Unraveling NAGMA: A Case Series of Intravenous Nimodipine-Induced Metabolic Acidosis in Neuro-ICU Patients
Asian Journal of Neurosurgery,
Год журнала:
2025,
Номер
unknown
Опубликована: Май 26, 2025
Abstract
Nimodipine,
a
calcium
channel
blocker
of
the
dihydropyridine
class,
is
used
prophylactically
in
ruptured
aneurysmal
subarachnoid
hemorrhage
(aSAH)
patients
to
reduce
incidence
poor
outcome,
delayed
cerebral
ischemia,
and
ischemic
neurological
deficits.
This
case
series
reports
nine
instances
normal
anion
gap
metabolic
acidosis
(NAGMA)
with
aSAH
following
intravenous
nimodipine
administration
neuro-intensive
care
unit
(NICU)
over
2
months.
The
patients,
aged
4
68
years
(seven
male,
two
female),
presented
acute
headaches
were
diagnosed
intracranial
aneurysms,
managed
clipping
or
coiling.
Intravenous
(1–2
mg/hour)
was
initiated
as
per
protocol,
along
standard
NICU
care.
After
48
72
hours,
developed
hyperventilation,
respiratory
alkalosis,
significant
decrease
bicarbonate,
leading
NAGMA.
Despite
ruling
out
common
causes
like
gastrointestinal
losses
nephrotoxic
drugs,
renal
tubular
suspected.
NAGMA
resolved
spontaneously
6
7
days
postsurgery,
coinciding
discontinuation
nimodipine.
A
retrospective
audit
revealed
factor:
using
specific
brand
nimodipine,
new
arrival
from
hospital
supply.
phenomenon
later
corroborated
similar
another
hospital.
highlights
importance
pharmacovigilance,
postmarketing
surveillance,
regulatory
oversight
identifying
rare
drug-related
adverse
events,
particularly
high-acuity
settings
NICU.
Язык: Английский
Understanding renal tubular acidosis
British Journal of Hospital Medicine,
Год журнала:
2024,
Номер
unknown, С. 1 - 12
Опубликована: Окт. 14, 2024
Renal
tubular
acidosis
is
a
group
of
disorders
characterised
by
metabolic
acidosis,
hyperchloraemia,
normal
anion
gap,
and
potassium
imbalance.
Genetic
mutations,
drugs
or
acquired
disrupt
the
function
various
transport
proteins
enzymes
in
renal
tubules,
causing
diminished
bicarbonate
reabsorption
inability
to
excrete
hydrogen
ions,
leading
proximal
(type
2)
distal
1)
respectively.
These
conditions
are
typically
associated
with
hypokalaemia,
which,
if
severe,
can
cause
muscle
paralysis
dangerous
cardiac
arrhythmias.
A
rare
mixed
variant
3),
including
features
both
type
1
2
has
also
been
described.
On
other
hand,
aldosterone
deficiency
resistance
leads
hyperkalaemic
form
4).
If
untreated,
lead
long-term
severe
complications
such
as
growth
retardation,
osteoporosis,
rickets,
osteomalacia,
calculi.
Moreover,
might
be
initial
presentation
more
underlying
pathology,
autoimmune
disease
plasma
cell
dyscrasias.
better
understanding
condition
help
physicians
diagnose
treat
it
early
prevent
adverse
outcomes.
Язык: Английский
Complexities, Benefits, Risks, and Clinical Implications of Sodium Bicarbonate Administration in Critically Ill Patients: A State-of-the-Art Review
Journal of Clinical Medicine,
Год журнала:
2024,
Номер
13(24), С. 7822 - 7822
Опубликована: Дек. 21, 2024
Sodium
bicarbonate
has
been
used
in
the
treatment
of
different
pathologies,
such
as
hyperkalemia,
cardiac
arrest,
tricyclic
antidepressant
toxicity,
aspirin
acute
acidosis,
lactic
diabetic
ketoacidosis,
rhabdomyolysis,
and
adrenergic
receptors’
resistance
to
catecholamine
patients
with
shock.
An
ongoing
debate
about
bicarbonate’s
efficacy
potential
harm
raised
for
decades
because
lack
evidence
supporting
its
efficacy.
Despite
guidelines’
restrictions,
sodium
overused
clinical
practice.
The
overuse
could
be
desire
correct
arterial
blood
gas
parameters
rapidly
instead
achieving
homeostasis
by
treating
cause
metabolic
acidosis.
Moreover,
it
is
believed
that
may
reverse
acidosis-induced
myocardial
depression,
hemodynamic
instability,
ventricular
arrhythmias,
impaired
cellular
energy
production,
catecholamines,
altered
metabolism,
enzyme
suppression,
immune
dysfunction,
ineffective
oxygen
delivery.
On
other
hand,
crucial
pay
attention
caused
excessive
administration.
paradoxical
respiratory
intracellular
hypokalemia,
hypocalcemia,
alkalosis,
delivery,
cerebrospinal
fluid
neurologic
dysfunction.
In
this
review,
we
discuss
pathophysiology
bicarbonate-induced
adverse
effects
benefits.
We
also
review
most
recent
trials,
observational
studies,
guidelines
discussing
use
pathologies.
Язык: Английский