Pathophysiology of Acid Base Balance: the Theory Practice Relationship
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Extracellular Volume in the Brain- the Relevance of the Chloride Space
Pediat. Res. 12: 635-645 (1978) A Review: Extracellular Volume in the Brain- The Relevance of the Chloride Space DONALD B. CHEEK(lZ2'AND A. BARRY HOLT Royal Children's Hospital Research Foundation, Parkville, Victoria, Australia By simultaneous infusion of anions into the blood and into the concerning brain water and the chloride space (C1 space) as a ventriculocisternal area it is possible to define two compart- measure of extracellular volume (ECV) . ments, one of blood plus brain and one of cerebrospinal fluid The rhesus monkey (Macaca mulatta) is a useful experimental (CSF) plus brain, with a zone of slow equilibration within the model. Comparisons of the macaque brain with the human brain brain where the two components meet. It would appear that during can prove rewarding. Our work on the growth of halogens (Br- and I-) have a much more remarkable and rapid the macaque brain and the distribution of C1- and H,O extends entrance into brain tissue from blood and, with increasing blood from midgestation (80 days) to term (165 days) and well into concentration, penetrate the second compartment significantly. the postnatal period (120 days after birth). The results of this Chloride is more strongly transported across the choroid plexus work have been documented in a recent publication (21). from blood to CSF (in comparison with I- or Br-). Chloride should resemble Br- and I- in diffusing rapidly through the intercellular canals back into the blood. However, knowledge I. CSF CIRCULATION AND ITS BARRIERS concerning C1- distribution dynamics is meager. The dynamics of chloride distribution, diffusion, and transport Homeostasis and the constancy of Claude Bernard's "Milieu using, for example, 36Cl-, 38Cl-, and stable C1-, have not been Interne" is essential for normal function of the central nervous studied sufficiently (in the two compartments), but circumstan- system (CNS). -
The History of Carbon Monoxide Intoxication
medicina Review The History of Carbon Monoxide Intoxication Ioannis-Fivos Megas 1 , Justus P. Beier 2 and Gerrit Grieb 1,2,* 1 Department of Plastic Surgery and Hand Surgery, Gemeinschaftskrankenhaus Havelhoehe, Kladower Damm 221, 14089 Berlin, Germany; fi[email protected] 2 Burn Center, Department of Plastic Surgery and Hand Surgery, University Hospital RWTH Aachen, Pauwelsstrasse 30, 52074 Aachen, Germany; [email protected] * Correspondence: [email protected] Abstract: Intoxication with carbon monoxide in organisms needing oxygen has probably existed on Earth as long as fire and its smoke. What was observed in antiquity and the Middle Ages, and usually ended fatally, was first successfully treated in the last century. Since then, diagnostics and treatments have undergone exciting developments, in particular specific treatments such as hyperbaric oxygen therapy. In this review, different historic aspects of the etiology, diagnosis and treatment of carbon monoxide intoxication are described and discussed. Keywords: carbon monoxide; CO intoxication; COHb; inhalation injury 1. Introduction and Overview Intoxication with carbon monoxide in organisms needing oxygen for survival has probably existed on Earth as long as fire and its smoke. Whenever the respiratory tract of living beings comes into contact with the smoke from a flame, CO intoxication and/or in- Citation: Megas, I.-F.; Beier, J.P.; halation injury may take place. Although the therapeutic potential of carbon monoxide has Grieb, G. The History of Carbon also been increasingly studied in recent history [1], the toxic effects historically dominate a Monoxide Intoxication. Medicina 2021, 57, 400. https://doi.org/10.3390/ much longer period of time. medicina57050400 As a colorless, odorless and tasteless gas, CO is produced by the incomplete combus- tion of hydrocarbons and poses an invisible danger. -
Acid-Base Abnormalities in Dogs with Diabetic Ketoacidosis: a Prospective Study of 60 Cases
325 Acid-base abnormalities in dogs with diabetic ketoacidosis: a prospective study of 60 cases Distúrbios ácido-base em cães com cetoacidose diabética: estudo prospectivo de 60 casos Ricardo DUARTE1; Denise Maria Nunes SIMÕES1; Khadine Kazue KANAYAMA1; Márcia Mery KOGIKA1 1School of Veterinary Medicine and Animal Science, University of São Paulo, São Paulo-SP, Brazil Abstract Diabetic ketoacidosis (DKA) is considered a typical high anion gap metabolic acidosis due to the retention of ketoanions. The objective of this study was to describe the acid-base disturbances of dogs with DKA and further characterize them, according to their frequency, adequacy of the secondary physiologic response, and occurrence of mixed disturbances. Sixty dogs with DKA were enrolled in the study. Arterial blood pH and gas tensions, plasma electrolytes, serum b-hydroxybutyrate (b-OHB), glucose, albumin and urea concentrations were determined for all dogs included in the study. All dogs were evaluated individually and systematically by the traditional approach to the diagnosis of acid- base disorders. Most of the dogs had a high anion gap acidosis, with appropriated respiratory response (n = 18; 30%) or concurrent respiratory alkalosis (n = 14; 23%). Hyperchloremic acidosis with moderated to marked increases in b-OHB was observed in 18 dogs (30%) and 7 of these patients had concurrent respiratory alkalosis. Hyperchloremic acidosis with mild increase in b-OHB was observed in 6 dogs (10%). Four dogs (7%) had a high anion gap acidosis with mild increase in b-OHB and respiratory alkalosis. Most of dogs with DKA had a high anion gap acidosis, but mixed acid-base disorders were common, chiefly high anion gap acidosis and concurrent respiratory alkalosis, and hyperchloremic acidosis with moderated to marked increases in serum b-OHB. -
CHEM 301 Assignment #3
CHEM 301 Assignment #3 Provide solutions to the following questions in a neat and well organized manner. Clearly state assumptions and reference sources for any constants used. Due date: November 18th 1. Methane and carbon dioxide are produced under anaerobic conditions by the fermentation of organic matter, approximated by the following equation 2 {CH2O} CH4 + CO2 As gas bubbles are evolved at the sediment interface at 5 m depth and remain in contact with water at the sediment surface long enough so that equilibrium is attained. The total pressure at this depth is 148 kPa. If the pH is 8.20, calculate the total carbonate concentration in the interstitial water at 25oC. How would you expect your answer to change if these gas bubbles were present at 500 m depth? Strategy: The total pressure inside the gas bubble must be equal to the total pressure on the outside of the gas bubble (or else it would either explode or collapse). Furthermore, the total pressure inside that gas bubble is equal to the sum of the partial pressures of CH4 and CO2. We can then use the partial pressure of CO2 inside the gas bubble and the corresponding Henry’s law constant to calculate the concentration of aqueous CO2 at equilibrium. Given the pH of the solution and the expressions for Ka1 and Ka2, we can determine the concentration of HCO3- and 2- CO3 . (see textbook pgs 241-242; Chap 11, Q9) Solution: The total carbonate concentration is given by; 2- - 2- [CO3 ]T = [CO2(aq)] + [HCO3 ] + [CO3 ] From the pH speciation diagram (Fig. -
Arterial Blood Gases: Acid-Base Balance
EDUCATIONAL COMMENTARY – ARTERIAL BLOOD GASES: ACID-BASE BALANCE Educational commentary is provided through our affiliation with the American Society for Clinical Pathology (ASCP). To obtain FREE CME/CMLE credits click on Earn CE Credits under Continuing Education on the left side of the screen. **Florida licensees, please note: This exercise will appear in CE Broker under the specialty of Blood Gas Analysis. LEARNING OUTCOMES On completion of this exercise, the participant should be able to • identify the important buffering systems in the human body. • explain the Henderson-Hasselbalch equation and its relationship to the bicarbonate/carbonic acid buffer system. • explain the different acid-base disorders, causes associated with them, and compensatory measures. • evaluate acid-base status using patient pH and pCO2 and bicarbonate levels. Introduction Arterial blood gas values are an important tool for assessing oxygenation and ventilation, evaluating acid- base status, and monitoring the effectiveness of therapy. The human body produces a daily net excess of acid through normal metabolic processes: cellular metabolism produces carbonic, sulfuric, and phosphoric acids. Under normal conditions, the body buffers accumulated hydrogen ions (H+) through a variety of buffering systems, the respiratory center, and kidneys to maintain a plasma pH of between 7.35 and 7.45. This tight maintenance of blood pH is essential: even slight changes in pH can alter the functioning of enzymes, the cellular uptake and use of metabolites, and the uptake and release of oxygen. Although diagnoses are made by physicians, laboratory professionals must be able to interpret arterial blood gas values to judge the validity of the laboratory results they report. -
Evaluation and Treatment of Alkalosis in Children
Review Article 51 Evaluation and Treatment of Alkalosis in Children Matjaž Kopač1 1 Division of Pediatrics, Department of Nephrology, University Address for correspondence Matjaž Kopač, MD, DSc, Division of Medical Centre Ljubljana, Ljubljana, Slovenia Pediatrics, Department of Nephrology, University Medical Centre Ljubljana, Bohoričeva 20, 1000 Ljubljana, Slovenia J Pediatr Intensive Care 2019;8:51–56. (e-mail: [email protected]). Abstract Alkalosisisadisorderofacid–base balance defined by elevated pH of the arterial blood. Metabolic alkalosis is characterized by primary elevation of the serum bicarbonate. Due to several mechanisms, it is often associated with hypochloremia and hypokalemia and can only persist in the presence of factors causing and maintaining alkalosis. Keywords Respiratory alkalosis is a consequence of dysfunction of respiratory system’s control ► alkalosis center. There are no pathognomonic symptoms. History is important in the evaluation ► children of alkalosis and usually reveals the cause. It is important to evaluate volemia during ► chloride physical examination. Treatment must be causal and prognosis depends on a cause. Introduction hydrogen ion concentration and an alkalosis is a pathologic Alkalosis is a disorder of acid–base balance defined by process that causes a decrease in the hydrogen ion concentra- elevated pH of the arterial blood. According to the origin, it tion. Therefore, acidemia and alkalemia indicate the pH can be metabolic or respiratory. Metabolic alkalosis is char- abnormality while acidosis and alkalosis indicate the patho- acterized by primary elevation of the serum bicarbonate that logic process that is taking place.3 can result from several mechanisms. It is the most common Regulation of hydrogen ion balance is basically similar to form of acid–base balance disorders. -
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BRITISH 511 Auc,.Auo. 25,25, 19621962 CARBON-MONOXIDE POISONIN6 MEDICAL JOURNAL Br Med J: first published as 10.1136/bmj.2.5303.511 on 25 August 1962. Downloaded from Case Reports HYPERVENTILATION IN Case 1.-A woman aged 61 was found with her head in CARBON-MONOXIDE POISONING a gas-oven. On admission to hospital she was deeply unconscious, with a generalized increase of muscle tone. BY pulse rate 140 a minute, and blood-pressure 110/70 mm. Hg. G. L. LEATHART, M.D., M.R.C.P. There was marked hyperventilation suggesting the possibility of coincident aspirin poisoning. A stomach wash-out, how- Nuflield Department of Industrial Health, the Medical ever, revealed no tablets, and a sample of urine collected School, King's College, Newcastle upon Tyne a few hours later contained no detectable salicylate. In 24 hours she had recovered fully and was transferred to a The recent revival of interest in the use of 5% or 7% mental hospital. carbogen in the treatment of carbon-monoxide poisoning Case 2.-An accountant aged 40 was working late in his has prompted the description of four unusual cases in office and was seen to be well at 9.15 p.m. At 8.45 a.m. which gross hyperventilation occurred. The investiga- the following morning he was found in the office with the tion of these cases was not very thorough, but such cases gas turned on but unlit. He was deeply unconscious with are seen so seldom that it is felt that even this incomplete strikingly deep and rapid respiration suggesting a condition report may be of value in stimulating further research. -
Guidelines for Potential Multiple Organ Donors (Adult). Part II
ARTIGO ESPECIAL Glauco Adrieno Westphal, Milton Diretrizes para manutenção de múltiplos órgãos Caldeira Filho, Kalinca Daberkow Vieira, Viviane Renata Zaclikevis, no potencial doador adulto falecido. Parte II. Miriam Cristine Machado Bartz, Ventilação mecânica, controle endócrino metabólico Raquel Wanzuita, Álvaro Réa-Neto, Cassiano Teixeira, Cristiano Franke, e aspectos hematológicos e infecciosos Fernando Osni Machado, Joel de Andrade, Jorge Dias de Matos, Guidelines for potential multiple organ donors (adult). Part II. Alfredo Fiorelli, Delson Morilo Lamgaro, Fabiano Nagel, Felipe Mechanical ventilation, endocrine metabolic management, Dal-Pizzol, Gerson Costa, José hematological and infectious aspects Mário Teles, Luiz Henrique Melo, Maria Emília Coelho, Nazah Cherif RESUMO das alterações hematológicas é igualmente Mohamed Youssef, Péricles Duarte, importante considerando as implicações Rafael Lisboa de Souza A atuação do intensivista durante a da prática transfusional inapropriada. manutenção do potencial doador falecido Ressalta-se ainda o papel da ventilação na busca da redução de perdas de doadores protetora na modulação inflamatória e e do aumento da efetivação de transplantes conseqüente aumento do aproveitamen- não se restringe aos aspectos hemodinâmi- to de pulmões para transplante. Por fim, cos. O adequado controle endócrino-me- assinala-se a relevância da avaliação crite- tabólico é essencial para a manutenção do riosa das evidências de atividade infecciosa aporte energético aos tecidos e do controle e da antibioticoterapia na busca do maior hidro-eletrolítico, favorecendo inclusive a utilização de órgãos de potenciais doadores estabilidade hemodinâmica. A abordagem falecidos. A presente diretriz é uma iniciativa conjunta da Associação de Medicina INTRODUÇAO Intensiva Brasileira (AMIB) e da Associação Brasileira de Transplantes de Órgãos (ABTO) e teve apoio de SC Durante a evolução para a morte encefálica (ME) ocorrem diversas alterações Transplantes - Central de Notificação fisiológicas como resposta à perda das funções do tronco cerebral. -
Oral Rehydration of Adult Cattle Using Isotonic Solution of Sugar, Sodium Chloride and Potassium Chloride
Haryana Vet. (Dec., 2019) 58(2), 166-169 Research Article ABSTRACT Fig 2: Transmission electron photomicrograph of monocyte of dog Present study comprised of 72 crossbred cows (group I= 60 endometritic and group II=12 healthy) at 30±2days postpartum. The showing heterochromatin (a), euchromatin (b), cytoplasmic process (c), polymorphonuclear neutrophils (PMN) cell coun Vacuole and nuclear membrane. Uranyl acetate and lead citrate × 25500 Figure 1: Cyclic conditions for PCR profiling for detection of Salmonella genes ASSOCIATION OF SEMEN TRAITS IN CONSECUTIVE EJACULATES WITH FSH-β GENE POLYMORPHISM IN HOLSTEIN-FRIESIAN CROSSBRED BULLS FROM INDIA VIJAY KADAM, ABH trus synchronizathod that synchronizes ovulations is Corresponding author: [email protected] Fig. 1. Histogram depicting frequency distribution of animal named briefly as “Ovsynch” (Pursley et al., 1995). The right score of respondents Clinical Article study was aimed to evaluate the efficacy of different methods of estrus sync Fig. 1. Semilogarithmic plot of plasma concentration time profile of amoxicillin and cloxacillin following single dose (10 mg/kg) i.v. and i.m. administration in sheep (n=4) Haryana Vet. (Dec., 2019) 58(2), 166-169 Research Article 2003) which might lead to increased chances of urolith the time for the urinary tract to restore patency (Parrah, Haryana Vet. (March, 2020) 59(SI), 93-95 Short Communication Research Article formation. The increased hospital incidence can also be 2009) in conjugation with supportive treatments like COMPARATIVE EFFICACY OF SYNCHRONIZATION PROTOCOLS FOR IMPROVING attributed to the proximity of the clinic as well. According to peritoneal lavage, urinary acidifiers and urinary ORAL REHYDRATION OF ADULT CATTLE USING ISOTONIC SOLUTION OF SUGAR, FERTILITY IN POSTPARTUM CROSSBRED DAIRY COWS data published by Department ff Soil Science, Haryana, antiseptics. -
TITLE: Acid-Base Disorders PRESENTER: Brenda Suh-Lailam
TITLE: Acid-Base Disorders PRESENTER: Brenda Suh-Lailam Slide 1: Hello, my name is Brenda Suh-Lailam. I am an Assistant Director of Clinical Chemistry and Mass Spectrometry at Ann & Robert H. Lurie Children’s Hospital of Chicago, and an Assistant Professor of Pathology at Northwestern Feinberg School of Medicine. Welcome to this Pearl of Laboratory Medicine on “Acid-Base Disorders.” Slide 2: During metabolism, the body produces hydrogen ions which affect metabolic processes if concentration is not regulated. To maintain pH within physiologic limits, there are several buffer systems that help regulate hydrogen ion concentration. For example, bicarbonate, plasma proteins, and hemoglobin buffer systems. The bicarbonate buffer system is the major buffer system in the blood. Slide 3: In the bicarbonate buffer system, bicarbonate, which is the metabolic component, is controlled by the kidneys. Carbon dioxide is the respiratory component and is controlled by the lungs. Changes in the respiratory and metabolic components, as depicted here, can lead to a decrease in pH termed acidosis, or an increase in pH termed alkalosis. Slide 4: Because the bicarbonate buffer system is the major buffer system of blood, estimation of pH using the Henderson-Hasselbalch equation is usually performed, expressed as a ratio of bicarbonate and carbon dioxide. Where pKa is the pH at which the concentration of protonated and unprotonated species are equal, and 0.0307 is the solubility coefficient of carbon dioxide. Four variables are present in this equation; knowing three variables allows for calculation of the fourth. Since pKa is a constant, and pH and carbon dioxide are measured during blood gas analysis, bicarbonate can, therefore, be determined using this equation. -
Ethylene Glycol Ingestion Reviewer: Adam Pomerlau, MD Authors: Jeff Holmes, MD / Tammi Schaeffer, DO
Pediatric Ethylene Glycol Ingestion Reviewer: Adam Pomerlau, MD Authors: Jeff Holmes, MD / Tammi Schaeffer, DO Target Audience: Emergency Medicine Residents, Medical Students Primary Learning Objectives: 1. Recognize signs and symptoms of ethylene glycol toxicity 2. Order appropriate laboratory and radiology studies in ethylene glycol toxicity 3. Recognize and interpret blood gas, anion gap, and osmolal gap in setting of TA ingestion 4. Differentiate the symptoms and signs of ethylene glycol toxicity from those associated with other toxic alcohols e.g. ethanol, methanol, and isopropyl alcohol Secondary Learning Objectives: detailed technical/behavioral goals, didactic points 1. Perform a mental status evaluation of the altered patient 2. Formulate independent differential diagnosis in setting of leading information from RN 3. Describe the role of bicarbonate for severe acidosis Critical actions checklist: 1. Obtain appropriate diagnostics 2. Protect the patient’s airway 3. Start intravenous fluid resuscitation 4. Initiate serum alkalinization 5. Initiate alcohol dehydrogenase blockade 6. Consult Poison Center/Toxicology 7. Get Nephrology Consultation for hemodialysis Environment: 1. Room Set Up – ED acute care area a. Manikin Set Up – Mid or high fidelity simulator, simulated sweat if available b. Airway equipment, Sodium Bicarbonate, Nasogastric tube, Activated charcoal, IV fluid, norepinephrine, Simulated naloxone, Simulate RSI medications (etomidate, succinylcholine) 2. Distractors – ED noise For Examiner Only CASE SUMMARY SYNOPSIS OF HISTORY/ Scenario Background The setting is an urban emergency department. This is the case of a 2.5-year-old male toddler who presents to the ED with an accidental ingestion of ethylene glycol. The child was home as the father was watching him. The father was changing the oil on his car. -
L7-Renal Regulation of Body Fluid [PDF]
Iden8fy and describe the role of the Sensors and Objectives Effectors in the Abbreviations renal regulaon of body fluid volume ADH An8diurec hormone & osmolality ECF Extracellular fluid ECV Effec8ve Circulang Iden8fy the site and Volume describe the Describe the role of ANF Atrial natriure8c factor influence of the kidney in aldosterone on regulaon of body ANP ATRIAL NATRIURETIC PEPTIDE reabsorp8on of Na+ fluid volume & in the late distal osmolality tubules. PCT Proximal convoluted tubules AVP arginine vasopressin Understand the role of ADH in the reabsorp8on of water and urea Mind map Blood volume remains exactly constant despite extreme changes in daily fluid intake and the reason for that is : 1- slight change in blood volume ! Renal regulaNon of marked change in Extra Cellular cardiac output Volume Is a reflex 2- a slight change mechanism in RegulaNon of ECF Thus, regulaon of in cardiac output which variables volume = Na+ also dependent !large change in reflecng total RegulaNon of body upon blood pressure body sodium and Na+= RegulaNon BP baroreceptors. 3-slight change in ECV are monitor by blood pressure ! appropriate sensor large change in (receptors) URINE OUTPUT . Con. Blood Volume regulation : Sensors Effectors Affecng 1- Rennin angiotensin, aldosterone. 1- Caro8d sinus Urinary Na excre8on. 2- ADH ( the result will cause a change in NA+ and water excre8on either 3- Renal sympathe8c nerve by increasing it or 2- Volume receptors decreasing it ) . (large vein, atria, intrarenalartery) 4- ANP Con. Blood Volume regulation : Cardiac atria Low pressure receptors Pulmonary vasculature Central vascular sensors Carod sinus Sensors in the CNS High pressure receptors AorNc arch Juxtaglomerular apparatus (renal afferent arteriole) Sensors in the liver ECF volume Receptors Con.