Bicarbonate Level
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2021 ◽  
Vol 8 ◽  
Hyo Jin Kim ◽  
Hyunjin Ryu ◽  
Eunjeong Kang ◽  
Minjung Kang ◽  
Miyeun Han ◽  

Background: We aimed to evaluate serum bicarbonate as a risk factor for renal progression, cardiovascular events, and mortality in Korean CKD patients.Methods: We analyzed 1,808 participants from a Korean CKD cohort whose serum bicarbonate levels were measured at enrollment. Serum bicarbonate levels were categorized as low, lower normal, higher normal, and high (total carbon dioxide <22, 22–26, 26.1–29.9, and ≥30 mmol/L, respectively) groups. Metabolic acidosis was defined as a serum bicarbonate level <22 mmol/L. The primary outcome was renal events defined as doubling of serum creatinine, 50% reduction of eGFR from the baseline values, or development of end-stage kidney disease. The secondary outcome consisted of cardiovascular events and death. In addition, patients whose eGFR values were measured more than three times during the follow-up period were analyzed for eGFR decline. The rapid decline in eGFR was defined as lower than the median value of the eGFR slope.Results: The mean serum bicarbonate level was 25.7 ± 3.7 mmol/L and 240 (13.2%) patients had metabolic acidosis. During the follow-up period of 55.2 ± 24.1 months, 545 (30.9%) patients developed renal events and 187 (10.6%) patients developed a composite of cardiovascular events and death. After adjustment, the low serum bicarbonate group experienced 1.27 times more renal events than the lower normal bicarbonate group [hazard ratio (HR): 1.27; 95% CI: 1.01–1.60, P = 0.043]. There was no significant association between the bicarbonate groups and the composite outcome of cardiovascular events and death. The low bicarbonate group showed a significantly rapid decline in eGFR [odds ratio (OR): 2.12; 95% CI: 1.39–3.22, P < 0.001] compared to the lower normal bicarbonate group.Conclusions: Metabolic acidosis was significantly associated with increased renal events and a rapid decline in renal function in Korean predialysis CKD patients.

2021 ◽  
Vol 11 (3) ◽  
Mostafa Mohammadi ◽  
Alireza Khafaee Pour Khamseh ◽  
Hesam Aldin Varpaei

Background: Severe coronavirus disease 2019 (COVID-19) can induce acute respiratory distress, which is characterized by tachypnea, hypoxia, and dyspnea. Intubation and mechanical ventilation are strategic treatments for COVID-19 distress or hypoxia. Methods: We searched PubMed, Embase, and Scopus databases to identify relevant randomized control trials, observational studies, and case series published from April 1, 2021. Results: 24 studies were included in this review. Studies had been conducted in the USA, China, Spain, South Korea, Italy, Iran, and Brazil. Most patients had been intubated in the intensive care unit. Rapid sequence induction had been mostly used for intubation. ROX index can be utilized as the predictor of the necessity of intubation in COVID-19 patients. According to the studies, the rate of intubation was 5 to 88%. It was revealed that 1.4 - 44.5% of patients might be extubated. Yet obesity and age (elderly) are the only risk factors of delayed or difficult extubation. Discussion and Conclusions: Acute respiratory distress in COVID-19 patients could require endotracheal intubation and mechanical ventilation. Severe respiratory distress, loss of consciousness, and hypoxia had been the most important reasons for intubation. Also, increased levels of C-reactive protein (CRP), ferritin, d-dimer, and lipase in combination with hypoxia are correlated with intubation. Old age, diabetes mellitus, respiratory rate, increased level of CRP, bicarbonate level, and oxygen saturation are the most valuable predictors of the need for mechanical ventilation. ICU admission mortality following intubation was found to be 15 to 36%. Awake-prone positioning in comparison with high-flow nasal oxygen therapy did not reduce the risk of intubation and mechanical ventilation. There was no association between intubation timing and mortality of the infected patients. Noninvasive ventilation may have survival benefits.

2021 ◽  
Vol 11 (2) ◽  
pp. 30188.1-30188.6
Zahra Ataei ◽  
Bita Dadpour ◽  
Anahita Alizadeh ◽  
Seyed Reza Mousavi ◽  

Background: Aluminum Phosphide (AlP) is a well-known rodenticide and insecticide, used as a fumigant to control pests and rodents in grain-storage facilities. Its intoxication presents a medical emergency that requires early rigorous management. This study aimed to investigate cardiac function by Electrocardiogram (ECG) changes in patients with AlP intoxication. We also explored the potential relationship between low bicarbonate and cardiac function. Methods: This cross-sectional study investigated 42 patients in the age range of 17-47 years, with a history of orally-administered AlP poisoning, known as “rice tablet”, admitted to the toxicology ward of Imam Reza Hospital from March 2019 to March 2021. The study patients’ demographic data were collected by trained interviewers, using pretested questionnaires. Systolic and diastolic blood pressure, as well as blood samples, were measured 12 hours from admission. Echocardiography was performed during the first 12 hours and on the fifth-day post-admission. All statistical analysis was performed using R 3.6.1. The significance level was set at 0.05 for all statistical tests. Results: In total, 48.78% of patients presented normal bicarbonate levels, and 24.39% and 26.83% had moderate and severe acidity, respectively. Moderately and severely decreased Left Ventricular Ejection Fraction (LVEF) was observed among 21 (51.2%) and 10 (24.4%) patients, respectively. Furthermore, mild Right Ventricular (RV) function was observed among 11 (26.8%) patients. A statistically significant association was observed between bicarbonate level and RV function (P<0.001) and LVEF (P<0.001). Besides, 19.5% of the explored patients expired. The proportion of expired patients was significantly higher in patients with mild RV function, compared to the other patients (P<0.001). Conclusion: Acute AlP intoxication is a worldwide serious problem. Severe metabolic acidosis and ECG abnormalities are associated with poor outcomes in this respect. Thus, conducting early ECG and echocardiography could be desirable instruments to predict prognosis. There is no antidote for AlP poisoning; thus, the replacement of a safer agent for in-store grain protection is strongly suggested.

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A334-A335
Benjamin Donald Hoag ◽  
Michelle Knoll ◽  
Emily Paprocki

Abstract Hyperglycemic hyperosmolar state (HHS) is rare in pediatrics, particularly in patients with antibody positive diabetes mellitus (DM). Recent literature has implicated COVID-19 in the reported increase in new-onset DM cases, as well as mixed diabetic ketoacidosis (DKA) and HHS cases, however a rise in HHS cases alone has not been well reported [1,2]. We noted an anecdotal increase in the frequency of HHS cases in our pediatric tertiary care center following the onset of the global COVID-19 pandemic. To investigate further, a retrospective chart review evaluating all patients with DM admitted in the first 6 months of 2019 and the first 6 months of 2020 was conducted. A diagnosis of HHS was defined as a blood glucose over 600 mg/dL with a serum osmolality (calculated or measured) greater than 320 mOsm/kg on initial laboratory evaluation. Patients with DKA, defined as a serum bicarbonate level less than 16 mmol/L with evidence of significant ketosis (serum ketones greater than 3 mmol/L), were excluded from the study. During the first 6 months of 2019, 1 patient met inclusion criteria. However, the diagnosis of HHS was complicated by a concurrent diagnosis of diabetes insipidus, which may have contributed to the hyperosmolar state, and a nonketotic lactic acidosis. Five HHS cases were noted in the first 6 months of 2020, 4 of which occurred in May and June. For the 2020 HHS cohort, the average patient age ± SD was 12 ± 3.34 years. The mean ± SD laboratory values included bicarbonate 18.2 ± 1.64 mmol/L, serum blood glucose 776.8 ± 30.75 mg/dL, calculated serum osmolality 328 ± 4.18 mOsm/kg, and HgA1C 12.72 ± 1.16%. All 5 patients in the 2020 cohort had new-onset DM, with 4 of the 5 patients having at least 1 positive DM antibody (GAD antibodies were positive in 3, ICA/IA-2 antibodies in 2, and Zinc Transporter 8 antibodies in 1). No patients displayed COVID-19 symptoms, and only 1 patient was tested for COVID-19 by PCR, which returned negative. However, SARS-CoV2 antibody testing was not available, and it is unknown if these patients had prior COVID-19 illness. In conclusion, we noted an increased incidence of HHS at our hospital, particularly among new-onset, antibody positive DM patients during the initial months of the COVID-19 pandemic. Further study and investigation are needed to determine the cause of this increased local incidence, and if infectious, social, or economic influences related to the COVID-19 pandemic contributed. References: [1] Chan, K.H., et al., Clinical characteristics and outcome in patients with combined diabetic ketoacidosis and hyperosmolar hyperglycemic state associated with COVID-19: A retrospective, hospital-based observational case series. Diabetes Res Clin Pract, 2020. 166: p. 108279. [2] Unsworth, R., et al., New-Onset Type 1 Diabetes in Children During COVID-19: Multicenter Regional Findings in the U.K. Diabetes Care, 2020.

2021 ◽  
Vol 36 (Supplement_1) ◽  
Detlef Bockenhauer ◽  
Francesco Emma ◽  
Amina Talhi ◽  
Svetlana Papizh ◽  
Bahriye Atmis ◽  

Abstract Background and Aims Distal renal tubular acidosis (dRTA) is a rare disorder characterised by an inability of the distal tubule to secrete acid, leading to metabolic acidosis. Clinical consequences typically include hypokalaemia, hypercalciuria with nephrocalcinosis and/or urolithiasis, as well as bone disease. Treatment with adequate alkali supplementation corrects the acidosis and hypercalciuria, but there are few data on long-term outcome. In 2018, a registry for dRTA was established by the European Society for Paediatric Nephrology, hosted by the European Rare Kidney Disease Reference Network. Here, we present an initial analysis of data in the registry. Method Analysis of data entered into the registry by the cut-off data of 18/11/2020. Results A total of 135 patients had been entered, of which 106 had additional data from an annual follow-up visit. Median age at last visit was 10 years (range 0-54), including 16 adults (&gt;17y). Genetic testing had been performed in 91 subjects and causative variants were reported in 74 (81%). Pertinent clinical details according to genetic group are listed in table 1. Treatment was provided with at least 15 different preparations, containing citrate or bicarbonate, given in 1-10 (median 3) daily doses. Adequate treatment at last follow-up, as judged by a plasma bicarbonate level &gt;21 mmol/l and a urine calcium-creatinine ratio in the age-specific normal range was present in 46% of subjects. There was a trend for higher eGFR and height SDS in subjects with adequate treatment compared to those without, but this was not statistically significant. Conclusion Currently available data demonstrate the difficulties in treating dRTA, with less than half of subjects achieving adequate control of their acidosis. By collecting long-term data, the registry will provide important information on the prognosis and complications of dRTA and to what degree these can be prevented with treatment. Enrollment of further, especially adult patients will contribute to our understanding of this rare disorder.

2021 ◽  
Vol In Press (In Press) ◽  
Samira Kafan ◽  
Kiana Tadbir Vajargah ◽  
Mehrdad Sheikhvatan ◽  
Gholamreza Tabrizi ◽  
Ahmad Salimzadeh ◽  

Background: COVID-19 has become a pandemic since December 2019, causing millions of deaths worldwide. It has a wide spectrum of severity, ranging from mild infection to severe illness requiring mechanical ventilation. In the middle of a pandemic, when medical resources (including mechanical ventilators) are scarce, there should be a scoring system to provide the clinicians with the information needed for clinical decision-making and resource allocation. Objectives: This study aimed to develop a scoring system based on the data obtained on admission, to predict the need for mechanical ventilation in COVID-19 patients. Methods: This study included COVID-19 patients admitted to Sina Hospital, Tehran University of Medical Sciences from February 20 to May 29, 2020. Patients' data on admission were retrospectively recruited from Sina Hospital COVID-19 Registry (SHCo-19R). Multivariable logistic regression and receiver operating characteristic (ROC) curve analysis were performed to identify the predictive factors for mechanical ventilation. Results: A total of 681 patients were included in the study; 74 patients (10.9%) needed mechanical ventilation during hospitalization, while 607 (89.1%) did not. Multivariate logistic analysis revealed that age (OR,1.049; 95% CI:1.008-1.09), history of diabetes mellitus (OR,3.216; 95% CI:1.134-9.120), respiratory rate (OR,1.051; 95% CI:1.005-1.100), oxygen saturation (OR,0.928; 95% CI:0.872-0.989), CRP (OR,1.013; 95% CI:1.001-1.024) and bicarbonate level (OR,0.886; 95% CI:0.790-0.995) were risk factors for mechanical ventilation during hospitalization. Conclusions: A risk score has been developed based on the available data within the first hours of hospital admission to predict the need for mechanical ventilation. This risk score should be further validated to determine its applicability in other populations.

Rodolfo J Galindo ◽  
Francisco J Pasquel ◽  
Priyathama Vellanki ◽  
Cesar Zambrano ◽  
Bonnie Albury ◽  

Abstract Introduction Differences in biochemical parameters of diabetic ketoacidosis in patients with end-stage kidney disease (ESKD) has not been established. Accordingly, we assessed the relationship between degree of metabolic acidosis and ß -hydroxybutyrate in patients ESKD (eGFR &lt;15 mL/min/1.73 m 2), moderate renal failure (eGFR 15-60) or preserved renal function (eGFR &gt;60). Methods This observational study included adults (18-80 years) with DKA, admitted to Emory University Hospitals between 01/01/2006 to 12/31/2016. DKA and renal stages were confirmed on admission laboratory values. Results Admission bicarbonate levels (13.9±5 vs 13.4±5.3 vs 13.8±4.2 mmol/L, p=0.7), and pH levels (7.2±0.3 vs 7.2±0.2 vs 7.2±0.2, p=0.8) were similar among groups. Patients with ESKD had lower mean ß -hydroxybutyrate (4.3±3.3 vs 5.6±2.9 vs 5.9±2.5 mmol/L, p=0.01), but higher admission glucose (852±340.4 vs 714.6±253.3 mg/dL vs 518±185.7 mg/dL, p &lt;0.01), anion gap (23.4±7.6 vs 23±6.9 vs 19.5±4.7 mmol/L, p &lt;0.01), and osmolality (306±20.6 vs 303.5± vs 293.1±3.1mOsm/kg, p&lt;0.01), compared to patients with moderate renal failure and preserved renal function. The sensitivity of ß-hydroxybutyrate &gt;3 mmol/L for diagnosing DKA by bicarbonate level &lt;15 and &lt;18 mmol/L was 86.9% and 72% in ESKD, 89.3% and 83.7% in moderate renal failure and 96.2% and 88.3% in preserved renal function. In patients with ESKD, the corresponding ß-hydroxybutyrate with bicarbonate levels &lt;10, 10-15, &lt;18 mmol/L were 5.5, 3.9, 3.0 mmol/L, respectively. Conclusions Significant metabolic differences were found among DKA patients with different levels of renal function. In patients with ESKD, a ß-hydroxybutyrate level &gt; 3 mmol/L may assist with confirmation of DKA diagnosis.

Rudresh Hiremath ◽  
Vinyasa Nagesh ◽  
Divya Vishwanatha Kini

Diabetic ketoacidosis is a hyperglycaemic state in which serum glucose level is more than 250 mg/dL, a pH less than 7.3, a serum bicarbonate level less than 18 mEq/L, and serum ketone level is raised and dehydration is present. Insulin deficiency is the main precipitating factor. Rarely, they present with neurological complications such as focal/generalised motor seizures, hemiparesis and sensory deficits which may be associated with various imaging features. With increasing prevalence of diabetes in the last decade, it is vital to familiarise with various hyperglycaemia induced imaging abnormalities in brain in order to provide accurate diagnosis for providing prompt treatment and preventing complications. T2W/FLAIR (Fluid-attenuated inversion recovery) subcortical hypointensity in ketotic patients presenting with focal seizures had been reported rarely. Here, presented are imaging findings of a 27-year-old female patient with newly diagnosed type II diabetes mellitus and diabetic ketoacidosis with new onset seizures. T2 subcortical white matter hypointensity was noted in the right post-central gyrus. Though non specific, this imaging finding was of importance in such cases of hyperglycaemia in order to formulate further patient care.

2020 ◽  
pp. 1-7
Mazlum Dursun ◽  
Hadice Selimoğlu Şen ◽  
Süreyya Yılmaz ◽  
Melike Demir ◽  
Gökhan Kırbaş ◽  

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