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PubMed1979

Side-effects at phlebography with ionized and non-ionized contrast medium.

In two studies 267 consecutive patients with suspected venous thrombosis were examined 125I-fibrinogen uptake test at phebography. In 161 patients meglumine metrizoate (Isopaque Cerebral) and in 106 patients metrizamide (Amipaque) was used as contrast medium. The quality of the examinations was equal in the two groups. During the examinations most of the patients examined with meglumine metrizoate had symptoms from the calf described as a cramp-like pain. Only few of the patients examined with metrizamide had such symptoms. In the two groups 47 patients examined with meglumine metrizoate and 41 examined with metrizamide had normal phlebography as well as initially normal 125I-fibrinogen uptake test. After phlebography, 29 of the patients in the first group had a significant rise in fibrinogen uptake while such a rise was not found in patients from the second group. Rephlebography showed fresh deep vein thrombosis in 7 out of 9 patients examined with meglumine metrizoate indicating that thrombosis could be provoked in as many as about half the patients with this high osmolar contrast medium. We have now used metrizamide in about 400 patients without any side-effects.

Humans↗
PubMed1991

Hemodynamic instability after the initiation of extracorporeal membrane oxygenation: role of ionized calcium.

OBJECTIVES: To prospectively document the occurrence of ionized hypocalcemia in infants and children treated with extracorporeal membrane oxygenation (ECMO), to determine if the type of calcium salt (calcium chloride or gluconate) used in priming the ECMO circuit affected ionized calcium, to determine if ionized calcium concentrations correlate with total calcium, protein, albumin, or total magnesium values, and to determine if the hypotension usually observed after ECMO initiation correlates with low circulating ionized calcium concentrations. DESIGN: Prospective study. SETTING: Pediatric ICU and neonatal ICU. PATIENTS: Sixteen neonatal and three pediatric patients who were started on ECMO for cardiopulmonary support. INTERVENTIONS: The ECMO circuit was primed in a standardized manner, 100 mg of calcium gluconate was added in group 1 patients and 100 mg of calcium chloride was added in group 2 patients. MEASUREMENTS: Ionized calcium was measured from the circuit before initiation of ECMO and from the patient before, and then 5, 10, 15, 30, 60, 120, and 240 mins after initiation of ECMO. Total calcium and ionized calcium concentrations were measured simultaneously every 6 hrs. Serum total protein, albumin, magnesium, and ionized calcium values were measured from blood samples collected simultaneously twice daily. RESULTS: A significant decrease in the mean serum ionized calcium value occurred 5 mins after the initiation of ECMO in both groups, p less than .001. The ionized calcium value remained significantly decreased until 30 mins after the initiation of ECMO. There were no differences between the ionized calcium concentrations obtained during priming with calcium gluconate vs. those concentrations obtained with calcium chloride priming (p = .79). Throughout the course of ECMO, the serum ionized calcium concentrations ranged from 0.60 to 1.86 mmol/L. Poor correlations existed between circulating ionized calcium values and total calcium (r2 = .30), total protein (r2 = .20), albumin (r2 = .20), and magnesium concentrations (r2 = .10). There was a good correlation between the patients' BP and ionized calcium concentrations after bypass was initiated (r2 = .87). CONCLUSION: Our data demonstrate that ionized hypocalcemia is a frequent occurrence after the initiation of ECMO. Since there is a poor correlation between ionized calcium and total calcium, ionized calcium concentrations should be measured directly in these patients.

Blood Pressure↗
PubMed1998

Intravenous correction of neonatal hypomagnesemia: effect on ionized magnesium.

OBJECTIVES: Neonatal hypomagnesemia is defined as total magnesium (TMg) < or = 0.65 mmol/L (1.6 mg/dl). However, magnesium (Mg) deficiency and sufficiency overlap at serum values of 0.57 to 0.74 mmol/L (1.4 to 1.8 mg/dl). We hypothesized that (1) some infants with TMg < or = 0.65 mmol/L (1.6 mg/dl) have normal ionized Mg values (normal neonatal range 0.40 to 0.56 mmol/L (0.97 to 1.36 mg/dl)); (2) the dose (6.0 mg of elemental Mg/kg) used to correct hypomagnesemia does not lead to elevation of ionized Mg; (3) after intravenous magnesium sulfate infusion, ionized calcium increases in patients with low baseline ionized Mg and decreases in patients with normal baseline ionized Mg. STUDY DESIGN: We recruited 22 neonates with TMg < or = 1.6 mg/dl. They received intravenous sulfate (6 mg elemental Mg/kg) over a 1-hour period. Serum TMg, ionized Mg, and ionized Ca were measured before and after magnesium sulfate infusion. An ion-selective electrode was used to allow direct measurement of ionized Mg and ionized Ca. RESULTS: Thirteen (59%) of 22 neonates with TMg < or = 0.65 mmol/L (1.6 mg/dl) had normal IMg. In 7 (31%) of 22 cases ionized Mg increased slightly above 0.56 mmol/L (1.36 mg/dl); the maximum value was 0.61 mmol/L (1.48 mg/dl). The change in ionized Ca concentrations and the baseline ionized Mg value were inversely correlated (r = -0.79; p < 0.0001). CONCLUSIONS: (1) Measurement of ionized Mg should prevent overdiagnosis and treatment of hypomagnesemia. (2) The dose used in this study is safe. (3) Ionized Mg concentrations are inversely correlated to the response of ionized Ca concentrations to an Mg load.

Calcium↗
PubMed1993

Ionized and total magnesium levels in cyclosporin-treated renal transplant recipients: relationship with cholesterol and cyclosporin levels.

1. Ionized magnesium, measured using a newly developed ion-selective electrode, total magnesium, and ionized and total calcium were evaluated in 39 stable, long-term, cyclosporin-treated renal transplant recipients and compared with those of age-matched, non-transplanted control subjects. Total cholesterol, cyclosporin trough level, serum creatinine, time after-transplant and the ratio of ionized calcium to ionized magnesium were also measured in renal transplant recipients and the relationships between these variables and ionized and total magnesium were evaluated. 2. Renal transplant recipients exhibited marked deficits in ionized magnesium, with a mean value of 0.54 +/- 0.01 mmol/l as compared with 0.61 +/- 0.006 mmol/l for normal control subjects (P < or = 0.05), with a more moderate deficit in total magnesium. Values for ionized and total calcium did not differ. By stepwise linear multiple regression analysis, ionized magnesium was significantly related to cyclosporin trough level and total cholesterol but not to serum creatinine, time after transplant or the dose of cyclosporin. Ionized magnesium correlated inversely with cyclosporin trough level and directly with total cholesterol. The ratio of ionized calcium to ionized magnesium was elevated in renal transplant recipients when compared with control subjects and correlated positively with the cyclosporin trough level. 3. Deficits in ionized magnesium are common during the late post-transplant period in cyclosporin-treated renal transplant recipients. Ionized magnesium may be a more sensitive clinical parameter than total magnesium in this population, in whom total magnesium may be only mildly decreased in the setting of a severe deficit in ionized magnesium. 4. Ionized magnesium correlates with the cyclosporin level.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed2004

Electron and nuclear dynamics of molecular clusters in ultraintense laser fields. II. Electron dynamics and outer ionization of the nanoplasma.

We explore electron dynamics in molecular (CD4)(1061) clusters and elemental Xen (n=249-2171) clusters, responding to ultraintense (intensity I=10(16)-10(19) W cm(-2)) laser fields. Molecular dynamics simulations (including magnetic field and relativistic effects) and analyses of high-energy electron dynamics and nuclear ion dynamics in a cluster interacting with a Gaussian shaped laser field (frequency 0.35 fs(-1), photon energy 1.44 eV, phase 0, temporal width 25 fs) elucidated the time dependence of inner ionization, the formation of a nanoplasma of unbound electrons within the cluster or its vicinity, and of outer ionization. We determined the cluster size and the laser intensity dependence of these three sequential-parallel electronic processes. The characteristic times for cluster inner ionization (tau(ii)) and for outer ionization (tau(oi)) fall in the femtosecond time domain, i.e., tau(ii)=2-9 fs and tau(oi)=4-15 fs for (CD4)(1061), tau(ii)=7-30 fs and tau(oi)=5-13 fs for Xe(n) (n=479,1061), with both tau(ii) and tau(oi) decreasing with increasing I, in accord with the barrier suppression ionization mechanism for inner ionization of the constituents and the cluster barrier suppression ionization mechanism for outer ionization. The positive delay times Deltatau(OI) between outer and inner ionization (e.g., Deltatau(OI)=6.5 fs for Xen at I=10(16) W cm(-2) and Deltatau(OI)=0.2 fs for (CD4)(1061) at I=10(19) W cm(-2)) demonstrate that the outer/inner ionization processes are sequential. For (CD4)(1061), tau(ii) tau(oi), reflecting on the energetic hierarchy in the ionization of the Xe atoms. Quasiresonance contributions to the outer ionization of the nanoplasma were established, as manifested in the temporal oscillations in the inner/outer ionization levels, and in the center of mass of the nanoplasma electrons. The formation characteristics, dynamics, and response of the nanoplasma in molecular or elemental clusters were addressed. The nanoplasma is positively charged, with a high-average electron density [rho(P)=(2-3)10(22) cm(-3)], being characterized by high-average electron energies epsilon(av) (e.g., in Xe(1061) clusters epsilon(av)=54 eV at I=10(16) W cm(-2) and epsilon(av)=0.56-0.37 keV at I=10(18) W cm(-2), with epsilon(av) proportional, variant I(1/2)). Beyond the cluster boundary the average electron energy markedly increases, reaching electron energies in the range of 1.2-40 keV for outer ionization of Xe(n) (n=249-2171) clusters. The nanoplasma exhibits spatial inhomogeneity and angular anisotropy induced by the laser field. Femtosecond time scales are predicted for the nanoplasma production (rise times 7-3 fs), for the decay (decay times approximately 5 fs), and for the persistence time (30-10 fs) of a transient nanoplasma at I=10(17)-10(18) W cm(-2). At lower intensities of I=10(16) W cm(-2) a persistent nanoplasma with a "long" lifetime of > 50 fs will prevail.

Journal Article↗
PubMed1985

Shifts in the apparent ionization constant of the carboxylic acid groups of gelatin.

Titration data of Type B gelatin were used to investigate shifts of the apparent ionization constant of the carboxylic acid groups caused by changes in the degree of ionization or net molecular charge and in ionic strength. The intrinsic ionization constant was estimated by comparison between titrations in water and in 0.10 molal NaCl. This estimated value of the carboxylic acid groups of gelatin was comparable to those reported for the carboxylic acid groups of poly(acrylic acid) and of a polyampholyte based on methacrylic acid. Neighboring cationic groups of the gelatin molecule assist in the removal of the proton from a carboxylic acid group by electrostatic repulsion while neighboring carboxylate ions hinder the ionization by electrostatic attraction of the proton. These interactions result in a negative or positive electrostatic free energy of ionization, respectively. This excess free energy was calculated by two analogous procedures, from the difference between the apparent and intrinsic ionization constants, and from the slope of a plot of the apparent ionization constant versus net molecular charge. These two methods of calculation gave comparable values for gelatin. Maximum values for the electrostatic free energy of ionization, determined at nearly complete ionization, were of the same order of magnitude for gelatin and for the synthetic polyampholyte. They were an order of magnitude larger for poly(acrylic acid) due to the lack of cationic groups. Addition of 0.10 molal NaCl shifted the apparent ionization constant of the carboxylic acid groups of gelatin toward their intrinsic ionization constant and reduced the absolute value of the electrostatic free energy of ionization compared to its values in water at comparable degrees of ionization.

Carboxylic Acids↗
PubMed2004

Electron and nuclear dynamics of molecular clusters in ultraintense laser fields. I. Extreme multielectron ionization.

In this paper we present a theoretical and computational study of extreme multielectron ionization (involving the stripping of all the electrons from light, first-row atoms, and the production of heavily charged ions, e.g., Xe(+q) (q< or =36) from heavy atoms) in elemental and molecular clusters of Xe(n),(D(2))(n), and (CD(4))(n) (n=55-1061) in ultraintense (intensity I=10(15)-10(19) W cm(-2)) laser fields. Single atom or molecule multielectron ionization can be adequately described by the semiclassical barrier suppression ionization (BSI) mechanism. Extreme cluster multielectron ionization is distinct from that of a single atomic or molecular species in terms of the mechanisms, the ionization level and the time scales for electron dynamics and for nuclear motion. The novel compound mechanism of cluster multielectron ionization, which applies when the cluster size (radius R(0)) considerably exceeds the barrier distance for the BSI of a single constituent, involves a sequential-parallel, inner-outer ionization. The cluster inner ionization driven by the BSI for the constituents is induced by a composite field consisting of the laser field and inner fields. The energetics and dynamics of the system consisting of high energy (< or =3 keV) electrons and of less, similar 100 keV ions in the laser field was treated by molecular dynamics simulations, which incorporate electron-electron, electron-ion, ion-ion, and charge-laser interactions. High-energy electron dynamics also incorporates relativistic effects and includes magnetic field effects. We treat inner ionization considering inner field ignition, screening and fluctuation contributions as well as small [(< or =13%)] impact ionization contributions. Subsequent to inner ionization a charged nanoplasma is contained within the cluster, whose response to the composite (laser+inner) field results in outer ionization, which can be approximately described by an entire cluster barrier suppression ionization mechanism.

Journal Article↗
PubMed2001

Increased total to ionized calcium ratio during continuous venovenous hemodialysis with regional citrate anticoagulation.

BACKGROUND: Citrate anticoagulation is commonly used for continuous venovenous hemodialysis (CVVHD) to minimize the risk of bleeding complications. We have previously reported a liver failure patient undergoing citrate-based CVVHD with elevated serum total to ionized calcium ratio. Diminished liver metabolism of citrate with resultant elevated systemic citrate was thought to be the cause. METHODS: To determine the incidence and clinical significance of an elevated total to ionized calcium ratio during citrate-based CVVHD, 161 patients undergoing citrate-based CVVHD were screened for the presence of an elevated total to ionized calcium ratio (the subset with increased total to ionized calcium ratio comprised the study group). Because all patients in the study group had liver failure, two control groups of patients with normal total to ionized calcium ratios were formed-those without liver failure (control I) and those with liver failure (control II). RESULTS: An elevated total to ionized calcium ratio was detected in 12% of all patients. Thirty-three percent of liver failure patients demonstrated an elevated total to ionized calcium ratio. The study group demonstrated significantly higher mean total calcium levels, significantly lower mean ionized calcium levels, and significantly higher mean total to ionized calcium ratios than controls. As a result, the study group also had significantly increased mean calcium chloride replacement requirements in comparison with controls. The mean calcium to citrate infusion ratio was elevated in the study group in comparison with controls. An elevated total to ionized calcium ratio was associated with increased mortality in comparison with controls. No patients suffered complications from ionized hypocalcemia or elevated serum total calcium. CONCLUSIONS: Systemic citrate accumulation as evidenced by an elevated total to ionized calcium ratio occurs commonly in patients requiring CVVHD using citrate-based regional anticoagulation. Observing changes in the total to ionized calcium ratio can aid in early detection of patients with hepatic failure who are unable to appropriately metabolize citrate and will require calcium chloride infusion rates significantly above normal.

Adult↗
PubMed2004

Atmospheric pressure photoionization. II. Dual source ionization.

In this paper we describe results based on the combination of atmospheric pressure photoionization (APPI) with atmospheric pressure chemical ionization (APCI) and electrospray ionization (ESI). The main purpose of combining more than one ionizer is to extend the range of compounds that can be simultaneously analyzed. Three modes of operation are presented; use of either ionizer, simultaneous use of two ionizers, and rapid switching between ionizers during a single chromatographic run. The dual ionizer configurations only minimally affect the performance of either ionizer relative to the standard single-ionizer sources. However, it is observed that the operation of both ionizers together does not typically give the sum signal from either source operating alone. For APCI/APPI the signal can range from less than that of either source alone to the sum of the two individual sources. For ESI/APPI, we observed large suppressions of the ESI multiply-charged signal of proteins when the APPI source was on. These behaviors are presumed to be due to the interaction of the initially formed ions by both sources and attests to the importance of ion-molecule reactions that occur during and after the primary ionization events. We give examples of compounds that are preferentially ionized by either APPI, APCI or ESI and present thermochemical arguments based on molecular structure and functionality to explain this behavior. The dual source is also shown to be able to operate in negative ion mode opening up the potential to conduct wide ranging chemical analyses.

Air Pressure↗
PubMed1985

The requirements for ionized calcium and magnesium in lymphocyte proliferation.

The extracellular ionized calcium and magnesium requirements for lectin-induced lymphocyte DNA synthesis were measured in a serum-free system. The use of this system permitted measurements of the ionized calcium and magnesium concentrations with ion-selective electrodes. Maximal DNA synthesis was observed at 270 microM ionized calcium and at 100 microM ionized magnesium in phytohemagglutinin-treated lymphocytes. Lymphocyte DNA synthesis was much more sensitive to reduction of external ionized calcium than to reduction of ionized magnesium. In calcium-free medium (ionized calcium 25 microM), DNA synthesis was reduced by 90%, but in magnesium-free medium (ionized magnesium concentration 7 microM) DNA synthesis was reduced by only 30%. Fifty percent of DNA synthesis stimulated by phytohemagglutinin (PHA) and concanavalin A (Con A) was observed at external ionized calcium concentrations of 97 and 43 microM, respectively. When lymphocytes were stimulated with PHA and the external calcium was chelated with EGTA, 50% inhibition of DNA synthesis was observed at 98 microM ionized calcium. This value agreed well with the free calcium required for PHA activation of DNA synthesis (97 microM). Cytoplasmic calcium, measured with the fluorescent probe Quin 2, increased following lectin exposure if the extracellular ionized calcium concentration was greater than 80 microM. No increase in cytoplasmic calcium could be detected in lectin-treated lymphocytes below 80 microM extracellular ionized calcium, although substantial DNA synthesis was sustained.

Calcium↗