Introduction This study highlights the significance of assessing acid-base balance and gas exchange in intensive care patients. The research investigates the applicability of using the "expected (pCO 2 = HCO 3 + 15)" formula, derived from venous blood gas samples, as an alternative to Winter's formula and practical formula. The study emphasizes the importance of identifying the primary acid-base abnormality accurately and efficiently for appropriate clinical intervention in critically ill patients. Methods This study included 400 adult patients admitted to the Anesthesia Clinic in the Third Stage Anesthesia and Reanimation Intensive Care Unit at Hitit University Erol Olçok Training and Research Hospital between April 2020 and July 2023. Blood gas samples were collected simultaneously from both arterial lines and venous catheters. Patients under 18 years, pregnant women, hemodialysis patients, and those with missing data were excluded. The study aimed to calculate the expected partial pressure of carbon dioxide (pCO 2 ) values using Winter's formula and simple formula for both arterial and venous blood gas samples and assess potential correlations between them. Results The results showed a narrow range for arterial pH values (7.12-7.72), a wider distribution for pCO 2 values (17.90-81.30 mmHg), and a moderate dispersion for HCO 3 values (12.80-44.33 mmol/L). Both Winter's and simple formulas were applied to estimate the expected pCO 2 values, showing strong positive correlations between arterial and venous pH, pCO 2 , and HCO 3 values. The scatterplot illustrated a very high level of association (Pearson's correlation coefficient, r = 1) between the expected pCO 2 values derived from both formulas using arterial and venous blood gas samples. Conclusion The clinical study demonstrates that estimating expected pCO 2 values in mixed acid-base disorders can be achieved using a simple and convenient formulation, eliminating the need for arterial blood gas sampling and its associated complications.
<b>Aim</b>: In primary hyperparathyroidism patients, avoiding hypoparathyroidism and hypocalcemia after surgery is essential. We aimed to evaluate if the delta parathormone percent value (ΔPTH%) can identify patients with an increased risk of developing hypocalcemia after parathyroid surgery for primary hyperparathyroidism.<br /> <b>Material and methods</b>: Eighty patients with parathyroid adenomas who underwent single parathyroidectomy were analyzed, and demographical data, preoperative, and postoperative laboratory data were collected were included in the study. Postoperative hypocalcemia was defined as a corrected calcium value below 8.5 mg/dL calculated from the blood values taken on the first postoperative day. The ΔPTH value was calculated by finding the difference between the preoperative PTH value and the postoperative PTH value, and the percentage of ΔPTH was calculated by dividing the ΔPTH value by the preoperative PTH (ΔPTH = Preoperative PTH – Postoperative PTH, and ΔPTH% = ΔPTH / Preoperative PTH).<br /> <b>Results</b>: Postoperative hypocalcemia developed in 7.5% of the patients. Hypocalcemic patients had higher ΔPTH and ΔPTH% values. The selection of 130.95 ng/L as ΔPTH level cutoff level divided patients with and without postoperative hypocalcemia with 83.3% sensitivity and 62.2% specificity. As for ΔPTH%, a cut-off value of 71.4% had 100.0% sensitivity, 56.8% specificity, and a 16-fold increase in odds of postoperative hypocalcemia.<br /> <b>Conclusion</b>: ΔPTH and ΔPTH% values are helpful predictors of postoperative hypocalcemia after parathyroidectomy and can be used as a guiding tool.
Impairment of cognitive functions can commonly develop in patients with chronic kidney disease (CKD) and increase morbidity and mortality. The antioxidant activity of selenium reduces cognitive decline by protecting neurons from free radical damage. We aimed to explore the associations between serum selenium levels, cognitive impairment, and depression in CKD patients in this research. MethodsIn this prospective cross-sectional research, 100 participants between the ages of 20 and 65 were included, and four groups of 25 patients each were formed (control group, stage 3-4 CKD, peritoneal dialysis [PD], hemodialysis [HD]). The Standardized Mini Mental Test (sMMT) was used to measure cognitive skills, and the Beck Depression Inventory (BDI) was utilized to diagnose depression. Simultaneously, measurements of serum selenium levels were done from collected blood samples. ResultsCognitive impairment was detected in 4% of the control group, 16% of CKD patients (n=75), and 30% of the dialysis patients (n=50). Depression was found in 16% of the control group, 40% of the stage 3-4 CKD group, 50% of the PD group, and 44% of the HD group. In the control group, sMMT scores were higher than the other groups (p<0.001 for all), while the BDI score was statistically significantly lower (p=0.003). Serum selenium levels were found to be higher than HD and PD groups in patients with non-dialysis CKD and control groups in the post hoc analyses (p=0.001, p<0.001, p<0.001, p<0.001, respectively). ConclusionDepression and cognitive impairment are particularly prevalent in CKD and dialysis patients. Our results indicate serum selenium insufficiency may be related to depression and cognitive impairment in this patient group. Nonetheless, these findings need to be confirmed by larger-scale studies.
Metformin (MTF) associated gastrointestinal symptoms are fairly common side effects that adversely affect patients' treatment adherence. However, the variability of gastrointestinal symptoms in MTF-using patients has not been fully explained. In our study, we aimed to investigate the relationship between vitamin B12 deficiency with MTF-related gastrointestinal symptoms. Patients with type 2 diabetes mellitus (T2DM) using MTF were included in the study sequentially. Demographic characteristics of the patients, duration of diabetes, MTF dose and duration used, and gastrointestinal symptoms were recorded. Afterward, a hemogram, HgbA1c, and vitamin B12 measurements were performed. Patients with and without vitamin B12 deficiency were divided into two groups. The two groups were compared with statistical methods. Twenty-five percent of patients had low serum vitamin B12 levels. Patients with vitamin B12 deficiency had a longer diabetes duration, and a longer MTF usage duration (p<0.001, p<0.001) than the patients without vitamin B12 deficiency. There was no correlation between B12 deficiency and MTF dosage (p=0.590). Gastrointestinal symptoms were seen more frequently in the B12 deficiency group (p=0.025). Bloating and constipation, nausea, abdominal pain, and vomiting were seen commonly in the B12 deficiency group (p=0.002, p<0.001, p=0.014, p=0.004, respectively). Three or more symptoms were frequently seen in B12-deficient patients (p<0.001). Patients with both a MTF usage duration of 10 years or higher and vitamin B12 deficiency are found to be 434% more likely to have active gastrointestinal symptoms than all other patient groups (OR:5.343, 95%CI (2.173-13.140), p<0.001). Study results have shown that gastrointestinal symptoms seen in patients with T2DM taking MTF may be associated with vitamin B12 deficiency. MTF-related gut microbiome changes may play a role in this relationship. In particular, we recommend that patients who have been using MTF for ≥10 years and have gastrointestinal complaints should be followed more closely for vitamin B12 deficiency.
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