Expert opinion: fomepizole may ameliorate the need for hemodialysis in methanol poisoning

2008 ◽  
Vol 27 (7) ◽  
pp. 539-546 ◽  
Author(s):  
KE Hovda ◽  
D Jacobsen
Keyword(s):  
Metabolic Acidosis ◽  
Base Deficit ◽  
Critically Ill Patient ◽  
Review Of The Literature ◽  
Stable Patient ◽  
Severe Metabolic Acidosis ◽  
New Approach ◽  
Methanol Poisoning ◽  
Toxic Anion ◽  
Visual Disturbances

Fomepizole is now the antidote of choice in methanol poisoning. The use of fomepizole may also change the indications for hemodialysis in these patients. We have addressed this change in a review of articles on methanol poisonings. Review of the literature (through PubMed®) combined with our own experiences from two recent methanol outbreaks in Estonia and Norway. The efficiency of dialysis during fomepizole treatment was reported in only a few reports. One recent study challenged the old indications, suggesting a new approach with delayed or even no hemodialysis. Methanol-poisoned patients on fomepizole treatment may be separated into two categories: 1) The critically ill patient, with severe metabolic acidosis (base deficit >15 mM) and/or visual disturbances should be given buffer, fomepizole and immediate hemodialysis: dialysis removes the toxic anion formate, and assists in correcting the metabolic acidosis, thereby also reducing formate toxicity. The removal of methanol per se is not important in this setting because fomepizole prevents further production of formic acid. 2) The stable patient, with less metabolic acidosis and no visual disturbances, should be given buffer and fomepizole. This treatment allows for the possibility to delay, or even drop, dialysis in this setting, because patients will not develop more clinical features from methanol poisoning when fomepizole and bicarbonate is given in adequate doses. Indications and triage for hemodialysis in methanol poisonings should be modified. Delayed hemodialysis or even no hemodialysis may be an option in selected cases.

Bilirubin binding and neonatal acidosis.

1981 ◽  
Vol 27 (11) ◽  
pp. 1872-1874 ◽  
Author(s):  
M Perlman ◽  
J Kapitulnik ◽  
S H Blondheim ◽  
A Alayoff ◽  
A Russell
Keyword(s):  
Metabolic Acidosis ◽  
Binding Sites ◽  
Gel Filtration ◽  
Organic Anions ◽  
Base Deficit ◽  
Fetal Hypoxia ◽  
Severe Metabolic Acidosis ◽  
Per Se ◽  
Bilirubin Binding

Abstract Plasma of neonates with severe metabolic acidosis secondary to fetal hypoxia bound less bilirubin than that of neonates without acidosis, as determined by Sephadex gel filtration. There was a significant correlation between the amount of bilirubin adsorbed by Sephadex and the base deficit. The method used ruled out any influence of plasma pH per se on binding. Our results suggest that organic anions that accumulate in the plasma of asphyxiated acidotic neonates may compete with bilirubin for binding sites on albumin.

Predictors of Mortality Among Very Low Birth Weight Infants With Gastrointestinal Perforation

2020 ◽  
pp. 000313482095692
Author(s):  
Marina L. Reppucci ◽  
Eliza H. Hersh ◽  
Prerna Khetan ◽  
Brian A. Coakley
Keyword(s):  
Metabolic Acidosis ◽  
Birth Weight ◽  
Low Birth Weight ◽  
Very Low Birth Weight ◽  
Severe Metabolic Acidosis ◽  
Related Factors ◽  
Vlbw Infants ◽  
Risk Of Death ◽  
Portal Venous Gas ◽  
Elevated Lactate

Background Gastrointestinal (GI) perforation is a risk factor for mortality in very low birth weight (VLBW) infants. Little data exist regarding pretreatment factors and patient characteristics known to independently correlate with risk of death. Materials and Methods A retrospective review of all VLBW infants who sustained GI perforation between 2011 and 2018 was conducted. Birth, laboratory, and disease-related factors of infants who died were compared to those who survived. Results 42 VLBW infants who sustained GI perforations were identified. Eleven (26.19%) died. There were no significant differences in birth-related factors, hematological lab levels at diagnosis, presence of pneumatosis, or bacteremia. Portal venous gas ( P = .03), severe metabolic acidosis ( P < .01), and elevated lactate at diagnosis ( P < .01) were statistically more likely to occur among infants who died. Discussion Portal venous gas, severe metabolic acidosis, and elevated lactate were associated with an increased risk of mortality among VLBW infants who develop a GI perforation. Further research is required to better identify risk factors.

scholarly journals Identifying prognostic factors of severe metabolic acidosis and uraemia in African children with severe falciparum malaria: a secondary analysis of a randomized trial

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Grace Mzumara ◽  
Stije Leopold ◽  
Kevin Marsh ◽  
Arjen Dondorp ◽  
Eric O. Ohuma ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Metabolic Acidosis ◽  
Falciparum Malaria ◽  
Model Building ◽  
Statistical Significance ◽  
Severe Metabolic Acidosis ◽  
African Countries ◽  
Prognostic Features ◽  
African Children ◽  
Severe Falciparum Malaria

Abstract Background Severe metabolic acidosis and acute kidney injury are major causes of mortality in children with severe malaria but are often underdiagnosed in low resource settings. Methods A retrospective analysis of the ‘Artesunate versus quinine in the treatment of severe falciparum malaria in African children’ (AQUAMAT) trial was conducted to identify clinical features of severe metabolic acidosis and uraemia in 5425 children from nine African countries. Separate models were fitted for uraemia and severe metabolic acidosis. Separate univariable and multivariable logistic regression were performed to identify prognostic factors for severe metabolic acidosis and uraemia. Both analyses adjusted for the trial arm. A forward selection approach was used for model building of the logistic models and a threshold of 5% statistical significance was used for inclusion of variables into the final logistic model. Model performance was assessed through calibration, discrimination, and internal validation with bootstrapping. Results There were 2296 children identified with severe metabolic acidosis and 1110 with uraemia. Prognostic features of severe metabolic acidosis among them were deep breathing (OR: 3.94, CI 2.51–6.2), hypoglycaemia (OR: 5.16, CI 2.74–9.75), coma (OR: 1.72 CI 1.17–2.51), respiratory distress (OR: 1.46, CI 1.02–2.1) and prostration (OR: 1.88 CI 1.35–2.59). Features associated with uraemia were coma (3.18, CI 2.36–4.27), Prostration (OR: 1.78 CI 1.37–2.30), decompensated shock (OR: 1.89, CI 1.31–2.74), black water fever (CI 1.58. CI 1.09–2.27), jaundice (OR: 3.46 CI 2.21–5.43), severe anaemia (OR: 1.77, CI 1.36–2.29) and hypoglycaemia (OR: 2.77, CI 2.22–3.46) Conclusion Clinical and laboratory parameters representing contributors and consequences of severe metabolic acidosis and uraemia were independently associated with these outcomes. The model can be useful for identifying patients at high risk of these complications where laboratory assessments are not routinely available.

Mobility-as-a-Service: Simulation of Multi-Modal Operations in Low-Density Cities

2021 ◽  
pp. 036119812110398
Author(s):  
Mohamed El-Agroudy ◽  
Hatem Abou-Senna ◽  
Essam Radwan
Keyword(s):  
Performance Measures ◽  
Magic Bullet ◽  
Low Density ◽  
The Novel ◽  
Review Of The Literature ◽  
Modal Interactions ◽  
New Approach ◽  
Novel Interactions ◽  
Alternative Scenarios ◽  
Urban Characteristics

In the case of the low-density city, empirical evidence continuously demonstrates that transit investment is not a magic bullet. Desirable outcomes are not guaranteed and are often dependent on development density and other urban characteristics. Mobility-as-a-service (MaaS) presents a new approach: a digital platform providing access to multi-modal travel alternatives and totally comprehensive integrated trip-making, planning, and payment services. Review of the literature highlights shortcomings in traditional transportation planning by examining aspects of multi-modal planning such as adoption, parterships, operations, integration, capacity implications, and impact analyses. To enhance the practice of multi-modal planning, the following experiment evaluates various performance measures and inter-modal interactions on International Drive in Orlando, Florida, U.S., via D- and I-optimal experimental designs in a simulated MaaS network. Alternative scenarios are developed comparing varied modal shares across five travel modes: personal vehicles, transit, ridesourcing (or ride-hailing), micro-mobility, and walking. The modal effects are analyzed to highlight the strengths and weakness of each mode under a variety of congestion conditions. While transit enjoys the lowest impact per person, ridesourcing demonstrates adverse effects across all measures. Based on the novel interactions of transit and ridesourcing with directional demand, strategies are outlined for optimizing ridesourcing-transit integration to reduce route travel time, queuing, and overall network delay. The performance impacts of curbside facilities are also discussed for improved multi-modal integration at the street level. These findings are applied to propose a framework for effective planning and implementation of mobility services in low-density cities, focused on operations, city-level connectivity, and curbside management.

scholarly journals Re-forming Initial Teacher Education in Wales: A Personal Review of the Literature

2020 ◽  
Vol 22 (1) ◽  
pp. 38-59
Author(s):  
John Furlong
Keyword(s):  
Teacher Education ◽  
Research Evidence ◽  
Initial Teacher Education ◽  
Reform Process ◽  
Review Of The Literature ◽  
Special Issue ◽  
Close Collaboration ◽  
New Approach ◽  
Partner Schools

The focus of this special issue is the changes to Initial Teacher Education (ITE) that have been instituted in Wales over the last two years. At the heart of the new approach is the insistence that in the future all programmes of ITE should be planned, led and delivered not by universities alone, but by universities working in close collaboration with a number of partner schools. But what is the justification for these radical changes? Why is a collaborative approach between universities and schools needed? This paper, which takes the form of a personal literature review, sets out the research evidence on which I drew in contributing the reform process. It considers evidence on three issues: the role of schools; the role of universities; and the ways in which they can effectively work together.

Sign in / Sign up

Export Citation Format

Share Document