sodium-bicarbonate and Vomiting

Iron poisoning continues to be a major toxicologic problem, with major impact on the gastrointestinal and circulatory systems. Failure to recognize the severity of iron intoxication may result in an inappropriate level of intervention. By using estimates of the total body burden of iron, clinical symptoms, and the serum iron concentration, an appropriate decision can be made to initiate aggressive chelation therapy with deferoxamine. In severe intoxication, the use of intravenous deferoxamine is indicated, along with supportive care, with particular attention to maintaining the intravascular volume. Other important measures include correction of acidosis and disorders of coagulation and replacement of blood components when there is evidence of gastrointestinal hemorrhage. Under rare circumstances in which large numbers of iron tablets are present in the gastrointestinal tract, surgical removal may be indicated. In addition, measures such as hemodialysis and exchange transfusion should be reserved for those unusual poisonings in which more conservative therapy is unsuccessful. In rare cases of iron intoxication, late sequelae such as hepatic necrosis and gastrointestinal scarring with obstruction may occur. The prompt recognition and initiation of management of children with acute iron poisoning is the single most critical element in decreasing the morbidity and mortality associated with these products.

Topics: Absorption; Bicarbonates; Chemical and Drug Induced Liver Injury; Child, Preschool; Deferoxamine; Diarrhea; Female; Fluid Therapy; Gastric Lavage; Gastrointestinal Hemorrhage; Humans; Infant; Ipecac; Iron; Necrosis; Renal Dialysis; Shock; Sodium; Sodium Bicarbonate; Vomiting

Although a considerable amount of literature exists on the ergogenic potential of ingesting sodium bicarbonate (NaHCO3) before short-term, high-intensity exercise, very little exists on optimal loading times before exercise. The purpose of this study was to determine the influence of NaHCO3 supplementation timing on repeated sprint ability (RSA). Eight men completed 3 (randomized and counterbalanced) trials of ten 10-second sprints separated by 50 seconds of active recovery (1:5 work-to-rest) on a nonmotorized treadmill. Before each trial, the subjects ingested 0.3 g·kg(-1) body weight of NaHCO3 at 60 (H1), 120 (H2), or 180 (H3) minutes before exercise. Additionally, the subjects were assessed for any side effects (gastrointestinal [GI] discomfort) from the NaHCO3 ingestion via a visual analog scale (VAS). Blood buffering was assessed using a 2-way analysis of variance (ANOVA) with repeated measures, whereas repeated sprint performance and GI discomfort were assessed via a 1-way ANOVA with repeated measures. Blood-buffering capacity was not different at preexercise times (HCO3(-) [millimoles per liter] H1: 30.2 ± 0.4, H2: 30.9 ± 0.6, H3: 31.2 ± 0.6; p > 0.74). Average speed, average power, and total distance covered progressively declined over the 10 sprints; however, there was no difference between conditions (p > 0.22). The incidence of GI discomfort was significantly higher (p < 0.05) from preingestion at all time points with the exception of 180 minutes, whereas severity was only different between 90 and 180 minutes. Ingestion times (between 60 and 180 minutes) did not influence the blood buffering or the ergogenic potential of NaHCO3 as assessed by RSA. However, VAS scores indicated that at 180 minutes postingestion, an individual is less prone to experiencing significant GI discomfort.

Topics: Adult; Alkalosis; Analysis of Variance; Athletic Performance; Buffers; Colic; Diarrhea; Eructation; Exercise Test; Flatulence; Humans; Male; Nausea; Recovery of Function; Running; Sodium Bicarbonate; Vomiting; Young Adult

The aim of the present study was to compare the efficacy and safety of a new aluminium-free formulation of alginate with placebo in infants with recurrent gastro-oesophageal reflux. This was a double-blind, randomised, parallel-group study conducted at 25 centres in the UK. Of the 90 paediatric patients recruited in a general practice setting, 42 were randomised to receive alginate and 48 to receive placebo. Infants were assessed before treatment and again after seven and 14 days of treatment. Analyses were based on the last, valid, non-missing observation for each variable for the intent-to-treat (ITT) population of 42 alginate and 46 placebo patients. For the primary efficacy measure (number of vomitting/regurgitation episodes), alginate was significantly superior to placebo (p = 0.009). For the secondary efficacy measure (severity of vomiting), a trend in favour of alginate was observed (p = 0.061). Patients receiving alginate achieved superior assessments of treatment outcome by both investigators (p = 0.008) and parent/guardians (p = 0.002) alike. In addition, alginate achieved a significantly greater reduction in the mean severity of vomiting episodes recorded in a daily diary compared with placebo (p = 0.027) and resulted in more patients having at least 10% symptom-free days (p = 0.027). For none of the variables measured did placebo have a superior effect. More than one-half of all patients experienced some adverse event, although no statistically significant differences were observed between the two treatment groups (p > 0.1), and adverse events accounted for withdrawal in only 12.5% of the patients (alginate, n = 4; placebo, n = 7). Aluminium-free alginate demonstrated superior efficacy over placebo in treating recurrent gastro-oesophageal reflux in paediatric patients. The safety profile of alginate was similar to that of placebo.

Topics: Age of Onset; Alginates; Aluminum Hydroxide; Analysis of Variance; Antacids; Area Under Curve; Chronic Disease; Consumer Product Safety; Double-Blind Method; Drug Combinations; Female; Gastroesophageal Reflux; Humans; Infant; Infant, Newborn; Male; Silicic Acid; Sodium Bicarbonate; Statistics, Nonparametric; Vomiting

Topics: Acetates; Acetic Acid; Adolescent; Adult; Bicarbonates; Blood Pressure; Fatigue; Headache; Humans; Kidney Failure, Chronic; Muscle Cramp; Renal Dialysis; Sodium Bicarbonate; Vomiting

A 47-year-old female patient presented nausea and vomiting for half a year and elevated serum creatinine for 3 days. Proximal renal tubular acidosis (RTA) complicated with anemiawas confirmed after admission. Secondary factors, such as autoimmune disease, drugs, poison, monoclonal gammopathy, were excluded. Renal biopsy revealed acute interstitial nephritis. The patient was administrated with daily prednisone 50 mg, sodium bicarbonate 4 g, 3 times per day, erythropoietin 3 000 U, 2 times per week, combined with potassium, calcium, and calcitriol tablets. Serum creatinine reduced to 90 μmol/L. However nausea and vomiting deteriorated with lactic acidosis. Bone marrow biopsy indicated the diagnosis of non-Hodgkin lymphoma, therefore the patient was treated with chemotherapy. Although metabolic acidosis improved gradually after chemotherapy, severe pneumocystis carinii pneumonia developed two weeks later. The patient refused further treatment and was discharged.. 患者女性，47岁。因恶心、呕吐半年，发现肾功能异常（血肌酐255 μmol/L）3 d就诊，入院检查发现近端肾小管酸中毒合并贫血，排除自身免疫病、药物、毒物、单克隆免疫球蛋白病等继发因素，肾脏穿刺活检组织病理提示急性间质性肾炎，予泼尼松50 mg/d；碳酸氢钠4 g，3次/d；促红细胞生成素3 000 U，2次/周；氯化钾缓释片500 mg，3次/d；碳酸钙500 mg，3次/d；骨化三醇0.5 μg，1次/d。患者血肌酐恢复至90 μmol/L，但随诊期间患者恶心呕吐加重，再次检查发现合并乳酸酸中毒（乳酸14.1 mmol/L）。骨髓穿刺提示非霍奇金淋巴瘤，予CHOP方案化疗，期间乳酸酸中毒逐步好转（乳酸由14.5 mmol/L降至3.1 mmol/L），半个月后发生重症耶氏肺孢子菌肺炎，最终放弃治疗出院。.

Topics: Acidosis, Lactic; Acidosis, Renal Tubular; Anemia; Antineoplastic Agents; Biopsy; Creatinine; Erythropoietin; Female; Humans; Lymphoma, Non-Hodgkin; Middle Aged; Nausea; Pneumonia, Pneumocystis; Prednisone; Renal Insufficiency; Sodium Bicarbonate; Treatment Refusal; Vomiting

We describe the feasibility and safety of an oral administration schedule of hydration, alkalinization and leucovorin rescue with an ambulatory high-dose methotrexate regimen.. From January 2016 to June 2018, 49 ambulatory high-dose methotrexate courses were given to 18 patients. No dose reduction was required afterwards. All patients completed succesfully the planned three doses in an outpatient basis, except four patients, one of them due to pneumonitis. Previous to methotrexate infusion, urinary pH > 7 was achieved in 35 (79.5%) cycles. Methotrexate clearance was achieved by 72 h in 35 courses (71.4%), and by 96 h in 100%. Neutropenia/trombocytopenia grades III/IV were observed in four cycles (8.16%) and two (4.08%) cycles, respectively. Around 20.40% were associated with stomatitis, 14.20% vomiting, 10.20% asthenia, 8.16% diarrhea and 6.12% with renal toxicity.. Ambulatory administration of high-dose methotrexate as CNS prophylaxis is safe and feasible following the described approach, allowing us to optimize healthcare resources.

Topics: Adult; Aged; Ambulatory Care Facilities; Diarrhea; Female; Humans; Leucovorin; Lymphoma, Non-Hodgkin; Male; Methotrexate; Middle Aged; Neutropenia; Prospective Studies; Sodium Bicarbonate; Vomiting; Young Adult

Atypical hemolytic uremic syndrome (aHUS) is a complement-mediated disease manifesting in thrombocytopenia, microangiopathic hemolytic anemia, and acute kidney injury. It has a higher incidence of extrarenal manifestations, including central nervous system findings like seizure or stroke, pancreatitis, and cardiac manifestations.. We present a case of an unimmunized 14-month-old girl presenting with generalized seizure and ultimately diagnosed with aHUS. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: These atypical neurological symptoms can cause the diagnosis to be commonly missed in the emergency department. The etiology of approximately 60% of patients with aHUS can be attributed to genetic mutations in complement regulators including factor H, membrane cofactor protein, factor I, activator factor B, or C3. Although previously treated with plasma transfusion and immunosuppressants, eculizumab is a newer treatment that has been changing prognosis and management of aHUS, but it should be administered within 48 h of symptom onset for best efficacy.

Topics: Atypical Hemolytic Uremic Syndrome; Buffers; Calcium Gluconate; Electroencephalography; Female; Humans; Hyperkalemia; Hypnotics and Sedatives; Incidence; Infant; Midazolam; Seizures; Sodium Bicarbonate; Thrombocytopenia; Vomiting

Single-patient methanol intoxications are a common clinical presentation, but outbreaks are rare and usually occur in settings in which there is limited access to ethanol and methanol is consumed as a substitute. In this case report, we describe an outbreak of methanol intoxications that was challenging from a public health perspective and discuss strategies for managing such an outbreak.

Topics: Acid-Base Equilibrium; Acidosis; Adult; Antidotes; Disease Outbreaks; Eating; Fomepizole; Humans; Hydraulic Fracking; Leucovorin; Male; Manitoba; Methanol; Middle Aged; Nausea; Poisoning; Pyrazoles; Renal Dialysis; Sodium Bicarbonate; Solvents; Vomiting; Young Adult

Mouthrinsing with antacids, following erosive episodes, have been suggested as a preventative strategy to minimize tooth surface loss due to their neutralizing effect. The purpose of this in situ study was to evaluate the effect of an antacid suspension containing sodium alginate, sodium bicarbonate and calcium carbonate in controlling simulated erosion of enamel of intrinsic origin.. The experimental units were 48 slabs (3×3×2mm) of bovine enamel, randomly divided among 12 volunteers who wore palatal appliances with two enamel slabs. One of them was exposed extra-orally twice a day to 25mL of a hydrochloric acid (HCl) solution (0.01M, pH 2) for 2min. There were two independent phases, lasting 5 days each. In the first phase, according to a random scheme, half of the participants rinsed with 10mL of antacid suspension (Gaviscon(®), Reckitt Benckiser Healthcare Ltd.), while the remainder was rinsed with deionized water, for 1min. For the second phase, new slabs were inserted and participants switched to the treatment not received in the first stage. Therefore, the groups were as follows: (a) erosive challenge with HCl+antacid suspension; (b) erosive challenge with HCl+deionized water (DIW); (c) no erosive challenge+antacid suspension; (d) no erosive challenge+DIW. Specimens were assessed in terms of surface loss using optical profilometry and Knoop microhardness. The data were analyzed using repeated measures two-way analysis of variance and Tukey's tests.. Compared to DIW rinses, surface loss of enamel was significantly lower when using an antacid rinse following erosive challenges (p=0.015). The Knoop microhardness of the enamel was significantly higher when the antacid rinse was used (p=0.026).. The antacid suspension containing sodium alginate, sodium bicarbonate and calcium carbonate, rinsed after erosive challenges of intrinsic origin, reduced enamel surface loss.

Topics: Adolescent; Adult; Alginates; Aluminum Hydroxide; Animals; Antacids; Cattle; Cross-Over Studies; Drug Combinations; Female; Humans; Hydrochloric Acid; Male; Mouthwashes; Silicic Acid; Sodium Bicarbonate; Suspensions; Tooth Erosion; Vomiting

Topics: Acidosis; Adult; Antidotes; Diagnosis, Differential; Ethanol; Ethylene Glycol; Female; Gastritis; Humans; Poisoning; Sodium Bicarbonate; Vomiting

Topics: Colonoscopy; Drug Combinations; Esophageal Diseases; Humans; Male; Middle Aged; Polyethylene Glycols; Potassium Chloride; Rupture, Spontaneous; Sodium Bicarbonate; Sodium Chloride; Sulfates; Therapeutic Irrigation; Vomiting

Topics: Acidosis; Bacterial Infections; Bicarbonates; Breast Feeding; Catheters, Indwelling; Diarrhea, Infantile; Follow-Up Studies; Humans; Infant, Newborn; Intestinal Obstruction; Male; Metronidazole; Milk, Human; Neomycin; Parenteral Nutrition; Ranitidine; Short Bowel Syndrome; Sodium; Sodium Bicarbonate; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination; Vomiting

120 cases of class IC antiarrhythmic overdose, including propafenone, flecainide, ajmaline and prajmaline overdose, were evaluated with respect to clinical course, therapy and outcome. Whereas drug overdose in general has an overall mortality of less than 1%, intoxication with antiarrhythmic drugs of class IC was associated with a mean mortality of 22.5%. Nausea, which occurred within the first 30 minutes after ingestion, was the earliest symptom. Spontaneous vomiting probably led to self-detoxication in about half the patients. Cardiac symptoms including bradycardia and, less frequently, tachyrhythmia occurred after about 30 minutes to 2 hours. Therapeutic measures included administration of activated charcoal, gastric lavage and a saline laxative, catecholamines, and in some patients, hypertonic sodium bicarbonate, insertion of a transvenous pacemaker and hemoperfusion. Fatal outcome was mainly due to cardiac conduction disturbances progressing to electromechanical dissociation or asystolia. Resuscitation, which had to be performed in 29 patients, was successful in only two of them. No correlation was found between fatal outcome, the type of antiarrhythmic, and ingested dose. Since a specific treatment is not available and resuscitive procedures including sodium bicarbonate and insertion of a pacemaker are of limited therapeutic value, early diagnosis and primary detoxification are most important for prevention of fatal outcome.

Topics: Ajmaline; Anti-Arrhythmia Agents; Bicarbonates; Bradycardia; Drug Overdose; Flecainide; Hemoperfusion; Humans; Hypertonic Solutions; Nausea; Prajmaline; Propafenone; Resuscitation; Retrospective Studies; Sodium; Sodium Bicarbonate; Tachycardia; Vomiting

The purpose of this study was to determine which urine electrolytes should be measured to confirm that the extracellular fluid (ECF) volume is depleted. ECF volume contraction was induced by furosemide administration to rats consuming an electrolyte-free diet. An external potassium balance was achieved by replacing potassium losses with KHCO3 and KCl so that the sodium and chloride deficits were comparable (equivalent to a 30% reduction in ECF volume). As expected, the urine sodium and chloride concentrations fell to 2 +/- 0.3 mmol/l and 3 +/- 0.3 mmol/l, respectively. Rats were then randomized to receive 50-75% of their sodium or chloride deficit as either: NaCl (control group), NH4Cl or NaHCO3 to mimic clinical situations associated with ECF volume contraction. In the NaCl group, the urine sodium and chloride concentrations remained low (6 +/- 2 mmol/l and 7 +/- 2 mmol/l), consistent with persistent ECF volume contraction. Although the NH4Cl group continued to have a low urine sodium concentration (2 +/- 0.2 mmol/l), there was now a marked increase in the urine chloride concentration (51 +/- 7 mmol/l; p less than 0.01 vs. NaCl group). In contrast, although the NaHCO3 group continued to have a low urine chloride concentration (2 +/- 1 mmol/l), there was a significant increase in the urine sodium concentration (19 +/- 3 mmol/l; p less than 0.01 vs. NaCl group). We conclude that the clinical assessment of ECF volume by urine electrolytes requires an evaluation of both the urine sodium and chloride concentrations.

Topics: Ammonium Chloride; Animals; Bicarbonates; Electrolytes; Furosemide; Male; Potassium Chloride; Random Allocation; Rats; Rats, Inbred Strains; Sodium; Sodium Bicarbonate; Sodium Chloride; Vomiting; Water-Electrolyte Imbalance

A case of progressive vomiting in a boy aged 5 months is reported. Vomiting was secondary to an obstruction in the antrum of the stomach caused by a mass consisting of alginate.

Topics: Alginates; Aluminum Hydroxide; Antacids; Bezoars; Bicarbonates; Domperidone; Drug Combinations; Humans; Infant; Male; Silicic Acid; Silicon Dioxide; Sodium Bicarbonate; Stomach; Vomiting

Topics: Adult; Alkalosis; Bicarbonates; Diabetes Complications; Humans; Male; Seizures; Self Medication; Sodium Bicarbonate; Vomiting

Topics: Alkalosis; Humans; Hypokalemia; Ketone Bodies; Nausea; Paralysis; Potassium; Sodium Bicarbonate; Vomiting