sodium-bicarbonate and Apnea

Apnoea of prematurity (AOP) frequently recurs in preterm infants. We have previously shown that a significant but variable proportion of AOP is induced by gastro-oesophageal reflux (GOR).. The aim of this study is to evaluate the efficacy of sodium alginate in reducing the frequency of GOR-related AOP.. Twenty-eight preterm infants with AOP were studied by a six-hour recording of combined multichannel intraluminal impedance and pH monitoring and polysomnography, including two three-hour postprandial periods: sodium alginate was given after one single meal named as drug-given (DG) meal, while the other as drug-free (DF).. During 165h of registration, 715 apnoeas were recorded, 368 after-DG and 347 after-DF (p=.99); furthermore, 851 GOR episodes were detected, 315 after-DG and 536 after-DF (p=.001). No differences in the number of AOP were found between DG and DF. A significant reduction in the number of acid GORs and in acid exposure was found during DG, while the administration of sodium alginate didn't influence non-acid GOR indexes. The frequency of GOR-related apnoeas didn't differ between DG and DF.. Sodium alginate doesn't reduce the total number of AOP nor GOR-related apnoeas. On the other hand, it reduces acid GOR features, while it had no effect on non-acid GOR indexes.

Topics: Alginates; Aluminum Hydroxide; Apnea; Drug Combinations; Female; Gastroesophageal Reflux; Glucuronic Acid; Hexuronic Acids; Humans; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases; Male; Silicic Acid; Sodium Bicarbonate

Topics: Alkalosis; Apnea; Female; Gastrointestinal Agents; Humans; Infant; Recurrence; Sodium Bicarbonate

The possible pathophysiology of the relationship between gastro-esophageal reflux disease and apnea of prematurity has been widely investigated. Various physiological protective reflex responses provide a plausible biological link between gastro-esophageal reflux and apnea of prematurity. It is uncertain whether or not there is a causal relationship between the two diseases. PATIENT'S FINDINGS: Twins were admitted to the neonatal intensive care unit due to feeding problems. Physical examination was normal except for reticulated, blueviolet skin changes. Short apneic attacks occurred on the first day in twin 1 and on the second day in twin 2, and these were initially treated by stimulation and increased ambient O2 concentration. Then, we conducted methylxanthine and continuous positive airway pressure treatment. Laboratory and radiological analysis were normal. As gastro-esophageal reflux disease was thought to be the causes of the treatment-refractory apnea, therapy with gaviscon and domperidon was begun for both cases. Apneic attacks did not recur after gaviscon and domperidon therapy.. Pharmacological therapy for gastro-esophageal reflux disease has not definitively been shown to be effective in improving symptoms and hence, should be reserved especially for infants with treatment refractory apnea episodes suspected as being gastro-esophageal reflux in premature infants.. 背景：胃食管反流病和早产儿呼吸暂停之间可能的病理生理学机制已被广泛 研究。多种生理保护性反射应答为胃食管反流和早产儿呼吸暂停提供了一个合 理的生物学联系，但二者之间是否存在因果关系尚不确定。患者的研究结 果：双胞胎因为喂养问题被送进新生儿重症监护病房，体格检查发现除了网 状蓝紫色皮肤改变，其它正常。双胞胎1 和双胞胎2 分别在第一天和第二天发 生了短暂的呼吸暂停。最初我们采用刺激和增加环境中氧气浓度来治疗，然后 进行了甲基黄嘌呤和持续气道正压通气治疗。实验室和影像学分析均正常。因 为胃食管反流被认为是难治性呼吸暂停的原因，开始用嘉胃斯康 和 多潘立酮 治疗这两种情况，嘉胃斯康 和 多潘立酮治疗后没有再发生窒息。结论：胃食 管反流病的药物治疗没有明确被证明能有效改善症状，因此，尤其在治疗难治 性呼吸暂停疑似有胃食管反流的早产儿时应谨慎。.

Topics: Alginates; Aluminum Hydroxide; Antacids; Antiemetics; Apnea; Diseases in Twins; Domperidone; Drug Combinations; Gastroesophageal Reflux; Gestational Age; Humans; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases; Silicic Acid; Sodium Bicarbonate; Twins

Severe cocaine toxicity causes acidemia and cardiac dysfunction. These manifestations are described in 4 patients who presented with seizures, psychomotor agitation, and cardiopulmonary arrest. Their initial laboratory values demonstrated acidemia and electrocardiographic findings that included a prolonged QRS complex and QTc duration and a rightward T40 ms axis deviation. Treatment of the patients with hyperventilation, sedation, active cooling, and sodium bicarbonate infusion led to the normalization of their blood pHs and reversal of their cardiac conduction disorders. Acidemia can contribute to cocaine cardiac disorders by promoting conduction delays, dysrhythmias, and depressed myocardial contractility. Good supportive care corrects the blood pH and cardiac conduction disorders and remains the major focus in the management of patients with cocaine toxicity.

Topics: Acid-Base Imbalance; Adult; Akathisia, Drug-Induced; Alkalies; Apnea; Arrhythmias, Cardiac; Cocaine; Cocaine-Related Disorders; Crack Cocaine; Electrocardiography; Heart; Heart Arrest; Humans; Hydrogen-Ion Concentration; Hypnotics and Sedatives; Hypothermia, Induced; Male; Myocardial Contraction; Narcotics; Respiration, Artificial; Seizures; Sodium Bicarbonate

Topics: Acidosis; Apnea; Atropine; Bicarbonates; Bis-Trimethylammonium Compounds; Gallamine Triethiodide; Humans; Infusions, Parenteral; Laparotomy; Meperidine; Neostigmine; Nitrous Oxide; Obesity; Peritonitis; Postoperative Complications; Sodium Bicarbonate; Thiopental; Toxicology