scholarly journals Opiate Withdrawal Complicated by Tetany and Cardiac Arrest

2014 ◽  
Vol 2014 ◽  
pp. 1-4
Author(s):  
Irfanali R. Kugasia ◽  
Nehad Shabarek
Keyword(s):  
Cardiac Arrest ◽  
Withdrawal Symptom ◽  
Respiratory Alkalosis ◽  
Withdrawal Symptoms ◽  
Opiate Withdrawal ◽  
Acid Base ◽  
Severe Withdrawal ◽  
Base Disorder ◽  
Life Threatening ◽  
Acid Base Status

Patients with symptoms of opiate withdrawal, after the administration of opiate antagonist by paramedics, are a common presentation in the emergency department of hospitals. Though most of opiate withdrawal symptoms are benign, rarely they can become life threatening. This case highlights how a benign opiate withdrawal symptom of hyperventilation led to severe respiratory alkalosis that degenerated into tetany and cardiac arrest. Though this patient was successfully resuscitated, it is imperative that severe withdrawal symptoms are timely identified and immediate steps are taken to prevent catastrophes. An easier way to reverse the severe opiate withdrawal symptom would be with either low dose methadone or partial opiate agonists like buprenorphine. However, if severe acid-base disorder is identified, it would be safer to electively intubate these patients for better control of their respiratory and acid-base status.

Influence of chronic respiratory acid-base disorders on acute CO2 titration curve

1985 ◽  
Vol 58 (4) ◽  
pp. 1231-1238 ◽  
Author(s):  
H. J. Adrogue ◽  
N. E. Madias
Keyword(s):  
Titration Curve ◽  
Respiratory Acidosis ◽  
Respiratory Alkalosis ◽  
Ion Concentration ◽  
Whole Body ◽  
Acid Base ◽  
Hydrogen Ion Concentration ◽  
Plasma Bicarbonate ◽  
Base Disorder ◽  
Acid Base Status

We have recently shown that background presence of chronic metabolic acid-base disorder markedly alters in vivo acute CO2 titration curve. These studies were carried out to assess the influence of chronic respiratory acid-base disorders on response to acute hypercapnia and to explore whether the chronic level of plasma pH is the factor responsible for alterations in the CO2 titration curve. We compared whole-body responses to acute hypercapnia of dogs with preexisting chronic respiratory alkalosis (n = 8) with that of normal animals (n = 4) and animals with chronic respiratory acidosis (n = 13). Chronic respiratory alkalosis and acidosis, as well as the acute CO2 titrations, were produced in unanesthetized dogs within a large environmental chamber. For comparison with our data on chronic metabolic acidosis and alkalosis, plasma bicarbonate levels, which are secondarily altered in chronic respiratory acid-base disorders, were used as an index of chronic acid-base status of the animals. Results indicate that, as with chronic metabolic acid-base disorders, a larger increment in plasma bicarbonate occurs during acute hypercapnia when steady-state plasma bicarbonate is low (respiratory alkalosis) than when it is high (respiratory acidosis). Yet, in further analogy with the metabolic studies, plasma hydrogen ion concentration is better defended at higher plasma bicarbonate levels in accordance with mathematical relationships defined by the Henderson-Hasselbalch equation. Combined results demonstrate that the influence of chronic acid-base status on whole-body response to acute hypercapnia is independent of initial plasma pH.

Intralipid and haemodialysis in caffeine overdose

2020 ◽  
Vol 13 (5) ◽  
pp. e234256
Author(s):  
Rebecca Harsten ◽  
Simon John Tetlow ◽  
Torbert Chan ◽  
Akshaya Ankuli
Keyword(s):  
Lethal Dose ◽  
Respiratory Alkalosis ◽  
Polymorphic Ventricular Tachycardia ◽  
Acid Base ◽  
Caffeine Concentration ◽  
Intentional Ingestion ◽  
Life Threatening ◽  
Acid Base Status ◽  
Caffeine Overdose ◽  
Viable Treatment

A 26-year-old woman presented after an intentional ingestion of 20 g of caffeine. She suffered a profound respiratory alkalosis with metabolic acidosis, hypokalaemia and sustained polymorphic ventricular tachycardia. She was treated with intravenous intralipid and haemodialysis, and her arrhythmia was controlled using magnesium sulphate. Once invasively ventilated and unable to hyperventilate the patient became acidotic and required intravenous bicarbonate to correct her acid–base status. Two days following the overdose the patient was extubated, haemodialysis was stopped and norepinephrine was weaned off. The patient was discharged after a further 7 days. Serial caffeine levels were taken during this patient’s care; the highest measured caffeine concentration 7 hours after ingestion was 147.1 mg/L. The known lethal dose of caffeine is 80 mg/L. Intralipid and haemodialysis represent a new and viable treatment in life-threatening caffeine overdose. Intravenous magnesium may terminate unstable arrhythmias in caffeine-poisoned patients.

Studies on the Pathophysiology of Encephalopathy in Reye's Syndrome: Hyperammonemia in Reye's Syndrome

PEDIATRICS ◽  
1975 ◽  
Vol 56 (6) ◽  
pp. 999-1004
Author(s):  
Daniel C. Shannon ◽  
Robert De Long ◽  
Barry Bercu ◽  
Thomas Glick ◽  
John T. Herrin ◽  
...  
Keyword(s):  
Metabolic Acidosis ◽  
Venous Drainage ◽  
Respiratory Alkalosis ◽  
Ammonia Concentration ◽  
Reye's Syndrome ◽  
Acid Base ◽  
Arterial Blood ◽  
Cerebral Venous Drainage ◽  
Acid Base Status ◽  
The Brain

The initial acid-base status of eight survivors of Reye's syndrome was characterized by acute respiratory alkalosis (Pco2=32 mm Hg; Hco3-= 22.0 mEq/liter) while that of eight children who died was associated with metabolic acidosis as well (HCO3-=10.0 mEq/liter). Arterialinternal jugular venous ammonia concentration differences on day 1 (299 mg/100 ml) and day 2 (90 mg/ 100 ml) reflected cerebral uptake of ammonia while those on days 3 and 4 (-43 and -55 mg/100 ml) demonstrated cerebral release. Arterial blood hyperammonemia can be detoxified safely in the brain as long as the levels do not exceed approximately 300µg/100 ml. Beyond that level lactic acidosis is observed, particularly in cerebral venous drainage. Arterial blood hyperammonemia was also related to the extent of alveolar hyperventilation. These findings are very similar to those seen in experimental hyperammonemia and support the concept that neurotoxicity in children with Reye's syndrome is at least partly due to impaired oxidative metabolism secondary to hyperammonemia.

scholarly journals Metabolic and volume status evaluation of hemodialysis patients with and without residual renal function in the long interdialytic interval

2019 ◽  
Vol 41 (4) ◽  
pp. 481-491 ◽  
Author(s):  
Lenina Ludimila Sampaio de Almeida ◽  
Luís Henrique Bezerra Cavalanti Sette ◽  
Fernando Luiz Affonso Fonseca ◽  
Leila Silveira Vieira da Silva Bezerra ◽  
Francisco Hélio Oliveira Júnior ◽  
...  
Keyword(s):  
Renal Function ◽  
Serum Potassium ◽  
Ph Value ◽  
Residual Renal Function ◽  
Acid Base ◽  
Serum Samples ◽  
Cross Sectional ◽  
Interdialytic Weight Gain ◽  
Base Disorder ◽  
Acid Base Status

Abstract Introduction: It is unclear whether residual renal function (RRF) in dialysis patients can attenuate the metabolic impact of the long 68-hour interdialytic interval, in which water, acid, and electrolyte accumulation occurs. Objective: to evaluate serum electrolyte levels, water balance, and acid-base status in dialytic patients with and without RRF over the long interdialytic interval (LII). Methodology: this was a single-center, cross-sectional, and analytical study that compared patients with and without RRF, defined by diuresis above 200 mL in 24 hours. Patients were weighed and serum samples were collected for biochemical and gasometric analysis at the beginning and at the end of the LII. Results: 27 and 24 patients with and without RRF were evaluated, respectively. Patients without RRF had a higher increase in serum potassium during the LII (2.67 x 1.14 mEq/L, p < 0.001), reaching higher values at the end of the study (6.8 x 5.72 mEq/L, p < 0.001) and lower pH value at the beginning of the interval (7.40 x 7.43, p = 0.018). More patients with serum bicarbonate < 18 mEq/L (50 x 14.8%, p = 0.007) and mixed acid-base disorder (57.7 x 29.2%, p = 0.042), as well as greater interdialytic weight gain (14.67 x 8.87 mL/kg/h, p < 0.001) and lower natremia (137 x 139 mEq/L, p = 0.02) at the end of the interval. Calcemia and phosphatemia were not different between the groups. Conclusion: Patients with RRF had better control of serum potassium, sodium, acid-base status, and volemia throughout the LII.

Teaching acid/base physiology in the laboratory

2010 ◽  
Vol 34 (4) ◽  
pp. 233-238 ◽  
Author(s):  
Ulla G. Friis ◽  
Ronni Plovsing ◽  
Klaus Hansen ◽  
Bent G. Laursen ◽  
Birgitta Wallstedt
Keyword(s):  
Metabolic Acidosis ◽  
Medical Students ◽  
Respiratory Alkalosis ◽  
Theory And Practice ◽  
Single Group ◽  
Acid Base ◽  
Laboratory Exercise ◽  
Base Disorder

Acid/base homeostasis is one of the most difficult subdisciplines of physiology for medical students to master. A different approach, where theory and practice are linked, might help students develop a deeper understanding of acid/base homeostasis. We therefore set out to develop a laboratory exercise in acid/base physiology that would provide students with unambiguous and reproducible data that clearly would illustrate the theory in practice. The laboratory exercise was developed to include both metabolic acidosis and respiratory alkalosis. Data were collected from 56 groups of medical students that had participated in this laboratory exercise. The acquired data showed very consistent and solid findings after the development of both metabolic acidosis and respiratory alkalosis. All results were consistent with the appropriate diagnosis of the acid/base disorder. Not one single group failed to obtain data that were compatible with the diagnosis; it was only the degree of acidosis/alkalosis and compensation that varied.

scholarly journals Effects of Environmental Heat and Intake of Tall Fescue Seed Infested with Acremonium Coenophialum on the Acid-Base Status of Young Bulls

1996 ◽  
Vol 8 (2) ◽  
pp. 233-237 ◽  
Author(s):  
L. L. Mills Wallace ◽  
D. W. Vogt ◽  
R. J. Lipsey ◽  
G. B. Gamer ◽  
C. N. Cornell
Keyword(s):  
Heat Stress ◽  
Tall Fescue ◽  
Festuca Arundinacea ◽  
Environmental Temperature ◽  
Respiratory Alkalosis ◽  
Acremonium Coenophialum ◽  
Acid Base ◽  
Arterial Blood ◽  
Metabolic Compensation ◽  
Acid Base Status

Effects of high environmental temperature and dietary intake of tall fescue ( Festuca arundinacea) seed containing the endophyte Acremonium coenophialum on bovine acid-base status were studied using 3 groups of bull calves (2 Simmental, 1 Angus). Experimental animals were housed in controlled-climate chambers and subjected to gradual increases in environmental temperature, first while being fed an endophyte-free diet and then while being fed a diet containing 17% endophyte-infested fescue seed. Marked acid-base disturbances were not observed in any animals. In general, Pco2, HCO3-, base excess, and arterial blood pH values were reduced in response to heat stress, both with endophyte-free and endophyte-containing diets. In most individuals anion gap increased. These results reflected metabolic compensation for mild chronic alveolar hyperventilation and retention of organic acids. These findings suggest that, under conditions similar to those found during the summer in central Missouri, normal cattle should not be at great risk of developing respiratory alkalosis or other severe acid-base disturbances as a result of heat stress and/or intake of tall fescue endophyte.

scholarly journals Acid based disorders in intensive care unit: a hospital-based study

2019 ◽  
Vol 6 (1) ◽  
pp. 62 ◽  
Author(s):  
Babu Rajendran ◽  
Seetha Rami Reddy Mallampati ◽  
Sheju Jonathan Jha J.
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Metabolic Acidosis ◽  
Infectious Diseases ◽  
Respiratory Alkalosis ◽  
Simple Type ◽  
Acid Base ◽  
Icu Patients ◽  
Mixed Acid ◽  
Base Disorder

Background: Acid base disorders are common in the ICU patients and pose a great burden in the management of the underlying condition.Methods: Identifying the type of acid-base disorders in ICU patients using arterial blood gas analysis This was a retrospective case-controlled comparative study. 46 patients in intensive care unit of a reputed institution and comparing the type of acid-base disorder amongst infectious (10) and non-infectious (36) diseases.Results: Of the study population, 70% had mixed acid base disorders and 30% had simple type of acid base disorders. It was found that sepsis is associated with mixed type of acid-base disorders with most common being metabolic acidosis with respiratory alkalosis. Non-infectious diseases were mostly associated with metabolic alkalosis with respiratory acidosis. Analysis of individual acid base disorders revealed metabolic acidosis as the most common disturbance.Conclusions: These results projected the probability of acid bases disorders in various conditions and help in the efficient management. Mixed acid base disorders are the most common disturbances in the intensive care setup which is metabolic acidosis with respiratory alkalosis in infectious diseases and metabolic acidosis is the most common simple type of acid base disorder.

Arterial blood gases and acid-base status of dogs during graded dynamic exercise

1986 ◽  
Vol 61 (5) ◽  
pp. 1914-1919 ◽  
Author(s):  
T. I. Musch ◽  
D. B. Friedman ◽  
G. C. Haidet ◽  
J. Stray-Gundersen ◽  
T. G. Waldrop ◽  
...  
Keyword(s):  
Steady State ◽  
Blood Gases ◽  
Respiratory Alkalosis ◽  
Submaximal Exercise ◽  
O2 Consumption ◽  
Arterial Blood Gases ◽  
Acid Base ◽  
Vo2 Max ◽  
Arterial Blood ◽  
Acid Base Status

The objective of this study was to determine whether arterial PCO2 (PaCO2) decreases or remains unchanged from resting levels during mild to moderate steady-state exercise in the dog. To accomplish this, O2 consumption (VO2) arterial blood gases and acid-base status, arterial lactate concentration ([LA-]a), and rectal temperature (Tr) were measured in 27 chronically instrumented dogs at rest, during different levels of submaximal exercise, and during maximal exercise on a motor-driven treadmill. During mild exercise [35% of maximal O2 consumption (VO2 max)], PaCO2 decreased 5.3 +/- 0.4 Torr and resulted in a respiratory alkalosis (delta pHa = +0.029 +/- 0.005). Arterial PO2 (PaO2) increased 5.9 +/- 1.5 Torr and Tr increased 0.5 +/- 0.1 degree C. As the exercise levels progressed from mild to moderate exercise (64% of VO2 max) the magnitude of the hypocapnia and the resultant respiratory alkalosis remained unchanged as PaCO2 remained 5.9 +/- 0.7 Torr below and delta pHa remained 0.029 +/- 0.008 above resting values. When the exercise work rate was increased to elicit VO2 max (96 +/- 2 ml X kg-1 X min-1) the amount of hypocapnia again remained unchanged from submaximal exercise levels and PaCO2 remained 6.0 +/- 0.6 Torr below resting values; however, this response occurred despite continued increases in Tr (delta Tr = 1.7 +/- 0.1 degree C), significant increases in [LA-]a (delta [LA-]a = 2.5 +/- 0.4), and a resultant metabolic acidosis (delta pHa = -0.031 +/- 0.011). The dog, like other nonhuman vertebrates, responded to mild and moderate steady-state exercise with a significant hyperventilation and respiratory alkalosis.(ABSTRACT TRUNCATED AT 250 WORDS)

Iatrogenic Opiate Withdrawal in Pediatric Patients: Implementation of a Standardized Methadone Weaning Protocol and Withdrawal Assessment Tool

2019 ◽  
pp. 089719001987561 ◽  
Author(s):  
Ryan A. Walters ◽  
Michael Izquierdo ◽  
Juan Carlos Rodriguez ◽  
Joanie Spiro Stevens ◽  
Gerald Lavandosky
Keyword(s):  
Withdrawal Symptom ◽  
Pediatric Patients ◽  
Assessment Tool ◽  
Demographic Data ◽  
Total Duration ◽  
Interquartile Range ◽  
Withdrawal Symptoms ◽  
Opiate Withdrawal ◽  
Methadone Dose ◽  
Scoring Tool

Methadone is frequently used to prevent withdrawal symptoms secondary to intended therapeutic opiate exposure. Absence of a standardized dose weaning strategy potentially results in increased exposure to narcotics and/or withdrawal symptoms. We sought to quantify the effect of implementing a standardized methadone weaning protocol and withdrawal assessment tool on methadone exposure and opiate withdrawal in pediatric patients receiving 5 or more days of continuous morphine or fentanyl infusions. The preintervention phase included patients weaned off of opiate infusions before implementation of a standardized weaning protocol and withdrawal symptom scoring tool. Patients in the postintervention phase were started on a standardized methadone wean based on total duration and dose of continuous opiate infusion exposure in the 24 hours preceding methadone initiation. Patients received either a 5- or 10-day wean, with the total daily methadone dose reduced by 20% daily or every other day, respectively. Patients in the postintervention phase were monitored for withdrawal using the withdrawal assessment tool (WAT-1). Postintervention patients were compared to preintervention patients treated with methadone. Total methadone duration decreased significantly from a median of 17 (13-22 interquartile range [IQR]) to 5 (5-10 IQR) days ( P = .00001) after implementation of the methadone weaning protocol. Number of morphine boluses administered increased from a median of 3 (0-6 IQR) to 4 (0-5 IQR) doses per patient ( P = .45). Demographic data were similar between both groups. Patients in the postintervention phase had significant reductions in methadone exposure after implementation of a standardized methadone weaning protocol and assessment tool.

scholarly journals Life-threatening metabolic alkalosis in Pendred syndrome

2011 ◽  
Vol 165 (1) ◽  
pp. 167-170 ◽  
Author(s):  
Narayanan Kandasamy ◽  
Laura Fugazzola ◽  
Mark Evans ◽  
Krishna Chatterjee ◽  
Fiona Karet
Keyword(s):  
Metabolic Alkalosis ◽  
Collecting Duct ◽  
Sensorineural Deafness ◽  
Apical Plasma Membrane ◽  
Cortical Collecting Duct ◽  
Loss Of Function ◽  
Pendred Syndrome ◽  
Acid Base ◽  
Life Threatening ◽  
Acid Base Status

IntroductionPendred syndrome, a combination of sensorineural deafness, impaired organification of iodide in the thyroid and goitre, results from biallelic defects in pendrin (encoded by SLC26A4), which transports chloride and iodide in the inner ear and thyroid respectively. Recently, pendrin has also been identified in the kidneys, where it is found in the apical plasma membrane of non-α-type intercalated cells of the cortical collecting duct. Here, it functions as a chloride–bicarbonate exchanger, capable of secreting bicarbonate into the urine. Despite this function, patients with Pendred syndrome have not been reported to develop any significant acid–base disturbances, except a single previous reported case of metabolic alkalosis in the context of Pendred syndrome in a child started on a diuretic.Case reportWe describe a 46-year-old female with sensorineural deafness and hypothyroidism, who presented with severe hypokalaemic metabolic alkalosis during inter-current illnesses on two occasions, and who was found to be homozygous for a loss-of-function mutation (V138F) in SLC26A4. Her acid–base status and electrolytes were unremarkable when she was well.ConclusionThis case illustrates that, although pendrin is not usually required to maintain acid–base homeostasis under ambient condition, loss of renal bicarbonate excretion by pendrin during a metabolic alkalotic challenge may contribute to life-threatening acid–base disturbances in patients with Pendred syndrome.

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