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    Acidosis, but Not Alkalosis, Affects Anaerobic Metabolism and Performance in a 4-km Time Trial.
    Med Sci Sports Exerc 2017 Apr 11. Epub 2017 Apr 11.
    1Sports Science Research Group, Department of Physical Education and Sports Science, CAV, Federal University of Pernambuco, Brazil; 2Endurance Performance Research Group (GEDAE-USP), School of Physical Education and Sport, University of São Paulo, Brazil; 3Institute of Sport, Exercise and Active Living, College of Sport and Exercise Science, Victoria University, Australia; 4School of Medical and Health Sciences, Edith Cowan University, Australia; 5Human Performance Research Group, Academic Department of Physical Education, Technological Federal University of Parana, Curitiba, Parana, Brazil.
    Purpose: To determine the effect of pre-exercise metabolic acidosis and alkalosis on power output (PO) and aerobic and anaerobic energy expenditure during a 4-km cycling time trial (TT).

    Methods: Eleven recreationally trained cyclists (VO2peak 54.1 ± 9. Read More

    HELLP syndrome in a pregnant patient with Gitelman syndrome.
    Kidney Res Clin Pract 2017 Mar 31;36(1):95-99. Epub 2017 Mar 31.
    Department of Internal Medicine, Konyang University College of Medicine, Daejeon, Korea.
    Gitelman syndrome is characterized by hypokalemia, metabolic alkalosis, hypocalciuria, and hypomagnesemia. The clinical course of Gitelman syndrome in pregnant women remains unclear, but it is thought to be benign. We report here the first Korean case of atypical eclampsia in a 31-year-old who was diagnosed with Gitelman syndrome incidentally during an antenatal screening test. Read More

    Hypocapnic hypothesis of Leigh disease.
    Med Hypotheses 2017 Apr 1;101:23-27. Epub 2017 Feb 1.
    The Children's Memorial Health Institute, Department of Pediatrics, Nutrition and Metabolic Diseases, Aleja Dzieci Polskich 20, 04-730 Warsaw, Poland. Electronic address:
    Leigh syndrome (LS) is a neurogenetic disorder of children caused by mutations in at least 75 genes which impair mitochondrial bioenergetics. The changes have typical localization in basal ganglia and brainstem, and typical histological picture of spongiform appearance, vascular proliferation and gliosis. ATP deprivation, free radicals and lactate accumulation are suspected to be the causes. Read More

    Persistent pulmonary hypertension of the newborn.
    Semin Fetal Neonatal Med 2017 Mar 23. Epub 2017 Mar 23.
    Departments of Pediatrics and Obstetrics, Gynecology and Women's Health, Albert Einstein College of Medicine and the Children's Hospital at Montefiore, Bronx, NY, USA. Electronic address:
    Failure of the normal circulatory adaptation to extrauterine life results in persistent pulmonary hypertension of the newborn (PPHN). Although this condition is most often secondary to parenchymal lung disease or lung hypoplasia, it may also be idiopathic. PPHN is characterized by elevated pulmonary vascular resistance with resultant right-to-left shunting of blood and hypoxemia. Read More

    A new SLC12A3 founder mutation (p.Val647Met) in Gitelman's syndrome patients of Roma ancestry.
    Nefrologia 2017 Mar 18. Epub 2017 Mar 18.
    Hôpital Européen Georges Pompidou, France.
    Background: Gitelman's syndrome (GS) is an autosomal recessive disorder caused by mutations in the SLC12A3 gene. GS is characterized by hypokalaemic metabolic alkalosis, hypomagnesemia and hypocalciuria. Most of the reported patients of Roma ancestry are homozygous for an SLC12A3 intron 9 frameshifting mutation (c. Read More

    Gitelman Syndrome.
    J Coll Physicians Surg Pak 2017 Mar;27(3):S30-S32
    Department of Chemical Pathology and Endocrinology, Armed Forces Institute of Pathology, Rawalpindi.
    Gitelman syndrome (GS) is the most frequently inherited renal salt-wasting tubulointerstitial disease. It follows variable but usually asymptomatic benign course. We present a rare case of GS that remained clinical enigma. Read More

    Changes in Serum Bicarbonate Levels Caused by Acetate-Containing Bicarbonate-Buffered Hemodialysis Solution: An Observational Prospective Cohort Study.
    Ther Apher Dial 2017 Apr 13;21(2):157-165. Epub 2017 Mar 13.
    The Regional Center of Excellence for Transplantation & Kidney Care at Erie County Medical Center, Buffalo, New York.
    Fresenius Medical Care's NaturaLyte dialysate has been associated with increased risk of sudden cardiac death by causing metabolic alkalosis from its acetate content based on retrospective data using pre-dialysis bicarbonate levels only. The study objective was to measure inter/intra-dialytic changes in serum bicarbonate and degree of alkalosis conferred by varying concentrations of NaturaLyte bicarbonate dialysate. Thirty-nine hemodialysis patients were divided into four groups based on prescribed bicarbonate dialysate concentrations; Group 1 (N = 9): 30-32 mEq/L, Group 2 (N = 5): 33-34 mEq/L, Group 3 (N = 10): 35-36 mEq/L, Group 4 (N = 15): 37-40 mEq/L. Read More

    Acid-base disturbances in nephrotic syndrome: analysis using the CO2/HCO3 method (traditional Boston model) and the physicochemical method (Stewart model).
    Clin Exp Nephrol 2017 Mar 13. Epub 2017 Mar 13.
    Division of Nephrology and Rheumatology, Department of Internal Medicine, Aichi Medical University School of Medicine, Nagakute, Japan.
    Background: The Stewart model for analyzing acid-base disturbances emphasizes serum albumin levels, which are ignored in the traditional Boston model. We compared data derived using the Stewart model to those using the Boston model in patients with nephrotic syndrome.

    Methods: Twenty-nine patients with nephrotic syndrome and six patients without urinary protein or acid-base disturbances provided blood and urine samples for analysis that included routine biochemical and arterial blood gas tests, plasma renin activity, and aldosterone. Read More

    Poor phenotype-genotype association in a large series of patients with Type III Bartter syndrome.
    PLoS One 2017 13;12(3):e0173581. Epub 2017 Mar 13.
    Pediatric Nephrology, Vall d'Hebron University Hospital, Universitat Autonoma, Barcelona, Spain.
    Introduction: Type III Bartter syndrome (BS) is an autosomal recessive renal tubule disorder caused by loss-of-function mutations in the CLCNKB gene, which encodes the chloride channel protein ClC-Kb. In this study, we carried out a complete clinical and genetic characterization in a cohort of 30 patients, one of the largest series described. By comparing with other published populations, and considering that 80% of our patients presented the p. Read More

    Effects of early administration of acetazolamide on the duration of mechanical ventilation in patients with chronic obstructive pulmonary disease or obesity-hypoventilation syndrome with metabolic alkalosis. A randomized trial.
    Pulm Pharmacol Ther 2017 Mar 7. Epub 2017 Mar 7.
    Intensive Care Department, Hospital Sant Joan de Reus, Av. del Dr Josep Laporte, 2, 43204 Reus, Spain. Electronic address:
    Background: Metabolic alkalosis (MA) inhibits respiratory drive and may delay weaning from mechanical ventilation (MV). MA is common in CO2-retainer patients that need MV. Acetazolamide (ACTZ) decreases serum bicarbonate concentration and stimulates respiratory drive. Read More

    Na(+)/HCO3(-) Cotransporter NBCn2 Mediates HCO3(-) Reclamation in the Apical Membrane of Renal Proximal Tubules.
    J Am Soc Nephrol 2017 Mar 9. Epub 2017 Mar 9.
    Department of Biophysics and Molecular Physiology, Key Laboratory of Molecular Biophysics of Ministry of Education, Huazhong University of Science and Technology School of Life Science and Technology, Wuhan, Hubei, China; and
    The kidney maintains systemic acid-base balance by reclaiming from the renal tubule lumen virtually all HCO3(-) filtered in glomeruli and by secreting additional H(+) to titrate luminal buffers. For proximal tubules, which are responsible for about 80% of this activity, it is believed that HCO3(-) reclamation depends solely on H(+) secretion, mediated by the apical Na(+)/H(+) exchanger NHE3 and the vacuolar proton pump. However, NHE3 and the proton pump cannot account for all HCO3(-) reclamation. Read More

    Protein-losing enteropathy in an infant with rotavirus infection.
    Paediatr Int Child Health 2017 Mar 6:1-4. Epub 2017 Mar 6.
    a Department of Paediatrics , University of Chieti , Chieti , Italy.
    Protein-losing enteropathy (PLE) is a rare gastro-intestinal complication characterised by intestinal loss of proteins with consequent hypoproteinaemia and generalised oedema. Rotavirus infection associated with PLE in children has rarely been reported. A 6-month-old girl presented with diarrhoea, fever and generalised oedema. Read More

    The importance of genetic counseling and genetic screening: a case report of a 16-year-old boy with resistant hypertension and severe hypokalemia.
    J Am Soc Hypertens 2017 Feb 3. Epub 2017 Feb 3.
    Department of Cardiovascular, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi Province, China. Electronic address:
    Liddle's syndrome, an autosomal dominant form of monogenic hypertension, is characterized by salt-sensitive hypertension with early penetrance, hypokalemia, metabolic alkalosis, suppression of plasma rennin activity and aldosterone secretion, and a clear-cut response to epithelial sodium channel blockers but not spironolactone therapy. Here, we describe the case of a 16-year-old boy patient with resistant hypertension (maintain 170-180/100-110 mm Hg after administration four kinds of antiypertensive drugs) and severe hypokalemia. After a series of checks, we exclude primary aldosteronism and renal artery stenosis and other diseases. Read More

    Perioperative Concerns for Profound Metabolic Alkalosis During Kidney Transplantation: A Case Report.
    Iran Red Crescent Med J 2016 Nov 2;18(11):e38728. Epub 2016 Oct 2.
    Department of Anesthesiology and Pain Medicine, Gachon University, Gil Medical Center, Incheon, South Korea.
    Introduction: Profound metabolic alkalosis is an uncommon consideration for the anesthetic management of kidney transplantation. Serum total carbon dioxide content and complex electrolyte abnormalities might be important diagnostic clues for the presence of metabolic alkalosis in the absence of arterial blood gas analysis.

    Case Presentation: A 34-year-old female visited Gachon University Gil Medical Center, Incheon, South Korea during year 2015. Read More

    Experiences with Continuous Venovenous Hemofiltration using 18mmol/L predilution Citrate anticoagulation and a Phosphate Containing Replacement Solution.
    Indian J Crit Care Med 2017 Jan;21(1):11-16
    Department of Intensive Care, Intensive Care Unit, Queen Elizabeth Hospital, Kowloon, Hong Kong.
    Context: Regional citrate anticoagulation for continuous renal replacement therapy is associated with a longer filter-life, less bleeding events and improved mortality. Problems associated with using Prismocitrate 10/2 solution in continuous renal replacement therapy, include hypomagnesemia, hypophosphatemia and the need for additional bicarbonate infusion.

    Aims: This study uses the new Prismocitrate 18/0 solution for improved buffer balance and Phoxilium solution for a more favourable electrolyte profile. Read More

    Dynamics of acid-base and hematological regulation in day 15 chicken embryos (Gallus gallus domesticus) exposed to graded hypercapnia and hypoxia.
    Respir Physiol Neurobiol 2017 May 9;239:55-63. Epub 2017 Feb 9.
    Developmental Integrative Biology, Department of Biological Sciences, University of North Texas, 1155 Union Circle #305220, Denton, TX 76203, USA.
    Most experiments examining acid-base regulation of chicken embryos have employed static, single time point measurements rather than dynamic, multiple time point measurements that might reveal additional components of developing acid-base regulation. Thus, we studied blood acid-base balance and hematology of day 15 chicken embryos under 24h exposure to graded hypercapnia (1%-7% CO2) accompanied by graded hypoxia (20% O2 down to 13% O2). Across all hypercapnic/hypoxic environments, respiratory acidosis occurred 2h after exposure in proportion to the magnitude of hypercapnia. Read More

    Corrected to uncorrected? The metabolic conundrum of hypertrophic pyloric stenosis.
    J Pediatr Surg 2017 Jan 28. Epub 2017 Jan 28.
    Division of Pediatric General Surgery, IWK Health Centre; Dalhousie University; Halifax, Nova Scotia, Canada.
    Objectives: The purpose of this study was to evaluate factors associated with repeat blood testing after establishment of normal metabolic parameters and factors associated with reversal of metabolic correction back an uncorrected form in preoperative management of infants with Hypertrophic Pyloric Stenosis (HSP).

    Methods: A retrospective review of infants with HSP undergoing repeat serum chemistries after already having normal labs were identified. Variables associated with repeating normal bloodwork and reversion of normal to abnormal labs were identified. Read More

    Gitelman syndrome in a South African family presenting with hypokalaemia and unusual food cravings.
    BMC Nephrol 2017 Jan 26;18(1):38. Epub 2017 Jan 26.
    Division of Nephrology, Department of Medicine, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa.
    Background: Gitelman syndrome (GS) is an autosomal recessive renal tubular disorder characterised by renal salt wasting with hypokalaemia, metabolic alkalosis, hypomagnesaemia and hypocalciuria. It is caused by mutations in SLC12A3 encoding the sodium-chloride cotransporter on the apical membrane of the distal convoluted tubule. We report a South African family with five affected individuals presenting with hypokalaemia and unusual food cravings. Read More

    [Gitelman´s syndrome as common cause of hypokalemia and hypomagnesemia].
    Vnitr Lek 2016 ;62(Supplementum 6):78-83
    The Gitelman syndrome (GS) is an autosomal recessive disorder characterized by hypokalemic metabolic alkalosis and presence of hypocalciuria and hypomagnesemia. It is one of the most common congenital "salt-wasting" tubulo-pathies, where the impairment of function of the Na+-Cl- cotransporter (NCCT) in the distal convoluted tubule is primary and hypokalemia secondary. Hypomagnesemia is caused by the impairment of magnesium reabsorption through TRPM6 channel which is located just by NCCT. Read More

    [Metabolic acidosis in chronic kidney disease].
    Vnitr Lek 2016 ;62(Supplementum 6):30-39
    Metabolic acidosis (MAC) is a constant symptom of chronic kidney disease (CKD) in advanced stages. However, its onset and degree do not depend only on the decrease of glomerular filtration but also on tubular functions. Therefore, in patients with predominant tubulointerstitial involvement it may already appear in earlier stages of CKD, usually as MAC with normal anion gap. Read More

    [[Na+] - [Cl-] difference significantly contributes to acidemia in patients with liver cirrhosis].
    Vnitr Lek 2016 ;62(Supplementum 6):14-20
    Aim: To evaluate the role of strong ion difference (SID) in acid-base disorders in patients with liver disease.

    Patients And Methods: We evaluated the acid-base status in 11 patients with liver cirrhosis both by traditional and quantitative Stewart-Fencl methods.

    Results: Nine of eleven patients had pH within the norm, 2/11 had pH above 7. Read More

    Out of Warburg effect: An effective cancer treatment targeting the tumor specific metabolism and dysregulated pH.
    Semin Cancer Biol 2017 Jan 22. Epub 2017 Jan 22.
    Department of Therapeutic Research and Medicine Evaluation, National Institute of Health, Rome, Italy.
    As stated by Otto Warburg nearly a century ago, cancer is a metabolic disease, a fermentation caused by malfunctioning mitochondria, resulting in increased anabolism and decreased catabolism. Treatment should, therefore, aim at restoring the energy yield. To decrease anabolism, glucose uptake should be reduced (ketogenic diet). Read More

    Ectopic Cushing syndrome in small cell lung cancer: A case report and literature review.
    Thorac Cancer 2017 Mar 8;8(2):114-117. Epub 2016 Nov 8.
    Department of Thoracic Medical Oncology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital and Institute, Beijing, China.
    Small cell lung cancer (SCLC) is a neuroendocrine tumor with the potential to secrete various peptides or hormones that can lead to paraneoplastic syndromes, such as Ectopic Cushing syndrome (ECS). Because of the aggressive nature of the syndrome and its atypical features, ECS in small-cell lung cancer is difficult to diagnose and has a poor prognosis. We report a case of a 74-year-old male patient who presented with severe hypokalemia, proximal muscle weakness, peripheral edema, metabolic alkalosis, and worsening hyperglycemia. Read More

    A novel SLC12A1 gene mutation associated with hyperparathyroidism, hypercalcemia, nephrogenic diabetes insipidus, and nephrocalcinosis in four patients.
    Bone 2017 Apr 14;97:121-125. Epub 2017 Jan 14.
    Center for Endocrinology, Diabetes and Metabolism, Division of Endocrinology, Children's Hospital Los Angeles, Los Angeles, CA, United States; Keck School of Medicine of University of Southern California, Los Angeles, CA, United States. Electronic address:
    Solute Carrier Family 12 member 1 (SLC12A1) gene encodes the sodium-potassium-chloride co-transporter (NKCC2) at the apical membrane of the thick ascending loop of Henle (TAL). Bartter's syndrome (BS) type I is a rare, autosomal recessive, renal tubular disorder associated with mutation of the SLC12A1 gene. Presenting features include: hypokalemic metabolic alkalosis, hypercalciuria and nephrocalcinosis. Read More

    Hypokalemic Paralysis Complicated by Concurrent Hyperthyroidism and Hyperaldosternoism: A Case Report.
    Am J Case Rep 2017 Jan 4;18:12-16. Epub 2017 Jan 4.
    Department of Medicine, Fu-Jen Catholic University School of Medicine, Taipei, Taiwan.
    BACKGROUND Thyrotoxic periodic paralysis (TPP) is commonly observed in patients with acute paralysis and hyperthyroidism. However, there is a possibility of secondary causes of hypokalemia in such a setting. CASE REPORT Herein, we present the case of a 38-year-old woman with untreated hypertension and hyperthyroidism. Read More

    Alkalosis in Critically Ill Patients with Severe Sepsis and Septic Shock.
    PLoS One 2017 3;12(1):e0168563. Epub 2017 Jan 3.
    Institute for Clinical Sciences Malmö, Lund University, Lund, Sweden.
    Introduction: Although metabolic alkalosis is a common occurrence in intensive care units (ICUs), no study has evaluated its prevalence or outcomes in patients with severe sepsis or septic shock.

    Methods: This is a retrospective cohort study of critically ill patients suffering from severe sepsis and septic shock admitted to the ICUs of Halmstad and Varberg County hospitals. From 910 patient records, 627 patients met the inclusion criteria. Read More

    A novel mutation of CLCNKB in a Korean patient of mixed phenotype of Bartter-Gitelman syndrome.
    Korean J Pediatr 2016 Nov 30;59(Suppl 1):S103-S106. Epub 2016 Nov 30.
    Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Korea.
    Bartter syndrome (BS) is an inherited renal tubular disorder characterized by low or normal blood pressure, hypokalemic metabolic alkalosis, and hyperreninemic hyperaldosteronism. Type III BS is caused by loss-of-function mutations in CLCNKB encoding basolateral ClC-Kb. The clinical phenotype of patients with CLCNKB mutations has been known to be highly variable, and cases that are difficult to categorize as type III BS or other hereditary tubulopathies, such as Gitelman syndrome, have been rarely reported. Read More

    Gitelman syndrome: consensus and guidance from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference.
    Kidney Int 2017 Jan;91(1):24-33
    Hôpital Européen Georges Pompidou, Assistance Publique Hôpitaux de Paris, Centre d'Investigation Clinique, Paris, France; Centre de Référence des Maladies Rénales Héréditaires de l'Enfant et de l'Adulte, Paris, France.
    Gitelman syndrome (GS) is a rare, salt-losing tubulopathy characterized by hypokalemic metabolic alkalosis with hypomagnesemia and hypocalciuria. The disease is recessively inherited, caused by inactivating mutations in the SLC12A3 gene that encodes the thiazide-sensitive sodium-chloride cotransporter (NCC). GS is usually detected during adolescence or adulthood, either fortuitously or in association with mild or nonspecific symptoms or both. Read More

    Surviving Without Oxygen: How Low Can the Human Brain Go?
    High Alt Med Biol 2017 Mar 21;18(1):73-79. Epub 2016 Dec 21.
    1 Neurovascular Research Laboratory, Faculty of Life Sciences and Education, University of South Wales , Glamorgan, United Kingdom .
    Bailey, Damian M., Christopher K. Willie, Ryan L. Read More

    [Clinical evaluation of acid-base status: Henderson-Hasselbalch, or Stewart-Fencl approach?]
    Cas Lek Cesk 2016 ;155(7):365-369
    Two approaches have been used in clinical evaluation the acid-base status: traditional (bicarbonate-centered) is based on the Henderson-Hasselbalch equation complemented by calculation of the anion gap, and more recent quantitative approach proposed by Stewart and Fencl. The latter method defines the three independent variables, which regulate pH. These include: the difference between the sum of charges carried by strong plasma cations and anions termed the strong ion difference - SID (decrease causes acidosis, and vice versa); the total concentration of the weak non-volatile acids [Atot] (inorganic phosphate and albumin, decrease causes alkalosis and vice versa), and pCO2. Read More

    Acquired Bartter syndrome following gentamicin therapy.
    Indian J Nephrol 2016 Nov-Dec;26(6):461-463
    Department of Microbiology, Institute of Medical Science, BHU, Varanasi, Uttar Pradesh, India.
    Aminoglycoside nephrotoxicity may manifest as nonoliguric renal failure or tubular dysfunction, such as Fanconi-like syndrome, Bartter-like syndrome (BS), or distal renal tubular acidosis. We report a case who developed severe renal tubular dysfunction on the the 7(th) day of gentamicin therapy, resulting in metabolic alkalosis, refractory hypokalemia, hypocalcemia, hypomagnesemia, and polyuria. The patient was diagnosed as a case of transient BS associated with gentamicin exposure. Read More

    Mixed acid-base disorder secondary to topiramate use in traumatic brain injury.
    Indian J Nephrol 2016 Nov-Dec;26(6):452-454
    Department of Neurosurgery, Yashoda Hospitals, Secunderabad, Telangana, India.
    We report a case of a man with traumatic brain injury. He was started on to prophylactic topiramate which led to a mixed acid-base disorder. He had severe metabolic acidosis secondary to renal tubular acidification defect and respiratory alkalosis secondary to hyperventilation. Read More

    A Quick Reference on Respiratory Alkalosis.
    Vet Clin North Am Small Anim Pract 2017 Mar 8;47(2):181-184. Epub 2016 Dec 8.
    Department of Surgical Sciences, University of Wisconsin - Madison, 2015 Linden Drive, Madison, WI 53706, USA. Electronic address:
    Respiratory alkalosis, or primary hypocapnia, occurs when alveolar ventilation exceeds that required to eliminate the carbon dioxide produced by tissues. Concurrent decreases in Paco2, increases in pH, and compensatory decreases in blood HCO3(-) levels are associated with respiratory alkalosis. Respiratory alkalosis can be acute or chronic, with metabolic compensation initially consisting of cellular uptake of HCO3(-) and buffering by intracellular phosphates and proteins. Read More

    Adrenocortical carcinoma, an unusual cause of secondary hypertension.
    BMJ Case Rep 2016 Dec 7;2016. Epub 2016 Dec 7.
    Department of Endocrinology, Hospital Regional Licenciado Adolfo Lopez Mateos, Ciudad de Mexico, Mexico.
    We present the case of a female patient aged 39 years who was admitted to our hospital due to hypertension, severe hypokalaemia and metabolic alkalosis; physical examination was remarkable for plethoric moon face, centripetal obesity and bilateral lower extremity oedema. She was admitted for intravenous potassium replacement and further assessment of hypertension and associated clinical findings. Laboratory testing showed increased levels of aldosterone, renin, cortisol, testosterone and androstenedione. Read More

    Vertebral Subluxation Repair in a Pet Goat.
    Vet Surg 2017 Jan 7;46(1):81-88. Epub 2016 Dec 7.
    Department of Anaesthesiology and Perioperative Intensive-Care Medicine, University of Veterinary Medicine, Vienna, Austria.
    Objectives: To describe the perioperative management, including surgery, anesthesia, metabolic derangements, and physiotherapy, in a goat referred for paraparesis secondary to a road traffic accident.

    Study Design: Case report.

    Animals: 2-year-old mixed breed dwarf 44 kg female pet goat. Read More

    A Quick Reference on Metabolic Alkalosis.
    Vet Clin North Am Small Anim Pract 2017 Mar 1;47(2):197-200. Epub 2016 Dec 1.
    Lois Bates Acheson Veterinary Teaching Hospital, Magruder Hall, Oregon State University, 700 Southwest 30th Street, Corvallis, OR 97331, USA.
    Metabolic alkalemia is characterized by an increase in bicarbonate concentration and base excess, an increase in pH, and a compensatory increase in carbon dioxide pressure. This article outlines indications for analysis, reference ranges, causes, and clinical signs of metabolic alkalosis. Algorithms for evaluation of patients with acid-base disorders and metabolic alkalosis are included. Read More

    Long-term follow-up of composite bladder augmentation incorporating stomach in a multi-institutional cohort of patients with cloacal exstrophy.
    J Pediatr Urol 2017 Feb 28;13(1):43.e1-43.e6. Epub 2016 Oct 28.
    Division of Pediatric Urology, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, IN, USA.
    Introduction: Composite bladder augmentation, incorporating gastric and bowel segments, has the theoretical advantage of metabolic neutrality while potentially avoiding the morbidities of gastrocystoplasty, such as hematuria-dysuria syndrome. The most common indication for this operation is a paucity of bowel, such as in cloacal exstrophy. Despite several early descriptive studies of this technique, there are no reports, to date, of long-term follow-up in this population. Read More

    Implementation of a Simplified Regional Citrate Anticoagulation Protocol for Post-Dilution Continuous Hemofiltration Using a Bicarbonate Buffered, Calcium Containing Replacement Solution.
    Blood Purif 2016 19;42(4):349-355. Epub 2016 Nov 19.
    Critical Care and Perioperative Medicine Research Group, William Harvey Research Institute, Queen Mary University of London, London, UK.
    Background/aims: Recent updates to the Nikkiso Aquarius continuous renal replacement therapy (CRRT) platform allowed us to develop a post-dilution protocol for regional citrate anticoagulation (RCA) using standard bicarbonate buffered, calcium containing replacement solution with acid citrate dextrose formula-A as a citrate source. Our objective was to demonstrate that the protocol was safe and effective.

    Methods: Prospective audit of consecutive patients receiving RCA for CRRT within intensive care unit, who were either contraindicated to heparin or had poor filter lifespan (<12 h for 2 consecutive filters) on heparin. Read More

    Secondary elements of blood pH variation can influence the effort effectiveness based on adaptive changes within a group of elite athletes.
    Clujul Med 2016 20;89(4):506-512. Epub 2016 Oct 20.
    Epidemiology Department, University of Medicine and Pharmacy Tîrgu Mureş, Romania.
    Aim: pH is the direct indicator of the body reaction following the activities performed. Establishing precise correlations between pH and blood biochemical parameters might support the balancing of values during periods of marked physical activity.

    Method: We conducted a case study in a group of elite rowers. Read More

    WNK signalling pathways in blood pressure regulation.
    Cell Mol Life Sci 2017 Apr 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

    The Warburg Effect and the Hallmarks of Cancer.
    Anticancer Agents Med Chem 2017 ;17(2):164-170
    Al-Ghad International College for Applied Medical Sciences, Al-Madinah Al-Munawarah, KSA, Center for Evolution and Cancer, University of California San Francisco, San Francisco, CA,United States.
    It is a longstanding debate whether cancer is one disease or a set of very diverse diseases. The goal of this paper is to suggest strongly that most of (if not all) the hallmarks of cancer could be the consequence of the Warburg's effect. As a result of the metabolic impairment of the oxidative phosphorylation, there is a decrease in ATP concentration. Read More

    Acquired Gitelman Syndrome in an Anti-SSA Antibody-positive Patient with a SLC12A3 Heterozygous Mutation.
    Intern Med 2016;55(21):3201-3204. Epub 2016 Nov 1.
    Department of Rheumatology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Japan.
    A 36-year-old woman developed hypokalemic metabolic alkalosis after anti SS-A antibody was found to be positive. Diuretic loading test results were compatible with Gitelman syndrome (GS). The patient had a heterozygous mutation in SLC12A3, which encodes for thiazide-sensitive NaCl cotransporter (NCCT). Read More

    Fluid and ion transfer across the blood-brain and blood-cerebrospinal fluid barriers; a comparative account of mechanisms and roles.
    Fluids Barriers CNS 2016 Oct 31;13(1):19. Epub 2016 Oct 31.
    Department of Pharmacology, University of Cambridge, Tennis Court Road, Cambridge, CB2 1PD, UK.
    The two major interfaces separating brain and blood have different primary roles. The choroid plexuses secrete cerebrospinal fluid into the ventricles, accounting for most net fluid entry to the brain. Aquaporin, AQP1, allows water transfer across the apical surface of the choroid epithelium; another protein, perhaps GLUT1, is important on the basolateral surface. Read More

    The influence of sodium bicarbonate on maximal force and rates of force development in the triceps surae and brachii during fatiguing exercise.
    Exp Physiol 2016 Nov;101(11):1383-1391
    Sport and Exercise Science, School of Science and Health, Western Sydney University, Sydney, New South Wales, Australia.
    New Findings: What is the central question of this study? Does metabolic alkalosis in humans, induced by sodium bicarbonate, affect rates of skeletal muscle fatigue differentially in muscle groups composed predominately of slow- and fast-twitch fibres? What is the main finding and its importance? Sodium bicarbonate exhibited no effect on the fatigue profile observed between triceps surae and brachii muscle groups during and after 2 min of tetanic stimulation. For the first time in exercising humans, we have profiled the effect of sodium bicarbonate on the voluntary and involuntary contractile characteristics of muscle groups representative of predominately slow- and fast-twitch fibres. The effect of metabolic alkalosis on fibre-specific maximal force production and rates of force development (RFD) has been investigated previously in animal models, with evidence suggesting an improved capacity to develop force rapidly in fast- compared with slow-twitch muscle. Read More

    Cryptic exon activation in SLC12A3 in Gitelman syndrome.
    J Hum Genet 2017 Feb 27;62(2):335-337. Epub 2016 Oct 27.
    Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan.
    Gitelman syndrome (GS) is an autosomal recessive renal tubulopathy characterized by hypokalemic metabolic alkalosis with hypocalciuria and hypomagnesemia. GS clinical symptoms range from mild weakness to muscular cramps, paralysis or even sudden death as a result of cardiac arrhythmia. GS is caused by loss-of-function mutations in the solute carrier family 12 member 3 (SLC12A3) gene, but molecular mechanisms underlying such a wide range of symptoms are poorly understood. Read More

    A new peritoneal dialysis fluid for Japanese patients: a randomized non-inferiority clinical trial of safety and efficacy.
    Clin Exp Nephrol 2016 Oct 25. Epub 2016 Oct 25.
    Therapeutic Area, Baxter Healthcare (Asia) Pte Ltd, Singapore, Singapore.
    Background: We report here two new peritoneal dialysis fluids (PDFs) for Japan [BLR 250, BLR 350 (Baxter Limited, Japan)]. The PDFs use two-chamber systems, and have bicarbonate and lactate buffer to a total of 35 mmol/L. In separate trials, the new PDFs were compared to two "standard" systems [PD-4, PD-2 (Baxter Limited, Japan)]. Read More

    The Effect of Supplemental Oxygen in Obesity Hypoventilation Syndrome.
    J Clin Sleep Med 2016 Oct 15;12(10):1379-1388. Epub 2016 Oct 15.
    Department of Medicine, Section of Pulmonary and Critical Care, University of Chicago, Chicago, IL.
    Study Objectives: Low flow supplemental oxygen is commonly prescribed to patients with obesity hypoventilation syndrome (OHS). However, there is a paucity of data regarding its efficacy and safety. The objective of this study was to assess the medium-term treatment efficacy of adding supplemental oxygen therapy to commonly prescribed treatment modalities in OHS. Read More

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