The Use of THAM in the Treatment of Status Asthmaticus

The treatment of status asthmaticus (epinephrine-fast state in an acutely ill asthmatic patient) has been described frequently; however, the need to correct the respiratory and metabolic acidosis which accompanies this condition has not been emphasized. Recently such recommendations have appeared in the nonpediatric literature of this country and of Europe. The purpose of this paper is to report two pediatric patients with status asthmaticus who recovered after administration of Tris (hydroxymethyl) aminomethane (THAM), an amine alkalinizing agent. Methods The Astrup technique employing the ME-l equipment and Sigaard-Andersen's nomogram were used to determine pH, pCO2, Base Excess (B.E.), Buffer Base (B.B.) and Standard Bicarbonate (S.B.) of capillary blood. Serum electrolytes were determined by conventional methods. [SEE TABLE I AND II IN SOURCE PDF].

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New onset diabetes with diabetic ketoacidosis in a child with multisystem inflammatory syndrome due to COVID-19

Journal of Pediatric Endocrinology and Metabolism ◽

10.1515/jpem-2020-0426 ◽

2020 ◽

Vol 0 (0) ◽

Cited By ~ 1

Author(s):

Monica N. Naguib ◽

Jennifer K. Raymond ◽

Alaina P. Vidmar

Keyword(s):

Metabolic Acidosis ◽

Diabetic Ketoacidosis ◽

Pediatric Patients ◽

Systolic Function ◽

Hemodynamic Instability ◽

Case Presentation ◽

Onset Diabetes ◽

Potential Trigger ◽

Inflammatory Syndrome ◽

New Onset

AbstractIntroductionMultisystem inflammatory syndrome in children (MIS-C) is a unique clinical complication of SARS-CoV-2 infection observed in pediatric patients. COVID-19 is emerging as a potential trigger for the development of diabetes in children. Here, we report a patient presenting with MIS-C and new onset diabetes, and discuss the implication and clinical management of these concomitant conditions.Case presentationAn eight-year-old female presented with hyperglycemia, ketosis and metabolic acidosis consistent with diabetic ketoacidosis (DKA) in the setting of fever, rash, respiratory distress, hemodynamic instability, reduced systolic function with dilation of the left anterior descending artery, and positive SARS-CoV-2 antibodies suggestive of MIS-C.

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Analysis of blood gas beyond bicarbonate in outpatients with stage 3–5 chronic kidney disease

Turkish Journal of Biochemistry ◽

10.1515/tjb-2020-0073 ◽

2020 ◽

Vol 0 (0) ◽

Author(s):

Ilter Bozaci ◽

Ali Nazmi Can Doğan ◽

Merve Aktar ◽

Alev Mahşer ◽

Gizem Yıldırım ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Metabolic Acidosis ◽

Kidney Disease ◽

Odds Ratio ◽

Mixed Type ◽

Base Excess ◽

Blood Gas ◽

Ckd Progression ◽

Group 1

AbstractObjectivesMetabolic acidosis is a common disorder seen in course of chronic kidney disease (CKD). In this study, we aimed to investigate the association of Base excess (BE), Anion gap (AG) and Delta Ratio with progression of CKD, renal replacement therapy (RRT) requirement and mortality in patients with stage 3–5 CKD.MethodsA total of 212 patients with stage 3–5 CKD were included in this study. Patients were divided into two groups according to the baseline BE level. Patients were also grouped according to the delta ratio such as non- AG, High AG and mixed type.ResultsMean BE level was significantly lower (−4.7 ± 4.0 vs. −3.3 ± 4.3; p=0.02) in patients with CKD progression. The patients in group 1 (n: 130) (Be<−2.5) revealed more CKD progression (%53 vs. %32; p=0.002), and RRT requirement (%35 vs. %15; p=0.001). Baseline BE <−2.5 (odds ratio, 0.38; 95% CI, 0.16 to 0.91; p<0.05) and baseline GFR (odds ratio, 0.94; 95% CI, 0.90 to 0.97; p<0.001) were independently related to RRT requirement. Delta BE was independently associated with mortality (odds ratio, 0.90; 95% CI, 0.85–0.96; p<0.01).ConclusionsLow BE levels were associated with CKD progression and RRT requirement. BE change is associated with mortality during the follow-up of those patients.

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Evaluation of the Capillary Microhematocrit as a Screening Test for Anemia in Pediatric Office Practice

PEDIATRICS ◽

10.1542/peds.78.2.206 ◽

1986 ◽

Vol 78 (2) ◽

pp. 206-209

Author(s):

Paul C. Young ◽

Barbara Hamill ◽

Richard C. Wasserman ◽

Joseph D. Dickerman

Keyword(s):

Lower Limit ◽

Screening Test ◽

Pediatric Patients ◽

Capillary Blood ◽

White Children ◽

Predictive Values ◽

Special Skill ◽

Capillary Sample ◽

Sensitivity Specificity ◽

Lower Limit Of Normal

The capillary microhematocrit test is widely used to screen pediatric patients for anemia. Recently, it has been suggested that this method produces spuriously elevated values compared with venous hematocrits measured by a Coulter electronic counter and might consequently fail to detect children who are truly anemic. To address this issue we studied 66 white children 9 months to 14 years of age whose capillary hematocrits were either below, equal to, or one or two points above the lower limit of normal for age. Venous specimens were obtained simultaneously with the capillary sample; hemoglobin, hematocrit, and mean corpuscular volume results were obtained using a Coulter electronic counter. Using published standards of venous hemoglobin, we determined the sensitivity, specificity, and predictive values of the capillary microhematocrit in this population of patients with low or borderline values. Twenty of the 66 patients had venous hemoglobin values less than the lower limit of normal. The sensitivity of the microhematocrit was 90.0%; the specificity was 43.5%. The predictive values for a normal (negative) hematocrit was 90.1%; the predictive value for a low (positive) hematocrit was 40.9%. We conclude that the microhematocrit method using capillary blood will miss very few patients with significantly low venous hemoglobin values and is thus an acceptable screening test for anemia. Because it does not require expensive equipment or special skill to obtain the specimen or perform the test, it is ideal for physicians' offices or nonhospital-based clinics.

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Clinical utility of standard base excess in the diagnosis and interpretation of metabolic acidosis in critically ill patients

Brazilian Journal of Medical and Biological Research ◽

10.1590/s0100-879x2006005000199 ◽

2008 ◽

Vol 41 (3) ◽

pp. 241-249 ◽

Cited By ~ 14

Author(s):

M Park ◽

L.U Taniguchi ◽

D.T Noritomi ◽

A.B. Libório ◽

A.T Maciel ◽

...

Keyword(s):

Metabolic Acidosis ◽

Critically Ill ◽

Critically Ill Patients ◽

Clinical Utility ◽

Base Excess ◽

Standard Base Excess ◽

Standard Base

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The role of myokines in the development of insulin resistance in children, with type 1 diabetes mellitus

Ukrainian Journal of Pediatric Endocrinology ◽

10.30978/ujpe2021-2-19 ◽

2021 ◽

pp. 19-26

Author(s):

O. Ye. Pashkova ◽

N. I. Chudova ◽

O. S. Litvinenko

Keyword(s):

Diabetes Mellitus ◽

Insulin Resistance ◽

Type 1 Diabetes ◽

Muscle Strength ◽

Blood Serum ◽

Muscle Mass ◽

Pediatric Patients ◽

Control Group

The aim — to study the role of myokines in the development of insulin resistance in children with type 1 diabetes mellitus.Materials and methods. Observations involved 68 children with type 1 diabetes mellitus (DM 1), with the mean age 11 to 17 years. Depending on the glycemic controllevel, patients were divided into 3 research groups. The control group consisted of 20 relatively healthy children. Muscle mass, the skeletal muscles index, fat mass and the percentage of fat in the bodywere determined in all patients. The Lovett’s test was used to assess the loss of muscle strength; evaluation of insulin resistance was made based onthe triglycerideglucose index (TYG). Levels of myostatin, irisin, interleukins 6 and 13were measured in blood serum.Results and discussion. It has been established that with deterioration in the level of glycemic controlin DM 1 children, the component redistribution of body composition took place with an increased fat mass proportionand decreased muscle mass. This resulted in the reduced insulin-mediatedabsorption of glucose, that was confirmed by the significant increase in TYG level compared to control group. The analysis of cytokines in the blood serum showed a significant increase in the level of myostatin and interleukin6 compared with the control group and the tendency to increased levels of the interleukins 13 and the level of irisin in the blood serum in pediatric patients with DM 1. The increased levels of myostatin in DM 1childrenassociated with an increase in the triglycerides content (r = 0.44, p < 0.05) and raised TYG index (r = 0.33, p < 0.05), testifying theclose correlation between the high myostatin levels and the development of insulin resistance.Conclusions. In children with diabetes mellitus, the reduction of muscle strength and muscle mass take place with a deterioration in the state of glycemic control, accompanying by the development of insulin resistance. The violation of myokines synthesis,along with the chronic hyperglycemia and diabetic myopathy, plays the leading role in the formation of insulin resistance in pediatric patients with DM 1. It is manifested by the increased production of myostatin and interleukin6 in the absence of activation of irisin and interleukin13synthesis.

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Monoject Samplette capillary blood container with serum separator evaluated for collection of specimens for therapeutic drug assays and common clinical-chemical tests.

Clinical Chemistry ◽

10.1093/clinchem/32.3.523 ◽

1986 ◽

Vol 32 (3) ◽

pp. 523-526 ◽

Cited By ~ 4

Author(s):

M Landt ◽

L L Norling ◽

M Steelman ◽

C H Smith

Keyword(s):

Pediatric Patients ◽

Capillary Blood ◽

Therapeutic Drug ◽

Blood Collection ◽

Therapeutic Drugs ◽

Clinical Chemical ◽

Drug Assays ◽

Separator Material ◽

Clinically Significant

Abstract The Monoject Samplette (Sherwood) capillary serum-separator tube was evaluated for use in pediatric capillary blood collection. When patients' values for eight common clinical-chemical tests and five therapeutic drugs were compared with values from specimens concomitantly collected in plain Caraway tubes, only chloride and total CO2 were significantly different. The chloride differences (range 0-2 mmol/L) were considered to be clinically insignificant. Higher CO2 values in Samplette specimens were apparently ascribable to decreased loss to the atmosphere. Samplette values for therapeutic drugs were higher than corresponding Caraway values, but only the differences for digoxin were judged to be clinically significant. Both recoverable serum and the incidence of hemolysis were lower in Samplette specimens than in Caraway specimens. Storage of serum over the clots (with separator material interposed) in Samplettes for 24 h had no clinically significant effect on results for glucose or potassium. Storage of specimens for as long as 24 h had no effect on theophylline, phenytoin, and gentamicin concentrations, but phenobarbital reproducibly decreased after 24 h. We conclude that the Samplette serum-separator tube is suitable for the collection of capillary blood for many of the chemical tests commonly ordered for pediatric patients.

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A prospective cohort for the investigation of alteration in temporal transcriptional and microbiome trajectories preceding preterm birth: a study protocol

BMJ Open ◽

10.1136/bmjopen-2018-023417 ◽

2019 ◽

Vol 9 (1) ◽

pp. e023417 ◽

Cited By ~ 3

Author(s):

Tobias Brummaier ◽

Basirudeen Syed Ahamed Kabeer ◽

Stephen Lindow ◽

Justin C Konje ◽

Sasithon Pukrittayaamee ◽

...

Keyword(s):

Preterm Birth ◽

Blood Serum ◽

Postpartum Period ◽

Transcript Abundance ◽

Ethics Committee ◽

Capillary Blood ◽

Oral Microbiome ◽

Control Analysis ◽

Term Neonates ◽

Non Coding Rna

IntroductionPreterm birth (PTB) results from heterogeneous influences and is a major contributor to neonatal mortality and morbidity that continues to have adverse effects on infants beyond the neonatal period. This protocol describes the procedures to determine molecular signatures predictive of PTB through high-frequency sampling during pregnancy, at delivery and the postpartum period.Methods and analysisFour hundred first trimester pregnant women from either Myanmar or Thailand of either Karen or Burman ethnicity, with a viable, singleton pregnancy will be enrolled in this non-interventional, prospective pregnancy birth cohort study and will be followed through to the postpartum period. Fortnightly finger prick capillary blood sampling will allow the monitoring of genome-wide transcript abundance in whole blood. Collection of stool samples and vaginal swabs each trimester, at delivery and postpartum will allow monitoring of intestinal and vaginal microbial composition. In a nested case–control analysis, perturbations of transcript abundance in capillary blood as well as longitudinal changes of the gut, vaginal and oral microbiome will be compared between mothers giving birth to preterm and matched cases giving birth to term neonates. Placenta tissue of preterm and term neonates will be used to determine bacterial colonisation as well as for the establishment of coding and non-coding RNA profiles. In addition, RNA profiles of circulating, non-coding RNA in cord blood serum will be compared with those of maternal peripheral blood serum at time of delivery.Ethics and disseminationThis research protocol that aims to detect perturbations in molecular trajectories preceding adverse pregnancy outcomes was approved by the ethics committee of the Faculty of Tropical Medicine, Mahidol University in Bangkok, Thailand (Ethics Reference: TMEC 15–062), the Oxford Tropical Research Ethics Committee (Ethics Reference: OxTREC: 33–15) and the local Tak Province Community Ethics Advisory Board. The results of this cooperative project will be disseminated in multiple publications staggered over time in international peer-reviewed scientific journals.Trial registration numberNCT02797327; Pre-results.

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Comparison of arterial and capillary blood gas values in poisoning department assessment

Human & Experimental Toxicology ◽

10.1177/0960327109107001 ◽

2009 ◽

Vol 28 (10) ◽

pp. 665-670 ◽

Cited By ~ 4

Author(s):

Nastaran Eizadi-Mood ◽

Sam Alfred ◽

Ahmad Yaraghi ◽

Chanh Huynh ◽

Ali Shayesteh Moghadam

Keyword(s):

Emergency Department ◽

Confidence Interval ◽

Prospective Study ◽

Base Excess ◽

Vital Signs ◽

Area Under The Curve ◽

Capillary Blood ◽

Blood Gas ◽

Arterial Blood Gas ◽

Arterial Blood

The aim of this study was to compare simultaneously obtained arterial and capillary blood gas (CBG) values in comatose-poisoned patients presented with stable vital signs. Forty-five adult patients with a diagnosis of coma because of poisoning and stable vital signs were included in this prospective study. With respect to pH, the arterial blood gas (ABG) and CBG values correlated satisfactorily (r2 = .91) and had an acceptable limit of agreements (LOAs; —0.04 to 0.06). With respect to base excess (BE), the ABG and CBG values correlated well (r2 = .85), but their 95% LOAs seem too wide to allow substitution (—4.4 to 2.7). PCO2 (r2 = .61), HCO3 (r2 = .71) and PO2 (r2 = .53) correlated less reliably. A capillary PCO2 of 51.7 mm Hg had a sensitivity of 100% and a specificity of 95.12% for detecting hypercarbia (area under the curve, 0.99; 95% Confidence Interval, 0.90-0.99; p < .0001). In conclusion, CBG analysis for pH may be a reliable substitute for ABG analysis in the initial evaluation of patients presenting with coma and stable vital signs to the poisoning emergency department (PED). Subsequent ABG may be required in patients with capillary PCO2 > 51.7 mm Hg.

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