Understanding the Acid-Base Response to Respiratory Derangements: Finding, and Clinically Applying, the In Vivo Base Excess.

Objectives: To evaluate the base excess response during acute in vivo carbon dioxide changes.

Design: Secondary analysis of individual participant data from experimental studies.

Setting: Three experimental studies investigating the effect of acute in vivo respiratory derangements on acid-base variables.

Pitfalls in anticoagulant-related nephropathy.

Anticoagulant-related nephropathy (ARN) is a rare but important disease and often misdiagnosed. The hallmark of the diagnosis is acute kidney injury (AKI) superimposed on preexisting kidney disease due to anticoagulation-induced glomerular hemorrhage with histologic features of widespread tubular obstruction by red blood cells and red cell casts. As ARN is a diagnosis of exclusion only proven by renal biopsy, the diagnosis is often unlikely to be confirmed histologically because of fear of biopsy-related bleeding during anticoagulant therapy.

Altitude Pre-Acclimatization with an Erythropoiesis-Stimulating Agent.

Introduction: High altitude illness is a complication of rapid ascent above 2,500 m elevation. Ventilatory, circulatory and haematological adjustments, known as acclimatization, occur to maintain adequate delivery of oxygen. Although (non-)pharmaceutical strategies that modulate ventilation and circulation have long been accepted, the haematological approach has not.

Hyperosmolar Therapy for Diabetic Hyperosmolar Ketoacidosis.

Unlabelled: Hyperglycaemic hyperosmolar state (HHS) and diabetic ketoacidosis (DKA) features can occur simultaneously in 27% of diabetic emergencies and have a two-fold increased risk of death. Despite the high prevalence of this combination, recommended treatments from leading guidelines may not be compatible with the clinical picture. A 36-year-old man presented with explicit concurrent HHS and DKA.

Intoxication by Hand-Sanitizers and other Toxic Alcohols in a Low-Resource Setting: Two Case Reports.

Unlabelled: Toxic alcohol poisoning can be lethal if not identified early and treated appropriately. Toxic alcohol assays are often unavailable in low-resource setting, so clinicians have to infer a diagnosis based on suspicion, repeated evaluation and biochemical course. We report a case of toxic alcohol poisoning concealed by auto-intoxication with in-hospital hand sanitizer.

Review of the Diagnostic Evaluation of Normal Anion Gap Metabolic Acidosis.

Background: Normal anion gap metabolic acidosis is a common but often misdiagnosed clinical condition associated with diarrhea and renal tubular acidosis (RTA). Early identification of RTA remains challenging for inexperienced physicians, and diagnosis and treatment are often delayed.

Summary: The presence of RTA should be considered in any patient with a high chloride level when the CL/Na ratio is above 0.

Acid-base pathophysiology after 130 years: confusing, irrational and controversial.

Background: The interface between acid-base physiology and blood gas interpretation is historically both stimulating and turbulent. Since the pioneering work of many celebrated names in the history of acid-base disorders, such as Arrhenius, Henderson, Hasselbalch and many more to follow, substantial progress in acid-base knowledge has been made over the last 130 years. Out of the chaos of competing definitions, concepts and terms, many have tried to bring an orderly approach to acid-base balance.

Chloride: the queen of electrolytes?

Background: Channelopathies, defined as diseases that are caused by mutations in genes encoding ion channels, are associated with a wide variety of symptoms and have been documented extensively over the past decade. In contrast, despite the important role of chloride in serum, textbooks in general do not allocate chapters exclusively on hypochloremia or hyperchloremia and information on chloride other than channelopathies is scattered in the literature.

Study Design: To systematically review the function of chloride in man, data for this review include searches of MEDLINE, PubMed, and references from relevant articles including the search terms "chloride," "HCl," "chloride channel" "acid-base," "acidosis," "alkalosis," "anion gap" "strong anion gap" "Stewart," "base excess" and "lactate.