sodium-bicarbonate and Hemorrhage

Traumatic hemorrhagic shock (THS) is the main cause of death in trauma patients with high mortality. Rapid control of the source of bleeding and early resuscitation are crucial to clinical treatment. Guidelines recommend isotonic crystal resuscitation when blood products are not immediately available. However, the selection of isotonic crystals has been controversial. Sodium bicarbonate Ringer solutions (BRS), containing sodium bicarbonate, electrolyte levels, and osmotic pressures closer to plasma, are ideal. Therefore, in this study, we will focus on the effects of BRS on the first 6 h of resuscitation, complications, and 7-day survival in patients with THS.. /design. This single-center, prospective, randomized controlled trial will focus on the efficacy and safety of BRS in early THS resuscitation. A total of 400 adults THS patients will be enrolled in this study. In addition to providing standard care, enrolled patients will be randomized in a 1:1 ratio to receive resuscitation with BRS (test group) or sodium lactate Ringer's solution (control group) until successful resuscitation from THS. Lactate clearance at different time points (0.5, 1, 1.5, 3, and 6 h) and shock duration after drug administration will be compared between the two groups as primary end points. Secondary end points will compare coagulation function, temperature, acidosis, inflammatory mediator levels, recurrence of shock, complications, medication use, and 7-day mortality between the two groups. Patients will be followed up until discharge or 7 days after discharge.. At present, there are still great differences in the selection of resuscitation fluids, and there is a lack of systematic and detailed studies to compare and observe the effects of various resuscitation fluids on the effectiveness and safety of early resuscitation in THS patients. This trial will provide important clinical data for resuscitation fluid selection and exploration of safe dose of BRS in THS patients.. Chinese Clinical Trial Registry (ChiCTR), ChiCTR2100045044. Registered on 4 April 2021.

Topics: Adult; Electrolytes; Fluid Therapy; Hemorrhage; Humans; Inflammation Mediators; Isotonic Solutions; Prospective Studies; Resuscitation; Ringer's Solution; Shock, Hemorrhagic; Sodium Bicarbonate; Sodium Lactate

Superficial bleeding after labor epidural catheter placement is a common phenomenon. In addition to delaying securing the epidural catheter, it may loosen the adhesive catheter dressing. The primary aim of this study was to determine whether skin infiltration with epinephrine-containing rather than plain lidocaine reduces superficial bleeding after catheter placement. Secondary objectives were to determine whether adding epinephrine and/or sodium bicarbonate affected infiltration pain.. After institutional review board approval and informed consent, 80 healthy women receiving epidural analgesia during labor were randomly assigned in a double-blind manner to four local anesthetic mixtures (n=20 in each group): group L: lidocaine 1.5%, group LB: lidocaine 1.5% with 8.4% sodium bicarbonate, group LE: lidocaine 1.5% with epinephrine 1:200000, and group LEB: lidocaine 1.5% with epinephrine 1:200000 and 8.4% sodium bicarbonate. Clinical endpoints included the amount of superficial bleeding at the catheter site, pain during local anesthetic infiltration and epidural catheter movement during labor.. Demographic data were similar among the groups. The addition of epinephrine to lidocaine significantly reduced superficial bleeding. Solutions containing epinephrine were well tolerated and caused no cardiovascular disturbances. The addition of epinephrine did not increase pain, while bicarbonate reduced it [verbal score (scale 0-10) 3.6+/-2.2 vs. 2.6+/-1.8; P=0.04]. There were no differences in epidural catheter movement among the groups; no catheters became displaced during labor.. Local infiltration of epinephrine-containing lidocaine before epidural catheter insertion reduces superficial bleeding and the addition of bicarbonate decreases pain during skin infiltration.

Topics: Adolescent; Adult; Anesthesia, Epidural; Anesthesia, Obstetrical; Anesthetics, Local; Catheterization; Double-Blind Method; Drug Combinations; Epinephrine; Female; Hemorrhage; Humans; Injections, Epidural; Lidocaine; Middle Aged; Pain; Pregnancy; Prospective Studies; Reference Values; Sodium Bicarbonate; Vasoconstrictor Agents

Impella 5.5 (Abiomed; Danvers, MA) (IMP5) is a commonly used, surgically implanted, tMCS device that requires systemic anticoagulation and purge solution to avoid pump failure. To avoid heparin-induced thrombocytopenia (HIT) from unfractionated heparin (UFH) use, our program has explored the utility of bivalirudin (BIV) for systemic anticoagulation and sodium bicarbonate-dextrose purge solution (SBPS) in IMP5.5.. This single center, retrospective study included 34 patients supported on IMP5.5 with BIV based AC and SBPS between December 1st 2020 to December 1st 2021.The efficacy and safety end points were incidence of development of HIT, Tissue Plasminogen Activator (tPA) use for suspected pump thrombosis, stroke, and device failure as well as clinically significant bleeding.. The median duration of IMP5.5 support was 9.8 days (IQR: 6-15). Most patients were bridged to HTX (58%) followed by recovery (27%) and LVAD implantation (15%). Patients were therapeutic on bivalirudin for 64% of their IMP5.5 support. One patient (2.9%) suffered from ischemic stroke and 26.5% (9) patients developed clinically significant bleeding. tPA was administered to 7(21%) patients. One patient in the entire cohort developed HIT.. Our experience supports the use of systemic BIV and SBPS as a method to avoid heparin exposure in a patient population predisposed to the development of HIT.

Topics: Anticoagulants; Hemorrhage; Heparin; Hirudins; Humans; Peptide Fragments; Recombinant Proteins; Retrospective Studies; Sodium Bicarbonate; Thrombocytopenia; Tissue Plasminogen Activator; Treatment Outcome

The purpose was to determine prognosis of patients presenting extreme acidosis (pH <7) on admission to the intensive care unit (ICU) and to identify mortality risk factors.. We retrospectively analyzed all patients who presented with extreme acidosis within 24 hours of admission to a polyvalent ICU in a university hospital between January 2011 and July 2013. Multivariate analysis and survival analysis were used.. Among the 2156 patients admitted, 77 patients (3.6%) presented extreme acidosis. Thirty (39%) patients suffered cardiac arrest before admission. Although the mortality rate predicted by severity score was 93.6%, death occurred in 52 cases (67.5%) in a median delay of 13 (5-27) hours. Mortality rate depended on reason for admission, varying between 22% for cases linked to diabetes mellitus and 100% for cases of mesenteric infarction (P = .002), cardiac arrest before admission (P < .001), type of lactic acidosis (P = .007), high Simplified Acute Physiology Score II (P = .008), and low serum creatinine (P = .012).. Patients with extreme acidosis on admission to ICU have a less severe than expected prognosis. Whereas mortality is almost 100% in cases of cardiac arrest before admission, mortality is much lower in the absence of cardiac arrest before admission, which justifies aggressive ICU therapies.

Topics: Acidosis; Acidosis, Lactic; Acidosis, Respiratory; Adult; Aged; Diabetes Mellitus; Extracorporeal Membrane Oxygenation; Female; Heart Arrest; Hemorrhage; Hospital Mortality; Hospitalization; Hospitals, University; Humans; Hypoglycemic Agents; Infarction; Intensive Care Units; Male; Mesenteric Ischemia; Metformin; Middle Aged; Multivariate Analysis; Prognosis; Renal Dialysis; Respiration, Artificial; Retrospective Studies; Risk Factors; Severity of Illness Index; Sodium Bicarbonate; Survival Analysis; Vasoconstrictor Agents

Sodium bicarbonate is the most physiological alkalinizing agent. The effect of a new bicarbonated Ringer's solution (BRS) containing Mg2+, on metabolic acidosis and serum magnesium abnormality were evaluated and compared with those of acetated Ringer's (ARS), lactated Ringer's (LRS) and Ringer's (RS) solutions in an experimental haemorrhagic shock model with dogs.. Animals were randomly divided into six groups (n = 6 in each group), a sham-operated group, an operated group without infusion, and 4 operated groups with infusion (BRS, ARS, LRS and RS groups). Each RS was intravenously administered at 60 mL kg(-1) h(-1) for 1.5 h. Arterial blood gases, plasma electrolytes and cardiovascular parameters were analysed.. BRS significantly improved blood base excess values, which were decreased by blood-letting, faster and more markedly than did LRS and RS (BRS--6.3 +/- 0.5 mEq L(-1); LRS--9.2 +/- 1.1 mEq L(-1); RS--12.4 +/- 1.0 mEq L(-1) at the end of infusion). The alkalinizing effect of BRS tended to be better than that of ARS but not significantly so. The serum Mg2+ concentration was well-maintained by BRS as compared to other RS (BRS 1.5 +/- 0.0 mgdL(-1); ARS 1.2 +/- 0.0mgdL(-1); LRS 1.1 +/- 0.0mgdL(-1); RS 1.3 +/- 0.1 mgdL(-1), at the end of infusion).. These results suggest that BRS is a suitable perioperative solution for metabolic acidosis and serum electrolyte balance among RS tested.

Topics: Acid-Base Equilibrium; Acidosis; Animals; Blood Pressure; Carbon Dioxide; Disease Models, Animal; Dogs; Heart Rate; Hematocrit; Hemoglobins; Hemorrhage; Infusions, Intravenous; Isotonic Solutions; Lactic Acid; Magnesium; Male; Oxygen; Random Allocation; Ringer's Lactate; Ringer's Solution; Shock; Sodium Bicarbonate; Time Factors

We report the survival of a multiply injured patient with exanguinating haemorrhage and an arterial pH of 6.5, following a road vehicle crash. The previously healthy 38 years old male driver veered off the motorway and collided with a tree. The ambulance arrived at the scene 9 min after being called by an eyewitness and, following rapid extrication from the wreckage; the patient arrived in hospital 27 min later (with a GCS of 6), and was immediately intubated. The patient had suffered near-complete amputation of the left leg at upper femoral shaft level, along with multiple distal fractures and open wounds. He also sustained a head injury and closed displaced fractures of left radius and ulna. The patient received 2 l of crystalloids in the pre-hospital phase. Once in hospital the haemorrhage was controlled with a pressure dressing and intra-venous fluids were kept to a minimum until he was taken promptly to theatre. His initial arterial blood sample revealed a pH of 6.57, pCo(2) of 9.18 kPa, a pO(2) of 70.11 kPa and a base excess of -27.5 mmol l(-1). The co-oximeter Hb was 5.8 g dl(-1). Haemorrhage was controlled in theatre where he was transfused a total of 30 U of blood, 1 pack of platelets, 12 U of fresh frozen plasma, 3.5 l of crystalloids and 1.5 l of colloid. Sodium bicarbonate was administered three times. He subsequently remained ventilated in intensive care unit (ICU). Over the following week he survived sepsis, disseminated intravascular coagulation and myoglobinuria (with transient renal failure) attributable to rhabdomyolysis secondary to muscle necrosis. He later underwent diversion colostomy and disarticulating amputation of the left femur after several debridements. After 6 weeks on ICU he made an excellent recovery will full return of his mental abilities. In this case, the serial arterial blood samples obtained were reliable. The lactic acidosis observed was the result of profound tissue hypo-perfusion and its rate of clearance seems to have greater prognostic value than its peak or initial value. Several factors may have contributed to the patient's survival: rapid retrieval from the scene; early intubation with excellent subsequent oxygenation (thus avoiding the dangerous combination of hypoxia and acidosis with synergistic influence on cardiac depression) and limited initial fluid resuscitation in the emergency department with prompt surgical intervention and vigorous restoration of organ perfusion after surgical haemostasis. Immediat

Topics: Accidents, Traffic; Acidosis, Lactic; Adult; Amputation, Traumatic; Blood Gas Analysis; Hemorrhage; Humans; Hydrogen-Ion Concentration; Intensive Care Units; Male; Multiple Trauma; Shock, Hemorrhagic; Sodium Bicarbonate

An intravenous administration of sodium bicarbonate (NaHCO3) forms excess CO2, resulting in an immediate increase in end-tidal carbon dioxide tension (PETCO2). We hypothesized that the time until PETCO2 reached a maximum, and the magnitude of the increase in PETCO2 are influenced by cardiac output and haemoglobin concentration, respectively. To test this hypothesis, we examined changes in PETCO2 following an intravenous administration of NaHCO3 at different levels of cardiac output and haemoglobin concentration. We administered 0.2 mmol.kg-1 of 8.4% NaHCO3 into the vena cava in 15 anesthetized dogs under mechanical ventilation of 20 breaths per min. Cardiac output was increased by dopamine infusion, and decreased by blood withdrawal under halothane anaesthesia. Haemoglobin concentrations were changed by haemodilution with hydroxyethyl starch. When control measurements were taken, time-max (the time until the increase in PETCO2 reached a maximum) was 4 +/- 0.2 breaths-time, and delta CO2-max (the magnitude of the increase in PETCO2) was 0.90 +/- 0.04 kPa (6.6 +/- 0.3 mmHg). Cardiac output was inversely correlated with time-max (r = 0.94, P < 0.0001), while it revealed a poor correlation with delta CO2-max. Haemoglobin concentration showed a significant correlation with delta CO2-max (r = 0.736, P < 0.005), but not with time-max. We concluded that the time course and the magnitude of changes in PETCO2 following intravenous administration of NaHCO3 reflect changes in cardiac output and haemoglobin concentration, respectively.

Topics: Anesthesia, Inhalation; Animals; Carbon Dioxide; Cardiac Output; Dogs; Dopamine; Halothane; Hemodilution; Hemoglobins; Hemorrhage; Hydroxyethyl Starch Derivatives; Injections, Intravenous; Lactates; Respiration, Artificial; Sodium Bicarbonate; Tidal Volume; Time Factors

Topics: Acidosis; Bicarbonates; Blood Component Transfusion; Brain; Cerebral Hemorrhage; Female; Fluid Therapy; Hemorrhage; Humans; Infant, Newborn; Magnetic Resonance Imaging; Scalp; Sodium; Sodium Bicarbonate; Tomography, X-Ray Computed; Vacuum Extraction, Obstetrical

The protective effect of sodium bicarbonate (NaHCO3), a urine modifier, to alleviate murine ochratoxicosis was investigated. The study included two trials. Urinary pH was altered before oral administration of ochratoxin A (OA) in Trial 1, and animals were given combined doses of OA and ethyl biscoumacetate (Eb) in Trial 2. Acute toxicity of OA as measured by LD50 values was reduced by 23% and 20% in rats treated with NaHCO3 for Trials 1 and 2 respectively. Bicarbonate-treated rats dosed with 20 mg/kg OA or with a combination dose of OA at 17 mg/kg and Eb at 50 mg/kg, had a lower frequency of histological lesions in kidneys, liver, lung, spleen and heart. Two types of heart lesions found in the present study are described.

Topics: Animals; Antidotes; Bicarbonates; Hemorrhage; Hydrogen-Ion Concentration; Male; Myocardium; Ochratoxins; Rats; Sodium; Sodium Bicarbonate; Urine

Approximately 30% of patients affected of PCT present scleroderma-like lesion of the skin. Two cases of PCT, presenting scleroderma-like lesions are reported. The patients were diabetic but not alcoholic and tolerate relatively well sunshine. Porphyrin elimination diminished with urine alkalinization and phlebotomies, and the scleroderma-like lesions improved with N-acetyl-hydroxy-proline administration.

Topics: Aged; Animals; Bicarbonates; Cricetinae; Diabetes Complications; Diagnosis, Differential; Hemorrhage; Humans; Hydroxyproline; Inflammation; Male; Middle Aged; Porphyrias; Scleroderma, Systemic; Skin; Skin Diseases; Sodium; Sodium Bicarbonate