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B J Materson

Publications and source records attributed to B J Materson.

97 records · Page 6Linked to original sources
PubMedDate not supplied

The anion gap of patients receiving bicarbonate maintenance hemodialysis.

To compare the effect of maintenance bicarbonate hemodialysis on the serum anion gap (AG) and the serum HCO3, the authors retrospectively evaluated the data of 28 patients using the first-of-the-month blood chemistries. Data were available for at least 9 of the previous 12 months in each case. For the entire group, the average AG was 15.8 +/- 0.1 mEq/L and the HCO3 21.7 +/- 0.2 mEq/L. Comparing these values with the data compiled recently by three different groups of investigators in undialyzed patients with severe chronic renal failure indicates that the AG of the dialyzed patients was similar to that of untreated patients, but the HCO3 levels of dialyzed patients averaged 2 to 3 mEq/L higher. Separate prospective evaluation of the acute effect of two consecutive bicarbonate dialyses in 31 patients revealed that the average acute (immediate postdialysis) decrease (from predialysis values) in AG was only about 40% of that of the increase in HCO3. The authors conclude that bicarbonate dialysis is more effective in improving serum HCO3 than AG.

Acid-Base Equilibrium↗
PubMedDate not supplied

Metabolic alkalosis induced by regional citrate hemodialysis.

Two patients are described in whom regional citrate dialysis (RCD) and induced metabolic alkalosis with marked increases in serum HCO3, which were sustained during the period of repeated treatments. As currently employed, RCD of necessity delivers large amounts of potential bicarbonate (several hundred mEq) to the patient and may cause severe metabolic alkalosis. Studies should be carried out to determine an effective method to avoid this complication whenever repeated RCD is necessary or is used in patients with pre-existing alkalosis.

Adult↗
PubMedDate not supplied

[The cost of quality assurance].

This paper views quality assurance costs as appraisal costs. We used cost accounting techniques to estimate the cost of quality assurance activities in a large university affiliated Veteran Administration Medical Center. In addition to the personnel employed full-time for quality assurance activities, all other employees in or directly in support of clinical services were interviewed in order to determine the per cent of their work time devoted to specific quality assurance activities. The per cent time committed was multiplied by the salary and benefits package for each employee and the total computed for the facility. In addition, non-salary overhead expenses were estimated by multiplying the salary and fringe benefit costs to the ratio of total medical center non-personnel costs to total medical center costs. We found that 3.39 per cent of the total budget or $4,884,775 was devoted to quality assurance activities. The highest costs aside from the designated quality assurance personnel were for pharmacy, Laboratory, extended care (including nursing home), psychiatry, and nursing services. We did not attempt a formal benefit analysis. We concluded that quality assurance activities in a major medical center are not free. Careful cost accounting studies should be performed both to determine the cost of quality assurance and to identify its specific benefits.

Costs and Cost Analysis↗
PubMedDate not supplied

Acetaminophen-related acute renal failure without fulminant liver failure.

BACKGROUND: Our patient experienced acute renal failure but not fulminant hepatic failure from acetaminophen toxicity. OBJECTIVE: To review the clinical and laboratory characteristics of similar cases of acetaminophen nephrotoxicity. METHODS: A MEDLINE search and medical record search at two large teaching hospitals. RESULTS: We reviewed our index case, a patient at Jackson Memorial Hospital, and 34 additional patients with acetaminophen nephrotoxicity reported in the literature. Oliguria was present in 23 of 31 patients. There was no difference in peak serum creatinine levels between patients treated with N-acetylcysteine and those not treated. The onset of acute renal failure was from 2-5 days after overdose, and peak serum creatinine levels occurred 3-16 days (average 7.3 days) after overdose. Thirteen patients required hemodialysis; all but one were oliguric. Renal failure was spontaneously reversible in all patients. CONCLUSION: Although uncommon, it is possible to have acute renal failure due to acetaminophen toxicity in the absence of fulminant hepatic failure.

Acetaminophen↗