Potassium and intracellular pH

Impaired distal renal potassium handling in streptozotocin-induced diabetic mice

Diabetes is closely associated with K+ disturbances during disease progression and treatment. However, it remains unclear whether K+ imbalance occurs in diabetes with normal kidney function. In this study, we examined the effects of dietary K+ intake on systemic K+ balance and renal K+ handling in streptozotocin (STZ)-induced diabetic mice. The control and STZ mice were fed low or high K+ diet for 7 days to investigate the role of dietary K+ intake in renal K+ excretion and K+ homeostasis and to explore the underlying mechanism by evaluating K+ secretion-related transport proteins in distal nephrons. K+-deficient diet caused excessive urinary K+ loss, decreased daily K+ balance, and led to severe hypokalemia in STZ mice compared with control mice. In contrast, STZ mice showed an increased daily K+ balance and elevated plasma K+ level under K+-loading conditions. Dysregulation of the NaCl cotransporter (NCC), epithelial Na+ channel (ENaC), and renal outer medullary K+ channel (ROMK) was observed in diabetic mice fed either low or high K+ diet. Moreover, amiloride treatment reduced urinary K+ excretion and corrected hypokalemia in K+-restricted STZ mice. On the other hand, inhibition of SGLT2 by dapagliflozin promoted urinary K+ excretion and normalized plasma K+ levels in K+-supplemented STZ mice, at least partly by increasing ENaC activity. We conclude that STZ mice exhibited abnormal K+ balance and impaired renal K+ handling under either low or high K+ diet, which could be primarily attributed to the dysfunction of ENaC-dependent renal K+ excretion pathway, despite the possible role of NCC.NEW & NOTEWORTHY Neither low dietary K+ intake nor high dietary K+ intake effectively modulates renal K+ excretion and K+ homeostasis in STZ mice, which is closely related to the abnormality of ENaC expression and activity. SGLT2 inhibitor increases urinary K+ excretion and reduces plasma K+ level in STZ mice under high dietary K+ intake, an effect that may be partly due to the upregulation of ENaC activity.

Effects of thiazides and new findings on kidney stones and dysglycemic side effects

Thiazide and thiazide-like diuretics (thiazides) belong to the most frequently prescribed drugs worldwide. By virtue of their natriuretic and vasodilating properties, thiazides effectively lower blood pressure and prevent adverse cardiovascular outcomes. In addition, through their unique characteristic of reducing urine calcium, thiazides are also widely employed for the prevention of kidney stone recurrence and reduction of bone fracture risk. Since their introduction into clinical medicine in the early 1960s, thiazides have been recognized for their association with metabolic side effects, particularly impaired glucose tolerance, and new-onset diabetes mellitus. Numerous hypotheses have been advanced to explain thiazide-induced glucose intolerance, yet underlying mechanisms remain poorly defined. Regrettably, the lack of understanding and unpredictability of these side effects has prompted numerous physicians to refrain from prescribing these effective, inexpensive, and widely accessible drugs. In this review, we outline the pharmacology and mechanism of action of thiazides, highlight recent advances in the understanding of thiazide-induced glucose intolerance, and provide an up-to-date discussion on the role of thiazides in kidney stone prevention.

Kir4.2 mediates proximal potassium effects on glutaminase activity and kidney injury

Inadequate potassium (K+) consumption correlates with increased mortality and poor cardiovascular outcomes. Potassium effects on blood pressure have been described previously; however, whether or not low K+ independently affects kidney disease progression remains unclear. Here, we demonstrate that dietary K+ deficiency causes direct kidney injury. Effects depend on reduced blood K+ and are kidney specific. In response to reduced K+, the channel Kir4.2 mediates altered proximal tubule (PT) basolateral K+ flux, causing intracellular acidosis and activation of the enzyme glutaminase and the ammoniagenesis pathway. Deletion of either Kir4.2 or glutaminase protects from low-K+ injury. Reduced K+ also mediates injury and fibrosis in a model of aldosteronism. These results demonstrate that the PT epithelium, like the distal nephron, is K+ sensitive, with reduced blood K+ causing direct PT injury. Kir4.2 and glutaminase are essential mediators of this injury process, and we identify their potential for future targeting in the treatment of chronic kidney disease.

Challenges in diuretic therapy: A case-based discussion

Diuretics are amongst the most prescribed medications in both the inpatient and outpatient settings. They are used extensively in diverse disease states including heart failure, acute and chronic kidney disease, cirrhosis, and diseases of excess capillary permeability such as sepsis, malignancy, and malnutrition. All are characterized by total body sodium overabundance which commonly manifests as edema. The use of diuretics is however not bereft of complications. These complications frequently limit the correction of hypervolemia, resulting in continued patient suffering and frustration for the clinician. In this review, we employ a case-based approach to discuss three common challenges encountered during diuretic therapy: diuretic resistance that characterizes the nephrotic syndrome, diuretic-induced metabolic alkalosis, and diuretic-associated hyponatremia. We empower the clinician to effectively meet these challenges by providing a mechanistic understanding of these complications and their solutions.

Preclinical and Clinical Evidence of Effect of Acid on Bone Health

Acid can have ill effect on bone health in the absence of frank clinical acidosis but affecting the bone mioneral matrix and bone cells via complex pathways botyh ascute;y and chronically. While the reaction of bone to an acid load is conserved in evolution and is adaptive, the capacity can be overwhelmed resulting in dire consequences. The preclinical an clincl evidence of the acdi effect on bone is very convincing and the clinical evidence in both association and interventiopn studies are also quite credible, The adverse effects of acid on bone is underappreoicated, under-investigated, and the potential benefits of alkali therapy is not generrally known.

Cardiopulmonary function and intestinal blood flow in anaesthetised, experimentally endotoxaemic horses given a constant rate infusion of dexmedetomidine

BACKGROUND

Endotoxaemia causes untoward inflammatory-mediated effects that might be attenuated by dexmedetomidine.

OBJECTIVES

To evaluate the effects of a dexmedetomidine intravenous (IV) infusion on systemic and intestinal haemodynamics and arterial blood gas values in sevoflurane-anaesthetised horses administered Escherichia coli O55:B5 lipopolysaccharides (LPS).

STUDY DESIGN

Randomised controlled in vivo experiment.

METHODS

A total of 13 horses weighing 456 ± 86 kg (mean ± standard deviation) and aged 13.9 ± 9.0 years donated for euthanasia underwent ventral midline celiotomy using sevoflurane anaesthesia. Baseline physiological variables were recorded after a 90-minute equilibration period. All horses were given 0.1 mcg/kg bwt LPS IV. Horses were randomly assigned to no further treatment (group LPS; seven horses) or IV administration of dexmedetomidine (loading dose 1.75 mcg/kg bwt followed by 1.75 mcg/kg bwt/h; group LPS-Dex; six horses) with concurrent target sevoflurane dose reduction of 50%. Cardiac index (CI; thermodilution), intestinal blood flow, arterial blood parameters and plasma dexmedetomidine concentration measurements were recorded every 30 minutes until euthanasia at 390 minutes. Data were compared between and within groups to baseline using a mixed model analysis (significance P < .05).

RESULTS

In LPS-Dex horses, intestinal blood flow and CI were transiently decreased after the dexmedetomidine loading dose, but no significant differences were found compared with baseline during the infusion. Sevoflurane dose was reliably reduced by approximately 40%. Significant differences were identified in creatinine (115  umol/L LPS-Dex; 195 umol/L LPS), bicarbonate (29.7 mmol/L LPS-Dex; 23 mmol/L LPS) and base excess (2.0 mmol/L LPS-Dex; -5.3 mmol/L LPS). Dexmedetomidine plasma concentrations were highest after the loading dose and stable during infusion dosing.

MAIN LIMITATIONS

Experimental conditions are not reflective of clinical colic management.

CONCLUSIONS

A dexmedetomidine infusion with sevoflurane dose reduction attenuated some deleterious changes in anaesthetised horses administered LPS without sustained negative cardiovascular effects and may be beneficial during colic surgery.

CG4928 Is Vital for Renal Function in Fruit Flies and Membrane Potential in Cells: A First In-Depth Characterization of the Putative Solute Carrier UNC93A

The number of transporter proteins that are not fully characterized is immense. Here, we used Drosophila melanogaster and human cell lines to perform a first in-depth characterization of CG4928, an ortholog to the human UNC93A, of which little is known. Solute carriers regulate and maintain biochemical pathways important for the body, and malfunctioning transport is associated with multiple diseases. Based on phylogenetic analysis, CG4928 is closely related to human UNC93A and has a secondary and a tertiary protein structure and folding similar to major facilitator superfamily transporters. Ubiquitous knockdown of CG4928 causes flies to have a reduced secretion rate from the Malpighian tubules; altering potassium content in the body and in the Malpighian tubules, homologous to the renal system; and results in the development of edema. The edema could be rescued by using amiloride, a common diuretic, and by maintaining the flies on ion-free diets. CG4928-overexpressing cells did not facilitate the transport of sugars and amino acids; however, proximity ligation assay revealed that CG4928 co-localized with TASK¹ channels. Overexpression of CG4928 resulted in induced apoptosis and cytotoxicity, which could be restored when cells were kept in high-sodium media. Furthermore, the basal membrane potential was observed to be disrupted. Taken together, the results indicate that CG4928 is of importance for generating the cellular membrane potential by an unknown manner. However, we speculate that it most likely acts as a regulator or transporter of potassium flows over the membrane.

Electrochemical patterns during Drosophila oogenesis: ion-transport mechanisms generate stage-specific gradients of pH and membrane potential in the follicle-cell epithelium

Background

Alterations of bioelectrical properties of cells and tissues are known to function as wide-ranging signals during development, regeneration and wound-healing in several species. The Drosophila follicle-cell epithelium provides an appropriate model system for studying the potential role of electrochemical signals, like intracellular pH (pH_i) and membrane potential (V_mem), during development. Therefore, we analysed stage-specific gradients of pH_i and V_mem as well as their dependence on specific ion-transport mechanisms.

Results

Using fluorescent indicators, we found distinct alterations of pH_i- and V_mem-patterns during stages 8 to 12 of oogenesis. To determine the roles of relevant ion-transport mechanisms in regulating pH_i and V_mem and in establishing stage-specific antero-posterior and dorso-ventral gradients, we used inhibitors of Na⁺/H⁺-exchangers and Na⁺-channels (amiloride), V-ATPases (bafilomycin), ATP-sensitive K⁺-channels (glibenclamide), voltage-dependent L-type Ca²⁺-channels (verapamil), Cl⁻-channels (9-anthroic acid) and Na⁺/K⁺/2Cl⁻-cotransporters (furosemide). Either pH_i or V_mem or both parameters were affected by each tested inhibitor. While the inhibition of Na⁺/H⁺-exchangers (NHE) and amiloride-sensitive Na⁺-channels or of V-ATPases resulted in relative acidification, inhibiting the other ion-transport mechanisms led to relative alkalisation. The most prominent effects on pH_i were obtained by inhibiting Na⁺/K⁺/2Cl⁻-cotransporters or ATP-sensitive K⁺-channels. V_mem was most efficiently hyperpolarised by inhibiting voltage-dependent L-type Ca²⁺-channels or ATP-sensitive K⁺-channels, whereas the impact of the other ion-transport mechanisms was smaller. In case of very prominent effects of inhibitors on pH_i and/or V_mem, we also found strong influences on the antero-posterior and dorso-ventral pH_i- and/or V_mem-gradients. For example, inhibiting ATP-sensitive K⁺-channels strongly enhanced both pH_i-gradients (increasing alkalisation) and reduced both V_mem-gradients (increasing hyperpolarisation). Similarly, inhibiting Na⁺/K⁺/2Cl⁻-cotransporters strongly enhanced both pH_i-gradients and reduced the antero-posterior V_mem-gradient. To minor extents, both pH_i-gradients were enhanced and both V_mem-gradients were reduced by inhibiting voltage-dependent L-type Ca²⁺-channels, whereas only both pH_i-gradients were reduced (increasing acidification) by inhibiting V-ATPases or NHE and Na⁺-channels.

Conclusions

Our data show that in the Drosophila follicle-cell epithelium stage-specific pH_i- and V_mem-gradients develop which result from the activity of several ion-transport mechanisms. These gradients are supposed to represent important bioelectrical cues during oogenesis, e.g., by serving as electrochemical prepatterns in modifying cell polarity and cytoskeletal organisation.

Electronic supplementary material

The online version of this article (10.1186/s12861-019-0192-x) contains supplementary material, which is available to authorized users.

Renal potassium physiology: integration of the renal response to dietary potassium depletion

We summarize the current understanding of the physiology of the renal handling of potassium (K⁺), and present an integrative view of the renal response to K⁺ depletion caused by dietary K⁺ restriction. This renal response involves contributions from different nephron segments, and aims to diminish the rate of excretion of K⁺ as a result of: decreasing the rate of electrogenic (and increasing the rate of electroneutral) reabsorption of sodium in the aldosterone-sensitive distal nephron (ASDN), decreasing the abundance of renal outer medullary K⁺ channels in the luminal membrane of principal cells in the ASDN, decreasing the flow rate in the ASDN, and increasing the reabsorption of K⁺ in the cortical and medullary collecting ducts. The implications of this physiology for the association between K⁺ depletion and hypertension, and K⁺ depletion and formation of calcium kidney stones are discussed.

Postulating the major environmental condition resulting in the expression of essential hypertension and its associated cardiovascular diseases: Dietary imprudence in daily selection of foods in respect of their potassium and sodium content resulting in oxidative stress-induced dysfunction of the vascular endothelium, vascular smooth muscle, and perivascular tissues

We hypothesize that the major environmental determinant of the expression of essential hypertension in America and other Westernized countries is dietary imprudence in respect of the consumption of daily combinations of foods containing suboptimal amounts of potassium and blood pressure-lowering phytochemicals, and supraphysiological amounts of sodium. We offer as premise that Americans on average consume suboptimal amounts of potassium and blood pressure-lowering phytochemicals, and physiologically excessive amounts of sodium, and that such dietary imprudence leads to essential hypertension through oxidative stress-induced vascular endothelial and smooth muscle dysfunction. Such dysfunctions restrict nitric oxide bioavailability, impairing endothelial cell-mediated relaxation of the underlying vascular smooth muscle, initiating and maintaining inappropriately increased peripheral and renal vascular resistance. The biochemical steps from oxidative stress to vascular endothelial dysfunction and its pernicious cardiovascular consequences are well established and generally accepted. The unique aspect of our hypothesis resides in the contention that Americans' habitual consumption of foods resulting in suboptimal dietary intake of potassium and supraphysiological intake of sodium result in oxidative stress, the degree of which, we suggest, will correlate with the degree of deviation of potassium and sodium intake from optimal. Because suboptimal intakes of potassium reflect suboptimal intakes of fruits and vegetables, associated contributors to oxidative stress include suboptimal intakes of magnesium, nitrate, polyphenols, carotenoids, and other phytochemical antioxidants for which fruits and vegetables contain abundant amounts. Currently Americans consume potassium-to-sodium in molar ratios of less than or close to 1.0 and the Institute of Medicine (IOM) recommends a molar ratio of 1.2. Ancestral diets to which we are physiologically adapted range from molar ratios of 5.0 to 10.0 or higher. Accordingly, we suggest that the average American is usually afflicted with oxidative stress-induced vascular endothelial dysfunction, and therefore the standards for normal blood pressure and pre-hypertension often reflect a degree of clinically significant hypertension. In this article, we provide support for those contentions, and indicate the findings that the hypothesis predicts.

Detection of K+ Efflux from Stimulated Cortical Neurons by an Aptamer-Modified Silicon Nanowire Field-Effect Transistor

The concentration gradient of K⁺ across the cell membrane of a neuron determines its resting potential and cell excitability. During neurotransmission, the efflux of K⁺ from the cell via various channels will not only decrease the intracellular K⁺ content but also elevate the extracellular K⁺ concentration. However, it is not clear to what extent this change could be. In this study, we developed a multiple-parallel-connected silicon nanowire field-effect transistor (SiNW-FET) modified with K⁺-specific DNA-aptamers (aptamer/SiNW-FET) for the real-time detection of the K⁺ efflux from cultured cortical neurons. The aptamer/SiNW-FET showed an association constant of (2.18 ± 0.44) × 10⁶ M^-1 against K⁺ and an either less or negligible response to other alkali metal ions. The α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA) stimulation induced an outward current and hyperpolarized the membrane potential in a whole-cell patched neuron under a Na⁺/K⁺-free buffer. When neurons were placed atop the aptamer/SiNW-FET in a Na⁺/K⁺-free buffer, AMPA (13 μM) stimulation elevated the extracellular K⁺ concentration to ∼800 nM, which is greatly reduced by 6,7-dinitroquinoxaline-2,3-dione, an AMPA receptor antagonist. The EC₅₀ of AMPA in elevating the extracellular K⁺ concentration was 10.3 μM. By stimulating the neurons with AMPA under a normal physiological buffer, the K⁺ concentration in the isolated cytosolic fraction was decreased by 75%. These experiments demonstrate that the aptamer/SiNW-FET is sensitive for detecting cations and the K⁺ concentrations inside and outside the neurons could be greatly changed to modulate the neuron excitability.

Combined Effects of High-Dose Bisphenol A and Oxidizing Agent (KBrO3) on Cellular Microenvironment, Gene Expression, and Chromatin Structure of Ku70-deficient Mouse Embryonic Fibroblasts

BACKGROUND

Exposure to bisphenol A (BPA) has been reported to alter global gene expression, induce epigenetic modifications, and interfere with complex regulatory networks of cells. In addition to these reprogramming events, we have demonstrated that BPA exposure generates reactive oxygen species and promotes cellular survival when co-exposed with the oxidizing agent potassium bromate (KBrO3).

OBJECTIVES

We determined the cellular microenvironment changes induced by co-exposure of BPA and KBrO3 versus either agent alone.

METHODS

Ku70-deficient cells were exposed to 150 μM BPA, 20 mM KBrO3, or co-exposed to both agents. Four and 24 hr post-damage initiation by KBrO3, with BPA-only samples timed to coincide with these designated time points, we performed whole-genome microarray analysis and evaluated chromatin structure, DNA lesion load, glutathione content, and intracellular pH.

RESULTS

We found that 4 hr post-damage initiation, BPA exposure and co-exposure transiently condensed chromatin compared with untreated and KBrO3-only treated cells; the transcription of DNA repair proteins was also reduced. At this time point, BPA exposure and co-exposure also reduced the change in intracellular pH observed after treatment with KBrO3 alone. Twenty-four hours post-damage initiation, BPA-exposed cells showed less condensed chromatin than cells treated with KBrO3 alone; the intracellular pH of the co-exposed cells was significantly reduced compared with untreated and KBrO3-treated cells; and significant up-regulation of DNA repair proteins was observed after co-exposure.

CONCLUSION

These results support the induction of an adaptive response by BPA co-exposure that alters the microcellular environment and modulates DNA repair. Further work is required to determine whether BPA induces similar DNA lesions in vivo at environmentally relevant doses; however, in the Ku70-deficient mouse embryonic fibroblasts, exposure to a high dose of BPA was associated with changes in the cellular microenvironment that may promote survival.

CITATION

Gassman NR, Coskun E, Jaruga P, Dizdaroglu M, Wilson SH. 2016. Combined effects of high-dose bisphenol A and oxidizing agent (KBrO3) on cellular microenvironment, gene expression, and chromatin structure of Ku70-deficient mouse embryonic fibroblasts. Environ Health Perspect 124:1241-1252; http://dx.doi.org/10.1289/EHP237.

Urinary citrate excretion in patients with renal stone: roles of leucocyte ATP citrate lyase activity and potassium salts therapy

BACKGROUND

Hypocitraturia is a major metabolic abnormality in rural Northeast Thais with renal stones. These people also have low serum and urinary potassium and consume a high carbohydrate and low fat diet, which together might influence the intracellular metabolism and urinary excretion of citrate.

METHODS

In Study A, we measured plasma and urinary chemistries and assayed leucocyte ATP citrate lyase (ACL) activity in 30 normal urban control subjects (Group A1) and 30 rural renal stone patients (Group A2) in Northeast Thailand. Some of the subjects from both groups were also used to evaluate the intake of carbohydrate, protein and fat. In Study B, we examined the effects of potassium salts therapy with another group of 30 rural renal stone patients: Group B1 (n = 15) treated with potassium chloride and Group B2 (n = 15) with potassium-sodium citrate (with an aim to achieve 42 mEq potassium, 21 mEq sodium and 62 mEq citrate per day for 1 month).

RESULTS

In Study A, the leucocyte ACL activity of Group A1 was much lower than that of Group A2 (3.2 +/- 0.7 vs. 9.3 +/- 3.8 micromol acetylhydroxamate/mg protein/30 min, p < 0.0001). The plasma potassium, urinary excretions of potassium and citrate in Group A1 were higher than in Group A2. When data of the two groups were combined, urinary citrate excretion was inversely correlated with leucocyte ACL activity (r = 0.6783, p < 0.001). While the dietary protein intake did not differ between Groups A1 and A2, the carbohydrate intake by Group A1 was significantly lower (65.2 +/- 7.9% vs. 83.1 +/- 2.9%, p < 0.01) and fat higher (21.0 +/- 6.4% vs. 6.2 +/- 4.1%, p < 0.002) than Group A2. After treatment with potassium chloride (Group B1), only the potassium was increased (p < 0.001), while those treated with potassium-sodium citrate (Group B2) experienced a significant increase in urinary pH (p < 0.002), potassium (p < 0.001) and citrate (p < 0.001), and a decrease in leucocyte ACL activity (p < 0.001).

CONCLUSIONS

Compared to normal subjects, renal stone patients have low urinary citrate excretion with high leucocyte ACL activity. In Northeast Thailand, low potassium status and a high carbohydrate and low fat diet may cause the increased ACL activity. However, hypokaliuria, hypocitraturia and high leucocyte ACL activity can be corrected by potassium-sodium citrate salt therapy.

Role of skeletal muscle in plasma ion and acid-base regulation after NaHCO3 and KHCO3 loading in humans

This paper examines the time course of changes in plasma electrolyte and acid-base composition in response to NaHCO3 and KHCO3 ingestion. It was hypothesized that skeletal muscle is involved in the correction of the ensuing plasma disturbance by exchanging ions, gasses, and fluids between cells and extracellular fluids. Five male subjects, with catheters in a brachial artery and antecubital vein, ingested 3.57 mmol/kg body mass NaHCO3 or KHCO3. While seated, blood samples were taken 30 min before ingestion of the solution, at 10-min intervals during the 60-min ingestion period, and periodically for 210 min after ingestion was complete. Blood was analyzed for gases, hematocrit, plasma ions, and total protein. With NaHCO3, arterial plasma Na+ concentration ([Na+]) increased from 143 +/- 1 to 147 +/- 1 (SE) meq/l, H+ concentration ([H+]) decreased by 6 +/- 1 neq/l, and PCO2 increased by 5 +/- 1 mmHg. There was no detectable net Na+ uptake by tissues. An increased plasma strong ion difference ([SID]) accounted fully for the decrease in plasma [H+]. With KHCO3, K+ concentration increased from 4.25 +/- 0.10 to 7.17 +/- 0.13 meq/l, plasma volume decreased by 15.5 +/- 2.3%, [H+] decreased by 4 +/- 1 neq/l, and there was no change in PCO2. The decrease in [H+] in the KHCO3 trial primarily arose in response to the increased [SID]. Net K+ uptake by tissues accounted for 37 +/- 5% of the ingested K+. In conclusion, ingestion of NaHCO3 and KHCO3 produced markedly different fluid and ionic disturbances and associated regulatory responses by skeletal muscle. Accordingly, the physicochemical origins of the acid-base disturbances also differed between treatments. The tissues did not play a role in regulating plasma [Na+] after ingestion of NaHCO3. In contrast, the net influx of K+ to tissues played an important role in removing K+ from the extracellular compartment after ingestion of KHCO3.

Plasma potassium response after tromethamine (THAM) or sodium bicarbonate in the acidotic rabbit

The purpose of this study was to evaluate the plasma potassium (K+) response after administration of tromethamine (THAM) or sodium bicarbonate (NaHCO3) in an acidotic rabbit model. Eighteen healthy, adult female New Zealand White rabbits were subjected to severe hypoxia until a base deficit of -10 mEq/L resulted. Rabbits were then randomized to receive THAM solution, NaHCO3, or no drug (control). The drug was administered over 2 min in quantities calculated to correct a base deficit of 10 or greater. Plasma K+ and sodium (Na+) were measured for 45 min after drug administration. No difference in K+ response was noted after THAM, NaHCO3, or no drug. In contrast, THAM resulted in significantly lower Na+ concentrations when compared to the NaHCO3 or the control group (P < 0.05). In this rabbit model, alkalinization after THAM administration results in K+ changes similar to those after NaHCO3. THAM should be considered when treating acidosis in patients where hypernatremia is a concern.

Effect of a new model of hemodialysis potassium removal on the control of ventricular arrhythmias

The primary aim of this multicenter, prospective, randomized cross-over study was to clarify whether a new model of hemodialysis (HD) potassium (K) removal using a decreasing intra-HD dialysate K concentration and a constant plasma-dialysate K gradient (treatment B) is capable of reducing the arrhythmogenic effect of standard HD, which has a constant dialysate K concentration and decreasing plasma-dialysate K gradient (treatment A). The secondary aim was to verify whether this new model is clinically safe. In treatment B, the initial dialysate K concentration had to be 1.5 mEq/liter less than the plasma K concentration, and exponentially decrease to 2.5 mEq/liter at the end of HD. Forty-two chronic HD patients with an increase in premature ventricular complexes (PVC) during dialysis were enrolled from 18 participating centers, and randomly assigned to either sequence 1 (ABA) or sequence 2 (BAB). A pool of 333 of 378 expected ECG Holter recordings were checked for signal quality; 269 (71%) from 36 patients (86%) had a satisfactory signal quality and 108 were selected for analysis (1 per patient per period). There was a difference in the natural logarithm of the increase in PVC/hr and PVC couplets/hr during HD between treatments A and B (1.70 +/- 1.59 vs. 1.09 +/- 1.76 and 0.94 +/- 0.86 vs. 0.64 +/- 1.01, a reduction of 36% and 32%, P = 0.011 and 0.047, respectively) without any carry over effect (P = 0.61 and 0.24, respectively). The fact that this decrease of one third is due to a lower plasma-dialysate K gradient is supported by the observation that it was more evident during the first than the last two hours of HD (a reduction in the natural logarithm of the increase in PVC/hr and PVC couplets/hr of 60% and 60%, P 0.002 and 0.009, vs. 26% and 17%, P = 0.098 and 0.332, respectively): the initial plasma-dialysate K gradient was 2.3 times lower during treatment B than during treatment A, without adversely affecting pre-HD plasma K levels. These results could have a considerably clinical impact not only because of the possibility of physiologically decreasing the arrhythmogenic effect of HD, but also because this effect can be considered a "marker" of the electrophysiological derangement induced by the administration of standard HD three times a week for years ("electric disequilibrium syndrome").

Application of multivariate autoregressive modelling for analysing chloride/potassium/bicarbonate relationship in the body

The authors repeatedly analysed course data of acid-base disturbances accompanying hypochloraemia and/or hypokalaemia by means of multivariate autoregressive modelling. It was found that the regulatory relationship between chloride and bicarbonate is inverse between the following two hypochloraemic hyperbicarbonataemic states: the one induced by chloride depletion and the other induced by CO2 retention. Also, the study revealed an independent role of potassium deficiency in the development of metabolic alkalosis, especially in cases with mineralocorticoid-induced alkalosis. The present approach enabled the authors to solve a long-standing problem, i.e. to differentiate between the roles of chloride and potassium in the development of metabolic alkalosis.

Potassium and anaesthesia

Potassium is the principle intracellular ion, and its concentration and gradients greatly influence the electrical activity of excitable membranes. Because anaesthesia is so intimately involved with electrically active cells, potassium concentrations in surgical patients have received considerable attention in diagnostic and therapeutic applications. With the ongoing evolution in the indications for potassium, it is important to review the role of potassium in cellular activity, in storage and regulation, in diseases that alter potassium homeostasis, and in the therapeutic implications of perioperative alterations of potassium concentration. A rational approach to abnormal potassium values and the use of potassium in the operating room is sought, based on a physiological understanding of risks and benefits.

Renal ammoniagenesis in humans with chronic potassium depletion

Renal ammonia production and distribution and ammonia precursor utilization were evaluated in eight patients with chronic potassium depletion (CPD) and aldosterone-producing adenoma and in 20 controls. In CPD, urinary ammonia excretion and ammonia added to renal venous blood were about twofold higher than in controls; thus, total ammonia production was significantly augmented (88.0 +/- 10.3 mumol/min.1.73 m2 vs. 45.0 +/- 2.6 in controls). Total ammonia production was inversely correlated with serum potassium and directly correlated with urine flow. Stepwise multiple regression analysis showed that both factors, mainly serum potassium, significantly influence ammonia production and account for 61.4% of variations in ammonia production. Renal extraction of glutamine was significantly increased (56.6 +/- 5.9 mumol/min.1.73 m2 vs. 34.6 +/- 3.1 in controls), and this could account for ammonia production. The ratio of urinary ammonia excretion to total ammonia production, an index of the intrarenal ammonia distribution, was similar in patients and controls, and was significantly correlated with urine pH and true renal blood flow (RBF). Stepwise multiple regression analysis showed that RBF, urine pH and urine flow also significantly affected ammonia distribution. However, these factors accounted for only 41.7% of variations in intrarenal ammonia partition, urine pH having a minor role. We conclude that in patients with CPD other factors besides urine pH, urine flow and RBF intervene in the ammonia partition between urine and blood.

A patient with hyperkalemia and metabolic acidosis

Uptake of potassium by extrarenal tissues, primarily muscle and liver, represents a major defense mechanism in the maintenance of normokalemia following an acute elevation in the serum potassium concentration. Insulin, epinephrine, and aldosterone all play major roles in maintaining the normal distribution of potassium between the intracellular and extracellular environment. In addition to hormonal regulation, changes in blood pH and tonicity also exert a strong influence on extrarenal potassium metabolism. Last, the serum potassium concentration per se directly influences its own cellular uptake and this transport mechanism appears to be inhibited by uremia.

Feline kaliopenic polymyopathy/nephropathy syndrome

The prevalence of hypokalemia in cats has probably been underestimated until recently. Like many other "contemporary" diseases, this syndrome is probably not new; however, it is now more easily recognized because of the identification of associated dietary and disease risk factors, clinical signs, and laboratory abnormalities, which have been linked to the expected pathophysiology of potassium depletion in the cat.

Ca2+ and pH affect the neurite formation in cultured mollusc isolated neurones

Neurite formation in neurones isolated from adult molluscs in culture has been shown to depend on the total content of Ca in the cells, intracellular Ca2+ concentration, intracellular acid-alkaline balance, extracellular pH, and the capacity and composition of buffers. The neurones with a low total Ca content prior to cultivating (1.2 mmol/kg) and low buffer capacity of cytoplasm (pH artificially shifted to the acidic level) possess the most pronounced capability of neurite regeneration. Optimal media for neurite regeneration appear to contain sodium bicarbonate as a buffer either alone or with small additions of organic buffers (1.5-3 mM) at pHs increasing from 7.6 to 8.2 under equilibrium with air. In the absence of sodium bicarbonate, when only organic buffers are used (Tris-HCl; HEPES-Na2CO3), at constant pH values ranging from 7.5 to 8.2, no neurites are formed. Artificial enhancement of intracellular Ca2+ concentration at the beginning of culture completely inhibits neurite outgrowth, and when applied on the third to fifth days of culture, it causes retraction of the neurites already formed. Neurones loaded with calcium (10 mmol/kg) form no neurites regardless of medium composition and concentrations of buffers used at pHs ranging from 7.5 to 8.2. The results obtained allow to suggest that neurite regeneration is controlled by Ca2+- and pH-regulating intracellular systems.

Secondary hypocapnia fails to protect "whole body" intracellular pH during chronic HCl-acidosis in the dog

Studies have demonstrated that the protective effect of secondary hypocapnia on plasma acidity during chronic HCl-acidosis is undermined by a renal-mediated decrement in plasma bicarbonate concentration induced by the hypocapnia itself. The present study was designed to assess whether the protection of "whole body" intracellular pH (pHi) is similarly undermined by this maladaptive response of the kidney. Whole body pHi was estimated by the 5,5 dimethyl-2,4-oxazolidinedione (DMO) method in seven unanesthetized dogs under each of three conditions: control, chronic HCl-acidosis (10 mEq H+/kg/day) with spontaneous secondary hypocapnia, and chronic HCl-acidosis with a normal level of carbon dioxide tension (maintained by the use of an environmental chamber). pHi was 6.71 +/- 0.02 during control, and 6.57 +/- 0.03 and 6.57 +/- 0.02 during the two acidosis periods, respectively. These results indicate that sustained secondary hypocapnia fails to render the intracellular compartment less acidic because of a maladaptive reduction in intracellular bicarbonate concentration.

Effects of acid base disturbances on basolateral membrane potential and intracellular potassium activity in the proximal tubule of Necturus

The effects of extracellular acid-base disturbances on intracellular potential (Em) and potassium activity (aiK) in the early proximal tubule of Necturus were examined. Using conventional and double barreled potassium ion selective microelectrodes it was possible to measure both the transient and steady-state responses to various states of extracellular acidosis and alkalosis. The results show that (i) when extracellular [HCO-3] is varied at constant pCO2, Em and aiK decrease in acidosis and increase in alkalosis. The greatest sensitivity in Em is between pH 7.6 and 6.8 with apparent saturation above and below these extremes; (ii) decreased [HCO-3] at constant pH = 7.6 also causes a depolarization of Em and reduces aiK, suggesting a major effect of extracellular [HCO-3] on intracellular potential and aiK; (iii) rapid perfusions and transient delta Em analysis suggest a high basolateral conductance for K+ and HCO-3 and a low Cl- conductance; (iv) increasing extracellular [K+] decreases the response of both Em and aiK to reduced [HCO-3] at constant pCO2. The results of this study demonstrate the important role of extracellular pH and/or [HCO-3] on the maintenance of cellular K+ homeostasis.

Element concentrations of renal and hepatic cells under potassium depletion

The effect of dietary potassium depletion on nuclear and cytoplasmic element concentrations in cortical renal tubular cells and hepatocytes was investigated using electron microprobe analysis. Significant differences in sodium and potassium concentrations between nucleus and cytoplasm were not detected either under control or under potassium-depleted conditions. Potassium depletion for at least 14 days resulted in a decrease in plasma potassium concentration from 4.4 +/- 0.1 to 2.0 +/- 0.1 mmoles X liter-1. There was a fall in cellular potassium from 151.6 +/- 3.5 to 120.2 +/- 2.1 in distal tubular cells, from 150.1 +/- 2.6 to 117.7 +/- 1.2 in proximal tubular cells, and from 140.6 +/- 1.3 to 128.0 +/- 1.3 mmoles X kg-1 of wet wt in hepatocytes. The cellular chlorine concentrations fell from 19.9 +/- 0.7 to 15.8 +/- 0.3 and from 21.3 +/- 0.4 to 17.2 +/- 0.4 in proximal tubular and liver cells, respectively, but remained unchanged at 11.4 +/- 0.7 and 11.0 +/- 0.4 mmoles X kg-1 of wet wt in distal tubular cells. The intracellular sodium concentrations rose from 10.4 +/- 0.7 to 15.8 +/- 0.8, 19.1 +/- 0.8 to 24.1 +/- 0.7 and 14.1 +/- 0.5 to 16.2 +/- 0.6 mmoles X kg-1 of wet wt in distal tubular, proximal tubular and liver cells, respectively. This rise in cellular sodium was insufficient in any cell type to compensate for the loss of potassium. No significant differences were found in the cellular electrolyte concentrations of the various distal tubular cell types which are thought to be involved in either potassium reabsorption or secretion. The decrease in potassium concentrations in distal tubular cells by about 20% does not seem sufficient to explain the marked fall in urinary potassium excretion.

Mechanism of volume expansion on citrate, ammonia, and acid excretion in the rat

Potassium-depleted rats receiving sodium chloride or i.v. mannitol decrease their blood bicarbonate concentration isohydrically, reduce urinary citrate, and increase urinary ammonia excretion per milligram of urinary creatinine. To determine the mechanisms of these renal changes, we volume expanded normal rats with mannitol, normal saline, or saline bicarbonate solutions. Blood pH in each group remained constant, but blood bicarbonate fell significantly in the mannitol and saline-infused rats. In these two groups, urinary citrate per unit GFR decreased 27% and 25% (P less than 0.01) but urinary ammonia excretion per unit GFR increased 120% and 90% (P less than 0.01). By contrast, in saline bicarbonate rats, citrate excretion increased 27% and urinary ammonia excretion rose 29% (P greater than 0.2). Rats with metabolic acidosis given saline did not alter blood pH or bicarbonate. Citrate excretion per unit GFR increased 150% (P less than 0.02) but urinary ammonia excretion rose insignificantly by 11%. Calculated net tubular reabsorption of citrate increased in the mannitol and saline-infused rats. The rise in urinary pH in these two groups during expansion suggest that renal ammonia production was also increased. We conclude that volume expansion changes renal citrate and ammonia metabolism by isohydrically reducing blood bicarbonate concentration, thereby demonstrating another effect of bicarbonate, independent of pH, on renal metabolism.

Inefficacy of bicarbonate infusions on the course of postischaemic acute renal failure in the rat

Since bicarbonate has been reported to elicit fast recovery from acute renal failure in man, clearance studies were performed to compare the effects of sodium bicarbonate and saline infusion on renal function in postischaemic renal failure in the rat. In a first set of experiments the left kidney and in a second both kidneys were clamped for a period of 45 min and renal function monitored up to 210 min after release of the clamp. Glomerular filtration rate (ml/min) decreased following clamping from (mean values +/- SEM) 1.33 +/- 0.09 to 0.12 +/- 0.02 (saline) or 1.43 +/- 0.1 to 0.08 +/- 0.01 (bicarbonate) in the unilaterally clamped kidney and from 2.94 +/- 0.20 to 0.41 +/- 0.10 (saline) or 2.81 +/- 0.17 to 0.22 +/- 0.03 (bicarbonate) when both kidneys were clamped. Fractional excretion of water and sodium increased to a similar extent in saline and bicarbonate treated animals. Plasma potassium decreased (from 3.37 +/- 0.10 to 2.95 +/- 0.07 [unilaterally clamped kidneys] or from 5.2 +/- 0.4 to 4.4 +/- 0.2 [bilaterally clamped kidneys]) in bicarbonate treated but remained constant in saline treated animals, an effect not related to altered renal potassium excretion. In conclusion, no evidence was found that bicarbonate improves renal function in postischaemic renal failure.

Extracellular K+ concentration and K+ balance of the gastrocnemius muscle of the dog during exercise

Exercise-induced changes of the extracellular and the venous K+ concentrations ([K+]e, [K+]ven) were measured continuously in autoperfused dog gastrocnemii using PVC liquid membrane electrodes. O2 consumption (VO2), blood flow and performance of the muscles were also determined. The muscles were stimulated indirectly and isotonic tetanic contractions (0.2 s) were produced every 0.7 s for more than 45 min. 1. [K+]e started to increase immediately after the onset of exercise and reached a maximal value of 7.4 meq/l after 4 min of exercise, thereafter it decreased, reaching 5.3 meq/1 at the end of the 12 min exercise. After 6 min of recovery [K+]e became lower than the control level. [K+]ven reached maximal values of 5.0 meq/l after 30 s of exercise and thereafter decreased slowly to 3.8 meq/l at the end of exercise. Thus, a K+ gradient of up to 3 meq/l was observed between the interstitial space and the venous blood. About 30 s after the end of exercise a net K+ uptake of up to 0.3 mu eq per min per g was observed. 2. The K+ loss of the muscle fibres reached maximal values of 1.5 mu eq per min per g at 1.5 min after the onset of exercise. Total K+ loss was 7% during 12 min of exercise and 12.5% of intracellular K+ during 45 min of exercise. 3. The changes of [K+]e correlated closely with performance and VO2 during exercise but not during recovery. On the other hand, blood flow correlated with the changes of [K+]e during both exercise and recovery. These results support the hypothesis that changes of [K+]e of the working muscle might be an important factor regulating exercise hyperemia.

Relationship of renal ammonia production and potassium homeostasis

Renal ammonia production appears to be intimately related to potassium homeostasis, and the two may comprise the components of a closed loop regulatory system. Studies with both intact organisms and in vitro systems indicate that potassium depletion stimulates and chronic potassium-loading suppresses renal ammonia production. An increase in ammoniagenesis has been shown to decrease potassium excretion. These observations suggest that changes in potassium modulate ammonia production, which in turn maintains hydrogen ion homeostasis and influences potassium excretion. Potassium depletion increases rat renal cortical ammonia production by altering metabolism in fashion identical to metabolic acidosis, but there is no convincing evidence that both processes are mediated by similar changes in either cellular hydrogen ion or potassium concentration. By contrast, potassium-loading, which depresses ammonia production, appears to affect primarily the outer medulla, a region that is not influenced by potassium depletion. Thus, potassium-loading apparently affects different portions of the renal tubule than depletion does, but the specific mechanism and physiologic significance of the different sites of action is unknown.