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Normal physiology of pregnancy
Published in Nadia Barghouthi, Jessica Perini, Endocrine Diseases in Pregnancy and the Postpartum Period, 2021
Rawan El-Amin, Loren Custer, Jennifer Silk
The increase in GFR alters the excretion of electrolytes and nutrients. Glucose, protein, albumin, amino acids, and calcium excretion are all increased. As a result of the respiratory alkalosis previously mentioned, the excretion of bicarbonate also increases. The rise in progesterone levels in pregnancy allows the kidneys to retain potassium, with excess potassium stored in the fetus and placenta.1,10
Drugs, accidents and poisoning
Published in Jagdish M. Gupta, John Beveridge, MCQs in Paediatrics, 2020
Jagdish M. Gupta, John Beveridge
15.15. Which of the following is/are associated with salicylate poisoning?Fever.Metabolic acidosis.Respiratory alkalosis.Pin point pupils.Hyperglycaemia.
Acid-Base, Electrolyte And Renal Emergencies
Published in Anthony FT Brown, Michael D Cadogan, Emergency Medicine, 2020
Anthony FT Brown, Michael D Cadogan
Causes include: Chronic renal failure, acute pancreatitis.Rhabdomyolysis, tumour lysis syndrome, whole blood transfusion and toxic shock syndrome.Primary respiratory alkalosis (hyperventilation).Post-parathyroidectomy or thyroid surgery; autoimmune hypoparathyroidism.
Prevalence of hyperventilation in patients with asthma
Published in Journal of Asthma, 2022
Duco D. Deenstra, Hanneke A. C. van Helvoort, Remco S. Djamin, Cathelijne van Zelst, Johannes C. C. M. in’t Veen, Jeanine C. Antons, Martijn A. Spruit, Alex J. van ’t Hul
In this study, for the first time large-scale blood gas analysis was performed in patients with stable asthma, that is, without acute exacerbation. A remarkably large proportion of patients, namely 40%, appeared to have a hyperventilation blood gas. A metabolic compensated respiratory alkalosis was found in 23% of the patients, indicating the presence of a longer lasting hyperventilation. An uncompensated respiratory alkalosis was observed in another 17% of the patients, representing an acute hyperventilation. Patients with a chronic hyperventilation were younger, more often female and had the best spirometric outcomes compared to patients without hyperventilation. The NQ turned out not to be a valid tool for use as a screening instrument for hyperventilation in patients with asthma.
Hospital mortality and long-term mortality among hospitalized patients with various admission serum ionized calcium levels
Published in Postgraduate Medicine, 2020
Charat Thongprayoon, Wisit Cheungpasitporn, Api Chewcharat, Michael A. Mao, Sorkko Thirunavukkarasu, Kianoush B. Kashani
Ionized calcium is a key mediator in a wide range of critical physiological processes ranging from cellular function, neuronal activity to coagulation [24]. Abnormalities in ionized calcium levels disrupt normal hemostasis which can predispose to arrhythmias, hypotension, and even seizures [25–28]. These effects could contribute to the observed higher mortality [9,10,24]. The findings from our study also demonstrated that patients with low serum ionized calcium carried an increased risk of ventricular arrhythmia. Additionally, ionized calcium can be influenced by several factors, but can be thought of as a sick index, or as a marker of disease severity. It is plausible that among the moribund patients, cells are not able to efflux calcium across the cell membrane, leading to low serum ionized calcium [29,30]. Conversely, elevated ionized calcium can lead to renal vasoconstriction and reduced renal blood flow, resulting in renal ischemia and acute kidney injury [3]. Hypercalcemia can also promote cardiovascular diseases via vascular calcification and hypercoagulability [31]. Altogether, both hypocalcemia and hypercalcemia are associated with in-hospital mortality with a U-shaped association. In addition, in cases of acid-base disturbances due to lactic acidosis, ionized calcium levels are higher than baseline, and acidosis could lead to the reported higher death rate [24]. On the other hand, among patients with alkalosis from respiratory distress, serum ionized calcium is lower than baseline [24]. These patients have higher mortality rates from the underlying problems that could have resulted in respiratory alkalosis.
A 29-year analysis of acute peak salicylate concentrations in fatalities reported to United States poison centers
Published in Clinical Toxicology, 2018
Brandon J. Warrick, Andrew King, Susan Smolinske, Ronald Thomas, Cynthia Aaron
Coingestants, specifically those that directly depress the respiratory drive, are associated with lower salicylate concentrations. This is consistent with the known protective effects of respiratory alkalosis. Salicylates are weak acids and the protonated forms are more lipid-soluble and better able to move across cell membranes and into the mitochondria and brain. Alkaline pH favors ionized forms, making them less likely to transit across membranes. Hyperventilation and subsequent alkalosis is protective by favoring charged molecules and keeping them out of the cell. Conversely, hypercapnic acidemia from agents depressing the respiratory drive will increase toxicity [12,13]. Sedative-hypnotics not only depress respirations but also make identification of salicylate-induced neurotoxicity difficult. Alteration of mental status may be inappropriately attributed to the sedative-hypnotic therapeutic effect rather than salicylate-induced neurotoxicity and thus delay initiation of needed extracorporeal removal. Interestingly, concomitant ingestion of ethanol or GABA agonists did not correlate with decreased salicylate concentrations in this review. This may be a result of the retrospective nature of the data.