Drug-induced acid-base disorders

Kitterer, Daniel; Schwab, Matthias; Alscher, M. Dominik; Braun, Niko; Latus, Joerg

doi:10.1007/s00467-014-2958-5

Cited by 50 publications

(34 citation statements)

References 181 publications

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“…Drug-induced acid-base disorder can be classified into five different categories based on the pathophysiology: 1) metabolic acidosis caused by acid overload, which may occur through the accumulation of acids by endogenous mechanisms, 2) base loss: proximal renal tubular acidosis caused by drugs, 3) alkalosis resulting from acid and/or chloride loss via renal or extrarenal (e.g., laxative drugs) mechanisms; 4) exogenous bicarbonate loads: milk-alkali syndrome, overshoot alkalosis after bicarbonate therapy or citrate administration; and 5) respiratory acidosis or alkalosis resulting from drug-induced depression of the respiratory center or neuromuscular impairment ( 13 ).…”

Section: Discussionmentioning

confidence: 99%

The Anion Gap is a Predictive Clinical Marker for Death in Patients with Acute Pesticide Intoxication

et al. 2016

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Pesticide formulation includes solvents (methanol and xylene) and antifreeze (ethylene glycol) whose metabolites are anions such as formic acid, hippuric acid, and oxalate. However, the effect of the anion gap on clinical outcome in acute pesticide intoxication requires clarification. In this prospective study, we compared the anion gap and other parameters between surviving versus deceased patients with acute pesticide intoxication. The following parameters were assessed in 1,058 patients with acute pesticide intoxication: blood chemistry (blood urea nitrogen, creatinine, glucose, lactic acid, liver enzymes, albumin, globulin, and urate), urinalysis (ketone bodies), arterial blood gas analysis, electrolytes (Na+, K+, Cl- HCO3-, Ca++), pesticide field of use, class, and ingestion amount, clinical outcome (death rate, length of hospital stay, length of intensive care unit stay, and seriousness of toxic symptoms), and the calculated anion gap. Among the 481 patients with a high anion gap, 52.2% had a blood pH in the physiologic range, 35.8% had metabolic acidosis, and 12.1% had acidemia. Age, anion gap, pesticide field of use, pesticide class, seriousness of symptoms (all P < 0.001), and time lag after ingestion (P = 0.048) were significant risk factors for death in univariate analyses. Among these, age, anion gap, and pesticide class were significant risk factors for death in a multiple logistic regression analysis (P < 0.001). In conclusions, high anion gap is a significant risk factor for death, regardless of the accompanying acid-base balance status in patients with acute pesticide intoxication.

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Section: Discussionmentioning

confidence: 99%

The Anion Gap is a Predictive Clinical Marker for Death in Patients with Acute Pesticide Intoxication

et al. 2016

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“…A number of drugs are known to affect the body's acid-base balance. Drugs that lead to metabolic acidosis caused by acid load or base loss have been reviewed [69]. AEDs that inhibit carbonic anhydrase may cause metabolic acidosis [70].…”

Section: Include a Lemon Or Lime Each Daymentioning

confidence: 99%

An acidosis-sparing ketogenic (ASK) diet to improve efficacy and reduce adverse effects in the treatment of refractory epilepsy

Yuen

Walcutt

Sander

2017

Epilepsy & Behavior

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Diets that increase production of ketone bodies to provide alternative fuel for the brain are evolving from the classic ketogenic diet for epilepsy devised nearly a century ago. The classic ketogenic diet and its more recent variants all appear to have similar efficacy with approximately 50% of users showing a greater than 50% seizure reduction. They all require significant medical and dietetic support, and there are tolerability issues. A review suggests that low-grade chronic metabolic acidosis associated with ketosis is likely to be an important contributor to the short term and long term adverse effects of ketogenic diets. Recent studies, particularly with the characterization of the acid sensing ion channels, suggest that chronic metabolic acidosis may increase the propensity for seizures. It is also known that low-grade chronic metabolic acidosis has a broad range of negative health effects and an increased risk of early mortality in the general population. The modified ketogenic dietary treatment we propose is formulated to limit acidosis by measures that include monitoring protein intake and maximizing consumption of alkaline mineral-rich, low carbohydrate green vegetables. We hypothesize that this acidosis-sparing ketogenic diet is expected to be associated with less adverse effects and improved efficacy. A case history of life-long intractable epilepsy shows this diet to be a successful long-term strategy but, clearly, clinical studies are needed.

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“…Acid-base disorders (ABDs) are often indicators for severe systemic disorders including acute kidney injury, major traumas, unstable postoperative conditions, and acute drug intoxications [ 14 - 17 ]. Serum anion gap (AG) and serum osmolar gap are not only highly sensitive diagnostic tools for distinguishing various ABDs but are also a severity index for ABDs [ 18 ].…”

Section: Introductionmentioning

confidence: 99%

Serum markers and development of delayed neuropsychological sequelae after acute carbon monoxide poisoning: anion gap, lactate, osmolarity, S100B protein, and interleukin-6

et al. 2018

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ObjectiveReliable biomarkers of delayed neuropsychological sequelae (DNS) after acute carbon monoxide (CO) poisoning are lacking. This study investigated the associations between potential serum markers and the development of DNS after acute CO poisoning.MethodsRetrospective chart reviews were conducted for patients diagnosed with acute CO poisoning during a 28-month period. The patients were divided into two groups according to the presence or absence of having developed DNS. Multivariate analysis was performed to identify predictors of DNS after CO poisoning.ResultsOf a total of 102 patients, 10 (9.8%) developed DNS. The levels of serum osmolarity, S100B protein, and serum lactate, as well as serum anion gap, were statistically significant in univariate analysis. Multiple logistic regression analysis showed that anion gap (adjusted odds ratio [AOR], 1.36; 95% confidence interval [CI], 1.11 to 1.88), serum lactate level (AOR, 1.74; 95% CI, 1.26 to 2.75), and serum S100B protein level ([AOR, 7.02×105; 95% CI, 4.56×102 to 9.00×1010] in model 1, [AOR, 3.69×105; 95% CI, 2.49×102 to 2.71×1011] in model 2) were independently associated with DNS development.ConclusionBased on our preliminary results, serum lactate level, serum anion gap, and serum S100B protein level in the emergency department could be informative predictors of DNS development in patients with acute CO poisoning. These markers might have the potential to improve early recognition of DNS in patients with acute CO poisoning.

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Drug-induced acid-base disorders

Cited by 50 publications

References 181 publications

The Anion Gap is a Predictive Clinical Marker for Death in Patients with Acute Pesticide Intoxication

The Anion Gap is a Predictive Clinical Marker for Death in Patients with Acute Pesticide Intoxication

An acidosis-sparing ketogenic (ASK) diet to improve efficacy and reduce adverse effects in the treatment of refractory epilepsy

Serum markers and development of delayed neuropsychological sequelae after acute carbon monoxide poisoning: anion gap, lactate, osmolarity, S100B protein, and interleukin-6

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