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Cholelithiasis and Nephrolithiasis
Published in John K. DiBaise, Carol Rees Parrish, Jon S. Thompson, Short Bowel Syndrome Practical Approach to Management, 2017
Blood tests should include measurements of electrolytes, calcium, phosphorus, and uric acid. The levels of 25-hydroxycholecalciferol, 1,25-dihydroxycholecalciferol, and parathyroid hormone should be measured if abnormalities of serum calcium and phosphorus are found. Depending upon clinical circumstances, a 24-hour urine collection on an ad libitum diet should be performed for measurement of urine volume, calcium, phosphorus, oxalate, uric acid, sodium, potassium, pH, bicarbonate, sulfate, ammonium, titratable acid, citrate, creatinine and the supersaturation ratios of calcium oxalate and phosphate, and monosodium urate. A 24-hour urine analysis helps to establish the diagnosis and assists with determination of optimal therapy. For follow-up, a 24-hour urine analysis under dietary manipulation with elemental calcium 400 mg/day (10 mmol/day) and sodium 100 mEq/day for 4–7 days can be beneficial to assess patient response to dietary modification.
Assessment of acid–base balance
Published in Jonathan Dakin, Mark Mottershaw, Elena Kourteli, Making Sense of Lung Function Tests, 2017
Jonathan Dakin, Mark Mottershaw, Elena Kourteli
Likewise, under conditions of respiratory acidosis, the kidneys increase excretion of the acid load. Free H+ ions cannot be excreted in isolation, so this is achieved by buffering of urinary H+ by combination with weak acids (titratable acidity). The major titratable acid buffer in urine is phosphate, though this system is not amenable to regulation by the kidney. However, the proximal renal tubules are able to up-regulate metabolism of glutamine to form ammonium (), which is secreted as ammonia (NH3) into the collecting ducts where it combines with H+, increasing excretion of the acid load.
Chapter Paper 1 Answers
Published in James Day, Amy Thomson, Tamsin McAllister, Nawal Bahal, Get Through, 2014
James Day, Amy Thomson, Tamsin McAllister, Nawal Bahal
In addition, hydrogen ions bind to filtered buffers in the urine and are excreted as titratable acid. The buffers are predominantly phosphate but beta hydroxybutyrate, creatinine and sulphates also contribute. The proximal tubule is the major site for this.
Estimation of the risk of local and systemic effects in infants after ingestion of low-concentrated weak acids from descaling products
Published in Clinical Toxicology, 2022
Arjen Koppen, Claudine C. Hunault, Regina G. D. M. van Kleef, Agnes G. van Velzen, Remco H. S. Westerink, Irma de Vries, Dylan W. de Lange
Local effects of acids are well known and described [3]. The severity of tissue damage due to acids depends on pH, the amount and the contact time of the acidic solution with tissue. The severity of injury can also be predicted by the titratable acid/alkaline reserve, i.e. the buffer capacity of an acidic solution [4]. In general, acid solutions with a pH of 2 or lower are considered to be strong corrosives, and exposure to these chemicals can result in severe burns, lesions and coagulation necrosis [5]. This latter effect reduces tissue penetration by acids, usually resulting in less tissue damage compared to caustic agents like alkaline chemicals [3]. Ingestion of acids may induce burns throughout the gastrointestinal tract, mainly esophageal, gastric and/or duodenal lesions. Eventually, esophageal stricture formation may occur due to scarring. In case of oral exposure to weak acids as found in household descaling products, it is not clear whether local tissue damage is likely to occur, especially when descalers are diluted and/or supplemented with baby milk powder.
A new perspective of the risk of caustic substance ingestion: the outcomes of 468 patients in one North Taiwan medical center within 20 years
Published in Clinical Toxicology, 2021
Yu-Jhou Chen, Chen-June Seak, Shih-Ching Kang, Tsung-Hsing Chen, Chien-Cheng Chen, Chip-Jin Ng, Chao-Wei Lee, Ming-Yao Su, Hsin-Chih Huang, Pin-Cheng Chen, Chun-Hsiang Ooyang, Sen-Yung Hsieh, Hao-Tsai Cheng
Conversely, the consensus is that caustic tissue damage simultaneously depends on the type of substance, commercial formulation, pH, dose, concentration, viscosity, duration of contact, and the concept of titratable acid/alkaline reserve [1–3,6–8,11,18–24]. However, exact information is difficult to obtain [1,8,11]. In clinical situations, miscellaneous caustic properties cannot immediately or directly offer physicians predictive insights. Moreover, symptoms are not sufficiently specific for the severity of injuries [2,6,18,19]. This study aimed to provide clinical physicians with a new perspective to overcome clinical uncertainty prior to examination data. The extent of GI tract injury, commonly encountered complications, and long-term overall survival outcomes are three important aspects for patients with caustic injury. We examined whether pH and ingested dose could provide an accurate risk assessment.