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Pippalapalli J, Lumb A. The respiratory system and acid-base disorders. BJA Educ 2023; 23:221-228. [PMID: 37223696 PMCID: PMC10201398 DOI: 10.1016/j.bjae.2023.03.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 03/01/2023] [Indexed: 05/25/2023] Open
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Cove M, Kellum JA. The End of the Bicarbonate Era? A Therapeutic Application of the Stewart Approach. Am J Respir Crit Care Med 2020; 201:757-758. [PMID: 31658424 PMCID: PMC7124708 DOI: 10.1164/rccm.201910-2003ed] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Matthew Cove
- Department of MedicineNational University Health SystemSingapore, Singaporeand
| | - John A Kellum
- Department of Critical Care MedicineUniversity of PittsburghPittsburgh, Pennsylvania
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Zanella A, Caironi P, Castagna L, Rezoagli E, Salerno D, Scotti E, Scaravilli V, Deab SA, Langer T, Mauri T, Ferrari M, Dondossola D, Chiodi M, Zadek F, Magni F, Gatti S, Gattinoni L, Pesenti AM. Extracorporeal Chloride Removal by Electrodialysis. A Novel Approach to Correct Acidemia. Am J Respir Crit Care Med 2020; 201:799-813. [DOI: 10.1164/rccm.201903-0538oc] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Affiliation(s)
- Alberto Zanella
- Department of Medical Physiopathology and Transplants, University of Milan, Milan, Italy
- Department of Anesthesia, Critical Care, and Emergency
| | - Pietro Caironi
- Department of Anesthesia and Critical Care, Azienda Ospedaliero-Universitaria S. Luigi Gonzaga, Orbassano, Italy; Department of Oncology, University of Turin, Orbassano, Italy
| | | | - Emanuele Rezoagli
- Department of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy
- Regenerative Medicine Institute at CÚRAM Centre for Research in Medical Devices, and Discipline of Anaesthesia, School of Medicine, National University of Ireland Galway, Galway, Ireland
- Department of Anaesthesia and Intensive Care Medicine, Galway University Hospitals, SAOLTA University Health Group, Galway, Ireland
| | - Domenico Salerno
- Department of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy
| | - Eleonora Scotti
- Department of Medical Physiopathology and Transplants, University of Milan, Milan, Italy
| | | | | | - Thomas Langer
- Department of Medical Physiopathology and Transplants, University of Milan, Milan, Italy
- Department of Anesthesia, Critical Care, and Emergency
| | - Tommaso Mauri
- Department of Medical Physiopathology and Transplants, University of Milan, Milan, Italy
- Department of Anesthesia, Critical Care, and Emergency
| | - Michele Ferrari
- Department of Medical Physiopathology and Transplants, University of Milan, Milan, Italy
| | - Daniele Dondossola
- Department of Medical Physiopathology and Transplants, University of Milan, Milan, Italy
- General and Liver Transplant Surgery Unit, and
| | - Manuela Chiodi
- Department of Medical Physiopathology and Transplants, University of Milan, Milan, Italy
| | - Francesco Zadek
- Department of Medical Physiopathology and Transplants, University of Milan, Milan, Italy
| | - Federico Magni
- Department of Emergency and Intensive Care, San Gerardo Hospital, Monza, Italy; and
| | - Stefano Gatti
- Center for Preclinical Research, Fondazione IRCCS Ca’ Granda-Ospedale Maggiore Policlinico, Milan, Italy
| | - Luciano Gattinoni
- Department of Anesthesiology, Emergency and Intensive Care Medicine, University of Göttingen, Göttingen, Germany
| | - Antonio M. Pesenti
- Department of Medical Physiopathology and Transplants, University of Milan, Milan, Italy
- Department of Anesthesia, Critical Care, and Emergency
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Gaudio E, Laubscher LL, Pfitzer S, Raath JP, Hoffman LC, De Benedictis GM. Immobilization quality and cardiopulmonary effects of etorphine alone compared with etorphine-azaperone in blesbok (Damaliscus pygargus phillipsi). Vet Anaesth Analg 2020; 47:528-536. [PMID: 32507718 DOI: 10.1016/j.vaa.2019.10.012] [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: 04/16/2019] [Revised: 09/04/2019] [Accepted: 10/07/2019] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To evaluate the immobilization quality and cardiopulmonary effects of etorphine alone compared with etorphine-azaperone in blesbok (Damaliscus pygargus phillipsi). STUDY DESIGN Blinded, randomized, crossover design. ANIMALS A total of 12 boma-habituated female blesbok weighing [mean ± standard deviation (SD)] 57.5 ± 2.5 kg. METHODS Each animal was administered etorphine (0.09 mg kg-1) or etorphine-azaperone (0.09 mg kg-1; 0.35 mg kg-1) intramuscularly with 1-week intertreatment washout period. Time to first sign of altered state of consciousness and immobilization time were recorded. Physiological variables were recorded, arterial blood samples were taken during a 40-minute immobilization period, and naltrexone (mean ± SD: 1.83 ± 0.06 mg kg-1) was intravenously administered. Recovery times were documented, and induction, immobilization and recovery were subjectively scored. Statistical analyses were performed; p < 0.05 was significant. RESULTS No difference was observed in time to first sign, immobilization time and recovery times between treatments. Time to head up was longer with etorphine-azaperone (0.5 ± 0.2 versus 0.4 ± 0.2 minutes; p = 0.015). Etorphine caused higher arterial blood pressures (mean: 131 ± 17 versus 110 ± 11 mmHg, p < 0.0001), pH, rectal temperature and arterial oxygen partial pressure (59.2 ± 7.7 versus 42.2 ± 9.8 mmHg), but lower heart (p = 0.002) and respiratory rates (p = 0.01). Etorphine-azaperone combination led to greater impairment of ventilatory function, with higher end-tidal carbon dioxide (p < 0.0001) and arterial partial pressure of carbon dioxide (58.0 ± 4.5 versus 48.1 ± 5.1 mmHg). Immobilization quality was greater with etorphine-azaperone than with etorphine alone (median scores: 4 versus 3; p < 0.0001). CONCLUSIONS AND CLINICAL RELEVANCE Both treatments provided satisfactory immobilization of blesbok; however, in addition to a deeper level of immobilization, etorphine-azaperone caused greater ventilatory impairment. Oxygen supplementation is recommended with both treatments.
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Affiliation(s)
- Eugenio Gaudio
- Department of Animal Medicine Production and Health, University of Padova, Padova, Italy; Department of Animal Sciences, Stellenbosch University, Stellenbosch, South Africa.
| | - Liesel L Laubscher
- Department of Animal Sciences, Stellenbosch University, Stellenbosch, South Africa; Wildlife Pharmaceuticals (Pty) Ltd., White River, South Africa
| | - Silke Pfitzer
- School of Veterinary and Life Sciences, Murdoch University, Perth, Australia
| | - Jacobus P Raath
- Wildlife Pharmaceuticals (Pty) Ltd., White River, South Africa; Wildlifevets.com, Ngongoni Game Lodge, Karino, South Africa
| | - Louw C Hoffman
- Department of Animal Sciences, Stellenbosch University, Stellenbosch, South Africa; Centre for Nutrition and Food Sciences, Queensland Alliance for Agriculture and Food Innovation, The University of Queensland, Brisbane, Australia
| | - Giulia M De Benedictis
- Department of Animal Medicine Production and Health, University of Padova, Padova, Italy
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Romano TG, Azevedo LCP, Mendes PV, Costa ELV, Park M. Effect of continuous dialysis on blood ph in acidemic hypercapnic animals with severe acute kidney injury: a randomized experimental study comparing high vs. low bicarbonate affluent. Intensive Care Med Exp 2017; 5:28. [PMID: 28560615 PMCID: PMC5449359 DOI: 10.1186/s40635-017-0141-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Accepted: 05/17/2017] [Indexed: 11/10/2022] Open
Abstract
Background Controlling blood pH during acute ventilatory failure and hypercapnia in individuals suffering from severe acute kidney injury (AKI) and undergoing continuous renal replacement therapy (CRRT) is of paramount importance in critical care settings. In this situation, the optimal concentration of sodium bicarbonate in the dialysate is still an unsolved question in critical care since high concentrations may worsen carbon dioxide levels and low concentrations may not be as effective in controlling pH. Methods We performed a randomized, non-blinded, experimental study. AKI was induced in 12 female pigs via renal hilum ligation and hypoventilation by reducing the tidal volume during mechanical ventilation with the goal of achieving a pH between 7.10–7.15. After achieving the target pH, animals were randomized to undergo isovolemic hemodialysis with one of two bicarbonate concentrations in the dialysate (40 mEq/L [group 40] vs. 20 mEq/L [group 20]). Results Hemodynamic, respiratory, and laboratory data were collected. The median pH value at CRRT initiation was 7.14 [7.12, 7.15] in group 20 and 7.13 [7.09, 7.14] in group 40 (P = ns). The median baseline PaCO2 was 74 [72, 81] mmHg in group 20 vs. 79 [63, 85] mmHg in group 40 (P = ns). After 3 h of CRRT, the pH value was 7.05 [6.95, 7.09] in group 20 and 7.12 [7.1, 7.14] in group 40 (P < 0.05), with corresponding values of PaCO2 of 85 [79, 88] mmHg vs. 81 [63, 100] mmHg (P = ns). The difference in pH after 3 h was due to a metabolic component [standard base excess −10.4 [−12.5, −9.5] mEq/L in group 20 vs. –7.6 [−9.2, −5.1] mEq/L in group 40) (P < 0.05)]. Despite the increased infusion of bicarbonate in group 40, the blood CO2 content did not change during the experiment. The 12-h survival rate was higher in group 40 (67% vs. 0, P = 0.032). Conclusions A higher bicarbonate concentration in the dialysate of animals undergoing hypercapnic respiratory failure was associated with improved blood pH control without increasing the PaCO2 levels. Electronic supplementary material The online version of this article (doi:10.1186/s40635-017-0141-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Thiago Gomes Romano
- Nephrology Department, ABC Medical School, Av. Príncipe de Gales, 821, Príncipe de Gales, Santo André, São Paulo, 09060-650, Brazil. .,Research and Education Institute, Hospital Sírio-Libanês, São Paulo, Brazil.
| | - Luciano Cesar Pontes Azevedo
- Research and Education Institute, Hospital Sírio-Libanês, São Paulo, Brazil.,Emergency Medicine Discipline, Hospital das Clínicas, University of São Paulo, São Paulo, Brazil
| | - Pedro Vitale Mendes
- Research and Education Institute, Hospital Sírio-Libanês, São Paulo, Brazil.,Emergency Medicine Discipline, Hospital das Clínicas, University of São Paulo, São Paulo, Brazil
| | - Eduardo Leite Vieira Costa
- Research and Education Institute, Hospital Sírio-Libanês, São Paulo, Brazil.,Cardio-Pulmonary Department, Pulmonary Division, Heart Institute (Incor), University of São Paulo, São Paulo, Brazil
| | - Marcelo Park
- Research and Education Institute, Hospital Sírio-Libanês, São Paulo, Brazil.,Emergency Medicine Discipline, Hospital das Clínicas, University of São Paulo, São Paulo, Brazil
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Atalan HK, Güçyetmez B. The effects of the chloride:sodium ratio on acid-base statusand mortality in septic patients. Turk J Med Sci 2017; 47:435-442. [PMID: 28425228 DOI: 10.3906/sag-1602-100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Accepted: 07/07/2016] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND/AIM Calculation of the chloride:sodium (Cl-:Na+) ratio is proposed to enable a quick evaluation of the effect of Cl- and Na+ on the acid-base balance in critically ill patients. In the present study, the relationship of the Cl-:Na+ ratio of septic patients with acid-base status and ICU mortality were investigated. MATERIALS AND METHODS In our two-center study, 434 patients who were diagnosed with sepsis were included. The patients were divided into three groups: low (<0.75), normal (≥0.75, <0.80), and high (≥0.80) Cl-:Na+ ratio groups. Patients' demographic data, blood gas values, length of ICU stay, and ICU mortality were recorded. RESULTS In the low and high groups, ICU mortality was significantly higher than in the normal group (29.3%, 37.1%) (P = 0.005). There was a negative correlation between the Cl:Na+ ratio and each of HCO3-, standard base excess, and PaCO2 (r2 = 0.21, r2 = 0.19, and r2 = 0.17) (P < 0.001 for each). In the multivariate analysis, the ICU mortality was increased 2.6-fold (1.2-5.8) by low Cl-:Na+ ratio (P = 0.019). CONCLUSION The Cl-:Na+ ratio is a useful parameter for showing the relationship between Cl- and Na+ and their impact on acid-base status. Low Cl-:Na+ ratio at ICU admission can be used as a prognostic indicator for increased ICU mortality in septic patients.
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Affiliation(s)
| | - Bülent Güçyetmez
- Department of Anesthesiology, Acıbadem University School of Medicine, İstanbul, Turkey
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Romano TG, Correia MDT, Mendes PV, Zampieri FG, Maciel AT, Park M. Metabolic acid-base adaptation triggered by acute persistent hypercapnia in mechanically ventilated patients with acute respiratory distress syndrome. Rev Bras Ter Intensiva 2017; 28:19-26. [PMID: 27096672 PMCID: PMC4828087 DOI: 10.5935/0103-507x.20160009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2015] [Accepted: 01/22/2016] [Indexed: 01/23/2023] Open
Abstract
Objective Hypercapnia resulting from protective ventilation in acute respiratory
distress syndrome triggers metabolic pH compensation, which is not entirely
characterized. We aimed to describe this metabolic compensation. Methods The data were retrieved from a prospective collected database. Variables
from patients' admission and from hypercapnia installation until the third
day after installation were gathered. Forty-one patients with acute
respiratory distress syndrome were analyzed, including twenty-six with
persistent hypercapnia (PaCO2 > 50mmHg > 24 hours) and 15
non-hypercapnic (control group). An acid-base quantitative physicochemical
approach was used for the analysis. Results The mean ages in the hypercapnic and control groups were 48 ± 18
years and 44 ± 14 years, respectively. After the induction of
hypercapnia, pH markedly decreased and gradually improved in the ensuing 72
hours, consistent with increases in the standard base excess. The metabolic
acid-base adaptation occurred because of decreases in the serum lactate and
strong ion gap and increases in the inorganic apparent strong ion
difference. Furthermore, the elevation in the inorganic apparent strong ion
difference occurred due to slight increases in serum sodium, magnesium,
potassium and calcium. Serum chloride did not decrease for up to 72 hours
after the initiation of hypercapnia. Conclusion In this explanatory study, the results indicate that metabolic acid-base
adaptation, which is triggered by acute persistent hypercapnia in patients
with acute respiratory distress syndrome, is complex. Furthermore, further
rapid increases in the standard base excess of hypercapnic patients involve
decreases in serum lactate and unmeasured anions and increases in the
inorganic apparent strong ion difference by means of slight increases in
serum sodium, magnesium, calcium, and potassium. Serum chloride is not
reduced.
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Affiliation(s)
- Thiago Gomes Romano
- Departamento de Nefrologia, Faculdade de Medicina do ABC, Santo André, SP, Brazil
| | - Mario Diego Teles Correia
- Unidade de Terapia Intensiva, Disciplina de Emergências Clínicas, Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | | | - Fernando Godinho Zampieri
- Unidade de Terapia Intensiva, Disciplina de Emergências Clínicas, Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | | | - Marcelo Park
- Unidade de Terapia Intensiva, Disciplina de Emergências Clínicas, Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
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Seifter JL, Chang HY. Disorders of Acid-Base Balance: New Perspectives. KIDNEY DISEASES (BASEL, SWITZERLAND) 2017; 2:170-186. [PMID: 28232934 PMCID: PMC5260542 DOI: 10.1159/000453028] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Revised: 11/26/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND Disorders of acid-base involve the complex interplay of many organ systems including brain, lungs, kidney, and liver. Compensations for acid-base disturbances within the brain are more complete, while limitations of compensations are more apparent for most systemic disorders. However, some of the limitations on compensations are necessary to survival, in that preservation of oxygenation, energy balance, cognition, electrolyte, and fluid balance are connected mechanistically. SUMMARY This review aims to give new and comprehensive perspective on understanding acid-base balance and identifying associated disorders. All metabolic acid-base disorders can be approached in the context of the relative losses or gains of electrolytes or a change in the anion gap in body fluids. Acid-base and electrolyte balance are connected not only at the cellular level but also in daily clinical practice. Urine chemistry is essential to understanding electrolyte excretion and renal compensations. KEY MESSAGES Many constructs are helpful to understand acid-base, but these models are not mutually exclusive. Electroneutrality and the close interconnection between electrolyte and acid-base balance are important concepts to apply in acid-base diagnoses. All models have complexity and shortcuts that can help in practice. There is no reason to dismiss any of the present constructs, and there is benefit in a combined approach.
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Affiliation(s)
- Julian L. Seifter
- Renal Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Hsin-Yun Chang
- Kaohsiung Medical University Hospital, Kaohsiung, Taiwan, ROC
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Sahin K, Orhan C, Tuzcu M, Muqbil I, Sahin N, Gencoglu H, Guler O, Padhye SB, Sarkar FH, Mohammad RM. Comparative in vivo evaluations of curcumin and its analog difluorinated curcumin against cisplatin-induced nephrotoxicity. Biol Trace Elem Res 2014; 157:156-63. [PMID: 24415068 DOI: 10.1007/s12011-014-9886-x] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2013] [Accepted: 01/01/2014] [Indexed: 12/12/2022]
Abstract
Curcumin, a polyphenol, has pharmacological effects including antioxidant, anti-inflammatory and anti-cancer features. In this study, we have performed comparative in vivo evaluations of CDF (curcumin difluorinated) and curcumin in cisplatin-induced nephrotoxicity in rats. Male Wistar rats were divided into four groups: (1) Control; (2) Cisplatin (7 mg/kg body wt, intraperitoneal as a single dose); (3) Cisplatin and CDF (50 mg/rat/day; for 12 days); (4) Cisplatin and curcumin (50 mg/rat/day), for 12 days). Cisplatin treated rats exhibited kidney injury manifested by increased serum N-urea and creatinine (P < 0.001). Kidney from cisplatin treated rats also exhibited significant increase in malondialdehyde (MDA) and 8-isoprostane levels (P < 0.001). Treatment with CDF and curcumin prevented the rise in serum N-urea, creatinine, MDA and 8-isoprostane as compared to experimental control group in kidney (P < 0.05). Compared to curcumin, CDF had greater potential in suppressing cisplatin-induced pro-inflammatory factors NF-κB and COX-2 as well as downstream markers Nrf2 and HO-1 (P < 0.05) in kidney. The analysis on anion transport markers (OAT1 and OAT3) showed a similar trend (CDF > curcumin). CDF could reduce the expression of multi-drug resistance markers OCT1, OCT2, MRP2 and MRP4 to a much greater extent than curcumin (P < 0.05). We also demonstrate that CDF influenced the expression of p-mTOR, p-p70S6K1, p-4E-BP1 and p-Akt. These data suggest that CDF can potentially be used to reduce the chemotherapy induced nephrotoxicity thereby enhancing the therapeutic window of cisplatin. The results also proved that compared to curcumin, CDF has superior protective effect in nephrotoxicity.
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Affiliation(s)
- Kazim Sahin
- Department of Animal Nutrition, Faculty of Veterinary Science, Firat University, Elazig, 23100, Turkey,
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Sawant OB, Ramadoss J, Hogan HA, Washburn SE. The role of acidemia in maternal binge alcohol-induced alterations in fetal bone functional properties. Alcohol Clin Exp Res 2013; 37:1476-82. [PMID: 23647364 DOI: 10.1111/acer.12118] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2012] [Accepted: 01/31/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND Heavy alcohol consumption during pregnancy negatively impacts the physical growth of the fetus. Although the deleterious effects of alcohol exposure during late gestation on fetal brain development are well documented, little is known about the effect on fetal bone mechanical properties or the underlying mechanisms. The purpose of this study was to investigate the effects of late gestational chronic binge alcohol consumption and alcohol-induced acidemia, a critical regulator of bone health, on functional properties of the fetal skeletal system. METHODS Suffolk ewes were mated and received intravenous infusions of saline or alcohol (1.75 g/kg) over 1 hour on 3 consecutive days per week followed by 4 days without treatment beginning on gestational day (GD) 109 and concluding on GD 132 (term = 147 days). The acidemia group was exposed to increased inspired fractional concentrations of CO2 to closely mimic the alcohol-induced decreases in maternal arterial pH seen in the alcohol group. RESULTS Fetal femurs and tibias from the alcohol and acidemia groups were ~3 to 7% shorter in length compared with the control groups (p < 0.05). Three-point bending procedure demonstrated that fetal femoral ultimate strength (MPa) for the alcohol group was decreased (p < 0.05) by ~24 and 29%, while the acidemia group exhibited a similar decrease (p < 0.05) of ~32 and 37% compared with the normal control and saline control groups, respectively. Bone extrinsic and intrinsic mechanical properties including maximum breaking force (N) and normalized breaking force (N/kg) of fetal bones from the alcohol and acidemia groups were significantly decreased (p < 0.05) compared with both control groups. CONCLUSIONS We conclude that late gestational chronic binge alcohol exposure reduces growth and impairs functional properties of the fetal skeletal system and that the repeated episodes of alcohol-induced maternal acidemia may be at least partially responsible for these effects.
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Affiliation(s)
- Onkar B Sawant
- Department of Veterinary Physiology and Pharmacology and Michael E. DeBakey Institute , College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, Texas
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