in serum bicarbonate levels immediately post-HD 26.7 mEq/L (r = 0.46, p < 0.01), 20-h post-HD 25.2 mEq/L (r = 0.38), and 44-h post-HD 23.2 mEq/L (r = 0.35, p = 0.01). No statistically significant correlations were found between the post-HD change in serum bicarbonate levels (metabolic alkalosis) with ambient ventricular arrhythmia, changes in serum calcium, potassium, or hemodynamics in any phase. Conclusions: High-bicarbonate dialysate prescription is associated with metabolic alkalosis following the HD procedure. A mild metabolic alkalosis induced by HD with an acetate-containing bicarbonate-buffered dialysate solution had no direct association with ambient ventricular arrhythmia on Holter monitoring and was not associated with changes in hemodynamics or changes in serum total calcium or potassium levels. This study helps to provide guidance for the safe use of high bicarbonate dialysate/prescription in patients with ESRD on HD.

scholarly journals Serum bicarbonate and cardiovascular events in hypertensive adults: results from the Systolic Blood Pressure Intervention Trial

2019 ◽  
Vol 35 (8) ◽  
pp. 1377-1384 ◽  
Author(s):  
Mirela Dobre ◽  
Nicholas M Pajewski ◽  
Srinivasan Beddhu ◽  
Michel Chonchol ◽  
Thomas H Hostetter ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Systolic Blood Pressure ◽  
Acute Decompensated Heart Failure ◽  
P Value ◽  
Bicarbonate Level ◽  
Serum Bicarbonate ◽  
Intervention Trial ◽  
Cvd Risk ◽  
Coronary Syndrome ◽  
Serum Bicarbonate Level

Abstract Background Low serum bicarbonate level is associated with increased mortality, but its role as a predictor of cardiovascular disease (CVD) is unclear. This study evaluates the association between serum bicarbonate concentration and CVD and whether the effect of intensive blood pressure (BP) lowering on CVD outcomes is modified by serum bicarbonate level. Methods The Systolic Blood Pressure Intervention Trial (SPRINT) randomized participants to a systolic BP target &lt;120 mmHg (intensive treatment) or &lt;140 mmHg (standard treatment). The primary CVD outcome was a composite of nonfatal myocardial infarction (MI), acute coronary syndrome not resulting in MI, stroke, acute decompensated heart failure and CVD death. Cox proportional hazards models adjusted for demographic, clinical and laboratory characteristics were used to evaluate the association of interest in 9334 SPRINT participants (ClinicalTrials.gov: NCT01206062). Results Over a median follow-up of 3.33 years (interquartile range 2.87–3.87 years), 618 (6.6%) participants experienced a primary CVD outcome. Participants with serum bicarbonate &lt;22 mEq/L had a significantly higher risk of the primary CVD outcome (hazard ratio 1.54; 95% confidence interval 1.11–2.14, P = 0.01), compared with participants with bicarbonate 22–26 mEq/L. The magnitude of the CVD risk reduction with intensive BP lowering was similar across bicarbonate strata (P-value for interaction = 0.97). Conclusions In hypertensive individuals, serum bicarbonate level &lt;22 mEq/L was associated with an increased CVD risk. The effect of intensive BP lowering on CVD outcomes was not modified by the serum bicarbonate level.

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