The therapeutic importance of acid-base balance

Abstract

Baking soda and vinegar have been used as home remedies for generations and today we are only a mouse-click away from claims that baking soda, lemon juice, and apple cider vinegar are miracles cures for everything from cancer to COVID-19. Despite these specious claims, the therapeutic value of controlling acid-base balance is indisputable and is the basis of Food and Drug Administration-approved treatments for constipation, epilepsy, metabolic acidosis, and peptic ulcers. In this narrative review, we present evidence in support of the current and potential therapeutic value of countering local and systemic acid-base imbalances, several of which do in fact involve the administration of baking soda (sodium bicarbonate). Furthermore, we discuss the side effects of pharmaceuticals on acid-base balance as well as the influence of acid-base status on pharmacokinetic properties of drugs. Our review considers all major organs systems as well as information relevant to several clinical specialties such as anesthesiology, infectious disease, oncology, dentistry, and surgery.

Case Report: Uroenteric Fistula in a Pediatric-en-bloc Kidney Transplant Manifests as Deceptive Watery Diarrhea and Normal Anion Gap Acidosis

“…The clinical presentation of severe acute hyperchloremic metabolic acidosis in association with deceptive watery diarrhea is a rare manifestation of a uroenteric fistula and an important lesson in its early recognition (1,2). The only previous report in the literature was of a 46-year-old woman with an enterovesical fistula between the urinary bladder and sigmoid colon presenting with watery diarrhea for 6 months and life-threatening normal anion gap acidosis (5). In the case of the 46-year-old woman, a high pressure neurogenic bladder with fistula formation into the sigmoid colon resulted in the flow of urine into the colon with deceptive watery diarrhea and profound acidosis (5).…”

“…The only previous report in the literature was of a 46-year-old woman with an enterovesical fistula between the urinary bladder and sigmoid colon presenting with watery diarrhea for 6 months and life-threatening normal anion gap acidosis (5). In the case of the 46-year-old woman, a high pressure neurogenic bladder with fistula formation into the sigmoid colon resulted in the flow of urine into the colon with deceptive watery diarrhea and profound acidosis (5). In the present case, the unusual fistulization causing urine flow into the jejunum with continuous exposure of urine to the entire bowel manifested as "watery diarrhea" and severe hyperchloremic acidosis.…”

“…The location and underlying disorder often determine the symptoms. The management involves resection of the bowel segment, stenting the ureter, and (rarely) placing a nephrostomy tube (1,2,5). A nephroureterectomy would only be indicated if the kidney were non-functioning.…”

“…In the present case, the unusual fistulization causing urine flow into the jejunum with continuous exposure of urine to the entire bowel manifested as “watery diarrhea” and severe hyperchloremic acidosis. As such, this case provides an opportunity to examine the pathophysiology of the profound acidosis that occurs when urine is exposed to the intestinal mucosa ( 6 – 11 ). Comparison of the pH and solute excretions from the bowel and the bladder, summarized in the Table 1 , supports the reabsorption of chloride and secretion of bicarbonate by the bowel mucosa.…”

"Regulatory Roles for miR-126 in Inflammatory Response and Programmed Death of Cardiac Myocytes Driven by Acidosis During Simulated Ischemia"

“…Hypoxic cardiac myocytes generate excess H + through increased anaerobic glycolysis, net hydrolysis of ATP, and CO 2 retention. Protons are extruded from the myoplasm to the interstitial space by the combined action of 3 major ion-specific membrane transporters, including the Na + /H + exchanger, Na + / HCO 3 cotransporter, and vacuolar proton ATPase [17,18]. Increased activity of the Na + /H + exchanger can cause Ca 2+ overload because the elevated intracellular Na + is subsequently exchanged for Ca 2+ via the Na + /Ca 2+ exchanger.…”