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Managing Crush Injuries on Arrival
Published in Kajal Jain, Nidhi Bhatia, Acute Trauma Care in Developing Countries, 2023
Sarvdeep Singh Dhatt, Deepak Neradi
Management of crush syndrome consists of adequate rehydration of the patient and alkalinization of urine. The condition of the patient can deteriorate quickly due to acute kidney injury from crush syndrome, and requires immediate and vigorous fluid replacement in the short window period to increase their chances of survival. Fluid replacement should be continued till myoglobinuria has disappeared. Forced alkaline diuresis can prevent dialysis even if fluid resuscitation is delayed. Sodium bicarbonate is administered to help correct metabolic acidosis and reduce myoglobulin precipitation, thus decreasing injury to kidneys and risk of kidney failure. Urine pH should be maintained at > 6.5 to prevent ARF. Overaggressive use of bicarbonate can cause metabolic alkalosis and metastatic calcification. Acetazolamide can help counter metabolic alkalosis while alkalizing urine. It can be given in metabolic alkalosis if urine pH < 6.5. The use of acetazolamide/bicarbonate should be according to urine output, urine pH and serum pH (Figure 27.3).
Biochemistry of Buffering Capacity and Ingestion of Buffers In Exercise and Athletic Performance
Published in Peter M. Tiidus, Rebecca E. K. MacPherson, Paul J. LeBlanc, Andrea R. Josse, The Routledge Handbook on Biochemistry of Exercise, 2020
Bryan Saunders, Guilherme G. Artioli, Eimear Dolan, Rebecca L. Jones, Joseph Matthews, Craig Sale
There is a perceived lower risk of GI discomfort compared to sodium bicarbonate (91, 95), although side effects still occur with sodium citrate. The most common symptoms include stomach cramps, bloating, nausea, vomiting, urge to defecate, diarrhoea, thirst, and headache (84, 109, 110); essentially the same side effects as sodium bicarbonate. Early studies reported no side effects from sodium citrate doses ranging from 0.1 to 0.5 g·kg−1BM (62, 74, 89), although these investigations failed to adequately record the incidence and severity of side effects, meaning that mild symptoms went unnoticed. Later studies reported side effects with doses of 0.5 g·kg−1BM (83, 84, 110), but GI distress was not experienced by volunteers in all studies (125). Symptom prevalence and severity increase in a dose-dependent manner for intakes of 0.5, 0.7, and 0.9 g·kg−1BM (124). Key moderators of these effects appear to be the volume of fluid supplied with the supplement and the time permitted to consume the fluid; concentrated solutions with a higher osmolality are more likely to result in GI distress (65). Higher doses potentiate these symptoms (124), and lower or staggered doses may reduce symptom prevalence and/or severity (74). Side effects may also have an ergolytic effect on exercise, particularly if sodium citrate is ingested 60–90 minutes pre-exercise, which means that individuals would perform exercise at the moment of the highest risk of GI distress and without reaching peak blood alkalosis (124).
Dietary Supplement Use in Wrestlers
Published in Charles Paul Lambert, Physiology and Nutrition for Amateur Wrestling, 2020
Also known as NaHCO3, Sodium Bicarbonate is an extracellular buffer. In many instances Sodium Bicarbonate given at 0.3 g/kg bodyweight or less (Costill et al. 1984) has been shown to improve high-intensity intermittent exercise performance. The proposed mechanism for this improvement in high-intensity exercise performance is an improved efflux of H+ from skeletal muscle, thus lessening the effect of these hydrogen ions on fatigue mechanisms within the muscle. One potential side effect of Sodium Bicarbonate ingestion is diarrhea. It must be noted that sodium bicarbonate is not always performance enhancing and much of this depends on the exercise paradigm or protocol.
Characteristics of emergency department presentations following ingestion of Taxus baccata (yew)
Published in Clinical Toxicology, 2023
Vanessa Alexandra Buetler, Alexandra Maria Braunshausen, Stefan Weiler, Jolanta Klukowska-Rötzler, Aristomenis K. Exadaktylos, Evangelia Liakoni
Gastroscopy occurred in 52 presentations (95%), with a median interval of 4.1 h (range 1.7 − 7.5 h) post-ingestion. Yew leaves were found in the gastrointestinal tract in 37 of 52 cases, with a median of 23 leaves and of range 0 (fifteen presentations) to 300 leaves (one presentation). A not strong positive correlation (correlation coefficient 0.41, p < 0.05) was found between the estimated number of leaves ingested and number recovered by gastroscopy (Figure 2). Table 3 includes details of the six presentations with ≥100 leaves found on gastroscopy (amount reported as potentially lethal [6]). Activated charcoal administration occurred in 24 presentations following gastroscopy and in one without gastroscopy (45% of total cases). Sodium bicarbonate was administered in two presentations. The patient with cardiac arrest received lipid emulsion, extracorporeal membrane oxygenation (ECMO), installation of a ventricular support device (Impella CP SmartAssist®, ABIOMED) and a temporary pacemaker.
Formulation, optimization, and evaluation of raft-forming formulations containing Nizatidine
Published in Drug Development and Industrial Pharmacy, 2019
Manal K. M. Darwish, Amal S. M. Abu El-Enin, Kamilia H. A. Mohammed
Nizatidine raft forming tablet formulation was successfully developed using sodium alginate as a raft forming polymer, calcium carbonate for raft strengthening and neutralizing effect. Finally, sodium bicarbonate was used as a gas generating agent. Maximum raft strength, acid neutralization capacity, and drug release were achieved at 275.92 mg of sodium alginate, 28.60 mg of sodium bicarbonate, and 202.14 mg of calcium carbonate in tablets prepared by direct compression. In tablets prepared by wet granulation, the values were 253.62 mg for sodium alginate, 24.60 mg for sodium bicarbonate, and 201.77 mg of calcium carbonate. X-ray for the most stable optimized tablets showed that raft tablet floated immediately after ingestion and remained intact for ∼3 h preventing reflux disorders associated with peptic ulcer. The pharmacokinetic study revealed a rapid onset of action indicated by lower time required to obtain maximum concentration as compared to market formulation. Thus, a promising floating raft forming system has been achieved which could be suitable for special populations as geriatrics and pediatrics leading to improved efficacy as well as enhanced patient compliance.
Incidence of rebound salicylate toxicity following cessation of urine alkalinization
Published in Clinical Toxicology, 2023
Mary O’Keefe, Matthew Stanton, Ryan Feldman, Jillian Theobald
During the five-year period, 512 acetylsalicylic acid overdose cases who had intravenous sodium bicarbonate infusion listed as a treatment were reviewed. Of these, 135 did not have a documented serum salicylate concentration after discontinuation of the bicarbonate infusion and were excluded. Of the 377 remaining cases, eight (2.1%) had serum salicylate concentration rebound after stopping intravenous sodium bicarbonate (Figure 1, Table 1). All eight (100%) of these rebound cases were acute ingestions (meaning none were therapeutically taking acetylsalicylic acid prior to the overdose). The median time from sodium bicarbonate infusion discontinuation to repeat concentration was 3.0 h (interquartile range 3.55 h).