Acid-Base Disorders in the Emergency Department: Incidence, Etiologies and Outcomes

Köse, Ataman; Armağan, Erol; Öner, Nuran; Köksal, Özlem; Mert, Dilek Kostak; Özdemir, Fatma Nurhan; Aydın, Şule

doi:10.5152/jaem.2014.27880

Cited by 10 publications

(5 citation statements)

References 25 publications

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“…These conditions have been reported to lead to development of acidosis or alkalosis. 18 Normally, the pH of blood plasma is maintained within narrow limits of 7.35–7.45. Most often, acidosis or alkalosis develops when there is a mild disturbance in blood plasma pH outside this range.…”

Section: Introductionmentioning

confidence: 99%

The role of acid-base imbalance in statin-induced myotoxicity

Taha

Moor

Barrett

et al. 2016

Translational Research

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Disturbances in acid-base balance, such as acidosis and alkalosis, have potential to alter the pharmacologic and toxicologic outcomes of statin therapy. Statins are commonly prescribed for elderly patients who have multiple comorbidities such as diabetes mellitus, cardiovascular, and renal diseases. These patients are at risk of developing acid-base imbalance. In the present study, the effect of disturbances in acid-base balance on the interconversion of simvastatin and pravastatin between lactone and hydroxy acid forms have been investigated in physiological buffers, human plasma, and cell culture medium over pH ranging from 6.8–7.8. The effects of such interconversion on cellular uptake and myotoxicity of statins were assessed in vitro using C2C12 skeletal muscle cells under conditions relevant to acidosis, alkalosis, and physiological pH. Results indicate that the conversion of the lactone forms of simvastatin and pravastatin to the corresponding hydroxy acid is strongly pH dependent. At physiological and alkaline pH, substantial proportions of simvastatin lactone (SVL; ∼87% and 99%, respectively) and pravastatin lactone (PVL; ∼98% and 99%, respectively) were converted to the active hydroxy acid forms after 24 hours of incubation at 37°C. At acidic pH, conversion occurs to a lower extent, resulting in greater proportion of statin remaining in the more lipophilic lactone form. However, pH alteration did not influence the conversion of the hydroxy acid forms of simvastatin and pravastatin to the corresponding lactones. Furthermore, acidosis has been shown to hinder the metabolism of the lactone form of statins by inhibiting hepatic microsomal enzyme activities. Lipophilic SVL was found to be more cytotoxic to undifferentiated and differentiated skeletal muscle cells compared with more hydrophilic simvastatin hydroxy acid, PVL, and pravastatin hydroxy acid. Enhanced cytotoxicity of statins was observed under acidic conditions and is attributed to increased cellular uptake of the more lipophilic lactone or unionized hydroxy acid form. Consequently, our results suggest that comorbidities associated with acid-base imbalance can play a substantial role in the development and potentiation of statin-induced myotoxicity.

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Section: Introductionmentioning

confidence: 99%

The role of acid-base imbalance in statin-induced myotoxicity

Taha

Moor

Barrett

et al. 2016

Translational Research

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“…It was noted in our study that ABD was more common in male than female, which is similar to the findings reported earlier. 4,7 In our study, it was seen that 29% of patients were suffering from simple ABD, whereas 34% of cases were of mixed ABD.…”

Section: Discussionmentioning

confidence: 49%

Study of Acid-Base Disorders and Biochemical Findings of Patients in a Tertiary Care Hospital: A Descriptive Cross-sectional Study

Shreewastav¹,

Jaishi²,

Pandey³

et al. 2019

J Nepal Med Assoc

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Introduction: Acid base disorder is a condition characterized by alteration in blood pH by theimbalance between the components of blood leading to a life threatening situation. The main aimof this study was to find the prevalence of acid-base disorders and biochemical findings of suchdisorders in patients in a tertairy care hospital. Methods: This descriptive cross-sectional study was conducted in Nobel Medical College TeachingHospital from 1st September, 2018 to 31st August, 2019. Ethical apporoval was taken from InstitutionalReview Committee. All the patients presented to emergency department, intensive care units andwards were included during the study period. Data were entered and calculations were done inMicrosoft Excel, point estimate at 95% Confidence Interval was calculated along with frequency andproportion for binary data. Results: Out of arterial blood gas analysis of 1144 patients, the prevalence of acid base disorderswas 718 (62.76%) at 95% Confidence Interval (59.96-65.56%). Simple and mixed acid base disorderswere observed in 332 (46.24%) and 386 (53.76%) patients respectively. Respiratory alkalosis was mostcommon among 134 (40.36%) cases in simple acid base disorder whereas metabolic acidosis andrespiratory alkalosis was most common among 204 (52.85%) in mixed acid base disorder. All typesof disorders were observed more in elderly people (41-60 and >60 age group) than other age groups. Conclusions: Acid base disorder was found to be more common in very ill patients in emergency andintensive care units compared to similar studies. Mixed acid base disorder was the most commonwith male and elderly patients in predominance.

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“…Respiratory alkalosis develops when there is a significant increase in alveolar ventilation relative to carbon dioxide production. If carbon dioxide production remains stable, hyperventilation causes hypocapnia from the excess loss of carbon dioxide resulting in respiratory alkalosis 1. The pH in the blood continues to rise (alkalaemia) due to a shift in the form of bicarbonate to its carbon dioxide form and the reduction of hydrogen ions in the blood.…”

Section: Discussionmentioning

confidence: 99%

“…Acid–base disorders (ABDs) are common in hospitalised patients, with a prevalence from 62% to 71% in cross-sectional studies of a pooled population in the intensive care unit (ICU) and emergency department (ED) 1 2. A prospective observational study identified that an elevated serum pH (alkalaemia) was associated with higher levels of morbidity and mortality, with a mortality rate as high as 48.5% in patients with a pH greater than 7.60 3.…”

Section: Introductionmentioning

confidence: 99%

Extreme alkalaemia with mixed alkalosis due to suspected acute-on-chronic respiratory alkalosis

et al. 2023

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Herein we present a case of severe alkalaemia (pH 7.81) due to suspected acute-on-chronic respiratory alkalosis in a patient with chronic anxiety and metabolic alkalosis secondary to emesis. The patient was managed in the intensive care unit with significant improvement and discharged in stable condition. The case report emphasises considering a broad differential of aetiologies that can cause acid–base status derangements and identifying the appropriate therapeutic approach.

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Acid-Base Disorders in the Emergency Department: Incidence, Etiologies and Outcomes

Cited by 10 publications

References 25 publications

The role of acid-base imbalance in statin-induced myotoxicity

The role of acid-base imbalance in statin-induced myotoxicity

Study of Acid-Base Disorders and Biochemical Findings of Patients in a Tertiary Care Hospital: A Descriptive Cross-sectional Study

Extreme alkalaemia with mixed alkalosis due to suspected acute-on-chronic respiratory alkalosis

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