Factors associated with metabolic acidosis in patients receiving parenteral nutrition

Abstract

The acetate-base regimen can decrease the occurrence of metabolic acidosis after parenteral nutrition. In addition, the risk of acidosis is higher in patients with impaired renal function.

Metabolic acidosis during parenteral nutrition: Pathophysiological mechanisms

“…Cationic amino acids are arginine, lysine and histidine (positive charge), and sulfur-containing amino acids like methionine, cysteine and cystine, while anionic amino acids are lactic, acetic, aspartatic and glutaminic acids (negative charge). [ 8 9 ] Solutions containing L-amino acids come in three different types, those containing only cationic amino acids, those with only anionic amino acids and mixed solutions. Metabolism of cationic amino acids of TPN results in production of H + according to equation:…”

“…Hydrochloric acid (not metabolized) and acetic acid (metabolized) are the most widely used acidifying mean for the maintenance of desired pH in the commercially available TPN solutions. [ 8 ]…”

“…showed that TPN solutions containing acetic acid caused MA to a lesser degree compared with solutions containing hydrochloric acid. [ 8 ] In a solution containing both hydrochloric and acetic acid the proportion of acetic/hydrochloric determines the degree of MA. A recent research showed that only nonmetabolizable acid might be a risk factor for MA.…”

Discontinuation of the causative agent is imperative in drug-induced metabolic acidosis

“…arginine, lysine) that release H + when metabolized Risk of metabolic acidosis is higher with parenteral nutrition that is Clbased than acetate based, and in pts with renal insufficiency [28] 'Pyroglutamic acidaemia' arginine, lysine) that release H + when metabolized Risk of metabolic acidosis is higher with parenteral nutrition that is Clbased than acetate based, and in pts with renal insufficiency [28] 'Pyroglutamic acidaemia'…”

Thermochemical Ablation: A Device for a Novel Interventional Concept

“…In fact, given the speed of conversion, measurement of sodium acetate levels in serum poses a significant challenge in clinical chemistry. The salt in this case is also used in formulations for parenteral nutrition [22]. The main potential issue in such an example would likely be the concentration in plasma for whatever portion of the injection eventually became intravascular.…”