Sodium bicarbonate controversy in lactic acidosis

Warburg Effect Revisited: Embodiment of Classical Biochemistry and Organic Chemistry. Current State and Prospects

The Nobel Prize Winner (1931) Dr. Otto H. Warburg had established that the primary energy source of the cancer cell is aerobic glycolysis (the Warburg effect). He also postulated the hypothesis about "the prime cause of cancer", which is a matter of debate nowadays. Contrary to the hypothesis, his discovery was recognized entirely. However, the discovery had almost vanished in the heat of battle about the hypothesis. The prime cause of cancer is essential for the prevention and diagnosis, yet the effects that influence tumor growth are more important for cancer treatment. Due to the Warburg effect, a large amount of data has been accumulated on biochemical changes in the cell and the organism as a whole. Due to the Warburg effect, the recovery of normal biochemistry and oxygen respiration and the restoration of the work of mitochondria of cancer cells can inhibit tumor growth and lead to remission. Here, we review the current knowledge on the inhibition of abnormal glycolysis, neutralization of its consequences, and normalization of biochemical parameters, as well as recovery of oxygen respiration of a cancer cell and mitochondrial function from the point of view of classical biochemistry and organic chemistry.

Machine-learning Prediction of Hypo- and Hyperglycemia from Electronic Health Records: Algorithm Development and Validation

Background

Acute blood glucose (BG) decompensations (hypoglycemia and hyperglycemia) represent a frequent and significant risk for inpatients and adversely affect patient outcomes and safety. The increasing need for BG management in inpatients poses a high demand on clinical staff and health care systems in addition.

Objective

This study aimed to generate a broadly applicable multiclass classification model for predicting BG decompensation events from patients’ electronic health records to indicate where adjustments in patient monitoring and therapeutic interventions are required. This should allow for taking proactive measures before BG levels are derailed.

Methods

A retrospective cohort study was conducted on patients who were hospitalized at a tertiary hospital in Bern, Switzerland. Using patient details and routine data from electronic health records, a multiclass prediction model for BG decompensation events (<3.9 mmol/L [hypoglycemia] or >10, >13.9, or >16.7 mmol/L [representing different degrees of hyperglycemia]) was generated based on a second-level ensemble of gradient-boosted binary trees.

Results

A total of 63,579 hospital admissions of 38,250 patients were included in this study. The multiclass prediction model reached specificities of 93.7%, 98.9%, and 93.9% and sensitivities of 67.1%, 59%, and 63.6% for the main categories of interest, which were nondecompensated cases, hypoglycemia, or hyperglycemia, respectively. The median prediction horizon was 7 hours and 4 hours for hypoglycemia and hyperglycemia, respectively.

Conclusions

Electronic health records have the potential to reliably predict all types of BG decompensation. Readily available patient details and routine laboratory data can support the decisions for proactive interventions and thus help to reduce the detrimental health effects of hypoglycemia and hyperglycemia.

The Use of Sodium Bicarbonate in the Treatment of Acidosis in Sepsis: A Literature Update on a Long Term Debate

Introduction. Sepsis and its consequences such as metabolic acidosis are resulting in increased mortality. Although correction of metabolic acidosis with sodium bicarbonate seems a reasonable approach, there is ongoing debate regarding the role of bicarbonates as a therapeutic option. Methods. We conducted a PubMed literature search in order to identify published literature related to the effects of sodium bicarbonate treatment on metabolic acidosis due to sepsis. The search included all articles published in English in the last 35 years. Results. There is ongoing debate regarding the use of bicarbonates for the treatment of acidosis in sepsis, but there is a trend towards not using bicarbonate in sepsis patients with arterial blood gas pH > 7.15. Conclusions. Routine use of bicarbonate for treatment of severe acidemia and lactic acidosis due to sepsis is subject of controversy, and current opinion does not favor routine use of bicarbonates. However, available evidence is inconclusive, and more studies are required to determine the potential benefit, if any, of bicarbonate therapy in the sepsis patient with acidosis.

Lactic acidosis and colon cancer: oncologic emergency?

We report the case of a 44-year-old woman who presented shortly after the diagnosis of metastatic colon cancer with profound lactic acidosis in the absence of tissue hypoperfusion or hypoxemia. Her acid-base disturbance was unresponsive to medical management but resolved after initiation of systemic chemotherapy. In addition to malignancy associated lactic acidosis, this case illustrates several other issues, including factors involved in choosing the initial chemotherapy regimen and sequencing subsequent therapies, and the role of carcinoembryonic antigen (CEA) in following response to treatment. It is important to report this case of a rare but serious complication of malignancy in order to increase recognition and understanding of this presentation.

Enteric-coated solid dosage forms containing sodium bicarbonate as a drug substance: an exception from the rule?

Sodium bicarbonate (sodium hydrogen carbonate) is used as an oral medication in disorders such as mild metabolic acidosis and chronic kidney disease. The two commercial products on the German market, bicaNorm and Nephrotrans, and also newly developed multiple-unit pellet formulations, have been characterized in these investigations by in-vitro methods like disintegration and dissolution testing. Both marketed products containing sodium bicarbonate are of sufficient pharmaceutical quality according to the European Pharmacopoeia. However, they and the novel pellet preparations showed different drug release at moderately elevated pH values. Early drug release may cause dose dumping in the stomach and adverse drug effects from the developed carbon dioxide. The soft capsule preparation (Nephrotrans) released the smallest amount of sodium bicarbonate at pH 1 and 4.5 of all formulations tested. It appeared that oral dosage formulations of sodium bicarbonate were an exception to the rule: the monolithic soft capsule seemed to be superior to an enteric-coated tablet as well as to multiple-unit pellet formulations from the biopharmaceutical point of view. Our results correspond with individual reports on adverse effects from patients treated with the sodium bicarbonate products.

Severe lactic acidosis in a patient with B-cell lymphoma: a case report and review of the literature

Lactic acidosis is commonly observed in clinical situations such as shock and sepsis, as a result of tissue hypoperfusion and hypoxia. Lymphoma and leukemia are among other clinical situations where lactic acidosis has been reported. We present a case of a 59-year-old female with lactic acidosis who was found to have aggressive B-cell lymphoma. There have been 29 cases of lymphoma induced lactic acidosis reported thus far; however all reported cases have abnormal vital signs or concomitant medical conditions that may lead to lactic acidosis. The pathogenesis of malignancy-induced lactic acidosis is not well understood; however associated factors include increased glycolysis, increased lactate production by cancer cells, and decreased hepatic clearance of lactate. When it occurs, lactic acidosis is a poor prognostic sign in these patients. Prompt diagnosis and treatment of underlying lymphoma or leukemia remains the only way to achieve complete resolution of lactic acidosis in these patients.

Lactate in veterinary critical care: pathophysiology and management

The measurement of blood lactate in people has proven to be a useful tool in the diagnosis, monitoring, and prognosis of a wide range of clinical syndromes. Its use in small animals is increasing, and several studies have been completed that demonstrate its potential role in critical care. This article summarizes the current state of knowledge regarding the physiology and pathophysiology of lactate production and lactic acidosis; current indications and the utility of measurement in a critical care setting are described; novel applications in the evaluation of cavitary effusions are highlighted; and a guide to the therapy of lactic acidosis is presented.

Renal Replacement Therapy I: Indications and Timing

The indications for initiation of renal replacement therapy in acute renal failure are controversial. Although volume overload, metabolic acidosis, hyperkalemia and other electrolyte disturbances, and overt uremic manifestations are commonly accepted indications for renal replacement therapy, specific criteria for initiation of therapy based on these conditions are highly subjective. Progressive azotemia in the absence of overt uremia is another common indication for renal replacement therapy although there is no consensus on the degree of azotemia that warrants initiation of therapy. The clinical data regarding timing and initiation of renal support in patients who have acute renal failure are reviewed. Definitive resolution of the appropriate indications and timing for initiation of renal replacement therapy in acute renal failure requires prospective evaluation in a randomized clinical trial.

Uses and abuses of sodium bicarbonate in the neonatal intensive care unit

Despite the lack of evidence for its effectiveness in the treatment of acid-base disturbances in critically ill patients of all ages, and despite several lines of evidence that indicate it might be dangerous, bicarbonate therapy is used routinely in many neonatal intensive care units. The justification for the persistent use of this controversial therapy comes from a variety of sources, many based more in philosophy than in science. Clinicians contemplating the use of bicarbonate therapy should consider what they expect the intervention to accomplish and what evidence exists that their therapeutic objective will be met. Without rigorous scientific support for this therapy, it should be considered of unproven value and, therefore, experimental.