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Cureus 2022 Apr 11;14(4):e24046. Epub 2022 Apr 11.

Internal Medicine, Rehman Medical Institute, Peshawar, PAK.

Hypokalemic periodic paralysis (hypo KPP) is a rare form of autosomal dominant channelopathy characterized by muscular weakness and paralysis caused by decreased potassium levels. Precipitating factors are a diet rich in starches and sweets, and rest after an unusual degree of exercise. Paralytic attacks are more common between the ages of 15 and 40 years. Read More

Clin Kidney J 2022 May 16;15(5):929-936. Epub 2021 Dec 16.

Department of Nephrology, Osaka University Graduate School of Medicine, Suita, Japan.

Background: Studies examining associations between metabolic acidosis and cardiovascular events in chronic kidney disease (CKD) have shown conflicting results and have not differentiated between normal anion gap (hyperchloremic) acidosis and high anion gap acidosis. We aimed to examine the impact of normal and high anion gap acidosis, separately, on the risk of cardiovascular events among patients with CKD.

Methods: This retrospective cohort study included 1168 patients with an estimated glomerular filtration rate (eGFR) of 10-60 mL/min/1. Read More

JA Clin Rep 2022 Apr 14;8(1):30. Epub 2022 Apr 14.

Department of Anesthesiology and Pain Medicine, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-Ku, Tokyo, 113-8421, Japan.

Background: Whole lung lavage (WLL) is an effective therapy for pulmonary alveolar proteinosis. We report a rare dilutional acidosis following WLL in a female patient.

Case Presentation: Under general anesthesia, a left-sided double-lumen tube was inserted with its bronchial lumen connected to the saline delivery system. Read More

Cureus 2022 Mar 1;14(3):e22755. Epub 2022 Mar 1.

Internal Medicine, Universidad de Antioquia, Medellín, COL.

Ifosfamide-induced Fanconi syndrome is a rare complication that occurs in patients in treatment with ifosfamide. It is usually characterized by type II proximal renal tubular dysfunction, as evidenced by glycosuria, proteinuria, electrolyte loss, and metabolic acidosis. We outline two case reports of patients who received ifosfamide as chemotherapy for Ewing's sarcoma and extranodal B-cell lymphoma. Read More

Heart Lung 2022 Jul-Aug;54:74-79. Epub 2022 Mar 28.

Department of Medicine, Einstein Medical Center, Philadelphia, USA.

Background: Current guidelines suggest the use of isotonic saline (IS) infusion as the preferred resuscitation fluid in the management of diabetic ketoacidosis (DKA). However, balanced electrolyte solutions (BES) have been proposed as an alternative due to a lower propensity to cause hyperchloremic metabolic acidosis. Evidence regarding the use of BES in DKA remains limited. Read More

Clin Transplant 2022 Mar 16:e14648. Epub 2022 Mar 16.

Department of Nephrology, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan.

Background: Hyperchloremic metabolic acidosis (HCMA) from renal tubular acidosis (RTA) is common in kidney transplant (KT) recipients. Calcineurin inhibitors (CNIs) are a potential cause of RTA, and whether HCMA is a determinant of poor graft prognosis is controversial.

Methods: The subjects were living-donor KT recipients (LDKTRs, n = 47) and matched donors (n = 43). Read More

Vet Clin North Am Equine Pract 2022 Apr 10;38(1):109-122. Epub 2022 Mar 10.

Littleton Equine Medical Center, 8025 South Santa Fe Drive, Littleton, CO 80120, USA. Electronic address:

This article overviews metabolic disorders associated with renal disease. Included is a discussion of the pathophysiology, clinical signs, and treatment of hyperchloremic metabolic acidosis associated with renal tubular acidosis. Conditions affecting the central nervous system including uremic encephalopathy and hyponatremic encephalopathy secondary to renal disease are presented. Read More

JA Clin Rep 2022 Mar 10;8(1):20. Epub 2022 Mar 10.

Department of Anesthesiology, Toho University Ohashi Medical Center, 2-22-36, Ohashi, Meguro, Tokyo, 153-8515, Japan.

Background: Recent technological advancements have enabled the use of electrolyte solutions such as saline or buffered electrolyte solution during transurethral resection or laser enucleation of the prostate. However, saline absorption may cause hyperchloremic metabolic acidosis.

Case Presentation: A male in his late seventies underwent holmium laser enucleation of the prostate under a combination of subarachnoid block and general anesthesia. Read More

World J Surg 2022 Jun 9;46(6):1325-1335. Epub 2022 Mar 9.

Department of Anesthesiology and Intensive Care Medicine, Hvidovre University Hospital, Kettegaard allé 30, Hvidovre, 2650, Copenhagen, Denmark.

Background: Patients undergoing emergency high-risk abdominal surgery potentially suffer from both systemic dehydration and hypovolaemia. Data on the prevalence and clinical impact of electrolyte disturbances in this patient group, specifically the differences in patients with intestinal obstruction (IO) versus perforated viscus (PV) are lacking.

Methods: Adult patients undergoing emergency high-risk abdominal surgery in a standardized perioperative pathway were included in this retrospective single-center cohort study. Read More

Saudi J Anaesth 2022 Jan-Mar;16(1):38-44. Epub 2022 Jan 4.

College of Medicine, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia.

Background: Normal saline is commonly used in the perioperative kidney transplant period; its high chloride content can cause hyperchloremic metabolic acidosis giving a possible advantage to balanced electrolyte solutions due to their lower chloride content. The evidence regarding the best practices in fluid management during kidney transplantation and its effect on the incidence of delayed graft function (DGF) is still limited.

Materials And Methods: One hundred thirty-eight patients were included and followed up for seven days after surgery. Read More

J Am Dent Assoc 2022 Mar 5. Epub 2022 Mar 5.

Background: Mutations in SLC4A4 have been reported to be associated with proximal renal tubular acidosis (RTA), short stature, band keratopathy, cataract, glaucoma, and hypoplastic-type amelogenesis imperfecta. In this study, the authors describe the clinical manifestations, and investigate the molecular etiology, in a patient with RTA.

Case Description: The authors report on a girl with distal RTA who carried a novel homozygous base substitution of 2 consecutive base pair variants (NM_001098484. Read More

Sci Rep 2022 02 22;12(1):3035. Epub 2022 Feb 22.

Neuroscience Critical Care Research Group, Department of Intensive Care Medicine, CHUV-Lausanne University Hospital and Faculty of Biology and Medicine, 1011, Lausanne, Switzerland.

Hypertonic lactate (HL) is emerging as alternative treatment of intracranial hypertension following acute brain injury (ABI), but comparative studies are limited. Here, we examined the effectiveness of HL on main cerebral and systemic physiologic variables, and further compared it to that of standard hypertonic saline (HS). Retrospective cohort analysis of ABI subjects who received sequential osmotherapy with 7. Read More

Rev Inst Med Trop Sao Paulo 2022 14;64:e10. Epub 2022 Feb 14.

Universidade Federal do Espírito Santo, Hospital Universitário Cassiano Antonio Moraes, Vitória, Espírito Santo, Brazil.

Tenofovir Disoproxil Fumarate (TDF) is one of the drugs in the initial first-line antiretroviral regimen for the treatment of hepatitis B and HIV infections. Despite its effectiveness and few adverse effects, it is related to renal and bone toxicity. We described two cases of HIV-positive middle-aged women who had been using TDF for two and four years (cases 1 and 2, respectively) and were admitted to the emergency room. Read More

Saudi J Kidney Dis Transpl 2021 May-Jun;32(3):869-874

Department of Critical Care Medicine, King Saud Medical City, Riyadh, Saudi Arabia.

The coronavirus disease 2019 (COVID-19) infection associated with multisystemic involvement including renal manifestations has been described in the literature. The recent data show a high mortality rate of 60%-90% once renal function begins to deteriorate. We report on three patients who were admitted to intensive care unit due to severe COVID-19 acute respiratory distress syndrome and developed distal renal tubular acidosis. Read More

CEN Case Rep 2022 Jan 31. Epub 2022 Jan 31.

Department of Pediatrics, Kagoshima University Hospital, 8-35-1 Sakuragaoka, Kagoshima, 8908520, Japan.

Persistent cloaca involves fusion of the bladder, vagina, and rectum into a single duct called the common duct. Although its pathogenesis remains unclear, it has been associated with hyperchloremic metabolic acidosis. Herein, we present the case of a neonatal girl with high-confluence type variant of persistent cloaca treated with vesicostomy (Blocksom) for refractory metabolic acidosis. Read More

Ann Hepatol 2022 Mar-Apr;27(2):100675. Epub 2022 Jan 21.

Nephroxenia Dialysis Center Ioannina, Ioannina, Greece.

In addition to the kidneys and lungs, the liver also plays an important role in the regulation of the Acid-Base Equilibrium (ABE). The involvement of the liver in the regulation of ABE is crucial because of its role in lactic acid metabolism, urea production and in protein homeostasis. The main acid-base imbalance that occurs in patients with liver cirrhosis is Respiratory Alkalosis (RAlk). Read More

Pediatr Crit Care Med 2022 03;23(3):181-191

Division of Critical Care, Department of Pediatrics, University of Ottawa, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada.

Objectives: The ideal crystalloid fluid bolus therapy for fluid resuscitation in children remains unclear, but pediatric data are limited. Administration of 0.9% saline has been associated with hyperchloremic metabolic acidosis and acute kidney injury. Read More

Case Rep Oncol 2021 Sep-Dec;14(3):1460-1465. Epub 2021 Oct 18.

National Cancer Center Hospital East, Chiba, Japan.

Hyperchloremic metabolic acidosis can be a problem in urinary diversion using the ileum. A 73-year-old Japanese male was hospitalized in emergency due to anorexia and malaise 3 weeks after being discharged from the hospital after getting robot-assisted radical cystoprostatectomy and intracorporeal ileal conduit urinary diversion. The blood analysis revealed metabolic acidosis, elevated chloride ions, and marked hyperglycemia: he was diagnosed with hyperchloremic metabolic acidosis and hyperglycemic hyperosmolar syndrome. Read More

Cureus 2021 Sep 29;13(9):e18373. Epub 2021 Sep 29.

Endocrinology, Aga Khan University Hospital, Karachi, PAK.

Chronic metabolic acidosis increases alkali mobilization from the bone and promotes the development of osteoporosis. We report the case of a 35-year-old Caucasian female who presented for surgical fixation of a left femoral fracture sustained six months previously from a ground level fall with known primary hypothyroidism (for 12 years, on thyroxine replacement) with history of hypokalemia for the last 13 years (on regular oral potassium supplements). There was no history of fracture in past. Read More

Cureus 2021 Sep 24;13(9):e18247. Epub 2021 Sep 24.

Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, IND.

Background The importance of optimal acid-base balance during renal transplant surgeries cannot be stressed enough. Optimal preload and electrolyte balance is important in maintaining this. There has been a debate on the choice of perioperative crystalloids in renal transplant surgeries over the past decades. Read More

J Nephrol 2022 Apr 8;35(3):921-929. Epub 2021 Oct 8.

Division of Nephrology and Hypertension, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA.

Background: The objective of this study was to characterize hypernatremia patients at hospital admission into clusters using an unsupervised machine learning approach and to evaluate the mortality risk among these distinct clusters.

Methods: We performed consensus cluster analysis based on demographic information, principal diagnoses, comorbidities, and laboratory data among 922 hospitalized adult patients with admission serum sodium of > 145 mEq/L. We calculated the standardized difference of each variable to identify each cluster's key features. Read More

Urologe A 2022 Jan 4;61(1):59-62. Epub 2021 Oct 4.

Klinik für Urologie, RKH-Klinikum Ludwigsburg, Posilipostr. 4, 71640, Ludwigsburg, Deutschland.

Systemic fluid absorption frequently occurs during endoscopic prostatic surgery. The introduction of lasers allowed the use of normal saline (0.9% sodium chloride). Read More

J Pediatr Endocrinol Metab 2022 Feb 6;35(2):253-257. Epub 2021 Sep 6.

Department of Pediatrics, Hallym University Sacred Heart Hospital, Anyang, Republic of Korea.

Gordon syndrome (GS), also known as pseudohypoaldosteronism type II, is a rare tubular disease characterized by hypertension, hyperkalemia, and metabolic acidosis. Its causative genes are , , , and , and they are associated with varying severity of the disease. Herein, we report the first case of GS caused by a mutation in a patient with short stature in Korea. Read More

Am J Kidney Dis 2021 10 13;78(4):590-600. Epub 2021 Aug 13.

Internal Medicine, Baylor University Medical Center, Dallas, Texas. Electronic address:

The anion gap (AG) is a mathematical construct that compares the blood sodium concentration with the sum of the chloride and bicarbonate concentrations. It is a helpful calculation that divides the metabolic acidoses into 2 categories: high AG metabolic acidosis (HAGMA) and hyperchloremic metabolic acidosis-and thereby delimits the potential etiologies of the disorder. When the [AG] is compared with changes in the bicarbonate concentration, other occult acid-base disorders can be identified. Read More

Front Pediatr 2021 12;9:687396. Epub 2021 Jul 12.

Division of Pediatric Nephrology, Department of Pediatrics, University of Miami/Holtz Children's Hospital, Miami, FL, United States.

The diagnosis of a post-surgical uroenteric fistula can be challenging and may be delayed for months after symptoms begin. A normal anion gap metabolic acidosis has been reported in up to 100% of patients after ureterosigmoidostomy, and bladder substitution using small bowel and/or colonic segments. Here, we describe a rare case of a pediatric patient who developed a uroenteric fistula from the transplant ureters into the small bowel, after an en-bloc kidney transplantation resulting in profound acidosis and deceptive watery diarrhea. Read More

Am J Case Rep 2021 Jul 15;22:e931639. Epub 2021 Jul 15.

Department of Urology, Uonuma Kikan Hospital, Minamiuonuma, Niigata, Japan.

BACKGROUND Immune checkpoint inhibitors (ICIs) are anticancer medications that enhance the antitumor immune response. The clinical benefit afforded by ICIs, however, can be accompanied by immune-related adverse events (IRAEs). One of the common endocrine IRAEs is hypophysitis, which often causes hypopituitarism with secondary adrenal insufficiency (AI). Read More

Kidney Res Clin Pract 2021 Sep 8;40(3):484-495. Epub 2021 Jun 8.

Department of Internal Medicine, Staten Island University Hospital, Northwell Health, Staten Island, NY, United States.

Background: Normal saline solution (NSS) has been the fluid of choice for renal transplant patients, but it can lead to hyperchloremic acidosis and hyperkalemia. This study was performed to compare the safety profile of low-chloride solutions with that of NSS in renal transplant patients.

Methods: We conducted a systemic review search on PubMed, Embase, and the Central Cochrane Registry. Read More

Diabetes Care 2021 09 29;44(9):2061-2068. Epub 2021 Jun 29.

Department of Pediatrics, University of California Davis Health, University of California, Davis, School of Medicine, Sacramento.

Objective: Fluid replacement to correct dehydration, acidosis, and electrolyte abnormalities is the cornerstone of treatment for diabetic ketoacidosis (DKA), but little is known about optimal fluid infusion rates and electrolyte content. The objective of this study was to evaluate whether different fluid protocols affect the rate of normalization of biochemical derangements during DKA treatment.

Research Design And Methods: The current analysis involved moderate or severe DKA episodes ( = 714) in children age <18 years enrolled in the Fluid Therapies Under Investigation in DKA (FLUID) Trial. Read More

J Int Med Res 2021 Jun;49(6):3000605211024480

Department of Anesthesiology and Pain Medicine, Kyung Hee University Hospital, Dongdaemun-gu, Seoul, Republic of Korea.

Compared with monopolar transurethral resection of the prostate (TURP), which requires electrolyte-free irrigation fluid, normal saline can be used as the irrigation solution in bipolar and laser TURP. The risk of TURP syndrome and severe electrolyte disturbance is minimized when normal saline is used as the irrigation fluid. However, the use of isotonic saline also causes acid-base imbalance and electrolyte disturbance. Read More

Cureus 2021 Apr 22;13(4):e14638. Epub 2021 Apr 22.

Emergency Department, Hamad Medical Corporation, Doha, QAT.

Urinary diversion, a surgical technique to redirect urine usually after cystectomy, and its complications are potential challenges to physicians and early recognition decreases mortality and morbidity. A 45-year-old male with a history of type 2 diabetes mellitus and hypertension for over three years underwent urinary diversion as a treatment for invasive bladder cancer and was discharged ambulatory with an indwelling Foleys catheter. The patient returned to the emergency room with a primary complaint of hematuria. Read More