To evaluate the safety and efficiency of citrate anticoagulant-based continuous blood purification in patients at high risk of bleeding. 
 Methods: One hundred and fifty-two patients at high risk of bleeding were divided into local citrate group (group A, n=68) and heparin group (group B, n=84). Clotting function, change of pH, ionized sodium, bicarbonate ion, ionized calcium, activated clotting time (ACT) and complications were monitored before and during treatment. 
 Results: Compared to the group A, the incidence of clotting in filter and chamber, the degree of bleeding or fresh bleeding were significantly reduced in the group B (P<0.05). ACT of post-filter at 4, 8 and 12 h during the treatment in the group A was significantly extended compared with that without treatment (P<0.05), while there was no significant change in group B (P>0.05). The pH value, the levels of ionized sodium, bicarbonate ion and ionized calcium during the treatment were maintained in normal range in both group A and group B.
 Conclusion: Local citrate-based continuous blood purification can achieve effective anticoagulation and decrease the incidence of bleeding. It is an ideal choice for patients at high risk of bleeding.
Anticoagulants ; pharmacology ; Bicarbonates ; blood ; Blood Coagulation ; drug effects ; Blood Coagulation Tests ; Calcium ; blood ; Citrates ; Citric Acid ; therapeutic use ; Female ; Hemodiafiltration ; adverse effects ; methods ; Hemofiltration ; Hemorrhage ; etiology ; prevention & control ; Heparin ; therapeutic use ; Humans ; Intensive Care Units ; Male ; Reference Values ; Renal Dialysis ; Sodium ; blood ; Treatment Outcome

BACKGROUND: The objective of this study was to examine the correlation between arterial blood gas (ABG) and peripheral venous blood gas (VBG) samples for all commonly used parameters in patients admitted to a medical intensive care unit (ICU). METHODS: A single-center, prospective trial was carried out in a medical ICU in order to determine the level of correlation of ABG and peripheral VBG measurements. A maximum of five paired ABG-VBG samples were obtained per patient to prevent a single patient from dominating the data set. RESULTS: Regression equations were derived to predict arterial values from venous values as follows: arterial pH=-1.108+1.145xvenous pH+0.008xPCO2-0.012xvenous HCO3+0.002xvenous total CO2 (R2=0.655), arterial PCO2=88.6-10.888xvenous pH+0.150xPCO2+0.812xvenous HCO3+0.124xvenous total CO2 (R2=0.609), arterial HCO3=-89.266+12.677xvenous pH+0.042xPCO2+0.675xvenous HCO3+0.185xvenous total CO2 (R2=0.782). The mean ABG minus peripheral VBG differences for pH, PCO2, and bicarbonates were not clinically important for between-person heterogeneity. CONCLUSION: Peripheral venous pH, PCO2, bicarbonates, and total CO2 may be used as alternatives to their arterial equivalents in many clinical contexts encountered in the ICU.
Bicarbonates ; Blood Gas Analysis ; Humans ; Hydrogen-Ion Concentration ; Critical Care ; Intensive Care Units ; Prospective Studies

BACKGROUND: The objective of this study was to examine the correlation between arterial blood gas (ABG) and peripheral venous blood gas (VBG) samples for all commonly used parameters in patients admitted to a medical intensive care unit (ICU). METHODS: A single-center, prospective trial was carried out in a medical ICU in order to determine the level of correlation of ABG and peripheral VBG measurements. A maximum of five paired ABG-VBG samples were obtained per patient to prevent a single patient from dominating the data set. RESULTS: Regression equations were derived to predict arterial values from venous values as follows: arterial pH=-1.108+1.145xvenous pH+0.008xPCO2-0.012xvenous HCO3+0.002xvenous total CO2 (R2=0.655), arterial PCO2=88.6-10.888xvenous pH+0.150xPCO2+0.812xvenous HCO3+0.124xvenous total CO2 (R2=0.609), arterial HCO3=-89.266+12.677xvenous pH+0.042xPCO2+0.675xvenous HCO3+0.185xvenous total CO2 (R2=0.782). The mean ABG minus peripheral VBG differences for pH, PCO2, and bicarbonates were not clinically important for between-person heterogeneity. CONCLUSION: Peripheral venous pH, PCO2, bicarbonates, and total CO2 may be used as alternatives to their arterial equivalents in many clinical contexts encountered in the ICU.
Bicarbonates ; Blood Gas Analysis ; Humans ; Hydrogen-Ion Concentration ; Critical Care ; Intensive Care Units ; Prospective Studies

PURPOSE: The aim of this study was to analyze the risk factors of systemic complications by caustic substances according to arterial blood gas analysis (ABGA). METHODS: The medical records of patients who visited our emergency department for caustic ingestion from January 2000 to December 2011 were reviewed. There were 129 patients included in this study, with a mean age of 45.4 years, and 46.9% of the patients were men. We performed a univariate analysis of factors associated with systemic complication and a logistic regression analysis of these predictive factors. RESULTS: The most frequent caustic ingested was base (53.8%). Systemic complications were found in 29 patients (22.5%) and advanced age, a low partial pressure of oxygen (PaO2), low bicarbonate ion (HCO3-), low oxygen saturation (SaO2), high anion gap (AG), acid ingestion, and severe acidosis were associated with systemic complications. Low SaO2, high AG, and severe acidosis were independent predictive factors of systemic complications. ED: HIGHLIGHT: Please spell out HCO3. CONCLUSION: Parameters of ABGA such as SaO2, AG, and pH predict the development of systemic complications by caustic ingestion. Therefore, these data have a role in the prognosis and treatment of caustic ingestion.
Acid-Base Equilibrium ; Acidosis ; Bicarbonates ; Blood Gas Analysis ; Caustics ; Eating ; Emergencies ; Humans ; Hydrogen-Ion Concentration ; Logistic Models ; Male ; Medical Records ; Oxygen ; Partial Pressure ; Prognosis ; Risk Factors

Chloracetanilide herbicides (alachlor, butachlor, metachlor) are used widely. Although there are much data about chronic low dose exposure to chloracetanilide in humans and animals, there are few data about acute chloracetanilide poisoning in humans. This study investigated the clinical feature of patients following acute oral exposure to chloracetanilide. We retrospectively reviewed the data on the patients who were admitted to two university hospitals from January 2006 to December 2010. Thirty-five patients were enrolled. Among them, 28, 5, and 2 cases of acute alachlor, metachlor, butachlor poisoning were included. The mean age was 49.8 +/- 15.4 yr. The poison severity score (PSS) was 17 (48.6%), 10 (28.6%), 5 (14.3%), 2 (5.7%), and 1 (2.9%) patients with a PSS of 0, 1, 2, 3, and 4, respectively. The age was higher for the symptomatic patients (1-4 PSS) than that for the asymptomatic patients (0 PSS) (43.6 +/- 15.2 vs 55.7 +/- 13.5). The arterial blood HCO3 was lower in the symptomatic patients (1-4 PSS) than that in the asymptomatic patients (0 PSS). Three patients were a comatous. One patient died 24 hr after the exposure. In conclusion, although chloracetanilide poisoning is usually of low toxicity, elder patients with central nervous system symptoms should be closely monitored and cared after oral exposure.
Acetamides/*poisoning ; Acetanilides/*poisoning ; Acute Disease ; Adult ; Aged ; Bicarbonates/blood ; Central Nervous System Diseases/diagnosis ; Female ; Herbicides/*poisoning ; Humans ; Male ; Middle Aged ; Poisoning/*diagnosis ; Retrospective Studies ; Severity of Illness Index ; Suicide, Attempted

PURPOSE: To determine whether analyte levels in serum laboratory tests and arterial blood gas analysis (ABGA) are helpful for differentiating between generalized seizures and syncope in the emergency department (ED). METHODS: Patients over 18 years old who presented to an ED of a tertiary care hospital with a transient loss of consciousness within 4 hours were selected to be in either the seizure (n=166) or syncope groups (n=168). After exclusion for criteria, we used ROC curves to determine AUC, optimal cut-off value, sensitivity, and specificity, depending on time (4 hour, 2 hour, 1 hour and 0.5 hour). We also did multivariate logistic regression. RESULTS: A total of 75 seizure group patients and 78 syncope group patients were studied. There were significant between group differences in total CO2 content, LDH, ammonia, pH, bicarbonate and lactate. AUC (area under the curve) values for blood tests were: 0.720 (tCO2), 0.686 (LDH), 0.737 (ammonia), 0.798 (pH), 0.710 (bicarbonate) and 0.770 (lactate). All AUC values were increased as the time from symptoms to ED arrival was shortened (except for LDH). On multivariate logistic regression analysis, pH (OR=9.587, 95% CI, 2.573-35.723. p=0.001) and ammonia (OR=3.932, 95% CI, 1.324-11.613, p=0.014) were statistically significant independent predictive factors. CONCLUSION: Serum laboratory testing and ABGA, especially serum ammonia and arterial pH, may be helpful for differentiating between generalized seizure and syncope in patients who experience a transient loss of consciousness and who come to the ED within 4 hours after the appearance of symptoms. But further evaluation is needed.
Ammonia ; Area Under Curve ; Bicarbonates ; Blood Gas Analysis ; Diagnosis, Differential ; Emergencies ; Hematologic Tests ; Humans ; Hydrogen-Ion Concentration ; Lactic Acid ; Logistic Models ; ROC Curve ; Seizures ; Sensitivity and Specificity ; Syncope ; Tertiary Healthcare ; Unconsciousness

We examined whether high flux membranes (HF) may induce a greater loss of amino acids compared to low flux membranes (LF). Ten hemodialysis patients participated in this study. Pre- and post-hemodialysis plasma amino acid profiles were measured by reverse-phase high pressure liquid chromatography for both HF and LF. We measured the dialysate amino acid losses during hemodialysis. The reduction difference for plasma total amino acid (TAA), essential amino acid (EAA), and branch chained amino acid (BCAA) was not significantly different in comparisons between the two membranes. (HF vs. LF; TAA 66.85+/-30.56 vs. 53.78+/-41.28, p=0.12; EAA 14.79+/-17.16 vs. 17.97+/-28.69, p=0.12; BCAA 2.21+/-6.08 vs. 4.16+/-10.98 mg/L, p=0.13). For the HF, the reduction in plasma amino acid levels for TAA and EAA were statistically significant. Although it was not statistically significant, the dialysate losses of BCAA were greater than the reduction in plasma (plasma reduction vs. dialysate loss; HF 2.21+/-6.08 vs. 6.58+/-4.32, LF 4.16+/-10.98 vs. 7.96+/-3.25 mg/L). HF with large pores and a sieving coefficient do not influence dialysate amino acid losses. Hemodialysis itself may influence the dialysate amino acid losses and may have an effect on protein metabolism.
Adult ; Aged ; Amino Acids/*blood/chemistry ; Bicarbonates/blood ; Blood Urea Nitrogen ; Chromatography, High Pressure Liquid ; Creatine/blood ; Dialysis Solutions/analysis ; Female ; Humans ; Male ; *Membranes, Artificial ; Middle Aged ; Potassium/blood ; Renal Dialysis/*instrumentation ; Sodium/blood

The effects of vitamin C on ketamine anesthesia was studied. In normal rabbits the onset and duration of ketamine induced anesthesia were 6.0+/-0.5 and 36.0+/-0.9 min, respectively. Pre-treatment of rabbits with 30, 60 and 240 mg/kg, i.m. of vitamin C followed by ketamine 40 mg/ kg i.m. resulted in significant (p<0.05)decrease in the onset and increase in duration of ketamine anesthesia to 5.0 +/-0.06 and 37.0+/-0.7;4.0 +/-0.5 and 39.0*0.6;2.0+/-2.3 and 44.0+/-0.8 min, respectively. There was also significant (p<0.05)decrease in the heart rates in the animals treated with vitamin C and ketamine combinations. Serum analysis showed a significant (p<0.05)increase in blood glucose. The observed decreased in serum calcium and phosphorous following ketamine injection was prevented by pretreatment with vitamin C. These results suggest that vitamin C at higher doses could potentiate ketamine anesthesia in rabbits.
Anesthesia/*veterinary ; Anesthesia, General/*veterinary ; *Anesthetics, Dissociative ; Animals ; Ascorbic Acid/*therapeutic use ; Bicarbonates/blood ; Blood Glucose/drug effects ; Body Temperature/drug effects ; Calcium/blood ; Dose-Response Relationship, Drug ; Female ; Heart Rate/drug effects ; *Ketamine ; Male ; Oxygen/blood ; Premedication/*veterinary ; *Rabbits ; Respiration/drug effects

OBJECTIVETo study the difference of plasma actual bicarbonate between the children with growth hormone deficiency (GHD) and idopathatic short stature (ISS) and to value the plasma bicarbonate standard deviation scores (SDS) in diagnosis of GHD.

METHODSForty-seven short stature children were divided into two groups (GHD and ISS) according to the peak GH response to provocative test. Plasma actual bicarbonate concentrations anion gap (AG), base excess and electrolytes were measured in 47 children with short stature before GH provocative tests.

RESULTSThe mean plasma actual bicarbonate concentrations, bicarbonate SDS were (22.60+/-1.29)mmol/L and -0.27+/-0.98 respectively in GHD children, which were significantly lower than those of ISS children (P<0.01), whereas AG was higher than that of ISS children [(11.73+/-4.52 vs 7.87+/-1.70) mmol/L], P<0.01. Seventy-two percent of patients with bicarbonate SDS

CONCLUSIONPlasma actual bicarbonate concentrations and bicarbonate SDS are lower in patients with GHD than those in patients with idopathatic short stature. Evaluation of plasma bicarbonate SDS of short stature children can predict the probability of GHD, especially when bicarbonate SDS is less than 1 s.

Acid-Base Equilibrium ; Adolescent ; Bicarbonates ; blood ; Child ; Child, Preschool ; Female ; Growth Disorders ; metabolism ; Human Growth Hormone ; deficiency ; Humans ; Male

The effects of epidural anesthesia for normal vaginal delivery on maternal cardiovascular system and boood gas analysis, and newborn umbilical arterial blood gas analysis and Apgar scores were studied in 24 paturients. The paturients were divided into two groups by random sampling, and one group underwent epidurial anesthesia and the other did not. Maternal systolie pressure, heart rate and cardiac output were measured at the time of 4 cm of cervical dilation (preanesthetic), 8 cm of cervical dilation, and immediate postpartum. PH, Pco, Po and bicarbonate levels of maternal atrerial blood were measured at the time of 4 cm and 8 cm of cervical dilation. PH, Pco, Po, and bicarbonate levels of newborn umbilical arterial blood were measured immediately after delivery. One minute and 5 minute Apgar scores of newborn were measured. Systolic blood presssures did not change in both groups. In non-epidural group diastolic and mean blood pressures decreased after delivery. In epidural group its slightly increased at the time of 8 cm of cervical dilation and returned to preanesthetic level after delivery. Heart rate and cardiac output also slightly increased at the time of 8 cm of cervical dilatior. and returned to preanesthetic level after delivery. Maternal pH slightly decreased at the time of 8 cm of cervical dilation in epidural group. Pco2 decreased in both groups, but the rate of decrease was smaller in epidural group. Po increased at the time of 8 cm of cervical dilation in epidural group. Bicarbonate ion level did not changed in both groups. Newborn umbilical arterial blood gas analysis and l minute and 5 minute Apgar scores were not different in both group.
Anesthesia ; Anesthesia, Epidural* ; Bicarbonates ; Blood Gas Analysis ; Cardiac Output ; Cardiovascular System ; Heart Rate ; Humans ; Hydrogen-Ion Concentration ; Infant, Newborn* ; Mothers* ; Postpartum Period