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PubMedDate not supplied

Hyperventilation in children with dengue hemorrhagic fever (DHF).

Many studies of Dengue Hemorrhagic Fever (DHF) have been done but only a few revealed the respiratory status. Respiratory problems arise because of plasma leakage through the damaged capillaries, causing lung edema and in turn result in hypoxemia. This later on will be compensated by a hyperventilation state. During a 6-month-period (May to September 1988), two aspects were studied in 85 patients hospitalized with DHF. First, the ventilatory pattern and second, the result of giving oxygen support in improving the respiratory disturbance, in this case alveolar hyperventilation. The incidence of alveolar hyperventilation in DHF grade II (DHF II) and Dengue Shock Syndrome (DSS) differed significantly. Hypoxemia occurred in DHF II and DSS with no significant differences. The difference of the incidence of metabolic acidosis in DHF II and DSS were significant. In DHF II patients having had hyperventilation state, oxygen therapy decreased respiration rate significantly and increased the PaCO2 though not significantly.

Acidosis, Respiratory↗
PubMed1987

Influence of intracellular acidosis on contractile function in the working rat heart.

The decrease in myocardial contractility during ischemia, hypoxia, and extracellular acidosis has been attributed to intracellular acidosis. Previous studies of the relationship between pH and contractile state have utilized respiratory or metabolic acidosis to alter intracellular pH. We developed a model in the working perfused rat heart to study the effects of intracellular acidosis with normal external pH and optimal O2 delivery. Intracellular pH and high-energy phosphates were monitored by 31P nuclear magnetic resonance spectroscopy. Hearts were perfused to a steady state with a medium containing 10 mM NH4Cl (extracellular pH, 7.4). The subsequent washout of NH3 from the cytosol generated a slight acidosis (from intracellular pH 7.0 to 6.8) which was associated with little change in the determinants of O2 consumption (rate-pressure product) and O2 delivery (coronary flow). Acidosis induced a substantial decrease in aortic flow and stroke volume which was associated with little change in peak systolic pressure. Results were qualitatively similar at different external [Ca2+] (1.75, 2.5, 3.15 mM) and preload (12 or 21 cmH2O) but were most prominent at the lowest external [Ca2+] and left atrial pressure. In contrast to this model of isolated intracellular acidosis, hearts subject to a respiratory (extracellular plus intracellular) acidosis showed a marked reduction in pressure development. It was concluded that 1) for the same intracellular acidosis the influence on tension development was more pronounced with a combined extra- and intracellular acidosis than with an isolated intracellular acidosis, and 2) stroke volume at constant preload was impaired by intracellular acidosis even though changes in developed pressure were minimal. These observations suggest that isolated intracellular acidosis has adverse effects on diastolic compliance and/or relaxation.

Acid-Base Equilibrium↗
PubMed1978

[Acid-base state and blood oxygenation in cardiac insufficiency treated by drug agents].

The effect of different drugs on the acid-base condition and gases of arterial blood was studied by Astrup's micromethod in 124 tests in patients with circulatory insufficiency. Cardiac glycosides correct the moderate decrease in blood oxygen tension and respiratory alkalosis in patients with left-ventricular failure. Morphine has a good arresting effect in attacks of cardiac asthma and corrects or reduces the respiratory alkalosis typical of the disease but at the same time reduces the saturation of blood with oxygen. The use of oxygen together with morphine removes this unfavourable effect of the drugs. Euphylline often intensifies respiratory alkalosis, while its effect on oxygen tension in the blood and its saturation with oxygen is poorly pronounced and diversely directed. Lasics causes a favourable correcting effect on the acid-base condition and oxygenation of blood in pulmonary edema marked by metabolic acidosis.

Acid-Base Equilibrium↗
PubMed1986

Acute respiratory failure. Pathophysiology, causes, and clinical manifestations.

Acute respiratory failure is a common life-threatening process with myriad causes. It is characterized by a failure of oxygenation or ventilation, or both. Hypoxemia is common to all causes of respiratory failure, whereas PaCO2 may be normal, decreased, or elevated. These abnormalities result from several pathophysiologic processes, including intrapulmonary venoarterial shunt, alveolar hypoventilation, diffusion impairment, and ventilation-perfusion mismatch. Type I failure results from processes that lead to hypocapnia or normocapnia; type II failure is distinguished by the presence of hypercapnia. The clinical manifestations of acute respiratory failure are nonspecific; for this reason, a high index of suspicion and early examination of arterial blood gases are essential to successful management.

Acidosis, Respiratory↗
PubMed1985

Effect of heparin on arterial blood gases.

To evaluate changes in arterial blood gas samples caused by the addition of liquid heparin, 50 patients had three simultaneous blood samples drawn, each with one of three amounts of heparin. The liquid heparin decreased statistically the PCO2, PO2, HCO3, and base excess, while the pH remained unchanged. By using a 2-cc blood sample with a 5-cc glass syringe and a 11/2-inch, 18-gauge needle to draw the heparin solution up to the 2-cc mark, and then completely evacuating it, we found that 0.025 cc of solution remained to coat the syringe. Although this remaining solution would cause a 1.25% error in the blood gas results, the error would be acceptable because it is generally less than the standard deviation of the laboratory results. Excess liquid heparin statistically exaggerated or produced false results consistent with a metabolic acidosis with respiratory compensation. We recommend that the complete evacuation of liquid heparin from the sampling syringe be included when performing an arterial blood gas analysis.

Acidosis↗
PubMed1989

Metabolic complications of cystoplasty.

A series of 48 patients with intestinal segments incorporated into the urinary tract underwent assessment of acid-base and electrolyte balance. All patients had abnormal blood gas analyses, usually a metabolic acidosis with respiratory compensation; 33% had hyperchloraemia. Radioisotope studies using sodium, potassium and bromine showed that all were absorbed and that absorption was unaffected by renal function. The results suggest that all such patients, but particularly women and children, may be at risk of the secondary effects of chronic acidosis, especially skeletal demineralisation, unless some compensatory mechanism is working to offset the effects of the acidosis.

Acidosis↗
PubMed2002

Lactic acidosis associated with the usual theophylline dose in a patient with asthma.

Metabolic and electrolyte abnormalities, including hypokalemia, hyperglycemia and lactic acidosis, are associated with theophylline overdose. However, we report an unusual case of sinus tachycardia, lactic acidosis, hypokalemia and hyperglycemia associated with the usual theophylline dose in a patient with asthma. The theophylline dose was 200 mg orally twice daily. Three hours after administration of the third dose, the patient experienced palpitation. An electrocardiogram showed a sinus tachycardia. Arterial blood gas analysis revealed a mixed metabolic acidosis and respiratory alkalosis. Serum lactate level was 51 mmol/L (normal 0.7-2.1 mmol/L). Biochemistry results were sodium 136 mEq/L, chloride 99 mEq/L, potassium 1.9 mEq/L and glucose 204 mg/dL. Our case suggests that a possibility of theophylline-associated metabolic abnormalities should be considered when an asthmatic patient given the usual theophylline dose presents with lactic acidosis, hypokalemia and hyperglycemia of unknown etiology.

Acidosis, Lactic↗
PubMed1997

Treatment of severe respiratory failure during status asthmaticus in children and adolescents using high flow oxygen and sodium bicarbonate.

OBJECTIVE: Status asthmaticus with respiratory failure is a potentially fatal complication of bronchial asthma. To prevent a fatality in status asthmaticus with respiratory failure, treatment with intravenous isoproterenol or mechanical ventilation has been advocated. These interventions also have serious potential complications, however, and while continuous inhalation of beta agonists has shown promise, the optimal therapy of severe status asthmaticus remains unclear. This paper describes our experience with a treatment protocol used in status asthmaticus with respiratory failure that seeks to avoid intravenous isoproterenol or assisted ventilation. STUDY DESIGN: Case series of pediatric intensive care patients with severe respiratory failure due to status asthmaticus. Six children and adolescents experienced a total of nine episodes of severe respiratory failure due to status asthmaticus. RESULTS: In seven of the nine episodes the patients were managed without either intravenous isoproterenol or mechanical ventilation. Hypercarbia persisted for an average of 25 hours (range 17 to 40 hours) in these seven episodes. All subjects recovered without notable sequelae. In two episodes, clinical and blood gas deterioration led to mechanical ventilation. Ventilation was required for 112 and 42 hours, respectively, in these episodes and the patients developed either pneumothorax or pneumomediastinum during ventilation. CONCLUSION: Using a protocol initiated in 1978 for correction of hypoxia and acidemia, many patients with severe respiratory failure from status asthmaticus can be treated without isoproterenol or mechanical ventilation. Since those treatments have significant risks, consideration should be given to this intervention before resorting to them.

Acidosis, Respiratory↗
PubMed1985

Acid-base changes and ventilator mode during maintenance ventilation.

Assist-control ventilation was compared to intermittent mandatory ventilation (IMV) for respiratory support of 35 patients without known respiratory disease, who had undergone coronary bypass surgery. Spontaneous respiratory rates and minute ventilation did not differ significantly between the two groups. Blood gas samples obtained during the assist-control mode had a significantly lower PaCO2 and higher pH than blood gases measured during high-rate IMV. There were six cases of severe alkalemia during assist-control ventilation, all respiratory in origin. These were attributable to the higher respiratory-rate settings and the extra respirator-delivered tidal volumes when spontaneous rates were higher than the set rates. IMV was associated with fewer ventilator-induced acid-base changes.

Acidosis, Respiratory↗
PubMed1997

Tension pneumopericardium following tracheoplasty for congenital tracheal stenosis.

Tension pneumopericardium is a rare complication of mechanical ventilation following tracheoplasty for congenital tracheal stenosis. This case report describes fatal tension pneumopericardium in a three-month-old male infant some 24 hours following tracheoplasty for this condition. Because of persisting stenosis of the left main bronchus, ventilation pressures of PIP 23 cm H2O and PEEP 5 cm, progressing to PIP 28 cm and PEEP 7 cm were needed to maintain adequate respiratory exchange. Partial relief of the pneumopericardium was achieved by vigorous cardiac massage, but three days later the infant died of massive airway haemorrhage.

Acidosis, Respiratory↗
PubMed1995

Comparison of intrapartum electronic fetal heart rate monitoring versus intermittent auscultation in detecting fetal acidemia at birth.

OBJECTIVE: Our purpose was to compare continuous intrapartum electronic fetal heart rate monitoring with intermittent auscultation for detecting fetal acidemia at birth. STUDY DESIGN: Data from a previously published randomized trial of electronic fetal heart rate monitoring versus intermittent auscultation were analyzed to identify any differences between the two methods in detecting fetal acidemia at birth. Fetal acidemia at birth was defined as the presence of cord blood arterial pH < 7.15. RESULTS: A total of 1419 patients with umbilical cord blood acid-base measurements were identified, 739 in the electronic FHR monitoring group and 680 in the auscultation group. Electronic FHR monitoring had significantly better sensitivity (97% vs 34%, p < 0.001), lower specificity (84% vs 91%, p < 0.001), higher positive predictive value (37% vs 22%, p < 0.05), and higher negative predictive value (99.5% vs 95%, p < 0.001) in detecting fetal acidemia at birth. In addition, electronic FHR monitoring was significantly better in detecting all types of acidemia: metabolic (95.5% vs 26.5%, p < 0.001), mixed (95% vs 37.5%, p < 0.001), and respiratory (100% vs 41.5%, p < 0.001). CONCLUSION: These data suggest that electronic FHR monitoring is superior to intermittent auscultation in detecting fetal acidemia at birth.

Acidosis↗
PubMedDate not supplied

[A case of respiratory distress syndrome complicated by the development of interstitial emphysema and pneumomediastinum].

A 15-year-old patient has been admitted to the intensive care unit for severe respiratory distress syndrome that developed as a result of pneumonia. Interstitial lung edema was confirmed by computer-aided tomography. It was successfully treated by positive pressure ventilation (PPV). Although PEEP did not exceed 7 cm H2O, PPV was complicated by interstitial emphysema, pneumomediastinum, and bilateral pneumothorax as a result of barotrauma. Pulmonary artery pressure (PAP) and pulmonary capillary wedge pressure (PCWP) were monitored. High PCWP values were inconsistent with the diagnosis of acute respiratory distress syndrome. The authors suggest that high PCWP was caused by high intraalveolar pressure, pneumomediastinum, and venule constriction in the hypoxic sites of the lung.

Acidosis, Respiratory↗
PubMed1990

Nonsteroidal anti-inflammatory drugs and coma: a case report of fenoprofen overdose.

We present the case of a 17-year-old girl who ingested 24 to 36 g fenoprofen as a suicidal gesture. She presented with coma, hypotension, metabolic acidosis, and respiratory depression within four hours of ingestion. The most common adverse effects of the nonsteroidal anti-inflammatory drugs occur in both therapeutic and toxic doses and include gastrointestinal upset, blood dyscrasias, and analgesic nephropathy. The propionic acid derivatives of nonsteroidal anti-inflammatory drugs, including fenoprofen and ibuprofen, are rarely associated with severe toxic effects. This is the first report of pure fenoprofen overdose presenting as coma and metabolic acidosis.

Acidosis↗
PubMed1995

Perinatal asphyxia: assessing its causal role and timing.

Perinatal asphyxia, whether prenatal, intrapartum, or neonatal is thought to be a significant contributor to newborn morbidity and mortality as well as long-term neurological deficits. Development of an intrapartum tool/test that can reliably identify and discriminate between varying degrees of fetal acidemia and suggest whether it is respiratory or metabolic in nature would be highly desirable. This article critically reviews the available experience with the currently available monitoring techniques and the significance of abnormalities of fetal and intrapartum measurements with respect to the predictive value of the observations available to the clinician.

Acidosis, Respiratory↗
PubMedDate not supplied

An introduction to blood gas analysis.

Blood gas analysis is a procedure that is associated with high dependency, intensive care and respiratory units, but equipment used to carry out blood gas analysis is now commonplace on hospital wards and in some community services. It is, therefore, important for nurses in primary and secondary care to understand the significance of blood gas analysis.

Acid-Base Equilibrium↗