Bicarbonate does not improve hemodynamics in critically ill patients who have lactic acidosis: a prospective, controlled clinical study

Article Abstract:

Patients with acidemia (low blood pH, causing excessive acidity) are often treated with sodium bicarbonate to elevate the pH level. The treatment has been thought to improve heart muscle contraction and increase cardiac output. However, the efficacy of this treatment has been debated, and has never been tested in a controlled clinical study. To determine if sodium bicarbonate is effective in improving the hemodynamics in patients with lactic acidosis, 14 critically ill patients were studied in a controlled clinical trial. All patients had blood bicarbonate concentration less than 17 millimoles per liter and lactic acid greater than 2.5 millimoles per liter. During the two-hour study period, patients received both a 2 millimole per kilogram of body weight sodium bicarbonate and a similar dose of sodium chloride to control the effects of injecting sodium ions. The results showed that the bicarbonate did not affect blood pressure, cardiac output, or other hemodynamic values. This was true even for the more acidotic patients, with blood pH less than 7.20. In addition, the widely held belief that the correction of acidemia increases the response to catecholamines (which is based largely upon animal studies) could not be confirmed in this trial. It was observed that the bicarbonate injection decreased the level of calcium ions in the blood, and increased the carbon dioxide tension. Both these phenomena may act to decrease cardiac muscle function, which may explain why the correction of acidemia does not produce the cardiac improvement which might have been expected. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Care and treatment, Physiological aspects, Acidosis, Bicarbonates, Acid-base equilibrium, Lactic acidosis

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A comparison of two regimens for the treatment of Mycobacterium avium complex bacteremia in AIDS: rifabutin, ethambutol, and clarithromycin versus rifampin, ethambutol, clofazimine, and ciprofloxacin

Article Abstract:

The combination of rifabutin, ethambutol and clarithromycin appears to be the most effective drug treatment for Mycobacterium avium complex infections in AIDS patients. Of 187 AIDS patients with this opportunistic infection, 97 received these 3 drugs and 90 received a 4-drug regimen including rifampin, ethambutol, clofazimine and ciprofloxacin. The 3-drug regimen cleared the infection in more patients than the 4-drug combination. The dose of rifabutin had to be reduced to lower the incidence of an eye inflammation called uveitis, but the 3-drug combination was still more effective.

Evaluation, Anti-infective agents, AIDS (Disease), Mycobacterial infections, Mycobacterium infections

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Vasopressin versus norepinephrine infusion in patients with septic shock

Article Abstract:

A study to ascertain the mortality rate when vasopressin and norepinephrine were used on patients with refractory septic shock is conducted. Results show no significant difference between patients treated with low-dose vasopressin and norepinephrine compared to catecholamine vasopressors.

United States, Dosage and administration, Noradrenaline, Norepinephrine, Septic shock, Vasopressin, Vasopressins, Catecholamines, Clinical report

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