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    [Hypertrophic Pyloric Stenosis - Five-Year Retrospective Analysis].
    Acta Med Croatica 2016 04;70(2):103-6
    Although the etiology of the disease has not yet been fully clarified in the 21st century, clinical significance of the disease is huge because it is frequent in the neonatal period compared with other diseases. Today, owing to advanced diagnostic possibilities, hypertrophic pyloric stenosis is easily distinguished from other differential diagnoses that are manifested by vomiting as the main symptom. At Department of Pediatric Surgery, Zagreb Children’s Hospital, efforts have been invested to successfully manage this and a number of other conditions that affect newborns. Read More

    [Disorders of water and electrolyte metabolism and changes in acid-base balance in patients with ascitic liver cirrhosis].
    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

    Post-prandial physiology and intestinal morphology of the Pacific hagfish (Eptatretus stoutii).
    J Comp Physiol B 2017 Jul 18. Epub 2017 Jul 18.
    Department of Biological Sciences, University of Alberta, 116 St. and 85 Ave., Edmonton, AB, T6G 2R3, Canada.
    Hagfishes are unique to the vertebrate lineage in that they acquire dissolved nutrients across multiple epithelia including the intestine, gill, and skin. This feat has been attributed to their immersive feeding behavior that likely simultaneously provides benefits (nutrient rich) and potentially adverse (hypercapnia, hypoxia, high environmental ammonia) physiological effects. Examinations have been conducted of the ex vivo transport capabilities of specific nutrients as well as in vivo effects of the hypothesized feeding environments, yet the physiological effects of feeding itself have never been elucidated. Read More

    Increased urinary prostaglandin E2 metabolite: A potential therapeutic target of Gitelman syndrome.
    PLoS One 2017 10;12(7):e0180811. Epub 2017 Jul 10.
    Department of Nephrology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
    Background: Gitelman syndrome (GS), an inherited autosomal recessive salt-losing renal tubulopathy caused by mutations in SLC12A3 gene, has been associated with normal prostaglandin E2 (PGE2) levels since 1995 by a study involving 11 clinically diagnosed patients. However, it is difficult to explain why cyclooxygenase-2 (COX2) inhibitors, which pharmacologically reduce PGE2 synthesis, are helpful to patients with GS, and few studies performed in the last 20 years have measured PGE2 levels. The relationships between the clinical manifestations and PGE2 levels were never thoroughly analyzed. Read More

    Reversible Hypokalemia and Bartter-Like Syndrome during Prolonged Systemic Therapy with Colistimethate Sodium in an Adult Patient.
    Drug Saf Case Rep 2017 Dec;4(1):10
    Section of Viral Diseases, Department of Clinical Medicine, University Hospital 'Federico II' of Naples, Via Sergio Pansini, 5, 80131, Naples, Italy.
    We present the case of a 58-year-old woman who developed hypokalaemia and metabolic alkalosis 2 weeks after therapy with colistimethate sodium for the treatment of chronic lower limb ulcer infection by extensively drug-resistant (XDR) Pseudomonas aeruginosa. The metabolic changes observed resembled Bartter syndrome, a group of congenital disorders affecting the distal segments of the renal tubules. The metabolic abnormalities reversed spontaneously 6 days after drug discontinuation. Read More

    [Poor weight gain, recurrent metabolic alkalosis and hypokalemia in a neonate].
    Zhongguo Dang Dai Er Ke Za Zhi 2017 Jul;19(7):812-815
    Nanjing Maternity and Child Health Care Hospital Affiliated to Nanjing Medical University, Nanjing 210004, China.
    The study reports a female neonate with a gestational age of 29(+2) weeks and a birth weight of 1 210 g. Ten minutes after birth, the neonate was admitted to the hospital due to shortness of breath. Several days after birth, the neonate presented with hyperglycemia, polyuria, and poor weight gain, accompanied by azotemia, hypochloremic metabolic alkalosis, hypokalemia, and hyponatremia. Read More

    Acquired Gitelman syndrome in a primary Sjögren syndrome patient with a SLC12A3 heterozygous mutation: A case report and literature review.
    Nephrology (Carlton) 2017 Aug;22(8):652-655
    Department of Nephrology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China.
    Acquired Gitelman's syndrome (GS) associated with Sjögren syndrome (SS) is rare. A 50-year-old woman was admitted to our department because of nausea, acratia and sicca complex. Laboratory tests after admission showed renal failure, hypokalaemia, metabolic alkalosis, hypomagnesaemia and hypocalciuria, all of which met the diagnostic criteria for GS. Read More

    Acid-base disorders in liver disease.
    J Hepatol 2017 Jul 3. Epub 2017 Jul 3.
    Department of Respiratory and Critical Care Medicine, Otto Wagner Spital, Vienna, Austria. Electronic address:
    Next to the kidneys and lungs, the liver has been recognized as an important regulator of acid-base homeostasis. While respiratory alkalosis is the most common acid-base disorder in chronic liver disease, various complex metabolic acid-base disorders may occur with liver dysfunction. Although the standard variables of acid-base equilibrium, such as pH and overall base excess, often fail to unmask the underlying cause of acid-base disorders, the physical-chemical acid-base model allows a more in-depth pathophysiological understanding and clinical judgement of acid-base disorders in patients with liver diseases. Read More

    The Basic Metabolic Profile in Heart Failure-Marker and Modifier.
    Curr Heart Fail Rep 2017 Jul 3. Epub 2017 Jul 3.
    Division of Nephrology, Department of Internal Medicine, University of Texas Southwestern Medical Center, 5939 Harry Hines Blvd, MC 8516, Dallas, TX, 75390, USA.
    Purpose Of Review: The physiologic determinants of each of the components of the basic metabolic profile in patients with heart failure will be explored. Additionally, the review will discuss the prognostic value of alterations in the basic metabolic profile as well as their effects on management.

    Recent Findings: Abnormalities in the basic metabolic profile have significant correlation with clinical outcomes and can modify treatment in heart failure. Read More

    A Dairy Herd Case Investigation with Very Low Dietary Cation-Anion Difference in Prepartum Dairy Cows.
    Front Nutr 2017 13;4:26. Epub 2017 Jun 13.
    Department of Veterinary Medicine and Surgery, College of Veterinary Medicine, University of Missouri, Columbia, MO, United States.
    During the periparturient period, subclinical hypocalcemia (total plasma Ca concentration <2.0 mmol/l) is a potential problem for the dairy cow; consequently, its prevention is essential for success of fertility and productive performance. Dietary cation-anion difference (DCAD) has been defined as the difference in milliequivalents of cations (Na, K) and anions (Cl, S) per kilogram of dry matter (DM) and has a direct impact on blood acid-base metabolism. Read More

    Pharmacodynamics of intravenous frusemide bolus in critically ill patients.
    Crit Care Resusc 2017 Jun;19(2):142-149
    Department of Intensive Care, Austin Hospital, Melbourne, VIC, Australia.
    Objective: To assess the physiological, biochemical and haemodynamic response to a single intravenous (IV) dose of frusemide in critically patients.

    Design, Setting And Patients: A prospective observational study of 21 critically ill patients in a tertiary intensive care unit in Australia.

    Interventions: We collected information on urine output (UO), fluid balance, serum and urinary electrolyte levels, serum biochemical levels and haemodynamics. Read More

    Pendred syndrome.
    Best Pract Res Clin Endocrinol Metab 2017 Mar 10;31(2):213-224. Epub 2017 May 10.
    Northwestern University, Division of Endocrinology, Metabolism and Molecular Medicine, Feinberg School of Medicine, Tarry 15, 303 East Chicago Avenue, Chicago, IL 60611, USA. Electronic address:
    Pendred syndrome is an autosomal recessive disorder that is classically defined by the combination of sensorineural deafness/hearing impairment, goiter, and an abnormal organification of iodide with or without hypothyroidism. The hallmark of the syndrome is the impaired hearing, which is associated with inner ear malformations such as an enlarged vestibular aqueduct (EVA). The thyroid phenotype is variable and may be modified by the nutritional iodine intake. Read More

    A Case of Pulmonary Carcinoid Tumor with a Superimposed Aspergilloma Presenting As a Covert Ectopic Adrenocorticotropic Hormone Syndrome.
    Front Endocrinol (Lausanne) 2017 8;8:123. Epub 2017 Jun 8.
    Division of Endocrinology, Department of Internal Medicine, Korea University College of Medicine, Seoul, South Korea.
    Ectopic adrenocorticotropic hormone (ACTH) syndrome is a challenging diagnosis only responsible for approximately 10% of Cushing syndrome cases. It has been associated with a variety of benign and malignant tumors including a carcinoid tumor accompanied by aspergilloma in our case that was significantly difficult to be detected. We report a patient over 70 years old with uncontrolled hypertension and hypokalemia presenting with generalized edema. Read More

    Acetazolamide Use in Severe Chronic Obstructive Pulmonary Disease. Pros and Cons.
    Ann Am Thorac Soc 2017 Jul;14(7):1086-1093
    University of Washington and Department of Veterans Affairs, Seattle, Washington.
    Acetazolamide is a carbonic anhydrase (CA) inhibitor sometimes used as a respiratory stimulant for patients with chronic obstructive pulmonary disease (COPD) with the goal of improving oxygenation, reducing carbon dioxide retention, and aiding liberation from mechanical ventilation and/or attempting to correct a metabolic alkalosis. However, the net effect of CA inhibition is multifactorial and complex, because CA is inhibited in many tissues that may negatively affect the patient with lung disease. The full impact of acetazolamide and other CA inhibitors depends critically on dosing, age, and pulmonary, renal, hepatic, hematological, and respiratory muscle function and reserves. Read More

    Cystic fibrosis prevalence among a group of high-risk children in the main referral children hospital in Iran.
    J Educ Health Promot 2017 5;6:54. Epub 2017 Jun 5.
    Department of Pediatric Pulmonology, Child Growth and Development Research Center, Faculty of Medicine, Research Institute for Primordial Prevention of Noncommunicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran.
    Background: Knowledge about cystic fibrosis (CF) in Iran is very limited. The objective of this study was to determine the prevalence of CF among a group of high-risk children with suggestive clinical features in the main referral hospital in Iran.

    Materials And Methods: This study children consisted of 505 patients who had presented with one or more of the following symptoms: chronic or recurrent respiratory symptoms, gastrointestinal symptoms as rectal prolapse, steatorrhea, hepatobiliary disease as prolonged jaundice, failure to thrive, hyperglycemia and glycosuria, hypochloremic metabolic alkalosis, hypoprothrombinemia, anemia or edema, and positive family history of CF. Read More

    Water, electrolyte, acid-base, and trace elements alterations in cirrhotic patients.
    Int Urol Nephrol 2017 Jun 12. Epub 2017 Jun 12.
    Department of Medicine, Geffen School of Medicine, UCLA, Los Angeles, CA, USA.
    Chronic hepatic patients, and particularly those suffering from cirrhosis, are predisposed to different sort of water, electrolyte, acid-base, and trace elements disorders due to their altered liver function, and also to their exposition to infectious, inflammatory, oncologic, and pharmacologic variables whose combination undermines their homeostatic capability. Hyponatremia, hypokalemia, hyperkalemia, hypocalcemia, metabolic acidosis, respiratory, and metabolic alkalosis are the main internal milieu alterations in this group. Read More

    Metabolic Acidosis or Respiratory Alkalosis? Evaluation of a Low Plasma Bicarbonate Using the Urine Anion Gap.
    Am J Kidney Dis 2017 Jun 6. Epub 2017 Jun 6.
    Section of Nephrology, Department of Medicine, Yale University School of Medicine, New Haven, CT.
    Hypobicarbonatemia, or a reduced bicarbonate concentration in plasma, is a finding seen in 3 acid-base disorders: metabolic acidosis, chronic respiratory alkalosis and mixed metabolic acidosis and chronic respiratory alkalosis. Hypobicarbonatemia due to chronic respiratory alkalosis is often misdiagnosed as a metabolic acidosis and mistreated with the administration of alkali therapy. Proper diagnosis of the cause of hypobicarbonatemia requires integration of the laboratory values, arterial blood gas, and clinical history. Read More

    Sedative and cardiorespiratory effects of detomidine constant rate infusion in sheep.
    Lab Anim 2017 Jan 1:23677217714013. Epub 2017 Jan 1.
    Department of Veterinary Medicine, Federal University of Goiás, Brazil.
    The use of sheep in experiments is widespread and is increasing worldwide, and so is the need to develop species-specific anaesthetic techniques to ensure animal safety. Previous studies have mentioned several protocols involving the administration of alpha-2 adrenergic agonists in sheep; however, assessment of the efficacy and safety of these infusion techniques is still relatively new. Thus, the aim of the present study is to assess the effectiveness of detomidine constant rate infusion (CRI) in sheep by measuring the cardiovascular and respiratory parameters, blood gas variables and sedation scores. Read More

    Does metabolic alkalosis influence cerebral oxygenation in infantile hypertrophic pyloric stenosis?
    J Surg Res 2017 May 30;212:229-237. Epub 2017 Jan 30.
    Department of Pediatric Surgery, St. Mary's Hospital, St. Elisabeth Group, Ruhr-University of Bochum, Herne, Germany.
    Background: This pilot study focuses on regional tissue oxygenation (rSO2) in patients with infantile hypertrophic pyloric stenosis in a perioperative setting. To investigate the influence of enhanced metabolic alkalosis (MA) on cerebral (c-rSO2) and renal (r-rSO2) tissue oxygenation, two-site near-infrared spectroscopy (NIRS) technology was applied.

    Materials And Methods: Perioperative c-rSO2, r-rSO2, capillary blood gases, and electrolytes from 12 infants were retrospectively compared before and after correction of MA at admission (T1), before surgery (T2), and after surgery (T3). Read More

    Ingestion of Sodium Bicarbonate (NaHCO3) Following a Fatiguing Bout of Exercise Accelerates Post-Exercise Acid-Base Balance Recovery and Improves Subsequent High-Intensity Cycling Time to Exhaustion.
    Int J Sport Nutr Exerc Metab 2017 May 22:1-25. Epub 2017 May 22.
    2 Department of Life Sciences, University of Derby, Derby, United Kingdom.
    This study evaluated the ingestion of sodium bicarbonate (NaHCO3) on post-exercise acid-base balance recovery kinetics and subsequent high-intensity cycling time to exhaustion. In a counterbalanced, crossover design, nine healthy and active males (age: 23±2 years, height: 179±5 cm, body mass: 74±9 kg, peak mean minute power (WPEAK) 256±45 W, peak oxygen uptake (V̇O2PEAK) 46±8 ml.kg(-1). Read More

    Effect of voluntary hypocapnic hyperventilation or moderate hypoxia on metabolic and heart rate responses during high-intensity intermittent exercise.
    Eur J Appl Physiol 2017 Aug 19;117(8):1573-1583. Epub 2017 May 19.
    Faculty of Health and Sport Sciences, University of Tsukuba, Tsukuba City, Ibaraki, 305-8574, Japan.
    Purpose: To investigate the effect of voluntary hypocapnic hyperventilation or moderate hypoxia on metabolic and heart rate responses during high-intensity intermittent exercise.

    Methods: Ten males performed three 30-s bouts of high-intensity cycling [Ex1 and Ex2: constant-workload at 80% of the power output in the Wingate anaerobic test (WAnT), Ex3: WAnT] interspaced with 4-min recovery periods under normoxic (Control), hypocapnic or hypoxic (2500 m) conditions. Hypocapnia was developed through voluntary hyperventilation for 20 min prior to Ex1 and during each recovery period. Read More

    [Procedural analysis of acid-base balance disorder: case serials in 4 patents].
    Zhonghua Wei Zhong Bing Ji Jiu Yi Xue 2017 May;29(5):436-441
    Department of Nephrology, Shuyang People's Hospital, Suqian 223600, Jiangsu, China (Ma CY); Teaching Section of Mathematics, China Medical University, Shenyang 110000, Liaoning, China (Wang GJ). Corresponding author: Wang Guijie, Email:
    Objective: To establish the standardization process of acid-base balance analysis, analyze cases of acid-base balance disorder with the aid of acid-base balance coordinate graph.

    Methods: The acid-base balance theory were reviewed systematically on recent research progress, and the important concepts, definitions, formulas, parameters, regularity and inference in the analysis of acid-base balance were studied. The analysis of acid-base balance disordered processes and steps were figured. Read More

    A Case of Paraneoplastic Cushing Syndrome Presenting as Hyperglycemic Hyperosmolar Nonketotic Syndrome.
    Case Rep Oncol 2017 Jan-Apr;10(1):321-324. Epub 2017 Apr 6.
    aWalter Reed National Military Medical Center, Bethesda, MD, USA.
    Carcinoid tumors are neuroendocrine tumors that mainly arise in the gastrointestinal tract, lungs, and bronchi. Bronchopulmonary carcinoids have been associated with Cushing syndrome, which results from ectopic adrenocorticotrophic hormone (ACTH) secretion. We report the case of a 65-year-old man, a colonel in the US Air Force, with metastatic bronchopulmonary carcinoid tumors treated on a clinical trial who was hospitalized for complaints of increasing thirst, polydipsia, polyuria, weakness, and visual changes. Read More

    Electrolyte and Acid-Base Disturbances in End-Stage Liver Disease: A Physiopathological Approach.
    Dig Dis Sci 2017 Aug 13;62(8):1855-1871. Epub 2017 May 13.
    Department of Internal Medicine, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Tlalpan, 14080, Mexico City, Mexico.
    Electrolyte and acid-base disturbances are frequent in patients with end-stage liver disease; the underlying physiopathological mechanisms are often complex and represent a diagnostic and therapeutic challenge to the physician. Usually, these disorders do not develop in compensated cirrhotic patients, but with the onset of the classic complications of cirrhosis such as ascites, renal failure, spontaneous bacterial peritonitis and variceal bleeding, multiple electrolyte, and acid-base disturbances emerge. Hyponatremia parallels ascites formation and is a well-known trigger of hepatic encephalopathy; its management in this particular population poses a risky challenge due to the high susceptibility of cirrhotic patients to osmotic demyelination. Read More

    Severe muscle fasciculations and tremor in a cat with hypochloraemic metabolic alkalosis secondary to duodenal obstruction.
    JFMS Open Rep 2017 Jan-Jun;3(1):2055116916686427. Epub 2017 Jan 1.
    The Cat Clinic, Mt Gravatt, Australia.
    Case Summary: An 18-month-old, female spayed, Australian Mist cat presented with a 24 h history of muscle tremors and inappetence progressing to collapse with generalised muscle fasciculations. The cat was diagnosed with a hypochloraemic metabolic alkalosis due to a duodenal foreign body found to be a trichobezoar at coeliotomy. The cat made a complete recovery after enterotomy to remove the trichobezoar, with cessation of neuromuscular clinical signs and normalisation of its electrolyte and acid-base imbalances. Read More

    [Application of improved regional citrate anticoagulation in continuous hemofiltration in children].
    Zhonghua Er Ke Za Zhi 2017 May;55(5):334-337
    Intensive Care Unit, the Children's Hospital, Chongqing Medical University; Ministry of Education Key Laboratory of Child Development and Disorders; Key Laboratory of Pediatrics in Chongqing; Chongqing International Science and Technology Cooperation Center for Child Development and Disorders, Chongqing 400014, China.
    Objective: To investigate the application of regional citrate anticoagulation with calcium hemofiltration basic solution in continuous hemofiltration in children. Method: The clinical data of 18 patients with citrate anticoagulation in continuous hemofiltration in children, excluding the hepatic failure and septic shock cases, were analyzed retrospectively, from September 2015 to August 2016 in Intensive Care Unit of the Children's Hospital of Chongqing Medical University.The commercial calcium hemofiltration basic solution was used as displacement liquid . Read More

    Hypercapnea and Acidemia despite Hyperventilation following Endotracheal Intubation in a Case of Unknown Severe Salicylate Poisoning.
    Case Rep Crit Care 2017 29;2017:6835471. Epub 2017 Mar 29.
    Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada.
    Salicylates are common substances for deliberate self-harm. Acute salicylate toxicity is classically associated with an initial respiratory alkalosis, followed by an anion gap metabolic acidosis. The respiratory alkalosis is achieved through hyperventilation, driven by direct stimulation on the respiratory centers in the medulla and considered as a compensatory mechanism to avoid acidemia. Read More

    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 Jun 7;44:30-37. 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 Mar 3;11(3):136-139. 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 May 28;52(5):734-738. 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

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