Arch Intern Med
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Unusually large bronchial casts developed in four patients. In two, the casts were associated with pneumonia. ⋯ Although unusual, bronchial cast formation may complicate a number of hypersecretory pulmonary diseases. Therapy ordinarily includes specific measures to treat the underlying disease state and maneuvers designed to remove or facilitate the expectoration of bronchial casts.
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We determined the clinical efficacy of using the venous CO2 value, as obtained with routine "electrolytes", in acid-base management. Venipuncture samples for venous CO2 content and chloride concentrations were obtained in 336 patients with arterial blood pH, PaO2, PaCO2, and oxygen saturation determinations. The linear correlation between actual calculated arterial HCO3- and the measured venous CO2 was significant (P less than .001). ⋯ We determined the effects of time delay, exposure to air, and acute changes in arterial blood pH and PaCO2 on venous CO2 levels. Venous CO2 determinations should not be substituted for the arterial HCO3 value in the Henderson-Hasselbalch equation to calculate arterial blood pH or PaCO2. Clinically, the venous CO2 value has little direct use, but when venous CO2 content is abnormal, it should alert the clinician to the need for obtaining arterial blood gas and pH values.
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Thirteen years' experience with home oxygen for patients with advanced chronic obstructive pulmonary disease are reviewed. Home oxygen is safe and relieves pulmonary hypertension and elevated RBC mass in some, but not all patients. ⋯ Chronic compensated carbon dioxide retention is well tolerated and adaptive in cases of severe chronic airflow obstruction. New oxygen concentrators are effective in correcting hypoxemia and may make home oxygen administration more convenient and less expensive.
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Lactic acidosis has been described in patients with leukemia and lymphoma, but its occurrence in other malignant diseases is not documented. We treated two patients with oat cell carcinoma of the lung and extensive liver metastases in whom lactic acidosis developed. Tumor-induced hepatic dysfunction appeared to be a major factor in the pathogenesis of the lactic acidosis observed in these patients.
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This study examined the acid-base disturbances in 67 adults with salicylate intoxication. On admission, 66 patients had an acid-base distrubance. In contract to previous suggestions, however, only 25% of the patients had simple respiratory alkalosis. ⋯ These additional drugs generally were CNS depressants and were important determinants of the variety of the acid-base disturbance. Those patients who ingested additional drugs had a significantly lower incidence of respiratory alkalosis (P less than .005) and a higher incidence of respiratory acidosis (P less than .005) and acidemia (P less than 0.25). The incidence of acidemia correlated with the presence of neurological symptoms.