scholarly journals Chloride Balance in Preterm Infants during the First Week of Life

2012 ◽  
Vol 2012 ◽  
pp. 1-7 ◽  
Author(s):  
Silvia Iacobelli ◽  
Elsa Kermorvant-Duchemin ◽  
Francesco Bonsante ◽  
Alexandre Lapillonne ◽  
Jean-Bernard Gouyon
Keyword(s):  
Preterm Infants ◽  
Neurological Outcome ◽  
Chloride Concentration ◽  
High Plasma ◽  
Total Carbon ◽  
Plasma Sodium ◽  
Strong Ion Difference ◽  
Increased Risk ◽  
Plasma Chloride ◽  
High Chloride

Objective. To describe the chloride balance in infants born 25–32-week gestation, analyze the association of chloride changes with hydroelectrolytic status and their relationship with perinatal conditions, morbidities, and neurological outcome.Methods. For 7 days after birth, sodium and chloride balance, plasma potassium, phosphate, and total carbon dioxide (tCO2) were prospectively determined and strong ion difference (SID) calculated. Three multivariate regression analyses were performed to identify factors associated with high plasma chloride concentration, low SID, and low tCO2.Results. 107 infants were studied. Plasma chloride concentration was significantly positively associated with plasma sodium concentration. Higher plasma chloride and lower SID were significantly associated with lower plasma tCO2. Chloride intake was the main independent factor associated with high plasma chloride, low SID, and low plasma tCO2, with lesser contribution of sodium intake and low gestational age (GA). Also, patent ductus arteriosus and birth weight loss were independent factors affecting plasma chloride and SID. Neither high chloride levels nor low SID were associated to impaired neurological outcome.Conclusions. In preterm infants, chloride balance is influenced by GA and by interrelationship between sodium and chloride intake. High chloride levels are associated with metabolic acidosis but not related to increased risk of impaired neurological outcome.

FURTHER OBSERVATIONS ON METABOLIC ALTERATIONS IN THE HYPOTHERMIC RAT

1961 ◽  
Vol 39 (1) ◽  
pp. 1-8 ◽  
Author(s):  
John R. Beaton
Keyword(s):  
Water Content ◽  
Chloride Concentration ◽  
Plasma Potassium ◽  
Inorganic Phosphorus ◽  
Plasma Sodium ◽  
Red Cell ◽  
Metabolic Alterations ◽  
Plasma Chloride ◽  
Sodium And Potassium ◽  
Sodium Plasma

Further observations on metabolic alterations in fasted rats cooled under ice to rectal temperatures approximating 15 °C are reported. In the hypothermic rats, metabolism of injected lactic acid does not appear to be impaired. There is however: increased concentration of inorganic phosphorus in blood but not in liver; increased concentration of glutathione in liver but not in blood; increased plasma chloride concentration; decreased red cell potassium concentration; increased red cell water content; decreased plasma water content. Hypothermia, under these conditions, did not alter concentrations of liver acid-extractable glycogen, red cell sodium, plasma sodium, plasma potassium, nor serum calcium. Administration of urea in saline prior to cooling elevated plasma sodium and potassium concentrations in hypothermic rats. These observations are discussed in relation to previously reported effects of hypothermia on carbohydrate metabolite levels.

Comparison of Point-of-Care Versus  Central Laboratory Measurement of Electrolyte Concentrations on Calculations of the Anion Gap and the Strong Ion Difference

2003 ◽  
Vol 98 (5) ◽  
pp. 1077-1084 ◽  
Author(s):  
Hiroshi Morimatsu ◽  
Jens Rocktäschel ◽  
Rinaldo Bellomo ◽  
Shigehiko Uchino ◽  
Donna Goldsmith ◽  
...  
Keyword(s):  
Point Of Care ◽  
Measurement Techniques ◽  
Chloride Concentration ◽  
Anion Gap ◽  
Plasma Sodium ◽  
Strong Ion Difference ◽  
Blood Gas ◽  
Central Laboratory ◽  
Acid Base ◽  
Chloride Concentrations

Background Clinicians calculate the anion gap (AG) and the strong ion difference (SID) to make acid-base diagnoses. The technology used is assumed to have limited impact. The authors hypothesized that different measurement technologies markedly affect AG and SID values. Methods SID and AG were calculated using values from the point-of-care blood gas and electrolyte analyzer and the central hospital laboratory automated blood biochemistry analyzer. Simultaneously measured plasma sodium, potassium, and chloride concentrations were also compared. Results Mean values for central laboratory and point-of-care plasma sodium concentration were significantly different (140.4 +/- 5.6 vs. 138.3 +/- 5.9 mm; P < 0.0001), as were those for plasma chloride concentration (102.4 +/- 6.5 vs. 103.4 +/- 6.0 mm; P < 0.0001) but not potassium. Mean AG values calculated with the two different measurement techniques differed significantly (17.6 +/- 6.2 mEq/l for central laboratory vs. 14.5 +/- 6.0 mEq/l for point-of-care blood gas analyzer; P < 0.0001). Using the Stewart-Figge methodology, SID values also differed significantly (43.7 +/- 4.8 vs. 40.7 +/- 5.6 mEq/l; P < 0.0001), with mean difference of 3.1 mEq/l (95% limits of agreement, -3.4, 9.5 mEq/l). For 83 patients (27.6%), differences in AG values were as high as 5 mEq/l or more, and for 46% of patients whose AG value was outside the reference range with one technology, a value within normal limits was recorded with the other. Conclusions Results with two different measurement technologies differed significantly for plasma sodium and chloride concentrations. These differences significantly affected the calculated AG and SID values and might lead clinicians to different assessments of acid-base and electrolyte status.

scholarly journals Spurious Hyperchloremia and Negative Anion Gap in a Child with Refractory Epilepsy

2016 ◽  
Vol 2016 ◽  
pp. 1-3
Author(s):  
Madhuradhar Chegondi ◽  
Balagangadhar R. Totapally
Keyword(s):  
Refractory Epilepsy ◽  
Chloride Concentration ◽  
Blood Chemistry ◽  
Anion Gap ◽  
Selective Electrode ◽  
Chloride Level ◽  
Plasma Chloride ◽  
Electrode Method ◽  
High Chloride ◽  
Negative Anion Gap

We report a case with spurious hyperchloremia with negative anion gap in a child who was taking potassium bromide for refractory epilepsy. Blood chemistry showed a high chloride level (171 mEq/L) and a negative anion gap (−52 mEq/L). Plasma chloride concentration is measured by an ion-selective electrode method; however the presence of other anions like bromide and iodides can interfere with chloride level and largely overestimates the chloride concentration. Thus hyperchloremia with a negative anion gap is a clue to the diagnosis of halides like bromide and iodide ingestion.

Acute subtraction alkalosis from gastric juice loss in dogs

1964 ◽  
Vol 207 (3) ◽  
pp. 619-626 ◽  
Author(s):  
Jared J. Grantham ◽  
Paul R. Schloerb
Keyword(s):  
Gastric Juice ◽  
Chloride Concentration ◽  
Plasma Potassium ◽  
Sodium Concentration ◽  
Clinical Syndrome ◽  
Body Water ◽  
Plasma Sodium ◽  
Body Sodium ◽  
Plasma Chloride ◽  
Total Body

The clinical syndrome of acute metabolic alkalosis secondary to pyloric obstruction and vomiting was simulated in 50 dogs by draining gastric juice through a cannula gastrostomy. This study was designed to quantify changes in body electrolyte and water utilizing radioisotope-dilution methods. Total body chloride decreased 43% with good correlation between the decrease in plasma chloride concentration and the decrease in total body chloride. Body sodium decreased 21% with no change in plasma sodium concentration. Body potassium decreased 20% but was not significantly related to the decrease in plasma potassium concentration. A highly significant correlation was obtained between plasma potassium and the product of blood hydrogen and intracellular potassium content. Intracellular pH (DMO) did not change significantly. Body water decreased 16% with isotonic loss of 169 mEq Na + K per liter body water. Sodium chloride solution alone corrected the alkalosis and acidified the urine. Potassium administration was necessary to prevent hypokalemia and aggravation of the cellular potassium deficit during rehydration. This study helps clarify the differences in body composition between the acute alkalosis of gastric juice loss and the alkalosis resulting from prolonged potassium depletion, sodium loading, and excess adrenocorticosteroid administration.

scholarly journals The Risk of Necrotizing Enterocolitis following the Administration of Hyperosmolar Enteral Medications to Extremely Preterm Infants

Neonatology ◽  
2021 ◽  
pp. 1-7
Author(s):  
Faiza Latheef ◽  
Hanna Wahlgren ◽  
Helene Engstrand Lilja ◽  
Barbro Diderholm ◽  
Mattias Paulsson
Keyword(s):  
Clinical Practice ◽  
Preterm Infants ◽  
Necrotizing Enterocolitis ◽  
Neonatal Intensive Care ◽  
Significant Risk ◽  
Quality Register ◽  
Increased Risk ◽  
Extremely Preterm ◽  
Extremely Preterm Infants ◽  
Hyperosmolar Solutions

<b><i>Introduction:</i></b> Necrotizing enterocolitis (NEC) is a disease predominantly affecting preterm infants. The administration of hyperosmolar solutions could lead to the development of NEC. The objective of this study was to measure the osmolality of enteral medications used in clinical practice and to assess the risk of NEC following exposure to hyperosmolar medications. <b><i>Methods:</i></b> A retrospective cohort study in extremely preterm infants (gestational age &#x3c;28 weeks) born between 2010 and 2016 at a tertiary neonatal intensive care unit in Sweden. 465 infants were identified via the Swedish Neonatal Quality register. Data relating to enteral administrations received during a two-week period were collected from the medical records. The osmolalities of medications were measured using an osmometer. Logistic regression was used to calculate the odds ratio of developing NEC. <b><i>Results:</i></b> A total of 253 patients met the inclusion criteria. The osmolalities of 5 commonly used medications significantly exceeded the recommended limit of 450 mOsm/kg set by the American Academy of Paediatrics (AAP). Most patients (94%) received at least one hyperosmolar medication. No significant risk of developing NEC could be found. <b><i>Conclusion:</i></b> The medications used in clinical practice can significantly exceed the limit set by the AAP. This study does not indicate an increased risk of developing NEC in extremely preterm infants following exposure to hyperosmolar medications. Further studies in larger cohorts are needed to determine the specific cut-off level of osmolality in relation to the pathogenesis of NEC.

Women with high plasma levels of PBDE-47 are at increased risk of preterm birth

2020 ◽  
Vol 0 (0) ◽  
Author(s):  
Morgan R. Peltier ◽  
Michael J. Fassett ◽  
Yuko Arita ◽  
Vicki Y. Chiu ◽  
Jiaxiao M. Shi ◽  
...  
Keyword(s):  
Preterm Birth ◽  
Los Angeles ◽  
Polybrominated Diphenyl Ethers ◽  
Flame Retardants ◽  
Plasma Concentrations ◽  
First Trimester ◽  
High Plasma ◽  
Thyroid Stimulating Hormone ◽  
Spontaneous Preterm Birth ◽  
Increased Risk

Abstract Objectives Nearly 100% of North American women have detectable levels of flame retardants such as polybrominated diphenyl ethers (PBDEs) in their plasma. These molecules have structural homology to thyroid hormones and may function as endocrine disruptors. Thyroid dysfunction has previously been associated with increased risk for preterm birth. Therefore, we conducted a multi-center, case-cohort study to evaluate if high plasma concentrations of a common PBDE congener in the first trimester increases the risk of preterm birth and its subtypes. Methods Pregnant women were recruited at the onset of initiation of prenatal care at Kaiser-Permanente Southern California (KPSC)-West Los Angeles and KPSC-San Diego medical centers. Plasma samples from women whose pregnancies ended preterm and random subset of those delivering at term were assayed for PBDE-47 and thyroid-stimulating hormone (TSH) by immunoassay. Quartile cutoffs were calculated for the patients at term and used to determine if women with exposures in the 4th quartile are at increased risk for preterm birth using logistic regression. Results We found that high concentrations of PBDE-47 in the first trimester significantly increased the odds of both indicated (adjusted odds ratio, adjOR=2.35, 95% confidence interval [CI]: 1.31, 4.21) and spontaneous (adjOR=1.76, 95% CI: 1.02, 3.03) preterm birth. Regardless of pregnancy outcome, TSH concentrations did not differ between women with high and low concentrations of PBDE-47. Conclusions These results suggest that high plasma concentrations of PBDE-47 in the first trimester, increases the risk of indicated and spontaneous preterm birth.

scholarly journals Intrauterine Growth Restriction and the Fetal Programming of the Hedonic Response to Sweet Taste in Newborn Infants

2012 ◽  
Vol 2012 ◽  
pp. 1-5 ◽  
Author(s):  
Caroline Ayres ◽  
Marilyn Agranonik ◽  
André Krumel Portella ◽  
Françoise Filion ◽  
Celeste C. Johnston ◽  
...  
Keyword(s):  
Preterm Infants ◽  
Fetal Programming ◽  
Intrauterine Growth Restriction ◽  
Sucrose Solution ◽  
Sweet Taste ◽  
Growth Restriction ◽  
Fetal Life ◽  
Intrauterine Growth ◽  
Sweet Solution ◽  
Increased Risk

Intrauterine growth restriction is associated with increased risk for adult metabolic syndrome and cardiovascular disease, which seems to be related to altered food preferences in these individuals later in life. In this study, we sought to understand whether intrauterine growth leads to fetal programming of the hedonic responses to sweet. Sixteen 1-day-old preterm infants received 24% sucrose solution or water and the taste reactivity was filmed and analyzed. Spearman correlation demonstrated a positive correlation between fetal growth and the hedonic response to the sweet solution in the first 15 seconds after the offer (r=0.864,P=0.001), without correlation when the solution given is water (r=0.314,P=0.455). In fact, the more intense the intrauterine growth restriction, the lower the frequency of the hedonic response observed. IUGR is strongly correlated with the hedonic response to a sweet solution in the first day of life in preterm infants. This is the first evidence in humans to demonstrate that the hedonic response to sweet taste is programmed very early during the fetal life by the degree of intrauterine growth. The altered hedonic response at birth and subsequent differential food preference may contribute to the increased risk of obesity and related disorders in adulthood in intrauterine growth-restricted individuals.

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