The effects of acid-base disturbances on cardiovascular and pulmonary function

Mitchell, Jere H.; Wildenthal, K.; Johnson, Robert L.

doi:10.1038/ki.1972.48

Cited by 240 publications

(112 citation statements)

References 80 publications

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“…Other clinical studies have shown that hyperchloremic acidosis resulting from saline infusion is associated with reduced gastric blood flow and mucosal pH in elderly surgical patients (Wilkes et al, 2001), delayed recovery of gut function, increased complications, prolonged hospital stay in patients undergoing colonic surgery (Lobo et al, 2002a;Brandstrup et al, 2003), and impairment in cardiac contractility as well as diminished response to inotrope causing hypotension (Mitchell et al, 1972;Levy et al, 2010;Schotola et al, 2012). Saline resuscitation for patients with gastrointestinal hemorrhage exacerbated bleeding resulting in more transfusions compared to balanced fluid resuscitation (Barak et al, 2004).…”

Section: Saline-induced Pathological Effects In Humansmentioning

confidence: 99%

0.9% saline is neither normal nor physiological

Sun

Yap

et al. 2016

J. Zhejiang Univ. Sci. B

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Abstract:The purpose of this review is to objectively evaluate the biochemical and pathophysiological properties of 0.9% saline (henceforth: saline) and to discuss the impact of saline infusion, specifically on systemic acid-base balance and renal hemodynamics. Studies have shown that electrolyte balance, including effects of saline infusion on serum electrolytes, is often poorly understood among practicing physicians and inappropriate saline prescribing can cause increased morbidity and mortality. Large-volume (>2 L) saline infusion in healthy adults induces hyperchloremia which is associated with metabolic acidosis, hyperkalemia, and negative protein balance. Saline overload (80 ml/kg) in rodents can cause intestinal edema and contractile dysfunction associated with activation of sodium-proton exchanger (NHE) and decrease in myosin light chain phosphorylation. Saline infusion can also adversely affect renal hemodynamics. Microperfusion experiments and real-time imaging studies have demonstrated a reduction in renal perfusion and an expansion in kidney volume, compromising O 2 delivery to the renal parenchyma following saline infusion. Clinically, saline infusion for patients post abdominal and cardiovascular surgery is associated with a greater number of adverse effects including more frequent blood product transfusion and bicarbonate therapy, reduced gastric blood flow, delayed recovery of gut function, impaired cardiac contractility in response to inotropes, prolonged hospital stay, and possibly increased mortality. In critically ill patients, saline infusion, compared to balanced fluid infusions, increases the occurrence of acute kidney injury. In summary, saline is a highly acidic fluid. With the exception of saline infusion for patients with hypochloremic metabolic alkalosis and volume depletion due to vomiting or upper gastrointestinal suction, indiscriminate use, especially for acutely ill patients, may cause unnecessary complications and should be avoided. More education regarding saline-related effects and adequate electrolyte management is needed.

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Section: Saline-induced Pathological Effects In Humansmentioning

confidence: 99%

0.9% saline is neither normal nor physiological

Sun

Yap

et al. 2016

J. Zhejiang Univ. Sci. B

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“…42 Acidosis has been associated with the reduction of Na + -K + -ATPase activity in myocardial cells, 43 which could lead to reduced myocardial contractility and congestive heart failure. 44 In addition, acidosis regulates endothelial cell adhesion and may play a role in the inflammatory response of vascular endothelial cells. 45 A potential link between the high concentration of hydrogen ions present in metabolic acidosis and the impaired heart function in CKD could be mediated through inflammatory processes.…”

Section: Cardiovascular Effects Of Metabolic Acidosis In Ckdmentioning

confidence: 99%

Current Status of Bicarbonate in CKD

Dobre

Rahman

Hostetter

2015

Journal of the American Society of Nephrology

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Metabolic acidosis was one of the earliest complications to be recognized and explained pathologically in patients with CKD. Despite the accumulated evidence of deleterious effects of acidosis, treatment of acidosis has been tested very little, especially with respect to standard clinical outcomes. On the basis of fundamental research and small alkali supplementation trials, correcting metabolic acidosis has a strikingly broad array of potential benefits. This review summarizes the published evidence on the association between serum bicarbonate and clinical outcomes. We discuss the role of alkali supplementation in CKD as it relates to retarding kidney disease progression, improving metabolic and musculoskeletal complications.

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“…8,9 CKD patients with metabolic acidosis could develop a wide range of pathophysiological changes such as changes; 1-bone resorption and osteopenia, 2-increase in protein catabolism in muscles, 3-worsening of secondary hyperparathyroidism, 4-hypothyroidism, 5-decrease in respiratory reserves and insufficient buffer systems in the body leads to and increased severity of acute diseases caused by the diminished respiratory reserves and insufficient buffering systems, 6-decreased myocardial contractility and heart failure which can lead into reduced Na-K ATPase activity, 7-endocrine disorders such as growth hormone and insulin resistance, and hypertriglyceridemia in erythrocytes and myocardial cells, 8-increase in systemic inflammmation, 9-hypotension and fatigue, 10-progression of renal damage. [10][11][12][13][14][15][16][17][18][19] The results of these studies suggest that metabolic acidosis in chronic kidney disorease may be associated with hematological changes in these patients either by contributing to the progression of the disease or by its pathophysiological effects. Treating metabolic acidosis with oral sodium bicarbonate was predicted to prevent these hematological 1 Internal Medicine Clinic, 2 Internal Medicine Clinic, 3 Internal Medicine Clinic, 4 Nephrology Clinic, Adana Numune Health Training and Research Center, University of Health Sciences, Adana, 5 Internal Medicine Clinic, 6 Internal Medicine Clinic, Istanbul Haseki Health Training and Research Center, University of Health Sciences, Istanbul, Turkey abnormalities.…”

Section: Introductionmentioning

confidence: 99%