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Impact of hyperkalaemia on renin-angiotensin-aldosterone (RAAS) inhibitor reduction or withdrawal following hospitalisation.
Clin Exp Med
December 2024
Department of Medicine, King's College Hospital NHS Foundation Trust, London, UK.
Background: Inhibitors of the renin-angiotensin-aldosterone system (RAAS), such as ACE inhibitors (ACEi), angiotensin-II receptor blockers and mineralocorticoid receptor antagonists, reduce morbidity and mortality in hypertension, congestive heart failure and chronic kidney disease. However, their use can lead to hyperkalaemia. We examined the proportions of RAAS inhibitor (RAASi) reduction or withdrawal, across GFR strata, following hospitalisation and the effect on patient mortality.
View Article and Find Full Text PDFOutcomes of Del Nido and hyperkalemic blood cardioplegia in adult cardiac surgery with prolonged aortic cross-clamp times★.
J Extra Corpor Technol
December 2024
College of Medicine and Public Health, Flinders University - Quality and Outcomes Unit, Cardiothoracic Surgical Unit, Division of Surgery, Flinders Medical Centre, Adelaide, South Australia, Australia.
Background: The utility and uptake of Del Nido cardioplegia in adult cardiac surgery is rapidly increasing. Cases with prolonged aortic cross-clamp times necessitate multi-dosing however an understanding of safe ischaemic times and definitive guidelines in this domain are lacking. Therefore, this study aimed to assess the safety and efficacy of our DNC strategy by comparing post-operative troponin profiles and clinical outcomes between Del Nido and hyperkalaemic cardioplegia for cases with aortic cross-clamp times of greater than 90 min.
View Article and Find Full Text PDFDetermining optimal pretreatment in cardiac surgery: an experimental study.
Gen Thorac Cardiovasc Surg
November 2024
Department of Cardiovascular Surgery, Nippon Medical School Hospital, 1-1-5 Sendagi, Bunkyo, Tokyo, 113-8603, Japan.
Objectives: Heart failure patients with reduced ejection fraction are currently treated with four drug combinations: angiotensin receptor/neprilysin inhibitors, beta-blockers, mineralocorticoid receptor antagonists, and sodium-glucose cotransporter 2 inhibitors, resulting in improved survival outcomes. Herein, we examined whether myocardial protection by esaxerenone or sacubitril/valsartan may present a counter-effect to the harm caused by cardioplegic arrest.
Methods: Male Wistar rats fed a normal diet were orally administered esaxerenone (3 mg/kg; Esax) or sacubitril/valsartan (68 mg/kg; SaV) once a day for 2 weeks from 6 weeks of age.
Understanding renal tubular acidosis.
Br J Hosp Med (Lond)
October 2024
Monash Rural Health Mildura, Monash University, Melbourne, Australia.
Renal tubular acidosis is a group of disorders characterised by metabolic acidosis, hyperchloraemia, normal anion gap, and potassium imbalance. Genetic mutations, drugs or acquired disorders disrupt the function of various transport proteins and enzymes in the renal tubules, causing diminished bicarbonate reabsorption or inability to excrete hydrogen ions, leading to proximal (type 2) and distal (type 1) renal tubular acidosis, respectively. These conditions are typically associated with hypokalaemia, which, if severe, can cause muscle paralysis and dangerous cardiac arrhythmias.
View Article and Find Full Text PDFSodium Bicarbonate In In-Hospital and Out-of-Hospital Cardiac Arrest: A Systematic Literature Review.
Cureus
August 2024
Intensive Care Department, Hospital Central do Funchal, Funchal, PRT.
Article Synopsis
- Cardiac arrest is a major global health issue, and sodium bicarbonate (SB) is often used during CPR to address metabolic acidosis, though its effectiveness is debated.
- A systematic review of studies from various medical databases found 12 relevant studies on SB's use in cardiac arrest, highlighting mixed results.
- Overall, while some studies hint at potential benefits in certain situations, the review concluded that SB is generally not recommended for standard cardiac arrest treatment, suggesting more research is needed to explore specific cases where it might be useful.
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