Journal of the Indian Medical Association
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Elevated pH and elevated plasma bicarbonate level above normal characterise metabolic alkalosis. When bicarbonate is elevated pCO2 must also be elevated to maintain pH to its normal range. Therefore with metabolic alkalosis, the compensation is to decrease alveolar ventilation, and increase pCO2. ⋯ In chloride responsive alkalosis in which the conditions are extracellular volume depletion, hypokalaemia and hypochloraemia correction of intravascular volume with sodium chloride is needed. In severe metabolic alkalosis of any cause dilute hydrochloric acid (0.1 N HCl) may be infused intravenously but haemolysis may be a complication. In emergency situation with severe hypokalaemia dialysis with higher K+, Cl- and low HCO3- bath will be appropriate.
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Case Reports
Continuous arteriovenous haemofiltration to regulate hyperkalaemia during renal transplantation: a case report.
Progressive hyperkalaemia is common in end stage renal disease patients waiting for renal transplantation. Ventricular tachycardia and ventricular fibrillation due to hyperkalaemia are life-threatening complications in these patients. ⋯ This improved his pulmonary oedema, controlled hyperkalaemia and surgery could be completed uninterruptedly. After anaesthetising live and related kidney donor for nephrectomy, since it is not prudent to stop recipient surgery because of unforeseen complication, the authors wish to recommend CAVH as an alternative method to prevent life threatening cardiac complication of hyperkalaemia.
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A retrospective study of 49 cases with persistent postmenopausal vaginal bleeding undergoing hysterectomy in the absence of postoperatively evident diagnosis of genital malignancy was carried out. Normal endometrium was the source of bleeding in 24 cases (48.9%) while 11 cases (22.4%) had evidence of endometritis. ⋯ However, there was high degree of suspicion of malignancy in these 2 cases based on the endometrial histopathology and ultrasonographic endometrial thickness. By careful correlation of clinical findings, endometrial histopathology and ultrasound measurement of endometrial thickness, most cases with postmenopausal bleeding can be managed conservatively.