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Bourgeois S, Houillier P. State of knowledge on ammonia handling by the kidney. Pflugers Arch 2024; 476:517-531. [PMID: 38448728 PMCID: PMC11006756 DOI: 10.1007/s00424-024-02940-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 02/28/2024] [Accepted: 03/01/2024] [Indexed: 03/08/2024]
Abstract
The disposal of ammonia, the main proton buffer in the urine, is important for acid-base homeostasis. Renal ammonia excretion is the predominant contributor to renal net acid excretion, both under basal condition and in response to acidosis. New insights into the mechanisms of renal ammonia production and transport have been gained in the past decades. Ammonia is the only urinary solute known to be produced in the kidney and selectively transported through the different parts of the nephron. Both molecular forms of total ammonia, NH3 and NH4+, are transported by specific proteins. Proximal tubular ammoniagenesis and the activity of these transport processes determine the eventual fate of total ammonia produced and excreted by the kidney. In this review, we summarized the state of the art of ammonia handling by the kidney and highlighted the newest processes described in the last decade.
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Affiliation(s)
- Soline Bourgeois
- Institut of Physiology, University of Zurich, Zurich, Switzerland.
| | - Pascal Houillier
- Centre de Recherche Des Cordeliers, INSERM, Sorbonne Université, Université Paris Cité, Paris, France
- Centre National de La Recherche Scientifique (CNRS), EMR 8228, Paris, France
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2
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Nagami GT, Kraut JA. The Role of the Endocrine System in the Regulation of Acid-Base Balance by the Kidney and the Progression of Chronic Kidney Disease. Int J Mol Sci 2024; 25:2420. [PMID: 38397097 PMCID: PMC10889389 DOI: 10.3390/ijms25042420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 02/07/2024] [Accepted: 02/16/2024] [Indexed: 02/25/2024] Open
Abstract
Systemic acid-base status is primarily determined by the interplay of net acid production (NEAP) arising from metabolism of ingested food stuffs, buffering of NEAP in tissues, generation of bicarbonate by the kidney, and capture of any bicarbonate filtered by the kidney. In chronic kidney disease (CKD), acid retention may occur when dietary acid production is not balanced by bicarbonate generation by the diseased kidney. Hormones including aldosterone, angiotensin II, endothelin, PTH, glucocorticoids, insulin, thyroid hormone, and growth hormone can affect acid-base balance in different ways. The levels of some hormones such as aldosterone, angiotensin II and endothelin are increased with acid accumulation and contribute to an adaptive increase in renal acid excretion and bicarbonate generation. However, the persistent elevated levels of these hormones can damage the kidney and accelerate progression of CKD. Measures to slow the progression of CKD have included administration of medications which inhibit the production or action of deleterious hormones. However, since metabolic acidosis accompanying CKD stimulates the secretion of several of these hormones, treatment of CKD should also include administration of base to correct the metabolic acidosis.
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Affiliation(s)
- Glenn T. Nagami
- Nephrology Section, VA Greater Los Angeles Healthcare System, Los Angeles, CA 90073, USA;
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA 90095, USA
| | - Jeffrey A. Kraut
- Nephrology Section, VA Greater Los Angeles Healthcare System, Los Angeles, CA 90073, USA;
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA 90095, USA
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3
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Wood CM, Wang J, Jung EH, Pelster B. The physiological consequences of a very large natural meal in a voracious marine fish, the staghorn sculpin (Leptocottus armatus). J Exp Biol 2023; 226:jeb246034. [PMID: 37675481 DOI: 10.1242/jeb.246034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Accepted: 08/26/2023] [Indexed: 09/08/2023]
Abstract
Little information exists on physiological consequences when wild fish eat natural food. Staghorn sculpins at 10-13°C voluntarily consumed 15.8% of their body mass in anchovies. Gastric clearance was slow with >60% of the meal retained in the stomach at 48 h, and was not complete until 84 h. At 14-24 h post-feeding, pH was depressed by 3 units and Cl- concentration was elevated 2-fold in gastric chyme, reflecting HCl secretion, while in all sections of the intestine, pH declined by 1 pH unit but Cl- concentration remained unchanged. PCO2 and total ammonia concentration were greatly elevated throughout the tract, whereas PNH3 and HCO3- concentration were depressed. Intestinal HCO3- secretion rates, measured in gut sacs in vitro, were also lower in fed fish. Whole-animal O2 consumption rate was elevated approximately 2-fold for 72 h post-feeding, reflecting 'specific dynamic action', whereas ammonia and urea-N excretion rates were elevated about 5-fold. Arterial blood exhibited a modest 'alkaline tide' for about 48 h, but there was negligible excretion of metabolic base to the external seawater. PaCO2 and PaO2 remained unchanged. Plasma total amino acid concentration and total lipid concentration were elevated about 1.5-fold for at least 48 h, whereas small increases in plasma total ammonia concentration, PNH3 and urea-N concentration were quickly attenuated. Plasma glucose concentration remained unchanged. We conclude that despite the very large meal, slow processing with high efficiency minimizes internal physiological disturbances. This differs greatly from the picture provided by previous studies on aquacultured species using synthetic diets and/or force-feeding. Questions remain about the role of the gastro-intestinal microbiome in nitrogen and acid-base metabolism.
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Affiliation(s)
- Chris M Wood
- Department of Zoology, University of British Columbia, Vancouver, BC, Canada, V6T 1Z4
- Bamfield Marine Sciences Centre, Bamfield, BC, Canada, V0R 1B0
- Department of Biology, McMaster University, Hamilton, ON, Canada, L8S 4K1
| | - Jun Wang
- Department of Zoology, University of British Columbia, Vancouver, BC, Canada, V6T 1Z4
- Bamfield Marine Sciences Centre, Bamfield, BC, Canada, V0R 1B0
- College of Marine Life Sciences, Ocean University of China, Qingdao 266003, China
| | - Ellen H Jung
- Department of Zoology, University of British Columbia, Vancouver, BC, Canada, V6T 1Z4
- Bamfield Marine Sciences Centre, Bamfield, BC, Canada, V0R 1B0
| | - Bernd Pelster
- Bamfield Marine Sciences Centre, Bamfield, BC, Canada, V0R 1B0
- Institute of Zoology, University of Innsbruck, 6020 Innsbruck, Austria
- Center for Molecular Biosciences, University Innsbruck, 6020 Innsbruck, Austria
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4
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Burggren WW, Andrewartha SJ, Mueller CA, Dubansky B, Tazawa H. Acid-base and hematological regulation in chicken embryos during internal progressive hypercapnic hypoxia. Respir Physiol Neurobiol 2023; 308:103996. [PMID: 36402363 DOI: 10.1016/j.resp.2022.103996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 11/11/2022] [Accepted: 11/14/2022] [Indexed: 11/19/2022]
Abstract
Development of the capacity to mitigate potential disturbances to blood physiology in bird embryos is incompletely understood. We investigated regulation of acid-base and hematology in day 15 chicken embryos exposed to graded intrinsic hypercapnic hypoxia created by varying degrees of water submersion. Metabolic acidosis with additional respiratory or metabolic acidosis occurred at 2 h according to magnitude of submersion. Acid-base disturbance was partially compensated by metabolic alkalosis at 6 h, but compensatory metabolic alkalosis was absent at 24 h. Following submersion with only air cell exposed to air, both hypercapnic respiratory acidosis and metabolic acidosis occurred within 10 min. Subsequently, both forms of acidosis created lethal levels of [HCO3-] at ∼120 min. Blood hematology showed small but significant effects associated with induced acid-base disturbance. Increased Hct occurring during partial egg submersion lasting 24 h was attributed to an increase in MCV. By day 15 of development chicken embryos are able to partially compensate for and withstand all but severe induced internal hypoxic hypercapnia.
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Affiliation(s)
- Warren W Burggren
- Developmental Integrative Biology, Department of Biological Sciences, University of North Texas, 1155 Union Circle #305220, Denton, TX 76203, USA.
| | - Sarah J Andrewartha
- Developmental Integrative Biology, Department of Biological Sciences, University of North Texas, 1155 Union Circle #305220, Denton, TX 76203, USA; CSIRO Marine and Atmosphere Research, Food Futures Flagship, CPO Box 1538, Hobart, Tasmania 7001, Australia
| | - Casey A Mueller
- Developmental Integrative Biology, Department of Biological Sciences, University of North Texas, 1155 Union Circle #305220, Denton, TX 76203, USA; Department of Biological Sciences, California State University San Marcos, 333S. Twin Oaks Valley Road, San Marcos, CA 92096, USA
| | - Benjamin Dubansky
- Developmental Integrative Biology, Department of Biological Sciences, University of North Texas, 1155 Union Circle #305220, Denton, TX 76203, USA; Department of Biological and Agricultural Engineering, Louisiana State University, 149 E. B. Doran Building, Baton Rouge, LA 70803, USA
| | - Hiroshi Tazawa
- Developmental Integrative Biology, Department of Biological Sciences, University of North Texas, 1155 Union Circle #305220, Denton, TX 76203, USA
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Abstract
Kidneys are central in the regulation of multiple physiological functions, such as removal of metabolic wastes and toxins, maintenance of electrolyte and fluid balance, and control of pH homeostasis. In addition, kidneys participate in systemic gluconeogenesis and in the production or activation of hormones. Acid-base conditions influence all these functions concomitantly. Healthy kidneys properly coordinate a series of physiological responses in the face of acute and chronic acid-base disorders. However, injured kidneys have a reduced capacity to adapt to such challenges. Chronic kidney disease patients are an example of individuals typically exposed to chronic and progressive metabolic acidosis. Their organisms undergo a series of alterations that brake large detrimental changes in the homeostasis of several parameters, but these alterations may also operate as further drivers of kidney damage. Acid-base disorders lead not only to changes in mechanisms involved in acid-base balance maintenance, but they also affect multiple other mechanisms tightly wired to it. In this review article, we explore the basic renal activities involved in the maintenance of acid-base balance and show how they are interconnected to cell energy metabolism and other important intracellular activities. These intertwined relationships have been investigated for more than a century, but a modern conceptual organization of these events is lacking. We propose that pH homeostasis indissociably interacts with central pathways that drive progression of chronic kidney disease, such as inflammation and metabolism, independent of etiology.
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Affiliation(s)
- Pedro Henrique Imenez Silva
- Institute of Physiology, University of Zurich, Winterthurerstrasse 190, CH-8057, Zurich, Switzerland.
- National Center of Competence in Research NCCR Kidney.CH, Zurich, Switzerland.
| | - Nilufar Mohebbi
- National Center of Competence in Research NCCR Kidney.CH, Zurich, Switzerland
- Praxis Und Dialysezentrum Zurich, Zurich, Switzerland
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Newbury JW, Cole M, Kelly AL, Chessor RJ, Sparks SA, McNaughton LR, Gough LA. The time to peak blood bicarbonate (HCO3-), pH, and the strong ion difference (SID) following sodium bicarbonate (NaHCO3) ingestion in highly trained adolescent swimmers. PLoS One 2021; 16:e0248456. [PMID: 34197456 PMCID: PMC8248647 DOI: 10.1371/journal.pone.0248456] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 06/17/2021] [Indexed: 11/18/2022] Open
Abstract
The timing of sodium bicarbonate (NaHCO3) supplementation has been suggested to be most optimal when coincided with a personal time that bicarbonate (HCO3–) or pH peaks in the blood following ingestion. However, the ergogenic mechanisms supporting this ingestion strategy are strongly contested. It is therefore plausible that NaHCO3 may be ergogenic by causing beneficial shifts in the strong ion difference (SID), though the time course of this blood acid base balance variable is yet to be investigated. Twelve highly trained, adolescent swimmers (age: 15.9 ± 1.0 years, body mass: 65.3 ± 9.6 kg) consumed their typical pre-competition nutrition 1–3 hours before ingesting 0.3 g∙kg BM-1 NaHCO3 in gelatine capsules. Capillary blood samples were then taken during seated rest on nine occasions (0, 60, 75, 90, 105, 120, 135, 150, 165 min post-ingestion) to identify the time course changes in HCO3–, pH, and the SID. No significant differences were found in the time to peak of each blood measure (HCO3–: 130 ± 35 min, pH: 120 ± 38 min, SID: 98 ± 37 min; p = 0.08); however, a large effect size was calculated between time to peak HCO3– and the SID (g = 0.88). Considering that a difference between time to peak blood HCO3– and the SID was identified in adolescents, future research should compare the ergogenic effects of these two individualized NaHCO3 ingestion strategies compared to a traditional, standardized approach.
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Affiliation(s)
- Josh W. Newbury
- Human Performance and Health Research Group, Centre for Life and Sport Sciences (CLaSS), Department of Sport and Exercise, Birmingham City University, Birmingham, United Kingdom
| | - Matthew Cole
- Human Performance and Health Research Group, Centre for Life and Sport Sciences (CLaSS), Department of Sport and Exercise, Birmingham City University, Birmingham, United Kingdom
| | - Adam L. Kelly
- Human Performance and Health Research Group, Centre for Life and Sport Sciences (CLaSS), Department of Sport and Exercise, Birmingham City University, Birmingham, United Kingdom
| | - Richard J. Chessor
- Sports Science and Sports Medicine Team, British Swimming, Loughborough, Leicestershire, United Kingdom
| | - S. Andy Sparks
- Sports Nutrition and Performance Research Group, Department of Sport and Physical Activity, Edge Hill University, Ormskirk, United Kingdom
- * E-mail:
| | - Lars R. McNaughton
- Sports Nutrition and Performance Research Group, Department of Sport and Physical Activity, Edge Hill University, Ormskirk, United Kingdom
| | - Lewis A. Gough
- Human Performance and Health Research Group, Centre for Life and Sport Sciences (CLaSS), Department of Sport and Exercise, Birmingham City University, Birmingham, United Kingdom
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Gucyetmez B, Tuzuner F, Atalan HK, Sezerman U, Gucyetmez K, Telci L. Base-excess chloride; the best approach to evaluate the effect of chloride on the acid-base status: A retrospective study. PLoS One 2021; 16:e0250274. [PMID: 33914794 PMCID: PMC8084199 DOI: 10.1371/journal.pone.0250274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 04/01/2021] [Indexed: 11/18/2022] Open
Abstract
To practically determine the effect of chloride (Cl) on the acid-base status, four approaches are currently used: accepted ranges of serum Cl values; Cl corrections; the serum Cl/Na ratio; and the serum Na-Cl difference. However, these approaches are governed by different concepts. Our aim is to investigate which approach to the evaluation of the effect of Cl is the best. In this retrospective cohort study, 2529 critically ill patients who were admitted to the tertiary care unit between 2011 and 2018 were retrospectively evaluated. The effects of Cl on the acid-base status according to each evaluative approach were validated by the standard base excess (SBE) and apparent strong ion difference (SIDa). To clearly demonstrate only the effects of Cl on the acid-base status, a subgroup that included patients with normal lactate, albumin and SIG values was created. To compare approaches, kappa and a linear regression model for all patients and Bland-Altman test for a subgroup were used. In both the entire cohort and the subgroup, correlations among BECl, SIDa and SBE were stronger than those for other approaches (r = 0.94 r = 0.98 and r = 0.96 respectively). Only BECl had acceptable limits of agreement with SBE in the subgroup (bias: 0.5 mmol L-1) In the linear regression model, only BECl in all the Cl evaluation approaches was significantly related to the SBE. For the evaluation of the effect of chloride on the acid-base status, BECl is a better approach than accepted ranges of serum Cl values, Cl corrections and the Cl/Na ratio.
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Affiliation(s)
- Bulent Gucyetmez
- Department of Anaesthesiology and Reanimation, Acıbadem Mehmet Ali Aydınlar University School of Medicine, Istanbul, Turkey
- General Intensive Care Unit, Acıbadem International Hospital, Istanbul, Turkey
| | - Filiz Tuzuner
- General Intensive Care Unit, Acıbadem Taksim Hospital, Istanbul, Turkey
| | | | - Uğur Sezerman
- Department of Biostatistics, Acıbadem Mehmet Ali Aydınlar University, Istanbul, Turkey
| | | | - Lutfi Telci
- General Intensive Care Unit, Acıbadem International Hospital, Istanbul, Turkey
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8
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Rzucidło-Hymczak A, Hymczak H, Kędziora A, Kapelak B, Drwiła R, Plicner D. Prognostic role of perioperative acid-base disturbances on the risk of Clostridioides difficile infection in patients undergoing cardiac surgery. PLoS One 2021; 16:e0248512. [PMID: 33730090 PMCID: PMC7968627 DOI: 10.1371/journal.pone.0248512] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Accepted: 02/26/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND It is unclear whether acid-base balance disturbances during the perioperative period may impact Clostridium difficile infection (CDI), which is the third most common major infection following cardiac surgery. We hypothesized that perioperative acid-base abnormalities including lactate disturbances may predict the probability of incidence of CDI in patients after cardiac procedures. METHODS Of the 12,235 analyzed patients following cardiac surgery, 143 (1.2%) developed CDI. The control group included 200 consecutive patients without diarrhea, who underwent cardiac procedure within the same period of observation. Pre-, intra and post-operative levels of blood gases, as well as lactate and glucose concentrations were determined. Postoperatively, arterial blood was drawn four times: immediately after surgery and successively; 4, 8 and 12 h following the procedure. RESULTS Baseline pH was lower and PaO2 was higher in CDI patients (p < 0.001 and p = 0.001, respectively). Additionally, these patients had greater base deficiency at each of the analyzed time points (p < 0.001, p = 0.004, p = 0.012, p = 0.001, p = 0.016 and p = 0.001, respectively). Severe hyperlactatemia was also more common in CDI patients; during the cardiac procedure, 4 h and 12 h after surgery (p = 0.027, p = 0.004 and p = 0.001, respectively). Multivariate logistic regression analysis revealed that independent risk factors for CDI following cardiac surgery were as follows: intraoperative severe hyperlactatemia (OR 2.387, 95% CI 1.155-4.933, p = 0.019), decreased lactate clearance between values immediately and 12 h after procedure (OR 0.996, 95% CI 0.994-0.999, p = 0.013), increased age (OR 1.045, 95% CI 1.020-1.070, p < 0.001), emergent surgery (OR 2.755, 95% CI 1.565-4.848, p < 0.001) and use of antibiotics other than periprocedural prophylaxis (OR 2.778, 95% CI 1.690-4.565, p < 0.001). CONCLUSION This study is the first to show that perioperative hyperlactatemia and decreased lactate clearance may be predictors for occurrence of CDI after cardiac surgery.
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Affiliation(s)
- Anna Rzucidło-Hymczak
- Department of Pediatric Infectious Diseases and Pediatric Hepatology, John Paul II Hospital, Krakow, Poland
| | - Hubert Hymczak
- Department of Anesthesiology and Intensive Care, John Paul II Hospital, Krakow, Poland
| | - Anna Kędziora
- Department of Cardiovascular Surgery and Transplantation, John Paul II Hospital, Krakow, Poland
| | - Bogusław Kapelak
- Department of Cardiovascular Surgery and Transplantation, John Paul II Hospital, Krakow, Poland
| | - Rafał Drwiła
- Jagiellonian University Medical College, Krakow, Poland
| | - Dariusz Plicner
- Unit of Experimental Cardiology and Cardiac Surgery, Faculty of Medicine and Health Sciences, Andrzej Frycz Modrzewski Krakow University, Krakow, Poland
- * E-mail:
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9
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Abstract
Baking soda and vinegar have been used as home remedies for generations and today we are only a mouse-click away from claims that baking soda, lemon juice, and apple cider vinegar are miracles cures for everything from cancer to COVID-19. Despite these specious claims, the therapeutic value of controlling acid-base balance is indisputable and is the basis of Food and Drug Administration-approved treatments for constipation, epilepsy, metabolic acidosis, and peptic ulcers. In this narrative review, we present evidence in support of the current and potential therapeutic value of countering local and systemic acid-base imbalances, several of which do in fact involve the administration of baking soda (sodium bicarbonate). Furthermore, we discuss the side effects of pharmaceuticals on acid-base balance as well as the influence of acid-base status on the pharmacokinetic properties of drugs. Our review considers all major organ systems as well as information relevant to several clinical specialties such as anesthesiology, infectious disease, oncology, dentistry, and surgery.
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Affiliation(s)
- Bianca N Quade
- Department of Physiology and Biophysics, The State University of New York, The University at Buffalo, Buffalo, NY 14203, USA
| | - Mark D Parker
- Department of Physiology and Biophysics, The State University of New York, The University at Buffalo, Buffalo, NY 14203, USA; Department of Ophthalmology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, Buffalo, NY, USA; State University of New York Eye Institute, University at Buffalo, The State University of New York, Buffalo, NY, USA
| | - Rossana Occhipinti
- Department of Physiology and Biophysics, Case Western Reserve University, School of Medicine, Cleveland, OH 44106, USA.
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10
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Limmer M, de Marées M, Platen P. Alterations in acid-base balance and high-intensity exercise performance after short-term and long-term exposure to acute normobaric hypoxic conditions. Sci Rep 2020; 10:13732. [PMID: 32792614 PMCID: PMC7426914 DOI: 10.1038/s41598-020-70762-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 08/04/2020] [Indexed: 11/21/2022] Open
Abstract
This investigation assessed the course of renal compensation of hypoxia-induced respiratory alkalosis by elimination of bicarbonate ions and impairments in anaerobic exercise after different durations of hypoxic exposure. Study A: 16 participants underwent a resting 12-h exposure to normobaric hypoxia (3,000 m). Blood gas analysis was assessed hourly. While blood pH was significantly increased, PO2, PCO2, and SaO2 were decreased within the first hour of hypoxia, and changes remained consistent. A substantial reduction in [HCO3-] levels was observed after 12 h of hypoxic exposure (- 1.35 ± 0.29 mmol/L, p ≤ 0.05). Study B: 24 participants performed in a randomized, cross-over trial portable tethered sprint running (PTSR) tests under normoxia and after either 1 h (n = 12) or 12 h (n = 12) of normobaric hypoxia (3,000 m). No differences occurred for PTSR-related performance parameters, but the reduction in blood lactate levels was greater after 12 h compared with 1 h (- 1.9 ± 2.2 vs 0.0 ± 2.3 mmol/L, p ≤ 0.05). These results indicate uncompensated respiratory alkalosis after 12 h of hypoxia and similar impairment of high-intensity exercise after 1 and 12 h of hypoxic exposure, despite a greater reduction in blood lactate responses after 12 h compared with 1 h of hypoxic exposure.
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Affiliation(s)
- Mirjam Limmer
- Institute of Sports Medicine and Sports Nutrition, Ruhr-University Bochum, Bochum, Germany.
- Institute of Outdoor Sports and Environmental Science, German Sports University Cologne, Cologne, Germany.
| | - Markus de Marées
- Institute of Sports Medicine and Sports Nutrition, Ruhr-University Bochum, Bochum, Germany
| | - Petra Platen
- Institute of Sports Medicine and Sports Nutrition, Ruhr-University Bochum, Bochum, Germany
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11
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Wall SM, Verlander JW, Romero CA. The Renal Physiology of Pendrin-Positive Intercalated Cells. Physiol Rev 2020; 100:1119-1147. [PMID: 32347156 PMCID: PMC7474261 DOI: 10.1152/physrev.00011.2019] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 11/06/2019] [Accepted: 11/12/2019] [Indexed: 12/13/2022] Open
Abstract
Intercalated cells (ICs) are found in the connecting tubule and the collecting duct. Of the three IC subtypes identified, type B intercalated cells are one of the best characterized and known to mediate Cl- absorption and HCO3- secretion, largely through the anion exchanger pendrin. This exchanger is thought to act in tandem with the Na+-dependent Cl-/HCO3- exchanger, NDCBE, to mediate net NaCl absorption. Pendrin is stimulated by angiotensin II and aldosterone administration via the angiotensin type 1a and the mineralocorticoid receptors, respectively. It is also stimulated in models of metabolic alkalosis, such as with NaHCO3 administration. In some rodent models, pendrin-mediated HCO3- secretion modulates acid-base balance. However, of probably more physiological or clinical significance is the role of these pendrin-positive ICs in blood pressure regulation, which occurs, at least in part, through pendrin-mediated renal Cl- absorption, as well as their effect on the epithelial Na+ channel, ENaC. Aldosterone stimulates ENaC directly through principal cell mineralocorticoid hormone receptor (ligand) binding and also indirectly through its effect on pendrin expression and function. In so doing, pendrin contributes to the aldosterone pressor response. Pendrin may also modulate blood pressure in part through its action in the adrenal medulla, where it modulates the release of catecholamines, or through an indirect effect on vascular contractile force. In addition to its role in Na+ and Cl- balance, pendrin affects the balance of other ions, such as K+ and I-. This review describes how aldosterone and angiotensin II-induced signaling regulate pendrin and the contribution of pendrin-positive ICs in the kidney to distal nephron function and blood pressure.
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Affiliation(s)
- Susan M Wall
- Departments of Medicine and Physiology, Emory University School of Medicine, Atlanta, Georgia; and Department of Medicine, University of Florida, Gainesville, Florida
| | - Jill W Verlander
- Departments of Medicine and Physiology, Emory University School of Medicine, Atlanta, Georgia; and Department of Medicine, University of Florida, Gainesville, Florida
| | - Cesar A Romero
- Departments of Medicine and Physiology, Emory University School of Medicine, Atlanta, Georgia; and Department of Medicine, University of Florida, Gainesville, Florida
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12
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Bobulescu IA. The Old West analogy for acid-base buffering. Adv Physiol Educ 2020; 44:210-211. [PMID: 32243219 PMCID: PMC7410069 DOI: 10.1152/advan.00033.2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 03/15/2020] [Accepted: 03/21/2020] [Indexed: 06/11/2023]
Affiliation(s)
- Ion Alexandru Bobulescu
- Department of Cell Biology and Biochemistry, Texas Tech University Health Sciences Center, Lubbock, Texas
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas
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13
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Boniface M, Porter I. Acid-base disturbances: an emergency department approach. Emerg Med Pract 2020; 22:1-24. [PMID: 32470246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Accepted: 03/10/2020] [Indexed: 06/11/2023]
Abstract
Acid-base disturbances are physiological responses to a wide variety of underlying conditions and critical illnesses. Homeostasis of acid-base physiology is complex and interdependent with the function of the lungs, kidneys, and endogenous buffer systems. Traditionally, these disturbances have been classified in terms of being caused by either a primary respiratory or a metabolic insult and by chronicity and compensation. While existing literature consists largely of physiology reviews, several well-designed studies and clinical practice guidelines provide relevant new perspectives on interpreting and managing acid-base disturbances. This review outlines several approaches to characterizing disturbances, with a case-based format and algorithms to aid in diagnostic testing and interpretation of arterial blood gases.
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Affiliation(s)
- Michael Boniface
- Instructor in Emergency Medicine, Mayo Clinic College of Medicine; Consultant, Department of Emergency Medicine, Mayo Clinic Florida, Jacksonville, FL
| | - Ivan Porter
- Assistant Professor of Medicine, Mayo Clinic College of Medicine; Consultant, Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic Florida, Jacksonville, FL
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14
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Gupta N, Nussbaum J. Points & Pearls: Acid-base disturbances: an emergency department approach. Emerg Med Pract 2020; 22:e1-e2. [PMID: 32510899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- Nachi Gupta
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Jeffrey Nussbaum
- EMS Fellow, University of Pittsburgh Medical Center, Pittsburgh, PA
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15
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Gam LTH, Thanh Huong DT, Tuong DD, Phuong NT, Jensen FB, Wang T, Bayley M. Effects of temperature on acid-base regulation, gill ventilation and air breathing in the clown knifefish, Chitala ornata. J Exp Biol 2020; 223:jeb216481. [PMID: 32001546 DOI: 10.1242/jeb.216481] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 01/23/2020] [Indexed: 11/20/2022]
Abstract
Chitala ornata is a facultative air-breathing fish, which at low temperatures shows an arterial PCO2 (PaCO2 ) level only slightly elevated above that of water breathers. By holding fish with in-dwelling catheters at temperatures from 25 to 36°C and measuring blood gasses, we show that this animal follows the ubiquitous poikilotherm pattern of reducing arterial pH with increasing temperature. Surprisingly, the temperature increase caused an elevation of PaCO2 from 5 to 12 mmHg while the plasma bicarbonate concentration remained constant at around 8 mmol l-1 The temperature increase also gave rise to a larger fractional increase in air breathing than in gill ventilation frequency. These findings suggest that air breathing, and hence the partitioning of gas exchange, is to some extent regulated by acid-base status in air-breathing fish and that these bimodal breathers will be increasingly likely to adopt respiratory pH control as temperature rises, providing an interesting avenue for future research.
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Affiliation(s)
- Le Thi Hong Gam
- College of Aquaculture and Fisheries, Can Tho University, Can Tho City, Vietnam
| | - Do Thi Thanh Huong
- College of Aquaculture and Fisheries, Can Tho University, Can Tho City, Vietnam
| | - Dang Diem Tuong
- College of Aquaculture and Fisheries, Can Tho University, Can Tho City, Vietnam
| | - Nguyen Thanh Phuong
- College of Aquaculture and Fisheries, Can Tho University, Can Tho City, Vietnam
| | - Frank Bo Jensen
- Department of Biology, University of Southern Denmark, 5230 Odense, Denmark
| | - Tobias Wang
- Zoophysiology, Department of Bioscience, Aarhus University, 8000 Aarhus, Denmark
- Aarhus Institute of Advanced Studies, 8000 Aarhus C, Denmark
| | - Mark Bayley
- Zoophysiology, Department of Bioscience, Aarhus University, 8000 Aarhus, Denmark
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16
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Warren DE, Hedrick MS. Introduction to the special issue: The state of acid-base physiology in a changing world. Comp Biochem Physiol A Mol Integr Physiol 2019; 241:110630. [PMID: 31812673 DOI: 10.1016/j.cbpa.2019.110630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Daniel E Warren
- Department of Biology, Saint Louis University, St. Louis, MO, USA.
| | - Michael S Hedrick
- Department of Biological Sciences, California State University East Bay, Hayward, CA, USA
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17
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Lujan HL, Petersen SA, LaFrance NC, DiCarlo SE. In the pink and why so blue? A metabolic acidosis "shock-and-awe" demonstration. Adv Physiol Educ 2019; 43:472-475. [PMID: 31460775 DOI: 10.1152/advan.00056.2019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- Heidi L Lujan
- Department of Physiology, College of Osteopathic Medicine, Michigan State University, East Lansing, Michigan
| | - Shelby A Petersen
- Department of Physiology, College of Osteopathic Medicine, Michigan State University, East Lansing, Michigan
| | - Nicole C LaFrance
- Department of Physiology, College of Osteopathic Medicine, Michigan State University, East Lansing, Michigan
| | - Stephen E DiCarlo
- Department of Physiology, College of Osteopathic Medicine, Michigan State University, East Lansing, Michigan
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18
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Abstract
Keeping blood pH levels stable within narrow limits is prerequisite for maintaining normal body function. Disruptions of this equilibrium can occur for a variety of reasons and may result in life-threatening conditions. Therefore, the identification and the interpretation of acid-base disorders are of great importance in emergency medicine. The same applies to intensive care as well as to almost all areas of internal medicine. In this article, we provide a practical overview of all relevant acid-base disorders that are due to both metabolic and respiratory disturbances. In addition, it shows how they can be diagnosed in everyday clinical practice by applying the simplified Stewart Approach.
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Affiliation(s)
- Mathis Hochrainer
- Abteilung für Innere Medizin und Pneumologie, Krankenhaus Nord - Klinik Floridsdorf, Brünner Str. 68, 1210, Wien, Österreich.
- Karl Landsteiner Institut für Lungenforschung und Pneumologische Onkologie, Wien, Österreich.
| | - Georg-Christian Funk
- Medizinische Abteilung mit Pneumologie, Wilhelminenspital, Wien, Österreich
- Karl Landsteiner Institut für Lungenforschung und Pneumologische Onkologie, Wien, Österreich
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19
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Lim J, Mearns A, Gresham C. Ethylene glycol poisoning: mind the gap. N Z Med J 2019; 132:74-78. [PMID: 31095547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Joevy Lim
- School of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland
| | - Anna Mearns
- ICU Registrar, Middlemore Hospital, Auckland
| | - Chip Gresham
- Emergency Medicine Consultant, Middlemore Hospital, Auckland; Medical Toxicology Consultant, The National Poisons Centre, Dunedin School of Medicine/University of Otago, Dunedin
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20
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Abstract
Oral administration of a solid dosage form requires drug dissolution in the gastrointestinal tract before absorption. Solubility is a key factor controlling dissolution, and it is recognized that, within the intestinal tract, this is influenced by the luminal fluid pH, amphiphile content, and composition. Various simulated intestinal fluid recipes have been introduced to mimic this behavior and studied using a range of different experimental techniques. In this article, we have measured equilibrium solubility utilizing a novel four component mixture design (4CMD) with biorelevant amphiphiles (bile salt, phospholipid, oleate, and monoglyceride) within a matrix of three pH values (5, 6, and 7) and total amphiphile concentrations (11.7, 30.6, and 77.5 mM) to provide a topographical and statistical overview. Three poorly soluble drugs representing acidic (indomethacin), basic (carvedilol), and neutral (fenofibrate) categories have been studied. The macroscopic solubility behavior agrees with literature and exhibits an overall increasing solubility from low pH and total amphiphile concentration to high pH and total amphiphile concentration. Within the matrix, all three drugs display different topographies, which can be related to the statistical effect levels of the individual amphiphiles or amphiphile interactions on solubility. The study also identifies previously unreported three and four way factor interactions notably between bile salt, phospholipid, pH, and total amphiphile concentration. In addition, the results also reveal that solubility variability is linked to the number of amphiphiles and the respective ratios in the measurement fluid, with the minimum variation present in systems containing all four amphiphiles. The individual 4CMD experiments within the matrix can be linked to provide a possible intestinal solubility window for each drug that could be applied in PBPK modeling systems. Overall the approach provides a novel overview of intestinal solubility topography along with greater detail on the impact of the various factors studied; however, each matrix requires 351 individual solubility measurements. Further studies will be required to refine the experimental protocol in order the maximize information garnered while minimizing the number of measurements required.
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Affiliation(s)
- Claire Dunn
- Strathclyde Institute of
Pharmacy and Biomedical Sciences, University
of Strathclyde, 161 Cathedral Street, Glasgow G4 0RE, United Kingdom
| | - Jeremy Perrier
- Strathclyde Institute of
Pharmacy and Biomedical Sciences, University
of Strathclyde, 161 Cathedral Street, Glasgow G4 0RE, United Kingdom
| | - Ibrahim Khadra
- Strathclyde Institute of
Pharmacy and Biomedical Sciences, University
of Strathclyde, 161 Cathedral Street, Glasgow G4 0RE, United Kingdom
| | - Clive G. Wilson
- Strathclyde Institute of
Pharmacy and Biomedical Sciences, University
of Strathclyde, 161 Cathedral Street, Glasgow G4 0RE, United Kingdom
| | - Gavin W. Halbert
- Strathclyde Institute of
Pharmacy and Biomedical Sciences, University
of Strathclyde, 161 Cathedral Street, Glasgow G4 0RE, United Kingdom
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21
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Convertino VA, Lye KR, Koons NJ, Joyner MJ. Physiological comparison of hemorrhagic shock and V˙ O 2max: A conceptual framework for defining the limitation of oxygen delivery. Exp Biol Med (Maywood) 2019; 244:690-701. [PMID: 31042073 PMCID: PMC6552402 DOI: 10.1177/1535370219846425] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
IMPACT STATEMENT Disturbance of normal homeostasis occurs when oxygen delivery and energy stores to the body's tissues fail to meet the energy requirement of cells. The work submitted in this review is important because it advances the understanding of inadequate oxygen delivery as it relates to early diagnosis and treatment of circulatory shock and its relationship to disturbance of normal functioning of cellular metabolism in life-threatening conditions of hemorrhage. We explored data from the clinical and exercise literature to construct for the first time a conceptual framework for defining the limitation of inadequate delivery of oxygen by comparing the physiology of hemorrhagic shock caused by severe blood loss to maximal oxygen uptake induced by intense physical exercise. We also provide a translational framework in which understanding the fundamental relationship between the body's reserve to compensate for conditions of inadequate oxygen delivery as a limiting factor to V ˙ O2max helps to re-evaluate paradigms of triage for improved monitoring of accurate resuscitation in patients suffering from hemorrhagic shock.
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Affiliation(s)
- Victor A Convertino
- Battlefield Health & Trauma Center for Human Integrative Physiology, U. S. Army Institute of Surgical Research, Fort Sam Houston, TX 78234, USA
| | - Kristen R Lye
- Battlefield Health & Trauma Center for Human Integrative Physiology, U. S. Army Institute of Surgical Research, Fort Sam Houston, TX 78234, USA
| | - Natalie J Koons
- Battlefield Health & Trauma Center for Human Integrative Physiology, U. S. Army Institute of Surgical Research, Fort Sam Houston, TX 78234, USA
| | - Michael J Joyner
- Department of Anesthesiology, Mayo Clinic, Rochester, MN 55905, USA
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22
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Mangan S, Wilson RW, Findlay HS, Lewis C. Acid-base physiology over tidal periods in the mussel Mytilus edulis: size and temperature are more influential than seawater pH. Proc Biol Sci 2019; 286:20182863. [PMID: 30963828 PMCID: PMC6408882 DOI: 10.1098/rspb.2018.2863] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 01/24/2019] [Indexed: 11/12/2022] Open
Abstract
Ocean acidification (OA) studies to date have typically used stable open-ocean pH and CO2 values to predict the physiological responses of intertidal species to future climate scenarios, with few studies accounting for natural fluctuations of abiotic conditions or the alternating periods of emersion and immersion routinely experienced during tidal cycles. Here, we determine seawater carbonate chemistry and the corresponding in situ haemolymph acid-base responses over real time for two populations of mussel ( Mytilus edulis) during tidal cycles, demonstrating that intertidal mussels experience daily acidosis during emersion. Using these field data to parameterize experimental work we demonstrate that air temperature and mussel size strongly influence this acidosis, with larger mussels at higher temperatures experiencing greater acidosis. There was a small interactive effect of prior immersion in OA conditions (pHNBS 7.7/pCO2 930 µatm) such that the haemolymph pH measured at the start of emersion was lower in large mussels exposed to OA. Critically, the acidosis induced in mussels during emersion in situ was greater (ΔpH approximately 0.8 units) than that induced by experimental OA (ΔpH approximately 0.1 units). Understanding how environmental fluctuations influence physiology under current scenarios is critical to our ability to predict the responses of key marine biota to future environmental changes.
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Affiliation(s)
- Stephanie Mangan
- Biosciences, University of Exeter, Geoffrey Pope Building, Stocker Road, Exeter EX4 4QD, UK
- Plymouth Marine Laboratory, Prospect Place, West Hoe, Plymouth PL1 3DH, UK
| | - Rod W. Wilson
- Biosciences, University of Exeter, Geoffrey Pope Building, Stocker Road, Exeter EX4 4QD, UK
| | - Helen S. Findlay
- Plymouth Marine Laboratory, Prospect Place, West Hoe, Plymouth PL1 3DH, UK
| | - Ceri Lewis
- Biosciences, University of Exeter, Geoffrey Pope Building, Stocker Road, Exeter EX4 4QD, UK
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23
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LeClair RJ, Binks AP. Integrating Acid-Base and Metabolic Lab Panels Across Systems in an M1 Classroom Activity. MedEdPORTAL 2019; 15:10793. [PMID: 30800993 PMCID: PMC6354792 DOI: 10.15766/mep_2374-8265.10793] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 11/24/2018] [Indexed: 06/09/2023]
Abstract
INTRODUCTION It is important to deliver acid-base balance concepts in the context of multiple physiological systems and metabolic processes that influence acid-base homeostasis. This activity combines the interactions of the respiratory, gastrointestinal, and renal systems in conjunction with basic metabolism to generate an integrated activity for first-year medical students. METHODS We developed four concise case scenarios around various presentations of acid-base disturbance along with five sets of arterial blood gases (ABGs) and five different metabolic lab panels. M1 students were given class time to match the three different types of data in order to address how the underlying biochemistry and physiology of a scenario translated into ABG and metabolic laboratory values. RESULTS Although not statistically significant, the students' performance on acid-base questions was marginally higher than on standardized National Board of Medical Examiners questions on other topics covered in the same exam, and the improvement over national average scores on the same questions increased. Student evaluation of the activity was positive, with general appreciation of its application and integration of concepts. DISCUSSION The incorporation of this activity into the M1 year was positively received and enhanced integration of content related to acid-base balance. The activity is flexible and can be adapted to most any curricular structure, with the potential to include additional content depending on the level of the learner.
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Affiliation(s)
- Renée J. LeClair
- Associate Professor, Department of Basic Science Education, Virginia Tech Carilion School of Medicine; Chair, Department of Basic Science Education, Virginia Tech Carilion School of Medicine
| | - Andrew P. Binks
- Associate Professor, Department of Basic Science Education, Virginia Tech Carilion School of Medicine; Director of Faculty Development, Department of Basic Science Education, Virginia Tech Carilion School of Medicine
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24
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Kraut JA, Lew V, Madias NE. Re-Evaluation of Total CO2 Concentration in Apparently Healthy Younger Adults. Am J Nephrol 2018; 48:15-20. [PMID: 29990967 DOI: 10.1159/000489965] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 04/30/2018] [Indexed: 11/19/2022]
Abstract
The initial assessment of acid-base status is usually based on the measurement of total CO2 concentration ([TCO2]) in venous blood, a surrogate for [HCO3-]. Previously, we posited that the reference limits of serum [TCO2] in current use are too wide. Based on studies on the acid-base composition of normal subjects, we suggested that the reference limits of serum [TCO2] at sea level be set at 23-30 mEq/L. To validate this proposal, we queried the University of California at Los Angeles (UCLA's) Integrated Clinical and Research Data Repository, a database containing information on 4.5 million patients seen at UCLA from 2006 to the present. Criteria for inclusion included adults (18-40 years of age), who were free of disorders that could affect acid-base balance, were not taking medications that could affect acid-base balance, and were seen for a routine medical examination or immunization in the outpatient setting. The number of individuals who met the inclusion criteria (52% female and 48% male) was 28,480, with a mean age of 28.9 ± 5.1 years. The mean serum [TCO2] level was slightly higher in males than females, 26.6 ± 2.16 mEq/L vs. 25.0 ± 2.11 mEq/L (p < 0.05). Ninety-one percent of patient values were within the proposed 23-30 mEq/L range and 61.7% were within the 24-27 mEq/L range. These findings validate our proposal that the reference range of serum [TCO2] in venous blood at sea level be narrowed to 23-30 mEq/L. Subjects with serum [TCO2] outside this range might require assessment with a venous blood gas to exclude the presence of clinically important acid-base disorders.
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Affiliation(s)
- Jeffrey A Kraut
- Medical and Research Services VHAGLA Healthcare System, UCLA Membrane Biology Laboratory, and Division of Nephrology VHAGLA Healthcare System and David Geffen School of Medicine, Los Angeles, California, USA
| | - Vivian Lew
- Department of Statistics, University of California at Los Angeles, Los Angeles, California, USA
| | - Nicolaos E Madias
- Department of Medicine, Division of Nephrology, St. Elizabeth's Medical Center, and Department of Medicine, Tufts University School of Medicine, Boston, Massachusetts, USA
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25
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Obara-Michlewska M, Ding F, Popek M, Verkhratsky A, Nedergaard M, Zielinska M, Albrecht J. Interstitial ion homeostasis and acid-base balance are maintained in oedematous brain of mice with acute toxic liver failure. Neurochem Int 2018; 118:286-291. [PMID: 29772253 DOI: 10.1016/j.neuint.2018.05.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 05/11/2018] [Accepted: 05/13/2018] [Indexed: 01/25/2023]
Abstract
Acute toxic liver failure (ATLF) rapidly leads to brain oedema and neurological decline. We evaluated the ability of ATLF-affected brain to control the ionic composition and acid-base balance of the interstitial fluid. ATLF was induced in 10-12 weeks old male C57Bl mice by single intraperitoneal (i.p.) injection of 100 μg/g azoxymethane (AOM). Analyses were carried out in cerebral cortex of precomatous mice 20-24 h after AOM administration. Brain fluid status was evaluated by measuring apparent diffusion coefficient [ADC] using NMR spectroscopy, Evans Blue extravasation, and accumulation of an intracisternally-injected fluorescent tracer. Extracellular pH ([pH]e) and ([K+]e) were measured in situ with ion-sensitive microelectrodes. Cerebral cortical microdialysates were subjected to photometric analysis of extracellular potassium ([K+]e), sodium ([Na+]e) and luminometric assay of extracellular lactate ([Lac]e). Potassium transport in cerebral cortical slices was measured ex vivo as 86Rb uptake. Cerebral cortex of AOM-treated mice presented decreased ADC supporting the view that ATLF-induced brain oedema is primarily cytotoxic in nature. In addition, increased Evans blue extravasation indicated blood brain barrier leakage, and increased fluorescent tracer accumulation suggested impaired interstitial fluid passage. However, [K+]e, [Na+]e, [Lac]e, [pH]e and potassium transport in brain of AOM-treated mice was not different from control mice. We conclude that in spite of cytotoxic oedema and deregulated interstitial fluid passage, brain of mice with ATLF retains the ability to maintain interstitial ion homeostasis and acid-base balance. Tentatively, uncompromised brain ion homeostasis and acid-base balance may contribute to the relatively frequent brain function recovery and spontaneous survival rate in human patients with ATLF.
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Affiliation(s)
- Marta Obara-Michlewska
- Department of Neurotoxicology, Mossakowski Medical Research Centre, Polish Academy of Sciences, 5 Pawińskiego St, 02-106 Warsaw, Poland.
| | - Fengfei Ding
- Center for Translational Neuromedicine, University of Rochester, NY, USA
| | - Mariusz Popek
- Department of Neurotoxicology, Mossakowski Medical Research Centre, Polish Academy of Sciences, 5 Pawińskiego St, 02-106 Warsaw, Poland
| | - Alexei Verkhratsky
- Faculty of Life Sciences, University of Manchester, UK; Achucarro Center for Neuroscience, IKERBASQUE, Basque Foundation for Science, 48011 Bilbao, Spain
| | - Maiken Nedergaard
- Center for Translational Neuromedicine, University of Rochester, NY, USA
| | - Magdalena Zielinska
- Department of Neurotoxicology, Mossakowski Medical Research Centre, Polish Academy of Sciences, 5 Pawińskiego St, 02-106 Warsaw, Poland
| | - Jan Albrecht
- Department of Neurotoxicology, Mossakowski Medical Research Centre, Polish Academy of Sciences, 5 Pawińskiego St, 02-106 Warsaw, Poland.
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Boedtkjer E. Acid-base regulation and sensing: Accelerators and brakes in metabolic regulation of cerebrovascular tone. J Cereb Blood Flow Metab 2018; 38:588-602. [PMID: 28984162 PMCID: PMC5888856 DOI: 10.1177/0271678x17733868] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Revised: 08/10/2017] [Accepted: 09/06/2017] [Indexed: 12/29/2022]
Abstract
Metabolic regulation of cerebrovascular tone directs blood flow to areas of increased neuronal activity and during disease states partially compensates for insufficient perfusion by enhancing blood flow in collateral blood vessels. Acid-base disturbances frequently occur as result of enhanced metabolism or insufficient blood supply, but despite definitive evidence that acid-base disturbances alter arterial tone, effects of individual acid-base equivalents and the underlying signaling mechanisms are still being debated. H+ is an important intra- and extracellular messenger that modifies cerebrovascular tone. In addition, low extracellular [HCO3-] promotes cerebrovascular contraction through an endothelium-dependent mechanism. CO2 alters arterial tone development via changes in intra- and extracellular pH but it is still controversial whether CO2 also has direct vasomotor effects. Vasocontractile responses to low extracellular [HCO3-] and acute CO2-induced decreases in intracellular pH can counteract H+-mediated vasorelaxation during metabolic and respiratory acidosis, respectively, and may thereby reduce the risk of capillary damage and cerebral edema that could be consequences of unopposed vasodilation. In this review, the signaling mechanisms for acid-base equivalents in cerebral arteries and the mechanisms of intracellular pH control in the arterial wall are discussed in the context of metabolic regulation of cerebrovascular tone and local perfusion.
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Affiliation(s)
- Ebbe Boedtkjer
- Department of Biomedicine, Aarhus University, Aarhus, Denmark
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Hietavala EM, Ihalainen JK, Frassetto LA, Schumann M, Eklund D, Pitkänen H, Häkkinen K, Mero AA. Effects of 12-Week Low or Moderate Dietary Acid Intake on Acid-Base Status and Kidney Function at Rest and during Submaximal Cycling. Nutrients 2018. [PMID: 29517990 PMCID: PMC5872741 DOI: 10.3390/nu10030323] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Prolonged effects of dietary acid intake on acid–base status and kidney function have not yet been studied in an intervention study in healthy subjects. Dietary acid load can be estimated by calculating the potential renal acid load (PRAL) of foods. Effects of low-PRAL and moderate-PRAL diets on acid–base status and kidney function were investigated during a 12-week exercise training period. Healthy, 20–50-year-old men (n = 21) and women (n = 25) participated in the study and were randomly divided into low-PRAL and moderate-PRAL groups. Before (PRE), mid-phase (MID) and after the intervention (POST), the subjects participated in measurement sessions, where a 12-h urine sample and fasting blood samples were collected, and a submaximal cycle ergometer test was performed. Net acid excretion was significantly lower after 12 weeks of the low-PRAL diet as compared to the moderate-PRAL diet, both in men and women. In low-PRAL females, capillary pH and bicarbonate were significantly higher at 75% of VO2max at POST as compared to PRE. Glomerular filtration rate decreased over the study period in moderate-PRAL men and women. The results of the present study suggest that an acidogenic diet and regularly training together may increase the acidic load of the body and start to impair the kidney function in recreationally active subjects.
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Affiliation(s)
- Enni-Maria Hietavala
- Biology of Physical Activity, Faculty of Sport and Health Sciences, University of Jyväskylä, P.O. Box 35 (VIV), 40014 Jyväskylä, Finland.
| | - Johanna K Ihalainen
- Biology of Physical Activity, Faculty of Sport and Health Sciences, University of Jyväskylä, P.O. Box 35 (VIV), 40014 Jyväskylä, Finland.
| | - Lynda A Frassetto
- General Clinical Research Center, University of California San Francisco, 505 Parnassus Avenue, San Francisco, CA 94117, USA.
| | - Moritz Schumann
- Department of Molecular and Cellular Sports Medicine, German Sport University, Am Sportpark Müngersdorf 6, 50933 Cologne, Germany.
| | - Daniela Eklund
- Biology of Physical Activity, Faculty of Sport and Health Sciences, University of Jyväskylä, P.O. Box 35 (VIV), 40014 Jyväskylä, Finland.
| | - Hannu Pitkänen
- Honka Holding, c/o Honkatarhat Oy, Kirkkokallio 20, 38950 Honkajoki, Finland.
| | - Keijo Häkkinen
- Biology of Physical Activity, Faculty of Sport and Health Sciences, University of Jyväskylä, P.O. Box 35 (VIV), 40014 Jyväskylä, Finland.
| | - Antti A Mero
- Biology of Physical Activity, Faculty of Sport and Health Sciences, University of Jyväskylä, P.O. Box 35 (VIV), 40014 Jyväskylä, Finland.
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28
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Chen GS, Lee SP, Huang SF, Chao SC, Chang CY, Wu GJ, Li CH, Loh SH. Functional and molecular characterization of transmembrane intracellular pH regulators in human dental pulp stem cells. Arch Oral Biol 2018. [PMID: 29524788 DOI: 10.1016/j.archoralbio.2018.02.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Homeostasis of intracellular pH (pHi) plays vital roles in many cell functions, such as proliferation, apoptosis, differentiation and metastasis. Thus far, Na+-H+ exchanger (NHE), Na+-HCO3- co-transporter (NBC), Cl-/HCO3- exchanger (AE) and Cl-/OH- exchanger (CHE) have been identified to co-regulate pHi homeostasis. However, functional and biological pHi-regulators in human dental pulp stem cells (hDPSCs) have yet to be identified. DESIGN Microspectrofluorimetry technique with pH-sensitive fluorescent dye, BCECF, was used to detect pHi changes. NH4Cl and Na+-acetate pre-pulse were used to induce intracellular acidosis and alkalosis, respectively. Isoforms of pHi-regulators were detected by Western blot technique. RESULTS The resting pHi was no significant difference between that in HEPES-buffered (nominal HCO3--free) solution or CO2/HCO3-buffered system (7.42 and 7.46, respectively). The pHi recovery following the induced-intracellular acidosis was blocked completely by removing [Na+]o, while only slowed (-63%) by adding HOE694 (a NHE1 specific inhibitor) in HEPES-buffered solution. The pHi recovery was inhibited entirely by removing [Na+]o, while adding HOE 694 pulse DIDS (an anion-transporter inhibitor) only slowed (-55%) the acid extrusion. Both in HEPES-buffered and CO2/HCO3-buffered system solution, the pHi recovery after induced-intracellular alkalosis was entirely blocked by removing [Cl-]o. Western blot analysis showed the isoforms of pHi regulators, including NHE1/2, NBCe1/n1, AE1/2/3/4 and CHE in the hDPSCs. CONCLUSIONS We demonstrate for the first time that resting pHi is significantly higher than 7.2 and meditates functionally by two Na+-dependent acid extruders (NHE and NBC), two Cl--dependent acid loaders (CHE and AE) and one Na+-independent acid extruder(s) in hDPSCs. These findings provide novel insight for basic and clinical treatment of dentistry.
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Affiliation(s)
- Gunng-Shinng Chen
- Division of Orthodontic, Dentofacial Orthopedic & Pediatric Dentistry, Department of Dentistry, School of Dentistry, Tri-Service General Hospital and National Defense Medical Center, Taipei 114, Taiwan
| | - Shiao-Pieng Lee
- Division of Oral and Maxillofacial Surgery, Department of Dentistry, School of Dentistry, Tri-Service General Hospital and National Defense Medical Center, Taipei 114, Taiwan
| | - Shu-Fu Huang
- Department of Clinical Pharmacy, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan
| | - Shih-Chi Chao
- Graduate Institute of Life Sciences, National Defense Medical Center, Taipei 114, Taiwan; Department of Pharmacology, National Defense Medical Center, Taipei 114, Taiwan
| | - Chung-Yi Chang
- Heart Center and Department of General Surgery, Cheng Hsin General Hospital, Taipei 112, Taiwan
| | - Gwo-Jang Wu
- Department of Obstetrics and Gynecology, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan
| | - Chung-Hsing Li
- Division of Orthodontic, Dentofacial Orthopedic & Pediatric Dentistry, Department of Dentistry, School of Dentistry, Tri-Service General Hospital and National Defense Medical Center, Taipei 114, Taiwan
| | - Shih-Hurng Loh
- Graduate Institute of Life Sciences, National Defense Medical Center, Taipei 114, Taiwan; Department of Pharmacology, National Defense Medical Center, Taipei 114, Taiwan.
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Shea MK, Dawson-Hughes B. Association of Urinary Citrate With Acid-Base Status, Bone Resorption, and Calcium Excretion in Older Men and Women. J Clin Endocrinol Metab 2018; 103:452-459. [PMID: 29211866 PMCID: PMC5800838 DOI: 10.1210/jc.2017-01778] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Accepted: 11/28/2017] [Indexed: 11/19/2022]
Abstract
CONTEXT Elevated urine net acid excretion (NAE), indicative of subclinical metabolic acidosis, has been associated with higher bone turnover. Urine citrate, which is a common clinical measure, changes in response to acid-base status but its association with bone turnover is uncertain. OBJECTIVE We evaluated the association between change in urine citrate and change in bone turnover and calcium excretion. DESIGN, INTERVENTION, AND PARTICIPANTS A total of 233 healthy men and women ≥60 years old were randomly assigned to 1.0 mmol/kg/d potassium bicarbonate (KHCO3), 1.5 mmol/kg/d KHCO3, or placebo for 84 days. OUTCOME MEASURES Urine citrate, NAE, N-telopeptide of collagen type-I (NTX), calcium excretion, and serum amino-terminal propeptide of type 1 procollagen (P1NP) were measured before and after intervention. RESULTS Urine citrate increased dose dependently after KHCO3 supplementation (P trend < 0.001). The urine citrate change was significantly inversely associated with P1NP change (P = 0.021) but not with change in NTX (P = 0.051) or calcium excretion (P = 0.652). The NAE change was positively associated with change in NTX and calcium excretion (P ≤ 0.003) but not with change in P1NP (P = 0.051). When the urine citrate change and NAE change were included in the same model, the urine citrate change was not associated with change in NTX, calcium excretion, or serum P1NP (P ≥ 0.086), whereas change in NAE remained associated with change in NTX and calcium excretion (P ≤ 0.003). CONCLUSION Urine citrate may not be a suitable alternative to NAE when assessing acid-base status in relation to bone turnover in older adults.
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Affiliation(s)
- M Kyla Shea
- Jean Mayer US Department of Agriculture Human Nutrition Research Center on Aging at Tufts University, Boston, Massachusetts
| | - Bess Dawson-Hughes
- Jean Mayer US Department of Agriculture Human Nutrition Research Center on Aging at Tufts University, Boston, Massachusetts
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Herreros J, Berjano EJ, Más P, Padrós C, Sales-Nebot L, Vlaanderen W, Díaz P, Páramo JA, Rábago G, Mercé S. Platelet Dysfunction in Cardiopulmonary Bypass: An Experimental Comparative Study between a Centrifugal and a New Pulsatile Pump. Int J Artif Organs 2018; 26:1086-94. [PMID: 14738192 DOI: 10.1177/039139880302601206] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The aim of this investigation was to study the effect of a new pulsatile pump for extracorporeal circulation (ECC) on platelet count and platelet function with respect to a Biomedicus centrifugal pump. Thirteen pigs, 8 in the pulsatile group (PG) and 5 in the centrifugal group (CG), underwent a partial extracorporeal circulation lasting 3 h. The animals were sacrificed 3 h post-ECC. The platelet study was both quantitative (platelet count) and qualitative (platelet function analysis) by assessing the closure time (CT) with a PFA-100 system. The decrease in platelet number from basal to 3 h post ECC was only significant in CG (p = 0.009). The platelet function was impaired in both groups, but the value of CT with col/ADP increased significantly only in CG (p < 0.001). The increase of CT with col/EPI was greater in CG (p = 0.07) than in PG (p = 0.2). The results indicated that the new pulsatile pump preserves platelets quantitatively and qualitatively well compared to a Biomedicus pump.
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Affiliation(s)
- J Herreros
- Cardiovascular Surgery Department, Clinica Universitaria, University of Navarra, Pamplona, Spain
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Naka T, Egi M, Bellomo R, Cole L, French C, Wan L, Fealy N, Baldwin I. Low-dose Citrate Continuous Veno-venous Hemofiltration (CVVH) and Acid-base Balance. Int J Artif Organs 2018; 28:222-8. [PMID: 15818544 DOI: 10.1177/039139880502800306] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective To evaluate the acid-base effect of low-dose regional citrate anticoagulation (RCA) during continuous veno-venous hemofiltration (CVVH). Design Prospective observational study. Setting ICUs of tertiary public and private hospitals. Subjects Thirty critically ill patients with acute renal failure at risk of bleeding or with a major contraindication to heparin-CVVH and/or short filter life. Methods We used a commercial citrate-based fluid (11 mmol/L, sodium: 140 mmol/L, chloride: 108 mmol/L and 1 mol/L of potassium) as pre-dilution replacement fluid during CVVH. Further potassium was added according to serum potassium levels. We measured all relevant variables for acid-base analysis according to the Stewart-Figge methodology. Results Before treatment, study patients had a slight metabolic acidosis, which worsened over 6 hours of RCA-CVVH (pH from 7.39 to 7.38, p<0.005; bicarbonate from 23.2 to 21.6 mmol/L, p<0.0001 and base excess from −2.0 to −3.0 mEq/L, p<0.0001) due to a significant increase in SIG (from 5.8 to 6.6 mEq/L, p<0.05) and a decrease in SIDa (from 37.5 to 36.6 mEq/L, p<0.05). These acidifying effects were attenuated by hypoalbuminemia and a decrease in lactate (from 1.48 to 1.34 mmol/L, p<0.005) and did not lead to progressive acidosis. On cessation of treatment, this acidifying effect rapidly self-corrected within six hours. Conclusions Low dose RCA-CVVH induces a mild acidosis secondary to an increased strong ion gap and decreased SIDa which fully self-corrects at cessation of therapy. Clinicians need to be aware of these effects to correctly interpret changes in acid-base status in such patients.
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Affiliation(s)
- T Naka
- Department of Intensive Care and Department of Medicine, Austin Hospital and Melbourne University, Melbourne, Australia
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Huang M, Chen JF, Chen LY, Pan LQ, Li XJ, Ye JY, Tan HY. A comparison of two different fluid resuscitation management protocols for pediatric burn patients: A retrospective study. Burns 2017; 44:82-89. [PMID: 29229195 DOI: 10.1016/j.burns.2017.07.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Revised: 06/20/2017] [Accepted: 07/10/2017] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Pediatric burn patients are more susceptible to burn shock than adults, and an effective fluid management protocol is critical to successful resuscitation. Our research aim was to investigate the safety and efficacy of two protocols for pediatric burn patients for use within the first 24h. METHODS A total of 113 pediatric burn patients were enrolled from January 2007 to October 2012. Of those patients, 57 received fluid titration regimens of alternating crystalloids and colloids once within 2h in the first 24h after burn (Group A), whereas the remaining patients received regimens of alternating crystalloids and colloids once within 1h in the first 24h after burn (Group B). The safety, fluid volume infused and urine output were recorded and compared. RESULTS All the patients survived in the first 24h after burn. There were no significant differences between Group A and Group B in lactic acid (LA) level and base excess (BE). The water infused in Group A were greater than that of Group B in the first 24h (P=0.024). No significant differences were found in total volume intake and hourly urine output between the 2 groups in the first 24h. CONCLUSION The implementation of fluid resuscitation using either protocol A or protocol B is safe and effective for pediatric burn patients in the first 24h. The total fluid infused were similar between two protocols. But using protocol A may be more convenient and labor-saving for nurses.
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Affiliation(s)
- Miao Huang
- Department of Nursing, Guangzhou Red Cross Hospital, Fourth Affiliated Hospital of Jinan University, Guangzhou, 510220, China
| | - Jun-Feng Chen
- Department of Infectious Diseases, Third Affiliated Hospital of Sun Yat-sen University, Ministry of Education, Guangzhou, 510630, China
| | - Li-Ying Chen
- Department of Burns, Guangzhou Red Cross Hospital, Fourth Affiliated Hospital of Jinan University, Guangzhou, 510220, China
| | - Li-Qin Pan
- Department of Burns, Guangzhou Red Cross Hospital, Fourth Affiliated Hospital of Jinan University, Guangzhou, 510220, China
| | - Xiao-Jian Li
- Department of Burns, Guangzhou Red Cross Hospital, Fourth Affiliated Hospital of Jinan University, Guangzhou, 510220, China
| | - Jie-Yu Ye
- Department of Burns, Guangzhou Red Cross Hospital, Fourth Affiliated Hospital of Jinan University, Guangzhou, 510220, China
| | - Hui-Yi Tan
- Department of Nursing, Guangzhou Red Cross Hospital, Fourth Affiliated Hospital of Jinan University, Guangzhou, 510220, China.
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Faure AM, Fischer K, Dawson-Hughes B, Egli A, Bischoff-Ferrari HA. Gender-specific association between dietary acid load and total lean body mass and its dependency on protein intake in seniors. Osteoporos Int 2017; 28:3451-3462. [PMID: 28971236 DOI: 10.1007/s00198-017-4220-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Accepted: 09/06/2017] [Indexed: 01/08/2023]
Abstract
UNLABELLED Diet-related mild metabolic acidosis may play a role in the development of sarcopenia. We investigated the relationship between dietary acid load and total lean body mass in male and female seniors age ≥ 60 years. We found that a more alkaline diet was associated with a higher %TLM only among senior women. INTRODUCTION The aim of this study was to determine if dietary acid load is associated with total lean body mass in male and female seniors age ≥ 60 years. METHODS We investigated 243 seniors (mean age 70.3 ± 6.3; 53% women) age ≥ 60 years who participated in the baseline assessment of a clinical trial on vitamin D treatment and rehabilitation after unilateral knee replacement due to severe knee osteoarthritis. The potential renal acid load (PRAL) was assessed based on individual nutrient intakes derived from a food frequency questionnaire. Body composition including percentage of total lean body mass (%TLM) was determined using dual-energy X-ray absorptiometry. Cross-sectional analyses were performed for men and women separately using multivariable regression models controlling for age, physical activity, smoking status, protein intake (g/kg BW per day), energy intake (kcal), and serum 25-hydroxyvitamin D concentration. We included a pre-defined subgroup analysis by protein intake (< 1 g/kg BW day, > 1 g/kg BW day) and by age group (< 70 years, ≥ 70 years). RESULTS Adjusted %TLM decreased significantly across PRAL quartiles only among women (P trend = 0.004). Moreover, in subgroup analysis, the negative association between the PRAL and %TLM was most pronounced among women with low protein intake (< 1 g/kg BW per day) and age below 70 years (P = 0.002). Among men, there was no association between the PRAL and %TLM. CONCLUSION The association between dietary acid load and %TLM seems to be gender-specific, with a negative impact on total lean mass only among senior women. Therefore, an alkaline diet may be beneficial for preserving total lean mass in senior women, especially in those with low protein intake.
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Affiliation(s)
- A M Faure
- Centre on Aging and Mobility, University Hospital Zurich and City Hospital Waid, Zurich, Switzerland
- Department of Geriatrics and Aging Research, University Hospital Zurich and University of Zurich, Raemistrasse 101, 8091, Zurich, Switzerland
| | - K Fischer
- Centre on Aging and Mobility, University Hospital Zurich and City Hospital Waid, Zurich, Switzerland
- Department of Geriatrics and Aging Research, University Hospital Zurich and University of Zurich, Raemistrasse 101, 8091, Zurich, Switzerland
| | - B Dawson-Hughes
- Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA, USA
| | - A Egli
- Centre on Aging and Mobility, University Hospital Zurich and City Hospital Waid, Zurich, Switzerland
- Department of Geriatrics and Aging Research, University Hospital Zurich and University of Zurich, Raemistrasse 101, 8091, Zurich, Switzerland
| | - H A Bischoff-Ferrari
- Centre on Aging and Mobility, University Hospital Zurich and City Hospital Waid, Zurich, Switzerland.
- Department of Geriatrics and Aging Research, University Hospital Zurich and University of Zurich, Raemistrasse 101, 8091, Zurich, Switzerland.
- University Clinic for Acute Geriatric Care, Waid City Hospital, Zurich, Switzerland.
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Gładki M, Składzień T, Żurek R, Broniatowska E, Wójcik E, Skalski JH. Effect of acid-base balance on postoperative course in children with hypoplastic left heart syndrome after the modified Norwood procedure. Medicine (Baltimore) 2017; 96:e7739. [PMID: 28834879 PMCID: PMC5572001 DOI: 10.1097/md.0000000000007739] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Hypoplastic left heart syndrome (HLHS) is a congenital heart defect that requires 3-stage cardiac surgical treatment and multidirectional specialist care. The condition of newborns in the first postoperative days following the modified Norwood procedure is characterized by considerable hemodynamic instability that may result in a sudden cardiac arrest. It is believed that the most important cause of hemodynamic instability is the fluctuations in redistribution between pulmonary and systemic blood flow.The paper analyzes the postoperative course in 40 neonates with HLHS following the modified Norwood procedure performed under deep hypothermic cardiopulmonary bypass hospitalized in Cardiac Surgical Intensive Care Unit (CSICU) in the years 2014-2015. For all hospitalized children, the arterial blood acid-base balance (ABB) parameters (pH, pO2, pCO2, HCO3, base excess (BE), and lactic acid) were measured 2 times a day during the first 5 postoperative days. The main goal of the studies is to analysis of ABB parameters and their influence on the clinical state of newborns with HLHS. Several descriptors were concerned to describe the neonates clinical state: the date of the surgery (the day of life when the child was operated on), the duration (number of days) of mechanical ventilation employment, the time of hospitalization in intensive care unit, and the total duration of treatment in CSICU.The statistical analysis of the particular ABB parameters revealed a significant dependence (P < .001) between the values of pH, pO2, pCO2, HCO3, BE, lactic acid, and all concerned descriptors of the newborn clinical state.The article shows that monitoring the ABB parameters, proper interpretation of the results, and appropriate modification of pharmacotherapy and respiratory treatment are crucial for therapeutic results and survival rates in neonates with HLHS after the modified Norwood procedure.
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Affiliation(s)
- Marcin Gładki
- Department of Pediatric Cardiac Surgery, University Children's Hospital, Jagiellonian University
| | | | - Rafał Żurek
- Department of Pediatric Cardiac Surgery, University Children's Hospital, Jagiellonian University
| | - Elżbieta Broniatowska
- Department of Bioinformatic and Telemedicine, Jagiellonian University, Krakow, Poland
| | - Elżbieta Wójcik
- Department of Pediatric Cardiac Surgery, University Children's Hospital, Jagiellonian University
| | - Janusz H. Skalski
- Department of Pediatric Cardiac Surgery, University Children's Hospital, Jagiellonian University
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Ltaief Z, Liaudet L, Manzon C. [Not Available]. Praxis (Bern 1994) 2017; 106:767-773. [PMID: 28677491 DOI: 10.1024/1661-8157/a002726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Zusammenfassung. Zusammenfassung: Respiratorische Insuffizienz aufgrund von pulmonaler oder kardialer Dekompensation ist ein medizinischer Notfall, der durch eine Gasaustauschstörung (Hypoxämie, isoliert oder in Verbindung mit Hyperkapnie) gekennzeichnet ist. Die Hauptursachen sind Lungenödem, Pneumonie, dekompensierte chronisch-obstruktive Lungenerkrankung, Lungenembolie und Asthma. Die unmittelbare Versorgung umfasst die Beurteilung der Schwere-Kriterien, wie Schock, verändertes Bewusstsein oder Atemnot mit schwerer Hypoxämie und/oder Hyperkapnie mit Azidose, die einen Transfer auf die Intensivstation erfordern. Die Behandlung umfasst Sauerstofftherapie und nicht-invasive Beatmung. Das Ansprechen auf die Behandlung in der ersten Stunde sollte unbedingt ausgewertet werden, und dessen Ausbleiben erfordert einen sofortigen Transfer auf die Intensivstation.
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Affiliation(s)
- Zied Ltaief
- 1 Service de Médecine Intensive Adulte et Centre des Brûlés, Centre Hospitalier Universitaire Vaudois et Faculté de Biologie et Médecine, Lausanne
| | - Lucas Liaudet
- 1 Service de Médecine Intensive Adulte et Centre des Brûlés, Centre Hospitalier Universitaire Vaudois et Faculté de Biologie et Médecine, Lausanne
| | - Cyril Manzon
- 1 Service de Médecine Intensive Adulte et Centre des Brûlés, Centre Hospitalier Universitaire Vaudois et Faculté de Biologie et Médecine, Lausanne
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Leite Figueiredo DA, Branco PC, Dos Santos DA, Emerenciano AK, Iunes RS, Shimada Borges JC, Machado Cunha da Silva JR. Ocean acidification affects parameters of immune response and extracellular pH in tropical sea urchins Lytechinus variegatus and Echinometra luccunter. Aquat Toxicol 2016; 180:84-94. [PMID: 27684601 DOI: 10.1016/j.aquatox.2016.09.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Revised: 09/12/2016] [Accepted: 09/13/2016] [Indexed: 06/06/2023]
Abstract
The rising concentration of atmospheric CO2 by anthropogenic activities is changing the chemistry of the oceans, resulting in a decreased pH. Several studies have shown that the decrease in pH can affect calcification rates and reproduction of marine invertebrates, but little attention has been drawn to their immune response. Thus this study evaluated in two adult tropical sea urchin species, Lytechinus variegatus and Echinometra lucunter, the effects of ocean acidification over a period of 24h and 5days, on parameters of the immune response, the extracellular acid base balance, and the ability to recover these parameters. For this reason, the phagocytic capacity (PC), the phagocytic index (PI), the capacity of cell adhesion, cell spreading, cell spreading area of phagocytic amebocytes in vitro, and the coelomic fluid pH were analyzed in animals exposed to a pH of 8.0 (control group), 7.6 and 7.3. Experimental pH's were predicted by IPCC for the future of the two species. Furthermore, a recovery test was conducted to verify whether animals have the ability to restore these physiological parameters after being re-exposed to control conditions. Both species presented a significant decrease in PC, in the pH of coelomic fluid and in the cell spreading area. Besides that, Echinometra lucunter showed a significant decrease in cell spreading and significant differences in coelomocyte proportions. The recovery test showed that the PC of both species increased, also being below the control values. Even so, they were still significantly higher than those exposed to acidified seawater, indicating that with the re-establishment of the pH value the phagocytic capacity of cells tends to restore control conditions. These results demonstrate that the immune system and the coelomic fluid pH of these animals can be affected by ocean acidification. However, the effects of a short-term exposure can be reversible if the natural values are re-established. Thus, the effects of ocean acidification could lead to consequences for pathogen resistance and survival of these sea urchin species.
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Affiliation(s)
- Débora Alvares Leite Figueiredo
- Department of Cell and Developmental Biology, Institute of Biomedical Science, University of São Paulo, Av Prof. Lineu Prestes, 1524, CEP 05509-900, São Paulo, SP, Brazil.
| | - Paola Cristina Branco
- Department of Cell and Developmental Biology, Institute of Biomedical Science, University of São Paulo, Av Prof. Lineu Prestes, 1524, CEP 05509-900, São Paulo, SP, Brazil
| | - Douglas Amaral Dos Santos
- Department of Cell and Developmental Biology, Institute of Biomedical Science, University of São Paulo, Av Prof. Lineu Prestes, 1524, CEP 05509-900, São Paulo, SP, Brazil
| | - Andrews Krupinski Emerenciano
- Department of Cell and Developmental Biology, Institute of Biomedical Science, University of São Paulo, Av Prof. Lineu Prestes, 1524, CEP 05509-900, São Paulo, SP, Brazil
| | - Renata Stecca Iunes
- Department of Cell and Developmental Biology, Institute of Biomedical Science, University of São Paulo, Av Prof. Lineu Prestes, 1524, CEP 05509-900, São Paulo, SP, Brazil
| | - João Carlos Shimada Borges
- Metropolitan United Faculties, Scholl of Veterinary Medicine, Rua Ministro Nelson Hungria, 541, São Paulo, SP, Brazil; Universidade Paulista, Av. Marquês de São Vicente, 3001 - Água Branca - São Paulo - Brazil
| | - José Roberto Machado Cunha da Silva
- Department of Cell and Developmental Biology, Institute of Biomedical Science, University of São Paulo, Av Prof. Lineu Prestes, 1524, CEP 05509-900, São Paulo, SP, Brazil
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Vasiliauskas D, Jasiukeviciene L. Impact of a correct breathing stereotype on pulmonary minute ventilation, blood gases and acid-base balance in post-myocardial infarction patients. ACTA ACUST UNITED AC 2016; 11:223-7. [PMID: 15179104 DOI: 10.1097/01.hjr.0000131678.96762.e8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
STUDY OBJECTIVE The aim of the study was to evaluate the impact of a long-term (6-month) correct breathing stereotype on minute ventilation, capillary blood gases and acid-base balance in post-myocardial infarction patients. METHODS Fifty-five men (age 57.2 +/- 12.5) were examined 2 months later after myocardial infarction. Spirometry and assessment of acid-base balance and capillary blood gases were performed at rest and repeated after 10 days and 6 months. Breathing correction was taught over 5 days. A session for the control and maintenance of the correct breathing skills was hosted once a month (during the 6-month period). RESULTS Changes of minute ventilation, capillary blood gases and acid-base balance were revealed in 55% of patients 2 months later after myocardial infarction. Twenty patients (group I) were randomly selected for breathing correction while 10 patients made up the control group (group II). After breathing correction minute ventilation significantly decreased (18.5 +/- 5.5 versus 9.8 +/- 2.5 l/min), oxygen ventilatory equivalent decreased (39.8 +/- 5.2 versus 22.5 +/- 3.8), partial pressure of blood carbon dioxide increased (33.2 +/- 1.7 versus 44.2 +/- 2.5 mmHg), plasma bicarbonate concentration augmented (19.1 +/- 2.2 versus 24.5 +/- 1.8 mmol/l), base excess normalized (-2.90 +/- 2.5 versus +1.3 +/- 2.1 mmol/l), and pH shifted to more alkaline value (7.36 +/- 0.01 versus 7.43 +/- 0.02). CONCLUSIONS A long-term correct breathing stereotype improved respiratory function and could be an additional measure in rehabilitation programmes for post-myocardial infarction patients.
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Affiliation(s)
- Donatas Vasiliauskas
- Laboratory of Cardiological Rehabilitation, Institute of Cardiology, Kaunas University of Medicine, Sukilëliø 17, Kaunas, Lithuania.
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Abstract
Acute kidney injury (AKI) is the most common cause of organ dysfunction in critically ill adults, with a single episode of AKI, regardless of stage, carrying a significant morbidity and mortality risk. Since the consensus on AKI nomenclature has been reached, data reflecting outcomes have become more apparent allowing investigation of both short- and long-term outcomes.Classically the short-term effects of AKI can be thought of as those reflecting an acute deterioration in renal function per se. However, the effects of AKI, especially with regard to distant organ function ("organ cross-talk"), are being elucidated as is the increased susceptibility to other conditions. With regards to the long-term effects, the consideration that outcome is a simple binary endpoint of dialysis or not, or survival or not, is overly simplistic, with the reality being much more complex.Also discussed are currently available treatment strategies to mitigate these adverse effects, as they have the potential to improve patient outcome and provide considerable economic health savings. Moving forward, an agreement for defining renal recovery is warranted if we are to assess and extrapolate the efficacy of novel therapies. Future research should focus on targeted therapies assessed by measure of long-term outcomes.
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Affiliation(s)
- James F Doyle
- Department of Intensive Care Medicine and Surrey Peri-Operative Anaesthesia and Critical Care Collaborative Research Group, Royal Surrey County Hospital NHS Foundation Trust, Egerton Road, Guildford, GU2 7XX, Surrey, UK
| | - Lui G Forni
- Department of Intensive Care Medicine and Surrey Peri-Operative Anaesthesia and Critical Care Collaborative Research Group, Royal Surrey County Hospital NHS Foundation Trust, Egerton Road, Guildford, GU2 7XX, Surrey, UK.
- Faculty of Health and Medical Sciences, University of Surrey, Guildford, Surrey, UK.
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Shioji N, Hayashi M, Morimatsu H. [Kidney, Fluid, and Acid-Base Balance]. Masui 2016; 65:503-510. [PMID: 27319095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Kidneys play an important role to maintain human homeostasis. They contribute to maintain body fluid, electrolytes, and acid-base balance. Especially in fluid control, we, physicians can intervene body fluid balance using fluid resuscitation and diuretics. In recent years, one type of fluid resuscitation, hydroxyl ethyl starch has been extensively studied in the field of intensive care. Although their effects on fluid resuscitation are reasonable, serious complications such as kidney injury requiring renal replacement therapy occur frequently. Now we have to pay more attention to this important complication. Another topic of fluid management is tolvaptan, a selective vasopressin-2 receptor antagonist Recent randomized trial suggested that tolvaptan has a similar supportive effect for fluid control and more cost effective compared to carperitide. In recent years, Stewart approach is recognized as one important tool to assess acid-base balance in critically ill patients. This approach has great value, especially to understand metabolic components in acid-base balance. Even for assessing the effects of kidneys on acid-base balance, this approach gives us interesting insight. We should appropriately use this new approach to treat acid-base abnormality in critically ill patients.
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Mazák K, Noszál B. Advances in microspeciation of drugs and biomolecules: Species-specific concentrations, acid-base properties and related parameters. J Pharm Biomed Anal 2016; 130:390-403. [PMID: 27066736 DOI: 10.1016/j.jpba.2016.03.053] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2016] [Revised: 03/24/2016] [Accepted: 03/25/2016] [Indexed: 01/14/2023]
Abstract
The pharmacokinetic and pharmacodynamic behaviour of drugs and the interacting biomolecules are highly influenced by their species-specific physico-chemical properties. The first of such bio-relevant, structure-dependent properties were the species-specific acid-base constants and the co-dependent concentrations, but the past decade brought significant advances to previously uncharted territories, including the experimental determination of species-specific partition coefficients, solubilities and redox equilibrium constants. This review gives an overview of the types and definitions of species-specific physico-chemical and analytical properties. We survey the pertinent literature, the fundamental relationships, and summarize some of our recent work that enabled the determination of species-specific partition coefficients for coexisting, inseparable protonation isomers and pH-independent, microscopic redox equilibrium constants. The thorough insight provided by these species-specific properties improves our understanding of the submolecular mechanism of pharmacokinetic processes. As a result, there are some pieces of clear-cut evidence of practical significance. A few of them are as follows: - passive diffusion into lipophilic media is not necessarily predominated by the non-charged species, contrary to the widespread misbelief. - the reactive microspecies in structure-controlled, highly specific biochemical reactions is not necessarily the major one. - a preventive defence system against oxidative stress can be based upon thiol-disulfide equilibria of custom-tailored redox potentials.
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Affiliation(s)
- Károly Mazák
- Semmelweis University, Department of Pharmaceutical Chemistry, Research Group of Drugs of Abuse and Doping Agents, Hungarian Academy of Sciences Hőgyes E. u. 9., H-1092 Budapest, Hungary
| | - Béla Noszál
- Semmelweis University, Department of Pharmaceutical Chemistry, Research Group of Drugs of Abuse and Doping Agents, Hungarian Academy of Sciences Hőgyes E. u. 9., H-1092 Budapest, Hungary.
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Oommen V, Ganesh G, Vadivel K, Kanthakumar P. The Henderson-Hasselbalch Equation : A Three Dimensional Teaching Model. Indian J Physiol Pharmacol 2016; 60:70-75. [PMID: 29953196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The Henderson-Hasselbalch equation can be considered as the backbone of acid base physiology. This is conventionally represented using two dimensional plots. Although two dimensional plots are simple to use, the equation in reality represents a surface in three dimensional space. Any combination of PaCO2, [HCO3 —] and blood pH values representing acid base disorders is restricted to this surface. Two models depicting the three dimensional surface generated by the Henderson-Hasselbalch equation were constructed from easily available materials. The first model was constructed using coloured beads, thin metal rods and plywood. This model depicted the Henderson-Hasselbalch surface as a collection of discreet points. The second model depicted the Henderson-Hasselbalch equation as a continuous surface using polystyrene sheets and white cement. The models were presented to undergraduate and post-graduate medical students along with other conventional two dimensional nomograms. Three dimensional models of the Henderson-Hasselbalch equation can serve as supplementary teaching material to ensure a deeper understanding of acid base physiology.
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Matoušovic K, Havlín J, Schück O. [Clinical evaluation of acid-base status: Henderson-Hasselbalch, or Stewart-Fencl approach?]. Cas Lek Cesk 2016; 155:365-369. [PMID: 27990831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Two approaches have been used in clinical evaluation the acid-base status: traditional (bicarbonate-centered) is based on the Henderson-Hasselbalch equation complemented by calculation of the anion gap, and more recent quantitative approach proposed by Stewart and Fencl. The latter method defines the three independent variables, which regulate pH. These include: the difference between the sum of charges carried by strong plasma cations and anions termed the strong ion difference - SID (decrease causes acidosis, and vice versa); the total concentration of the weak non-volatile acids [Atot] (inorganic phosphate and albumin, decrease causes alkalosis and vice versa), and pCO2. According to this approach, pH and bicarbonate are dependent variables. Their concentrations change if and only if one or more independent variables are altered.The main advantage of the Stewart-Fencl approach is the calculation of the concentration of plasma acids, which are not routinely measured. In the traditional approach, their presence is inferred from the anion gap. The correction of the value of anion gap according to the serum albumin level increases the specificity. This correction brings traditional approach closer to the Stewart-Fencl method that precisely calculates unmeasured strong anions by further adjustment of the corrected anion gap according to the serum phosphate, calcium and magnesium levels. The precise calculation of unmeasured anions is important in critically ill patients with the metabolic breakdown, where the traditional approach may overlook the presence of unmeasured anions. Consideration of the sodium-chloride difference draws the attention to acid-base disturbance caused by change of the strong ion difference.
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Middlemiss KL, Urbina MA, Wilson RW. Effects of seawater alkalinity on calcium and acid-base regulation in juvenile European lobster (Homarus gammarus) during a moult cycle. Comp Biochem Physiol A Mol Integr Physiol 2015; 193:22-8. [PMID: 26691956 DOI: 10.1016/j.cbpa.2015.12.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2015] [Revised: 12/07/2015] [Accepted: 12/07/2015] [Indexed: 11/18/2022]
Abstract
Fluxes of NH4(+) (acid) and HCO3(-) (base), and whole body calcium content were measured in European lobster (Homarus gammarus) during intermoult (megalopae stage), and during the first 24h for postmoult juveniles under control (~2000 μeq/L) and low seawater alkalinity (~830 μeq/L). Immediately after moulting, animals lost 45% of the total body calcium via the shed exoskeleton (exuvia), and only 11% was retained in the uncalcified body. At 24h postmoult, exoskeleton calcium increased to ~46% of the intermoult stage. Ammonia excretion was not affected by seawater alkalinity. After moulting, bicarbonate excretion was immediately reversed from excretion to uptake (~4-6 fold higher rates than intermoult) over the whole 24h postmoult period, peaking at 3-6h. These data suggest that exoskeleton calcification is not completed by 24h postmoult. Low seawater alkalinity reduced postmoult bicarbonate uptake by 29% on average. Net acid-base flux (equivalent to net base uptake) followed the same pattern as HCO3(-) fluxes, and was 22% lower in low alkalinity seawater over the whole 24h postmoult period. The common occurrence of low alkalinity in intensive aquaculture systems may slow postmoult calcification in juvenile H. gammarus, increasing the risk of mortalities through cannibalism.
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Affiliation(s)
- Karen L Middlemiss
- Biosciences, College of Life and Environmental Sciences, Geoffrey Pope Building, University of Exeter, Stocker Road, Exeter EX4 4QD, UK.
| | - Mauricio A Urbina
- Biosciences, College of Life and Environmental Sciences, Geoffrey Pope Building, University of Exeter, Stocker Road, Exeter EX4 4QD, UK; Departamento de Zoología, Facultad de Ciencias Naturales y Oceanográficas, Universidad de Concepción, Casilla 160-C, Concepción, Chile.
| | - Rod W Wilson
- Biosciences, College of Life and Environmental Sciences, Geoffrey Pope Building, University of Exeter, Stocker Road, Exeter EX4 4QD, UK.
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Morgan TJ, Venkatesh B, Bellomo R. Acid-base physiology: comments on 10 contentious assertions. CRIT CARE RESUSC 2015; 17:211-213. [PMID: 26282261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Affiliation(s)
- Thomas J Morgan
- Mater Research Institute, University of Queensland, Brisbane, QLD, Australia.
| | | | - Rinaldo Bellomo
- Australian and New Zealand Intensive Care Research Centre, Melbourne, VIC, Australia
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Hammon M, Grossmann S, Linz P, Kopp C, Dahlmann A, Janka R, Cavallaro A, Uder M, Titze J. 3 Tesla (23)Na magnetic resonance imaging during aerobic and anaerobic exercise. Acad Radiol 2015; 22:1181-90. [PMID: 26152501 DOI: 10.1016/j.acra.2015.06.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Revised: 05/28/2015] [Accepted: 06/03/2015] [Indexed: 11/19/2022]
Abstract
RATIONALE AND OBJECTIVES The aim of the work described here was to determine the feasibility of monitoring Na(+) concentration and distribution in muscle/skin during aerobic/anaerobic exercise with (23)Na magnetic resonance imaging (MRI). MATERIALS AND METHODS The Na(+) concentration and water content of muscle/skin of the left lower leg of six healthy subjects (mean age, 26 years; range, 22-30 years; three men and three women) were assessed before and after aerobic/anaerobic cycle ergometry and during recovery with 3-T (23)Na/(1)H MRI. (23)Na MRI was performed with a custom-made knee coil. A gradient echo sequence with an acquisition time of 3.25 minutes, echo time of 2.07 ms, repetition time of 100 ms, and spatial resolution of 3 × 3 × 30 mm(3) was applied. Phantoms with increasing sodium concentration served for quantification via linear extrapolation. Blood values were determined by blood gas analysis. RESULTS The concentration of Na(+) significantly increased during anaerobic exercise in all muscle compartments except the medial gastrocnemius muscle, whereas no significant change was observed in most muscle compartments during aerobic exercise (only the soleus muscle exhibited a significant increase in Na(+) concentration during aerobic exercise: 1.6 ± 1.5 mmol/kg, 4.5%, P = .046). During anaerobic exercise, the mean Na(+) concentration of the triceps surae and the whole leg increased by 9.0% (3.1 ± 2.1 mmol/kg, P = .016) and 6.5% (2.2 ± 1.3 mmol/kg, P < .01). MRI revealed a water-independent increase in Na(+) concentration in most muscle compartments during anaerobic exercise. Na(+) concentration significantly decreased during recovery after anaerobic and aerobic exercise in all muscle compartments except the soleus. The Na(+) concentration of the skin did not significantly change during anaerobic/aerobic exercise. CONCLUSIONS Sodium(23) MRI allows reliable and noninvasive visualization and quantification of Na(+) concentration and distribution in muscle and skin during exercise. (23)Na MRI can be used to gain new insights into Na(+) homeostasis, presumably leading to better comprehension of pathophysiology.
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Affiliation(s)
- Matthias Hammon
- Department of Radiology, University Hospital Erlangen, Maximiliansplatz 1, Erlangen 91054, Germany.
| | - Susan Grossmann
- Department of Radiology, University Hospital Erlangen, Maximiliansplatz 1, Erlangen 91054, Germany
| | - Peter Linz
- Department of Nephrology and Hypertension, University Hospital Erlangen, Erlangen, Germany
| | - Christoph Kopp
- Department of Nephrology and Hypertension, University Hospital Erlangen, Erlangen, Germany
| | - Anke Dahlmann
- Department of Nephrology and Hypertension, University Hospital Erlangen, Erlangen, Germany
| | - Rolf Janka
- Department of Radiology, University Hospital Erlangen, Maximiliansplatz 1, Erlangen 91054, Germany
| | - Alexander Cavallaro
- Department of Radiology, University Hospital Erlangen, Maximiliansplatz 1, Erlangen 91054, Germany
| | - Michael Uder
- Department of Radiology, University Hospital Erlangen, Maximiliansplatz 1, Erlangen 91054, Germany
| | - Jens Titze
- Department of Medicine, Vanderbilt University, Nashville, Tennessee
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Mutetwa EN, Shumbairerwa S, Crawford A, Madzimbamuto FD, Chimoga T, Marange-Chikuni D. Metabolic effects of Carbon Dioxide (CO2) insufflation during laparoscopic surgery: changes in pH, arterial partial Pressure of Carbon Dioxide (PaCo2) and End Tidal Carbon Dioxide (EtCO2). Cent Afr J Med 2015; 61:61-65. [PMID: 29144063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND Acid base alterations occur during laparoscopy with carbon dioxide insufflation. The purpose of this study was to investigate the effects of low tidal volume ventilation on acid base status during pneumoperitonium. MATERIALS AND METHODS 30 patients undergoing laparoscopic surgery under General Anaesthesia were ventilated with tidal volume of 6 ml/kg and respiratory rate of 12 breaths/minute. Arterial blood gas analysis was done before, during and after C02 pneumoperitoneum. Arterial haemoglobin oxygen saturation by pulse oximetry (SPO2) and EtC02 were monitored continuously throughout the laparoscopy. Respiratory adjustments were done for EtCO2 levels above 60mmHg or SPO2 below 92% or adverse haemodynamic changes. RESULTS low tidal volume ventilation during pneumoperitoneum resulted in a significant elevation in PaCO2 (p<0.001) and a fall of pH (p <0.001), ion bicarbonate (HCO3-) (p = 0.011), and base excess (ABE) (p <0.001). A correlation was found between the EtCO2 and PaCO2 during pneumoperitoneum. Oxygenation was well maintained during pneumoperitoneum. No ventilatory adjustments were instituted on any of the patients as they maintained EtCO2 below 60mmHg throughout pneumoperitoneum. CONCLUSION Ventilation with low tidal volume during pneumoperitoneum causes a mixed respiratory and metabolic acidosis. EtCO2 is still a good non-invasive monitor for estimation of PaCO2 during low tidal volume ventilation during pneumoperitoneum.
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Camacho M, Quintana MDP, Calabuig P, Luzardo OP, Boada LD, Zumbado M, Orós J. Acid-Base and Plasma Biochemical Changes Using Crystalloid Fluids in Stranded Juvenile Loggerhead Sea Turtles (Caretta caretta). PLoS One 2015; 10:e0132217. [PMID: 26167930 PMCID: PMC4500549 DOI: 10.1371/journal.pone.0132217] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Accepted: 06/14/2015] [Indexed: 11/18/2022] Open
Abstract
AIM The aim of this study was to compare the efficacy and effects on acid-base and electrolyte status of several crystalloid fluids in 57 stranded juvenile loggerhead turtles. METHODS Within a rehabilitation program four different crystalloid fluids were administered (0.9% Na Cl solution; 5% dextrose + 0.9% Na Cl solutions 1:1; 0.9% Na Cl + lactated Ringer's solutions 1:1; lactated Ringer's solution). Crystalloid fluids were intracoelomically administered during three days (20 ml/kg/day). Animals were sampled at three different moments: Upon admission for evaluating the type of acid-base or biochemical disorder, post-fluid therapy treatment for controlling the evolution of the disorder, and post-recovery period for obtaining the baseline values for rehabilitated loggerhead turtles. Each sample was analyzed with a portable electronic blood analyzer for pH, pO2, pCO2, lactate, sodium, potassium, chloride, glucose, and BUN concentration. Admission and post-fluid therapy treatment values were compared with those obtained for each turtle immediately before release. RESULTS The highest percentage of acid-base recovery and electrolyte balance was observed in turtles treated with mixed saline-lactated Ringer's solution (63.6%), followed by turtles treated with physiological saline solution (55%), lactated Ringer's solution (33.3%), and dextrose-saline solutions (10%). Most turtles treated with lactated Ringer's solution had lower lactate concentrations compared with their initial values; however, 66.6% of turtles treated with lactated Ringer's solution had metabolic alkalosis after therapy. Significant higher concentrations of glucose were detected after saline-dextrose administration compared with all the remaining fluids. CONCLUSIONS This is the first study evaluating the effects of several crystalloid fluids on the acid-base status and plasma biochemical values in stranded loggerhead sea turtles. Reference convalescent venous blood gas, acid-base, and plasma biochemical values, useful for veterinary surgeons involved in sea turtle conservation, are also provided.
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Affiliation(s)
- María Camacho
- Veterinary Faculty, University of Las Palmas de Gran Canaria, Arucas (Las Palmas), Spain
| | - María del Pino Quintana
- Department of Mathematics, University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Pascual Calabuig
- Tafira Wildlife Rehabilitation Center, Cabildo de Gran Canaria, Tafira Baja-Las Palmas de Gran Canaria, Spain
| | - Octavio P. Luzardo
- Veterinary Faculty, University of Las Palmas de Gran Canaria, Arucas (Las Palmas), Spain
| | - Luis D. Boada
- Veterinary Faculty, University of Las Palmas de Gran Canaria, Arucas (Las Palmas), Spain
| | - Manuel Zumbado
- Veterinary Faculty, University of Las Palmas de Gran Canaria, Arucas (Las Palmas), Spain
| | - Jorge Orós
- Veterinary Faculty, University of Las Palmas de Gran Canaria, Arucas (Las Palmas), Spain
- * E-mail:
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Abstract
This article examines acid-base balance and the interpretation of arterial blood gases (ABG). The article begins with a brief revision of related physiology, followed by a description of the primary disorders associated with acid-base imbalance. The normal ranges and the significance of abnormal ABG results are explored. The article concludes by providing an easy to follow four-step guide to ABG interpretation with practice examples presented in the CPD task section.
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de Vallière C, Wang Y, Eloranta JJ, Vidal S, Clay I, Spalinger MR, Tcymbarevich I, Terhalle A, Ludwig MG, Suply T, Fried M, Kullak-Ublick GA, Frey-Wagner I, Scharl M, Seuwen K, Wagner CA, Rogler G. G Protein-coupled pH-sensing Receptor OGR1 Is a Regulator of Intestinal Inflammation. Inflamm Bowel Dis 2015; 21:1269-81. [PMID: 25856770 PMCID: PMC4450952 DOI: 10.1097/mib.0000000000000375] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Accepted: 01/27/2015] [Indexed: 12/12/2022]
Abstract
BACKGROUND A novel family of proton-sensing G protein-coupled receptors, including OGR1, GPR4, and TDAG8, was identified to be important for physiological pH homeostasis and inflammation. Thus, we determined the function of proton-sensing OGR1 in the intestinal mucosa. MTEHODS OGR1 expression in colonic tissues was investigated in controls and patients with IBD. Expression of OGR1 upon cell activation was studied in the Mono Mac 6 (MM6) cell line and primary human and murine monocytes by real-time PCR. Ogr1 knockout mice were crossbred with Il-10 deficient mice and studied for more than 200 days. Microarray profiling was performed using Ogr1 and Ogr1 (WT) residential peritoneal macrophages. RESULTS Patients with IBD expressed higher levels of OGR1 in the mucosa than non-IBD controls. Treatment of MM6 cells with TNF, led to significant upregulation of OGR1 expression, which could be reversed by the presence of NF-κB inhibitors. Kaplan-Meier survival analysis showed a significantly delayed onset and progression of rectal prolapse in female Ogr1/Il-10 mice. These mice displayed significantly less rectal prolapses. Upregulation of gene expression, mediated by OGR1, in response to extracellular acidification in mouse macrophages was enriched for inflammation and immune response, actin cytoskeleton, and cell-adhesion gene pathways. CONCLUSIONS OGR1 expression is induced in cells of human macrophage lineage and primary human monocytes by TNF. NF-κB inhibition reverses the induction of OGR1 expression by TNF. OGR1 deficiency protects from spontaneous inflammation in the Il-10 knockout model. Our data indicate a pathophysiological role for pH-sensing receptor OGR1 during the pathogenesis of mucosal inflammation.
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Affiliation(s)
- Cheryl de Vallière
- Division of Gastroenterology and Hepatology, University Hospital Zürich, Zürich, Switzerland
| | - Yu Wang
- Division of Gastroenterology and Hepatology, University Hospital Zürich, Zürich, Switzerland
- Institute of Physiology, University of Zürich, Zürich, Switzerland
| | - Jyrki J. Eloranta
- Department of Clinical Pharmacology and Toxicology, University Hospital Zürich, Zürich, Switzerland; and
| | - Solange Vidal
- Novartis Institutes for Biomedical Research, Basel, Switzerland
| | - Ieuan Clay
- Novartis Institutes for Biomedical Research, Basel, Switzerland
| | - Marianne R. Spalinger
- Division of Gastroenterology and Hepatology, University Hospital Zürich, Zürich, Switzerland
| | - Irina Tcymbarevich
- Division of Gastroenterology and Hepatology, University Hospital Zürich, Zürich, Switzerland
| | - Anne Terhalle
- Division of Gastroenterology and Hepatology, University Hospital Zürich, Zürich, Switzerland
| | | | - Thomas Suply
- Novartis Institutes for Biomedical Research, Basel, Switzerland
| | - Michael Fried
- Division of Gastroenterology and Hepatology, University Hospital Zürich, Zürich, Switzerland
| | - Gerd A. Kullak-Ublick
- Department of Clinical Pharmacology and Toxicology, University Hospital Zürich, Zürich, Switzerland; and
| | - Isabelle Frey-Wagner
- Division of Gastroenterology and Hepatology, University Hospital Zürich, Zürich, Switzerland
| | - Michael Scharl
- Division of Gastroenterology and Hepatology, University Hospital Zürich, Zürich, Switzerland
| | - Klaus Seuwen
- Novartis Institutes for Biomedical Research, Basel, Switzerland
| | | | - Gerhard Rogler
- Division of Gastroenterology and Hepatology, University Hospital Zürich, Zürich, Switzerland
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