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      Carbon dioxide narcosis in the terminal stage of hemodialysis therapy: A case report with the possible pathophysiologies and the treatment methods

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          Abstract

          The cause and treatment of carbon dioxide narcosis in the terminal stage of hemodialysis have not been fully discussed. As we have experienced the case of complete recovery, we report the possible pathophysiologies and the treatment methods.

          Abstract

          The cause and treatment of carbon dioxide narcosis in the terminal stage of hemodialysis have not been fully discussed. As we have experienced the case of complete recovery, we report the possible pathophysiologies and the treatment methods.

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          Most cited references24

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          ERS guidelines on the diagnosis and treatment of chronic cough in adults and children

          These guidelines incorporate the recent advances in chronic cough pathophysiology, diagnosis and treatment. The concept of cough hypersensitivity has allowed an umbrella term that explains the exquisite sensitivity of patients to external stimuli such a cold air, perfumes, smoke and bleach. Thus, adults with chronic cough now have a firm physical explanation for their symptoms based on vagal afferent hypersensitivity. Different treatable traits exist with cough variant asthma (CVA)/eosinophilic bronchitis responding to anti-inflammatory treatment and non-acid reflux being treated with promotility agents rather the anti-acid drugs. An alternative antitussive strategy is to reduce hypersensitivity by neuromodulation. Low-dose morphine is highly effective in a subset of patients with cough resistant to other treatments. Gabapentin and pregabalin are also advocated, but in clinical experience they are limited by adverse events. Perhaps the most promising future developments in pharmacotherapy are drugs which tackle neuronal hypersensitivity by blocking excitability of afferent nerves by inhibiting targets such as the ATP receptor (P2X3). Finally, cough suppression therapy when performed by competent practitioners can be highly effective. Children are not small adults and a pursuit of an underlying cause for cough is advocated. Thus, in toddlers, inhalation of a foreign body is common. Persistent bacterial bronchitis is a common and previously unrecognised cause of wet cough in children. Antibiotics (drug, dose and duration need to be determined) can be curative. A paediatric-specific algorithm should be used.
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            Respiratory failure

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              Structure and mechanism of carbonic anhydrase.

              S Lindskog (1997)
              Carbonic anhydrase (CA; carbonate hydro-lyase, EC 4.2.1.1) is a zinc-containing enzyme that catalyzes the reversible hydration of carbon dioxide: CO2+ H2O HCO3(-)+H+. The enzyme is the target for drugs, such as acetazolamide, methazolamide, and dichlorphenamide, for the treatment of glaucoma. There are three evolutionarily unrelated CA families, designated alpha, beta, and gamma. All known CAs from the animal kingdom are of the alpha type. There are seven mammalian CA isozymes with different tissue distributions and intracellular locations, CA I-VII. Crystal structures of human CA I and II, bovine CA III, and murine CA V have been determined. All of them have the same tertiary fold, with a central 10-stranded beta-sheet as the dominating secondary structure element. The zinc ion is located in a cone-shaped cavity and coordinated to three histidyl residues and a solvent molecule. Inhibitors bind at or near the metal center guided by a hydrogen-bonded system comprising Glu-106 and Thr-199. The catalytic mechanism of CA II has been studied in particular detail. It involves an attack of zinc-bound OH- on a CO2 molecule loosely bound in a hydrophobic pocket. The resulting zinc-coordinated HCO3- ion is displaced from the metal ion by H2O. The rate-limiting step is an intramolecular proton transfer from the zinc-bound water molecule to His-64, which serves as a proton shuttle between the metal center and buffer molecules in the reaction medium.
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                Author and article information

                Contributors
                kinnereth@gaia.eonet.ne.jp
                Journal
                Clin Case Rep
                Clin Case Rep
                10.1002/(ISSN)2050-0904
                CCR3
                Clinical Case Reports
                John Wiley and Sons Inc. (Hoboken )
                2050-0904
                13 March 2021
                April 2021
                : 9
                : 4 ( doiID: 10.1002/ccr3.v9.4 )
                : 2419-2423
                Affiliations
                [ 1 ] Tesseikai Neurosurgical Hospital Dialysis Center Shijonawate Japan
                Author notes
                [*] [* ] Correspondence

                Akira Takahashi, Tesseikai Neurosurgical Hospital, Dialysis Center, 28‐1 Nakanohonmachi, Shijonawate, Japan.

                Email: kinnereth@ 123456gaia.eonet.ne.jp

                Author information
                https://orcid.org/0000-0001-6392-8349
                Article
                CCR34053
                10.1002/ccr3.4053
                8077385
                f8a140ee-2231-407b-b0e5-df59925ba425
                © 2021 The Authors. Clinical Case Reports published by John Wiley & Sons Ltd.

                This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

                History
                : 01 March 2021
                : 28 November 2020
                : 02 March 2021
                Page count
                Figures: 2, Tables: 1, Pages: 5, Words: 3119
                Categories
                Case Report
                Case Reports
                Custom metadata
                2.0
                April 2021
                Converter:WILEY_ML3GV2_TO_JATSPMC version:6.0.2 mode:remove_FC converted:27.04.2021

                carbon dioxide (co2) narcosis,carbonic anhydrase,carnitine,coenzyme q10 (coq10),hypozincemia

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