Blood lactate and acid-base balance in graded neonatal hypoxia: evidence for oxygen-restricted metabolism

1994 ◽  
Vol 77 (5) ◽  
pp. 2318-2324 ◽  
Author(s):  
S. M. Torrance ◽  
C. Wittnich
Keyword(s):  
Lactic Acidosis ◽  
Oxygen Uptake ◽  
Anaerobic Metabolism ◽  
Base Excess ◽  
Severe Hypoxia ◽  
Oxygen Extraction ◽  
Acid Base Balance ◽  
Acid Base ◽  
Neonatal Response ◽  
Base Balance

This study examines the neonatal response to graded hypoxia and determines the arterial PO2 (PaO2) threshold for oxygen-restricted metabolism as confirmed by the development of lactic acidosis and altered oxygen handling. Anesthetized, intubated, and ventilated 3-day-old pigs (n = 56) were randomly assigned to one of five predetermined acute (120 min) graded hypoxia groups: normoxia (PaO2 = 80 Torr) or mild (60 Torr), moderate (40 Torr), moderately severe (30 Torr), or severe (20 Torr) hypoxia. In moderate hypoxia, lactate and acid-base homeostasis were unaltered due to a significant increase in oxygen extraction (P < 0.05) that was sufficient to maintain the arteriovenous oxygen content difference (oxygen uptake). In moderately severe hypoxia, increased arterial lactate and decreased HCO3- and base excess were evidence of anaerobic metabolism, yet pH was unaltered, indicating adequate buffering. In this group, despite the increase in oxygen extraction, oxygen uptake was reduced, indicating the onset of oxygen-restricted metabolism. The severe hypoxia group had significantly increased lactate (21.7 +/- 3.9 mmol/l), decreased pH (7.01 +/- 0.07) and base excess (-21.5 +/- 3.0 mmol/l), and depletion of HCO3- (9.7 +/- 1.6 mmol/l) (P < 0.0001). Here, increases in oxygen extraction were severely limited by availability, resulting in significantly reduced oxygen uptake, anaerobic metabolism, and profound lactic acidosis.

scholarly journals Acid-base balance in sheep with experimentally induced acute ruminal lactic acidosis

2017 ◽  
Vol 69 (3) ◽  
pp. 637-643 ◽  
Author(s):  
A.F. Sabes ◽  
A.M. Girardi ◽  
D. Zangirolami Filho ◽  
G.M. Bueno ◽  
J.A. Oliveira ◽  
...  
Keyword(s):  
Lactic Acidosis ◽  
Base Excess ◽  
Blood Gas Analysis ◽  
Gas Analysis ◽  
Urine Samples ◽  
Acid Base Balance ◽  
Acid Base ◽  
Arterial Blood ◽  
Base Balance ◽  
Experimentally Induced

ABSTRACT This study aimed to investigate the changes in the acid-base balance of sheep with experimentally induced acute ruminal lactic acidosis (ARA). Ten ewes orally received 15 grams of sucrose per kilogram of body mass. Arterial blood samples for blood gas analysis were obtained at the following intervals: before the induction of ARA (control), and 2, 4, 6, 8, 10, 12, 16, 20, 24, 28, 32, 36, 48, 72, 96, 120 and 144 hours after sucrose administration. Urine samples for pH measurement were obtained at the following times: -15 days, -7 days, and immediately before sucrose administration, then at 24, 48, 72, 96, 120 and 144 hours. Thereafter, both blood and urine samples were obtained on the 2nd, 3rd, and 4th following weeks. From 4 hours after the induction, elevation of the pH, bicarbonate and base excess on the arterial blood was observed. After 12 hours, the animals showed a decrease of these parameters, as well as urine acidification, which are symptomatic of metabolic acidosis. Within 28 hours, all parameters were normalized except the base excess, which only returned to normal after 72 hours. Despite the occurrence of acidemia, there was no need for medication and no animals died.

scholarly journals Prognostic value of base excess as indicator of acid-base balance in acute heart failure

2020 ◽  
Vol 9 (5) ◽  
pp. 399-405 ◽  
Author(s):  
Hiroki Nakano ◽  
Toshiyuki Nagai ◽  
Yasuyuki Honda ◽  
Satoshi Honda ◽  
Naotsugu Iwakami ◽  
...  
Keyword(s):  
Heart Failure ◽  
Confidence Interval ◽  
Acute Heart Failure ◽  
Base Excess ◽  
Acid Base Balance ◽  
Acid Base ◽  
Heart Failure Patients ◽  
Base Balance ◽  
High Base

Background: Acid-base balance can change as a result of pulmonary oedema and low tissue perfusion in acute heart failure patients. However, its long-term prognostic significance remains to be clarified. Methods: We prospectively examined a cohort of 472 consecutive acute heart failure patients who underwent arterial blood gas analysis on admission between January 2013 and May 2016. Acidaemia, alkalaemia and normal range of base excess were defined as pH <7.38, >7.42 and −2 to 2 mEq/L, respectively. The primary outcome was all-cause death. Results: During a median follow-up period of 714 days, 101 patients died. Although there was no difference in mortality among patients with acidaemia, normal pH and alkalaemia ( p = 0.92), patients with high base excess had the highest mortality compared with others. Multivariable Cox proportional hazard models revealed that high base excess was an independent determinant of mortality (hazard ratio 1.83, 95% confidence interval 1.08–3.13 (high versus normal base excess), hazard ratio 0.81, 95% confidence interval 0.47–1.41 (low versus normal base excess)), even after adjustment for significant prognostic covariates. Furthermore, regarding mortality stratified by base excess and carbon dioxide partial pressure (pCO2), patients with high base excess (>2.1 mEq/L) and high pCO2 (>40 mmHg) had the highest mortality compared with others. Conclusions: High base excess, but not low base excess, on admission was associated with long-term mortality in acute heart failure patients, indicating the importance of evaluating acid-base balance on admission by base excess for stratifying the risk of mortality in patients with acute heart failure.

scholarly journals Isoflurane-induced acidosis depresses basal and PGE2-stimulated duodenal bicarbonate secretion in mice

2007 ◽  
Vol 292 (3) ◽  
pp. G899-G904 ◽  
Author(s):  
Markus Sjöblom ◽  
Olof Nylander
Keyword(s):  
Base Excess ◽  
Ringer Solution ◽  
Bicarbonate Secretion ◽  
Acid Base Balance ◽  
Acid Base ◽  
In Vivo Experiments ◽  
Arterial Blood ◽  
Blood Ph ◽  
Base Balance

When running in vivo experiments, it is imperative to keep arterial blood pressure and acid-base parameters within the normal physiological range. The aim of this investigation was to explore the consequences of anesthesia-induced acidosis on basal and PGE2-stimulated duodenal bicarbonate secretion. Mice (strain C57bl/6J) were kept anesthetized by a spontaneous inhalation of isoflurane. Mean arterial blood pressure (MAP), arterial acid-base balance, and duodenal mucosal bicarbonate secretion (DMBS) were studied. Two intra-arterial fluid support strategies were used: a standard Ringer solution and an isotonic Na2CO3 solution. Duodenal single perfusion was used, and DMBS was assessed by back titration of the effluent. PGE2 was used to stimulate DMBS. In Ringer solution-infused mice, isoflurane-induced acidosis became worse with time. The blood pH was 7.15–7.21 and the base excess was about −8 mM at the end of experiments. The continuous infusion of Na2CO3 solution completely compensated for the acidosis. The blood pH was 7.36–7.37 and base excess was about 1 mM at the end of the experiment. Basal and PGE2-stimulated DMBS were markedly greater in animals treated with Na2CO3 solution than in those treated with Ringer solution. MAP was slightly higher after Na2CO3 solution infusion than after Ringer solution infusion. We concluded that isoflurane-induced acidosis markedly depresses basal and PGE2-stimulated DMBS as well as the responsiveness to PGE2, effects prevented by a continuous infusion of Na2CO3. When performing in vivo experiments in isoflurane-anesthetized mice, it is recommended to supplement with a Na2CO3 infusion to maintain a normal acid-base balance.

scholarly journals Acid-base balance in acute ethylene glycol poisoning in rats treated with fomepizole

2014 ◽  
Vol 83 (1) ◽  
pp. 29-36
Author(s):  
Jędrzej Przystanowicz ◽  
Barbara Zielińska-Psuja ◽  
Joanna Kowalówka-Zawieja ◽  
Karina Sommerfeld
Keyword(s):  
Single Dose ◽  
Ethylene Glycol ◽  
Base Excess ◽  
Gas Analysis ◽  
Acid Base Balance ◽  
Bicarbonate Concentration ◽  
Acid Base ◽  
Balance Disorders ◽  
Blood Ph ◽  
Base Balance

Introduction. Ethylene glycol (EG) is relatively nontoxic but undergoes a multi-step oxidation to toxic metabolites, aldehydes and acids. The accumulation of organic acids, mainly glycolates, leads to the development of profound, life-threatening metabolic acidosis. A key therapy is an antidotal treatment with fomepizole (4-MP), the inhibitor of the first step of EG biotransformation enzyme, alcohol dehydrogenase.Aim. The aim of the study was to demonstrate the efficacy of fomepizole in the prevention of acid-base balance disorders in acute ethylene glycol poisonings in rats.Material and methods. Adult male Wistar rats were given EG (p.o.) with single (i.p.) or multiple (p.o.) doses of 4-MP (EG 3830 and 5745 mg/kg, respectively, 4-MP in single dose of 10 mg/kg or 15 mg/kg followed by 10 mg/kg every 12 hours). Blood gas analysis was performed and blood pH, bicarbonate concentration and base excess were evaluated.Results and conclusions. The single dose of 4-MP was effective in preventing a decrease in blood pH, bicarbonate concentration and base excess during the entire experimental period (pH 7.35 vs 7.21 at hour 12, bicarbonate concentration 27.2 vs 18.3 mmol/dm3 at hour 8, base excess 1.8 vs -8.2 mmol/dm3 at hour 18). The multiple administration of 4-MP started 2 hours after EG poisoning resulted in rapid restoration of proper values of acid- -base balance parameters. Fomepizole is highly efficacious in restraining the acid-base balance disorders which are concomitant with acute ethylene glycol poisonings.

Acid-base balance during repeated cycling sprints in boys and men

2002 ◽  
Vol 92 (2) ◽  
pp. 479-485 ◽  
Author(s):  
S. Ratel ◽  
P. Duche ◽  
A. Hennegrave ◽  
E. Van Praagh ◽  
M. Bedu
Keyword(s):  
Partial Pressure ◽  
Time Course ◽  
Base Excess ◽  
Acid Base Balance ◽  
Acid Base ◽  
Arterial Partial Pressure ◽  
Significant Relationships ◽  
Base Balance ◽  
Repeated Cycling ◽  
Rest Intervals

The aim of this study was to investigate the acid-base balance during repeated cycling sprints in children and adults. Eleven boys (9.6 ± 0.7 yr) and ten men (20.4 ± 0.8 yr) performed ten 10-s sprints on a cycle ergometer separated by 30-s passive recovery intervals. To measure the time course of lactate ([La]), hydrogen ions ([H+]), bicarbonate ions ([HCO[Formula: see text]]), and base excess concentrations and the arterial partial pressure of CO2, capillary blood samples were collected at rest and after each sprint. Ventilation and CO2output were continuously measured. After the 10th sprint, concentrations of boys vs. men were as follows: [La], 8.5 ± 2.1 vs. 15.4 ± 2.0 mmol/l; [H+], 43.8 ± 1.3 vs. 66.9 ± 9.9 nmol/l ( P < 0.001). Significant correlations showed that, for a given [La], [H+] was lower in the boys compared with the men ( P < 0.001). Significant relationships also indicated that, for a given [La], [HCO[Formula: see text]] and base excess concentration were similar in the boys compared with the men. Moreover, significant relationships revealed that, for a given [H+] or [HCO[Formula: see text]], arterial partial pressure of CO2was lower in the boys compared with the men ( P < 0.001). The ventilation-to-CO2output ratio was higher in the boys during the first five rest intervals and was then higher in the men during the last five sprints. To conclude, during repeated sprints, the ventilatory regulation related to the change in acid-base balance induced by lactic acidosis was more important during the first rest intervals in the boys compared with the men.

scholarly journals The hidden secrets of a neutral pH – Blood-Gas-Analysis of postoperative patients according to the Stewart approach

2020 ◽  
Author(s):  
Joost Janssen ◽  
Joris M.K. van Fessem ◽  
Tijmen Ris ◽  
Robert Jan Stolker ◽  
Markus Klimek
Keyword(s):  
Length Of Stay ◽  
Base Excess ◽  
Blood Gas Analysis ◽  
Gas Analysis ◽  
Blood Gas ◽  
Acid Base Balance ◽  
Metabolic Disturbances ◽  
Acid Base ◽  
Neutral Ph ◽  
Base Balance

Abstract Background: The superiority of either the traditional or Stewart based approach to acid-base balance has focused primarily on analyzing metabolic acidemia, with little attention given to patients with neutral pH. In this study, we evaluate metabolic disturbances in patients in the immediate postoperative period focusing on patients with neutral pH, while comparing the Stewart and traditional approach. Methods: We conducted a single center retrospective observational cohort study. Over a 17 month period, data on arterial blood gas analysis, electrolytes and albumin on the morning after surgery were retrieved from patients admitted to the postsurgical high dependency unit (HDU). Albumin corrected anion gap (AG), apparent (SIDa) and effective strong ion difference (SIDe) and strong ion gap (SIG) were calculated.Results: Out of 1207 HDU admissions, 400 cases had a complete set of laboratory-data including albumin of which 281 presented with neutral pH (7.35 ≤ pH ≤ 7.45), 64 with acidemia (pH < 7.35) and 55 with alkalemia (pH > 7.45). In pH neutral patients the following acidifying disturbances were found: SIDa was lowered in 101 (36%), SIG was raised in 60 (21%). Base excess (BE) was decreased in 16 (6%) and corrected AG raised in 107 (38%). The alkalizing effect of hypoalbuminemia was present in 137 (49%). Out of 134 cases with normal BE and corrected AG, SIDa was lowered in 58 (43%). Out of 136 cases with normal SIDa and SIG, none had lowered BE and 28 increased AG (21%). Length of stay was significantly longer in patients with hypoalbuminemia, lowered SIDa and increased corrected AG, but not decreased BE (Hypoalbuminemia: 16 days vs. 10 days, P < 0.001. Low SIDa: 15 days vs. 12 days, P = 0.015. Increased AG: 16 days vs. 11 days, P < 0.001. Low BE: 14 days vs. 13 days, P = 0.736).Conclusions: Metabolic disturbances, characterized mainly by the presence of lowered SIDa, increased AG and hypoalbuminemia, are frequent in our population with apparent neutral acid-base balance based on pH and base excess. These changes on the morning after surgery are associated with increased length of stay.

scholarly journals The hidden secrets of a neutral pH – Blood-Gas-Analysis of postoperative patients according to the Stewart approach

2020 ◽  
Author(s):  
Joost Janssen ◽  
Joris M.K. van Fessem ◽  
Tijmen Ris ◽  
Robert Jan Stolker ◽  
Markus Klimek
Keyword(s):  
Length Of Stay ◽  
Base Excess ◽  
Blood Gas Analysis ◽  
Gas Analysis ◽  
Blood Gas ◽  
Acid Base Balance ◽  
Metabolic Disturbances ◽  
Acid Base ◽  
Neutral Ph ◽  
Base Balance

Abstract Background The superiority of either the traditional or Stewart based approach to acid-base balance has focused primarily on analyzing metabolic acidemia, with little attention given to patients with neutral pH. In this study, we evaluate metabolic disturbances in patients in the immediate postoperative period focusing on patients with neutral pH, while comparing the Stewart and traditional approach. Methods We conducted a single center retrospective observational cohort study. Over a 17 month period, data on arterial blood gas analysis, electrolytes and albumin on the morning after surgery were retrieved from patients admitted to the postsurgical high dependency unit (HDU). Albumin corrected anion gap (AG), apparent (SIDa) and effective strong ion difference (SIDe) and strong ion gap (SIG) were calculated. Results Out of 1207 HDU admissions, 400 cases had a complete set of laboratory-data including albumin of which 281 presented with neutral pH (7.35 ≤ pH ≤ 7.45), 64 with acidemia (pH < 7.35) and 55 with alkalemia (pH > 7.45). In pH neutral patients the following acidifying disturbances were found: SIDa was lowered in 101 (36%), SIG was raised in 60 (21%). Base excess (BE) was decreased in 16 (6%) and corrected AG raised in 107 (38%). The alkalizing effect of hypoalbuminemia was present in 137 (49%). Out of 134 cases with normal BE and corrected AG, SIDa was lowered in 58 (43%). Out of 136 cases with normal SIDa and SIG, none had lowered BE and 28 increased AG (21%). Length of stay was significantly longer in patients with hypoalbuminemia, lowered SIDa and increased corrected AG, but not decreased BE (Hypoalbuminemia: 16 days vs. 10 days, P < 0.001. Low SIDa: 15 days vs. 12 days, P = 0.015. Increased AG: 16 days vs. 11 days, P < 0.001. Low BE: 14 days vs. 13 days, P = 0.736). Conclusions Metabolic disturbances, characterized mainly by the presence of lowered SIDa, increased AG and hypoalbuminemia, are frequent in our population with apparent neutral acid-base balance based on pH and base excess. These changes on the morning after surgery are associated with increased length of stay.

scholarly journals Respiratory gases and acid-base balance in shell-less avian embryos

1989 ◽  
Vol 143 (1) ◽  
pp. 529-536 ◽  
Author(s):  
K. Rowlett ◽  
K. Simkiss
Keyword(s):  
Calcium Carbonate ◽  
Base Excess ◽  
Normal Function ◽  
Functional Area ◽  
Acid Base Balance ◽  
Acid Base ◽  
Avian Embryos ◽  
Plasma Bicarbonate ◽  
Base Balance ◽  
Respiratory Gases

1. The PCO2 and PO2 levels of oxygenated and deoxygenated embryonic blood were measured in normal and shell-less cultured embryos. 2. Embryos in shell-less culture were both hypoxic and hypocapnic, suggesting that wetting the respiratory membranes and the reduction in their functional area is distorting their normal function. 3. Despite this hypocapnia, there was evidence for an increase in base excess during incubation. This suggests that plasma bicarbonate is derived from renal sources rather than by resorbing the eggshell calcium carbonate, which is, of course, absent from shell-less cultures.

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