Alkalosis, Respiratory ; Anesthesia, Local ; Diskectomy, Percutaneous ; Endoscopy ; Humans ; Intervertebral Disc Displacement ; Lumbar Vertebrae ; Retrospective Studies ; Treatment Outcome

Gitelman syndrome (GS) is a renal tubular disorder of the thiazide-sensitive sodium chloride cotransporter, which is located in the distal tubule of the loop of Henle. We present a rare case of GS complicated by severe hyponatraemia and hypophosphataemia. A 17-year-old boy was admitted to our institution with fever and lethargy. The workup revealed typical features of GS, i.e. hypokalaemia, hypomagnesaemia and metabolic alkalosis. In this report, we discuss the differential diagnoses and rationale for accepting GS as the most likely diagnosis. This case was complicated by severe hyponatraemia (115 mmol/L) and hypophosphataemia (0.32 mmol/L). We concluded that the syndrome of inappropriate secretion of antidiuretic hormones could not be ruled out and that respiratory alkalosis was the most likely aetiology of hypophosphataemia. This case report also generates an interesting discussion on water and electrolyte metabolism.
Adolescent ; Alkalosis, Respiratory ; diagnosis ; Electrolytes ; Fever ; Gitelman Syndrome ; complications ; diagnosis ; Humans ; Hyponatremia ; complications ; diagnosis ; Hypophosphatemia ; complications ; diagnosis ; Lethargy ; Male ; Vasopressins ; secretion

Metabolic acid-base disorders are comnom clinical problems in ICU patients. Arterial blood gas analysis and anion gap (AG) are important laboratory data in approaching acid-base interpretation. When measuring the AG, several factors such as albumin have influence on unmeasured anions and unmeasured cations. If a patient has hypoalbuminemia, the AG should be adjusted according to the albumin level. High AG metabolic acidoses including lactic acidosis, ketoacidosis, and ingestion of toxic alcohols are common in ICU patients. The treatment target of lactic acidosis and ketoacidosis is not the acidosis, but the underlying condition causing acidosis. Gastric acid loss, diuretics, volume depletion, renal compensation for respiratory acidosis, hypokalemia, and mineralocorticoid excess are common causes of metaboic alkalosis. In chloride responsive metaboic alkalosis, volume and potassium repletion are mandatory.
Acid-Base Equilibrium ; Acidosis ; Acidosis, Lactic ; Acidosis, Respiratory ; Alcohols ; Alkalosis ; Anions ; Blood Gas Analysis ; Cations ; Compensation and Redress ; Diuretics ; Eating ; Gastric Acid ; Humans ; Hypoalbuminemia ; Hypokalemia ; Ketosis ; Potassium

An endoscopic third ventriculostomy was performed in a 55-year-old man with an obstructive hydrocephalus due to aqueductal stenosis. The vital signs and laboratory studies upon admission were within the normal limits. Anesthesia was maintained with nitrous oxide in oxygen and 6% desflurane. The patient received irrigation with approximately 3,000 ml normal saline during the procedure. Anesthesia and operation were uneventful. However, he developed postoperative hyperventilation in the recovery room, and arterial blood gas analysis revealed acute respiratory alkalosis. We report a rare respiratory alkalosis that occurred after an endoscopic third ventriculostomy.
Alkalosis, Respiratory ; Anesthesia ; Blood Gas Analysis ; Humans ; Hydrocephalus ; Hyperventilation ; Isoflurane ; Middle Aged ; Nitrous Oxide ; Oxygen ; Recovery Room ; Ventriculostomy ; Vital Signs

The objective was to compare the two procedures of treatment for hypocalcemia in acute respiratory alkalosis performed by rebreathing into a small paper bag with that of the IV calcium replacement therapy. 25 patients with clinical manifestations of hypocalcemia admitted to the Department of Emergency, Cho Ray Hospital were prospectively included in this study. Patients were divided into two groups according to the time of day they visited the emergency department. Group I was treated by IV calcium replacement. Group II was treated rebreathing into a small paper bag without drug. In conclusion, group I had 3.80.8 minute and group II had 4.41.17 minute to disappear the manifestations of hypocalcemia. The average statistical test between these two groups in this study has shown that the two procedures were not different statistical significance
Alkalosis, Respiratory ; Respiratory Distress Syndrome, Adult ; Hypocalcemia ; Therapeutics

This cross-sectional study involved 339 students aged 12-15 at Sapa and Yen Binh regions. It measured and compared indexes such as vital capacity (VC), forced expiratory volume 1 (FEV1), and Tiffeneau index. Results: there weren’t significant differences between VC, FEV1 and Tiffeneau indexes of students in both sexes of 2 regions (p<0.05). There is a close correlation between VC and height of student (r>0.9), and between FEV1 and height (r>0.9)
Preventive Medicine ; Public Health ; Alkalosis, Respiratory

respiratory alkalosis associated with highly variable and impressive array of signs and symptoms. Typical features are tachypnea, paresthesia, carpopedal spasm, tetany, chest pain and dizziness. Rebreathing into a paper or vinyl bag will reverse the alkalosis-induced symptoms and help the patient calm down. We report hyperventilation syndrome associated with extraction of mandibular third molar and describe the physiology and treatment. Accidental displacement of mandibular third molars is rarely reported complication. Most common anatomic structures of dislodgement are submandibular space, lateral pharyngeal space and pterygomandibular space. This report describe an unusual case of two roots of mandibular third molar that were displaced into submandibular space.]]>
Alkalosis, Respiratory ; Chest Pain ; Dizziness ; Humans ; Hyperventilation ; Molar, Third ; Paresthesia ; Physiology ; Spasm ; Tachypnea ; Tetany

PURPOSE: D-lactate, optical isomer of L-lactate is not a human metabolite. Once the D-lactate enters the human body, it is mainly metabolized in liver. The metabolism of D-lactate can be changed in patients with decompensated liver cirrhosis with the exposure of antibiotics and the frequent trial of lactulose, if neccessory. The aim of this study is to analyze blood D-lactate level in cirrhotic patients and it's relationship with the degree of hepatic insufficiency and acid-base imbalance. METHODS: Plasma L-lactate and D-lactate levels were measured in 40 cirrhotic patients classified by Child-Pugh system with L-LDH and D-LDH with comparison of their changes before and after the use of antibiotics and lactulose(n=14). Also, acid-base disorders were analyzed in 35 cirrhotic patients, and plasma L, D-lactate levels were determined in each acid-base disorder. RESULTS: Plasma D-lactate level was not significantly elevated in cirrhotic patients compared to the control group(2.34+/-.48 mmol/L vs. 1.63+/-.26 mmol/ L, p=NS), but some patients(n=4, 10%) revealed abnormally elevated D-lactate level. The plasma L, D- lactate levels were not different in subgroups classified by Child-Pugh system as well as by underlying causes of liver cirrhosis, and plasma D-lactate level was not sugnificnatly different before and after the exposure of antibiotics and lactulose. Plasma D-lactate level was significantly increased in 3 patients with respiratory alkalosis and metabolic acidosis(12+/-.98 mmol/L) compared to others(p<0.05). CONCLUSION: These results suggest that, regardless of its decompensated degree and exposure to drugs, a subset of patients with liver cirrhosis can develop elevation of D-lactate in blood, particularly when metabolic acidosis is accompanied.
Acid-Base Imbalance* ; Acidosis ; Alkalosis, Respiratory ; Anti-Bacterial Agents ; Hepatic Insufficiency ; Human Body ; Humans ; Lactic Acid ; Lactulose ; Liver ; Liver Cirrhosis ; Metabolism ; Plasma*

No abstract available.
Acidosis, Respiratory* ; Alkalosis, Respiratory*

BACKGROUND: Patients with cardiac diseases who have structural defects in their heart bring about metabolic insult such as preoperative acid-base imbalance. Cardiac operation requires many nonphysiologic procedures such as extracorporeal circulation, hypothermia, and hemodilution. We studied the acid-base status of surgical heart diseases pre-operatively, during extracorporeal circulation, and post-operatively and researched the treatment indications of acid-base disturbances. MATERIAL AND METHOD: From January 1997 to May 1999, fifty two cases of open heart surgery were carried out under extracorporeal circulation, which divided into a set of pediatric and adult groups, congenital and acquired groups, non-cyanotic and cyanotic groups, The alpha-stat arterial blood gas analysis was done in each group during the preoperative period, during the operation with extracorporeal circulation, and during the postoperative period. RESULT: Before surgery, all patients present metabolic acidosis, PaO2 was low in adult group and acquired group and compensatory respiratory alkalosis was noted in cyanotic group. During extracorporeal circulation, adult group revealed alkalosis and normal in acquired group. Pediatric group presents low PaCO2, metabolic acidosis and respiratory alkalosis. Congenital group and non-cyanotic group showed non-compensatory alkalosis trend and non-compensatory respiratory acidosis were observed in cyanotic group during extracorporeal circulation. Postoperative acid-base status of adult group was recovered to normal and the standard bicarbonate was increased in the acquired group. All of the pediatric, congenital non-cyanotic, and cyanotic groups revealed the lack of buffer base. CONCLUSION: In Preoperative period, correction of metabolic acidosis was required in pediatric, congenital and non-cyanotic groups, while treatment of metabolic acidosis and low PaCO2 were required in adult and acquired groups. In the cyanotic group, metabolic acidosis and respiratory alkalosis needed to be corrected preoperatively. Using the extracorporeal circulation, minimal correction was required except acquired group which showed normal acid-base balance. In postoperative period, restriction of bicarbonate was required for acquired group while increase of buffer base was required for pediatric, congenital, non-cyanotic, and cyanotic groups.
Acid-Base Equilibrium ; Acid-Base Imbalance ; Acidosis ; Acidosis, Respiratory ; Adult ; Alkalosis ; Alkalosis, Respiratory ; Blood Gas Analysis ; Extracorporeal Circulation* ; Gases* ; Heart Diseases* ; Heart* ; Hemodilution ; Humans ; Hypothermia ; Postoperative Period* ; Preoperative Period* ; Thoracic Surgery