scholarly journals Use of intravenous sodium bicarbonate in neonatal intensive care units in Italy: a nationwide survey

2021 ◽  
Vol 47 (1) ◽  
Author(s):  
Luca Massenzi ◽  
◽  
Roberto Aufieri ◽  
Silvia Donno ◽  
Rocco Agostino ◽  
...  
Keyword(s):  
Sodium Bicarbonate ◽  
Neonatal Intensive Care ◽  
Current Knowledge ◽  
Nationwide Survey ◽  
Intracellular Acidosis ◽  
Acid Base Balance ◽  
Metabolic Disturbances ◽  
Attitudes And Practices ◽  
Base Balance ◽  
Intravenous Sodium

Abstract Background Metabolic Acidosis (MA) is a disturbance of the acid-base balance that can occur in preterm and critically ill term neonates due to different etiologies. Intravenous sodium bicarbonate (SB) has been traditionally used to correct such unbalance, despite the lack of evidence about its safety and efficacy. In literature, reported undesirable effects of treatment with SB in neonates include worsening of intracellular acidosis, impairment of myocardial function, cerebral blood flow fluctuations and intracranial hemorrhage. A national survey was conducted by the Neonatal Pharmacotherapy Study Group of the Italian Society of Neonatology with the aim to assess and describe attitudes and practices concerning the use of SB, particularly for the treatment of MA in Italian NICUs. Methods A questionnaire regarding treatment of MA and SB prescription habits was sent to the directors of 120 Italian NICUs from June 2017 to March 2018. Results The survey response rate was 97.5% (117/120 centers). Findings showed that in 55% of the surveyed NICUs (64/117 units) it is common practice to correct MA with intravenous SB. On the other hand, the remaining 45% of the units try to solve the metabolic disturbances adopting different approaches (improving perfusion, adjusting ventilation parameters or increasing blood volume). Moreover, to prevent the occurrence of MA, 37.6% of the NICUs (44/117) include buffer salts (lactate, acetate or both) in parenteral nutrition prescriptions. SB is also used as a treatment for other conditions, mainly pathologies with bicarbonate loss and tubular acidosis (respectively in 53.8 and 32.5% of the NICUs). Conclusion This survey showed how SB is a commonly used treatment for MA in more than half of Italian NICUs, with indications and prescription criteria that significantly vary across centers. Based on current knowledge, it is reasonable to suggest that the management of neonatal MA should be firstly directed to identify the underlying disorders. Thus, the use of SB should be reserved only for selected cases, also considering the severity of SB adverse effects and the lack of evidence about its efficacy. Guidance for the management of MA is required to harmonize practices and reduce the use of potentially inappropriate and unsafe treatments.

scholarly journals Use of Intravenous Sodium Bicarbonate in Neonatal Intensive Care Units in Italy: A Nationwide Survey

2020 ◽  
Author(s):  
Luca Massenzi ◽  
Roberto Aufieri ◽  
Silvia Donno ◽  
Rocco Agostino ◽  
Andrea Dotta
Keyword(s):  
Sodium Bicarbonate ◽  
Neonatal Intensive Care ◽  
Current Knowledge ◽  
Nationwide Survey ◽  
Intracellular Acidosis ◽  
Acid Base Balance ◽  
Metabolic Disturbances ◽  
Attitudes And Practices ◽  
Base Balance ◽  
Intravenous Sodium

Abstract Background Metabolic Acidosis (MA) is a disturbance of the acid-base balance that can occur in preterm and critically ill term neonates due to different etiologies. Intravenous sodium bicarbonate (SB) has been traditionally used to correct such unbalance, despite the lack of evidence about its safety and efficacy. In literature, reported undesirable effects of treatment with SB in neonates include worsening of intracellular acidosis, impairment of myocardial function, cerebral blood flow fluctuations and intracranial hemorrhage. A national survey was conducted by the Neonatal Pharmacotherapy Study Group of the Italian Society of Neonatology with the aim to assess and describe attitudes and practices concerning the use of SB, particularly for the treatment of MA in Italian NICUs. Methods A questionnaire regarding treatment of MA and SB prescription habits was sent to the directors of 120 Italian NICUs from June 2017 to March 2018. Results The survey response rate was 97.5% (117/120 centers). Findings showed that in 55% of the surveyed NICUs (64/117 units) it is common practice to correct MA with intravenous SB. On the other hand, the remaining 45% of the units try to solve the metabolic disturbances adopting different approaches (improving perfusion, adjusting ventilation parameters or increasing blood volume). Moreover, to prevent the occurrence of MA, 37.6% of the NICUs (44/117) include buffer salts (lactate, acetate or both) in parenteral nutrition prescriptions. SB is also used as a treatment for other conditions, mainly pathologies with bicarbonate loss and tubular acidosis (respectively in 53.8% and 32.5% of the NICUs). Conclusion This survey showed how SB is a commonly used treatment for MA in more than half of Italian NICUs, with indications and prescription criteria that significantly vary across centers. Based on current knowledge, it is reasonable to suggest that the management of neonatal MA should be firstly directed to identify the underlying disorders. Thus, the use of SB should be reserved only for selected cases, also considering the severity of SB adverse effects and the lack of evidence about its efficacy. Guidance for the management of MA is required to harmonize practices and reduce the use of potentially inappropriate and unsafe treatments.

scholarly journals Use of intravenous sodium bicarbonate in neonatal intensive care units in Italy: a nationwide survey.

2020 ◽  
Author(s):  
Luca Massenzi ◽  
Roberto Aufieri ◽  
Silvia Donno ◽  
Rocco Agostino ◽  
Andrea Dotta
Keyword(s):  
Sodium Bicarbonate ◽  
Neonatal Intensive Care ◽  
Current Knowledge ◽  
Nationwide Survey ◽  
Intracellular Acidosis ◽  
Acid Base Balance ◽  
Metabolic Disturbances ◽  
Attitudes And Practices ◽  
Base Balance ◽  
Intravenous Sodium

Abstract Background: Metabolic Acidosis (MA) is a disturbance of the acid-base balance that can occur in preterm and critically ill term neonates due to different etiologies. Intravenous sodium bicarbonate (SB) has been traditionally used to correct such unbalance, despite the lack of evidence about its safety and efficacy. In literature, reported undesirable effects of treatment with SB in neonates include worsening of intracellular acidosis, impairment of myocardial function, cerebral blood flow fluctuations and intracranial hemorrhage. A national survey was conducted by the Neonatal Pharmacotherapy Study Group of the Italian Society of Neonatology with the aim to assess and describe attitudes and practices concerning the use of SB, particularly for the treatment of MA in Italian NICUs. Methods: A questionnaire regarding treatment of MA and SB prescription habits was sent to the directors of 120 Italian NICUs from June 2017 to March 2018. Results: The survey response rate was 97.5% (117/120 centers). Findings showed that in 55% of the surveyed NICUs (64/117 units) it is common practice to correct MA with intravenous SB. On the other hand, the remaining 45% of the units try to solve the metabolic disturbances adopting different approaches (improving perfusion, adjusting ventilation parameters or increasing blood volume). Moreover, to prevent the occurrence of MA, 37.6% of the NICUs (44/117) include buffer salts (lactate, acetate or both) in parenteral nutrition prescriptions. SB is also used as a treatment for other conditions, mainly pathologies with bicarbonate loss and tubular acidosis (respectively in 53.8% and 32.5% of the NICUs). Conclusion: This survey showed how SB is a commonly used treatment for MA in more than half of Italian NICUs, with indications and prescription criteria that significantly vary across centers. Based on current knowledge, it is reasonable to suggest that the management of neonatal MA should be firstly directed to identify the underlying disorders. Thus, the use of SB should be reserved only for selected cases, also considering the severity of SB adverse effects and the lack of evidence about its efficacy. Guidance for the management of MA is required to harmonize practices and reduce the use of potentially inappropriate and unsafe treatments.

Decrease in ureagenesis by partial hepatectomy does not influence acid-base balance

1989 ◽  
Vol 257 (4) ◽  
pp. F696-F699
Author(s):  
T. Almdal ◽  
H. Vilstrup ◽  
K. Bjerrum ◽  
L. O. Kristensen
Keyword(s):  
Sodium Chloride ◽  
Sodium Bicarbonate ◽  
Synthesis Rate ◽  
Urea Synthesis ◽  
Ph Homeostasis ◽  
Acid Base Balance ◽  
Acid Base ◽  
Base Balance ◽  
Bicarbonate Infusion

It has been suggested that urea synthesis participates directly in body pH homeostasis by removal of bicarbonate. To elucidate this hypothesis sodium bicarbonate or sodium chloride was infused (11.5 mumol/min) for 90 min into control rats and into rats that had undergone an 85% hepatectomy immediately before starting the infusion. Urea synthesis rate was 2.6 +/- 0.3 mumol/min (mean +/- SE) in controls, and was significantly (P less than 0.01) reduced to 1.0 +/- 0.2 mumol/min in partially hepatectomized rats. At the start of bicarbonate infusion, pH was 7.38 and 7.34 in control and partially hepatectomized rats, respectively, and at the end of infusion, pH was 7.56 and 7.51. Standard bicarbonate at start of bicarbonate infusion was 21.9 and 21.3 mM in controls and partially hepatectomized, respectively, and it increased to 32.7 and 29.9 mM at end of infusion. In saline-infused rats a slight decrease of approximately 0.05 pH units was observed during the experiment, but again no difference emerged between control and partially hepatectomized rats. It is concluded that a major role of the liver in the regulation of acid-base balance is unlikely.

scholarly journals Comparative analysis of using balanced and normal saline solutions as an intraoperative therapy in newborns

2019 ◽  
Vol 9 (2) ◽  
pp. 41-49 ◽  
Author(s):  
Marianna M. Nasser ◽  
Yurii I. Kucherov ◽  
Yuliya V. Zhirkova
Keyword(s):  
Normal Saline ◽  
Saline Solution ◽  
Infusion Therapy ◽  
Hemodynamic Parameters ◽  
Acid Base Balance ◽  
Metabolic Disturbances ◽  
Acid Base ◽  
Group I ◽  
Base Balance ◽  
Group Ii

The purpose of the study was to compare the values of acid base balance, electrolytic and hemodynamic parameters in newborns depending on the composition of intraoperative infusion therapy. The study was done in 60 newborns who were given Staerofundin ISO basic infusion (10 ml/kg/hour) in group I (n=31) and normal saline solution in group II (n=29) during a surgery.Results: following the surgery, no differences in pH values were observed between the groups, moderate metabolic disturbances were found. In Group II, levels of bicarbonates decreased from 22.2 to 20.5 (р=0.047). By the end of the surgery, normal electrolyte composition was found more frequently in group I (29%) as compared to group II (20%). Hypopotassemia (34.5% and 22.6%), hyperpotassemia (44.8% and 25.8%) and hyperchloremia (63% and 51.7%) were found more frequently in group II as compared to group I, respectively. To achieve the target level of blood pressure, the bolus was injected to 29% (n=9) of children from group I and 17.2% (n=5) of children from group II. Adrenergic agonists were used in 42% of children from group I and 27.6% of children from group II (р=0,038). There were no differences between the cumulative doses.Conclusion. Sterofundin and normal saline solution demonstrated equivalent values of effectiveness and produced similar effect on the values of acid base balance, electrolytic and hemodynamic parameters during the intraoperative period in newborns.

Continuous Hemodiafiltration during Cardiopulmonary Bypass in Infants

2007 ◽  
Vol 15 (5) ◽  
pp. 376-380
Author(s):  
Naoki Yoshimura ◽  
Yoshihiro Oshima ◽  
Masahiro Yoshida ◽  
Hirohisa Murakami ◽  
Hironori Matsuhisa ◽  
...  
Keyword(s):  
Cardiopulmonary Bypass ◽  
Therapeutic Strategy ◽  
Base Excess ◽  
Acid Base Balance ◽  
Metabolic Disturbances ◽  
Homologous Blood ◽  
Continuous Hemodiafiltration ◽  
Physiological Conditions ◽  
Blood Ph ◽  
Base Balance

The homologous blood prime in cardiopulmonary bypass circuits contributes a significant electrolyte and metabolite load in small infants. The efficacy of hemofiltration and continuous hemodiafiltration of the blood prime in preventing metabolic disturbances in small infants was compared in two groups of 60 patients each. Blood pH, base excess, and calcium concentrations decreased during cardiopulmonary bypass in the hemofiltration group. The acid-base balance was well preserved during cardiopulmonary bypass by continuous hemodiafiltration. This therapeutic strategy may confer an advantage in maintaining more physiological conditions during cardiopulmonary bypass in small infants.

Branchial mechanisms of ion and acid–base regulation in the freshwater rainbow trout, Salmo gairdneri

1988 ◽  
Vol 66 (12) ◽  
pp. 2699-2708 ◽  
Author(s):  
D. G. McDonald ◽  
E. T. Prior
Keyword(s):  
Lactic Acid ◽  
Rainbow Trout ◽  
Sodium Bicarbonate ◽  
Ammonium Sulphate ◽  
Ammonia Excretion ◽  
Salmo Gairdneri ◽  
Acid Base Balance ◽  
Acid Base ◽  
Base Balance

Blood acid–base balance and branchial fluxes of Na+, Cl−, and acidic equivalents were examined in rainbow trout (Salmo gairdneri) in response to variations in external [NaCl] and following experimental acid or base loads (intravascular infusion of ammonium sulphate, lactic acid, or sodium bicarbonate). NaCl influx, NaCl efflux, and ammonia excretion covaried with external [NaCl]. Large fluxes of acidic equivalents across the gills were produced by infusion of both ammonium sulphate and sodium bicarbonate, but both treatments had little effect upon Na+ and Cl− uptake. We interpret this result as indicating that apical [Formula: see text] and [Formula: see text] exchange played little role in the branchial clearance of acidic equivalents. Instead, the results are consistent with the notion that acidic equivalents were excreted via diffusion through paracellular channels. A model is presented which suggests that the paracellular channels are the normal route for ionic efflux across the gills and that excretion of acidic equivalents results from modulation of the permselectivity of this pathway.

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.

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