scholarly journals Comparative analysis of acid-base balance in patients with severe sepsis and septic shock: traditional approach vs. physicochemical approach

2019 ◽  
Vol 67 (4) ◽  
pp. 441-446
Author(s):  
José Diaztagle Diaztagle-Fernández ◽  
Ingrid Juliana Moreno-Ladino ◽  
Jorge Alfredo Morcillo-Muñoz ◽  
Andrés Felipe Morcillo-Muñoz ◽  
Luis Alejandro Marcelo-Pinilla ◽  
...  
Keyword(s):  
Severe Sepsis ◽  
Metabolic Alkalosis ◽  
Traditional Approach ◽  
Strong Ion Difference ◽  
Acid Base Balance ◽  
Physicochemical Model ◽  
Acid Base ◽  
Base Balance ◽  
Diagnostic Approaches ◽  
Sepsis And Septic Shock

Introduction: The evaluation of metabolism and the diagnostic classification of acid-base disorders has generated great controversy. Acid-base balance (ABB) is approached by means of the physicochemical and Henderson’s models.Objective: To compare two diagnostic approaches to ABB in patients with severe sepsis.Materials and methods: Prospective, descriptive study conducted in patients with severe sepsis. ABB was analyzed within the first 24 hours. The diagnosis was compared according to each model and the causes of the disorders were compared according to the physicochemical model.Results: 38 patients were included in the study, of which 21 (55%) were women; the mean age was 49 years, the median APACHE II, 13.28, and the mortality at 28 days, 24.3%. The traditional approach identified 8 patients with normal ABB, 20 with metabolic acidosis, and 10 with other disorders. Based on the physicochemical model, all subjects had acidosis and metabolic alkalosis. Increased strong ion difference (SID) was the most frequently observed disorder.Conclusion: The physicochemical model was useful to diagnose more patients with acid-base disorders. According to these results, all cases presented with acidosis and metabolic alkalosis; the most frequent proposed mechanism of acidosis was elevated SID. The nature of these disorders and their clinical relevance is yet to be established.

scholarly journals The Physiology of Dehydration Stress in the Land Crab, Cardisoma Carnifex: Respiration, Ionoregulation, Acid-Base Balance and Nitrogenous Waste Excretion

1986 ◽  
Vol 126 (1) ◽  
pp. 271-296 ◽  
Author(s):  
CHRIS M. WOOD ◽  
R. G. BOUTILIER ◽  
D. J. RANDALL
Keyword(s):  
Metabolic Alkalosis ◽  
Ammonia Excretion ◽  
French Polynesia ◽  
Strong Ion Difference ◽  
Acid Base Balance ◽  
Acid Base ◽  
Land Crab ◽  
Base Balance ◽  
Ion Shifts ◽  
Total Body

Air-breathing Cardisoma carnifex, collected in Moorea, French Polynesia, were held in fresh water similar in chemical composition to that in their burrows. Under control conditions, which allowed branchial chamber flushing but not ventilation of the medium, crabs demonstrated net Na+ and Cl− uptake, and ammonia, urea and base excretion (= acidic equivalent uptake). Throughout 192 h of water deprivation, crabs dehydrated slowly at a rate of 0.55 g H2O kg−1 h−1, eventually reaching a near lethal 18% loss of total body water. Increases in haemolymph osmolytes were quite variable (0–29%); electrolyte excretion was negligible. MOO2 and MCOCO2 both decreased by approximately 55%, maintaining an unusually low gas exchange ratio (R = 0.53), and suggesting general metabolic depression. There was no evidence of internal hypoxia as haemolymph lactate remained at hydrated levels and PaOO2 actually increased. The dominant acid-base response was a progressive metabolic alkalosis accompanied by a partially compensating rise in PaCOCO2. Alkalosis was probably caused by blockage of the normal aquatic excretion of base produced by the metabolism of this herbivore. Other possible causes were eliminated: i.e. alkalaemia due to contraction of the ECFV; entrainment via strong ion shifts; CaCO3 mobilization; and ammonia accumulation in the haemolymph. In the absence of water, net ammonia production and excretion both appeared to cease, and alternate end products (urea, uric acid) did not generally accumulate. Within 2h of rehydration, crabs regained more than half the lost water, MOO2 and MCOCO2 increased above control levels, and ammonia excretion and haemolymph concentration both exhibited a prolonged (56 h) 4- to 6-fold rise. At the same time, metabolic alkalosis was reversed in association with elevated net base excretion into the water; the latter was correlated with an increase in the strong ion difference (SID) flux ([Na+ + K+ + Ca2+ + Mg2+ - Cl−]). Note:

Impact of Continuous Veno-venous Hemofiltration on Acid-base Balance

2003 ◽  
Vol 26 (1) ◽  
pp. 19-25 ◽  
Author(s):  
J. Rocktäschel ◽  
H. Morimatsu ◽  
S. Uchino ◽  
C. Ronco ◽  
R. Bellomo
Keyword(s):  
Renal Failure ◽  
Acute Renal Failure ◽  
Metabolic Alkalosis ◽  
Base Excess ◽  
Strong Ion Difference ◽  
Acid Base Balance ◽  
Strong Ion Gap ◽  
Acid Base ◽  
Biophysical Analysis ◽  
Base Balance

Background Continuous veno-venous hemofiltration (CVVH) appears to have a significant and variable impact on acid-base balance. However, the pathogenesis of these acid-base effects remains poorly understood. The aim of this study was to understand the nature of acid-base changes in critically ill patients with acute renal failure during continuous veno-venous hemofiltration by applying quantitative methods of biophysical analysis (Stewart-Figge methodology). Methods We studied forty patients with ARF receiving CVVH in the intensive care unit. We retrieved the biochemical data from computerized records and conducted quantitative biophysical analysis. We measured serum Na+, K+, Mg2+, Cl-, HCO3-, phosphate, ionized Ca2+, albumin, lactate and arterial blood gases and calculated the following Stewart-Figge variables: Strong Ion Difference apparent (SIDa), Strong Ion Difference Effective (SIDe) and Strong Ion Gap (SIG). Results Before treatment, patients had mild acidemia (pH: 7.31) secondary to metabolic acidosis (bicarbonate: 19.8 mmol/L and base excess: −5.9 mEq/L). This acidosis was due to increased unmeasured anions (SIG: 12.3 mEq/L), hyperphosphatemia (1.86 mmol/L) and hyperlactatemia (2.08 mmol/L). It was attenuated by the alkalinizing effect of hypoalbuminemia (22.5 g/L). After commencing CVVH, the acidemia was corrected within 24 hours (pH 7.31 vs 7.41, p <0.0001). This correction was associated with a decreased strong ion gap (SIG) (12.3 vs. 8.8 mEq/L, p <0.0001), phosphate concentration (1.86 vs. 1.49 mmol/L, p <0.0001) and serum chloride concentration (102 vs. 98.5 mmol/L, p <0.0001). After 3 days of CVVH, however, patients developed alkalemia (pH: 7.46) secondary to metabolic alkalosis (bicarbonate: 29.8 mmol/L, base excess: 6.7 mEq/L). This alkalemia appeared secondary to a further decrease in SIG to 6.7 mEq/L (p <0.0001) and a further decrease in serum phosphate to 0.77 mmol/L (p <0.0001) in the setting of persistent hypoalbuminemia (21.0 g/L; p=0.56). Conclusions CVVH corrects metabolic acidosis in acute renal failure patients through its effect on unmeasured anions, phosphate and chloride. Such correction coupled with the effect of hypoalbuminemia, results in the development of a metabolic alkalosis after 72 hours of treatment.

Influence of plasma bicarbonate concentration and pH on citrate excretion

1964 ◽  
Vol 206 (4) ◽  
pp. 875-882 ◽  
Author(s):  
David P. Simpson
Keyword(s):  
Linear Relationship ◽  
Metabolic Alkalosis ◽  
High Plasma ◽  
Alkaline Ph ◽  
Acid Base Balance ◽  
Bicarbonate Concentration ◽  
Acid Base ◽  
Plasma Bicarbonate ◽  
Close Relationship ◽  
Base Balance

Citrate excretion has been studied in dogs under various conditions of acid-base balance in order to determine which factors are responsible for the increased citrate clearance present in metabolic alkalosis. A close relationship, significantly modified by systemic pH, was found between plasma bicarbonate concentration and citrate clearance. In the presence of an alkaline plasma pH, there was a linear relationship between changes in plasma bicarbonate concentration and changes in citrate clearance. Other experiments also demonstrated the influence of plasma bicarbonate concentration on citrate clearance at alkaline pH. Under acidotic conditions citrate clearances were low and changes in plasma bicarbonate concentration had little effect on citrate excretion. A change in plasma pH from an acidotic to an alkalotic state, with a constant plasma bicarbonate concentration, produced an increase in citrate clearance. Thus the coexistence in metabolic alkalosis of high plasma bicarbonate concentration and high plasma pH results in a markedly increased citrate clearance.

scholarly journals Sex Differences in Inflammatory Response and Acid–Base Balance in Prepubertal Children with Severe Sepsis

Shock ◽  
2017 ◽  
Vol 47 (4) ◽  
pp. 422-428 ◽  
Author(s):  
Nicolas Lefèvre ◽  
Benjamin Noyon ◽  
Dominique Biarent ◽  
Francis Corazza ◽  
Jean Duchateau ◽  
...  
Keyword(s):  
Sex Differences ◽  
Severe Sepsis ◽  
Inflammatory Response ◽  
Acid Base Balance ◽  
Acid Base ◽  
Prepubertal Children ◽  
Base Balance

Effect of acetazolamide on citrate excretion in the dog

1964 ◽  
Vol 206 (4) ◽  
pp. 883-886 ◽  
Author(s):  
David P. Simpson
Keyword(s):  
Metabolic Alkalosis ◽  
Acid Base Balance ◽  
Acid Base ◽  
Marked Rise ◽  
Before And After ◽  
Base Balance

Clearance measurements were made on dogs in order to study the mechanism of the effect of acetazolamide on citrate excretion. Induction of metabolic alkalosis resulted in a marked rise in citrate clearance despite treatment with acetazolamide. Measurement of citrate clearances in alkalotic animals before and after acetazolamide infusion showed either no change or an increase in citrate clearance. No evidence was found that acetazolamide decreases citrate excretion when acidosis is prevented. These results are consistent with the hypothesis that changes in citrate clearance after acetazolamide administration are entirely secondary to changes in acid-base balance.

Cardiorespiratory effects of prolonged angiotensin II block in resting conscious dogs

2001 ◽  
Vol 79 (9) ◽  
pp. 825-830
Author(s):  
Donald B Jennings
Keyword(s):  
Angiotensin Ii ◽  
Salt Water ◽  
Respiratory Control ◽  
Conscious Dogs ◽  
Chow Diet ◽  
Strong Ion Difference ◽  
Ang Ii ◽  
Acid Base Balance ◽  
Acid Base ◽  
Base Balance

Intravenous (iv) infusion of the angiotensin II (ANG II) receptor blocker saralasin in resting conscious dogs during physiological pertubations, such as hypotension and prolonged hypoxia, indicates the presence of an ANG II drive to increase respiration and decrease the arterial partial pressure of CO2 (PaCO2). In contrast, in eupneic resting dogs on a regular chow diet, iv infusion of saralasin for short periods (up to 30 min) provides no evidence of a tonic effect of circulating levels of ANG II on acid-base balance, respiration, metabolism, or circulation. However, ANG II influences physiological processes involving salt, water, and acid-base balances, which are potentially expressed beyond a 30 min time period, and could secondarily affect respiration. Therefore, we tested the hypothesis that blocking ANG II with iv saralasin would affect respiration and circulation over a 4-h period. Contrary to the hypothesis, iv infusion of saralasin in resting conscious eupneic dogs on a regular chow diet over a 4-h period had no effects on plasma strong ions, osmolality, acid-base balance, respiration, metabolism, or circulation when compared with similar control studies in the same animals. Thus, ANG II does not play a tonic modulatory role in respiratory control under "normal" physiological conditions.Key words: acid-base balance, arginine vasopressin, saralasin, strong ions, strong ion difference.

Effect of chronic acetazolamide administration on gas exchange and acid-base control after maximal exercise

1994 ◽  
Vol 76 (3) ◽  
pp. 1211-1219 ◽  
Author(s):  
J. M. Kowalchuk ◽  
G. J. Heigenhauser ◽  
J. R. Sutton ◽  
N. L. Jones
Keyword(s):  
Gas Exchange ◽  
Muscle Power ◽  
Strong Ion Difference ◽  
Acid Base Balance ◽  
Acid Base ◽  
Arterial Lactate ◽  
Arterial Pco2 ◽  
Co2 Output ◽  
Base Balance ◽  
Arterial Plasma

The interaction between systems regulating acid-base balance (i.e., CO2, strong ions, week acids) was studied in six subjects for 10 min after 30 s of maximal isokinetic cycling during control conditions (CON) and after 3 days of chronic acetazolamide (ChACZ) administration (500 mg/8 h po) to inhibit carbonic anhydrase (CA). Gas exchange was measured; arterial and venous forearm blood was sampled for acid-base variables. Muscle power output was similar in ChACZ and CON, but peak O2 intake was lower in ChACZ; peak CO2 output was also lower in ChACZ (2,207 +/- 220 ml/min) than in CON (3,238 +/- 87 ml/min). Arterial PCO2 was lower at rest, and its fall after exercise was delayed in ChACZ. In ChACZ there was a higher arterial [Na+] and lower arterial [lactate-] ([La-]) accompanied by lower arterial [K+] and higher arterial [Cl-] during the first part of recovery, resulting in a higher arterial plasma strong ion difference (sigma [cations] - sigma [anions]). Venoarterial (v-a) differences across the forearm showed a similar uptake of Na+, K+, Cl-, and La- in ChACZ and CON. Arterial [H+] was higher and [HCO3-] was lower in ChACZ. Compared with CON, v-a [H+] was similar and v-a [HCO3-] was lower in ChACZ. Chronic CA inhibition impaired the efflux of CO2 from inactive muscle and its excretion by the lungs and also influenced the equilibration of strong ions.(ABSTRACT TRUNCATED AT 250 WORDS)

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