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Acute Kidney Injury
Published in Stephen M. Cohn, Alan Lisbon, Stephen Heard, 50 Landmark Papers, 2021
Jeffrey H. William, Melanie P. Hoenig
Background: Several prior studies revealed a relationship between saline administration and hyperchloremic acidosis, acute kidney injury, and even death [1–6]. However, others failed to show any difference in outcomes [7–8].
Surgery to Improve Reservoir Function
Published in Jacques Corcos, Gilles Karsenty, Thomas Kessler, David Ginsberg, Essentials of the Adult Neurogenic Bladder, 2020
Up to 15% of patients postaugmentation may develop renal insufficiency progressing to renal failure. Also hyperchloremic acidosis requiring oral bicarbonate may be seen in up to 16% of patients. Some patients also may have, due to their neurologic disease, weak bladder necks, leading to nocturnal incontinence, requiring anticholinergic medication and potentially bladder neck reconstruction or diversion. Other short-term complications may include transient diarrhea due to the interruption of bowel continuity, which usually clears up at about 3–4 months but may be persistent. Mucus formation from the bowel mucosa can be troublesome as it can lead to mucus collections that require removal by irrigation by large-bore catheter as well as occasionally by cystoscopy. Due to the persistent bacteriuria due to the intermittent catheterization and also changes in the pH due to bowel secretions, there may also be increased urinary stone formation that will need to be treated as required. Also, due to the interruption of the terminal ileum (if used), the absorption of vitamin B12 may be altered, leading to the need for parenteral supplementation to prevent macrocytic anemia and neurologic sequalae. This may take 3–4 years to appear due to generally good reserves of B12 in most well-nourished individuals.
Effects on Bone, on Vitamin D, and Calcium Metabolism
Published in Lars Friberg, Tord Kjellström, Carl-Gustaf Elinder, Gunnar F. Nordberg, Cadmium and Health: A Toxicological and Epidemiological Appraisal, 2019
One of the workers developed severe pains when turning over in his sleep, 12 years after the initial examination.48 Radiological examination of the bones showed a pseudofracture at the neck of the femur (Figure 11) and in the middle of the fibula. An iliac crest biopsy showed widened osteoid seams. Urinary abnormalities found were tubular proteinuria, renal glycosuria, generalized aminoaciduria, high hydroxyproline, low osmolality, and high pH, all of them indicating renal tubular damage (see Chapter 9, Section IV.B.2). A number of abnormalities were also found in the blood, including low creatinine clearance and high phosphate clearance as well as signs of hyperchloremic acidosis.
Phases of fluid management and the roles of human albumin solution in perioperative and critically ill patients
Published in Current Medical Research and Opinion, 2020
Observational data showed that children with severe dengue virus infection who received 20% HSA solution had better lactate clearance and shorter durations of mechanical ventilation, ICU stay and hospital stay than children treated with 5% HSA solution124. Improved lactate clearance, a viable surrogate marker of resuscitation adequacy125,126, also suggests that 20% HSA solution is superior to 5% HSA solution in fluid therapy of severe dengue infection124. The FEAST trial evaluated the role of fluid bolus therapy in the resuscitation of children in Africa with shock and life-threatening infections with severe febrile illness and impaired perfusion (mostly malaria), and reported higher 48-h mortality in those who received boluses of either saline or 5% albumin, as compared with a no bolus control group who received maintenance fluids127. A recent reanalysis of the FEAST trial found that worsening hyperchloremic acidosis, due to the chloride content of the saline or 5% albumin boluses, was a major contributor to the increased mortality risk128. This raises the possibility that lower-volume fluid therapy with buffered solution or higher-percentage HSA solution might help to minimize mortality in this setting, although this requires further study128,129.
The role of the clinical laboratory in diagnosing acid–base disorders
Published in Critical Reviews in Clinical Laboratory Sciences, 2019
Chloride plays a major role in intracellular and extracellular acid–base regulation [118]. As the AG formula is [Na+] – [Cl−] – [HCO3−], this sum remains the same or “normal” in metabolic acidosis when a decrease in bicarbonate is equalized by an increase in chloride. As the loss of [HCO3−] corresponds with an increase in [Cl−] to retain electroneutrality, it is also referred to as hyperchloremic metabolic acidosis. This type of acidosis occurs from gastrointestinal loss of bicarbonate (e.g. diarrhea, ureteral diversion), renal loss of bicarbonate with defective urinary acidification by the renal tubules (renal tubular acidosis, RTA), or in early renal failure when acid excretion is impaired [86,87,93]. Hospital-acquired hyperchloremic acidosis occurs frequently in situations where high volumes of normal saline (0.9%) are required and, because of iatrogenic acidosis, it may be misdiagnosed as ongoing disease activity. Normal saline has a pH of 5.5 and a chloride and sodium content of 154 mmol/L. This low pH has, however, little influence on the development of acidosis. As plasma sodium is much higher than chloride (140 mmol/L versus 106 mmol/L), the chloride increase will be relatively higher than the sodium increase with the infusion of NaCl (0.9%). Due to this rise in chloride, a decrease in bicarbonate follows to maintain electroneutrality. Serum chloride is responsible for about one-third of the extracellular fluid tonicity and two-thirds of all anionic charges in plasma, and therefore chloride represents the most important anion to balance extracellular cations [1,2,93,118].
Introducing isotonic fluids into pediatric oncology
Published in Pediatric Hematology and Oncology, 2022
Amadeus T. Heinz, Thomas Eichholz, Manon Queudeville, Ulrike Hartmann, Alexandra Ott, Oliver Heinzel, Rupert Handgretinger, Martin Ebinger
The prevalence of metabolic acidosis and hyperchloremic acidosis was greatly reduced, most probable due to the metabolizable anions contained in balanced fluids. As metabolic acidosis has a known detrimental impact,18 this might be a valuable effect.