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

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

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

BMC Nephrol 2016 Aug 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

BMC Pediatr 2016 Aug 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

Nephrology (Carlton) 2016 Jun 16. Epub 2016 Jun 16.

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

Mol Genet Genomic Med 2016 May 14;4(3):303-11. Epub 2016 Feb 14.

Département de Génetique Hôpital Européen Georges Pompidou Paris France.

Background: Autosomal recessive distal renal tubular acidosis (dRTA) is a rare disease characterized by a hyperchloremic metabolic acidosis with normal anion gap, hypokalemia, hypercalciuria, hypocitraturia, nephrocalcinosis, and conserved glomerular filtration rate. In some cases, neurosensorial deafness is associated. dRTA is developed during the first months of life and the main manifestations are failure to thrive, vomiting, dehydration, and anorexia. Read More

Clin Chest Med 2016 06 8;37(2):277-88. Epub 2016 Mar 8.

Division of Critical Care Medicine, Department of Anesthesia, University of California, San Francisco, 533 Parnassus Avenue, San Francisco, CA 94143, USA. Electronic address:

Acute kidney injury (AKI) is an abrupt decrease in kidney function that takes place over hours to days. Sepsis is the leading cause of AKI and portends a particularly high morbidity and mortality, although the severity may vary from a transient rise in serum creatinine to end-stage renal disease. With regard to acid-base management in septic AKI, caution should be used with hyperchloremic crystalloid solutions, and dialysis is often used in the setting of severe acidosis. Read More

Rev Med Suisse 2016 Feb;12(504):270-2, 274

Sodium chloride 0.9%, often incorrectly called physiological saline, contains higher concentration of chloride compared to plasma. It is known that the administration of sodium chloride 0. Read More

Contrib Nephrol 2016 8;187:84-93. Epub 2016 Feb 8.

Division of General Medicine, Department of Medicine, Taipei Veterans General Hospital, and Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan.

The goal of fluid therapy in critical care medicine is to restore hemodynamic stability and vital organ perfusion while avoiding interstitial edema. Acute kidney injury (AKI) is a common complication in critically ill patients. Decisions regarding fluid management in critically ill patients with AKI are difficult, as these patients often have accompanying oliguria as well as body fluid overload. Read More

Rev Gastroenterol Peru 2015 Oct-Dec;35(4):355-7

Servicio de Endocrinología del Hospital Guillermo Almenara Irigoyen. EsSalud. Lima, Perú.

Chronic secretory diarrhea is a frequent entity. Causes are multiple, that is why reaching final diagnosis can result in delay with complications that this causes in the general condition of the patient. We present the case of one older adult with chronic diarrhea, mild hypokalemia and metabolic hyperchloremic acidosis secondary to a VIPoma in retroperitoneum which is an unusual location of this type of tumor that was diagnosed by biopsy guided by tomography. Read More

Curr Opin Anaesthesiol 2016 Apr;29(2):158-65

Department of Intensive Care Medicine University Hospital, Aachen, Germany.

Purpose Of Review: Evidence-based fluid therapy is complicated by blurred boundaries toward other fields of therapy and the majority of trials not focusing on patient-relevant outcomes. Additionally, recent trials unsettled the faith in traditional concepts on fluid therapy. The article reviews the evidence on diagnosis and treatment of hypovolemia and discusses the use of balanced solutions and early goal-directed therapy (EGDT) in septic shock resuscitation. Read More

J Cardiothorac Vasc Anesth 2015 Dec 29;29(6):1432-40. Epub 2015 Jul 29.

Anesthesiology and Critical Care.

Objective: To determine the severity, duration, and contributing factors for metabolic acidosis after deep hypothermic circulatory arrest (DHCA).

Design: Retrospective observational study.

Setting: University hospital. Read More

Med Intensiva 2016 Mar 3;40(2):113-7. Epub 2015 Dec 3.

Cátedra de Medicina Intensiva, Centro de Tratamiento Intensivo, Hospital de Clínicas Dr. Manuel Quintela, Facultad de Medicina, Universidad de la República (UdeLaR), Montevideo, Uruguay.

Intracranial hypertension (ICH) is the most important modifiable factor with predictive negative value in brain injury patients. Osmotherapy is the most important first level specific measure in the treatment of ICH. Mannitol 20%, and 3, 7. Read More

Pol Merkur Lekarski 2015 Oct;39(232):237-40

Professor emeritus Department of Medical Rehabilitation Shalgren's Hospital Goethenburg University, Sweden.

Physiological saline can hardly be treated as physiological as it contains qualitatively and quantitatively different amounts of electrolytes. In particular, it contains 50% more chlorine ions than serum. Physiological saline can cause metabolic acidosis and in diabetic patients hyperchloremic acidosis. Read More

Anaesthesiol Intensive Ther 2015 20;47 Spec No:s78-88. Epub 2015 Nov 20.

Dipartimento di Anestesia, Rianimazione ed Emergenza Urgenza, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milan, Italy.

"Balanced" solutions are commonly defined as intravenous fluids having an electrolyte composition close to that of plasma. As such, they should minimally affect acid-base equilibrium, as compared to the commonly reported 0.9% NaCl-related hyperchloremic metabolic acidosis. Read More

Urology 2016 Feb 11;88:201-6. Epub 2015 Nov 11.

Department of Urology, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai, China; Shanghai Eastern Institute for Urologic Repair and Reconstruction, Shanghai, China.

Objective: To investigate the long-term outcome of ileal ureteric replacement using a proximal antirefluxing technique for the treatment of long-segment ureteric strictures.

Patients And Methods: Between January 1997 and December 2013, 41 patients with a long ureteral stricture or defect and 3 patients with unilateral mid-lower ureteral cancer (20 bilateral and 24 unilateral, 28 males and 16 females) were treated by ureteral substitution using a proximal antirefluxing technique. The distal part of the upper ureter (4 cm) was fixed between the psoas muscle and the ileal segment (the iliopsoas tunnel technique). Read More

Pediatr Int 2016 May 6;58(5):379-382. Epub 2015 Nov 6.

Department of Pediatric Gastroenterology, Gazi University Medical School, Ankara, Turkey.

Congenital diarrheal disorders are caused by disruption in nutrient digestion, absorption, or transport, enterocyte development and functioning, or enteroendocrine functioning. Many additional rare forms of congenital diarrhea are expected to be linked to genes associated with appropriate intestinal fluid and electrolyte balance. Neurogenin-3 mutation, a very rare form of congenital diarrhea, disrupts enteroendocrine cell differentiation and is characterized by malabsorption and the absence of pancreatic islet cells. Read More

CEN Case Rep 2015 Nov 19;4(2):200-205. Epub 2015 Feb 19.

Department of Pediatrics, Batra Hospital and Medical Research Centre, Delhi, India.

A 14-year-old female came with the history of sudden onset weakness; during work up, she was found to have hyperchloremic metabolic acidosis with normal anion gap and normal renal function suggesting the possibility of renal tubular acidosis (RTA). On further evaluation of RTA, she had positive antinuclear antibody, anti-Ro, and anti-La antibodies. On nuclear scan of salivary glands, her left parotid gland was nonfunctional. Read More

J Clin Lab Anal 2016 Sep 29;30(5):510-2. Epub 2015 Oct 29.

Department of Pathology and Laboratory Medicine, University of Texas at Houston, Houston, Texas.

Background: Monoclonal gammopathies associated with acquired Fanconi's syndrome (AFS) have been reported in the adult population. AFS is characterized by renal dysfunction resulting in proteinuria, aminoaciduria, hypophosphatemia, glucosuria, and hyperchloremic metabolic acidosis. In this case report, we document the clinical and laboratory findings of a preterm infant with features of both AFS and monoclonal gammopathy in the urine. Read More

Case Rep Nephrol 2015 3;2015:309791. Epub 2015 Sep 3.

University of Toronto and University Health Network, Toronto General Hospital, Room 8N-842, 200 Elizabeth Street, Toronto, ON, Canada M5G 2C4.

Cholestyramine is a bile acid sequestrant that has been used in the treatment of hypercholesterolemia, pruritus due to elevated bile acid levels, and diarrhea due to bile acid malabsorption. This medication can rarely cause hyperchloremic nonanion gap metabolic acidosis, a complication featured in this report of an adult male with concomitant acute kidney injury. This case emphasizes the caution that must be taken in prescribing cholestyramine to patients who may also be volume depleted, in renal failure, or taking spironolactone. Read More

Am J Med Sci 2015 Nov;350(5):427-8

University of Tennessee Health Science Center and Veterans Affairs Medical Center, Memphis, Tennessee, Division of Nephrology.

Eur J Clin Pharmacol 2016 Feb 24;72(2):247-8. Epub 2015 Sep 24.

Department of Biomedical and Clinical Sciences, Unit of Clinical Pharmacology, "Luigi Sacco" University Hospital, University of Milano, Milan, Italy.

J Clin Apher 2016 Oct 22;31(5):479-80. Epub 2015 Sep 22.

Service De Réanimation Neurologique, Hospices Civils De Lyon, Lyon, France.

Background: Therapeutic plasma exchanges are increasingly used, notably during myasthenia gravis crisis. Repeated exchanges may induce severe adverse events.

Case: We reported a case of symptomatic hyperchloremic metabolic acidosis following a therapeutic plasma exchange. Read More

J Extra Corpor Technol 2014 Sep;46(3):262-6

Avoiding or managing hyperkalemia during cardiac surgery, especially in a patient with chronic renal insufficiency, can be challenging. Hyperkalemic cardioplegia solution is usually administered to achieve and maintain an electrical arrest of the heart. This solution eventually mixes in with the systemic circulation, contributing to elevated systemic potassium levels. Read More

Crit Care 2015 Aug 28;19:305. Epub 2015 Aug 28.

ICU Department, UZ Brussel-VUB University, 101 Laarbeeklaan, 1090 Jette, Brussels, Belgium.

Rev Invest Clin 2015 May-Jun;67(3):191-8

Department of Pediatric Nephrology, Hospital Universitario "Nuestra Señora de La Candelaria", Santa Cruz de Tenerife, Spain.

Background: Primary distal renal tubular acidosis is a clinical disorder characterized by hyperchloremic metabolic acidosis, hypercalciuria, hypocitraturia, urinary acidification impairment, hypokalemia, metabolic bone disease, and nephrocalcinosis. Urinary acidification ability may be evaluated by an acidification test or maximum urinary pCO2 assessment with alkaline urine. The maximum urinary pCO2 test using acetazolamide and sodium bicarbonate is an easy test to confirm the lack of urine acidification in distal renal tubular acidosis in children. Read More

J Pediatr Gastroenterol Nutr 2015 Dec;61(6):605-9

*Neonatal and Pediatric Intensive Care Unit, CHU Armand Trousseau, Assistance Publique-Hôpitaux de Paris, Paris †Neonatal Intensive Care Unit, CHU Angers, Angers ‡Neonatal Intensive Care Unit, Pôle Médico-Chirurgical de Pédiatrie et de Génétique Clinique, CHU Rennes, Rennes §Division of Neonatology, AP-HM, Aix-Marseille University, Marseille ||Neonatal Intensive Care Unit, Pôle Femme Couple Enfant, CHU Amiens, Amiens ¶Neonatal and Pediatric Intensive Care Unit, CHU Félix Guyon, La Réunion #Neonatal Intensive Care Unit Port-Royal, Groupe Hospitalier Cochin-Broca-Hôtel Dieu, Assistance Publique-Hôpitaux de Paris, Paris **Neonatal Intensive Care Unit, Groupe Hospitalier Robert Debré, Assistance Publique-Hôpitaux de Paris, Paris, France.

Objectives: Recent guidelines for preterm neonates recommend early initiation of parenteral nutrition (PN) with high protein and relatively high caloric intake. This review considers whether these changes could influence homeostasis in very preterm infants during the first few postnatal weeks.

Methods: This systematic review of relevant literature from searches of PubMed and recent guidelines was reviewed by investigators from several perinatal centers in France. Read More

Int J Surg 2015 Aug 27;20:128-34. Epub 2015 Jun 27.

Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, Republic of Korea; Anesthesia and Pain Research Institute, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, Republic of Korea; Severance Biomedical Science Institute, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, Republic of Korea. Electronic address:

Introduction: In multi-level lumbar spinal fusion surgery yielding a large amount of blood loss, choice of fluid for volume resuscitation is an important issue since it can influence acid-base status, coagulation, and patients' outcome. This study compared the effect of plasmalyte to 0.9% saline on coagulation assessed by rotation thromboelastometry (ROTEM) and acid-base balance in the aforementioned patients. Read More

Internist (Berl) 2015 Jul;56(7):773-8

Medizinische Klinik D, Abteilung für Allg. Innere Medizin, Nephrologie und Rheumatologie, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Deutschland,

The nonphysiological high chloride content of 0.9 % saline causes hyperchloremic acidosis and rapidly reduces renal perfusion in healthy volunteers-negative affects not seen with balanced crystalloids with low chloride content. Evidence from recently published studies strongly suggests that 0. Read More

Am J Physiol Renal Physiol 2015 Sep 24;309(6):F523-30. Epub 2015 Jun 24.

Department of Cellular/Integrative Physiology, University of Nebraska Medical Center, Omaha, Nebraska; and

In many circumstances, the pathogenesis of distal renal tubular acidosis (dRTA) is not understood. In the present study, we report that a mouse model lacking the electrogenic Na(+)-HCO3 (-) cotransporter [NBCe2/Slc4a5; NBCe2 knockout (KO) mice] developed dRTA after an oral acid challenge. NBCe2 expression was identified in the connecting tubule (CNT) of wild-type mice, and its expression was significantly increased after acid loading. Read More