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Acute diarrhea and metabolic acidosis caused by tuberculous vesico-rectal fistula

World Journal of Gastroenterology 2014年第41期20卷 15462-15466页

作者： Xiu-Qing Wei Yan Zou Zhi-E Wu Kodjo-Kunale Abassa Wei Mao Jin Tao Zhuang Kang Zhuo-Fu Wen Bin Wu Department of Gastroenterology The Third Affiliated Hospital of Sun Yat-Sen University Department of Radiology The Third Affiliated Hospital of Sun Yat-Sen University

Acquired vesico-rectal fistula is an uncommon complication of pelvic malignant tumors,surgical injury,inflammatory disorders such as tuberculosis infection,radiotherapy and less commonly diverticulum of the urinary *** fistula is often identified by urinary tract abnormalities such as dysuria,recurrent urinary tract infection,pneumaturia,and ***,we report an unusual case of a patient with a vesico-rectal fistula of tuberculous origin,presenting with severe acute diarrhea,metabolic acidosis,hyperchloremia and hypokalemia while with only mild urinary tract *** patient was cured by tuberculostatic therapy.

关键词： Vesico-rectal fistula Tuberculous Diarrhea Acidosis hyperchloremia Hypokalemia

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0.9% saline is neither normal nor physiological

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Journal of Zhejiang University-Science B(Biomedicine & Biotechnology) 2016年第3期17卷 181-187页

作者： Heng LI Shi-ren SUN John Q.YAP Jiang-hua CHEN Qi QIAN Kidney Disease Center the First Affiliated HospitalSchool of MedicineZhejiang University Division of Nephrology Xijing HospitalFourth Military University College of Medicine Department of Physiology and Biomedical Engineering Mayo Clinic College of Medicine Division of Nephrology and Hypertension Department of MedicineMayo Clinic College of Medicine

The purpose of this review is to objectively evaluate the biochemical and pathophysiological properties of 0.9% saline （henceforth： saline） and to discuss the impact of saline infusion, specifically on systemic acid-base bal- ance and renal hemodynamics. Studies have shown that electrolyte balance, including effects of saline infusion on serum electrolytes, is often poorly understood among practicing physicians and inappropriate saline prescribing can cause increased morbidity and mortality. Large-volume （〉2 L） saline infusion in healthy adults induces hyperohloremia which is associated with metabolic acidosis, hyperkalemia, and negative protein balance. Saline overload （80 ml/kg） in rodents can cause intestinal edema and contractile dysfunction associated with activation of sodium-proton exchanger （NHE） and decrease in myosin light chain phosphorylation. Saline infusion can also adversely affect renal hemody- namics. Microperfusion experiments and real-time imaging studies have demonstrated a reduction in renal perfusion and an expansion in kidney volume, compromising 02 delivery to the renal perenchyma following saline infusion. Clinically, saline infusion for patients post abdominal and cardiovascular surgery is associated with a greater number of adverse effects including more frequent blood product transfusion and bicarbonate therapy, reduced gastric blood flow, delayed recovery of gut function, impaired cardiac contractility in response to inotropes, prolonged hospital stay, and possibly increased mortality. In critically ill patients, saline infusion, compared to balanced fluid infusions, in- creases the occurrence of acute kidney injury. In summary, saline is a highly acidic fluid. With the exception of saline infusion for patients with hypochloremic metabolic alkalosis and volume depletion due to vomiting or upper gastroin- testinal suction, indiscriminate use, especially for acutely ill patients, may cause unnecessary complications and should be avoided. M

关键词： 0.9% saline hyperchloremia Acidosis Hyperkalemia Balanced fluids Renal hemodynamics

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Increase in chloride from baseline is independently associated with mortality in intracerebral hemorrhage patients admitted to intensive care unit:A retrospective study

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Journal of Intensive Medicine 2022年第4期2卷 274-281页

作者： Dawei Zhou Tong Li Dong Zhao Qing Lin Dijia Wang Chao Wang Rongli Zhang Department of Critical Care Medicine Beijing Tongren HospitalCapital Medical UniversityNo.1 Dongjiaominxiang StreetDongcheng DistrictBeijing 100730China

Background:hyperchloremia is associated with increased mortality in critically ill *** objective of this study was to investigate the association between increased chloride levels and mortality outcomes in intracerebral hemorrhage(ICH)patients admitted to the intensive care unit(ICU).Methods:We performed a retrospective study of all patients diagnosed with ICH and included in the Medical Information Mart for Intensive Care(MIMIC-III)from 2001 to *** criteria were the first diagnosis of ICH,ICU length of stay(LOS)over 72 h,and not receiving hypertonic saline *** chloride perturbation within 72 h of admission was evaluated as a predictor of *** increase in chloride from baseline was dichotomized based on an increase in chloride in 72 h(≤5 mmol/L or>5 mmol/L).The primary outcome was 90-day ***:A total of 376 patients(54.5%male,median age 70 years,interquartile range:58–79 years)were *** overall 90-day mortality was 32.2%(n=121),in-hospital mortality was 25.8%(n=97),and Day 2 acute kidney injury(AKI)occurred in 29.0%(n=109)of *** prevalence of hyperchloremia on admission,during the first 72 h,and an increase in chloride(>5 mmol/L)were 8.8%,39.4%,and 42.8%,*** adjusting for confounders,the hazard ratio of increase in chloride(>5 mmol/L)was 1.66(95%confidence interval:1.05–2.64,P=0.031).An increase in chloride(>5 mmol/L)was associated with a higher odds ratio for 90-day mortality in both the AKI and non-AKI ***:An increase in chloride from baseline is common in adult patients with ICH admitted to *** increase is significantly associated with elevated *** results support the significance of diligently monitoring chloride levels in these patients.

关键词： Intracerebral hemorrhage hyperchloremia Normal saline Serum chloride Mortality

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