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Ge Q, Zhang ZY, Li SN, Ma JQ, Zhao Z. Liquid biopsy: Comprehensive overview of circulating tumor DNA (Review). Oncol Lett 2024; 28:548. [PMID: 39319213 PMCID: PMC11420644 DOI: 10.3892/ol.2024.14681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2024] [Accepted: 08/29/2024] [Indexed: 09/26/2024] Open
Abstract
Traditional tumor diagnosis methods rely on tissue biopsy, which can be invasive and unsuitable for long-term monitoring of tumor dynamics. The advent of liquid biopsy has notably improved the overall management of patients with cancer. Liquid biopsy techniques primarily involve detection of circulating tumor cells (CTCs) and circulating tumor DNA (ctDNA). The present review focuses on ctDNA because of its significance in tumor diagnosis, monitoring and treatment. The use of ctDNA-based liquid biopsy offers several advantages, including non-invasive or minimally invasive collection methods, the ability to conduct repeated assessment and comprehensive insights into tumor biology. It serves crucial roles in disease management by facilitating screening of high-risk patients, dynamically monitoring therapeutic responses and diagnosis. Furthermore, ctDNA can be used to demonstrate pseudo-progression, monitor postoperative tumor status and guide adaptive treatment plans. The present study provides a comprehensive review of ctDNA, exploring its origins, metabolism, detection methods, clinical role and the current challenges associated with its application.
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Affiliation(s)
- Qian Ge
- Graduate School, Xi'an Medical University, Xi'an, Shaanxi 710000, P.R. China
| | - Zhi-Yun Zhang
- Graduate School, Shaanxi University of Chinese Medicine, Xianyang, Shaanxi 712046, P.R. China
| | - Suo-Ni Li
- Department of Internal Medicine, Shaanxi Provincial Cancer Hospital, Xi'an, Shaanxi 710000, P.R. China
| | - Jie-Qun Ma
- Department of Internal Medicine, Shaanxi Provincial Cancer Hospital, Xi'an, Shaanxi 710000, P.R. China
| | - Zheng Zhao
- Department of Internal Medicine, Shaanxi Provincial Cancer Hospital, Xi'an, Shaanxi 710000, P.R. China
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Barletta JF, Muir J, Brown J, Dzierba A. A Systematic Approach to Understanding Acid-Base Disorders in the Critically Ill. Ann Pharmacother 2024; 58:65-75. [PMID: 37125739 DOI: 10.1177/10600280231165787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023] Open
Abstract
OBJECTIVE The objective of this review is to discuss acid-base physiology, describe the essential steps for interpreting an arterial blood gas and relevant laboratory tests, and review the 4 distinct types of acid-base disorders. DATA SOURCES A comprehensive literature search and resultant bibliography review of PubMed from inception through March 7, 2023. STUDY SELECTION AND DATA EXTRACTION Relevant English-language articles were extracted and evaluated. DATA SYNTHESIS Critically ill patients are prone to significant acid-base disorders that can adversely affect clinical outcomes. Assessing these acid-base abnormalities can be complex because of dynamic aberrations in plasma proteins, electrolytes, extracellular volume, concomitant therapies, and use of mechanical ventilation. This article provides a systematic approach to acid-base abnormalities which is necessary to facilitate prompt identification of acid-base disturbances and prevent untoward morbidity and mortality. RELEVANCE TO PATIENT CARE AND CLINICAL PRACTICE Many acid-base disorders result from medication therapy or are treated with medications. Pharmacists are uniquely poised as the medication experts on the multidisciplinary team to assist with acid-base assessments in the context of pharmacotherapy. CONCLUSION The use of a systematic approach to address acid-base disorders can be performed by all pharmacists to improve pharmacotherapy and optimize patient outcomes.
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Affiliation(s)
- Jeffrey F Barletta
- Department of Pharmacy Practice, College of Pharmacy, Midwestern University, Glendale, AZ, USA
| | - Justin Muir
- Department of Pharmacy, NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, NY, USA
| | - Judah Brown
- Department of Pharmacy, NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, NY, USA
| | - Amy Dzierba
- Department of Pharmacy, NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, NY, USA
- Center for Acute Respiratory Failure, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
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Liu SY, Xu SY, Yin L, Yang T, Jin K, Zhang QB, Sun F, Tan DY, Xin TY, Chen YG, Zhao XD, Yu XZ, Xu J. Management of regional citrate anticoagulation for continuous renal replacement therapy: guideline recommendations from Chinese emergency medical doctor consensus. Mil Med Res 2023; 10:23. [PMID: 37248514 DOI: 10.1186/s40779-023-00457-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 04/28/2023] [Indexed: 05/31/2023] Open
Abstract
Continuous renal replacement therapy (CRRT) is widely used for treating critically-ill patients in the emergency department in China. Anticoagulant therapy is needed to prevent clotting in the extracorporeal circulation during CRRT. Regional citrate anticoagulation (RCA) has been shown to potentially be safer and more effective and is now recommended as the preferred anticoagulant method for CRRT. However, there is still a lack of unified standards for RCA management in the world, and there are many problems in using this method in clinical practice. The Emergency Medical Doctor Branch of the Chinese Medical Doctor Association (CMDA) organized a panel of domestic emergency medicine experts and international experts of CRRT to discuss RCA-related issues, including the advantages and disadvantages of RCA in CRRT anticoagulation, the principle of RCA, parameter settings for RCA, monitoring of RCA (mainly metabolic acid-base disorders), and special issues during RCA. Based on the latest available research evidence as well as the paneled experts' clinical experience, considering the generalizability, suitability, and potential resource utilization, while also balancing clinical advantages and disadvantages, a total of 16 guideline recommendations were formed from the experts' consensus.
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Affiliation(s)
- Shu-Yuan Liu
- Emergency Department, The Sixth Medical Center, Chinese PLA General Hospital, Beijing, 100048, China
| | - Sheng-Yong Xu
- State Key Laboratory of Complex Severe and Rare Diseases, Emergency Department, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100730, China
| | - Lu Yin
- Emergency Department, Peking University Shenzhen Hospital, Shenzhen, 518000, China
| | - Ting Yang
- Emergency Department, The First Affiliated Hospital of Kunming Medical University, Kunming, 650000, China
| | - Kui Jin
- Emergency Department, The First Affiliated Hospital of University of Science and Technology of China, Hefei, 230001, China
| | - Qiu-Bin Zhang
- Emergency Department, The Second Affiliated Hospital of Hainan Medical College, Haikou, 570100, China
| | - Feng Sun
- Emergency Department, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Ding-Yu Tan
- Emergency Department, Northern Jiangsu People's Hospital, Clinical Medical College of Yangzhou University, Yangzhou, 225001, China
| | - Tian-Yu Xin
- Emergency Department, The Sixth Medical Center, Chinese PLA General Hospital, Beijing, 100048, China
| | - Yu-Guo Chen
- Emergency Department and Chest Pain Center, Qilu Hospital of Shandong University, Jinan, 100005, China.
- Shandong Provincial Clinical Research Center for Emergency and Critical Care Medicine, Jinan, 100005, China.
- Key Laboratory of Emergency and Critical Care Medicine of Shandong Province, Qilu Hospital of Shandong University, Jinan, 100005, China.
| | - Xiao-Dong Zhao
- Emergency Department, The Fourth Medical Center, Chinese PLA General Hospital, Beijing, 100048, China.
| | - Xue-Zhong Yu
- State Key Laboratory of Complex Severe and Rare Diseases, Emergency Department, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100730, China.
| | - Jun Xu
- State Key Laboratory of Complex Severe and Rare Diseases, Emergency Department, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100730, China.
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Ring T, Rees SE, Frische S. Acid content and buffer-capacity: a charge-balance perspective. Scand J Clin Lab Invest 2022; 82:356-362. [PMID: 35792720 DOI: 10.1080/00365513.2022.2092903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Rational treatment and thorough diagnostic classification of acid-base disorders requires quantitative understanding of the mechanisms that generate and dissipate loads of acid and base. A natural precondition for this tallying is the ability to quantify the acid content in any specified fluid. Physical chemistry defines the pH-dependent charge on any buffer species, and also on strong ions on which, by definition, the charge is pH-invariant. Based, then, on the requirement of electroneutrality and conservation of mass, it was shown in 1914 that pH can be calculated and understood on the basis of the chemical composition of any fluid. Herein we first show that this specification for [H+] of the charge-balance model directly delivers the pH-dependent buffer-capacity as defined in the literature. Next, we show how the notion of acid transport as proposed in experimental physiology can be understood as a change in strong ion difference, ΔSID. Finally, based on Brønsted-Lowry theory we demonstrate that by defining the acid content as titratable acidity, this is equal to SIDref - SID, where SIDref is SID at pH 7.4. Thereby, any chemical situation is represented as a curve in a novel diagram with titratable acidity = SIDref - SID as a function of pH. For any specification of buffer chemistry, therefore, the change in acid content in the fluid is path invariant. Since constituents of SID and titratable acidity are additive, we thereby, based on first principles, have defined a new framework for modeling acid balance across a cell, a whole organ, or the whole-body.
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Affiliation(s)
- Troels Ring
- Department of Biomedicine, Aarhus University, Aarhus, Denmark
| | - Stephen Edward Rees
- Respiratory and Critical Care Group, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
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Adrogué HJ, Tucker BM, Madias NE. Clinical Approach to Assessing Acid-Base Status: Physiological vs Stewart. Adv Chronic Kidney Dis 2022; 29:343-354. [PMID: 36175072 DOI: 10.1053/j.ackd.2022.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 04/12/2022] [Accepted: 04/25/2022] [Indexed: 01/25/2023]
Abstract
Evaluation of acid-base status depends on accurate measurement of acid-base variables and their appropriate assessment. Currently, 3 approaches are utilized for assessing acid-base variables. The physiological or traditional approach, pioneered by Henderson and Van Slyke in the early 1900s, considers acids as H+ donors and bases as H+ acceptors. The acid-base status is conceived as resulting from the interaction of net H+ balance with body buffers and relies on the H2CO3/HCO3- buffer pair for its assessment. A second approach, developed by Astrup and Siggaard-Andersen in the late 1950s, is known as the base excess approach. Base excess was introduced as a measure of the metabolic component replacing plasma [HCO3-]. In the late 1970s, Stewart proposed a third approach that bears his name and is also referred to as the physicochemical approach. It postulates that the [H+] of body fluids reflects changes in the dissociation of water induced by the interplay of 3 independent variables-strong ion difference, total concentration of weak acids, and PCO2. Here we focus on the physiological approach and Stewart's approach examining their conceptual framework, practical application, as well as attributes and drawbacks. We conclude with our view about the optimal approach to assessing acid-base status.
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Affiliation(s)
- Horacio J Adrogué
- Department of Medicine, Section of Nephrology, Baylor College of Medicine, Houston, TX; Department of Medicine, Division of Nephrology, Houston Methodist Hospital, Houston, TX
| | - Bryan M Tucker
- Department of Medicine, Section of Nephrology, Baylor College of Medicine, Houston, TX; Department of Medicine, Division of Nephrology, Houston Methodist Hospital, Houston, TX
| | - Nicolaos E Madias
- Department of Medicine, Tufts University School of Medicine, Boston, MA; Department of Medicine, Division of Nephrology, St Elizabeth's Medical Center, Boston, MA.
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Rodríguez MR, DiNardo JA. Biventricular Repair as an Alternative to Single Ventricle Palliation in the Child with Hypoplastic Left Heart Structures: What the Anesthesiologist Should Know. J Cardiothorac Vasc Anesth 2022; 36:3927-3938. [DOI: 10.1053/j.jvca.2022.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 06/04/2022] [Accepted: 06/13/2022] [Indexed: 11/11/2022]
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Forsal I, Bodelsson M, Wieslander A, Nilsson A, Pouchoulin D, Broman M. Analysis of acid-base disorders in an ICU cohort using a computer script. Intensive Care Med Exp 2022; 10:11. [PMID: 35377054 PMCID: PMC8980140 DOI: 10.1186/s40635-022-00437-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 03/03/2022] [Indexed: 12/05/2022] Open
Abstract
Background/aims Acid–base status is important for understanding pathophysiology, making a diagnosis, planning effective treatment and monitoring progress of critically ill patients. Manual calculations are cumbersome, easily result in wrong conclusions. We wanted to develop an automated assessment of acid–base status. Methods A simplified adaptive MATLAB script processing all available theory to date was created, evaluated and used on blood gas analyses drawn immediately after admission to ICU. The script was compared to golden standard, calculating manually by two experienced ICU physicians. Results Results from the script correlated completely with detailed manual calculations of randomly chosen 100 blood gas results and it was able to deliver complex data on cohort level with advanced graphics. The initial blood gas analyses from 8875 admissions constituted the cohort, of which 4111 (46.3%) were normal. Respiratory acidosis was the primary disturbance in 2753 (31.0%) and metabolic acidosis in 464 (5.2%). Respiratory alkalosis was the primary disturbance in 1501 (17.0%) and metabolic alkalosis in 46 (0.5%). Of the disturbances 74.7% were mixed with two and 2.1% with three simultaneous disturbances. Acidoses were less compensated compared to alkaloses. Conclusions Acid–base theories are developed on ideal models and not on critical care patients, they require inputs that might not be available, and therefore, estimations are needed. In our cohort, it was difficult to develop a working script based on Stewart, whereas Boston/Copenhagen worked better. Acidoses were more common and more deviated compared to alkaloses.
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Affiliation(s)
- Innas Forsal
- Baxter Gambro Lundia, Magistratsvägen 16, 22643, Lund, Sweden
| | - Mikael Bodelsson
- Skåne University Hospital Perioperative and Intensive Care, Entregatan 7, 22242, Lund, Sweden
| | | | - Anders Nilsson
- Baxter Gambro Lundia, Magistratsvägen 16, 22643, Lund, Sweden
| | | | - Marcus Broman
- Skåne University Hospital Perioperative and Intensive Care, Entregatan 7, 22242, Lund, Sweden.
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Grimm LM, Humann-Ziehank E, Zinne N, Zardo P, Ganter M. Analysis of pH and electrolytes in blood and ruminal fluid, including kidney function tests, in sheep undergoing long-term surgical procedures. Acta Vet Scand 2021; 63:43. [PMID: 34775972 PMCID: PMC8591915 DOI: 10.1186/s13028-021-00611-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 11/02/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The physiology of sheep as small ruminants is remarkably different from monogastric animals especially regarding the forestomach system. Using sheep for surgical procedures during scientific research thereby presents an exceptional setting for the anaesthetist. Long-term anaesthesia generally demands deprivation of food to reduce the risk of bloat in sheep. This might influence the energy and electrolyte balance. In horses and companion animals, close monitoring of mean arterial blood pressure, capnography and blood gas analysis are common procedures during long-term surgery. However, few data are available on reference ranges for blood gas in sheep and these cover only short periods of anaesthesia. To the authors' knowledge, there is no study available that includes the monitoring of electrolytes and pH in ruminal fluid and kidney function tests in sheep undergoing long term anaesthesia. Thereby, the aim of the present study was to gather data on blood parameters, and data on ruminal fluid and kidney function during long-term anaesthesia in sheep. Data were obtained from eight sheep undergoing the invasive surgical procedure of left pneumonectomy and auto-transplantation or isolated left lung perfusion. After a 19-h fasting period, the animals were administered xylazine and ketamine and then intubated and maintained in general anaesthesia under artificial ventilation using isoflurane in oxygen. Blood samples were evaluated during 9 h of anaesthesia; ruminal fluid and kidney function tests were evaluated during 7 h of anaesthesia. RESULTS Blood parameters such as electrolytes and partial pressure of carbon dioxide revealed few changes, yet blood glucose decreased and beta-hydroxybutyric acid increased significantly. All animals showed an elevated arterial pH and bicarbonate concentration despite artificial ventilation. In ruminal fluid, the pH significantly decreased and no significant changes in electrolytes occurred. Kidney function tests revealed no significant changes in any of the animals. However, fractional excretion of water and phosphate was slightly increased. One animal showed severe complications due to hypokalaemia. CONCLUSION Invasive surgery under long-term anaesthesia in sheep is possible without great imbalances of arterial pH and electrolytes. Nevertheless, potassium concentrations should be monitored carefully, as a deficiency can lead to life-threatening complications. The operated sheep tended not to develop metabolic acidosis and the mean kidney function could be maintained within the physiological range throughout anaesthesia. However, slight elevations in renal fractional water and phosphate excretion could suggest an early tubular reabsorption dysfunction. In ruminal fluid, acidification occurred, though no significant changes were observed in L- and D-lactate levels or in electrolyte concentrations. To our knowledge, the role of the rumen in storing fluids and balancing electrolytes in the blood has not yet been documented during anaesthesia. However, the importance of the rumen for fluid equilibrium in sheep indicates the necessity for routine monitoring and further research.
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Affiliation(s)
- Lucie M Grimm
- Clinic for Swine, Small Ruminants and Forensic Medicine, University of Veterinary Medicine Hannover, Foundation, Bischofsholer Damm 15, 30173, Hannover, Germany.
| | - Esther Humann-Ziehank
- LABVETCON, Laboratory Veterinary Consulting, Föhrenkamp 20, 31303, Burgdorf, Germany
| | - Norman Zinne
- Department of Cardiothoracic, Transplantation and Vascular Surgery (HTTG), Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
| | - Patrick Zardo
- Department of Cardiothoracic, Transplantation and Vascular Surgery (HTTG), Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
| | - Martin Ganter
- Clinic for Swine, Small Ruminants and Forensic Medicine, University of Veterinary Medicine Hannover, Foundation, Bischofsholer Damm 15, 30173, Hannover, Germany
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Abstract
This study contrasts the abilities and mechanisms of two physicochemical, mathematical models to predict experimental bicarbonate kinetics, hence, buffer transport, during a hemodialysis (HD) treatment in chronic renal failure patients. The existing Sargent model assumes that the body fluids can be described as a single, homogeneous extracellular fluid (EC) compartment whose volume decreases because of a constant ultrafiltration rate during HD. Bicarbonate and acetate transport between HD fluid and the EC compartment are by convection and diffusion with acetate metabolized in that compartment. The new model formulated in this study assumes the same conditions as Sargent et al., but constrains ion concentrations in the EC to be electrically neutral at all times. This constraint requires inclusion in the EC of other transportable small ions, Na+, K+, Cl- and unidentified, anionic organic acids in addition to an electrical charge on impermeable albumin. The findings are that the new electroneutrality model predicts plasma bicarbonate-concentration kinetics as closely as the Sargent model, but bicarbonate transport is an unlikely mechanism. Rather, the findings are better explained by rapid interconversion of CO2 and bicarbonate in this simplified EC compartment model. The results of this study bring into question the ability of the Sargent et al. hypothesized H+-mobilization model to explain buffer-transport kinetics during HD.
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Affiliation(s)
- Matthew B Wolf
- From the Department of Pharmacology, Physiology and Neuroscience, University of South Carolina, Columbia, South Carolina
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Mechanisms of Peritoneal Acid-Base Kinetics During Peritoneal Dialysis: A Mathematical Model Study. ASAIO J 2021; 67:809-816. [PMID: 33181546 DOI: 10.1097/mat.0000000000001300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
To investigate mechanisms of acid-base changes during peritoneal dialysis (PD), a mathematical model was developed that describes kinetics of peritoneal bicarbonate, CO2, and pH during the dwell with both high and low lactate-containing dialysis fluids. The model was based on a previous modification of the Rippe 3-Pore model of water and solute kinetic transport across the peritoneal membrane during the PD dwell. A central feature of the present modification is an electroneutrality constraint on peritoneal-fluid ion concentrations, which results in the conclusion that peritoneal bicarbonate-concentration kinetics are entirely dependent on the kinetics of the other ions. This new model was able to closely predict peritoneal bicarbonate-concentration kinetics during the dwell. Predictions of total peritoneal bicarbonate-mass kinetics were greater than those of porous, transmembrane bicarbonate transport, suggesting that a portion of bicarbonate comes from CO2 transport, both porous and nonporous and then a partial conversion to bicarbonate. Fitting the model to experimental pH data during the dwell, required addition of a peritoneal CO2 mass-conservation constraint, coupled with the description for peritoneal bicarbonate kinetics. Predicted pH kinetics during the dwell, closely mimicked the experimental data. The conclusion was that the mechanisms describing peritoneal bicarbonate and pH kinetics during PD must include 1) electroneutrality of peritoneal fluid, 2) porous transport of bicarbonate and CO2, 3) nonporous transport of CO2, and 4) CO2 conversion to bicarbonate. These mechanisms are quite different and more complex than the bicarbonate-centered, lactate to acid-generation mechanisms previously proposed.
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Gil HW, Hong M, Lee H, Cho NJ, Lee EY, Park S. Impact of Acid-Base Status on Mortality in Patients with Acute Pesticide Poisoning. TOXICS 2021; 9:toxics9020022. [PMID: 33498605 PMCID: PMC7911411 DOI: 10.3390/toxics9020022] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 01/13/2021] [Accepted: 01/19/2021] [Indexed: 01/09/2023]
Abstract
We investigated clinical impacts of various acid-base approaches (physiologic, base excess (BE)-based, and physicochemical) on mortality in patients with acute pesticide intoxication and mutual intercorrelated effects using principal component analysis (PCA). This retrospective study included patients admitted from January 2015 to December 2019 because of pesticide intoxication. We compared parameters assessing the acid-base status between two groups, survivors and non-survivors. Associations between parameters and 30-days mortality were investigated. A total of 797 patients were analyzed. In non-survivors, pH, bicarbonate concentration (HCO3−), total concentration of carbon dioxide (tCO2), BE, and effective strong ion difference (SIDe) were lower and apparent strong ion difference (SIDa), strong ion gap (SIG), total concentration of weak acids, and corrected anion gap (corAG) were higher than in survivors. In the multivariable logistic analysis, BE, corAG, SIDa, and SIDe were associated with mortality. PCA identified four principal components related to mortality. SIDe, HCO3−, tCO2, BE, SIG, and corAG were loaded to principal component 1 (PC1), referred as total buffer bases to receive and handle generated acids. PC1 was an important factor in predicting mortality irrespective of the pesticide category. PC3, loaded mainly with pCO2, suggested respiratory components of the acid-base system. PC3 was associated with 30-days mortality, especially in organophosphate or carbamate poisoning. Our study showed that acid-base abnormalities were associated with mortality in patients with acute pesticide poisoning. We reduced these variables into four PCs, resembling the physicochemical approach, revealed that PCs representing total buffer bases and respiratory components played an important role in acute pesticide poisoning.
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Affiliation(s)
- Hyo-Wook Gil
- Department of Internal Medicine, Soonchunhyang University Cheonan Hospital, Cheonan 31151, Korea; (H.-W.G.); (N.-j.C.); (E.-Y.L.)
| | - Min Hong
- Department of Software Convergence, Soonchunhyang University, Asan 31538, Korea; (M.H.); (H.L.)
| | - HwaMin Lee
- Department of Software Convergence, Soonchunhyang University, Asan 31538, Korea; (M.H.); (H.L.)
| | - Nam-jun Cho
- Department of Internal Medicine, Soonchunhyang University Cheonan Hospital, Cheonan 31151, Korea; (H.-W.G.); (N.-j.C.); (E.-Y.L.)
| | - Eun-Young Lee
- Department of Internal Medicine, Soonchunhyang University Cheonan Hospital, Cheonan 31151, Korea; (H.-W.G.); (N.-j.C.); (E.-Y.L.)
| | - Samel Park
- Department of Internal Medicine, Soonchunhyang University Cheonan Hospital, Cheonan 31151, Korea; (H.-W.G.); (N.-j.C.); (E.-Y.L.)
- Correspondence:
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Acid-base effects of continuous infusion furosemide in clinically stable surgical ICU patients: an analysis based on the Stewart model. Clin Exp Nephrol 2020; 24:541-546. [PMID: 32152833 DOI: 10.1007/s10157-020-01867-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 02/25/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVES We sought to test the strength of correlation between predicted and observed systemic acid-base status based on the Stewart model equations during continuous infusion (CI) furosemide therapy. DESIGN, SETTING AND PARTICIPANTS This was a prospective, single-center, observational study conducted in the Surgical ICU of a large academic medical center. Ten critically ill patients who received CI furosemide were included. MAIN OUTCOMES AND MEASURES The primary purpose was to characterize the relationship between changes in serum electrolyte and acid-base status and the excretion of electrolytes in the urine during infusion of CI furosemide in critically ill patients. As a secondary endpoint, we sought to evaluate the predictive application of the Stewart model. Over 72-h, intake and output volumes, electrolyte content of fluids administered, plasma and urine electrolytes, urine pH, and venous blood gases were collected. Predicted and observed changes in acid-based status were compared for each day of diuretic therapy using Spearman's correlation coefficient. RESULTS The mean (SD) strong ion difference (SID) increased from 45.2 (3.2) at baseline to 49.6 (4.0) after 72 h of continuous infusion furosemide. At Day 1, the mean SID (observed) (SD) was 47.5 (3.5) and the predicted SID was 49.5 (5.8). Day 1 observed plasma SID was positively correlated with the predicted SID (rs = 0.80, p = 0.01). By Days 2 and 3, the correlations of observed and predicted SID were no longer statistically significant. CONCLUSIONS AND RELEVANCE Using the Stewart model, increases in SID as an indicator of metabolic alkalosis due to the chloruretic effects of furosemide were observed. Predicted and observed SID correlated well over the first 24 h of treatment.
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The Janus faces of bicarbonate therapy in the ICU: con. Intensive Care Med 2019; 46:519-521. [PMID: 31728566 DOI: 10.1007/s00134-019-05842-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 10/23/2019] [Indexed: 10/25/2022]
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Jung B, Martinez M, Claessens YE, Darmon M, Klouche K, Lautrette A, Levraut J, Maury E, Oberlin M, Terzi N, Viglino D, Yordanov Y, Claret PG, Bigé N. Diagnostic et Prise en Charge de l’Acidose Métabolique Recommandations formalisées d’experts communes Société de réanimation de langue française (SRLF) – Société française de médecine d’urgence (SFMU). ANNALES FRANCAISES DE MEDECINE D URGENCE 2019. [DOI: 10.3166/afmu-2019-0162] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
L’acidose métabolique est un trouble fréquemment rencontré en médecine d’urgence et en médecine intensive réanimation. La littérature s’étant enrichie de nouvelles données concernant la prise en charge de l’acidose métabolique, la Société de Réanimation de Langue Française (SRLF) et la Société Française de Médecine d’Urgence (SFMU) ont élaboré des recommandations formalisées d’experts selon la méthodologie GRADE. Les champs de la stratégie diagnostique, de l’orientation et de la prise en charge thérapeutique ont été traités et vingt-neuf recommandations ont été formulées : quatre recommandations fortes (Grade 1), dix recommandations faibles (Grade 2) et quinze avis d’experts. Toutes ont obtenu un accord fort. L’application des méthodes d’Henderson-Hasselbalch et de Stewart pour le diagnostic du mécanisme de l’acidose métabolique est discutée et un algorithme diagnostique est proposé. L’utilisation de la cétonémie et des lactatémies veineuse et capillaire est également traitée. L’intérêt du pH, de la lactatémie et de sa cinétique pour l’orientation des patients en pré-hospitalier et aux urgences est envisagé. Enfin, les modalités de l’insulinothérapie au cours de l’acidocétose diabétique, les indications de la perfusion de bicarbonate de sodium et de l’épuration extra-rénale ainsi que les modalités de la ventilation mécanique au cours des acidoses métaboliques sévères sont traitées dans la prise en charge thérapeutique.
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15
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Buffering Capacity in Sepsis: A Prospective Cohort Study in Critically Ill Patients. J Clin Med 2019; 8:jcm8111759. [PMID: 31652676 PMCID: PMC6912238 DOI: 10.3390/jcm8111759] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 10/18/2019] [Indexed: 11/19/2022] Open
Abstract
Background: The concept of buffering generally refers to the ability of a system/organism to withstand attempted changes. For acid-base balance in particular, it is the body’s ability to limit pH aberrations when factors that potentially affect it change. Buffering is vital for maintaining homeostasis of an organism. The present study was undertaken in order to investigate the probable buffering capacity changes in septic patients. Materials and methods: This prospective cohort study included 113 ICU patients (96 septic and 17 critically-ill non-septic/controls). The buffering capacity indices were assessed upon ICU admission and reassessed only in septic patients, either at improvement or upon severe deterioration. Applying Stewart’s approach, the buffering capacity was assessed with indices calculated from the observed central venous-arterial gradients: a) ΔPCO2/Δ[H+] or ΔpH, b) ΔSID/Δ[H+] or ΔpH. Results: In a generalized estimating equation linear regression model, septic patients displayed significant differences in ΔPCO2/ΔpH [beta coefficient = –47.63, 95% CI (–80.09) – (–15.17), p = 0.004], compared to non-septic patients on admission. Lower absolute value of ΔPCO2/ΔpH (%) on admission was associated with a significant reduction in ICU mortality (HR 0.98, 95% CI: 0.97–0.99, p = 0.02). At septic-group reassessment (remission or deterioration), one-unit increase of ΔPCO2/Δ[H+] reduced the ICU death hazard by 44% (HR 0.56, 95% CI: 0.33–0.96, p = 0.03). Conclusions: In the particular cohort of patients studied, a difference in the buffering capacity was recorded between septic and non-septic patients on admission. Moreover, buffering capacity was an independent predictor of fatal ICU outcome at both assessments, ICU-admission and sepsis remission or deterioration.
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16
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Aminov D, Pines D, Kiefer PM, Daschakraborty S, Hynes JT, Pines E. Intact carbonic acid is a viable protonating agent for biological bases. Proc Natl Acad Sci U S A 2019; 116:20837-20843. [PMID: 31570591 PMCID: PMC6800339 DOI: 10.1073/pnas.1909498116] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Carbonic acid H2CO3 (CA) is a key constituent of the universal CA/bicarbonate/CO2 buffer maintaining the pH of both blood and the oceans. Here we demonstrate the ability of intact CA to quantitatively protonate bases with biologically-relevant pKas and argue that CA has a previously unappreciated function as a major source of protons in blood plasma. We determine with high precision the temperature dependence of pKa(CA), pKa(T) = -373.604 + 16,500/T + 56.478 ln T. At physiological-like conditions pKa(CA) = 3.45 (I = 0.15 M, 37 °C), making CA stronger than lactic acid. We further demonstrate experimentally that CA decomposition to H2O and CO2 does not impair its ability to act as an ordinary carboxylic acid and to efficiently protonate physiological-like bases. The consequences of this conclusion are far reaching for human physiology and marine biology. While CA is somewhat less reactive than (H+)aq, it is more than 1 order of magnitude more abundant than (H+)aq in the blood plasma and in the oceans. In particular, CA is about 70× more abundant than (H+)aq in the blood plasma, where we argue that its overall protonation efficiency is 10 to 20× greater than that of (H+)aq, often considered to be the major protonating agent there. CA should thus function as a major source for fast in vivo acid-base reactivity in the blood plasma, possibly penetrating intact into membranes and significantly helping to compensate for (H+)aq's kinetic deficiency in sustaining the large proton fluxes that are vital for metabolic processes and rapid enzymatic reactions.
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Affiliation(s)
- Daniel Aminov
- Department of Chemistry, Ben-Gurion University of the Negev, 84105 Beer-Sheva, Israel
| | - Dina Pines
- Department of Chemistry, Ben-Gurion University of the Negev, 84105 Beer-Sheva, Israel
| | - Philip M Kiefer
- Department of Chemistry, University of Colorado Boulder, Boulder, CO 80309-0215
| | | | - James T Hynes
- Department of Chemistry, University of Colorado Boulder, Boulder, CO 80309-0215;
- PASTEUR, Départmente de Chimie, Ecole Normale Supérieure, PSL Research University, Sorbonne Université, UPMC Université Paris 06, CNRS, 75005 Paris, France
| | - Ehud Pines
- Department of Chemistry, Ben-Gurion University of the Negev, 84105 Beer-Sheva, Israel;
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Jung B, Martinez M, Claessens YE, Darmon M, Klouche K, Lautrette A, Levraut J, Maury E, Oberlin M, Terzi N, Viglino D, Yordanov Y, Claret PG, Bigé N. Diagnosis and management of metabolic acidosis: guidelines from a French expert panel. Ann Intensive Care 2019; 9:92. [PMID: 31418093 PMCID: PMC6695455 DOI: 10.1186/s13613-019-0563-2] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Accepted: 07/30/2019] [Indexed: 02/07/2023] Open
Abstract
Metabolic acidosis is a disorder frequently encountered in emergency medicine and intensive care medicine. As literature has been enriched with new data concerning the management of metabolic acidosis, the French Intensive Care Society (Société de Réanimation de Langue Française [SRLF]) and the French Emergency Medicine Society (Société Française de Médecine d’Urgence [SFMU]) have developed formalized recommendations from experts using the GRADE methodology. The fields of diagnostic strategy, patient assessment, and referral and therapeutic management were addressed and 29 recommendations were made: 4 recommendations were strong (Grade 1), 10 were weak (Grade 2), and 15 were experts’ opinions. A strong agreement from voting participants was obtained for all recommendations. The application of Henderson–Hasselbalch and Stewart methods for the diagnosis of the metabolic acidosis mechanism is discussed and a diagnostic algorithm is proposed. The use of ketosis and venous and capillary lactatemia is also treated. The value of pH, lactatemia, and its kinetics for the referral of patients in pre-hospital and emergency departments is considered. Finally, the modalities of insulin therapy during diabetic ketoacidosis, the indications for sodium bicarbonate infusion and extra-renal purification as well as the modalities of mechanical ventilation during severe metabolic acidosis are addressed in therapeutic management.
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Affiliation(s)
- Boris Jung
- Département de Médecine Intensive et Réanimation, CHU Montpellier, 34000, Montpellier, France. .,INSERM U-1046, CNRS U-9234 (PhyMedExp), Université de Montpellier, Montpellier, France.
| | - Mikaël Martinez
- Pôle Urgence, CH du Forez, 42605, Montbrison, France.,Réseau d'urgence Ligérien Ardèche Nord (REULIAN), Centre Hospitalier Le Corbusier, 42700, Firminy, France
| | - Yann-Erick Claessens
- Département de Médecine d'urgence, Centre Hospitalier Princesse-Grace, Avenue Pasteur, 98012, Monaco, France
| | - Michaël Darmon
- Unité de Médecine Intensive et Réanimation, Hôpital Universitaire Saint-Louis, Assistance Publique-Hôpitaux de Paris, Avenue Claude-Vellefaux, 75010, Paris, France.,Faculté de Médecine, Université Paris-Diderot, Sorbonne-Paris-Cité, Paris, France.,France Inserm, ECSTRA Team, UMR 1153, Centre d'Epidémiologie et de Biostatistique, CRESS, Biostatistics and Clinical Epidemiology, Sorbonne-Paris-Cité, Paris, France
| | - Kada Klouche
- INSERM U-1046, CNRS U-9234 (PhyMedExp), Université de Montpellier, Montpellier, France.,Département de Médecine Intensive-Réanimation, CHU Lapeyronie, 371, Avenue Doyen-Gaston-Giraud, 34295, Montpellier, France
| | - Alexandre Lautrette
- Réanimation, Centre Jean-Perrin, CHU de Clermont-Ferrand, 63000, Clermont-Ferrand, France.,LMGE, UMR CNRS 6023, Université Clermont-Auvergne, Clermont-Ferrand, France
| | - Jacques Levraut
- Département de Médecine d'urgence, CHU de Nice, Hôpital Pasteur-II, 30, Avenue de la Voie Romaine, 06000, Nice, France.,UFR de Médecine, Université de Nice Côte d'Azur, Avenue de Vallombrose, 06000, Nice, France
| | - Eric Maury
- Service de Médecine Intensive-Réanimation, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, 184, Rue du Faubourg-Saint-Antoine, 75571 Paris Cedex 12, Paris, France.,Sorbonne Université, Université Pierre-et-Marie Curie-Paris-VI, Paris, France.,Inserm U1136, 75012, Paris, France
| | - Mathieu Oberlin
- Structure des Urgences, Centre Hospitalier de Cahors, 335, Rue Wilson, 46000, Cahors, France
| | - Nicolas Terzi
- Service de Médecine Intensive-Réanimation, Centre Hospitalier Universitaire de Grenoble, Université de Grenoble, Grenoble, France.,Inserm, U1042, Université Grenoble-Alpes, HP2, 38000, Grenoble, France
| | - Damien Viglino
- Service des Urgences Adultes, CS 10217, CHU Grenoble-Alpes, 38043 Grenoble Cedex 09, Grenoble, France.,Inserm U1042, Laboratoire HP2 Hypoxie-Physiopathologies, Université Grenoble-Alpes, Grenoble, France
| | - Youri Yordanov
- Faculté de Médecine, Sorbonne Universités, 75013, Paris, France.,Inserm, U1153, Université Paris-Descartes, 75006, Paris, France.,Service des Urgences, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris (AP-HP), 75012, Paris, France
| | - Pierre-Géraud Claret
- Pôle Anesthésie Réanimation Douleur Urgences, Centre Hospitalier Universitaire de Nîmes, 4, Rue du Professeur-Robert-Debré, 30029, Nîmes, France
| | - Naïke Bigé
- Service de Médecine Intensive-Réanimation, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, 184, Rue du Faubourg-Saint-Antoine, 75571 Paris Cedex 12, Paris, France
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18
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Kimura S, Shabsigh M, Morimatsu H. Traditional approach versus Stewart approach for acid-base disorders: Inconsistent evidence. SAGE Open Med 2018; 6:2050312118801255. [PMID: 30263119 PMCID: PMC6156212 DOI: 10.1177/2050312118801255] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Accepted: 08/27/2018] [Indexed: 12/15/2022] Open
Abstract
Purpose The traditional approach and the Stewart approach have been developed for evaluating acid-base phenomena. While some experts have suggested that the two approaches are essentially identical, clinical researches have still been conducted on the superiority of one approach over the other one. In this review, we summarize the concepts of each approach and investigate the reasons of the discrepancy, based on current evidence from the literature search. Methods In the literature search, we completed a database search and reviewed articles comparing the Stewart approach with the traditional, bicarbonate-centered approach to November 2016. Results Our literature review included 17 relevant articles, 5 of which compared their diagnostic abilities, 9 articles compared their prognostic performances, and 3 articles compared both diagnostic abilities and prognostic performances. These articles show a discrepancy over the abilities to detect acid-base disturbances and to predict patients' outcomes. There are many limitations that could yield this discrepancy, including differences in calculation of the variables, technological differences or errors in measuring variables, incongruences of reference value, normal range of the variables, differences in studied populations, and confounders of prognostic strength such as lactate. Conclusion In conclusion, despite the proposed equivalence between the traditional approach and the Stewart approach, our literature search shows inconsistent results on the comparison between the two approaches for diagnostic and prognostic performance. We found crucial limitations in those studies, which could lead to the reasons of the discrepancy.
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Affiliation(s)
- Satoshi Kimura
- Department of Anesthesiology and Resuscitation, Okayama University Hospital, Okayama, Japan
| | - Muhammad Shabsigh
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Hiroshi Morimatsu
- Department of Anesthesiology and Resuscitation, Okayama University Hospital, Okayama, Japan
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19
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Schneider AG, Journois D, Rimmelé T. Complications of regional citrate anticoagulation: accumulation or overload? CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2017; 21:281. [PMID: 29151020 PMCID: PMC5694623 DOI: 10.1186/s13054-017-1880-1] [Citation(s) in RCA: 75] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 10/31/2017] [Indexed: 01/01/2023]
Abstract
Regional citrate anticoagulation (RCA) is now recommended over systemic heparin for continuous renal replacement therapy in patients without contraindications. Its use is likely to increase throughout the world. However, in the absence of citrate blood level monitoring, the diagnosis of citrate accumulation, the most feared complication of RCA, remains relatively complex. It is therefore commonly mistaken with other conditions. This review aims at providing clarifications on RCA-associated acid-base disturbances and their management at the bedside. In particular, the authors wish to propose a clear distinction between citrate accumulation and net citrate overload.
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Affiliation(s)
- Antoine G Schneider
- Adult Intensive Care Unit, Centre Hospitalier Universitaire Vaudois (CHUV), 46 avenue du Bugnon, 1011, Lausanne, Switzerland. .,Université de Lausanne, UNIL, Lausanne, Switzerland.
| | - Didier Journois
- Anesthesiology and Intensive Care Medicine, Cochin Hospital, Assistance Publique Hôpitaux de Paris, René Descartes University, Paris, France
| | - Thomas Rimmelé
- Anesthesiology and Intensive Care Medicine, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France.,EA 7426 (Université Claude Bernard Lyon 1 - Hospices Civils de Lyon - bioMérieux) "Pathophysiology of Injury-induced Immunosupression - PI3", Joint Research Unit, Edouard Herriot Hospital, Lyon, France
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20
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Adrogué HJ, Madias NE. In Reply to 'Sodium-Chloride Difference as a Simple Parameter for Acid-Base Status Assessment'. Am J Kidney Dis 2017; 69:708. [PMID: 28285872 DOI: 10.1053/j.ajkd.2017.01.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Accepted: 01/20/2017] [Indexed: 11/11/2022]
Affiliation(s)
- Horacio J Adrogué
- Baylor College of Medicine, Methodist Hospital, Veterans Affairs Medical Center, Houston, Texas
| | - Nicolaos E Madias
- Tufts University School of Medicine, St. Elizabeth's Medical Center, Boston, Massachusetts
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21
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Havlin J, Matousovic K, Schück O. Sodium-Chloride Difference as a Simple Parameter for Acid-Base Status Assessment. Am J Kidney Dis 2017; 69:707-708. [PMID: 28285873 DOI: 10.1053/j.ajkd.2016.12.019] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Accepted: 12/01/2016] [Indexed: 11/11/2022]
Affiliation(s)
- Jan Havlin
- Charles University in Prague and Faculty Hospital Motol, Prague, Czech Republic
| | - Karel Matousovic
- Charles University in Prague and Faculty Hospital Motol, Prague, Czech Republic
| | - Otto Schück
- Charles University in Prague and Faculty Hospital Motol, Prague, Czech Republic
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22
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Ring T, Nielsen S. Whole body acid-base modeling revisited. Am J Physiol Renal Physiol 2016; 312:F647-F653. [PMID: 28031171 DOI: 10.1152/ajprenal.00560.2016] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Revised: 12/14/2016] [Accepted: 12/21/2016] [Indexed: 01/15/2023] Open
Abstract
The textbook account of whole body acid-base balance in terms of endogenous acid production, renal net acid excretion, and gastrointestinal alkali absorption, which is the only comprehensive model around, has never been applied in clinical practice or been formally validated. To improve understanding of acid-base modeling, we managed to write up this conventional model as an expression solely on urine chemistry. Renal net acid excretion and endogenous acid production were already formulated in terms of urine chemistry, and we could from the literature also see gastrointestinal alkali absorption in terms of urine excretions. With a few assumptions it was possible to see that this expression of net acid balance was arithmetically identical to minus urine charge, whereby under the development of acidosis, urine was predicted to acquire a net negative charge. The literature already mentions unexplained negative urine charges so we scrutinized a series of seminal papers and confirmed empirically the theoretical prediction that observed urine charge did acquire negative charge as acidosis developed. Hence, we can conclude that the conventional model is problematic since it predicts what is physiologically impossible. Therefore, we need a new model for whole body acid-base balance, which does not have impossible implications. Furthermore, new experimental studies are needed to account for charge imbalance in urine under development of acidosis.
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Affiliation(s)
- Troels Ring
- Department of Nephrology, Aalborg University Hospital, Aalborg, Denmark; and .,Department of Health and Science Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - Søren Nielsen
- Department of Health and Science Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
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