sodium-bicarbonate and Dyspnea

Treatment of dyspnea in patients with advanced cancer is an important issue. The purpose of the present study was to assess the effect of induced-metabolic alkalosis produced by administration of sodium bicarbonate on dyspneic sensation. In seven healthy subjects, dyspnea was induced by having them breathe with a flow-resistive load (24 cm H2O/L/sec) for 6 min before and after administration of sodium bicarbonate (0.5 mmol/kg, per os+2 mmol/kg, IV). The intensity of dyspnea was rated using a visual analogue scale (VAS). The VAS scores and minute ventilation during loaded breathing after administration of sodium bicarbonate were significantly lower than those before administration of sodium bicarbonate. These results indicate that induced metabolic alkalosis may alleviate the intensity of dyspneic sensation by a reduction in ventilatory drive.

Topics: Adult; Blood Gas Analysis; Dyspnea; Female; Humans; Male; Middle Aged; Neoplasms; Respiration, Artificial; Respiratory Mechanics; Sodium Bicarbonate

In a prospective, randomised, open trial 103 term newborns with persisting dyspnoea, tachypnoea and/or cyanosis were treated with oxygen for 5-10 min and then with oxygen plus mask continuous positive airway pressure (CPAP) for another 5-15 min. Cases with overt prenatal or intrapartum obstetric pathology had been excluded from the study. Forty-one infants (40%) responded to this procedure within 10-25 min. The remaining 62 infants (60%) were randomly allocated to one of three forms of further treatment: continuation of mask CPAP for 20 min (group A, n = 24), volume expansion with 9 ml of 3 ml albumin, 3 ml glucose, and 3 mEq of sodium bicarbonate (group B, n = 24), or volume expansion with 4.5 ml albumin and 4.5 ml glucose (group C, n = 14). There was no statistical difference in birth weight, gestational age or Apgar scores at 1 and 5 min between the infants of the groups. Time to normalisation of symptoms was significantly shorter in the volume expansion groups (B: 45 +/- 41 min, range 20-180, and C: 80 +/- 72 min, range 20-210) than in the mask CPAP group (A; 224 +/- 256 min, range 30-1200, P = 0.02). There were statistical differences in umbilical cord and capillary pH values among the infants of the three groups, but the response to therapy was not related to the degree of acidaemia. Thirty-four infants (33%) who did not respond were admitted to a special care unit for further examination (group A: 21/24, group B: 7/24; group C: 6/14). Of these, 23 had no abnormal findings, 8 infants had radiological signs of transitory respiratory distress, and 1 had a non-tension pneumothorax. Septicaemia was found in two infants. No infant was intubated. At discharge all 103 infants did well.. Incremental application of simple primary care procedures including volume expansion (with or without alkali) in term newborns with persisting postnatal tachypnoea and dyspnoea helps avoid overtreatment and unnecessary separation from the mothers in most cases and reliably selects infants who need close monitoring or special treatment.

Topics: Analysis of Variance; Cyanosis; Dyspnea; Humans; Infant, Newborn; Intensive Care, Neonatal; Oxygen Inhalation Therapy; Plasma Substitutes; Positive-Pressure Respiration; Prospective Studies; Respiratory Therapy; Sodium Bicarbonate; Statistics, Nonparametric; Vascular Resistance

Topics: Albuterol; Analgesics, Opioid; Anti-Inflammatory Agents; Bronchodilator Agents; Chlorides; Dyspnea; Female; Gas Poisoning; Humans; Ipratropium; Methylprednisolone; Middle Aged; Morphine; Nausea; Nebulizers and Vaporizers; Sodium Bicarbonate

Chlorine gas is a potent pulmonary irritant that affects the mucous membranes and induces severe disturbances of pulmonary gas exchange within minutes of inhalation. The present study evaluated an extraordinary type of mass inhalational exposure.. Clinical reports of 25 soldiers who were admitted to the emergency department of Maresal Cakmak Military Hospital, Erzurum were retrospectively evaluated. All patients were exposed to chlorine gas as a result of mixing sodium hypochlorite with hydrochloric acid during cleaning activities.. All patients were male and the mean age of patients was 22.04+/-2.98 years. The main symptoms were coughing and dyspnea in 18 patients (72%). Forced expiratory volume in 1 second (FEV1) and FEV1/forced volume capacity (FVC) ratio were found to be normal in all patients but FVC and peak expiratory flow (PEF) were below the normal range (80%) in 9 patients (36%). All patients received warmed humidified oxygen combined with nebulized salbutamol. Inhaled budesonide and nebulized sodium bicarbonate were ordered additionally for 19 patients (76%). Thirteen patients (52%) were discharged from the emergency department and 12 patients (48%) were hospitalized. No mortality was observed.. Chlorine gas is a potent pulmonary irritant that causes acute damage in both the upper and lower respiratory tract. We suggest that inhaled steroids combined with nebulized sodium bicarbonate could be a safe and effective alternative for the treatment of symptomatic patients. Education of the public about the dangers of mixing of hypochlorite bleach with acidic cleaning agents is also very important.

Topics: Acute Disease; Administration, Inhalation; Adult; Albuterol; Bronchodilator Agents; Budesonide; Chemical Warfare Agents; Chlorine; Cough; Drug Therapy, Combination; Dyspnea; Gas Poisoning; Glucocorticoids; Hospitals, Military; Humans; Inhalation Exposure; Male; Mass Casualty Incidents; Oxygen; Pulmonary Gas Exchange; Respiratory Function Tests; Retrospective Studies; Sodium Bicarbonate; Treatment Outcome; Turkey; Young Adult