Abstract
Metabolic acidosis is among the most common abnormalities seen in patients suffering from critical illness. Its etiologies are multiple and treatment of the underlying condition is the mainstay of therapy. However, growing evidence suggests that acidosis itself has profound effects on the host, particularly in the area of immune function. Given the central importance of immune function to the outcome of critical illness, there is renewed interest in elucidating the effects of this all too common condition on the immune response. In this review we concentrate on the effects of extracellular acids on production and release of inflammatory mediators, and we demonstrate that different acids produce different effects despite similar extracellular pH. Finally, we discuss potential clinical implications.
Highlights
Critical illness is exemplified by a state of profound disruption in normal homeostatic mechanisms
In a recent study [37], we found that normal (0.9%) saline (NS) resuscitation resulted in a decreased survival time and reduced the standard base excess (SBE) by 5–10 mEq/l as compared with a balanced colloid solution
The regulation of nitric oxide (NO) release and synthesis has been found to be significantly effected by pHo both in vitro and in vivo, and may be partially responsible for acidosis-associated hemodynamic instability
Summary
Critical illness is exemplified by a state of profound disruption in normal homeostatic mechanisms. Our understanding of this condition is extremely limited, numerous observations suggest that alterations in the immune response are caused by but may be the cause of ongoing organ injury, and these alterations may adversely affect patients’ ability to recover. Both increased inflammation and immune suppression have been implicated in the pathogenesis of multiple organ failure. The clinical significance of these alterations is not yet known, but their magnitude suggests that they may play an important role in the development or maintenance of immune dysfunction If this is the case, they represent attractive targets (or even tools) for therapy. Extracellular pH (pHo) for circulating leukocytes (i.e. blood pH) is altered and for good or bad, changes in pH may rapidly alter the immune response in these cells
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