1.
Hypersensitivity reactions to bicarbonate dialysate containing acetate: a case report with literature review.
Nishiuchi, Y, Shima, H, Fukata, Y, Tao, T, Okamoto, T, Takamatsu, N, Okada, K, Minakuchi, J
CEN case reports. 2020;(3):243-246
Abstract
Although hemodialysis-hypersensitivity reactions have various causes, only a few cases of hypersensitivity to acetate dialysate accompanied by fever have been reported. We present the case of a 69-year-old hemodialysis patient who was admitted due to fever after dialysis. He had undergone online hemodiafiltration using acetate-free citrate-containing dialysate. After admission, we switched to acetate-containing bicarbonate dialysate. He was diagnosed with pneumonia and treated with ceftriaxone. However, fever that occurred post dialysis persisted, displaying a gradual elevation in CRP level and eosinophils (up to 9.7 mg/dL and 3774 cells/μL, respectively). After a series of negative workups for infection and dialysis membrane allergy, we suspected that acetate-containing bicarbonate dialysate to be the cause of the allergic reaction and switched to acetate-free bicarbonate dialysate. Consequently, eosinophil count decreased and the fever abated. The drug-induced lymphocyte stimulation test finding (for acetate dialysate) was positive, and he was diagnosed with acetate dialysate-induced hypersensitivity reactions. The condition was not detected earlier due to the complications associated with pneumonia.
2.
[Disorders of the acid-base balance and the anion gap].
Kimmel, M, Alscher, MD
Deutsche medizinische Wochenschrift (1946). 2016;(21):1549-1554
Abstract
The regulation of the acid-base balance and pH is critical for the organism. The most important buffer system is CO2 / HCO3-. The kidney controls systemic bicarbonate and therefore the metabolic regulation and the lung is relevant for respiratory regulation by an effective CO2 elimination. There are four acid-base disorders with two metabolic and two respiratory disorders (acidosis and alkalosis). The anion gap enables a further workup of metabolic acidosis.
3.
Application of base deficit in resuscitation of trauma patients.
Ziglar, MK
International journal of trauma nursing. 2000;(3):81-4
Abstract
Clinical measures, such as blood pressure or urine output, have been the traditional methods used to assess tissue perfusion in trauma patients with hypovolemia. Hypoperfusion of tissues results in increased levels of lactate and carbonic acids. Base deficit is a clinical measure of metabolic acidosis that normalizes rapidly with adequate resuscitation and hemorrhage control, and it can be used to monitor the initial care of a patient with trauma. The method used to measure base deficit is discussed, along with its clinical uses and limitations. A case study is used to correlate changes in base deficit with other clinical parameters.