Quantitative Physicochemical Analysis of Acid-Base Balance and Clinical Utility of Anion Gap and Strong Ion Gap in 806 Neonatal Calves with Diarrhea

BackgroundAcid-base abnormalities in neonatal diarrheic calves can be assessed by using the Henderson-Hasselbalch equation or the simplified strong ion approach which use the anion gap (AG) or the strong ion gap (SIG) to quantify the concentration of unmeasured strong anions such as d-lactate. Hypothesis/ObjectivesTo determine and compare the clinical utility of AG and SIG in quantifying the unmeasured strong anion charge in neonatal diarrheic calves, and to examine the associations between biochemical findings and acid-base variables by using the simplified strong ion approach. We hypothesized that the SIG provides a more accurate prediction of unmeasured strong anions than the AG. AnimalsEight hundred and six neonatal diarrheic calves admitted to a veterinary teaching hospital. MethodsRetrospective study utilizing clinicopathologic findings extracted from medical records. ResultsHyperphosphatemia was an important predictor of venous blood pH. Serum inorganic phosphorus and plasma d-lactate concentrations accounted for 58% of the variation in venous blood pH and 77% of the variation in AG and SIG. Plasma d- and total lactate concentrations were slightly better correlated with SIG (r(s)=-0.69;-0.78) than to AG (r(s)=0.63;0.74). Conclusions and Clinical ImportanceStrong ion gap is slightly better at quantifying the unmeasured strong anion concentration in neonatal diarrheic calves than AG. Phosphorus concentrations should be included as part of the calculation of A(tot) when applying the simplified strong ion approach to acid-base balance to critically ill animals with hyperphosphatemia

Quantitative Physicochemical Analysis of Acid-Base Balance and Clinical Utility of Anion Gap and Strong Ion Gap in 806 Neonatal Calves with Diarrhea

BackgroundAcid-base abnormalities in neonatal diarrheic calves can be assessed by using the Henderson-Hasselbalch equation or the simplified strong ion approach which use the anion gap (AG) or the strong ion gap (SIG) to quantify the concentration of unmeasured strong anions such as d-lactate. Hypothesis/ObjectivesTo determine and compare the clinical utility of AG and SIG in quantifying the unmeasured strong anion charge in neonatal diarrheic calves, and to examine the associations between biochemical findings and acid-base variables by using the simplified strong ion approach. We hypothesized that the SIG provides a more accurate prediction of unmeasured strong anions than the AG. AnimalsEight hundred and six neonatal diarrheic calves admitted to a veterinary teaching hospital. MethodsRetrospective study utilizing clinicopathologic findings extracted from medical records. ResultsHyperphosphatemia was an important predictor of venous blood pH. Serum inorganic phosphorus and plasma d-lactate concentrations accounted for 58% of the variation in venous blood pH and 77% of the variation in AG and SIG. Plasma d- and total lactate concentrations were slightly better correlated with SIG (r(s)=-0.69;-0.78) than to AG (r(s)=0.63;0.74). Conclusions and Clinical ImportanceStrong ion gap is slightly better at quantifying the unmeasured strong anion concentration in neonatal diarrheic calves than AG. Phosphorus concentrations should be included as part of the calculation of A(tot) when applying the simplified strong ion approach to acid-base balance to critically ill animals with hyperphosphatemia

Electrocardiographic findings in 130 hospitalized neonatal calves with diarrhea and associated potassium balance disorders

Background: Hyperkalemia in neonatal diarrheic calves can potentially result in serious cardiac conduction abnormalities and arrhythmias. Objective: To document electrocardiographic (ECG) findings and the sequence of ECG changes that are associated with increasing plasma potassium concentrations (cK(+)) in a large population of neonatal diarrheic calves. Animals: One hundred and thirty neonatal diarrheic calves (age 21 days). Methods: Prospective observational study involving calves admitted to a veterinary teaching hospital. Results: Hyperkalemic calves (cK(+): 5.8-10.2, blood pH: 6.55-7.47) had significantly (P6.5 mmol/L, S wave amplitude voltage decreased when cK(+) >7.4 mmol/L, QRS duration increased when cK(+) >7.8 mmol/L, J point amplitude increased when cK(+) >7.9 mmol/L, and ST segment angle increased when cK(+) >9.1 mmol/L. P wave amplitude was characterized by a second common break point at cK(+)=8.2 mmol/L, above which value the amplitude was 0. Conclusions and Clinical Importance: Hyperkalemia in neonatal diarrheic calves is associated with serious cardiac conduction abnormalities. In addition to increased S and T wave amplitude voltages, alterations of P and Ta wave amplitudes are early signs of hyperkalemia, which is consistent with the known sensitivity of atrial myocytes to increased cK(+)

Patient's thoughts and expectations about centres of expertise for PKU

Background: In the Netherlands (NL) the government assigned 2 hospitals as centres of expertise (CE) for Phenylketonuria (PKU), while in the United Kingdom (UK) and Germany no centres are assigned specifically as PKU CE's. Methods: To identify expectations of patients/caregivers with PKU of CEs, a web-based survey was distributed through the national Phenylketonuria societies of Germany, NL and UK. Results: In total, 105 responded (43 patients, 56 parents, 4 grandparents, 2 other) of whom 59 were from NL, 33 from UK and 13 from Germany. All participants (n = 105) agreed that patients and/or practitioners would benefit from CEs. The frequency patients would want to visit a CE, when not treated in a CE (n = 83) varied: every hospital visit (24%, n = 20), annual or bi-annual (45%, n = 37), at defined patient ages (6%, n = 5), one visit only (22%, n = 18), or never (4%, n = 3). Distance was reported as a major barrier (42%, n = 35). 78% (n = 65) expected CE physicians and dieticians to have a higher level of knowledge than in non-CE centres. For participants already treated in a CE (n = 68), 66% requested a more extensive annual or bi-annual review. In general, psychology review and neuropsychologist assessment were identified as necessary by approximately half of the 105 participants. In addition, 66% (n = 68) expected a strong collaboration with patient associations. Conclusion: In this small study, most participants expected that assigning CEs will change the structure of and delivery of Phenylketonuria care

Advances in prevention and therapy of neonatal dairy calf diarrhoea : a systematical review with emphasis on colostrum management and fluid therapy

Neonatal calf diarrhoea remains the most common cause of morbidity and mortality in preweaned dairy calves worldwide. This complex disease can be triggered by both infectious and non-infectious causes. The four most important enteropathogens leading to neonatal dairy calf diarrhoea are Escherichia coli, rota-and coronavirus, and Cryptosporidium parvum. Besides treating diarrhoeic neonatal dairy calves, the veterinarian is the most obvious person to advise the dairy farmer on prevention and treatment of this disease. This review deals with prevention and treatment of neonatal dairy calf diarrhoea focusing on the importance of a good colostrum management and a correct fluid therapy

Off shell behaviour of the in medium nucleon-nucleon cross section

The properties of nucleon-nucleon scattering inside dense nuclear matter are investigated. We use the relativistic Brueckner-Hartree-Fock model to determine on-shell and half off-shell in-medium transition amplitudes and cross sections. At finite densities the on-shell cross sections are generally suppressed. This reduction is, however, less pronounced than found in previous works. In the case that the outgoing momenta are allowed to be off energy shell the amplitudes show a strong variation with momentum. This description allows to determine in-medium cross sections beyond the quasi-particle approximation accounting thereby for the finite width which nucleons acquire in the dense nuclear medium. For reasonable choices of the in-medium nuclear spectral width, i.e. $\Gamma\leq 40$ MeV, the resulting total cross sections are, however, reduced by not more than about 25% compared to the on-shell values. Off-shell effect are generally more pronounced at large nuclear matter densities.Comment: 31 pages Revtex, 12 figures, typos corrected, to appear in Phys. Rev.

Untreated PKU patients without intellectual disability: What do they teach us?

Phenylketonuria (PKU) management is aimed at preventing neurocognitive and psychosocial dysfunction by keeping plasma phenylalanine concentrations within the recommended target range. It can be questioned, however, whether universal plasma phenylalanine target levels would result in optimal neurocognitive outcomes for all patients, as similar plasma phenylalanine concentrations do not seem to have the same consequences to the brain for each PKU individual. To better understand the inter-individual differences in brain vulnerability to high plasma phenylalanine concentrations, we aimed to identify untreated and/or late-diagnosed PKU patients with near-normal outcome, despite high plasma phenylalanine concentrations, who are still alive. In total, we identified 16 such cases. While intellectual functioning in these patients was relatively unaffected, they often did present other neurological, psychological, and behavioral problems. Thereby, these “unusual” PKU patients show that the classical symptomatology of untreated or late-treated PKU may have to be rewritten. Moreover, these cases show that a lack of intellectual dysfunction despite high plasma phenylalanine concentrations does not necessarily imply that these high phenylalanine concentrations have not been toxic to the brain. Also, these cases may suggest that different mechanisms are involved in PKU pathophysiology, of which the relative importance seems to differ between patients and possibly also with increasing age. Further research should aim to better distinguish PKU patients with respect to their cerebral effects to high plasma phenylalanine concentrations

Untreated PKU patients without intellectual disability: what do they teach us?

Phenylketonuria (PKU) management is aimed at preventing neurocognitive and psychosocial dysfunction by keeping plasma phenylalanine concentrations within the recommended target range. It can be questioned, however, whether universal plasma phenylalanine target levels would result in optimal neurocognitive outcomes for all patients, as similar plasma phenylalanine concentrations do not seem to have the same consequences to the brain for each PKU individual. To better understand the inter-individual differences in brain vulnerability to high plasma phenylalanine concentrations, we aimed to identify untreated and/or late-diagnosed PKU patients with near-normal outcome, despite high plasma phenylalanine concentrations, who are still alive. In total, we identified 16 such cases. While intellectual functioning in these patients was relatively unaffected, they often did present other neurological, psychological, and behavioral problems. Thereby, these "unusual" PKU patients show that the classical symptomatology of untreated or late-treated PKU may have to be rewritten. Moreover, these cases show that a lack of intellectual dysfunction despite high plasma phenylalanine concentrations does not necessarily imply that these high phenylalanine concentrations have not been toxic to the brain. Also, these cases may suggest that different mechanisms are involved in PKU pathophysiology, of which the relative importance seems to differ between patients and possibly also with increasing age. Further research should aim to better distinguish PKU patients with respect to their cerebral effects to high plasma phenylalanine concentrations

Untreated PKU Patients without Intellectual Disability: What Do They Teach Us?

Phenylketonuria (PKU) management is aimed at preventing neurocognitive and psychosocial dysfunction by keeping plasma phenylalanine concentrations within the recommended target range. It can be questioned, however, whether universal plasma phenylalanine target levels would result in optimal neurocognitive outcomes for all patients, as similar plasma phenylalanine concentrations do not seem to have the same consequences to the brain for each PKU individual. To better understand the inter-individual differences in brain vulnerability to high plasma phenylalanine concentrations, we aimed to identify untreated and/or late-diagnosed PKU patients with near-normal outcome, despite high plasma phenylalanine concentrations, who are still alive. In total, we identified 16 such cases. While intellectual functioning in these patients was relatively unaffected, they often did present other neurological, psychological, and behavioral problems. Thereby, these "unusual" PKU patients show that the classical symptomatology of untreated or late-treated PKU may have to be rewritten. Moreover, these cases show that a lack of intellectual dysfunction despite high plasma phenylalanine concentrations does not necessarily imply that these high phenylalanine concentrations have not been toxic to the brain. Also, these cases may suggest that different mechanisms are involved in PKU pathophysiology, of which the relative importance seems to differ between patients and possibly also with increasing age. Further research should aim to better distinguish PKU patients with respect to their cerebral effects to high plasma phenylalanine concentrations