The effect of acute respiratory acidosis on the internal equilibrium of potassium

Blood Gas Disturbances and Disproportionate Body Weight Distribution in Broilers With Wooden Breast

Wooden breast syndrome is a widespread and economically important myopathy and vasculopathy of fast growing, commercial broiler chickens, primarily affecting birds with high feed efficiency and large breast muscle yield. To investigate potential systemic physiological differences between birds affected and unaffected by wooden breast, a total of 103 market-age Cobb 500 broilers were sampled for 13 blood parameters and the relative weights of the pectoralis major muscle, pectoralis minor muscle, external oblique muscle, wing, heart, lungs, liver, and spleen. Blood analysis was performed on samples taken from the brachial vein of live birds and revealed significant differences in venous blood gases between affected and unaffected chickens. Chickens with wooden breast exhibited significantly higher potassium (K⁺) and lower partial pressure of oxygen (pO₂), oxygen saturation (sO2), and pH. Additionally, affected males had significantly higher partial pressure of carbon dioxide (pCO₂) and total carbon dioxide (TCO₂) than unaffected males. Wooden breast affected broilers also possessed a significantly heavier pectoralis major muscle and whole feathered wing compared to unaffected broilers. Blood gas disturbances characterized by high pCO₂ and low pH are indicative of insufficient respiratory gas exchange, suggesting that wooden breast affected broilers have an elevated metabolic rate that may also be inadequately compensated due to cardiovascular deficiencies such as poor venous return or respiratory insufficiency. Lung tissues from 12 birds with extreme sO₂ values were subsequently examined to assess whether lung pathology contributed to the observed blood gas disturbance. Comparison of lung morphology between affected and unaffected birds revealed no apparent differences that could contribute to decreased parabronchial gas exchange. However, an interesting finding was the detection of pulmonary phlebitis in one of the wooden breast-affected samples consistent with vascular changes observed in pectoralis major muscle exhibiting the wooden breast phenotype. Our results suggest that the effects of wooden breast are not limited to the pectoralis major muscle and further indicate the importance of research into metabolic changes associated with the myopathy.

Effects of intravenous administration of dimethyl sulfoxide on cardiopulmonary and clinicopathologic variables in awake or halothane-anesthetized horses

OBJECTIVE

To evaluate the cardiopulmonary and clinicopathologic effects of rapid IV administration of dimethyl sulfoxide (DMSO) in awake and halothane-anesthetized horses.

DESIGN

Prospective study.

ANIMALS

6 adult horses.

PROCEDURES

Horses received IV infusion of 5 L of a balanced electrolyte solution with and without 1 g/kg (0.45 g/lb) of 10% DMSO solution when they were awake and anesthetized with halothane (4 treatments/horse). Arterial and venous blood samples were collected immediately before and at intervals during or after fluid administration and analyzed for blood gases and hematologic and serum biochemical variables, respectively. Heart rate, respiratory rate, and arterial blood pressure variables were recorded prior to, during, and after fluid administration.

RESULTS

After administration of fluid with or without DMSO, changes in measured variables were detected immediately, but most variables returned to baseline values within 4 hours. One awake control horse had signs of anxiety; agitation and tachycardia were detected in 2 awake horses administered DMSO. These clinical signs disappeared when the rate of infusion was reduced. In anesthetized horses, increased concentrations of WBCs and plasma fibrinogen and serum creatine kinase activity persisted for 24 hours, which was related to the stress of anesthesia more than the effects of fluid administration.

CONCLUSIONS AND CLINICAL RELEVANCE

Infusion of 5 L of balanced electrolyte solution with or without 10% DMSO induced minimal changes in cardiopulmonary function and clinicopathologic variables in either awake or halothane-anesthetized horses. Stress associated with anesthesia and recovery had a greater influence on measured variables in anesthetized horses than fluid administration.

A comparative analysis of molar sodium lactate and other agents in the treatment of induced hyperkalemia in nephrectomized dogs

Molar sodium lactate, sodium bicarbonate, sodium chloride, glucose insulin, and calcium chloride were used in the treatment of induced hyperkalemia in nephrectomized dogs. The effect of these agents on the electrocardiogram and on potassium partition was studied. Molar sodium lactate appeared to be the agent of choice in the treatment of the hyperkalemic state under these experimental conditions.

Effect of prolonged bicarbonate administration on plasma potassium in terminal renal failure

In hemodialysis patients with hyperkalemia, i.v. sodium bicarbonate has recently been found to be ineffective in lowering plasma potassium within one hour. In the present study the effect of a prolonged bicarbonate infusion on plasma potassium was investigated. Twelve patients with terminal renal failure who were on hemodialysis were infused i.v. with 8.4% sodium bicarbonate (4 mmol/min) for one hour and with 1.4% (0.5 mmol/min) for five hours (total amount 390 mmol). Plasma bicarbonate rose from 17.5 at baseline to 28.4 and 29.6 mmol/liter, and blood pH from 7.32 to 7.46 and 7.48 at one and six hours, respectively. Plasma potassium did not change significantly after one and two hours (6.04 at baseline, 5.91 and 5.77 mmol/liter, respectively). Only at four and six hours did a moderate decline to 5.44 (P less than 0.05) and to 5.30 (P less than 0.01) occur, of which approximately half was calculated to be due to ECF volume expansion. However, no change or a very moderate decrease was observed in three patients even after six hours (+0.19, -0.32, -0.33 mmol/liter). Five patients with higher baseline plasma potassium (6.15 to 8.15 mmol/liter) behaved like seven with lower levels (5.25 to 5.87 mmol/liter). Tented T-waves in the ECG of seven patients disappeared after one hour only in one patient. Plasma aldosterone, norepinephrine and epinephrine were normal to elevated before and tended to fall during i.v. bicarbonate. Plasma dopamine and insulin were in the normal range.(ABSTRACT TRUNCATED AT 250 WORDS)

Effects of acute hyperventilation on serum potassium in the dog

The effects of increasing respiratory rates on arterial pH, PaCO2, HCO3, and potassium (K) were measured in normal anesthetized dogs. Hyperventilation resulted in increased pH, decreased PaCO2, decreased HCO3, and decreased K compared with those parameters in spontaneously breathing dogs. The changes were related quantitatively: each 10 mmHg decrease in PaCO2 was associated with a pH increase of 0.1, a HCO3 decrease of 2.0 mEq/L, and a K decrease of 0.4 mEq/L. There were no cardiac arrhythmias or clinical signs of hypokalemia. After termination of hyperventilation, serum K was slower to return to control values than PaCO2. The ratio of the duration of hyperventilation to the time required for return of serum K to control was 0.67.

Effect of various therapeutic approaches on plasma potassium and major regulating factors in terminal renal failure

PURPOSE

The development of life-threatening hyperkalemia poses a risk for patients with chronic preterminal renal failure. Various therapeutic options have been suggested for hyperkalemic emergencies in these patients; to date, however, no study has evaluated the relative efficacies of these measures in the presence of renal failure. Our goal was to examine the acute effects of a variety of therapeutic approaches, as well as those of hemodialysis, on plasma potassium levels in a hemodialysis population.

PATIENTS AND METHODS

Ten patients with terminal renal failure undergoing maintenance hemodialysis were enrolled in the study. Blood gas parameters and plasma sodium, potassium, glucose, osmolality, renin, aldosterone, epinephrine, norepinephrine, dopamine, and insulin were measured before, during, and after 60-minute infusions of bicarbonate, epinephrine, and insulin in glucose, and before, during, and after performance of regular hemodialysis for one hour.

RESULTS

Hypertonic as well as isotonic intravenous bicarbonate (2 to 4 mmol/minute) induced a marked rise in plasma bicarbonate and pH, but failed to lower the plasma potassium level (5.66 versus 5.83 mmol/liter before and after). Epinephrine, 0.05 microgram/kg/minute administered intravenously, decreased plasma potassium only slightly from 5.57 to 5.25 mmol/liter, and five patients showed no decline. On the other hand, insulin in glucose, 5 mU/kg/minute intravenously, effectively lowered plasma potassium levels from 5.62 to 4.70 mmol/liter, and hemodialysis induced the most rapid decline from 5.63 to 4.29 mmol/liter. Plasma aldosterone was elevated before treatment; it correlated with plasma potassium and dropped during intravenous bicarbonate administration or hemodialysis. Pretreatment plasma renin activity, insulin, epinephrine, norepinephrine, and dopamine levels were generally normal.

CONCLUSION

We conclude that in patients with terminal renal failure undergoing maintenance hemodialysis, intravenous bicarbonate is ineffective in lowering plasma potassium rapidly, and epinephrine is effective in only half the patients, whereas insulin in glucose is a fast and reliable form of therapy for hyperkalemic emergencies. Plasma aldosterone levels are appropriate in relationship to plasma potassium levels, and levels of other potassium-influencing hormones are generally normal.

The distribution of potassium, sodium and chloride across the apical membrane of renal tubular cells: effect of acute metabolic alkalosis

Studies were undertaken to define the effect of acute metabolic alkalosis (hypertonic sodium bicarbonate i.v.) on the chemical gradients for potassium, sodium and chloride across the apical membrane of individual renal tubule cells. Electron microprobe analysis was used on freeze-dried cryosections of the rat renal cortex to measure electrolyte concentrations in proximal tubule cells and in the various cell types of the superficial distal tubule. Analyses were also performed in fluid samples obtained by micropuncture from proximal and early and late distal collection sites. Compared with the appropriate controls (hypertonic sodium chloride i.v.), administration of sodium bicarbonate resulted only in small and mostly insignificant increases in cell potassium concentrations and induced only minor alterations in the cell/tubule fluid potassium concentration gradient for all cell types analysed. This observation suggests that under this condition factors other than an increase in cell potassium concentration are important in modulating potassium transfer across the apical membrane of potassium secreting cells. Nevertheless, since in alkalosis phosphorus and cell dry weight were decreased, and hence cell volume increased, in all but the intercalated cells, actually the potassium content of most tubular cells was higher under this condition. In comparison with animals infused with isotonic saline at low rates (hydropenic controls), infusion of either hypertonic sodium chloride or sodium bicarbonate led to a sharp increase in distal tubule fluid sodium concentrations and in the sodium concentrations of distal convoluted tubule, connecting tubule and principal cells, indicating that under both conditions the primary event causing enhanced transepithelial sodium absorption is stimulation of the sodium entry step.(ABSTRACT TRUNCATED AT 250 WORDS)

Electrolyte disorders in the elderly

Normal human ageing impairs homeostatic mechanisms in such a way as to exaggerate and prolong the effects of stress. Thus, an event--pathological or traumatic--which produces a trivial change in plasma electrolytes of young people may produce major oscillations of plasma levels in the elderly, which take much longer to return to 'normal levels'. This is especially apparent with perturbations in the plasma levels of sodium and potassium, mainly due to changes in renal function and neurohumeral mechanisms which occur with increasing age. Paradoxically this does not mean that the clinician should be over-enthusiastic in attempting to correct electrolyte imbalance because, for the same reasons, the danger of over-treatment producing the opposite and equally dangerous electrolyte imbalance is ever-present. Indeed, in clinical practice most electrolyte disturbances in old age are iatrogenic in origin. Cautious patience and vigilance should be the clinical approach with elderly patients. A high index of suspicion should lead to a careful appraisal of the drug (diuretic, intravenous fluid) and environmental (dehydration) aetiology of most electrolyte disturbances in old age.

Hyperpotassemia during massive blood transfusions

Eleven of 21 patients having received more than 10 units of whole blood developed hyperpotassemia during the rapid phase of transfusion. The increase in serum potassium from initial values correlated well (r = 0.74) with the rate of the transfusion. Three of the hyperpotassemic patients developed cardiac arrest but no life-threatening arrhythmias were registered in the normokalemic patients. In contrast to most previous studies, transient hyperpotassemia often necessitating aggressive therapy was quite common in our massively transfused patients.

Local vasoactivity of oxygen and carbon dioxide in the right coronary circulation of the dog and pig

1. Eight mongrel dogs were anaesthetized with sodium thiamylal and chloralose-urethane, ventilated, vagotomized and heparinized. Five Poland-China pigs were anaesthetized with sodium thiamylal and nitrous oxide, ventilated, vagotomized and heparinized. 2. Extracorporeal perfusion of the right coronary artery at constant pressure (100 mmHg) was instituted. A lung from a donor animal was interposed in the coronary perfusion circuit to effect changes in CO2 and O2 tensions in the coronary arterial blood while systemic blood gases were maintained at normal levels. 3. Local hypoxia (PO2 range 17-22 mmHg) produced a 25-75% decrease in coronary vascular resistance (P less than 0.05) and a 0-24% (not significant) decrease in right ventricular dP/dt. 4. Local changes in PCO2 over the range 8-105 mmHg were associated with a 17-58% decrease in coronary vascular resistance (P less than 0.05), a 19-24% decrease in right ventricular dP/dt (P less than 0.05) with no change in right ventricular end-diastolic pressure, and a 1-18% (not significant) decrease in heart rate. 5. These studies suggest that local decreases in O2 or increases in CO2 tensions produce decreases in right coronary vascular resistance that are in the opposite direction to those that would be expected from the observed changes in heart rate and contractility (two primary determinants of myocardial oxygen consumption). 6. These data support the hypothesis that CO2 and O2 are locally vasoactive in the coronary circulation.

The influence of fazadinium on the potassium efflux produced by succinylcholine

Succinylcholine-induced potassium efflux was studied in two groups of healthy adult patients presenting for elective surgery. One group (Group 1) of 12 patients received alfathesin induction followed by succinylcholine. The other group (Group 2) of 12 patients were pre-treated with fazadinium 0.075 mg . kg-1 about three minutes before administration of alfathesin and succinylcholine. Serial blood samples were taken pre-induction, post-induction and after succinylcholine for estimation of plasma potassium. The results show that pre-treatment with fazadinium 0.075 mg . kg-1 was effective in preventing succinylcholine-induced potassium efflux.

Dynamics of serum potassium change during acute respiratory alkalosis

In summary, one should be aware that hyperventilation and hypokalaemia occur frequently in the operating room under ordinary clinical conditions. An awareness of the rapidity with which these changes occur, and their extent as well as their potential hazards, should cause consideration of more aggressive attempts to maintain normocarbia and to use supplemental potassium during anaesthesia, particularly in patients with cardiac disease.

Effects of acute hypercapnia and hypocapnia on plasma and red cell potassium, blood lactate and base excess in man during anesthesia

In order to test the relationship between changes in plasma potassium concentration and pH changes of respiratory origin, we produced hypercapnia (mean PaCO2 71 mmHg = 9.5 kPa) in a group of 17 patients and hypocapnia (mean PaCO2 21 mmHg = 2.8 kPa) in another 20 patients during neurolept analgesia and intraabdominal operations. A control group of 19 patients was studied under normocapnia but otherwise identical conditions. During hypercapnia, serum potassium rose, deltaK/deltapH amounting to -0.82, -1.05 and -1.34 after 30, 60 and 90 min, respectively. During hypocapnia, serum potassium decreased, deltaK/deltapH being a little more negative than during hypercapnia (mean values -1.62, -2.44 and -1.60). Red cell potassium concentration decreased in all three groups to a similar extent. Blood lactate levels during hypercapnia decreased to 75% of control and during hypocapnia rose to a maximum of 186% of control. In order to obtain reasonable values for base excess in primarily respiratory acid-base disorders, it is necessary to use nomograms based on in vivo ECF-CO2-titration curves. With this premise, hypercapnia or hypocapnia in our patients was not associated with significant changes in base excess.

Potassium metabolism

In man, mechanisms for potassium excretion are complex and highly developed, while potassium conservation is potentially inadequate. Potassium balance is regulated by alterations in excretion in the distal renal tubule, where mineralocorticoid hormones and Na-K ATPase are the major regulating factors. The distribution of potassium across cell membranes is influenced by changes in acid-base status, by pancreatic hormones and by the autonomic nervous system. Potassium stimulates insulin and aldosterone secretion and increases Na-K ATPase in the distal nephron, so promoting its own redistribution or excretion. Emergency management of hyperkalaemia is best effected by promoting cell-entry of potassium, rather than renal excretion. The speed of replacement of deficits is always limited by the small extracellular potassium pool.

Correction of hyperkalemia by bicarbonate despite constant blood pH

Patients having hyperkalemia often are given bicarbonate to raise blood pH and shift extracellular potassium into cells. Blood pH in many hyperkalemic patients, however, is compensated. To determine whether bicarbonate, independent of its pH action, affects plasma potassium, 14 hyperkalemic patients were treated with bicarbonate in 5% dextrose. In five patients (changed pH group), blood pH rose at least 0.08, while in nine (constant pH group), it changed less than 0.04. In the first group, pH rose 0.12, bicarbonate rose 5.9 mEq/liter, and plasma potassium fell 1.6 mEq/liter, and plasma potassium fell 1.4 mEq/liter. The correlation between changes in plasma potassium and bicarbonate was identical in the two groups and independent of urinary potassium excretion. Four additional patients, who were treated with 5% dextrose alone, did not significantly lower their plasma potassium, although subsequent treatment with bicarbonate in 5% dextrose lowered their plasma potassium. Thus, bicarbonate lowers plasma potassium, independent of its effect on blood pH, and despite a risk of volume overload, should be used to treat hyperkalemia in compensated acid-base disorders, even in the presence of renal failure, provided the plasma bicarbonate concentration is decreased.

Potassium and intracellular pH

Recent work has clarified some of the complex interrelationships between cell pH and potassium. These studies have been limited by the techniques available for accurately measuring cell pH. At present it is obvious that intracellular pH is a major regulator of the cellular potassium concentration, but the precise relationship between these two is still uncertain. It has become increasingly clear, however, that no simple relationship exists between the intracellular to extracellular hydrogen ion and potassium ion ratios. Many experiments do demonstrate that the extracellular metabolic alkalosis of potassium depletion is accompanied by a decrease in skeletal muscle pH in rat, rabbit, and probably dog. The response of cardiac and renal tubular cell pH to potassium depletion is less clear, although most evidence indicates that there is also a reduction in the pH of these tissues. This effect on cell pH appears to be independent of chloride. By contrast, hyperkalemia seems to raise muscle cell pH at the same time it induces an extracellular metabolic acidosis. The metabolic and physiologic consequences of potassium-induced alterations in cell pH have yet to be fully elucidated.

The effect of mild hyperventilation on red cell sodium

Control subjects voluntarily overbreathed to produce end-tidal PCO2 levels similar to those found in patients suffering from neurotic or endogenous non-retarded depression. Red cell sodium content was found to decrease during overbreathing in all the subjects. The changes were similar to those usually reported for depressed patients. The results imply that red cell sodium levels are in part dependent on respiratory behaviour. They suggest a need for considerable caution in interpreting red cell sodium values from psychiatric patients.

Isohydric regulation of plasma potassium by bicarbonate in the rat

pH and bicarbonate affect many metabolic reactions but each may change independently. To study bicarbonate's effect onplasma potassium, blood bicarbonate in normal, hypokalemic or hyperkalemic rats was either maintained constant, lowered by hydrochloric acid or raised by sodium bicarbonate administraion. Blood pH was maintained constant by changing PCO2. In normokalemia lowering bicarbonate increased plasma potassium 2.0mEq above values obtained in the other groups. To eliminate urinary potassium losses, experiments were also performed in rats with bilateral ureteral ligation. Again, plasma potassium concentration rose significantly more in the lowered bicarbonate group. Similarly, in hypokalemia, plasma potassium rose 1.2 and 0.4mEq in the lowered and unchanged groups, but fell 0.2mEq/liter in the elevated group. Differences could not be ascribed to renal potassium losses as potassium excretion was essentially zero in each group. In hyperkalemia, plasma potassium concentration remained elevated for 150 min in the lowered bicarbonate group but fell 1.3 and 2.0mEq in the unchanged and elevated groups, respectively. Urinary potassium losses in the three groups were statistically identical. In all experiments blood pH was maintained unchanged during the experiment. The data show that bicarbonate, independent of blood pH, alters transcellular potassium distribution suggesting the usefulness of bicarbonate therapy in hyperkalemia even at a compensated blood pH.

Effects of CO2 on transmembrane potentials of rat liver and muscle in vivo

1. The effects of increasing the inspired CO(2) concentration on the transmembrane resting potential (RP), intracellular electrolytes, and cell pH of rat liver and muscle were studied.2. Elevation of CO(2) produced a rapid reversible fall in hepatic RP. This effect is mediated by a decrease in plasma pH and is in part due to hypoxia.3. The decrease in hepatic RP could not be accounted for by shifts in electrolytes, and an effect on membrane permeability is suggested.4. The hepatic RP was also found to be decreased by hypoxia and increased by hyperoxia.5. Muscle RP showed no immediate change in response to CO(2) but after 60 min there was significant depolarization. This effect could be accounted for on the basis of electrolyte shifts between cells and plasma, by use of the Goldman equation.6. Cell pH data showed that liver is buffered approximately threefold more than skeletal muscle.7. While intracellular pH fell in response to CO(2) the H(+) gradient remained constant in muscle and increased in liver.

Electrocardiogram in Asiatic cholera. Separated studies of effects of hypovolaemia, acidosis, and potassium loss

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