Evaluation of Respiratory Compensation in Metabolic Alkalosis 12

Roberts, Kate; Poppell, J. William; Vanamee, Parker; Beals, Robert; Randall, Henry T.

doi:10.1172/jci103271

Cited by 39 publications

(10 citation statements)

References 10 publications

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“…Though early studies did not show any relationship between alkalosis and hypoventilation (Roberts, Popell, Vanamee, Beals & Randall, 1956), more recent studies have reported a close physiological relationship (Bradley & Semple, 1962;Fencl, Miller & Pappenheimer, 1966;Goldring, Cannon, Heinemann & Fishman, 1968;Mitchell & Singer, 1965;Stone, 1962). We also found an excellent correlation between Peo 2 and [HC0 3 -]e (r = 0'934).…”

Section: Relationships Between Extracellular Ionssupporting

confidence: 64%

Relationships between Potassium, Chloride, Intracellular and Extracellular pH in Dogs

Wilson

Simmons

1970

Clinical Science

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1. Total body, intracellular, and extracellular electrolyte and acid-base changes were studied following sodium nitrate-induced potassium and chloride depletion and subsequent selective chloride repletion.2. It was found that potassium and chloride depletion was associated with markedly decreased extracellular Na, K, CI and water content. Intracellular Na increased, intracellular K decreased and there was a large transcellular redistribution of acid, i.e. extracellular alkalosis and intracellular acidosis ensued.3. Selective chloride repletion was associated with return of extracellular pH towards normal. Extracellular K and intracellular parameters showed very little change. Further chloride administration was followed by extracellular acidosis, but extracellular K remained low.4. There was close relationship between extracellular chloride and hydrogen ion concentrations ([CI-]e and [H+]e) and extracellular potassium and intracellular hydrogen ion ([K +]e and [H+]i) but not between any of the other parameters. The close relationship between [H+]e and [CI-]e may be explained by the chemical relationship between [H+]e, Peo 2 , and [HC0 3 -]e and empirical relationships between [Cl-]e and [HC0 3-]e, and Pco, and [HC0 3 -leoThe role of potassium and chloride in the control of extracellular pH (pH e ) and intracellular pH (pH j) is unsettled.Potassium and chloride may be varied independently of each other by initial depletion of potassium and chloride stores with repeated infusions of sodium nitrate and then selective replenishment of chloride. However, analysis of results is clouded by secondary changes of body fluid compartments. When these selective electrolyte depletions are combined with measurement of pl-l, and pHi as well as body fluid constituents, quantitative interrelationships between electrolytes and acid-base parameters may be explored.It was found that the extracellular alkalosis observed after nitrate infusion was due in part to transcellular acid shifts and development of intracellular acidosis, in part to extracellular fluid (ECF) contraction, and in small part to other causes. Intracellular acidosis persisted but extracellular hydrogen ion concentration [H+]e returned to normal when chloride was repleted and potassium was not replaced, suggesting that to a large extent [H+]e is a function of extracellular chloride concentration [Cl"je and intracellular hydrogen ion concentration ([H+]i) of intracellular potassium concentration ([K +]i). The failure of others to find intracellular acidosis during potassium depletion will be discussed. METHODSThirteen trained, unanaesthetized dogs of both sexes ranging from 12·5 to 27·5 kg were studied in twenty-two experiments. The animals were maintained throughout the experiment on a diet low in Na, K, and CI by feeding 7 g kg-1 day " ! of ground horsemeat which had been washed thoroughly with distilled water and then oven-dried, removing virtually all the sodium, potassium and chloride (Na 26·3 ±2'3, K 45·8 ± 3'5, CII9'0±0'9 J.lEq/g dry weight (average of five det...

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Section: Relationships Between Extracellular Ionssupporting

confidence: 64%

Relationships between Potassium, Chloride, Intracellular and Extracellular pH in Dogs

Wilson

Simmons

1970

Clinical Science

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“…Similar elevations of the blood pH with a normal pCO2 have been observed by us in hypochloremic alkalosis and following alkali infusion in both dog and man. Only with superimposed pulmonary disease, anesthesia or with morphine administration have we consistently observed "respiratory compensations" to occur in metabolic alkalosis (24).…”

Section: Resultsmentioning

confidence: 88%

Effects of Potassium on Renal Tubular Reabsorption of Bicarbonate 12

Roberts¹,

Randall²,

Sanders³

et al. 1955

J. Clin. Invest.

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It is generally recognized that potassium deprivation may result in the development of a plasma alkalosis, which is characterized by the paradoxical excretion of an acid urine (1-12). Conversely, the administration of sufficient potassium chloride results in a plasma acidosis and the simultaneous excretion of an alkaline urine (8,(13)(14)(15)(16). Studies previously reported have shown that the dichotomous plasma and urinary findings following potassium administration result from a decrease in the renal tubular reabsorption of base-bound bicarbonate (13). The inappropriate aciduria occurring in hypokalemic alkalosis has led to the suggestion that renal reabsorption of bicarbonate is increased in circumstances where inadequate intake or excessive losses of potassium have occurred (1, 13, 17). This implies a renal failure to compensate the plasma alkalosis accompanying hypokalemia and assumes a renal contribution to the continuation of the plasma alkalosis. Although it has not been measured previously, it would appear virtually certain that hypokalemia enhances the renal tubular reabsorption of bicarbonate; the mechanism whereby the influence of potassium is mediated, however, remains more speculative (1,13,17). Accordingly, the studies described herein were carried out on human subjects and on dogs 1) to determine the effects of potassium depletion on the renal mechanisms implicated in stabilizing the plasma bicarbonate, and 2) to clarify the mechanisms whereby potassium influences the renal tubular reabsorption and urinary excretion of bicarbonate bound base.The studies reported below indicate that hypokalemia results in an increased renal tubular reab-

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“…Firstly, isolated changes in H + are mainly sensed by the peripheral chemoreceptors [26], which only contribute a small amount to ventilation. Secondly, respiratory compensation to metabolic alkalosis is controversial [27, 28, 29]. Early studies indicated that there was little to no respiratory compensation in humans and dogs [27, 28].…”

Section: Discussionmentioning

confidence: 99%

“…Secondly, respiratory compensation to metabolic alkalosis is controversial [27, 28, 29]. Early studies indicated that there was little to no respiratory compensation in humans and dogs [27, 28]. Later studies have shown that in some human cases there is respiratory compensation, although the magnitude of compensation is highly variable, and in all cases limited [30].…”

Section: Discussionmentioning

confidence: 99%

A mathematical model of tumour and blood pHe regulation: The buffering system

Martin

Gaffney

Gatenby

et al. 2011

Mathematical Biosciences

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Malignant tumours are characterised by a low, acidic extracellular pH (pHe) which facilitates invasion and metastasis. Previous research has proposed the potential benefits of manipulating systemic pHe, and recent experiments have highlighted the potential for buffer therapy to raise tumour pHe, prevent metastases, and prolong survival in laboratory mice. To examine the physiological regulation of tumour buffering and investigate how perturbations of the buffering system (via metabolic/respiratory disorders or changes in parameters) can alter tumour and blood pHe, we develop a simple compartmentalised ordinary differential equation model of pHe regulation by the buffering system. An approximate analytical solution is constructed and used to carry out a sensitivity analysis, where we identify key parameters that regulate tumour pHe in both humans and mice. From this analysis, we suggest promising alternative and combination therapies, and identify specific patient groups which may show an enhanced response to buffer therapy. In addition, numerical simulations are performed, validating the model against well-known metabolic/respiratory disorders and predicting how these disorders could change tumour pHe.

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Evaluation of Respiratory Compensation in Metabolic Alkalosis 12

Cited by 39 publications

References 10 publications

Relationships between Potassium, Chloride, Intracellular and Extracellular pH in Dogs

Relationships between Potassium, Chloride, Intracellular and Extracellular pH in Dogs

Effects of Potassium on Renal Tubular Reabsorption of Bicarbonate 12

A mathematical model of tumour and blood pHe regulation: The buffering system

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