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BMJ Case Rep 2021 May 12;14(5). Epub 2021 May 12.

Emergency Admission Unit, Colchester General Hospital, Colchester, UK.

A 32-year-old woman presented with an incidental finding of hypokalaemia on routine bloods at 9 weeks of a second pregnancy, on a background of lifelong salt craving. Her previous pregnancy was uncomplicated. She had no previous significant medical or family history. Read More

Retin Cases Brief Rep 2021 Apr 30. Epub 2021 Apr 30.

Retina Service, Department of Ophthalmology, Northwest Permanente, Portland, OR West Coast Retina Medical Group/California Pacific Medical Center, San Francisco, CA.

Purpose: To report a case of Purtscher-like retinopathy in a patient with milk-alkali syndrome and pancreatitis.

Methods: Case report and review of the literature.

Results: A 46-year-old woman presented with decreased vision following discharge from the intensive care unit, where she had been admitted for milk-alkali syndrome secondary to long-term calcium supplementation and over-the-counter antacid use, and pancreatitis. Read More

BMC Endocr Disord 2021 May 10;21(1):98. Epub 2021 May 10.

Department of Endocrinology and Metabolism, The First Affiliated Hospital of Xi'an Jiaotong University, No.277 West Yanta Road, 710061, Xi'an, People's Republic of China.

Background: Manifestations of hypokalaemia in ectopic adrenocorticotropic hormonesyndrome(EAS) vary from mild muscle weakness to life-threatening arrhythmia. Herein, we present a rare case of EAS with concomitant rhabdomyolysis(RM) as a result of intractable hypokalaemia.

Case Presentation: A 64-year-old man was admitted for limb weakness and facial hyperpigmentation for 2 weeks. Read More

J Physiol 2021 May 7. Epub 2021 May 7.

Department of Biomedicine, Physiology, Health, Aarhus University, Aarhus, Denmark.

This review summarizes the newly discovered molecular mechanism of secretin-stimulated urine HCO excretion and the role of CFTR in renal HCO excretion. The secretin receptor is functionally expressed in the basolateral membrane of the HCO -secreting beta-intercalated cells of the collecting duct. Here it activates a fast and efficient secretion of HCO into the urine serving to normalize metabolic alkalosis. Read More

Cureus 2021 Apr 2;13(4):e14253. Epub 2021 Apr 2.

Internal Medicine/Nephrology, Metropolitan Hospital Center, New York Medical College, New York, USA.

Gitelman syndrome (GS) is an autosomal recessive disease characterized by hypokalemia, hypomagnesemia, metabolic alkalosis, and hypocalciuria. It is caused by mutations in gene SLC12A3 (located in chromosome 16q) encoding NaCl cotransporter. GS is usually asymptomatic for several years and is diagnosed in late childhood or adulthood. Read More

BMC Nephrol 2021 Apr 30;22(1):159. Epub 2021 Apr 30.

General medicine, National Hospital of Sri Lanka, Colombo, Sri Lanka.

Background: Acquired Gitelman syndrome is a very rare disorder reported in association with autoimmune disorders, mostly Sjögren syndrome. It is characterized by the presence of hypokalaemic metabolic alkalosis, hypocalciuria, hypomagnesaemia and hyper-reninaemia, in the absence of typical genetic mutations associated with inherited Gitelman syndrome.

Case Presentation: A 20 year old woman who was previously diagnosed with primary Sjögren syndrome and autoimmune thyroiditis presented with two week history of lower limb weakness and salt craving. Read More

J Vet Emerg Crit Care (San Antonio) 2021 Apr 30. Epub 2021 Apr 30.

California Animal Health and Food Safety Lab, School of Veterinary Medicine, University of California, Davis, Davis, California, USA.

Objective: To describe the clinical course and novel biochemical findings in 3 dogs with amitraz toxicosis.

Case Series Summary: Three Labrador Retrievers developed acute onset obtundation to stupor after being in a rice field. On admittance to the hospital, they all displayed bradycardia, hyperglycemia, hyperlactatemia, respiratory acidosis, and metabolic alkalosis. Read More

Am J Nephrol 2021 Apr 23:1-14. Epub 2021 Apr 23.

Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology, Hypertension and Kidney Transplantation, Department of Medicine, School of Medicine, University of California Irvine, Orange, California, USA.

Background: Serum bicarbonate or total carbon dioxide (CO2) concentrations decline as chronic kidney disease (CKD) progresses and rise after dialysis initiation. While metabolic acidosis accelerates the progression of CKD and is associated with higher mortality among patients with end stage renal disease (ESRD), there are scarce data on the association of CO2 concentrations before ESRD transition with post-ESRD mortality.

Methods: A historical cohort from the Transition of Care in CKD (TC-CKD) study includes 85,505 veterans who transitioned to ESRD from October 1, 2007, through March 31, 2014. Read More

Ann Intensive Care 2021 Apr 23;11(1):62. Epub 2021 Apr 23.

Division of Intensive Care and Emergency Medicine, Department of Internal Medicine, Medical University Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria.

Background: Metabolic alkalosis is a frequently occurring problem during continuous veno-venous hemofiltration (CVVH) with regional citrate anticoagulation (RCA). This study aimed to evaluate the effectiveness of switching from high to low bicarbonate (HCO) replacement fluid in alkalotic critically ill patients with acute kidney injury treated by CVVH and RCA.

Methods: A retrospective-comparative study design was applied. Read More

AACE Clin Case Rep 2021 Jan-Feb;7(1):65-68. Epub 2020 Dec 28.

College of Medicine, California Northstate University, Elk Grove, California.

Objective: Liddle syndrome (LS) is a rare autosomal dominant condition secondary to a gain-of-function mutation affecting the epithelial sodium channels (ENaCs) in the distal nephron. It presents with early-onset hypertension, hypokalemia, and metabolic alkalosis in the face of hyporeninemia and hypoaldosteronism. We report a novel mutation affecting the ENaCs in a normotensive adolescent with LS. Read More

Sci Prog 2021 Apr-Jun;104(2):368504211004028

Shanghai First Maternity and Infant Hospital, Tongji University, School of Medicine, Pudong, Shanghai, China.

Paraneoplastic syndromes are rarely seen in gynecological tumors especially in endometrial cancer. Early identification of paraneoplastic syndromes plays a significant role in the treatment and prognosis of cancer. Here, we reported a rare case with endometrial cancer with a 2. Read More

Int J Sports Physiol Perform 2021 Apr 8:1-7. Epub 2021 Apr 8.

Purpose: To examine whether an ecologically valid, intermittent, sprint-based warm-up strategy impacted the ergogenic capacity of individualized sodium bicarbonate (NaHCO3) ingestion on 4-km cycling time-trial (TT) performance.

Methods: A total of 8 male cyclists attended 6 laboratory visits for familiarization, determination of time to peak blood bicarbonate, and 4 × 4-km cycling TTs. Experimental beverages were administered doubleblind. Read More

BMJ Case Rep 2021 Apr 7;14(4). Epub 2021 Apr 7.

Department of Pediatrics, Dokkyo Medical University, Shimotsuga-gun, Tochigi, Japan.

Bartter syndrome (BS) is a well-recognised inherited tubular dysfunction that causes polyuria, metabolic alkalosis and hypokalaemia. Among BS cases, antenatal/neonatal BS (ABS) usually shows distinct polyhydramnios prenatally and presents features of BS in the early neonatal period. We encountered a premature infant with type 3 ABS presenting with mild polyuria and discuss the pathogenesis of mild polyuria in type 3 ABS. Read More

BMC Anesthesiol 2021 Mar 30;21(1):96. Epub 2021 Mar 30.

Department of medical ICU, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, 1 Shuai Fu Yuan, Dongcheng District, Beijing, 100730, China.

Background: The cumbersome program and the shortage of commercial solution hindered the regular application of regional citrate anticoagulation (RCA). It is urgent to simplify the protocol using only commercial preparations. The aim of this study was to explore the feasibility and efficacy of the modified protocol for continuous veno-venous hemofiltration (CVVH) in unselected critically ill patients. Read More

QJM 2021 Mar 27. Epub 2021 Mar 27.

Department of Nephrology, West China Hospital, Sichuan University, Guoxue Alley No.37, Chengdu, Sichuan Province, 610041, China.

Background: Gitelman syndrome (GS) is an autosomal recessive disease primarily caused by mutations in the SLC12A3 gene, characterized by the hypokalaemic metabolic alkalosis with hypomagnesemia. Here, we investigated the mutation of SLC12A3 gene in a Chinese pedigree with GS and analyzed the clinical manifestations.

Case Presentation: We present the case of a 17-year-old boy diagnosed of GS due to persistent hypokalaemia. Read More

Clin Case Rep 2021 Mar 7;9(3):1283-1287. Epub 2021 Jan 7.

Division of Nephrology Department of Medicine Tri-Service General Hospital National Defense Medical Center Taipei Taiwan.

Abnormal acid-base status (metabolic acidosis or alkalosis), inappropriate urine electrolytes excretion (high or low Na and Cl), and higher required dose of potassium supplement (4-5 mmol/kg) are suggestive of non-TPP causes of hypokalemia. Read More

BMJ Case Rep 2021 Mar 23;14(3). Epub 2021 Mar 23.

Department of Paediatric Medicine, KK Women's and Children's Hospital, Singapore.

A 7-month-old female infant presented with failure to thrive. She was breastfed till 3 months of age, thereafter switched to soy-based milk formula. There was no history to suggest excess energy losses, recurrent infections or chronic diarrhoea. Read More

Cureus 2021 Feb 11;13(2):e13291. Epub 2021 Feb 11.

Internal Medicine, Hackensack Meridian Health Palisades Medical Center, North Bergen, USA.

Milk-alkali syndrome or calcium-alkali syndrome (CAS) is the triad of hypercalcemia, metabolic alkalosis and renal impairment. It is often related to ingestion of high amounts of calcium carbonate, which was used historically for the treatment of peptic ulcer disease. The incidence of the syndrome decreased dramatically after the introduction of newer peptic ulcer medications such as proton pump inhibitors and histamine blocking agents. Read More

Zhonghua Wei Zhong Bing Ji Jiu Yi Xue 2021 Feb;33(2):216-222

Department of Nephrology, Suzhou Ninth People's Hospital, Suzhou 215200, Jiangsu, China. Corresponding author: Ling Kai, Email:

Objective: To develop a diagnostic analysis software for determining the type of acid-base balance disorder.

Methods: Mathematical models were built based on Henderson-Hasselbalch equations and compensation formulas, to determine the important parameters of acid-base balance disorder, and to develope acid-base balance disorder analysis process. The software was compiled using the Visual Basic. Read More

Clin J Am Soc Nephrol 2021 Mar 16. Epub 2021 Mar 16.

Renal Division, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts.

Am J Emerg Med 2021 Mar 2. Epub 2021 Mar 2.

Lehigh Valley Health Network, Department of Emergency, Hospital Medicine/USF Morsani College of Medicine, Cedar Crest Boulevard & I-78, Allentown, PA 18103, USA.

Central neurogenic hyperventilation (CNH) is a neurogenic disorder rarely described within Emergency Medicine literature. CNH is a primary cause of hyperventilation, most commonly due to primary central nervous system neoplasms. Patient presentation varies based on the underlying cause, and may present with a sole chief complaint of dyspnea. Read More

J Appl Physiol (1985) 2021 Mar 11. Epub 2021 Mar 11.

Department of Biology, Faculty of Science and Technology, Mount Royal University, Canada.

Rapid ascent to high altitude imposes an acute hypoxic and acid-base challenge, with ventilatory and renal acclimatization countering these perturbations. Specifically, ventilatory acclimatization improves oxygenation, but with concomitant hypocapnia and respiratory alkalosis. A compensatory, renally-mediated relative metabolic acidosis follows via bicarbonate elimination, normalizing arterial pH(a). Read More

PLoS One 2021 10;16(3):e0248264. Epub 2021 Mar 10.

External Consultant, Ingeniero de Caminos, Canales y Puertos e Ingeniero Técnico de Obras Públicas.

Background: Point-of-care arterial blood gas (ABG) is a blood measurement test and a useful diagnostic tool that assists with treatment and therefore improves clinical outcomes. However, numerically reported test results make rapid interpretation difficult or open to interpretation. The arterial blood gas algorithm (ABG-a) is a new digital diagnostics solution that can provide clinicians with real-time interpretation of preliminary data on safety features, oxygenation, acid-base disturbances and renal profile. Read More

J Intensive Care Med 2021 Mar 10:885066621992751. Epub 2021 Mar 10.

Division of Critical Care Medicine, Summa Health, Akron, OH, USA.

Objective: Continuous kidney replacement therapy (CKRT) is the primary therapeutic modality utilized in hemodynamically unstable patients with severe acute kidney injury. As the circuit is extracorporeal, it poses an increased risk of blood clotting and circuit loss; frequent circuit losses affect the provider's ability to provide optimal treatment. The objective of this meta-analysis is to evaluate the safety and efficacy of the extracorporeal anticoagulants in the pediatric CKRT population. Read More

Front Nutr 2021 19;8:634465. Epub 2021 Feb 19.

Sports Nutrition and Performance Research Group, Department of Sport and Physical Activity, Edge Hill University, Ormskirk, United Kingdom.

Sodium bicarbonate (NaHCO) is a well-established nutritional ergogenic aid that is typically ingested as a beverage or consumed in gelatine capsules. While capsules may delay the release of NaHCO and reduce gastrointestinal (GI) side effects compared with a beverage, it is currently unclear whether the capsule size may influence acid-base responses and GI symptoms following supplementation. This study aims to determine the effects of NaHCO supplementation, administered in capsules of different sizes, on acid-base responses, GI symptoms, and palatability. Read More

Cureus 2021 Feb 1;13(2):e13056. Epub 2021 Feb 1.

Pulmonology and Critical Care Medicine, Westchester General Hospital, Miami, USA.

Among the pertinent differentials for hypercalcemia, milk-alkali syndrome remains a diagnosis of exclusion following a thorough workup of other severe causes. However, several key signs may increase a clinician's index of suspicion for possible milk-alkali syndrome, including a prolonged history of antacid ingestion. Milk-alkali syndrome commonly presents with a classic triad: hypercalcemia, metabolic alkalosis, and acute kidney injury. Read More

J Strength Cond Res 2021 Mar 2. Epub 2021 Mar 2.

LBEPS, Univ Evry, IRBA, University of Paris-Saclay, Evry, France; French Institute of Sport (INSEP), Laboratory Sport, Expertise and Performance, Paris, France; Laboratory Movement, Interactions, Performance, University of Nantes, France; and French Athletics Federation, Paris, France.

Abstract: Thomas, C, Delfour-Peyrethon, R, Dorel, S, and Hanon, C. Positive effects of pre-exercise metabolic alkalosis on perceived exertion and post-exercise squat jump performance in world-class cyclists. J Strength Cond Res XX(X): 000-000, 2020-This study aimed to determine the effects of pre-exercise alkalosis in world-class cyclists on their general (rate of perceived exertion [RPE]) and local (category-ratio scale [CR10]) perceived rates of exertion and acid-base status during 2 types of training sessions. Read More

Cureus 2021 Jan 21;13(1):e12841. Epub 2021 Jan 21.

Nephrology, Nephrology Specialists, P.C, Munster, USA.

Metabolic alkalosis is an increase in blood pH to >7.45 due to a primary increase in serum bicarbonate (HCO). Metabolic alkalosis results from alkali accumulation or acid loss, and it is associated with a secondary increase in carbon dioxide arterial pressure (PCO). Read More

Pediatr Nephrol 2021 Feb 23. Epub 2021 Feb 23.

Department of Pediatric Nephrology, Ankara City Hospital, Ankara Yıldırım Beyazıt University, Ankara, Turkey.

Pediatr Nephrol 2021 Feb 23. Epub 2021 Feb 23.

Department of Pediatric Nephrology, Ankara City Hospital, Ankara Yıldırım Beyazıt University, Ankara, Turkey.