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    Saline as a vehicle control does not alter ventilation in male CD-1 mice.
    Physiol Rep 2018 May;6(10):e13702
    Department of Biological Sciences, Le Moyne College, Syracuse, New York.
    Saline (0.9% NaCl) is used in clinical and research settings as a vehicle for intravenous drug administration. While saline is a standard control in mouse studies, there are reports of hyperchloremic metabolic acidosis in high doses. Read More

    Impact of the hyperchloremic component of metabolic acidosis on the patient's hydration status and the treatment of diabetic ketoacidosis.
    Arch Argent Pediatr 2018 06;116(3):e365-e370
    Unidad de Nefrología, Hospital General de Niños Pedro de Elizalde, Ciudad Autónoma de Buenos Aires, Argentina.
    Introduction: Diabetic ketoacidosis (DKA) is characterized by metabolic acidosis (MA) with a high anion gap (AG), although, occasionally, it can present with hyperchloremia. It has been postulated that the early presence of hyperchloremia could reflect a better hydration status; however, its prevalence and impact on DKA treatment remain unknown. determine the prevalence of the hyperchloremic component in MA prior to treatment and to assess whether it is associated with a better hydration status and a shorter recovery time from DKA compared to patients with high AG only. Read More

    Acid-base status and its clinical implications in critically ill patients with cirrhosis, acute-on-chronic liver failure and without liver disease.
    Ann Intensive Care 2018 Apr 19;8(1):48. Epub 2018 Apr 19.
    Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria.
    Background: Acid-base disturbances are frequently observed in critically ill patients at the intensive care unit. To our knowledge, the acid-base profile of patients with acute-on-chronic liver failure (ACLF) has not been evaluated and compared to critically ill patients without acute or chronic liver disease.

    Results: One hundred and seventy-eight critically ill patients with liver cirrhosis were compared to 178 matched controls in this post hoc analysis of prospectively collected data. Read More

    Influence of Proportion of Normal Saline Administered in the Perioperative Period of Renal Transplantation on Kalemia Levels.
    Transplant Proc 2018 Mar;50(2):569-571
    Public Health Department, Facultad de Medicina, Universidad de Cantabria, Cantabria, Spain.
    Background: The hyperchloremic metabolic acidosis triggered by the infusion of normal saline (NS) significantly increases the level of extracellular potassium. In this study we assessed the influence of proportion of NS administered in the perioperative period of renal transplantation on potassium levels in usual clinical practice.

    Methods: This study was a retrospective cohort analysis of patients undergoing renal transplantation during a 24-month period (2015-2016). Read More

    Sporadic hypothyroidism-related hypokalemic paralysis: Diagnosis in a resource-poor setting.
    J Family Med Prim Care 2017 Oct-Dec;6(4):862-864
    Department of Neurology, JIPMER, Puducherry, India.
    Hypothyroidism and distal renal tubular acidosis causing hypokalemic paralysis (HP) have been described only in four female patients. HP as the initial manifestation of uncomplicated diabetes has been reported only in three young males. We report two middle-aged patients presenting with gradual-onset areflexic quadriparesis and neck flop, associated with urinary potassium losses, and recovering over 3 days. Read More

    Crystalloid fluid choice in the critically ill : Current knowledge and critical appraisal.
    Wien Klin Wochenschr 2018 Apr 2;130(7-8):273-282. Epub 2018 Mar 2.
    Clinic for General Anesthesiology, Intensive Care and Pain Management, Medical University of Vienna, Vienna, Austria.
    Intravenous infusion of crystalloid solutions is one of the most frequently administered medications worldwide. Available crystalloid infusion solutions have a variety of compositions and have a major impact on body systems; however, administration of crystalloid fluids currently follows a "one fluid for all" approach than a patient-centered fluid prescription. Normal saline is associated with hyperchloremic metabolic acidosis, increased rates of acute kidney injury, increased hemodynamic instability and potentially mortality. Read More

    Life-Threatening Hypokalemic Quadriplegia in a Postoperative Patient.
    J Coll Physicians Surg Pak 2018 Mar;28(3):S5-S6
    Department of Anaesthesiology, Dr. S.N. Medical College, Jodhpur, India.
    Acute hypokalemic paralysis is a reversible but potentially lethal clinical condition. We report a case, who developed rapidonset quadriparesis in immediate postoperative period after undergoing right percutaneous nephrolithotomy for bilateral renal stones. On evaluation, she was found to have hypernatremic, hyperchloremic, hypokalemic acidosis. Read More

    Balanced Fluid Versus Saline-Based Fluid in Post-operative Severe Traumatic Brain Injury Patients: Acid-Base and Electrolytes Assessment.
    Malays J Med Sci 2017 Oct 26;24(5):83-93. Epub 2017 Oct 26.
    Department of Anaesthesiology and Intensive Care, School of Medical Sciences, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia.
    Background: Normal saline (NS) is a common fluid of choice in neurosurgery and neuro-intensive care unit (ICU), but it does not contain other electrolytes and has the potential to cause hyperchloremic metabolic acidosis with prolonged infusion. These problems may be reduced with the availability of balanced fluid (BF), which becomes a more physiological isotonic solution with the presence of complete electrolyte content. This study aimed to compare the changes in electrolytes and acid-base between NS and BF (Sterofundin® ISO) therapy for post-operative severe traumatic brain injury (TBI) patients in neuro-ICU. Read More

    Balanced crystalloids vs 0.9% saline for adult patients undergoing non-renal surgery: A meta-analysis.
    Int J Surg 2018 Mar 12;51:1-9. Epub 2018 Jan 12.
    Department of Anesthesiology, West China Hospital of Sichuan University, Chengdu, Sichuan, 610041, PR China. Electronic address:
    Background: Fluid maintenance and resuscitation is an important strategy during major surgeries. There has been a debate on the choice of crystalloids over the past decades. 0. Read More

    Recurrent Hypokalemia leading to Flaccid Quadriparesis: A Renal or Connective Tissue Disorder.
    P R Health Sci J 2017 Dec;36(4):240-242
    Assistant Professor, Department of Medicine, University College of Medical Sciences, Delhi University.
    Hypokalemic periodic paralysis (hypoKPP) is a clinical entity characterized by recurrent skeletal muscle paralysis due to a decrease in serum potassium levels; hypoKPP can have either a primary (familial) or a secondary cause. One of the secondary causes of hypoKPP is distal renal tubular acidosis (dRTA). Distal renal tubular acidosis (dRTA) is diagnosed when the urinary pH is greater than 5. Read More

    An in vitro splicing assay reveals the pathogenicity of a novel intronic variant in ATP6V0A4 for autosomal recessive distal renal tubular acidosis.
    BMC Nephrol 2017 Dec 4;18(1):353. Epub 2017 Dec 4.
    Department of Pediatrics, Kobe University Graduate School of Medicine, 7-5-1 Kusunokicho, Chuo, Kobe, Hyogo, 6500017, Japan.
    Background: Autosomal recessive distal renal tubular acidosis (dRTA) is a rare hereditary disease caused by pathogenic variants in the ATP6V0A4 gene or ATP6V1B1 gene, and characterized by hyperchloremic metabolic acidosis with normal anion gap, hypokalemia, hypercalciuria, hypocitraturia and nephrocalcinosis. Although several intronic nucleotide variants in these genes have been detected, all of them fell in the apparent splice consensus sequence. In general, transcriptional analysis is necessary to determine the effect on function of the novel intronic variants located out of splicing consensus sequences. Read More

    Choice of resuscitative fluids and mortality in emergency department patients with sepsis.
    Am J Emerg Med 2018 Apr 7;36(4):625-629. Epub 2017 Oct 7.
    Department of Emergency Medicine, The Icahn School of Medicine at Mount Sinai, New York, NY, USA; Elmhurst Hospital Center, Queens, NY, USA; Division of Medical Toxicology, The Icahn School of Medicine at Mount Sinai, New York, NY, USA.
    Objective: Balanced resuscitative fluids (BF) have been associated with decreased incidence of hyperchloremic metabolic acidosis in sepsis. We hypothesized that higher proportions of BF during resuscitation would thus be associated with improved mortality in Emergency Department (ED) patients with sepsis.

    Methods: This was a retrospective chart review of adult ED patients who presented with sepsis to a large, urban teaching hospital over one year. Read More

    A child with distal (type 1) renal tubular acidosis presenting with progressive gross motor developmental regression and acute paralysis.
    BMC Res Notes 2017 Nov 25;10(1):618. Epub 2017 Nov 25.
    Nutrition Unit, Lady Ridgeway Hospital for Children, Colombo, Sri Lanka.
    Background: Distal (Type 1) renal tubular acidosis (dRTA) is characterized by inability to secrete hydrogen irons from the distal tubule. The aetiology of dRTA is diverse and can be either inherited or acquired. Common clinical presentations of dRTA in the paediatric age group include polyuria, nocturia, failure to thrive, constipation, abnormal breathing and nephrolithiasis. Read More

    Metabolic and Nutritional Consequences of Urinary Diversion Using Intestinal Segments to Reconstruct the Urinary Tract.
    Urol Clin North Am 2018 Feb;45(1):19-24
    Indiana University School of Medicine, Suite 150 Indiana Cancer Pavilion, 535 North Barnhill Drive, Indianapolis, IN 46202, USA. Electronic address:
    Intestinal segments in various forms have been used to reconstruct the urinary tract since the mid-1800s. Currently, many different forms of continent and incontinent diversion options exist. Incorporating bowel mucosa within the urinary tract leads to predictable metabolic and nutritional consequences. Read More

    Hypertonic saline resuscitation after emergent laparotomy and temporary abdominal closure.
    J Trauma Acute Care Surg 2018 Feb;84(2):350-357
    From the Department of Surgery and Sepsis and Critical Illness Research Center (T.J.L., P.A.E., T.M.B., M.D.R., C.A.C., R.S.S., F.A.M., A.M.M., S.C.B.), University of Florida Health, Gainesville, Florida.
    Background: Our objective was to establish the safety of 3% hypertonic saline (HTS) resuscitation for trauma and acute care surgery patients undergoing emergent laparotomy and temporary abdominal closure (TAC) with the hypothesis that HTS administration would be associated with hyperosmolar hypercholoremic acidosis, lower resuscitation volumes, and higher fascial closure rates, without adversely affecting renal function.

    Methods: We performed a retrospective cohort analysis of 189 trauma and acute care surgery patients who underwent emergent laparotomy and TAC, comparing patients with normal baseline renal function who received 3% HTS at 30 mL/h (n = 36) to patients with standard resuscitation (n = 153) by baseline characteristics, resuscitation parameters, and outcomes including primary fascial closure and Kidney Disease: Improving Global Outcomes stages of acute kidney injury.

    Results: The HTS and standard resuscitation groups had similar baseline illness severity and organ dysfunction, though HTS patients had lower serum creatinine at initial laparotomy (1. Read More

    Pathophysiology, diagnosis and treatment of inherited distal renal tubular acidosis.
    J Nephrol 2017 Oct 9. Epub 2017 Oct 9.
    National Center for Competence in Research NCCR Kidney.CH, Zurich, Switzerland.
    Distal renal tubular acidosis (dRTA) is a tubular disorder with a primary defect of urinary acidification and acid excretion in the collecting duct system. Consequently, patients develop hyperchloremic metabolic acidosis with an inappropriately alkaline urine. Inherited forms of dRTA are due to mutations in at least three distinct genes: SLC4A1, ATP6V1B1, ATP6V0A4. Read More

    Relationship of at Admission Lactate, Unmeasured Anions, and Chloride to the Outcome of Critically Ill Patients.
    Crit Care Med 2017 Dec;45(12):e1233-e1239
    Servicio de Terapia Intensiva, Sanatorio Otamendi y Miroli, Buenos Aires, Argentina.
    Objectives: To investigate the association between the concentration of the causative anions responsible for the main types of metabolic acidosis and the outcome.

    Design: Prospective observational study.

    Setting: Teaching ICU. Read More

    Branchio-oto-renal syndrome presenting with syndrome of hyporeninemic hypoaldosteronism.
    Saudi J Kidney Dis Transpl 2017 Sep-Oct;28(5):1165-1168
    Division of Pediatric Nephrology, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, Maharashtra, India.
    Branchio-oto-renal (BOR) syndrome is an autosomal dominant, clinically heterogeneous disorder characterized by branchial arch anomalies, hearing impairment, and renal malformations. We report the case of a 10-year-old boy with BOR syndrome who presented with hyperkalemic hyperchloremic metabolic acidosis due to hyporeninemic hypoaldosteronism. The child also had mental retardation and spastic diplegia which have hitherto not been described in BOR syndrome. Read More

    Topiramate and metabolic acidosis: an evolving story.
    Hosp Pract (1995) 2017 Dec 1;45(5):192-195. Epub 2017 Sep 1.
    a Harvard Medical School , Massachusetts General Hospital , Boston , MA , USA.
    Topiramate is an anticonvulsant that is being increasingly used for a number of different off-label indications. Its inhibition of carbonic anhydrase isoenzymes can lead to metabolic acidosis, elevated urine pH, reduced urine citrate, and hypercalciuria, thereby creating a milieu that is ripe for calcium phosphate stone formation. In this review, we describe a case of topiramate-induced metabolic acidosis. Read More

    Proximal Renal Tubular Acidosis (Fanconi Syndrome) Induced by Apremilast: A Case Report.
    Am J Kidney Dis 2017 Nov 18;70(5):729-731. Epub 2017 Aug 18.
    Department of Nephrology, Orlando VA Medical Center, Orlando, FL.
    Apremilast is a recently developed phosphodiesterase 4-inhibitory medication approved for use to treat psoriasis and psoriatic arthritis. We report a case of Fanconi syndrome and proximal renal tubular acidosis that was associated with this medication. Our patient was started on treatment with apremilast 2 weeks before his admission. Read More

    The Influence of Chloride for the Interpretation of Plasma Bicarbonate During the Treatment of Diabetic Ketoacidosis.
    Pediatr Emerg Care 2017 Jul 24. Epub 2017 Jul 24.
    From the *Comité de Docencia e Investigación, †Servicio de Nutrición y Diabetes, and ‡Servicio de Nefrología, Hospital General de Niños Pedro de Elizalde, Buenos Aires, Argentina.
    Introduction: Hyperchloremic metabolic acidosis can occur in diabetic ketoacidosis (DKA) and may affect the acid-base interpretation during treatment.

    Objectives: This study aims to describe the prevalence of hyperchloremia during the treatment of DKA and its effect on the interpretation of bicarbonate value.

    Methods: A cross-sectional study, including all cases of DKA in patients aged 1 to 18 years old admitted from 2010 to 2015, was performed. Read More

    Lack of Impact of Hyperchloremia in Brain-Dead Organ Donors on the Onset of Kidney Allograft Function in the Recipients.
    Transplant Proc 2017 Jul - Aug;49(6):1262-1269
    Institute for Clinical and Experimental Medicine, Transplantcentre, Prague, Czech Republic; Department of Anesthesiology and Intensive Care, Prague, Czech Republic. Electronic address:
    Background: Hyperchloremia produces renal vasoconstriction and fall in glomerular filtration rate. In 90% of brain-dead organ donors, diabetes insipidus develops, characterized by inappropriate diuresis, hyperosmolality, and hyperchloremia. The aim of this study was to determine the relationship between the serum concentration of chlorides of the donor and the onset of the function of the kidney allograft in the recipient. Read More

    [Disorders of water and electrolyte metabolism and changes in acid-base balance in patients with ascitic liver cirrhosis].
    Cas Lek Cesk 2017 ;156(3):150-152
    In patients with advanced cirrhosis with ascites disorders of water and electrolyte metabolism are often present and they are associated with changes in acid-base balance. These changes can be very complicated, their diagnosis and treatment difficult. Dilutional hyponatremia is the most common disorder. Read More

    Pregnancy in a Treated Case of Ectopia Vesicae.
    J Coll Physicians Surg Pak 2016 Nov;26(11):124-126
    Department of Gynaecology Unit-II, Jinnah Hospital, Lahore.
    The patient was born with bladder exstrophy and underwent multiple surgeries for its correction. Finally, she had ureterosigmoidostomy at the age of 9 years, which ultimately led her to live till reproductive age. The children born with this defect are capable of surviving till adult life. Read More

    Assessment of renal hemodynamic toxicity of fluid challenge with 0.9% NaCl compared to balanced crystalloid (PlasmaLyte) in a rat model with severe sepsis.
    Ann Intensive Care 2017 Dec 14;7(1):66. Epub 2017 Jun 14.
    CHU d'Angers, 4 rue Larrey, 49000, Angers, France.
    Background: According to international guidelines, volume expansion with crystalloids is the first-line treatment for hemodynamic management in patients with severe sepsis or septic shock. Compared to balanced crystalloids, 0.9% sodium chloride (0. Read More

    Secondary Sjogren's Syndrome Presenting with Distal Tubular Acidosis and Quadriparesis.
    Indian J Crit Care Med 2017 Apr;21(4):243-244
    Department of Critical Care Medicine, Yashoda Multi-speciality Hospital, Hyderabad, Telangana, India.
    A 52-year-old female patient was admitted to Intensive Care Unit with complaints of quadriparesis. Investigations revealed distal renal tubular acidosis (DRTA) secondary to Sjogren's syndrome with involvement of the parotid and thyroid glands. Laboratory investigations showed hyperchloremic metabolic acidosis and an alkaline urine pH with clinical signs of sicca syndrome. Read More

    Hypokalemia-associated paralysis and metabolic acidosis in a patient with bilateral ureterosigmoidostomy.
    CEN Case Rep 2016 May 9;5(1):40-42. Epub 2015 Jul 9.
    Renal Division, Department of Internal Medicine, Iwata City Hospital, 512-3 Ohkubo, Iwata, Shizuoka, 438-8550, Japan.
    Ureterosigmoidostomy is a urological intervention performed to treat various conditions such as invasive bladder cancer, bladder exstrophy, vesicovaginal fistula, or urethral trauma. However, this intervention may lead to several metabolic complications. Here, we report an interesting case with quadriparesis and intestinal paralysis resulting from severe hypokalemia (the serum potassium level, 1. Read More

    Contemporary Approaches to Perioperative IV Fluid Therapy.
    World J Surg 2017 10;41(10):2457-2463
    Smiths Medical Professor of Anaesthesia and Critical Care, National Institute of Health Research Biomedical Research Centre, University College London Hospitals, London, UK.
    Background: Intravenous fluid therapy is required for most surgical patients, but inappropriate regimens are commonly prescribed. The aim of this narrative review was to provide evidence-based guidance on appropriate perioperative fluid management.

    Method: We did a systematic literature search of the literature to identify relevant studies and meta-analyses to develop recommendations. Read More

    Ureteral Reconstruction With Ileum: Long-term Follow-up of Renal Function.
    Urology 2017 Jun 22;104:225-229. Epub 2017 Feb 22.
    Department of Urology, Indiana University School of Medicine, Indianapolis, IN. Electronic address:
    Objective: To assess long-term renal preservation and surgical outcomes in patients undergoing ureteric substitution with ileum. This has been a mainstay of reconstruction options for lengthy ureteral defects.

    Methods: Consecutive patients aged 18 or older undergoing ileal ureters at our institution were retrospectively reviewed (from 1989 to June 2013). Read More

    Three cases of Gordon syndrome with dominant KLHL3 mutations.
    J Pediatr Endocrinol Metab 2017 Mar;30(3):361-364
    Background: Gordon syndrome (GS) is a rare form of monogenic hypertension characterized by low renin hypertension, hyperkalemia, hyperchloremic metabolic acidosis, and normal glomerular filtration rate. To date, four genes causing GS have been identified as: WNK1, WNK4, CUL3, and KLHL3.

    Case Presentation: We report three cases of GS in two families. Read More

    Hyperchloremic Metabolic Acidosis Following Total Gut Irrigation with Normal Saline in Pediatric Patients: A Rare Occurrence.
    Indian J Crit Care Med 2017 Jan;21(1):55-56
    Department of Paediatric Surgery, Post Graduate Institute and Medical Education Research, Chandigarh, India.
    Use of 0.9% sodium chloride for total gut irrigation (TGI) through nasogastric route is an effective method of bowel preparation in children undergoing colorectal surgeries. TGI with normal saline (NS) can result in nausea, vomiting, abdominal distension, and mild electrolyte imbalance; however, hyperchloremic metabolic acidosis has not been documented. Read More

    [Metabolic acidosis].
    G Ital Nefrol 2016 Nov-Dec;33(6)
    Metabolic acidosis is frequently observed in clinical practice, especially among critically ill patients and/or in the course of renal failure. Complex mechanisms are involved, in most cases identifiable by medical history, pathophysiology-based diagnostic reasoning and measure of some key acid-base parameters that are easily available or calculable. On this basis the bedside differential diagnosis of metabolic acidosis should be started from the identification of the two main subtypes of metabolic acidosis: the high anion gap metabolic acidosis and the normal anion gap (or hyperchloremic) metabolic acidosis. Read More

    Controlled trial of Hartmann's solution versus 0.9% saline for diabetic ketoacidosis.
    J Paediatr Child Health 2017 Jan;53(1):12-17
    Department of Paediatric Critical Care, Women's and Children's Hospital, Adelaide, South Australia, Australia.
    Aim: We aimed to determine whether using a balanced salt solution, Hartmann's solution (HS), in diabetic ketoacidosis (DKA) shortens the time to normalise acid-base status through the avoidance of hyperchloremic metabolic acidosis compared with 0.9% normal saline (NS).

    Methods: We conducted a double-blind, randomised controlled trial comparing HS to NS as the initial intravenous fluid in children with DKA. Read More

    A Quick Reference on Hyperchloremic Metabolic Acidosis.
    Vet Clin North Am Small Anim Pract 2017 Mar 23;47(2):201-203. Epub 2016 Dec 23.
    Department of Clinical Sciences, College of Veterinary Medicine, Oregon State University, 700 Southwest 30th Street, Corvallis, OR 97331, USA. Electronic address:
    Metabolic acidosis results from an increase in the concentration of a strong anion. Metabolic acidosis is divided into hyperchloremic metabolic acidosis and high anion gap acidosis based on the changes in the anion gap. Hyperchloremic metabolic acidosis is the result of chloride retention, excessive loss of sodium relative to chloride, or excessive gain of chloride relative to sodium. Read More

    Complicated pregnancies in inherited distal renal tubular acidosis: importance of acid-base balance.
    J Nephrol 2017 Jun 22;30(3):455-460. Epub 2016 Dec 22.
    Division of Nephrology, University Hospital Zurich, Rämistr. 100, 8091, Zurich, Switzerland.
    Inherited distal renal tubular acidosis (dRTA) is caused by impaired urinary acid excretion resulting in hyperchloremic metabolic acidosis. Although the glomerular filtration rate (GFR) is usually preserved, and hypertension and overt proteinuria are absent, it has to be considered that patients with dRTA also suffer from chronic kidney disease (CKD) with an increased risk for adverse pregnancy-related outcomes. Typical complications of dRTA include severe hypokalemia leading to cardiac arrhythmias and paralysis, nephrolithiasis and nephrocalcinosis. Read More

    Review of the Diagnostic Evaluation of Renal Tubular Acidosis.
    Ochsner J 2016 ;16(4):525-530
    Department of Anaesthesia and Intensive Care Medicine, Caboolture Hospital, Caboolture, Queensland, Australia.
    Background: The term renal tubular acidosis (RTA) describes a group of uncommon kidney disorders characterized by defective acid-base regulation. Reaching the diagnosis of RTA is complex and often delayed, resulting in suboptimal treatment.

    Methods: This article provides an overview of the clinical features of RTA and diagnostic approaches in a format accessible to physicians for everyday use. Read More

    Clinical analysis of hyperkalemic renal tubular acidosis caused by calcineurin inhibitors in solid organ transplant recipients.
    J Clin Pharm Ther 2017 Feb 14;42(1):122-124. Epub 2016 Dec 14.
    Department of Nephrology, The Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China.
    What Is Known And Objective: Calcineurin inhibitor (CNI)-based immunosuppressive regimen is widely used for preventing rejection in solid organ transplantation. Hyperkalemic renal tubular acidosis (RTA) caused by CNI is uncommon and potentially underappreciated. We reported four such cases to increase awareness of this risk and to provide recommendations for its management based on our experience. Read More

    Intravenous fluids: balancing solutions.
    J Nephrol 2017 Aug 29;30(4):485-492. Epub 2016 Nov 29.
    Division of Nephrology and Transplantation, Department of Internal Medicine, Erasmus Medical Center, Room D-438, PO Box 2040, 3000, CA, Rotterdam, The Netherlands.
    The topic of intravenous (IV) fluids may be regarded as "reverse nephrology", because nephrologists usually treat to remove fluids rather than to infuse them. However, because nephrology is deeply rooted in fluid, electrolyte, and acid-base balance, IV fluids belong in the realm of our specialty. The field of IV fluid therapy is in motion due to the increasing use of balanced crystalloids, partly fueled by the advent of new solutions. Read More

    WNK signalling pathways in blood pressure regulation.
    Cell Mol Life Sci 2017 04 4;74(7):1261-1280. Epub 2016 Nov 4.
    Division of Experimental Medicine and Immunotherapeutics, Department of Medicine, University of Cambridge, Cambridge, CB2 2QQ, UK.
    Hypertension (high blood pressure) is a major public health problem affecting more than a billion people worldwide with complications, including stroke, heart failure and kidney failure. The regulation of blood pressure is multifactorial reflecting genetic susceptibility, in utero environment and external factors such as obesity and salt intake. In keeping with Arthur Guyton's hypothesis, the kidney plays a key role in blood pressure control and data from clinical studies; physiology and genetics have shown that hypertension is driven a failure of the kidney to excrete excess salt at normal levels of blood pressure. Read More

    Metabolic Acidosis Assessment in High-Risk Surgeries: Prognostic Importance.
    Anesth Analg 2016 11;123(5):1163-1171
    From the *Anesthesiology Department, Hospital das Clinicas-FMUSP, SP, SP/Brazil; †Anesthesiology Department, Hospital do Servidor Público Estadual-IAMSPE, SP, SP/Brazil; and ‡Intensive Care Department, Hospital do Câncer de Barretos, SP, SP/Brazil.
    Background: Metabolic acidosis frequently is present in surgical patients; however, different types of metabolic acidosis (hyperlactatemia, hyperchloremia, and others) may have different relationships to perioperative outcomes. We hypothesized that in postoperative surgical patients, distinctive types of metabolic acidosis would correlate differently with the outcomes of high-risk surgeries.

    Methods: A prospective, multicenter observational study was performed in 3 different tertiary care hospitals. Read More

    A comparative study of Sterofundin and Ringer lactate based infusion protocol in scoliosis correction surgery.
    Anesth Essays Res 2016 Sep-Dec;10(3):532-537
    Department of Anesthesiology and Intensive Care, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India.
    Background: A major change in anesthesia practice as regards to intraoperative infusion therapy is the present requirement. Switching over to balanced fluids can substantially decrease the incidence of lactic acidosis and hyperchloremic acidosis. The deleterious effects of unbalanced fluids are more recognizable during major surgeries. Read More

    Effects of Different Crystalloid Solutions on Hemodynamics, Peripheral Perfusion, and the Microcirculation in Experimental Abdominal Sepsis.
    Anesthesiology 2016 Oct;125(4):744-754
    From the Department of Intensive Care, Erasme University Hospital, Unversité Libre de Bruxelles, Brussels, Belgium.
    Background: Crystalloid solutions are used to restore intravascular volume in septic patients, but each solution has limitations. The authors compared the effects of three crystalloid solutions on hemodynamics, organ function, microcirculation, and survival in a sepsis model.

    Methods: Peritonitis was induced by injection of autologous feces in 21 anesthetized, mechanically ventilated adult sheep. Read More

    The efficacy and safety of sevelamer and lanthanum versus calcium-containing and iron-based binders in treating hyperphosphatemia in patients with chronic kidney disease: a systematic review and meta-analysis.
    Nephrol Dial Transplant 2017 01;32(1):111-125
    Department of Epidemiology & Biostatistics, Western University, London, ON, Canada.
    Background: It remains unclear which phosphate binders should be preferred for hyperphosphatemia management in chronic kidney disease (CKD).

    Methods: We performed a systematic review and meta-analysis of randomized trials comparing sevelamer or lanthanum with other phosphate binders in CKD.

    Results: Fifty-one trials (8829 patients) were reviewed. Read More

    Hyperkalemia in young children: blood pressure checked?
    Eur J Pediatr 2016 Dec 17;175(12):2011-2013. Epub 2016 Sep 17.
    Queen Mathilde Mother and Child Care Centre, University Hospital Antwerp, Antwerp, Belgium.
    Hyperkalemia in young children is a rare phenomenon and in many cases caused by hemolysis in the specimen due to difficulties in obtaining a sample. However, hyperkalemia can also be a sign of a rare Mendelian syndrome known as familial hyperkalemic hypertension or pseudohypoaldosteronism type II. This disease is characterized by hyperkalemia, hypertension, and mild hyperchloremic metabolic acidosis (with normal anion gap) despite normal glomerular filtration. Read More

    Chloride Content of Fluids Used for Large-Volume Resuscitation Is Associated With Reduced Survival.
    Crit Care Med 2017 Feb;45(2):e146-e153
    All authors: Center for Critical Care Nephrology and CRISMA Center, Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA.
    Objective: We sought to investigate if the chloride content of fluids used in resuscitation was associated with short- and long-term outcomes.

    Design: We identified patients who received large-volume fluid resuscitation, defined as greater than 60 mL/kg over a 24-hour period. Chloride load was determined for each patient based on the chloride ion concentration of the fluids they received during large-volume fluid resuscitation multiplied by the volume of fluids. Read More

    [The difference and ratio between serum concentrations of natrium and chlorides in patients with hyponatremia].
    Vnitr Lek Fall 2016;62(7-8):629-34
    Unlabelled: The differential diagnosis of hyponatremia is often difficult. This most frequently occurring disorder of the water and electrolyte metabolism is frequently connected with deviations relating to the acid-base balance (ABB). This survey analyzes the relationship between the changes of the volume of body fluids and ABB and infers to what extent the analysis of combinations of the two disorders can support the differential diagnosis of different forms of hyponatremia (differentiation between the dilution vs. Read More

    Chloride content of solutions used for regional citrate anticoagulation might be responsible for blunting correction of metabolic acidosis during continuous veno-venous hemofiltration.
    BMC Nephrol 2016 08 26;17(1):119. Epub 2016 Aug 26.
    Intensive Care Department, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, 1090, Brussels, Belgium.
    Background: Citrate, the currently preferred anticoagulant for continuous veno-venous hemofiltration (CVVH), may influence acid-base equilibrium.

    Methods: The effect of 2 different citrate solutions on acid-base status was assessed according to the Stewart-Figge approach in two consecutive cohorts of critically ill adult patients. The first group received Prismocitrate 10/2 (PC10/2; 10 mmol citrate/L). Read More

    A randomized trial of Plasma-Lyte A and 0.9 % sodium chloride in acute pediatric gastroenteritis.
    BMC Pediatr 2016 08 2;16:117. Epub 2016 Aug 2.
    Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
    Background: Compare the efficacy and safety of Plasma-Lyte A (PLA) versus 0.9 % sodium chloride (NaCl) intravenous (IV) fluid replacement in children with moderate to severe dehydration secondary to acute gastroenteritis (AGE).

    Methods: Prospective, randomized, double-blind study conducted at eight pediatric emergency departments (EDs) in the US and Canada (NCT#01234883). Read More

    Hyperchloremic acidosis is associated with acute kidney injury after abdominal surgery.
    Nephrology (Carlton) 2017 Sep;22(9):720-727
    Department of Anesthesiology, Hamamatsu Rosai Hospital, Japan Organizaition of Occupational Health and Safety, Higashi-ku, Hamamatsu, Japan.
    Aim: Hyperchloremic acidosis may have an important role as a precursor of acute kidney injury (AKI) in the hyperchloremic environment induced by chloride-rich fluids, but this remains unclear. We tested the hypothesis that hyperchloremic acidosis assessed by the Stewart approach is associated with postoperative AKI.

    Methods: A historical cohort study was conducted in adult patients who had normal renal function preoperatively and required admission to the intensive care unit after elective abdominal surgery. Read More

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