The Respiratory System and Its Disorders
Walter F. Stanaszek, Mary J. Stanaszek, Robert J. Holt, Steven Strauss in Understanding Medical Terms, 2020
The inability of the lungs to eliminate carbon dioxide results in a condition called respiratory acidosis, a decrease in serum pH from the excess carbonic acid of dissolved CO2. Alkalosis is a condition that results when the lungs eliminate too much carbon dioxide, increasing serum pH. Diseases that impair the ability of the lungs to transfer oxygen to the blood may produce hypoxia, in which oxygen in the blood is insufficient for the tissues, or anoxia, in which no oxygen enters the blood.
Disseminated Intravascular Coagulation
Rodger L. Bick in Disseminated Intravascular Coagulation and Related Syndromes, 2019
Patients with leukemias of either an acute or chronic variety are candidates for disseminated intravascular coagulation. The most common acute leukemia which is associated with disseminated intravascular coagulation is that of acute hypergranular promyelocytic leukemia. The mechanisms for this have been carefully investigated by Gralnick and Tan54,55 and consist of procoagulant material release from granules of the progranulocyte. Furthermore, these authors and others have clearly shown that the use of heparin or mini-heparin before the initiation of cytotoxic chemotherapy will often ward off the development of and potentially prolong survival in these patients.56,59 It has been this author’s experience that certainly if a patient with acute promyelocytic leukemia does not present with findings of DIC, they will almost always develop acute DIC when cytotoxic chemotherapy is initiated, associated with a large population cell “kill” and the resultant release of procoagulant granule material. The next most common acute leukemia that is associated with acute DIC is myelomonocytic leukemia60 although the mechanisms are less clearly understood. However, any acute leukemia or, less commonly, chronic leukemia may be associated with acute disseminated intravascular coagulation and may significantly alter prognosis of the patient. Any of the chronic leukemias can also be associated with acute DIC however, much less commonly so than the acute leukemic disorders. Acidosis, and much less commonly alkalosis, may provide triggers for DIC.61,63 In the case of acidosis the triggering event may simply be due to endothelial sloughing with attendant activation of Factor XII and/or platelets with subsequent activation of the clotting sequence. The mechanism(s) in cases of alkalosis remain totally unknown.
Nephrology
Fazal-I-Akbar Danish in Essential Lists of Differential Diagnoses for MRCP with diagnostic hints, 2017
Metabolic alkalosis:1 Vomiting.2 Diuretic use.3 Antacid use.4 Hyperaldosteronism.
PDE3-inhibitor enoximone prevented mechanical ventilation in patients with SARS-CoV-2 pneumonia
Published in Experimental Lung Research, 2021
Jan Beute, Pieter Boermans, Bart Benraad, Jan Telman, Zuzana Diamant, Alex KleinJan
Similar to our previous experiences in CAS, enoximone achieved a rapid symptomatic relief in two out of four patients, with full recovery within a few hours (patients 1 and 4), while the other two patients (patients 2 and 3, with comorbid obesity or COPD GOLD III) required a longer time to respond (24–36 h) due to sputum retention. Compared to controls, the enoximone-treated patients had no need for mechanical ventilation (Chi-Square Tests, Fisher’s exact test p = 0.029), had a shorter stay in ICU (2–5 days for enoximone-treated patients versus 12–31 days for controls), and an overall shorter stay in hospital (13–15 days for enoximone-treated patients versus 22–46 days for controls) as well as a shorter recovery time (Figure 1; Table 3) (Mann-Whitney U test p = 0.05). Blood gas analysis (Supplementary Table 1) showed a minimal improvement in three out of four patients between before and 1 h after enoximone. The apparent alkalosis is mainly due to hyperventilation (in turn due to patient anxiety). pO2 levels are all at the right side of the sigmoid curve of saturation, reflecting maximal oxygen saturation despite severe dyspnea (Supplementary Table 1).
High anion gap metabolic acidosis induced by cumulation of ketones, L- and D-lactate, 5-oxoproline and acute renal failure
Published in Acta Clinica Belgica, 2018
Laura Heireman, Boris Mahieu, Mark Helbert, Wim Uyttenbroeck, Jan Stroobants, Marian Piqueur
In the case presented here, the patient was chronically treated with fosfomycin antibiotic therapy. It is not known whether this antibiotic is associated with 5-oxoproline intoxication. Moreover, in addition to the HAGMA, decreased ammonia production due to renal failure and diarrhoea may have contributed to the acidosis. In contrast, vomiting may cause a metabolic alkalosis. However, the so-called delta ratio, defined as [(anion gap-12)/(24-bicarbonate serum concentration)], was 1.3, revealing the presence of a pure HAGMA (range 1.0–2.0). Uncontrolled glycaemia resulting in diminished glutathione levels in combination with chronic paracetamol (and fosfomycin) intake, urosepsis and impaired renal function may have played an important role in the induction of 5-oxoproline acidosis in this case.
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.