Application of sodium hydrocarbonate solution on purpose of correction acid-base state in patient with comorbid pathology – COPD and community-acquired pneumonia

Abstract

Background. Community-acquired pneumonia is a frequent complication of chronic obstructive pulmonary disease (COPD), especially in patients with small weight. Respiratory acidosis is a natural manifestation of COPD, which clinically is characterized by dominated obstructive pulmonary ventilation. Respiratory acidosis is a form of acid-base deviation which associated with insufficient excretion of carbon dioxide by the lungs. But in patients with comorbid pathology (COPD and community-acquired pneumonia) in addition to respiratory acidosis also can be evolved a metabolic acidosis (MA) conditioned by tissue hypoxia, intense systemic inflammation with next disturbances in correlation between pro-inflammatory and anti-inflammatory mediators, accelerating catabolic processes. The severity of acid-base deviation in patients with the possibility of developing decompensated acidosis depends not only on the degree of obstructive ventilation disorders, but also increasingly to the gravity of community-acquired pneumonia which causes severe acidotic metabolic changes.
 Objective. To evaluate the expediency of application 4.2 % buffered sodium bicarbonate solution (Soda-buffer) in the case of mixed acidosis in patients with comorbid pathology: COPD which is compounded by community-acquired pneumonia.
 Materials and methods. To all patients with comorbid pathology aged from 18 to 75 were prescribed the drug Soda-buffer manufactured by “Yuria-Pharm” (Ukraine), which contains 42 mg of sodium bicarbonate intravenously at a rate of 1.5 mmol/kg per hour (4.2 % Soda-buffer – 3 ml/kg per hour) under control of blood pH, acid-base and water-electrolyte (water-salt) balance of the body.
 Results and discussion. Qualified treatment of patients with comorbid pathology (COPD and community-acquired pneumonia) should be comprehensive and directed towards the struggle against the manifestations of obstructive ventilation disorders and hypoxemia, lower respiratory tract infection, intense inflammatory process in the lung parenchyma and bronchial tree. The complex treatment includes not only modern antibacterial drugs in combination with systemic glucocorticoids, but also methods of correction of metabolic, hemodynamic and coagulation disorders. With the aim of acidosis correction the most effective way is using infusion solutions which contain sodium bicarbonate. Due to dissociation of sodium bicarbonate has released a bicarbonate anion that binds hydrogen ions to form of carbonic acid, which then decomposes into water and carbon dioxide. In case of severe respiratory insufficiency oxidation of sodium hydrocarbonate can contribute increasing of hypercapnia by the connection with the accumulated CO2. It was found that 4.2 % buffered sodium bicarbonate solution in the comprehensive therapy of patients with comorbid pathology of COPD and community-acquired pneumonia helps to restore acid-base balance, reduce metabolic disorders and improve the clinical condition of patients. In the matter of normalization of the function of external respiration and reduction of the manifestations of respiratory insufficiency, usually substantially reduces not only respiratory, but also MA. Therefore, during correction of concomitant MA by Soda-buffer we should compensate the deficiency of bases not more than half percentage. In situation with rapid balancing of acidosis, particularly in the case of impaired pulmonary ventilation, the rapid release of CO2 may exacerbate cerebral acidosis. It’s a well known fact that small uses of Soda-buffer together with other infusion solutions with an acidic pH are provided a neutralizing agent and prevent the appearance of post-infusion phlebitis after administration of widely used infusion solutions (glucose fluids of different concentrations, chloride solution, ciprofloxacin and some other fluoroquinolones).
 Conclusions. Soda-buffer (4.2 % sodium bicarbonate buffered solution) is an effective infusion agent for the correction of MA in patients with comorbid pathology (COPD and community-acquired pneumonia) in condition of provided effective gas exchange. This solution is a physiological bicarbonate buffer that maintains a constant pH level, prevents abrupt alkalization of the blood and provides a smooth correction of acidosis at the same time with increasing alkaline blood reserves. The drug also increases the excretion of sodium and chlorine ions, osmotic diuresis, alkalizes urine.