Metabolic consequences of high mass-transfer hemodialysis

Tolchin, Nathan; Roberts, Jimmy L.; Hayashi, James A.; Lewis, Edmund J.

doi:10.1038/ki.1977.54

Cited by 103 publications

(54 citation statements)

References 21 publications

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“…Of note, the sodium acetate load during dialysis is much larger than that during standard intravenous infusion, and adverse events reported with dialysis may not parallel sodium acetate infusions in medical toxicology. This is highlighted by Tolchin et al who suggested that sodium acetate used during dialysis may saturate its metabolic pathways; in a single dialysis treatment using a 40-mM sodium acetate bath and lasting 4 h, approximately 90 % of the acetate load is converted to bicarbonate [21]. Under these conditions, the authors calculated a maximum metabolic threshold of 48 μM/min/kg body weight [21].…”

Section: Pharmacology Of Sodium Acetatementioning

confidence: 99%

“…This is highlighted by Tolchin et al who suggested that sodium acetate used during dialysis may saturate its metabolic pathways; in a single dialysis treatment using a 40-mM sodium acetate bath and lasting 4 h, approximately 90 % of the acetate load is converted to bicarbonate [21]. Under these conditions, the authors calculated a maximum metabolic threshold of 48 μM/min/kg body weight [21]. As the sodium acetate load exceeds this level, acetate levels increase without an equimolar rise in bicarbonate.…”

Section: Pharmacology Of Sodium Acetatementioning

confidence: 99%

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Sodium Acetate as a Replacement for Sodium Bicarbonate in Medical Toxicology: a Review

et al. 2013

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Sodium bicarbonate is central to the treatment of many poisonings. When it was placed on the FDA drug shortage list in 2012, alternative treatment strategies to specific poisonings were considered. Many hospital pharmacies, poison centers, and medical toxicologists proposed sodium acetate as an adequate alternative, despite a paucity of data to support its use in medical toxicology. The intention of this review is to educate the clinician on the use of sodium acetate and to advise them on the potential adverse events when given in excess. We conducted a literature search focused on the pharmacology of sodium acetate, its use as a buffer in pathologic acidemia and dialysis baths, and potential adverse events associated with excess sodium acetate infusion. It appears safe to replace sodium bicarbonate infusion with sodium acetate on an equimolar basis. The metabolism of acetate, however, is more complex than bicarbonate. Future prospective studies will be needed to confirm the efficacy of sodium acetate in the treatment of the poisoned patient.

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Section: Pharmacology Of Sodium Acetatementioning

confidence: 99%

Section: Pharmacology Of Sodium Acetatementioning

confidence: 99%

Sodium Acetate as a Replacement for Sodium Bicarbonate in Medical Toxicology: a Review

et al. 2013

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“…[1-13 C]Oleic acid, sodium [U- 13 C]acetate, sodium [1-13 C]acetate, [U- 13 C]citric acid, [1,[5][6][7][8][9][10][11][12][13] C]citric acid, and [U- 13 C] malonic acid were purchased from Isotec (Miamisburg, OH). [U- 13 C]malonyl-CoA was prepared from [U- 13 C]malonic acid as described previously [11], and purified by high pressure liquid chromatography.…”

Section: Experimental Procedures Materialsmentioning

confidence: 99%

“…The 13 C-labeling of the acetyl moiety of citrate (a probe of mitochondrial acetyl-CoA) was assayed by cleaving citrate with ATP-citrate lyase isolated from rat liver [18] and analyzing acetyl-CoA by ion trap liquid chromatography-mass spectrometry (LC-MS) [19]. The assay was set up using standards of [1,[5][6][7][8][9][10][11][12][13] C]citrate and [U- 13 C]citrate which generate M1 and M2 acetyl-CoA, respectively. In the calculations of molar percent enrichments (MPE) all raw data were corrected for natural abundance of 13 C.…”

Section: Analytical Proceduresmentioning

confidence: 99%

“…The main exogenous sources of acetate are ethanol oxidation in the liver, and hemodialysis against solutions containing up to 40 mM acetate 1 . In patients dialyzed against such solutions, the capacity to oxidize acetate can be exceeded, and arterial acetate concentrations can increase up to 11 mM [5]. Adverse effects of acetate include hypoxemia and cardiovascular effects which have been ascribed to uncontrolled AMP degradation to adenosine [6].…”

Section: Introductionmentioning

confidence: 99%

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Competition between acetate and oleate for the formation of malonyl-CoA and mitochondrial acetyl-CoA in the perfused rat heart

Bian¹,

Kasumov²,

Jobbins³

et al. 2006

Journal of Molecular and Cellular Cardiology

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We previously showed that in the perfused rat heart, the capacity of n-fatty acids to generate mitochondrial acetyl-CoA decreases as their chain length increases. In the present study, we investigated whether the oxidation of a long-chain fatty acid, oleate, is inhibited by short-chain fatty acids, acetate or propionate (which do and do not generate mitochondrial acetyl-CoA, respectively). We perfused rat hearts with buffer containing 4 mM glucose, 0.2 mM pyruvate, 1 mM lactate, and various concentrations of either (i) [U-13 C]acetate, (ii) [U-13 C]acetate plus [1-13 C]oleate, or (iii) unlabeled propionate plus [1-13 C]oleate. Using mass isotopomer analysis, we determined the contributions of the labeled substrates to the acetyl moiety of citrate (a probe of mitochondrial acetylCoA) and to malonyl-CoA. We found that acetate, even at low concentration, markedly inhibits the oxidation of [1-13 C]oleate in the heart, without change in malonyl-CoA concentration. We also found that propionate, at a concentration higher than 1 mM, decreases (i) the contribution of [1-13 C]oleate to mitochondrial acetyl-CoA, and (ii) malonyl-CoA concentration. The inhibition by acetate or propionate of acetyl-CoA production from oleate probably results from a competition for mitochondrial CoA between the CoA-utilizing enzymes.

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Leukopenia and Hypoxemia

Dumler¹

1979

Arch Intern Med

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Metabolic consequences of high mass-transfer hemodialysis

Cited by 103 publications

References 21 publications

Sodium Acetate as a Replacement for Sodium Bicarbonate in Medical Toxicology: a Review

Sodium Acetate as a Replacement for Sodium Bicarbonate in Medical Toxicology: a Review

Competition between acetate and oleate for the formation of malonyl-CoA and mitochondrial acetyl-CoA in the perfused rat heart

Leukopenia and Hypoxemia

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