Diabetic ketoacidosis(DKA) is a severe and toocommon complication of uncontrolled diabetes mellitus. Acidosis is one of the fundamental disruptions stemming from the disease process, the complications of which are pot...Diabetic ketoacidosis(DKA) is a severe and toocommon complication of uncontrolled diabetes mellitus. Acidosis is one of the fundamental disruptions stemming from the disease process, the complications of which are potentially lethal. Hydration and insulin administration have been the cornerstones of DKA therapy; however, adjunctive treatments such as the use of sodium bicarbonate and protocols that include serial monitoring with blood gas analysis have been much more controversial. There is substantial literature available regarding the use of exogenous sodium bicarbonate in mild to moderately severe acidosis; the bulk of the data argue against significant benefit in important clinical outcomes and suggest possible adverse effects with the use of bicarbonate. However, there is scant data to support or refute the role of bicarbonate therapy in very severe acidosis. Arterial blood gas(ABG) assessment is an element of some treatment protocols, including society guidelines, for DKA. We review the evidence supporting these recommendations. In addition, we review the data supporting some less cumbersome tests, including venous blood gas assessment and routine chemistries. It remains unclear that measurement of blood gas pH, via arterial or venous sampling, impacts management of the patient substantially enough to warrant the testing, especially if sodium bicarbonate administration is not being considered. There are special circumstances when serial ABG monitoring and/or sodium bicarbonate infusion are necessary, which we also review. Additional studies are needed to determine the utility of these interventions in patients with severe DKA and pH less than 7.0.展开更多
Red-cell membrane sodium-lithium countertransport (Na+-Li+CT) and sodium sensitivity (SS) were measured in 300 children in Hanzhong.By comparison and retrospective study, the results showed:①In children with higher b...Red-cell membrane sodium-lithium countertransport (Na+-Li+CT) and sodium sensitivity (SS) were measured in 300 children in Hanzhong.By comparison and retrospective study, the results showed:①In children with higher blood pressure(HBP) and positive rainily history (FH+),Na+-Li+ CT rate was signiricantly higher than that in controls (P<0. 01).②6-year retrospective review of blood pressure evolution, the blood pressure increased degree (ASBP) in children with higher Na+-Li+ CT rate was much greater than that in those with lower one (P<0.05), and at the same time,the percentiles of systolic blood pressure (PSBP) for children with higher countertransport mostly kept rising or kept higher levels during this period.③In children with SS, Na+-Li+ CT rate was increased than that in SR group (P<0. 01),and was correlated to the concentration of intra-erythrocytic Na+ (P= 0.004).These suggest that, as intermediate phenotype of essential hypertension, red-cell membrane sodium-lithium countertransport defect could participate in the regulation of blood pressure and pathogensis or hypertension development in children.展开更多
The renal handling of Na^+ balance is a major determinant of the blood pressure(BP) level. The inability of the kidney to excrete the daily load of Na+ represents the primary cause of chronic hypertension. Among the d...The renal handling of Na^+ balance is a major determinant of the blood pressure(BP) level. The inability of the kidney to excrete the daily load of Na+ represents the primary cause of chronic hypertension. Among the different segments that constitute the nephron, those present in the distal part(i.e., the cortical thick ascending limb, the distal convoluted tubule, the connecting and collecting tubules) play a central role in the fine-tuning of renal Na^+ excretion and are the target of many different regulatory processes that modulate Na^+ retention more or less efficiently. G-protein coupled receptors(GPCRs) are crucially involved in this regulation and could represent efficient pharmacological targets to control BP levels. In this review, we describe both classical and novel GPCR-dependent regulatory systems that have been shown to modulate renal Na^+ absorption in the distal nephron. In addition to the multiplicity of the GPCR that regulate Na^+ excretion, this review also highlights the complexity of these different pathways, and the connections between them.展开更多
Dietacy surveys were done using a standardized 24-hour recall method and the timed overnight urine sodium,potassium and creatinine (standardized to 8 hours)were determined in a total of 178 farmers, aged 25 to 59 year...Dietacy surveys were done using a standardized 24-hour recall method and the timed overnight urine sodium,potassium and creatinine (standardized to 8 hours)were determined in a total of 178 farmers, aged 25 to 59 years,of Jiangsu province from Autumn 1984 to Spring 1985.A common food table was used to estimate nutrients intake.For each subject of the test group the relationship of nutritional factors and dietary electrolytes to blood pressure was studied by multiple regression analyses adjusted for age,sex, body mass index,hypertensive family history and alcohol intake habit. The results revealed a significant positive association of mean daily intake of fat and urine sodium cxcretion with systolic, diastolic and mean arterial blood pressure. Whereas the total energy(Kcal)intake is negatively associated with the systolic blood pressure.展开更多
Objective: To explore the consistency and relevance of the results of the bedside rapid blood gas analyzer GEM premier 3000, the Vitros5.1+5600 biochemical immunoassay analyzer and the SYSMEX XN-9000 automatic blood c...Objective: To explore the consistency and relevance of the results of the bedside rapid blood gas analyzer GEM premier 3000, the Vitros5.1+5600 biochemical immunoassay analyzer and the SYSMEX XN-9000 automatic blood cell analyzer in the central laboratory detecting serum potassium (K<sup>+</sup>), serumsodium (Na<sup>+</sup>), blood glucose (Glu), hemoglobin (Hb) and red blood cell volume (Hct). And to provide a reference for the accurate interpretation of the bedside blood gas analysis report. Method: Usually, ICU patients will be taken arterial blood gas, biochemical and blood samples through the arterial indwelling needle;at the same time patients’ potassium, serum sodium, blood glucose, hemoglobin and red blood cell volume will be detected. This study implemented paired t-test and correlation regression analysis on each group of data, and used the analysis quality requirements (allowable total error) of CLIA’88 proficiency testing program as the criteria for clinical acceptance. Results: The paired t-test showed that the serum potassium, serum sodium and blood glucose detected by GEM premier 3000 and Vitros5.1+5600 were significantly different;and the hemoglobin and red blood cell volume detected by GEM premier 3000 and SYSMEX XN-9000 were significantly different (P < 0.05). The Pearson correlation coefficients (r) of hemoglobin, red blood cell volume and red blood cell volume were 0.860, 0.886, 0.924, 0.841 and 0.856, respectively, and the above test items all had good correlations (P < 0.05). The average (SE) of the paired differences of K<sup>+</sup>, Na<sup>+</sup>, Glu, Hb and Hct detected by the two sets of instruments is less than the allowable error of CLIA’88, and the SE of blood Na<sup>+</sup> and Hb is less than half of the allowable error of CLIA’88. Conclusion: The test results of GEM premier 3000, the central laboratory Vitros5.1+5600 and SYSMEX XN-9000 have good correlation, but the consistency is not good. The test results of GEM premier 3000 cannot replace the central laboratory.展开更多
<strong>Background.</strong> Intradialytic hypertension, a paradoxical rise in systolic blood pressure from pre- to postdialysis, is a poorly understood and difficult-to-treat phenomenon. We examined the e...<strong>Background.</strong> Intradialytic hypertension, a paradoxical rise in systolic blood pressure from pre- to postdialysis, is a poorly understood and difficult-to-treat phenomenon. We examined the effects of individually adjusted isonatremic and hyponatremic dialysate on intradialytic and interdialytic blood pressure in patients with intradialytic hypertension. <strong>Methods.</strong> We enrolled 11 patients with intradialytic hypertension in a prospective randomized cross-over study, with 4 treatment periods of different dialysate sodium concentrations. Period 1 (run-in) and 3 (wash-out) were standardized at 140 mEq/L;period 2 and 4 with iso- or hyponatremic sodium dialysate. Blood pressure was recorded each dialysis session, and 24-hour ambulatory blood pressure monitoring was performed at the end of each treatment period. <strong>Results.</strong> Isonatremic and hyponatremic dialysate were associated with significantly lower pre- and post-dialysis blood pressure as compared to baseline 140 mEq/L dialysate (predialysis 148.3 ± 24.7/67.7 ± 12.0 and 144.4 ± 16.5/68.8 ± 13.3 vs. 158.0 ± 18.3/75.6 ± 11.4 mmHg, resp p = 0.04 and 0.007 for systolic and p = 0.004 and 0.04 for diastolic blood pressure;postdialysis 154.2 ± 25.5/76.6 ± 14.1 and 142.5 ± 20.7/73.0 ± 12.9 vs. 159.1 ± 21.6/80.3 ± 12.1 mmHg, resp NS and p = 0.01 for systolic and NS and p = 0.04 for diastolic blood pressure). Postdialysis and 24 h systolic blood pressure tended to be lower with hyponatremic compared to isonatremic dialysate. <strong>Conclusion.</strong> Individually tailoring dialysate sodium concentration, based on the sodium set-point of each patient, resulted in a lower pre- and post-dialysis blood pressure in patients with intradialytic hypertension. 24 h blood pressure values tended to be lower as well with hyponatremic dialysate.展开更多
目的:探讨UGT1A6 A541G、A552C基因多态对丙戊酸钠血药浓度的影响。方法:计算机检索PubMed、Medline、Cochrane Library、EMbase、CNKI、万方数据库,检索年限从建库至2024年4月,收集UGT1A6基因多态性与丙戊酸钠血药浓度文献,提取数据与...目的:探讨UGT1A6 A541G、A552C基因多态对丙戊酸钠血药浓度的影响。方法:计算机检索PubMed、Medline、Cochrane Library、EMbase、CNKI、万方数据库,检索年限从建库至2024年4月,收集UGT1A6基因多态性与丙戊酸钠血药浓度文献,提取数据与质量评价,采用Revman5.3软件进行Meta分析。结果:共纳入文献11篇,999例癫痫患者。Meta分析结果显示,在UGT1A6 A541G基因中,除AG vs GG[MD=0.16,95%CI(-0.39,0.70),P=0.50]外,AA vs AG[MD=0.53,95%CI(0.32,0.75),P<0.00001],AA vs GG[MD=0.67,95%CI(0.10,1.23),P=0.02],AA vs AG+GG[MD=0.61,95%CI(0.45,0.76)P<0.00001],两者差异均具有统计学意义,说明癫痫患者UGT1A6 A541G AA型丙戊酸钠血药浓度高于AG型或/和GG型。在UGT1A6 A552C中,除AC vs CC[MD=0.21,95%CI(-0.31,0.74),P=0.43]外,AA vs AC[MD=0.90,95%CI(0.77,1.03),P<0.00001],AA vs CC[MD=0.90,95%CI(0.77,1.03),P<0.00001],AA vs AC+CC[MD=1.58,95%CI(1.07,2.10),P<0.00001],两者差异均具有统计学意义,说明UGT1A6 A552C AA型丙戊酸钠血药浓度高于AC型或/和CC型。结论:癫痫患者UGT1A6 A541G和A552C基因多态性与丙戊酸钠血药浓度具有相关性,且基因突变可能导致丙戊酸钠血药浓度降低。展开更多
In this study, we investigated the effect of sodium bicarbonate (NaHCO3) supplementation at a dose of 0.2 g·kg−1 40 min before an exercise on intermittent endurance performance and gastrointestina...In this study, we investigated the effect of sodium bicarbonate (NaHCO3) supplementation at a dose of 0.2 g·kg−1 40 min before an exercise on intermittent endurance performance and gastrointestinal distress. The participants were six healthy male students of a university. The Yo-Yo intermittent recovery test level 2 (Yo-Yo IR2) was used for the evaluation of intermittent endurance. The participants ingested water (Cont) or NaHCO3 independently at three timings. After drinking water, the Yo-Yo IR1 was performed for 2 min as warm-up. After resting for 5 min, the Yo-Yo IR2 was initiated. The measurement items were exercise distance, nutrition intake, biochemical test results, and blood gas analysis findings. The participants who ingested NaHCO3 had a 14% extended distance than those who ingested Cont, and 2/3 of those who took NaHCO3 showed a better motor performance. No significant difference was observed between the participants who took Cont and NaHCO3 in terms of pH level at baseline, and the NaHCO3 level was significantly higher during pre- and post-exercise (p 3 in terms of bicarbonate ion level at baseline, and the NaHCO3 level was significantly higher during pre- and post-exercise (p 3 at a low dose (0.2 g·kg−1), their exercise ability during an intermittent endurance test has improved. Furthermore, when digestive absorption is considered, eating a meal in advance may be able to suppress the onset of gastrointestinal distress.展开更多
文摘Diabetic ketoacidosis(DKA) is a severe and toocommon complication of uncontrolled diabetes mellitus. Acidosis is one of the fundamental disruptions stemming from the disease process, the complications of which are potentially lethal. Hydration and insulin administration have been the cornerstones of DKA therapy; however, adjunctive treatments such as the use of sodium bicarbonate and protocols that include serial monitoring with blood gas analysis have been much more controversial. There is substantial literature available regarding the use of exogenous sodium bicarbonate in mild to moderately severe acidosis; the bulk of the data argue against significant benefit in important clinical outcomes and suggest possible adverse effects with the use of bicarbonate. However, there is scant data to support or refute the role of bicarbonate therapy in very severe acidosis. Arterial blood gas(ABG) assessment is an element of some treatment protocols, including society guidelines, for DKA. We review the evidence supporting these recommendations. In addition, we review the data supporting some less cumbersome tests, including venous blood gas assessment and routine chemistries. It remains unclear that measurement of blood gas pH, via arterial or venous sampling, impacts management of the patient substantially enough to warrant the testing, especially if sodium bicarbonate administration is not being considered. There are special circumstances when serial ABG monitoring and/or sodium bicarbonate infusion are necessary, which we also review. Additional studies are needed to determine the utility of these interventions in patients with severe DKA and pH less than 7.0.
文摘Red-cell membrane sodium-lithium countertransport (Na+-Li+CT) and sodium sensitivity (SS) were measured in 300 children in Hanzhong.By comparison and retrospective study, the results showed:①In children with higher blood pressure(HBP) and positive rainily history (FH+),Na+-Li+ CT rate was signiricantly higher than that in controls (P<0. 01).②6-year retrospective review of blood pressure evolution, the blood pressure increased degree (ASBP) in children with higher Na+-Li+ CT rate was much greater than that in those with lower one (P<0.05), and at the same time,the percentiles of systolic blood pressure (PSBP) for children with higher countertransport mostly kept rising or kept higher levels during this period.③In children with SS, Na+-Li+ CT rate was increased than that in SR group (P<0. 01),and was correlated to the concentration of intra-erythrocytic Na+ (P= 0.004).These suggest that, as intermediate phenotype of essential hypertension, red-cell membrane sodium-lithium countertransport defect could participate in the regulation of blood pressure and pathogensis or hypertension development in children.
文摘The renal handling of Na^+ balance is a major determinant of the blood pressure(BP) level. The inability of the kidney to excrete the daily load of Na+ represents the primary cause of chronic hypertension. Among the different segments that constitute the nephron, those present in the distal part(i.e., the cortical thick ascending limb, the distal convoluted tubule, the connecting and collecting tubules) play a central role in the fine-tuning of renal Na^+ excretion and are the target of many different regulatory processes that modulate Na^+ retention more or less efficiently. G-protein coupled receptors(GPCRs) are crucially involved in this regulation and could represent efficient pharmacological targets to control BP levels. In this review, we describe both classical and novel GPCR-dependent regulatory systems that have been shown to modulate renal Na^+ absorption in the distal nephron. In addition to the multiplicity of the GPCR that regulate Na^+ excretion, this review also highlights the complexity of these different pathways, and the connections between them.
文摘Dietacy surveys were done using a standardized 24-hour recall method and the timed overnight urine sodium,potassium and creatinine (standardized to 8 hours)were determined in a total of 178 farmers, aged 25 to 59 years,of Jiangsu province from Autumn 1984 to Spring 1985.A common food table was used to estimate nutrients intake.For each subject of the test group the relationship of nutritional factors and dietary electrolytes to blood pressure was studied by multiple regression analyses adjusted for age,sex, body mass index,hypertensive family history and alcohol intake habit. The results revealed a significant positive association of mean daily intake of fat and urine sodium cxcretion with systolic, diastolic and mean arterial blood pressure. Whereas the total energy(Kcal)intake is negatively associated with the systolic blood pressure.
文摘Objective: To explore the consistency and relevance of the results of the bedside rapid blood gas analyzer GEM premier 3000, the Vitros5.1+5600 biochemical immunoassay analyzer and the SYSMEX XN-9000 automatic blood cell analyzer in the central laboratory detecting serum potassium (K<sup>+</sup>), serumsodium (Na<sup>+</sup>), blood glucose (Glu), hemoglobin (Hb) and red blood cell volume (Hct). And to provide a reference for the accurate interpretation of the bedside blood gas analysis report. Method: Usually, ICU patients will be taken arterial blood gas, biochemical and blood samples through the arterial indwelling needle;at the same time patients’ potassium, serum sodium, blood glucose, hemoglobin and red blood cell volume will be detected. This study implemented paired t-test and correlation regression analysis on each group of data, and used the analysis quality requirements (allowable total error) of CLIA’88 proficiency testing program as the criteria for clinical acceptance. Results: The paired t-test showed that the serum potassium, serum sodium and blood glucose detected by GEM premier 3000 and Vitros5.1+5600 were significantly different;and the hemoglobin and red blood cell volume detected by GEM premier 3000 and SYSMEX XN-9000 were significantly different (P < 0.05). The Pearson correlation coefficients (r) of hemoglobin, red blood cell volume and red blood cell volume were 0.860, 0.886, 0.924, 0.841 and 0.856, respectively, and the above test items all had good correlations (P < 0.05). The average (SE) of the paired differences of K<sup>+</sup>, Na<sup>+</sup>, Glu, Hb and Hct detected by the two sets of instruments is less than the allowable error of CLIA’88, and the SE of blood Na<sup>+</sup> and Hb is less than half of the allowable error of CLIA’88. Conclusion: The test results of GEM premier 3000, the central laboratory Vitros5.1+5600 and SYSMEX XN-9000 have good correlation, but the consistency is not good. The test results of GEM premier 3000 cannot replace the central laboratory.
文摘<strong>Background.</strong> Intradialytic hypertension, a paradoxical rise in systolic blood pressure from pre- to postdialysis, is a poorly understood and difficult-to-treat phenomenon. We examined the effects of individually adjusted isonatremic and hyponatremic dialysate on intradialytic and interdialytic blood pressure in patients with intradialytic hypertension. <strong>Methods.</strong> We enrolled 11 patients with intradialytic hypertension in a prospective randomized cross-over study, with 4 treatment periods of different dialysate sodium concentrations. Period 1 (run-in) and 3 (wash-out) were standardized at 140 mEq/L;period 2 and 4 with iso- or hyponatremic sodium dialysate. Blood pressure was recorded each dialysis session, and 24-hour ambulatory blood pressure monitoring was performed at the end of each treatment period. <strong>Results.</strong> Isonatremic and hyponatremic dialysate were associated with significantly lower pre- and post-dialysis blood pressure as compared to baseline 140 mEq/L dialysate (predialysis 148.3 ± 24.7/67.7 ± 12.0 and 144.4 ± 16.5/68.8 ± 13.3 vs. 158.0 ± 18.3/75.6 ± 11.4 mmHg, resp p = 0.04 and 0.007 for systolic and p = 0.004 and 0.04 for diastolic blood pressure;postdialysis 154.2 ± 25.5/76.6 ± 14.1 and 142.5 ± 20.7/73.0 ± 12.9 vs. 159.1 ± 21.6/80.3 ± 12.1 mmHg, resp NS and p = 0.01 for systolic and NS and p = 0.04 for diastolic blood pressure). Postdialysis and 24 h systolic blood pressure tended to be lower with hyponatremic compared to isonatremic dialysate. <strong>Conclusion.</strong> Individually tailoring dialysate sodium concentration, based on the sodium set-point of each patient, resulted in a lower pre- and post-dialysis blood pressure in patients with intradialytic hypertension. 24 h blood pressure values tended to be lower as well with hyponatremic dialysate.
文摘目的:探讨UGT1A6 A541G、A552C基因多态对丙戊酸钠血药浓度的影响。方法:计算机检索PubMed、Medline、Cochrane Library、EMbase、CNKI、万方数据库,检索年限从建库至2024年4月,收集UGT1A6基因多态性与丙戊酸钠血药浓度文献,提取数据与质量评价,采用Revman5.3软件进行Meta分析。结果:共纳入文献11篇,999例癫痫患者。Meta分析结果显示,在UGT1A6 A541G基因中,除AG vs GG[MD=0.16,95%CI(-0.39,0.70),P=0.50]外,AA vs AG[MD=0.53,95%CI(0.32,0.75),P<0.00001],AA vs GG[MD=0.67,95%CI(0.10,1.23),P=0.02],AA vs AG+GG[MD=0.61,95%CI(0.45,0.76)P<0.00001],两者差异均具有统计学意义,说明癫痫患者UGT1A6 A541G AA型丙戊酸钠血药浓度高于AG型或/和GG型。在UGT1A6 A552C中,除AC vs CC[MD=0.21,95%CI(-0.31,0.74),P=0.43]外,AA vs AC[MD=0.90,95%CI(0.77,1.03),P<0.00001],AA vs CC[MD=0.90,95%CI(0.77,1.03),P<0.00001],AA vs AC+CC[MD=1.58,95%CI(1.07,2.10),P<0.00001],两者差异均具有统计学意义,说明UGT1A6 A552C AA型丙戊酸钠血药浓度高于AC型或/和CC型。结论:癫痫患者UGT1A6 A541G和A552C基因多态性与丙戊酸钠血药浓度具有相关性,且基因突变可能导致丙戊酸钠血药浓度降低。
文摘In this study, we investigated the effect of sodium bicarbonate (NaHCO3) supplementation at a dose of 0.2 g·kg−1 40 min before an exercise on intermittent endurance performance and gastrointestinal distress. The participants were six healthy male students of a university. The Yo-Yo intermittent recovery test level 2 (Yo-Yo IR2) was used for the evaluation of intermittent endurance. The participants ingested water (Cont) or NaHCO3 independently at three timings. After drinking water, the Yo-Yo IR1 was performed for 2 min as warm-up. After resting for 5 min, the Yo-Yo IR2 was initiated. The measurement items were exercise distance, nutrition intake, biochemical test results, and blood gas analysis findings. The participants who ingested NaHCO3 had a 14% extended distance than those who ingested Cont, and 2/3 of those who took NaHCO3 showed a better motor performance. No significant difference was observed between the participants who took Cont and NaHCO3 in terms of pH level at baseline, and the NaHCO3 level was significantly higher during pre- and post-exercise (p 3 in terms of bicarbonate ion level at baseline, and the NaHCO3 level was significantly higher during pre- and post-exercise (p 3 at a low dose (0.2 g·kg−1), their exercise ability during an intermittent endurance test has improved. Furthermore, when digestive absorption is considered, eating a meal in advance may be able to suppress the onset of gastrointestinal distress.
