Browsing by Author "Sepúlveda Palamara, Rodrigo Andrés"

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    Bicarbonato de sodio intravenoso ¿Cuándo, cómo y por qué utilizarlo?
    (2022) Sepúlveda Palamara, Rodrigo Andrés; Juanet Lecaros, Cristián Ignacio; Sharp Segovia, Joaquín Andrés; Kattan Tala, Eduardo José
    Severe metabolic acidosis is defined by a pH < 7.2 with HCO3− < 8 mE- q/L in plasma. Its best treatment is to correct the underlying cause. However, acidemia produces multiple complications such as resistance to the action of catecholamines, pulmonary vasoconstriction, impaired cardiovascular function, hyperkalemia, immunological dysregulation, respiratory muscle fatigue, neurological impairment, cellular dysfunction, and finally, it contributes to multisystemic failure. Intravenous NaHCO3 buffers severe acidemia, preventing the associated damage and gains time while the causal disease is corrected. Its indication requires a risk-benefit assessment, considering its complications. These are hypernatremia, hypokalemia, ionic hypocalcemia, rebound alkalosis, and intracellular acidosis. For this reason, therapy must be “adapted” and administered judiciously. The patient will require monitoring with serial evaluation of the internal environment, especially arterial blood gases, plasma electrolytes, and ionized calcium. Isotonic solutions should be preferred instead of hypertonic bicarbonate. The development of hypernatremia must be prevented, calcium must be provided for hypocalcemia to improve cardiovascular function. Furthermore, in mechanically ventilated patients, a respiratory response similar to the one that would develop physiologically, must be established to be able to extract excess CO2 and thus avoid intracellular acidosis. It is possible to estimate the bicarbonate deficit, speed, and volume of its infusion. However, the calculations are only for reference. More important is to start intravenous NaHCO3 when needed, administer it judiciously, manage its side effects, and continue it to a safe goal. In this review we address all the necessary elements to consider in the administration of intravenous NaHCO3, highlighting why it is the best buffer for the management of severe metabolic acidosis.
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    Clinical presentation and management of atypical hemolytic uremic syndrome in Latin America: a narrative review of the literature
    (2024) Sepúlveda Palamara, Rodrigo Andrés; Modelli de Andrade, Lg.; Fortunato, Rm.; Gómez, B.; Nieto-Ríos, Jf.
    Introduction: comprehensive information about atypical hemolytic uremic syndrome (aHUS) is rela-tively scarce outside of Europe and North America. This narrative review assembles available published data about the clinical presentation and management of aHUS in Latin America. Areas covered: A search conducted in February 2023 of the MEDLINE (from inception), Embase (frominception), and LILACS/IBECS (1950 to 2023) databases using search terms 'atypical hemolytic uremicsyndrome’ and ‘Latin America’ and their variations retrieved 51 records (full papers and conferenceabstracts) published in English, Spanish, or Portuguese. After de-duplication, manual screening of titles/abstracts and addition of author-known articles, 25 articles were included of which 17 (68%) are full papers. All articles were published during the years 2013–2022. Articles include cohort studies, a registry analysis,and case reports from Argentina, Brazil, Chile and Columbia. Overall, Latin American patients with aHUSpresent the classic epidemiological, clinical, and genetic characteristics associated with this condition asdescribed in other world regions. Depending on the country and time of reporting, aHUS in Latin Americawas treated mainly with plasma therapy and/or eculizumab. Where reported, eculizumab substantiallyimproved aHUS-related outcomes in almost all adult and pediatric patients.Expert opinion: Eculizumab has dramatically altered the natural course of aHUS, improving prognosisand patient outcomes. Addressing economic challenges and investing in healthcare infrastructure willbe essential to implement strategies for timely detection and early treatment of aHUS in Latin America.
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    Insuficiencia renal aguda secundaria a rabdomiolisis como manifestación de infección por SARS-CoV-2
    (Sociedad Médica Santiago, 2021) Pérez, Javier; Sánchez Zagal, Sebastián Antonio; Sepúlveda Palamara, Rodrigo Andrés; Vera Alarcón, María Magdalena; Mery Ponce, Pablo Agustin; Garayar Pulgar, Bernardita; Jalil Milad, Roberto Daniel
    SARS-CoV-2 infection has a wide spectrum of clinical manifestations secondary to the impairment of different organs, including kidney. Rhabdomyolysis is produced by disintegration of striated muscle and the liberation of its contents to the extracellular fluid and bloodstream. This may produce hydro electrolytic disorders and acute kidney injury. We report a 35-year-old female with a history of SARS-CoV-2 infection who was hospitalized because of respiratory failure and developed renal failure. The etiologic study showed elevated total creatine kinase levels and a magnetic resonance imaging confirmed rhabdomyolysis. The patient required supportive treatment with vasoactive drugs, mechanic ventilation and kidney replacement therapy. She had a favorable evolution with resolution of respiratory failure and improvement of kidney function.
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    WCN25-1962 USE OF HEMODIALYSIS FOR THE CORRECTION OF EXTREME METABOLIC ALKALOSIS
    (2025) Medina Pedraza, Álvaro Ignacio; Sepúlveda Palamara, Rodrigo Andrés; Avila Jiménez, Eduardo Rodolfo