• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.27 no.2
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• pp.88-94
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• 2024

Purpose: Infantile hypertrophic pyloric stenosis (IHPS) is a common gastrointestinal disease in neonates and hypochloremia metabolic alkalosis is a typical laboratory finding in affected patients. This study aimed to analyze the clinical characteristics of infants with IHPS and evaluate the association of clinical and laboratory parameters with ultrasonographic findings. Methods: Infants diagnosed with IHPS between January 2017 and July 2022 were retrospectively evaluated. Results: A total of 67 patients were included in the study. The mean age at diagnosis was 40.5±19.59 days, and the mean symptom duration was 11.97±9.91 days. The mean pyloric muscle thickness and pyloric canal length were 4.87±1.05 mm and 19.6±3.46 mm, respectively. Hyponatremia and metabolic alkalosis were observed in five (7.5%) and 36 (53.7%) patients, respectively. Serum sodium (p=0.011), potassium (p=0.023), and chloride levels (p=0.015) were significantly lower in patients with high bicarbonate levels (≥30 mmol/L). Furthermore, pyloric canal length was significantly higher in patients with high bicarbonate levels (p=0.015). To assess metabolic alkalosis in IHPS patients, the area under the receiver operating characteristic curve of pyloric canal length was 0.910 and the optimal cutoff value of the pyloric canal length was 23.5 mm. Conclusion: We found a close association between laboratory and ultrasonographic findings of IHPS. Clinicians should give special consideration to patients with pyloric lengths exceeding 23.5 mm and appropriate fluid rehydration should be given to these patients.

• Journal of Veterinary Clinics
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• v.27 no.3
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• pp.257-261
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• 2010

The development of blood ionic changes could be precipitated in acid-base disorder and subsequent treatment. As technology for detecting circulating ionized $Mg^{2+}$ (the most interesting form with respect to physiological and biological properties) is now available in veterinary clinical medicine. This present study investigated the changes of whole blood ionized $Mg^{2+}$ correlated with acute metabolic and respiratory alkalosis in rodent model. Metabolic alkalosis was induced by intravenous infusion with $NaHCO_3$ and mechanical hyperventilation was applied for respiratory alkalosis. We founded that the blood ionized $Mg^{2+}$ could be reversibly decreased by the $NaHCO_3$-induced acute metabolic alkalosis but irreversibly increased by the mechanical hyperventilation-induced respiratory acidosis and respiratory acidosis. We suggested that the potential change in blood suggested that the potential change in blood ionized $Mg^{2+}$ should be counted in treatment of acid-base disorders.

• The Korean Journal of Physiology
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• v.5 no.2
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• pp.41-44
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• 1971

Thiocyanate space was determined in 23 bilaterally nephrectomized rabbits in acute metabolic acidosis and alkalosis. Acid-base disturbances were induced by the infusion of 0.3 N HCI or 0.3 N NaOH solution intravenously with the rate of 1 ml/min for 40 to 60 minutes. The blood pressure was monitored throughout the experiment and no changes in blood pressure was confirmed. The following results were obtained. 1. In the saline infused control rabbits, PH was 7.385 with negligible change in pH after the infusion, SCN space was 23.6% of body weight. 2. In the metabolic acidosis group, pH dropped from 7.417 to 7 130 and SCN space was 22.8% of body weight and suggested a negligible change in the extracellular space volume. 3. In the metabolic alkalosis group, pH increased from 7.393 to 7.478 and SCN space was 25.7% of body weight which confirmed a significant increase in the extracellular space volume.

• Journal of Biomedical Engineering Research
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• v.14 no.4
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• pp.349-354
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• 1993

To investigate the relations between the physical constitutions, the acid-base balance, and the autonomic nervous function, the blood gas, the heart rate and the concentrations of Na, K of serum were measured pre-and poststimulation. As the result, it is shown that in the normal condition the macro-negative(strong liver- weak lung type) is the metabolic alkalosis, the macro-positive (strong lung-weak liver type) is the metabolic acidosis, the micro-negative(strong kidney-weak spleen type) is the alkalosis and the micro-positive (strong spleen-weak kidney type) is the acidosis. And the ntacro-positive and micro-positive are the sympathetic lead, the macro-negative and micro-negative are the parasympathetic lead. In the macro-positive and micro-positive subjects, the concentration of K in serum is relatively high. This si coincided with the acidosis. But in the macro-negative and micro-negative subjects, the concentration of K in serum is relatively low. This is coincided with the alkalosis.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.16 no.3
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• pp.195-199
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• 2013

Congenital chloride diarrhea (CLD) is a rare inherited autosomal recessive disorder. Mutations of the solute carrier family 26 member 3 gene cause profuse, chloride ion rich diarrhea, which results in hypochloremia, hyponatremia and metabolic alkalosis with dehydration. If a fetal ultrasound shows bowel dilatation suggestive of bowel obstruction, or if a neonate shows persistent diarrhea and metabolic alkalosis, CLD should be considered in the differential diagnosis. The severity of CLD varies, but early detection and early therapy can prevent complications including growth failure. We report a case of dizygotic twins affected by CLD who had been born to non-consanguineous parents. Both of them showed growth failure, but one of the twins experienced worse clinical course. He showed developmental delay, along with dehydration and severe electrolyte imbalance. He was diagnosed with CLD first at 6-month age, and then the other one was also diagnosed with CLD.

• Journal of Chest Surgery
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• v.17 no.1
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• pp.101-109
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• 1984

The influences of acute respiratory and metabolic acid-base disturbances on the carotid, renal and coronary blood flow were measured in dogs. Respiratory acidosis was induced by artificial respiration with 8% CO2 -02 gas mixture and respiratory alkalosis was induced by hyperventilation under the control of respirator. Metabolic acidosis and metabolic alkalosis were induced by intravenous infusion of 0.3N hydrochloric acid and 0.6M sodium bicarbonate solution. To observe the effect of hyperkalemia, isotonic potassium chloride solution was infused. CVI electromagnetic flowmeter probes were placed on the left common carotid artery, left renal artery and left circumflex coronary artery. Each flow was recorded on polygraph. 1. The carotid blood flow showed rapid showed rapid and marked increase in acute respiratory acidosis. Even in the cases when arterial blood pressure was lowered during the state of respiratory acidosis, carotid blood flow increased. By the infusion of hydrochloric acid, carotid blood flow increased slowly and returned to the previous label after discontinuation of the infusion. Carotid blood flow also increased by the infusion of large amount of sodium bicarbonate, but it might be the combined effect of expansion of extracellular fluid and compensatory elevation of carbon dioxide tension. 2.The renal blood flow remained unchanged during the acute acid-base disturbances, suggesting effective autoregulation. Renal blood flow, however, increased very slowly when the infusion of potassium chloride continued for a long period. 3.Although less marked than the carotid blood flow, the coronary blood flow increased in the acute respiratory and metabolic acidosis. In asphyxiated condition, coronary blood flow increased most markedly and this might be the combined effect of hypoxia, hypercapnea, and lowering of pH. In summary, the carotid blowflow showed more marked change in the acute respiratory and metabolic acidosis than the renal and coronary blood flow. Respiratory and metabolic components of acid-base disturbances may influence the local blood flow concomitantly, there being more differences in the individual responses, but respiratory component manifested more rapid and marked effect than metabolic component.

• Childhood Kidney Diseases
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• v.9 no.2
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• pp.255-262
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• 2005

Battler and Bartter-like syndromes, which include classic Bartter syndrome(type III), neonatat Bartter syndrome(type I, II or IV) and Gitelman syndrome, are autosomal - recessively inherited renal tubular disorders characterized b)r hypokalemic metabolic alkalosis, salt wasting and normal to low blood pressure. Neonatal Bartter syndrome is characterized by intrauterine polyhydramnios, premature delivery, life-threatening episodes of fever and dehydration, subsequent failure to thrive, and severe hypercalciuria with nephrocalcinosis and osteopenia. It is caused by mutations in NKCC2(type I), ROMK(type II) or BSND(type IV) genes. If diagnosed and treated early, the progression to renal failure can be prevented and catch-up growth and normal development are achieved. We report here a 6 month-old infant with neonatal Bartter syndrome who presented with hypokalemic metabolic alkalosis, polyhydramnios and premature delivery, persistent high fever and dehydration, failure to thrive, hypercalciuria, and nephrocalcinosis. He received indomethacin and potassium chloride per os and show ed catch-up growth and normal developmental profile at 19 months of age. (J Korean Soc Pediatr Nephrol 2005;9:255-262)

• Childhood Kidney Diseases
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• v.25 no.1
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• pp.35-39
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• 2021

Bartter syndrome is an autosomal recessive hypokalemic salt-losing tubulopathy, and classic Bartter syndrome is associated with mutations in the CLCNKB gene. While chronic hypokalemia is known to induce renal cyst formation in different renal diseases, renal cyst formation in Bartter syndrome is rarely reported. Russian six-year-old identical male twins were referred to our hospital for the evaluation of renal cysts, which were incidentally detected on abdominal sonography due to diarrhea. Both twins had shown symptoms of polydipsia, polyuria, and nocturia since they were one year olds. Vital signs including blood pressure were normal in both twins. Renal sonography revealed nephromegaly, increased echogenicity of renal cortex, and various sized multiple cysts in both kidneys for both twins. Laboratory findings included hyponatremia, hypokalemia, hypochloremia, and metabolic alkalosis. Bartter syndrome with renal cysts were suspected. Genetic analysis for both twins confirmed a homozygous c.1614delC deletion on exon 15 of the CLCNKB gene, which was confirmed as a previously unreported variant to the best of our knowledge. They were managed with potassium chloride, nonsteroidal anti-inflammatory drugs, and angiotensin-converting-enzyme inhibitors. Metabolic alkalosis, hypokalemia, hypochloremia, and polyuria partially improved during the short course of treatment. This is the first report of a homozygous mutation in the CLCNKB gene in an identical twin, presenting with renal cysts.

• Korean Journal of Veterinary Service
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• v.46 no.1
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• pp.81-85
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• 2023

This case report is about hemolymph nodes found in a dairy cow whose function is still not fully elucidated. A 4-month Holstein cow presented severe respiratory symptoms and hematochezia for a while with respiratory acidosis and metabolic alkalosis. Coccidiosis was diagnosed and treated immediately, but the cow died from respiratory acidosis and metabolic alkalosis. At necropsy, no abnormal appearance in thoracic and peritoneal organs was observed, but hemolymph nodes were observed being multifocally stuck on omasum serosa and the subcutaneous fascia of abdominal region, and the larger dark red lymph nodes were found along the omasum great curvature. Microscopically, lymphoid depletion and lymphadenitis in the lymph nodes were examined to point systemic infection, and in the hemolymph node, multifocally demarcated pale lesions with macrophage infiltration and fibrin deposition nearby subcapsular sinus. In subcapsular sinus of the hemolymph node, rod to linear gram-negative bacteria were found. Through this study, we might conclude that the hemolymph node is involved in pathogen phagocytosis.

• Journal of Yeungnam Medical Science
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• v.33 no.1
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• pp.48-51
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• 2016

Milk-alkali syndrome (MAS), a triad of hypercalcemia, metabolic alkalosis, and renal failure, is associated with ingestion of large amounts of calcium and absorbable alkali. MAS is the third most common cause of hypercalcemia in hospital, after primary hyperparathyroidism and malignant neoplasm. MAS is not often reported in the Korean literature. We describe MAS secondary to intake of calcium citrate for the treatment of osteoporosis with thoracic spine compression fracture. A 70-year-old man presented to our hospital with a 1-week history of general weakness and lethargy. He was found with acute kidney injury (serum creatinine, 4.6 mg/dL), hypercalcemia (total calcium, 14.8 mg/dL), and alkalosis. Laboratory evaluation excluded both hyperparathyroidism and malignancy. Mental status and serum calcium level was normalized within a week after proper hydration and intravenous administration of furosemide. However, he developed aspiration pneumonia, pseudomembranous colitis, and sepsis with multi-organ failure. Despite intensive treatment including inotropics, mechanical ventilation, and renal replacement therapy, he expired with no signs of renal recovery on the 28th hospital day.