This essay is to present an improvement on the concentration assay for sodium chloride in bicarbonate dialysate.
Bicarbonates ; analysis ; chemistry ; Dialysis Solutions ; analysis ; chemistry ; Sodium Chloride ; analysis

Study Design: prospective, randomized, double-blinded clinical trial; Objective: To compare the efficacy of peribulbar block augmentated with sodium bicarbonate to that augmented with sodium hyaluronate; Subjects: 99 eyes from 94 patients undergoing cataract surgery divided into 3 groups receiving either anesthetic alone, anesthetic with bicarbonate, or anesthetic with hyaluronidase; Observation Parameters: (1) lid and ocular sensitivity to pain immediately after anesthetic injection, 30 minutes after injection and immediately after surgery, (2) onset and duration of lid and ocular analgesia and akinesia, (3) complications, and (4) the need for supplemental injections; Data Analysis: Mean onset of analgesia and akinesia, pain scores and motion scores were determined. F-test ANOVA followed by post-hoc tests (- LSD and Duncans Multiple Range Test) were used to analyze continuous data. Kruskall-Wallis test ANOVA followed by pair-wise comparison using Mann-Whitney U tests were used to analyze ordinal data. Chi square was used to analyze nominal data. Wilcoxon Signed Ranks test was used for within group analysis after data splitting. Relative risk, relative risk reduction, absolute risk reduction, and number needed to treat, were also computed. Conclusion: Peribulbar blockade using sodium bicarbonate as adjunct was found to be as effective as that which was augmented with hyaluronidase. Anesthetic solutions with additives (sodium bicarbonate or hyaluronidase) were found to be superior to pure anesthetics in terms of latency, intensity of analgesia, and degree of akinesia.
Human ; Aged ; Middle Aged ; CATARACT SURGERY ; CATARACT EXTRACTION ; SODIUM BICARBONATE ; BICARBONATES AND SODIUM ;

PURPOSE: Urine alkalinization is commonly used to treat rhabdomyolysis and to prevent the rapid progression of rhabdomyolysis into acute renal failure. However, there are no prospective studies on the beneficial effect of urine alkalinization on rhabdomyolysis. We prospectively examined whether fluid hydration with urine alkalinization treatment would be more effective than single hydration treatment in treating rhabdomyolysis and preventing acute renal failure in the emergency department. METHODS: We performed a prospective randomized trial with fifty-eight patients who were diagnosed with rhabdomyolysis. Thirty-five patients were treated with crystalloid alone, while the others were treated with crystalloid mixed with sodium bicarbonates. Creatine phosphokinase (CPK) and creatinine levels were checked every 4 hours for the first 24 hours and then checked every 8 hours thereafter. Data collected included "peak CPK time"(time from the start of treatment to achievement of the maximal CPK value), increasing and decreasing rate of CPK, and whether acute renal failure developed. RESULTS: Patient's age, sex, initial CPK concentrations, and initial creatinine concentrations were not statistically different between the single hydration treatment group and the hydration with urine alkalinization group. Mean time to peak CPK was 10.2+/-13.7 hours in the single hydration group and 8.1+/-10.2 hours in the hydration with urine alkalinization group. Neither the time to peak CPK nor the CPK change rates was statistically different between the two groups (p=0.547, p=0.176, p=0.696). CONCLUSION: Hydration with urine alkalinization as a treatment for rhabdomyolysis and prevention of acute renal failure did not improve patient results over single hydration treatment.
Acute Kidney Injury ; Bicarbonates ; Creatine Kinase ; Creatinine ; Emergency Service, Hospital ; Humans ; Prospective Studies ; Rhabdomyolysis* ; Sodium

A 21-year-old woman ingested 1,250 mg of diphenhydramine in a single overdose. Diphenhydramine, a rare ingredient in over-the-counter medication, is used to treat insomnia in Korea. Toxicity is usually limited to anticholinergic symptoms. The standard approach to therapy for the treatment of diphenhydramine overdose is supportive care, including physostigmines and sodium bicarbonates. Here, we review the literature and for the first time report a case of acute diphenhydramine overdosage in Korea, complicated with seizures.
Bicarbonates ; Diphenhydramine ; Female ; Humans ; Korea ; Physostigmine ; Seizures ; Sleep Initiation and Maintenance Disorders ; Sodium ; Young Adult

The administration of oral rehydration solution (ORS) has rescued the lives of people with diarrhea. Although diarrhea mortality rates have dropped by 75% from 1980 to 2008 in worldwide, diarrhea continues to be a major cause of child death, especially in children younger than 5 years. The clinical application of the standard WHO-ORS in large-scale campaigns resulted in decreased mortality associated with acute diarrheal disease in children. Many clinical trials on variants of ORS such as hypo-osmolar solutions, rice-based solutions, zinc supplementation, and the addition on other advantageous substances have been performed to improve outcomes of diarrheal treatment. This paper reviews the pathophysiologic base and history of ORS, composition of ORS, and its clinical use for acute diarrhea and other intestinal diseases.
Bicarbonates ; Child ; Diarrhea ; Electrolytes ; Fluid Therapy ; Glucose ; Humans ; Intestinal Diseases ; Potassium Chloride ; Sodium Chloride ; Zinc

HCO3(-) reabsorption in the renal tubules plays a critically important role in maintaining the global acid-base balance. Loss of HCO3(-) causes metabolic acidosis. Proximal renal tubule is the major site for HCO3(-) reabsorption, accounting for more than 80% of total HCO3(-) reabsorption along the nephron. Over the past more than half centuries, tremendous progresses have been made on understanding the molecular mechanisms underlying the HCO3(-) reabsorption in proximal tubules. The transepithelial movement of HCO3(-) involves the coordinated operation of machineries on both the apical and the basolateral membranes of the epithelial cells. On the apical domain, Na(+)-H(+) exchanger NHE3 and the vacuolar H(+)-ATPase are two major pathways mediating the apical uptake of HCO3(-)-related species. Taken together, NHE3 and H(+)-ATPase are responsible for about 80% of HCO3(-) reabsorption in the proximal tubule. The remaining 20% is likely mediated by pathways yet to be characterized. On the basolateral membrane, NBCe1 represents the only major known pathway mediating the extrusion of HCO3(-) coupled with Na(+) into the interstitial space. In the present article, we provide a historical view about the studies on the mechanisms of HCO3(-) reabsorption since 1940s. Moreover, we summarize the latest progresses emerging over the past decade in the physiological as well as pathological roles of acid-base transporters underlying the HCO3(-) reabsorption in proximal tubules.
Acidosis ; physiopathology ; Animals ; Bicarbonates ; metabolism ; Humans ; Kidney Tubules, Proximal ; physiopathology ; Sodium-Hydrogen Exchangers ; physiology ; Vacuolar Proton-Translocating ATPases ; physiology

Cystic fibrosis (CF) of the pancreas is the most widely accepted name of the most common fatal inherited single gene defect disease among Caucasians. Its incidence among other races is thought to be significantly less, but mutations in the gene have been reported in most, if not all, major populations. This review is intended to give general concepts of the molecular as well as physiological basis of the pathology that develops in the disease. First, an overview of the organ pathology and genetics is presented, followed by the molecular structure of the gene product (cystic fibrosis transmembrane conductance regulator, CFTR), its properties, functions, and controls as currently understood. Second, since mutations appear to be expressed primarily as a defect in electrolyte transport, effects and mechanisms of pathology are presented for two characteristically affected organs where the etiology is best described: the sweat gland, which excretes far too much NaCl ("salt") and the pancreas, which excretes far too little HCO3(- )("soda"). Unfortunately, morbidity and mortality in CF develop principally from refractory airway infections, the basis of which remains controversial. Consequently, we conclude by considering possible mechanisms by which defects in anion transport might predispose the CF lung to chronic infections.
Anions ; metabolism ; Bicarbonates ; Cystic Fibrosis ; physiopathology ; Cystic Fibrosis Transmembrane Conductance Regulator ; metabolism ; Humans ; Ion Transport ; Pancreas ; physiopathology ; Sodium Chloride ; Sweat Glands ; physiopathology

Diarrheal disease is one of the leading causes of worldwide morbidity and mortality, especially in children. It causes loss of body fluid, which may lead to severe dehydration, electrolyte imbalance, shock and even to death. The mortality rate from acute diarrhea has decreased over the last few decades. This decline, especially in developing countries is largely due to the implantation of the standard World Health Organization-oral rehydration solution (WHO-ORS). However, the use of standard ORS has been limited by its inability to reduce fecal volume or diarrhea duration. Subsequently, this has led to various attempts to modify its compositions. And these modifications include the use of reduced osmolarity ORS, polymer-based ORS and zinc supplementation. Some of these variations have been successful and others are still under investigation. Therefore, further trials are needed to progress toward the ideal ORS. In this article, we briefly reviewed the pathophysiologic basis of the ORS, followed by the standard WHO-ORS and several modifications to improve the ORS.
Bicarbonates ; Body Fluids ; Child ; Dehydration ; Developing Countries ; Diarrhea ; Electrolytes ; Fluid Therapy ; Glucose ; Humans ; Osmolar Concentration ; Potassium Chloride ; Shock ; Sodium Chloride ; World Health ; World Health Organization ; Zinc

Following a radical cystectomy to treat bladder cancer, the ureters can be implanted in a short loop of ileum, which serves as an orthotopic bladder replacement. However, several investigators have reported the frequent development of a normal anion gap metabolic acidosis and electrolyte disturbance in these patients. The colon segments secrete sodium and bicarbonate ions and reabsorb ammonium, hydrogen, and chloride ions when exposed to urine, causing metabolic acidosis. In most cases, the acid-base disorder is not very troublesome. The metabolic acidosis can usually be corrected by administering sodium bicarbonate. We experienced a case of severe metabolic acidosis associated with urinary diversion that improved with continuous renal replacement therapy (CRRT).
Acid-Base Equilibrium ; Acidosis ; Bicarbonates ; Colon ; Cystectomy ; Humans ; Hydrogen ; Ileum ; Ions ; Quaternary Ammonium Compounds ; Renal Replacement Therapy ; Research Personnel ; Sodium ; Sodium Bicarbonate ; Ureter ; Urinary Bladder ; Urinary Bladder Neoplasms ; Urinary Diversion

Acetates ; pharmacology ; Animals ; Bicarbonates ; pharmacology ; Drug Combinations ; Endothelium, Corneal ; drug effects ; pathology ; Female ; Glutathione ; pharmacology ; Hydrogen-Ion Concentration ; Minerals ; pharmacology ; Ophthalmic Solutions ; pharmacology ; Rabbits ; Retina ; drug effects ; pathology ; Sodium Chloride ; pharmacology ; Vitreous Body ; drug effects