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Curr Opin Crit Care 2019 Jan 22. Epub 2019 Jan 22.

Division of Neurosciences Critical Care, Departments of Anesthesiology and Critical Care Medicine, Neurology, and Neurosurgery Johns Hopkins School of Medicine, Baltimore Maryland. USA.

Purpose Of Review: To discuss recent updates in fluid management and use of hyperosmolar therapy in neurocritical care.

Recent Findings: Maintaining euvolemia with crystalloids seems to be the recommended fluid resuscitation for neurocritical care patients. Buffered crystalloids have been shown to reduce hyperchloremia in patients with subarachnoid hemorrhage without causing hyponatremia or hypo-osmolality. Read More

Emerg (Tehran) 2018 25;6(1):e52. Epub 2018 Aug 25.

Department of Medical, Surgical, Neurological, Metabolic and Geriatrics Sciences, University of Campania "L. Vanvitelli", Italy.
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Introduction: Early detection is crucial for prompt management of acute kidney injury (AKI) patients in emergency department (ED). This study aimed to investigate the usefulness of hyperchloremic metabolic acidosis (HCMA) levels in this regard.

Methods: In this retrospective observational study, > 18 years old critically ill patients presenting to ED of Marcianise Hospital, Italy, were divided into non-AKI and AKI group according to KDIGO guideline. Read More

BMC Nephrol 2018 Dec 17;19(1):364. Epub 2018 Dec 17.

Central Laboratory, The Affiliated Hospital of Qingdao University, 1677 Wutaishan Road, Qingdao, 266555, China.

Background: Distal renal tubular acidosis (dRTA) is a heterogeneous disorder characterized by normal anion gap metabolic acidosis. Autosomal recessive dRTA is usually caused by mutations occurring in ATP6V1B1 and ATP6V0A4 genes,encoding subunits B1 and a4 of apical H-ATPase, respectively. The heterogeneous clinical manifestations of dRTA have been described in different ethnic groups harboring distinct mutations. Read More

Semin Respir Crit Care Med 2018 Oct 28;39(5):538-545. Epub 2018 Nov 28.

Saint Eloi ICU, Montpellier University Hospital, Montpellier, France.

Liver failure can occur in patients with or without underlying chronic liver disease (mainly cirrhosis) and is, respectively, termed acute on chronic liver failure or acute liver failure (ALF). In both cases, it is associated with marked systemic inflammation and profound hemodynamic disturbances, that is, increased cardiac output, peripheral vasodilation, and decreased systemic vascular resistance, on top of several superimposed etiologies of shock. In patients with cirrhosis, sepsis is the main cause of intensive care unit admission but portal hypertension-related gastrointestinal hemorrhage is also common. Read More

Paediatr Anaesth 2019 Feb 8;29(2):186-192. Epub 2019 Jan 8.

School of Medicine, University of Nottingham, Nottingham, UK.

Background: Plasma-Lyte 148® is a balanced, crystalloid intravenous (IV) fluid which is both calcium-free and isotonic. It prevents the hyperchloremic metabolic acidosis and iatrogenic hyponatremia seen with use of 0.9% sodium chloride and hypotonic solutions, respectively. Read More

Pediatr Clin North Am 2019 02;66(1):135-157

Division of Nephrology, Department of Pediatrics, The Montreal Children's Hospital, McGill University Health Centre, Room B RC.6651, Montreal, Quebec H4A 3J1, Canada; Al Jalila Children's Hospital, Al Jadaf PO Box 7662, Dubai, UAE. Electronic address:

Renal tubular acidosis should be suspected in poorly thriving young children with hyperchloremic and hypokalemic normal anion gap metabolic acidosis, with/without syndromic features. Further workup is needed to determine the type of renal tubular acidosis and the presumed etiopathogenesis, which informs treatment choices and prognosis. The risk of nephrolithiasis and calcinosis is linked to the presence (proximal renal tubular acidosis, negligible stone risk) or absence (distal renal tubular acidosis, high stone risk) of urine citrate excretion. Read More

Am J Respir Crit Care Med 2018 Nov 8. Epub 2018 Nov 8.

University of Pittsburgh, Pittsburgh, Pennsylvania, United States.

Intravenous fluid therapy is the most common intervention received by acutely ill patients. Historically, saline (0.9% sodium chloride) has been the most frequently administered intravenous fluid, especially in North America. Read More

Ann Card Anaesth 2018 Oct-Dec;21(4):413-418

Department of Anaesthesia, Sri Siddhartha Medical College, Tumakur, Karnataka, India.

Context And Aims: Off-pump coronary artery bypass graft (OPCABG) is a form of CABG surgery. It is performed without the use of cardiopulmonary bypass machine as a surgical treatment for coronary heart disease. Acute kidney injury (AKI) is one of the common postoperative complications of OPCABG. Read More

Pediatr Endocrinol Diabetes Metab 2018 ;24(2):56-64

Division of Pediatric Intensive Care, Department of Pediatrics, Lady Hardinge Medical College and associated Kalawati Saran Children's Hospital, New Delhi - 110001, India.

Introduction: The optimal fluid therapy in children with DKA is a matter of debate, especially if we take into account its association with cerebral edema, the most important complication. Hypertonic Saline Solution is used in the treatment of cerebral edema, and also has been used for volume resuscitation in children with shock.

Aim Of Study: To compare the effects of 3% saline and 0. Read More

J Minim Invasive Gynecol 2018 Sep 27. Epub 2018 Sep 27.

Department of Anesthesia (Dr. Brown), BC Women's Hospital, Vancouver, British Columbia, Canada; Department of Anesthesiology, Pharmacology and Therapeutics (Dr. Brown), University of British Columbia, Vancouver, British Columbia, Canada. Electronic address:

We present a case of severe hypokalemia, metabolic acidosis, and arrhythmia after absorption of 2500 mL normal saline during a hysteroscopic myomectomy. The patient was a 36-year-old woman with abnormal uterine bleeding caused by a submucosal leiomyoma. She received a total of 3500 mL normal saline (2500 mL was absorbed via the uterus and 1000 mL given intravenously) during hysteroscopy. Read More

Clin Toxicol (Phila) 2019 Jan 27;57(1):64-65. Epub 2018 Sep 27.

a Swedish Poisons Information Centre , Stockholm , Sweden.

Neurol India 2018 Sep-Oct;66(5):1338-1344

Department of Biochemistry, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India.

Background: The choice of fluid is important in neurosurgical patients, who may be dehydrated due to the administration of diuretics in order to reduce cerebral edema. Normal saline, the infused fluid routinely used in neurosurgical patients, can cause hyperchloremic metabolic acidosis. A balanced crystalloid (BC) may help to maintain the metabolic status more favorably in these patients, without adversely affecting brain relaxation. Read More

Medicine (Baltimore) 2018 Sep;97(36):e12221

Departamento de Doentes Graves-Hospital Israelita Albert Einstein-São Paulo.

Metabolic acid-base disorders, especially metabolic acidosis, are common in critically ill patients who require renal replacement therapy. Continuous veno-venous hemodiafiltration (CVVHDF) achieves profound changes in acid-base status, but metabolic acidosis can remain unchanged or even deteriorate in some patients. The objective of this study is to understand the changes of acid-base variables in critically ill patients with septic associated acute kidney injury (SA-AKI) during CVVHDF and to determine how they relate to clinical outcome. Read More

Kidney Int 2018 09 7;94(3):514-523. Epub 2018 Jul 7.

Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche 970, Paris, France; Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche 1188, CYROI, Sainte Clotilde, La Réunion, France; Centre National de la Recherche Scientifique, Délégation Paris Michel-Ange, Paris, France. Electronic address:

Pseudohypoaldosteronism type II (PHAII) is a genetic disease characterized by association of hyperkalemia, hyperchloremic metabolic acidosis, hypertension, low renin, and high sensitivity to thiazide diuretics. It is caused by mutations in the WNK1, WNK4, KLHL3 or CUL3 gene. There is strong evidence that excessive sodium chloride reabsorption by the sodium chloride cotransporter NCC in the distal convoluted tubule is involved. Read More

Adv Chronic Kidney Dis 2018 Jul;25(4):358-365

Division of Nephrology and Hypertension, Henry Ford Hospital, Detroit, MI; and Division of Pulmonary and Critical Care Medicine, Henry Ford Hospital, Detroit, MI.

Hyperchloremic metabolic acidosis, particularly renal tubular acidosis, can pose diagnostic challenges. The laboratory phenotype of a low total carbon dioxide content, normal anion gap, and hyperchloremia may be misconstrued as hypobicarbonatemia from renal tubular acidosis. Several disorders can mimic renal tubular acidosis, and these must be appropriately diagnosed to prevent inadvertent and inappropriate application of alkali therapy. Read More

Adv Chronic Kidney Dis 2018 Jul;25(4):351-357

Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, USA; and Pediatrics Department B, Schneider Children's Medical Center of Israel, Sackler School of Medicine, Tel Aviv University, Israel.

Proximal renal tubular acidosis (pRTA) is an inherited or acquired clinical syndrome in which there is a decreased bicarbonate reclamation in the proximal tubule resulting in normal anion gap hyperchloremic metabolic acidosis. In children, pRTA may be isolated but is often associated with a general proximal tubular dysfunction known as Fanconi syndrome which frequently heralds an underlying systemic disorder from which it arises. When accompanied by Fanconi syndrome, pRTA is characterized by additional renal wasting of phosphate, glucose, uric acid, and amino acids. Read More

Adv Chronic Kidney Dis 2018 Jul;25(4):321-333

Division of Nephrology, Northwestern University Feinberg School of Medicine, Chicago, IL; Division of Nephrology, University of Illinois at Chicago, Chicago, IL.

In contrast to distal type I or classic renal tubular acidosis (RTA) that is associated with hypokalemia, hyperkalemic forms of RTA also occur usually in the setting of mild-to-moderate CKD. Two pathogenic types of hyperkalemic metabolic acidosis are frequently encountered in adults with underlying CKD. One type, which corresponds to some extent to the animal model of selective aldosterone deficiency (SAD) created experimentally by adrenalectomy and glucocorticoid replacement, is manifested in humans by low plasma and urinary aldosterone levels, reduced ammonium excretion, and preserved ability to lower urine pH below 5. Read More

Adv Chronic Kidney Dis 2018 Jul;25(4):303-320

Pathophysiology Division, Pathology Department, School of Medicine, National University of Cuyo, Mendoza, Argentina; and Division of Nephrology, Department of Medicine, Northwestern University, Feinberg School of Medicine, Chicago, IL. Electronic address:

Distal renal tubular acidosis (DRTA) is defined as hyperchloremic, non-anion gap metabolic acidosis with impaired urinary acid excretion in the presence of a normal or moderately reduced glomerular filtration rate. Failure in urinary acid excretion results from reduced H secretion by intercalated cells in the distal nephron. This results in decreased excretion of NH and other acids collectively referred as titratable acids while urine pH is typically above 5. Read More

Exp Clin Transplant 2018 12 17;16(6):754-756. Epub 2018 Aug 17.

Department of Anesthesiology and Pain Medicine, Yeungnam University Hospital, Daegu, Korea.

An interaction between regained renal function in a transplanted kidney and hyperventilation syndrome may interfere with correct diagnosis of acid-base status in patients with preoperative nongap acidosis. Here, we present a patient with glomerular nephritis and hyperchloremia who underwent kidney transplant. Progressively increasing bicarbonate reabsorption by the renal graft, which thereby changed the arterial carbon dioxide tension-to-bicarbonate ratio, resulted in a time-sequence swing of an acid-base interpretation despite persistent mixed respiratory alkalosis due to hyperventilation syndrome and nongap metabolic acidosis due to preexisting hyperchloremia. Read More

J Neurosurg Anesthesiol 2019 Jan;31(1):30-35

Departments of Anesthesiology.

Background: Balanced crystalloid solutions induce less hyperchloremia than normal saline, but their role as primary fluid replacement for children undergoing surgery is unestablished. We hypothesized that balanced crystalloids induce less chloride and metabolic derangements than 0.9% saline solutions in children undergoing brain tumor resection. Read More

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

J Nephrol 2018 Aug 9;31(4):511-522. 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

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

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

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

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

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

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

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

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

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

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

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

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