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  1. Article ; Online: The Role of the Endocrine System in the Regulation of Acid-Base Balance by the Kidney and the Progression of Chronic Kidney Disease.

    Nagami, Glenn T / Kraut, Jeffrey A

    International journal of molecular sciences

    2024  Volume 25, Issue 4

    Abstract: Systemic acid-base status is primarily determined by the interplay of net acid production (NEAP) arising from metabolism of ingested food stuffs, buffering of NEAP in tissues, generation of bicarbonate by the kidney, and capture of any bicarbonate ... ...

    Abstract Systemic acid-base status is primarily determined by the interplay of net acid production (NEAP) arising from metabolism of ingested food stuffs, buffering of NEAP in tissues, generation of bicarbonate by the kidney, and capture of any bicarbonate filtered by the kidney. In chronic kidney disease (CKD), acid retention may occur when dietary acid production is not balanced by bicarbonate generation by the diseased kidney. Hormones including aldosterone, angiotensin II, endothelin, PTH, glucocorticoids, insulin, thyroid hormone, and growth hormone can affect acid-base balance in different ways. The levels of some hormones such as aldosterone, angiotensin II and endothelin are increased with acid accumulation and contribute to an adaptive increase in renal acid excretion and bicarbonate generation. However, the persistent elevated levels of these hormones can damage the kidney and accelerate progression of CKD. Measures to slow the progression of CKD have included administration of medications which inhibit the production or action of deleterious hormones. However, since metabolic acidosis accompanying CKD stimulates the secretion of several of these hormones, treatment of CKD should also include administration of base to correct the metabolic acidosis.
    MeSH term(s) Humans ; Acid-Base Equilibrium/physiology ; Bicarbonates/metabolism ; Aldosterone/metabolism ; Angiotensin II/metabolism ; Kidney/metabolism ; Renal Insufficiency, Chronic/metabolism ; Acidosis/metabolism ; Endothelins/metabolism ; Endocrine System/metabolism
    Chemical Substances Bicarbonates ; Aldosterone (4964P6T9RB) ; Angiotensin II (11128-99-7) ; Endothelins
    Language English
    Publishing date 2024-02-19
    Publishing country Switzerland
    Document type Journal Article ; Review
    ZDB-ID 2019364-6
    ISSN 1422-0067 ; 1422-0067 ; 1661-6596
    ISSN (online) 1422-0067
    ISSN 1422-0067 ; 1661-6596
    DOI 10.3390/ijms25042420
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: Regulation of Acid-Base Balance in Patients With Chronic Kidney Disease.

    Nagami, Glenn T / Kraut, Jeffrey A

    Advances in chronic kidney disease

    2022  Volume 29, Issue 4, Page(s) 337–342

    Abstract: Normallly the kidneys handle the daily acid load arising from net endogenous acid production from the metabolism of ingested animal protein (acid) and vegetables (base). With chronic kidney disease, reduced acid excretion by the kidneys is primarily due ... ...

    Abstract Normallly the kidneys handle the daily acid load arising from net endogenous acid production from the metabolism of ingested animal protein (acid) and vegetables (base). With chronic kidney disease, reduced acid excretion by the kidneys is primarily due to reduced ammonium excretion such that when acid excertion falls below acid porduction, acid accumulation occurs. With even mild reductions in glomerular filtration rate (60 to 90 ml/min), net acid excretion may fall below net acid production resulting in acid retention which may be initially sequestered in interstitial compartments in the kidneys, bones, and muscles resulting in no fall in measured systemic bicarbonate levels (eubicarbonatemic metabolic acidosis). With greater reductions in kidney function, the greater quantities of acid retained spillover systemically resulting in low pH (overt metabolic acidosis). The evaluation of acid-base balance in patients with CKD is complicated by the heterogeneity of clinical acid-base disorders and by the eubicarbonatemic nature of the early phase of acid retention. If supported by more extensive studies, blood gas analyses to confirm the acid-base disorder and newer ways for assessing the presence of acidosis such as urinary citrate measurements may become routine tools to evaluate and treat acid-base disorders in individuals with CKD.
    MeSH term(s) Acid-Base Equilibrium ; Acid-Base Imbalance/etiology ; Animals ; Bicarbonates ; Citrates ; Humans ; Renal Insufficiency, Chronic
    Chemical Substances Bicarbonates ; Citrates
    Language English
    Publishing date 2022-09-26
    Publishing country United States
    Document type Journal Article ; Review ; Research Support, Non-U.S. Gov't
    ISSN 1548-5609 ; 1548-5595
    ISSN (online) 1548-5609
    ISSN 1548-5595
    DOI 10.1053/j.ackd.2022.05.004
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    Zs.A 4627: Show issues Location:
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  3. Article ; Online: Assessment of Acid-Base Status: Beyond Serum Bicarbonate.

    Kraut, Jeffrey A / Raphael, Kalani L

    Clinical journal of the American Society of Nephrology : CJASN

    2021  Volume 16, Issue 9, Page(s) 1429–1431

    MeSH term(s) Acid-Base Equilibrium ; Bicarbonates/blood ; Humans
    Chemical Substances Bicarbonates
    Language English
    Publishing date 2021-06-04
    Publishing country United States
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 2226665-3
    ISSN 1555-905X ; 1555-9041
    ISSN (online) 1555-905X
    ISSN 1555-9041
    DOI 10.2215/CJN.02760221
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  4. Article ; Online: Response to "Ethylene glycol poisoning: A diagnostic challenge in a patient with persistent seizures and a severe metabolic acidosis".

    Mullins, Michael E / Kraut, Jeffrey A

    African journal of emergency medicine : Revue africaine de la medecine d'urgence

    2021  Volume 11, Issue 2, Page(s) 263

    Language English
    Publishing date 2021-04-05
    Publishing country Netherlands
    Document type Journal Article
    ISSN 2211-4203
    ISSN (online) 2211-4203
    DOI 10.1016/j.afjem.2021.02.006
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  5. Article ; Online: Treatment of acute acidaemia in the seriously ill patient: Should base be given?

    Kraut, Jeffrey A

    Anaesthesia, critical care & pain medicine

    2018  Volume 37, Issue 6, Page(s) 495–497

    MeSH term(s) Acidosis/drug therapy ; Acidosis/etiology ; Acidosis/mortality ; Acidosis, Respiratory/drug therapy ; Acute Disease ; Sodium Bicarbonate/adverse effects ; Sodium Bicarbonate/therapeutic use
    Chemical Substances Sodium Bicarbonate (8MDF5V39QO)
    Language English
    Publishing date 2018-12-20
    Publishing country France
    Document type Editorial
    ISSN 2352-5568
    ISSN (online) 2352-5568
    DOI 10.1016/j.accpm.2018.11.005
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  6. Article ; Online: The Role of the Nephrologist in Management of Poisoning and Intoxication: Core Curriculum 2022.

    Mullins, Michael E / Kraut, Jeffrey A

    American journal of kidney diseases : the official journal of the National Kidney Foundation

    2021  Volume 79, Issue 6, Page(s) 877–889

    Abstract: Poisoning is a common problem in the United States. Acid-base disturbances, electrolyte derangements, or acute kidney injury result from severe poisoning from toxic alcohols, salicylates, metformin, and acetaminophen. Lithium is highly sensitive to small ...

    Abstract Poisoning is a common problem in the United States. Acid-base disturbances, electrolyte derangements, or acute kidney injury result from severe poisoning from toxic alcohols, salicylates, metformin, and acetaminophen. Lithium is highly sensitive to small changes in kidney function. These poisonings and drug overdoses often require the nephrologist's expertise in diagnosis and treatment, which may require correction of acidosis, administration of selective enzyme inhibitors, or timely hemodialysis. The clinical and laboratory abnormalities associated with the poisonings and drug overdoses can develop rapidly and lead to severe cellular dysfunction and death. Understanding the pathophysiology of the disturbances and their clinical and laboratory findings is essential for the nephrologist to rapidly recognize the poisonings and establish an effective treatment plan. This installment of AJKD's Core Curriculum in Nephrology presents illustrative cases of individual poisonings and drug overdoses and summarizes up to date information on their prevalence, clinical and laboratory findings, pathophysiology, diagnosis, and treatment.
    MeSH term(s) Acidosis ; Curriculum ; Drug Overdose/diagnosis ; Drug Overdose/therapy ; Humans ; Metformin ; Nephrologists ; Poisoning/diagnosis ; Poisoning/epidemiology ; Poisoning/therapy
    Chemical Substances Metformin (9100L32L2N)
    Language English
    Publishing date 2021-12-09
    Publishing country United States
    Document type Journal Article ; Review ; Research Support, Non-U.S. Gov't
    ZDB-ID 604539-x
    ISSN 1523-6838 ; 0272-6386
    ISSN (online) 1523-6838
    ISSN 0272-6386
    DOI 10.1053/j.ajkd.2021.06.030
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    Zs.A 1669: Show issues Location:
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  7. Article ; Online: Psychological safety and perceived organizational support in emergency medicine residencies.

    Goodrich, Margaret / McCabe, Kerry / Basford, Jesse / Bambach, Kimberly / Kraut, Aaron / Love, Jeffrey N

    AEM education and training

    2024  Volume 8, Issue 2, Page(s) e10964

    Abstract: Background: The clinical learning environment (CLE) is a key focus of the Accreditation Council of Graduate Medical Education. It impacts knowledge acquisition and professional development. A previous single-center study evaluated the psychological ... ...

    Abstract Background: The clinical learning environment (CLE) is a key focus of the Accreditation Council of Graduate Medical Education. It impacts knowledge acquisition and professional development. A previous single-center study evaluated the psychological safety and perceived organizational support of the CLE across different specialties. Building on this work, we explored and evaluated psychological safety and perceived organizational support across multiple heterogeneous emergency medicine (EM) residencies to identify trends and factors affecting perceptions of the CLE.
    Methods: Using the Psychological Safety Scale (PSS) and Survey of Perceived Organizational Support (SPOS), residents from seven U.S. EM residencies were surveyed using REDCap software from September through November 2021, with 300 potential respondents. As an adjunct to these surveys, three open-ended questions were included regarding features of their learning environments.
    Results: A total of 137 out of 300 residents completed the survey. The overall response rate was 45.7%. There was a variable response rate across programs (26.0%-96.7%). Pooled results demonstrate an overall positive perception of CLEs, based on positive mean responses (i.e., "Members of my department are able to bring up problems and tough issue" had a mean of 4.2 on a 5-point Likert scale). Open responses identified teaching, collegiality, and support from program leadership as supportive features of the CLE. Confrontational interdisciplinary communication, a sense of being devalued, and off-service rotations were identified as threats or areas for improvement to the CLE.
    Conclusions: PSS and SPOS scores were generally positive in this multi-institution study, consistent with the prior single-institution study indicating that EM is often considered psychologically safe and supportive. EM training programs can consider using the PSS/SPOS to audit their own programs to identify areas for improvement and foster supportive features already in place.
    Language English
    Publishing date 2024-04-13
    Publishing country United States
    Document type Journal Article
    ISSN 2472-5390
    ISSN (online) 2472-5390
    DOI 10.1002/aet2.10964
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  8. Article ; Online: Disturbances in Acid-Base, Potassium, and Sodium Balance in Patients With CKD: New Insights and Novel Therapies.

    Kraut, Jeffrey A

    Advances in chronic kidney disease

    2017  Volume 24, Issue 5, Page(s) 272–273

    Language English
    Publishing date 2017
    Publishing country United States
    Document type Editorial
    ISSN 1548-5609 ; 1548-5595
    ISSN (online) 1548-5609
    ISSN 1548-5595
    DOI 10.1053/j.ackd.2017.07.001
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  9. Article ; Online: Assessing Acid-Base Status in Patients With CKD: Does Measurement of Blood pH Matter?

    Raphael, Kalani L / Kraut, Jeffrey A

    American journal of kidney diseases : the official journal of the National Kidney Foundation

    2020  Volume 77, Issue 1, Page(s) 9–11

    MeSH term(s) Acid-Base Imbalance/blood ; Acid-Base Imbalance/etiology ; Bicarbonates/analysis ; Bicarbonates/blood ; Humans ; Hydrogen-Ion Concentration ; Prognosis ; Renal Insufficiency, Chronic/diagnosis ; Renal Insufficiency, Chronic/metabolism ; Risk Assessment/methods
    Chemical Substances Bicarbonates
    Language English
    Publishing date 2020-10-13
    Publishing country United States
    Document type Editorial
    ZDB-ID 604539-x
    ISSN 1523-6838 ; 0272-6386
    ISSN (online) 1523-6838
    ISSN 0272-6386
    DOI 10.1053/j.ajkd.2020.08.005
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  10. Article ; Online: Approach to the Treatment of Methanol Intoxication.

    Kraut, Jeffrey A

    American journal of kidney diseases : the official journal of the National Kidney Foundation

    2016  Volume 68, Issue 1, Page(s) 161–167

    Abstract: Methanol intoxication is an uncommon but serious poisoning. Its adverse effects are due primarily to the impact of its major metabolite formic acid and lactic acid resulting from cellular hypoxia. Symptoms including abdominal pain and loss of vision can ... ...

    Abstract Methanol intoxication is an uncommon but serious poisoning. Its adverse effects are due primarily to the impact of its major metabolite formic acid and lactic acid resulting from cellular hypoxia. Symptoms including abdominal pain and loss of vision can appear a few hours to a few days after exposure, reflecting the time necessary for accumulation of the toxic byproducts. In addition to a history of exposure, increases in serum osmolal and anion gaps can be clues to its presence. However, increments in both parameters can be absent depending on the nature of the toxic alcohol, time of exposure, and coingestion of ethanol. Definitive diagnosis requires measurement with gas or liquid chromatography, which are laborious and expensive procedures. Tests under study to detect methanol or its metabolite formate might facilitate the diagnosis of this poisoning. Treatment can include administration of ethanol or fomepizole, both inhibitors of the enzyme alcohol dehydrogenase to prevent formation of its metabolites, and hemodialysis to remove methanol and formate. In this Acid-Base and Electrolyte Teaching Case, a patient with methanol intoxication due to ingestion of model airplane fuel is described, and the value and limitations of current and new diagnostic and treatment measures are discussed.
    MeSH term(s) Acid-Base Imbalance/chemically induced ; Acid-Base Imbalance/therapy ; Female ; Humans ; Methanol/poisoning ; Poisoning/diagnosis ; Poisoning/therapy ; Young Adult
    Chemical Substances Methanol (Y4S76JWI15)
    Language English
    Publishing date 2016-07
    Publishing country United States
    Document type Case Reports ; Journal Article
    ZDB-ID 604539-x
    ISSN 1523-6838 ; 0272-6386
    ISSN (online) 1523-6838
    ISSN 0272-6386
    DOI 10.1053/j.ajkd.2016.02.058
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