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Khan AH, Gai J, Faruque F, Bost JE, Patel AK, Pollack MM. Pediatric Mortality and Acute Kidney Injury Are Associated with Chloride Abnormalities in Intensive Care Units in the United States: A Multicenter Observational Study. J Pediatr Intensive Care 2020; 11:91-99. [DOI: 10.1055/s-0040-1719172] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 09/28/2020] [Indexed: 01/19/2023] Open
Abstract
AbstractOur objective was to determine in children in the intensive care unit (ICU) the incidence of hyperchloremia (>110 mmol/L) and hypochloremia (<98 mmol/L), the association of diagnoses with chloride abnormalities, and the associations of mortality and acute kidney injury (AKI) with chloride abnormalities. We analyzed the initial, maximum, and minimum chloride measurements of 14,684 children in the ICU with ≥1 chloride measurement in the Health Facts database between 2009 and 2016. For hyperchloremia and hypochloremia compared with normochloremia, mortality rates increased three to fivefold and AKI rates increased 1.5 to threefold. The highest mortality rate (7.7%; n = 95/1,234) occurred with hyperchloremia in the minimum chloride measurement group and the highest AKI rate (7.7%; n = 72/930) occurred with hypochloremia in the initial chloride measurement group. The most common diagnostic categories associated with chloride abnormalities were injury and poisoning; respiratory; central nervous system; infectious and parasitic diseases; and endocrine, nutritional, metabolic, and immunity disorders. Controlled for race, gender, age, and diagnostic categories, mortality odds ratios, and AKI odds ratios were significantly higher for hyperchloremia and hypochloremia compared with normochloremia. In conclusion, hyperchloremia and hypochloremia are independently associated with mortality and AKI in children in the ICU.
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Affiliation(s)
- Aamer H. Khan
- Division of Critical Care Medicine, Children's National Hospital, Washington, District of Columbia, United States
| | - Jiaxing Gai
- Division of Critical Care Medicine, Children's National Hospital, Washington, District of Columbia, United States
| | - Farhana Faruque
- Division of Critical Care Medicine, Children's National Hospital, Washington, District of Columbia, United States
| | - James E. Bost
- Division of Biostatistics and Study Methodology, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, United States
| | - Anita K. Patel
- Division of Critical Care Medicine, Children's National Hospital, Washington, District of Columbia, United States
- Division of Biostatistics and Study Methodology, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, United States
| | - Murray M. Pollack
- Division of Critical Care Medicine, Children's National Hospital, Washington, District of Columbia, United States
- Division of Biostatistics and Study Methodology, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, United States
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Abstract
Metabolic alkalosis defined by the increase of both plasma HCO3- level (>26 mmol/L) and blood arterial pH (>7.43) is quite frequent and usually accompanied by hypokalemia. Its pathogenesis requires both the generation of alkalosis and its maintenance. Generation may be due to excessive hydrogen ion loss by the gastrointestinal tract (e.g. vomiting) or by the kidney (e.g. use of loop diuretics) or may be due to exogenous base gain. Maintenance reflects the inability of the kidney to excrete the excess of bicarbonate because of hypovolemia, chloride depletion, hypokalemia, hyperaldosteronism, renal failure or a combination of these factors. The evaluation of volemic status and measurement of urinary Cl- and plasma levels of renin and aldosterone are crucial to identify the cause(s) of metabolic alkalosis. The cornerstone of treatment is the correction of existing depletions and the prevention of further losses. In vomiting-induced chloride depletion alkalosis, infusion of potassium chloride restores the excretion of bicarbonate by the kidney.
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Affiliation(s)
- Valentine Gillion
- Division of Nephrology, Cliniques universitaires Saint-Luc, Brussels, Belgium
| | - Michel Jadoul
- Institute of Physiology, University of Zurich, Zurich, Switzerland
| | - Olivier Devuyst
- Division of Nephrology, Cliniques universitaires Saint-Luc, Brussels, Belgium
- Institute of Physiology, University of Zurich, Zurich, Switzerland
| | - Jean-Michel Pochet
- Division of Nephrology, Cliniques universitaires Saint-Luc, Brussels, Belgium
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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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van Noord C, Zietse R, van den Dorpel MA, Hoorn EJ. The case ∣ a 62-year-old man with severe alkalosis. Kidney Int 2012; 81:711-2. [PMID: 22419048 DOI: 10.1038/ki.2011.447] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Charlotte van Noord
- Department of Internal Medicine, Maasstad Hospital, Rotterdam, The Netherlands.
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Ramadoss J, Stewart RH, Cudd TA. Acute renal response to rapid onset respiratory acidosis. Can J Physiol Pharmacol 2012; 89:227-31. [PMID: 21423296 DOI: 10.1139/y11-008] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Renal strong ion compensation to chronic respiratory acidosis has been established, but the nature of the response to acute respiratory acidosis is not well defined. We hypothesized that the response to acute respiratory acidosis in sheep is a rapid increase in the difference in renal fractional excretions of chloride and sodium (Fe(Cl) - Fe(Na)). Inspired CO(2) concentrations were increased for 1 h to significantly alter P(a)CO(2) and pH(a) from 32 ± 1 mm Hg and 7.52 ± 0.02 to 74 ± 2 mm Hg and 7.22 ± 0.02, respectively. Fe(Cl) - Fe(Na) increased significantly from 0.372 ± 0.206 to 1.240 ± 0.217% and returned to baseline at 2 h when P(a)CO(2) and pH(a) were 37 ± 0.6 mm Hg and 7.49 ± 0.01, respectively. Arterial pH and Fe(Cl) - Fe(Na) were significantly correlated. We conclude that the kidney responds rapidly to acute respiratory acidosis, within 30 min of onset, by differential reabsorption of sodium and chloride.
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Affiliation(s)
- Jayanth Ramadoss
- Department of Veterinary Physiology and Pharmacology, Michael E. DeBakey Institute, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, 77843, USA
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Dzierba AL, Abraham P. A practical approach to understanding acid-base abnormalities in critical illness. J Pharm Pract 2011; 24:17-26. [PMID: 21507871 DOI: 10.1177/0897190010388153] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Acid-base disorders are common in the critically ill. Arterial blood gas (ABG) analysis is frequently used to identify and manage acid-base disturbances. Using a systematic problem-solving approach to acid-base disturbances will facilitate the identification and assess the progression and severity of the metabolic and respiratory abnormality. The intent of this review is to examine acid-base physiology and regulation, provide a method to evaluate a patient's acid-base disorder, and provide therapeutic interventions.
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Affiliation(s)
- Amy L Dzierba
- NewYork-Presbyterian Hospital, Columbia University, New York, NY, USA.
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Bench-to-bedside review: Chloride in critical illness. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2010; 14:226. [PMID: 20663180 PMCID: PMC2945073 DOI: 10.1186/cc9052] [Citation(s) in RCA: 198] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Chloride is the principal anion in the extracellular fluid and is the second main contributor to plasma tonicity. Its concentration is frequently abnormal in intensive care unit patients, often as a consequence of fluid therapy. Yet chloride has received less attention than any other ion in the critical care literature. New insights into its physiological roles have emerged together with progress in understanding the structures and functions of chloride channels. In clinical practice, interest in a physicochemical approach to acid-base physiology has directed renewed attention to chloride as a major determinant of acid-base status. It has also indirectly helped to generate interest in other possible effects of disorders of chloraemia. The present review summarizes key aspects of chloride physiology, including its channels, as well as the clinical relevance of disorders of chloraemia. The paper also highlights current knowledge on the impact of different types of intravenous fluids on chloride concentration and the potential effects of such changes on organ physiology. Finally, the review examines the potential intensive care unit practice implications of a better understanding of chloride.
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REFSUM HE. Hypokalemic Alkalosis During Recovery from Compensated Respiratory Acidosis. Scandinavian Journal of Clinical and Laboratory Investigation 2009; 14:545-53. [PMID: 13973621 DOI: 10.3109/00365516209051277] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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de Seigneux S, Malte H, Dimke H, Frøkiaer J, Nielsen S, Frische S. Renal compensation to chronic hypoxic hypercapnia: downregulation of pendrin and adaptation of the proximal tubule. Am J Physiol Renal Physiol 2006; 292:F1256-66. [PMID: 17182533 DOI: 10.1152/ajprenal.00220.2006] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The molecular basis for the renal compensation to respiratory acidosis and specifically the role of pendrin in this condition are unclear. Therefore, we studied the adaptation of the proximal tubule and the collecting duct to respiratory acidosis. Male Wistar-Hannover rats were exposed to either hypercapnia and hypoxia [8% CO(2) and 13% O(2) (hypercapnic, n = 6) or normal air (controls, n = 6)] in an environmental chamber for 10 days and were killed under the same atmosphere. In hypercapnic rats, arterial pH was lower than controls (7.31 +/- 0.01 vs. 7.39 +/- 0.01, P = 0.03), blood HCO(3)(-) concentration was increased (42 +/- 0.9 vs. 32 +/- 0.24 mM, P < 0.001), arterial Pco(2) was increased (10.76 +/- 0.4 vs. 7.20 +/- 0.4 kPa, P < 0.001), and plasma chloride concentration was decreased (92.2 +/- 0.7 vs. 97.2 +/- 0.5 mM, P < 0.001). Plasma aldosterone levels were unchanged. In the proximal tubule, immunoblotting showed an increased expression of sodium/bicarbonate exchanger protein (188 +/- 22 vs. 100 +/- 11%, P = 0.005), confirmed by immunohistochemistry. Total Na/H exchanger protein expression in the cortex was unchanged by immunoblotting (119 +/- 10 vs. 100 +/- 11%, P = 0.27) and immunohistochemistry. In the cortex, the abundance of pendrin was decreased (51 +/- 9 vs. 100 +/- 7%, P = 0.003) by immunoblotting. Immunohistochemistry revealed that this decrease was clear in both cortical collecting ducts (CCDs) and connecting tubules (CNTs). This demonstrates that pendrin expression can be regulated in acidotic animals with no changes in aldosterone levels and no external chloride load. This reduction of pendrin expression may help in redirecting the CNT and CCD toward chloride excretion and bicarbonate reabsorption, contributing to the increased plasma bicarbonate and decreased plasma chloride of chronic respiratory acidosis.
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Affiliation(s)
- Sophie de Seigneux
- The Water and Salt Research Center, Institute of Anatomy, Bldg. 1234, Univ. of Aarhus, DK-8000 Aarhus C, Denmark
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Affiliation(s)
- John H Galla
- Division of Nephrology and Hypertension, Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio
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TOUSSAINT C, TELERMAN M, VEREERSTRAETEN P. Bicarbonate excretion after prolonged exposure to carbon dioxide in the normal dog. ACTA ACUST UNITED AC 1998; 15:434-6. [PMID: 13839063 DOI: 10.1007/bf02157700] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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12
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POLAK A, HAYNIE GD, HAYS RM, SCHWARTZ WB. Effects of chronic hypercapnia on electrolyte and acid-base equilibrium. I. Adaptation. J Clin Invest 1998; 40:1223-37. [PMID: 13736670 PMCID: PMC290836 DOI: 10.1172/jci104353] [Citation(s) in RCA: 97] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
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SCHWARTZ WB, HAYS RM, POLAK A, HAYNIE GD. Effects of chronic hypercapnia on electrolyte and acid-base equilibrium. II. Recovery, with special reference to the influence of chloride intake. J Clin Invest 1998; 40:1238-49. [PMID: 13749130 PMCID: PMC290837 DOI: 10.1172/jci104354] [Citation(s) in RCA: 74] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Sasaki S, Yoshiyama N. Interaction of chloride and bicarbonate transport across the basolateral membrane of rabbit proximal straight tubule. Evidence for sodium coupled chloride/bicarbonate exchange. J Clin Invest 1988; 81:1004-11. [PMID: 2450891 PMCID: PMC329624 DOI: 10.1172/jci113410] [Citation(s) in RCA: 45] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
The existence of chloride/bicarbonate exchange across the basolateral membrane and its physiologic significance were examined in rabbit proximal tubules. S2 segments of the proximal straight tubule were perfused in vitro and changes in intracellular pH (pHi) and chloride activity (aCli) were monitored by double-barreled microelectrodes. Total peritubular chloride replacement with gluconate increased pHi by 0.8, and this change was inhibited by a pretreatment with an anion transport inhibitor, SITS. Peritubular bicarbonate reduction increased aCli, and most of this increase was lost when ambient sodium was totally removed. The reduction rates of pHi induced by a peritubular bicarbonate reduction or sodium removal were attenuated by 20% by withdrawal of ambient chloride. SITS application to the bath in the control condition quickly increased pHi, but did not change aCli. However, the aCli slightly decreased in response to SITS when the basolateral bicarbonate efflux was increased by reducing peritubular bicarbonate concentration. It is concluded that sodium coupled chloride/bicarbonate exchange is present in parallel with sodium-bicarbonate cotransport in the basolateral membrane of the rabbit proximal tubule, and it contributes to the basolateral bicarbonate and chloride transport.
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Affiliation(s)
- S Sasaki
- Department of Internal Medicine, Tokyo Medical and Dental University, Japan
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17
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Abstract
The metabolic pathways involved in renal ammonia production have been considered and potential sites of regulatory control have been delineated. New information that acute acidosis stimulates renal ammonia production and that chronic respiratory acidosis does not result in an adaptive increase in the renal capacity to produce ammonia has been emphasized. The effect of potassium on renal ammonia production and the physiologic and pathophysiologic implication of this relationship have been detailed. Finally, the mechanism of urinary ammonium excretion and the impact of altered ammoniagenesis on urinary acidification, and the interpretation of clinical acidification tests have been discussed.
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Hansen AC, Wamberg S, Engel K, Kildeberg P. Balance of net base in the rat: adaptation to and recovery from sustained hypercapnia. Scand J Clin Lab Invest 1979; 39:723-30. [PMID: 531494 DOI: 10.1080/00365517909108163] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Net base and mineral balances were evaluated in a group of male 350 g Wistar rats exposed to 10% carbon dioxide in air for 10 days with a view to identifying the source of net base subject to retention during renal compensation of sustained respiratory acidosis. In response to hypercapnia, the rate of renal net acid excretion rose but insignificantly. However, a rise in whole body net base concentration from about 215 mmol/kg to about 250 mmol/kg came about by ongoing gastrointestinal absorption in the weight-losing animal, absorbed net base being distributed to extracellular and non-extracellular compartments of the body, presumably including bone. During an 8-day recovery period, a small decrement in whole body net base concentration was observed.
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Webb RK, Woodhall PB, Tisher CC, Glaubiger G, Neelon FA, Robinson RR. Relationship between phosphaluria and acute hypercapnia in the rat. J Clin Invest 1977; 60:829-37. [PMID: 19498 PMCID: PMC372431 DOI: 10.1172/jci108837] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Standard clearance studies were performed in mechanically ventilated intact and acutely thyroparathyroidectomized (TPTX) rats to document and characterize the effect of hypercapnia (HC) on urinary phosphorus excretion (U(P)V). HC as compared to normocapnia (NC) was associated with an increase in U(P)V in intact (62.5 vs. 7.93 mug/min) and TPTX (30.5 vs. 0.59 mug/min) rats, an increase in filtered load of phosphorus in intact (218 vs. 191 mug/min) and TPTX (243 vs. 146 mug/min) rats, an increase in blood bicarbonate concentration in intact (27.8 vs. 26.0 meq/liter) and TPTX (24.5 vs. 22.3 meq/liter) animals, and a decrease in blood pH in intact (7.15 vs. 7.42) and TPTX (7.07 vs. 7.39) rats. Additional TPTX rats with NC and HC were studied during phosphorus infusion at a comparable filtered load of phosphorus (NC = 307 mug/min and HC = 328 mug/min). U(P)V was 18.5 mug/min in NC and 85.2 mug/min in HC animals. Intact NC animals infused with NaHCO(3) achieved a blood bicarbonate of 45.9 meq/liter compared to 26.0 meq/liter in intact NC NaCl-infused rats. U(P)V was 10.0 mug/min in the NaHCO(3) and 7.93 mug/min in NaCl-infused animals. In intact HC animals infused with NaHCO(3), blood pH was 7.36 compared to 7.42 in NC intact NaCl-infused animals. U(P)V was 83.2 mug/min in the HC bicarbonate-infused and 7.93 mug/min in the NC NaCl-infused rats. These experiments demonstrate that elevated blood carbon dioxide tension per se increases U(P)V. Increases in filtered load of phosphorus and blood bicarbonate which are associated with HC contribute to the phosphaturia as does parathyroid hormone. The phosphaturia is not dependent upon reduction of extracellular pH.
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Sanyal SK, Ghosh K, Nigam R, Sarkar D, Madhavan S. Biochemical aspects of congestive heart failure in children. II. J Pediatr 1974; 84:650-5. [PMID: 4820700 DOI: 10.1016/s0022-3476(74)80004-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Turino GM, Goldring RM, Heinemann HO. Renal response to mechanical ventilation in patients with chronic hypercapnia. Am J Med 1974; 56:151-61. [PMID: 4521389 DOI: 10.1016/0002-9343(74)90592-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Lai YL, Martin ED, Attebery BA, Brown EB. Mechanisms of extracellular pH adjustments in hypercapnia. RESPIRATION PHYSIOLOGY 1973; 19:107-14. [PMID: 4763075 DOI: 10.1016/0034-5687(73)90069-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Goldring RM, Turino GM, Heinemann HO. Respiratory-renal adjustments in chronic hypercapnia in man. Extracellular bicarbonate concentration and the regulation of ventilation. Am J Med 1971; 51:772-84. [PMID: 5129545 DOI: 10.1016/0002-9343(71)90305-6] [Citation(s) in RCA: 44] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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Sanyal SK, Ghosh K, Nigam R, Sarkar D, Madhavan S. The biochemical aspects of congestive heart failure in children. I. J Pediatr 1971; 79:250-4. [PMID: 5560047 DOI: 10.1016/s0022-3476(71)80109-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Luke RG, Levitin H. The renal and electrolyte response to respiratory acidosis in the adrenalectomized rat. THE YALE JOURNAL OF BIOLOGY AND MEDICINE 1966; 39:27-37. [PMID: 5975535 PMCID: PMC2591236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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HUTCHIN P, McLAUGHLIN JS, HAYES MA. Renal response to acidosis during anesthesia and operation. III. Maintenance of homeostasis in acute respiratory acidosis during intravenous infusion of Ringer's Lactate and 5 percent glucose in water. Ann Surg 1961; 154:161-80. [PMID: 13717044 PMCID: PMC1465873 DOI: 10.1097/00000658-196108000-00002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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TOUSSAINT C, VEREERSTRAETEN P. Effects of stimulation and inhibition of bicarbonate reabsorption on the renal tubular transport of sodium and chloride in the dog. Cell Mol Life Sci 1961; 17:81-2. [PMID: 13777736 DOI: 10.1007/bf02171435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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