Clin Nephrol
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The low-flow method has been shown as a reliable evaluation of access recirculation. Few data is available on temporary central catheter blood recirculation; results of 2% and 4% have been reported in subclavian, 10% in 24 cm long femoral, and 18% in 15 cm long femoral catheters, mostly in indwelling catheters for chronic hemodialysis. The purpose of this prospective study was to evaluate blood recirculation in a larger number of recently inserted temporary intravenous catheters for acute hemodialysis, comparing subclavian and femoral sites. ⋯ It was significantly higher for sessions performed with subclavian than with femoral catheters (62.5 +/- 10.9%, n = 24, versus 54.5 +/- 14.2%, n = 26) (p = 0.03). In conclusion, the expected blood recirculation in well-functioning and recently inserted temporary dialysis catheters is under 5% for subclavian, over 12% in 19.5 cm femoral, and over 22% in shorter 13.5 cm femoral catheters at a blood flow rate of 300 ml/min. The consequently reduced dialysis efficiency with femoral catheters is another factor to be considered in the choice of a site for temporary dialysis catheter insertion in acute renal failure patients, particularly when dialysis dose delivery is a priority, such as intoxication cases treated by extracorporeal therapy.
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Hypotension is the principal complication of chronic hemodialysis. Autonomic insufficiency is thought to be a primary contributing cause of hemodialysis hypotension. We treated patients who experience hemodialysis hypotension with midodrine, a selective alpha-1 adrenergic pressor agent in an initial effort to assess potential efficacy. ⋯ Also, the post-dialysis blood pressures (systolic/diastolic) were significantly increased from 115.6 + or - 3.1/62.3 + or - 2.1 to 129.9 + or - 3.9/68.1 + or - 1.7 mmHg (p <0.01 and 0.05, respectively). No apparent clinical or laboratory abnormalities were observed. Oral midodrine appears to be a safe and effective therapy for the treatment of hemodialysis hypotension.
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The association of severe hyponatremia and the ingestion of large quantities of beer, termed beer potomania, has been known for several years. We report two new cases, and review 20 others from the medical literature. These patients usually have a history of binge beer drinking, poor dietary intake, and then present with severe hyponatremia and various mental status changes or seizures. ⋯ We propose that the pivotal pathophysiologic mechanism in beer potomania syndrome is the minimal intake of solute and the hypoosmolality of the beer ingested. This will lead to the inability to excrete sufficient amounts of free water to keep up with the ingestion of large quantities of the hyposmolar beer. Treatment with isotonic sodium chloride results in the rapid clearance of the accumulated excess free water.
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Comparative Study
The acute impact of NaHCO3 in treatment of metabolic acidosis on back-titration of non-bicarbonate buffers: a quantitative analysis.
The major non-bicarbonate buffers are intracellular proteins, a detrimental effect of severe acidosis could be their titration with H+. This in turn would lead to their net charge becoming more positive, and possibly, to changes in their shape and function. Since NaHCO3 is a treatment option in patients with severe metabolic acidosis, the purpose of this study was to examine the acute effect of the administration of NaHCO3 on back-titration of non-bicarbonate buffers in metabolic acidosis. ⋯ The administration of NaHCO3 does not acutely lead to a significant back-titration of non-bicarbonate buffers, especially under conditions of fixed ventilation.
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The objective of the present study was to estimate how glomerular filtration rate and kidney size change after six years of diabetes in subjects with non-insulin-dependent disease. It is a population-based prospective study of a cohort of non-insulin diabetic patients (n = 150) diagnosed 1985-1988. The baseline studies utilized a non-diabetic control group, whose basic characteristics were equal to the study group. ⋯ We conclude that after the first six years of non-insulin-dependent diabetes the glomerular filtration rate remains high. Kidney size increases further from the attained increase at diagnosis and is an important determinant of continuing hyperfiltration. The deleterious effect of serum cholesterol and high blood glucose on the glomerular filtration rate at this early stage of diabetic kidney disease is suggestive.