Effect of routine doses of antacid on renal acidification

Antacids revisited: a review of their clinical pharmacology and recommended therapeutic use

Antacids are commonly used self-prescribed medications. They consist of calcium carbonate and magnesium and aluminum salts in various compounds or combinations. The effect of antacids on the stomach is due to partial neutralisation of gastric hydrochloric acid and inhibition of the proteolytic enzyme, pepsin. Each cation salt has its own pharmacological characteristics that are important for determination of which product can be used for certain indications. Antacids have been used for duodenal and gastric ulcers, stress gastritis, gastro-oesophageal reflux disease, pancreatic insufficiency, non-ulcer dyspepsia, bile acid mediated diarrhoea, biliary reflux, constipation, osteoporosis, urinary alkalinisation and chronic renal failure as a dietary phosphate binder. The development of histamine H2-receptor antagonists and proton pump inhibitors has significantly reduced usage for duodenal and gastric ulcers and gastro-oesophageal reflux disease. However, antacids can still be useful for stress gastritis and non-ulcer dyspepsia. The recent release of proprietary H2 antagonists has likely further reduced antacid use for non-ulcer dyspepsia. Other indications are still valid but represent minor uses. Antacid drug interactions are well noted, but can be avoided by rescheduling medication administration times. This can be inconvenient and discourage compliance with other medications. All antacids can produce drug interactions by changing gastric pH, thus altering drug dissolution of dosage forms, reduction of gastric acid hydrolysis of drugs, or alter drug elimination by changing urinary pH. Most antacids, except sodium bicarbonate, may decrease drug absorption by adsorption or chelation of other drugs. Most adverse effects from antacids are minor with periodic use of small amounts. However, when large doses are taken for long periods of time, significant adverse effects may occur especially patients with underlying diseases such as chronic renal failure. These adverse effects can be reduced by monitoring of electrolyte status and avoiding aluminum-containing antacids to bind dietary phosphate in chronic renal failure. Antacids, although effective for discussed indications of duodenal and gastric ulcer and gastro-oesophageal reflux disease, have been replaced by newer, more effective agents that are more palatable to patients. Antacids are likely to continue to be used for non-ulcer dyspepsia, minor episodes of heartburn (gastro-oesophageal reflux disease) and other clear indications. Although their wide-spread use may decline, these drugs will still be used, and clinicians should be aware of their potential drug interactions and adverse effects.

Variation of urinary pH and bicarbonate concentrations of students in metropolitan and rural areas of Japan

Changes in urinary pH and bicarbonate levels were studied in urine collected before and after final examinations taken by 91 medical students (65 males, 26 females) in Tokyo and from 87 students (73 males, 14 females) in Kanazawa, a rural municipality. Bicarbonate levels and pH in the urine of students in both cities increased significantly after attending 2 h of final examinations. The highest pH value and highest bicarbonate level were 7.66 and 80.3 mM, respectively, found in the urine of a student in Kanazawa. Urinary pH and bicarbonate levels averaged 6.48 and 11.1 mM, respectively, for students in Tokyo and 6.26 and 8.91 mM, respectively, for students in Kanazawa. Given that the concentrations of carbon dioxide in the air of the classrooms in both cities increased drastically during the final examinations (i.e., from 700 ppm to 1 200 ppm in Tokyo and from 700 ppm to 1 500 ppm in Kanazawa), it appears that the increases in urinary pH and bicarbonate levels were correlated with the increase of carbon dioxide (known to be convertible to bicarbonate in blood) in the rooms. This was also supported by the increase in urinary pH and bicarbonate levels found in urine collected from 20 students who stayed in a cinema for 3 h, at which location carbon dioxide levels in air reached 1 200 ppm.

Acid-base disturbances in gastrointestinal disease

Gastrointestinal disorders are associated with severe and often complex acid-base disturbances. We review the most important types of metabolic alkalosis and metabolic acidosis associated with gastrointestinal disorders, excluding liver disease. Special emphasis is placed on pathophysiologic mechanisms. This information may help the clinician understand the generation and maintenance of these disorders and to plan an effective therapeutic approach.