2,524 results match your criteria Respiratory Alkalosis


Inappropriate Ventilatory Homeostatic Responses in Hospitalized COVID-19 Patients.

Front Neurol 2022 15;13:909915. Epub 2022 Jun 15.

Division of Medical Specialties, University College London Hospitals NHS Foundation Trust, London, United Kingdom.

Background: The clinical presentation of COVID-19 suggests altered breathing control - tachypnoea, relative lack of dyspnoea, and often a discrepancy between severity of clinical and radiological findings. Few studies characterize and analyse the contribution of breathing drivers and their ventilatory and perceptual responses.

Aim: To establish the prevalence of inappropriate ventilatory and perceptual response in COVID-19, by characterizing the relationships between respiratory rate (RR), dyspnoea and arterial blood gas (ABG) in a cohort of COVID-19 patients at presentation to hospital, and their post-Covid respiratory sequelae at follow-up. Read More

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Cardiac Pacing a Rare Cause of Ventilator Auto Triggering.

Indian J Crit Care Med 2022 May;26(5):643-645

Department of Critical Care Medicine, Narayana Hrudayalaya, Bengaluru, Karnataka, India.

Ventilator auto triggering is an avoidable complication in ventilators, if left unnoticed can lead to deleterious effects. There are various causes for ventilator auto triggering. Though rare, there are some cardiac causes for inadvertent ventilator triggering. Read More

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AMPK facilitates the hypoxic ventilatory response through non-adrenergic mechanisms at the brainstem.

Pflugers Arch 2022 Jun 10. Epub 2022 Jun 10.

Centre for Discovery Brain Sciences, College of Medicine and Veterinary Medicine, Hugh Robson Building, University of Edinburgh, Edinburgh, EH8 9XD, UK.

We recently demonstrated that the hypoxic ventilatory response (HVR) is facilitated by the AMP-activated protein kinase (AMPK) in catecholaminergic neural networks that likely lie downstream of the carotid bodies within the caudal brainstem. Here, we further subcategorise the neurons involved, by cross-comparison of mice in which the genes encoding the AMPK-α1 (Prkaa1) and AMPK-α2 (Prkaa2) catalytic subunits were deleted in catecholaminergic (TH-Cre) or adrenergic (PNMT-Cre) neurons. As expected, the HVR was markedly attenuated in mice with AMPK-α1/α2 deletion in catecholaminergic neurons, but surprisingly was modestly augmented in mice with AMPK-α1/α2 deletion in adrenergic neurons when compared against a variety of controls (TH-Cre, PNMT-Cre, AMPK-α1/α2 floxed). Read More

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Fetomaternal Acid-Base Balance and Electrolytes during Pregnancy.

Authors:
Armin Ahmed

Indian J Crit Care Med 2021 Dec;25(Suppl 3):S193-S199

Department of Critical Care Medicine, King George Medical University, Lucknow, Uttar Pradesh, India.

A pregnant mother undergoes significant changes in acid-base status as well as sodium and calcium metabolism to combat her physiological needs of pregnancy. Pregnant patients experience mild respiratory alkalosis due to the stimulation of the respiratory center by progesterone. This is associated with a corresponding increase in bicarbonate excretion by kidneys; as a result, the pH remains slightly high (7. Read More

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December 2021

Detecting Concealing Heart Failure in a Young Alcohol-Related Liver Failure Patient Using the Most Basic Pathophysiological Principle.

Cureus 2022 Mar 28;14(3):e23570. Epub 2022 Mar 28.

Department of Medicine, Roger Williams Medical Center, Providence, USA.

Long-term alcohol abuse can cause alcohol-related liver injury (acute alcoholic hepatitis, acute liver failure, hepatic steatosis, fibrosis, or cirrhosis), as well as cardiac injury. Alcoholic cardiomyopathy is a severe consequence of chronic alcohol abuse. Incidence of alcoholic cardiomyopathy ranges from 1-2% of all heavy alcohol users. Read More

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Acid-Base Disorders in COVID-19 Patients with Acute Respiratory Distress Syndrome.

J Clin Med 2022 Apr 8;11(8). Epub 2022 Apr 8.

Department of Anesthesia and Intensive Care, ASST Santi Paolo e Carlo, San Paolo University Hospital, Via Di Rudini 9, 20122 Milan, Italy.

Our aim was to investigate the distribution of acid-base disorders in patients with COVID-19 ARDS using both the Henderson-Hasselbalch and Stewart's approach and to explore if hypoxemia can influence acid-base disorders. COVID-19 ARDS patients, within the first 48 h of the need for a non-invasive respiratory support, were retrospectively enrolled. Respiratory support was provided by helmet continuous positive airway pressure (CPAP) or by non-invasive ventilation. Read More

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Caffeine Combined With Sodium Bicarbonate Improves Pacing and Overall Performance During a High-Intensity Time Trial.

Res Q Exerc Sport 2022 Apr 18:1-10. Epub 2022 Apr 18.

CESMAC University Center.

: No study has demonstrated the effects of sodium bicarbonate plus caffeine (NaHCO + CAF) on power output (PO) distribution (e.g., pacing), physiological parameters and energy system contribution during a 4-km cycling time trial (TT). Read More

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Central Neurogenic Hyperventilation and Hyperlactatemia After Resection of a Fourth Ventricle Tumor: A Case Report.

A A Pract 2022 Apr 12;16(4):e01585. Epub 2022 Apr 12.

From the Department of Anesthesia and Pain Management, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada.

We report a rare case of central neurogenic hyperventilation (CNH) and hyperlactatemia after resection of a fourth ventricle tumor. Our management consisted of close monitoring and exclusion of alternate causes of hyperventilation and hyperlactatemia. We hypothesize that a localized increase in tissue lactate, related to tumor metabolism, may have triggered CNH in our patient through stimulation of the brainstem respiratory centers. Read More

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Analysis of acid-base disorders in an ICU cohort using a computer script.

Intensive Care Med Exp 2022 Apr 4;10(1):11. Epub 2022 Apr 4.

Skåne University Hospital Perioperative and Intensive Care, Entregatan 7, 22242, Lund, Sweden.

Background/aims: Acid-base status is important for understanding pathophysiology, making a diagnosis, planning effective treatment and monitoring progress of critically ill patients. Manual calculations are cumbersome, easily result in wrong conclusions. We wanted to develop an automated assessment of acid-base status. Read More

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Dyspnea in Post-COVID Syndrome following Mild Acute COVID-19 Infections: Potential Causes and Consequences for a Therapeutic Approach.

Medicina (Kaunas) 2022 Mar 12;58(3). Epub 2022 Mar 12.

Institute of Medical Immunology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 13353 Berlin, Germany.

Dyspnea, shortness of breath, and chest pain are frequent symptoms of post-COVID syndrome (PCS). These symptoms are unrelated to organ damage in most patients after mild acute COVID infection. Hyperventilation has been identified as a cause of exercise-induced dyspnea in PCS. Read More

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Determinants of hypokalemia following hypertonic sodium bicarbonate infusion.

Pflugers Arch 2022 06 11;474(6):603-612. Epub 2022 Mar 11.

Department of Medicine, Tufts University School of Medicine, Boston, MA, USA.

The hypokalemic response to alkali infusion has been attributed to the resulting extracellular fluid (ECF) expansion, urinary potassium excretion, and internal potassium shifts, but the dominant mechanism remains uncertain. Hypertonic NaHCO infusion (1 N, 5 mmol/kg) to unanesthetized dogs with normal acid-base status or one of the four chronic acid-base disorders decreased plasma potassium concentration ([K]) at 30 min in all study groups (Δ[K], - 0.16 to - 0. Read More

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Complex connections: A young man presenting with shortness of breath, hypoxemia, right lumbar pain and left limb swelling.

Echocardiography 2022 04 6;39(4):631-636. Epub 2022 Mar 6.

Department of Clinical, Internal, Anesthesiologic and Cardiovascular Sciences "Sapienza", University of Rome, Policlinico Umberto I, Rome, Italy.

A 43-year-old Caucasian man was admitted to hospital due to shortness of breath, right lumbar pain and lower left limb swelling. Arterial blood gas sample showed mild hypoxemia and respiratory alkalosis. CT scan confirmed pulmonary embolism, splenic and bilateral renal ischemic lesions. Read More

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Self-Induced Euglycemic Diabetic Ketoacidosis: When to Stop the Drip.

Cureus 2022 Jan 31;14(1):e21768. Epub 2022 Jan 31.

Internal Medicine, Ascension Providence Hospital, Southfield, USA.

Diabetic ketoacidosis (DKA) is a well-known, serious complication that many patients with type 1 and 2 diabetes face due to either a relative or absolute insulin deficiency. Sodium-glucose cotransporter 2 (SGLT-2) inhibitors have gained increased popularity due to their diabetic, cardiovascular, and renal benefits. An associated complication of SGLT2 inhibitors is euglycemic DKA. Read More

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January 2022

Global REACH 2018: Characterizing Acid-Base Balance Over 21 Days at 4,300 m in Lowlanders.

High Alt Med Biol 2022 06 28;23(2):185-191. Epub 2022 Feb 28.

Centre for Heart, Lung and Vascular Health, School of Health and Exercise Sciences, University of British Columbia-Okanagan, Kelowna, British Columbia, Canada.

Steele, Andrew R., Philip N. Ainslie, Rachel Stone, Kaitlyn Tymko, Courtney Tymko, Connor A. Read More

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Proximal Tubule Dysfunction Secondary to Salicylate Intoxication.

Glob Pediatr Health 2022 22;9:2333794X211050800. Epub 2022 Feb 22.

Kootenai Medical Center, Coeur d'Alene, ID, USA.

Aspirin overdose is still a common cause of presentation to the emergency department and is commonly seen in the setting of one-time, accidental or intentional ingestion of large amounts of salicylate-containing compounds, though can occur with long-term ingestion of super-therapeutic doses of medications. Salicylate toxicity has a predictable progression from early respiratory alkalosis to late metabolic acidosis. We present the case of a 14-year-old girl who intentionally ingested a handful of Aspirin and despite appropriate therapy, developed transient proximal tubule dysfunction. Read More

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February 2022

Severe Protracted Hypophosphatemia in a Patient with Persistent Vegetative State on Long-Term Assisted Respiratory Support.

Am J Case Rep 2022 Feb 26;23:e934532. Epub 2022 Feb 26.

Long Term Respiratory Care Division, Herzog Medical Center; Hadassah-Hebrew University Faculty of Medicine, Jerusalem, Israel.

BACKGROUND Phosphorous is an essential component of cell structure and physiology, and is required for energy conservation and expenditure. Severe hypophosphatemia can lead to profound dysfunction and injury affecting most organs and can be life-threatening. It can also compromise weaning of mechanically ventilated patients. Read More

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February 2022

Cerebrospinal Fluid and Arterial Acid-Base Equilibrium of Spontaneously Breathing Patients with Aneurismal Subarachnoid Hemorrhage.

Neurocrit Care 2022 08 23;37(1):102-110. Epub 2022 Feb 23.

Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.

Background: Hyperventilation resulting in hypocapnic alkalosis (HA) is frequently encountered in spontaneously breathing patients with acute cerebrovascular conditions. The underlying mechanisms of this respiratory response have not been fully elucidated. The present study describes, applying the physical-chemical approach, the acid-base characteristics of cerebrospinal fluid (CSF) and arterial plasma of spontaneously breathing patients with aneurismal subarachnoid hemorrhage (SAH) and compares these results with those of control patients. Read More

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Hyperlactataemia and acid-base disturbances in normotensive patients with acute heart failure.

Eur Heart J Acute Cardiovasc Care 2022 Mar;11(3):242-251

Department of Cardiology, Rambam Health Care Campus, Bat Galim, POB 9602, Haifa 31096, Israel.

Aims: Acute heart failure (AHF) may be associated with low-tissue perfusion and/or hypoxaemia leading to increased lactate levels and acid-base perturbations. Few data are available on the clinical significance of elevated lactate levels and primary acid-base disorders in the setting of AHF.

Methods And Results: Arterial blood gas was obtained at admission in 4012 normotensive (systolic blood pressure ≥ 90 mmHg) patients with AHF. Read More

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Acid-base abnormalities and liver dysfunction.

Ann Hepatol 2022 Mar-Apr;27(2):100675. Epub 2022 Jan 21.

Nephroxenia Dialysis Center Ioannina, Ioannina, Greece.

In addition to the kidneys and lungs, the liver also plays an important role in the regulation of the Acid-Base Equilibrium (ABE). The involvement of the liver in the regulation of ABE is crucial because of its role in lactic acid metabolism, urea production and in protein homeostasis. The main acid-base imbalance that occurs in patients with liver cirrhosis is Respiratory Alkalosis (RAlk). Read More

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Pharmacokinetics and pharmacodynamics studies of a loading dose of cisatracurium in critically ill patients with respiratory failure.

BMC Anesthesiol 2022 01 22;22(1):32. Epub 2022 Jan 22.

Department of Pharmacy, Faculty of Pharmacy, Mahidol University, 447 Sri-Ayutthaya Road, Ratchathewi, Bangkok, 10400, Thailand.

Background: Previous studies reported a slow neuromuscular response with the currently recommended dose of cisatracurium in critically ill patients. Pharmacokinetic and pharmacodynamic studies of cisatracurium in critically ill patients are still limited. To our knowledge, this is the first study performed to better understand the pharmacokinetics (PKs) and pharmacodynamics (PDs) of a loading dose of cisatracurium and to identify factors that affect PK and PD changes in critically ill patients. Read More

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January 2022

Acid-base balance at high altitude in lowlanders and indigenous highlanders.

J Appl Physiol (1985) 2022 02 13;132(2):575-580. Epub 2022 Jan 13.

Centre for Heart, Lung and Vascular Health, School of Health and Exercise Sciences, University of British Columbia - Okanagan, Kelowna, British Columbia, Canada.

High-altitude exposure results in a hyperventilatory-induced respiratory alkalosis followed by renal compensation (bicarbonaturia) to return arterial blood pH (pHa) toward sea-level values. However, acid-base balance has not been comprehensively examined in both lowlanders and indigenous populations-where the latter are thought to be fully adapted to high altitude. The purpose of this investigation was to compare acid-base balance between acclimatizing lowlanders and Andean and Sherpa highlanders at various altitudes (∼3,800, ∼4,300, and ∼5,000 m). Read More

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February 2022

Respiratory alkalosis provokes spike-wave discharges in seizure-prone rats.

Elife 2022 01 4;11. Epub 2022 Jan 4.

Department of Pharmacology, University of Virginia, Charlottesville, United States.

Hyperventilation reliably provokes seizures in patients diagnosed with absence epilepsy. Despite this predictable patient response, the mechanisms that enable hyperventilation to powerfully activate absence seizure-generating circuits remain entirely unknown. By utilizing gas exchange manipulations and optogenetics in the WAG/Rij rat, an established rodent model of absence epilepsy, we demonstrate that absence seizures are highly sensitive to arterial carbon dioxide, suggesting that seizure-generating circuits are sensitive to pH. Read More

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January 2022

Diabetic ketoacidosis in pregnancy - Case series, pathophysiology, and review of the literature.

Eur J Obstet Gynecol Reprod Biol 2022 Feb 21;269:41-46. Epub 2021 Dec 21.

Department of Emergency Medicine, Soroka University Medical Center, Beer-Sheva, Israel.

Objective: Diabetic ketoacidosis (DKA) during pregnancy is a life-threatening emergency for both the mother and the fetus. The pathophysiology of DKA in pregnancy has its own characteristics due to multiple factors, such as insulin resistance, accelerated starvation and respiratory alkalosis, thus creating ketosis-prone state, with DKA occurring at milder degrees of hyperglycemia, even in normoglycemic levels, which can result in delayed diagnosis and treatment with potential for adverse metabolic consequences.

Study Design: In this article, we presented 8 clinical cases of DKA during pregnancy. Read More

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February 2022

Systematic online academic resource (SOAR) review: Endocrine, metabolic, and nutritional disorders.

AEM Educ Train 2021 Aug 1;5(4):e10716. Epub 2021 Aug 1.

Division of Emergency Medicine Greater Los Angeles VA Healthcare System Los Angeles California USA.

Background: Free open-access medical education (FOAM) has become an integral resource for medical school and residency education. However, questions of quality and inconsistent coverage of core topics remain. In this second entry of the SAEM Systematic Online Academic Resource (SOAR) series, we describe the application of a systematic methodology to identify, curate, and describe FOAM topics specific to endocrine, metabolic, and nutritional disorders as defined by the 2016 Model of the Clinical Practice of Emergency Medicine (MCPEM). Read More

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Natural History of Aerosol-Induced Ebola Virus Disease in Rhesus Macaques.

Viruses 2021 11 17;13(11). Epub 2021 Nov 17.

US Army Medical Research Institute of Infectious Diseases (USAMRIID), Fort Detrick, Frederick, MD 21702, USA.

Ebola virus disease (EVD) is a serious global health concern because case fatality rates are approximately 50% due to recent widespread outbreaks in Africa. Well-defined nonhuman primate (NHP) models for different routes of Ebola virus exposure are needed to test the efficacy of candidate countermeasures. In this natural history study, four rhesus macaques were challenged via aerosol with a target titer of 1000 plaque-forming units per milliliter of Ebola virus. Read More

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November 2021

Emergence of lesions outside of the basal ganglia and irreversible damage to the basal ganglia with severe β-ketothiolase deficiency: A case report.

World J Clin Cases 2021 Oct;9(30):9276-9284

Department of Pharmacy, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang 621000, Sichuan Province, China.

Background: β-ketothiolase deficiency (β-KTD) is an inherited disease, and insufficient attention has been paid to imageology due to its lower morbidity. Therefore, few lesions outside the basal ganglia have been found before, and the persistent pathological changes have rarely been reported.

Case Summary: A 10-mo-old Chinese female patient with a free previous medical history but with poor physical and athletic development had received the haemophilus influenzae vaccine and then developed a low fever 2 d prior. Read More

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October 2021

Prevalence and predictors of pulmonary embolism in patients with acute exacerbation of chronic obstructive pulmonary disease.

Lung India 2021 Nov-Dec;38(6):533-539

Department of Internal and Pulmonary Medicine, Sher E Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India.

Background: The prevalence of pulmonary embolism (PE) in patients of acute exacerbation of chronic obstructive pulmonary disease (AECOPD) varies over a wide range. Early detection and treatment of PE in AECOPD is a key to improve patient outcome. The purpose of the study was to investigate the prevalence and predictors of PE in patients of AECOPD in a high burden region of North India. Read More

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November 2021

A Rapidly Progressive Case of Ectopic Adrenocorticotropic Hormone (ACTH) Syndrome.

Am J Case Rep 2021 Nov 3;22:e934437. Epub 2021 Nov 3.

Department of Internal Medicine, University of Pikeville-Kentucky College of Osteopathic Medicine, Pikeville, KY, USA.

BACKGROUND Adrenocorticotropic hormone (ACTH)-dependent Cushing's syndrome (CS) secondary to an ectopic source is an uncommon condition, accounting for 4-5% of all cases of CS. Refractory hypokalemia can be the presenting feature in patients with ectopic ACTH syndrome (EAS), and is seen in up to 80% of cases. EAS can be rapidly progressive and life-threatening without timely diagnosis and intervention. Read More

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November 2021

Acid-base balance and cerebrovascular regulation.

J Physiol 2021 12 26;599(24):5337-5359. Epub 2021 Nov 26.

Centre for Heart, Lung and Vascular Health, School of Health and Exercise Sciences, University of British Columbia, Okanagan, Kelowna, Canada.

The regulation and defence of intracellular pH is essential for homeostasis. Indeed, alterations in cerebrovascular acid-base balance directly affect cerebral blood flow (CBF) which has implications for human health and disease. For example, changes in CBF regulation during acid-base disturbances are evident in conditions such as chronic obstructive pulmonary disease and diabetic ketoacidosis. Read More

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December 2021