Occurrence Of Metabolic Acidosis Research Articles

Prevalence, Risk Factors, and Management of Metabolic Acidosis in Chronic Kidney Disease Patients: A Multicenter Retrospective Study in Malaysia.

Background Metabolic acidosis in chronic kidney disease (CKD) patients has lately gained attention due to the growing evidence of its treatment benefits. This study aims to provide baseline data on the prevalence, risk factors, and current management of metabolic acidosis among the pre-dialysis adult Malaysian CKD population. Methodology This multicenter cross-sectional retrospective study involved pre-dialysis CKD patients above 18 years old on regular nephrology clinic follow-up at three Malaysian government hospitals with nephrology subspecialty. Demographic data, clinical information, laboratory data, and a list of concomitant medications were collected. Factors associated with the occurrence of metabolic acidosis were identified via multiple logistic regression. Results Six hundred and fifty-seven CKD patients were screened for this study, in which only39.4% (n=259) had available bicarbonate levels. From this, a total of 86.1% (n=223) had metabolic acidosis.Higher estimated glomerular filtration rate (odds ratio (OR) 0.96, 95% confidence interval (CI) 0.93-1.00, p=0.043) and those with cardiovascular disease (OR 0.33, 95% CI 0.15-0.73; p=0.007) were significantly associated with lower odds of metabolic acidosis. There were 43.0% (n=96) on alkali therapy with sodium bicarbonate solution being the most common (n=91, 94.8%). Among those receiving alkali therapy, only 19.8% (n=19) achieved bicarbonate levels of ≥ 22 mEq/L. Conclusion Our study showed that metabolic acidosis was highly prevalent, although few achieved target levels despite supplementation, supporting the need for focused management of metabolic acidosis in the CKD population.

Perianesthetic metabolic acidosis is associated with 2% dorzolamide eye drops in dogs that underwent ophthalmic surgery: a retrospective study (2019-2022).

To evaluate whether the administration of 2% dorzolamide ophthalmic solution in dogs undergoing ophthalmic surgery is associated with perianesthetic metabolic acidosis. 60 dogs, with or without dorzolamide administration, underwent arterial blood gas analysis immediately after anesthesia for ophthalmic surgery between 2019 and 2022; a total of 60 surgeries were evaluated. This was a retrospective cross-sectional study. Logistic regression analysis was performed to investigate the association between the administration of 2% dorzolamide ophthalmic solution in dogs and the development of metabolic acidosis. Additionally, the influence of various potential risk factors, including age, body weight, sex, use of topical or systemic NSAIDs, and preoperative medications on the occurrence of metabolic acidosis, was evaluated. A significant association was found between the use of 2% dorzolamide ophthalmic solution and perianesthetic metabolic acidosis (OR, 6.79; 95% CI, 2.00 to 23.02; P = .002). Furthermore, topical dorzolamide administration was significantly associated with both perianesthetic hypokalemia (OR, 3.52; 95% CI, 1.11 to 11.20; P = .033) and perianesthetic hyperchloremia (OR, 9.25; 95% CI, 1.71 to 50.01; P = .010). The use of 2% dorzolamide ophthalmic solution is associated with perianesthetic metabolic acidosis, hypokalemia, and hyperchloremia in dogs. It is prudent to be aware of these risks, especially before anesthesia.

Implications of hyperchloremia in critically ill patients

ABSTRACT Hyperchloremia is a repeated insult in critically ill subjects, leading to more morbidity and mortality. There is a strong relation between hyperchloremia with mortality and morbidity, as renal injury, more extended ICU stay, more mechanical ventilation (MV) period, and other electrolyte disturbances. Our aim is to evaluate the association of hyperchloremia in critically ill subjects with the incidence of mortality and also to study the development of morbidities such as renal injury and electrolyte disturbances and development of metabolic acidosis and its relationship to the period of MV and ICU stay time. A total number of 400 patients subjected to hyperchloremia estimation and laboratory tests were divided into two groups: hyperchloremic group (HG) and non-hyperchloremic group (NHG). The whole incidence of hyperchloremia for the total cohort has been estimated, as well as the whole incidence of mortality, duration of MV, ICU stay time, development of renal injury, and its association with occurrence of metabolic acidosis and electrolyte disturbances among the HG and NHG. The study included 400 patients, 180 of them (45%) were HG, and 220 (55%) were NHG. Mortality was more in 128 HG patients (71.1%), while 48 patients died (21.8%) in NHG (p-value = 0.005). The incidence of morbidities was more in HG than NHG as more; period of MV, ICU stay, renal injury, acidosis and more electrolyte disturbances (p-value < 0.05). Hyperchloremic patients had an increased incidence of mortality. Moreover, they were susceptible to longer mechanical ventilation, ICU stay, renal injury, metabolic acidosis, and electrolytes disorders.

The global peripheral chemoreflex drive in patients with systemic sclerosis: a rebreathing and exercise study.

Exercise intolerance (EI) in systemic sclerosis (SSc) is difficult to manage by the clinician. The peripheral chemoreflex drive compensates for metabolic acidosis during exercise and may be related to EI. To assess the global peripheral chemoreflex drive (GPCD) in patients with SSc at rest and during exercise. Consecutively tested SSc patients (n = 49) were evaluated by pulmonary function tests, carbon dioxide (CO2) rebreathing studies and non-invasive cardiopulmonary exercise testing (CPET). Results of their CO2 rebreathing tests were compared with those of controls (n = 32). Respiratory compensation for metabolic acidosis during CPET was defined by the occurrence of a sharp increase in minute ventilation (VdotE) and the ventilatory equivalent for CO2 (V'E and V'CO2) at the end of the isocapnic buffer phase. Euoxic (eVHR) and hyperoxic (hVHR) ventilatory responses to hypercapnia were measured and its difference (eVHR - hVHR) was considered to reflect the GPCD. In 45 patients with SSc, CPET results showed respiratory compensation at the occurrence of metabolic acidosis. eVHR - hVHR in patients with diffuse cutaneous SSc (dcSSc) differed significantly from that in patients with limited cutaneous SSc (lcSSc) and from that in controls (0.47 ± 0.38 (dcSSc) vs. 0.90 ± 0.77 (lcSSc) and 0.90 ± 0.49 (controls) l/min/mmHg; P = 0.04 and P = 0.03, respectively). Respiratory compensation for metabolic acidosis occurred in all patients. However, the GPCD was diminished in dcSSc patients, suggesting an altered control of breathing. Its assessment may help the clinician to better understand reported EI and exertional dyspnea in dcSSc patients.

Migraine and Topiramate Induced Dyspnea

Topiramate is effective in migraine headache prophylaxis. Pulmonary symptoms are rarely described as adverse effects. We report the case of a 42-year-old woman with migraine headaches who developed chronic shortness of breath while taking topiramate. Our patient experienced hand paresthesiae at a dose of 25 mg daily, and exercise induced dyspnea at doses above 50 mg daily; these symptoms worsened with increasing topiramate doses. Physical exam and chest x-ray were normal. Blood gas revealed a metabolic acidosis. Symptoms resolved after discontinuation of topiramate. Topiramate induces a lowering of blood carbon dioxide, which is usually asymptomatic. This is due to inhibition of carbonic anhydrase at the proximal renal tubule resulting in impaired proximal bicarbonate reabsorption. The decrease in CO(2) blood level facilitates the occurrence of metabolic acidosis. To our knowledge, this is the first case report of topiramate-induced dyspnea in a patient with migraine headaches.

Intestinal Ileus as a Possible Cause of Hypobicarbonatemia

The possible occurrence of metabolic acidosis in patients with intestinal ileus is not well recognized. We describe a patient with acute alcohol-induced pancreatitis and a large transverse colon ileus in which plasma bicarbonate dropped rapidly in the absence of an increase in the plasma anion gap. The urinary anion gap and ammonium excretion were consistent with an appropriate renal response to metabolic acidosis and against the possibility of respiratory alkalosis. The cause of the falling plasma bicarbonate was ascribed to intestinal bicarbonate sequestration owing to the enhancement of chloride-bicarbonate exchange in a dilated paralyzed colon.

Excess Casein in the Diet Is Not the Unique Cause of Low-Grade Metabolic Acidosis: Role of a Deficit in Potassium Citrate in a Rat Model

This study examined the effects of a dietary model of protein excess and K anion salt deficit on the occurrence of metabolic acidosis in rat. Rats were adapted to diets containing either 13 or 26% casein, together with mineral imbalance, through lowering K/increasing sodium/omitting alkalinizing anions. For each protein level, a group of rats was supplemented with K citrate. Dietary K citrate resulted in neutral urinary pH, whatever the protein level. Urea excretion was higher in rats adapted to 26% casein than 13% casein diets, but K citrate enhanced this excretion and suppressed ammonium elimination. No citraturia could be observed in acidotic rats, whereas K citrate greatly stimulated citraturia and 2-ketoglutarate excretion. In conclusion, low-grade metabolic acidosis can occur with a moderate protein level in the diet. K citrate was apparently less effective in rats adapted to the 26% casein level than in those adapted to the 13% casein level with regard to magnesium, citrate and 2-ketoglutarate concentrations in urine.

Predisposition to metabolic acidosis induced by topiramate

Metabolic acidosis induced by topiramate is a well documented but infrequent adverse event. The objective was to demonstrate the lowering of carbon dioxide serum levels, which is usually asymptomatic but may facilitate the occurrence of metabolic acidosis in patients using topiramate. We evaluated, prospectively, the carbon dioxide serum levels of 18 patients seen at the epilepsy clinic of our university hospital, before and 3 months after introducing topiramate. Five patients were female and 13 were male, age ranging from 2 to 16 years old (mean=9. 3). Carbon dioxide mean serum levels were 25 and 21.2 mmol/L (normal = 22 to 30), before and 3 months after introducing topiramate, respectively. Dose ranged from 2.08 to 11.76 mg/kg/day (mean=6. 7mg/kg/day). Adverse events were anorexia, nausea and somnolence. We conclude that the lowering of carbon dioxide serum levels induced by topiramate is mostly asymptomatic, but may facilitate the occurrence of metabolic acidosis. Since patients in use of topiramate have refractory epilepsy, they may need epilepsy surgery, and must be carefully monitored for the risk of metabolic acidosis during surgery.

Occurrence of metabolic acidosis during total parenteral nutrition with glucose, fructose and xylitol solution: Case report and study using vitamin deficient rabbits : Yasufumi Miyake, Tetsuya Sakamoto, Masayuki Maeda, Shunji Araki, Mitsuo Nakayama, Shozo Aoi, and Tokuo Kuwahata From the Department of Critical Care Medicine, Showa General Hospital, 2-450, Tenjin-cho, Kodaira-city, Tokyo, 187, Japan

Occurrence of metabolic acidosis during total parenteral nutrition with glucose, fructose and xylitol solution: Case report and study using vitamin deficient rabbits : Yasufumi Miyake, Tetsuya Sakamoto, Masayuki Maeda, Shunji Araki, Mitsuo Nakayama, Shozo Aoi, and Tokuo Kuwahata From the Department of Critical Care Medicine, Showa General Hospital, 2-450, Tenjin-cho, Kodaira-city, Tokyo, 187, Japan

Effect of fetal metabolic acidosis upon oxygen environment

The occurrence of metabolic acidosis in the fetus is usually secondary to one occurring in the mother or is accompanied by fetal hypoxia. Pure fetal metabolic acidosis was produced in a series of lambs in utero at term by the infusion of hydrochloric acid. The uterine and umbilical blood flows were measured. By the simultaneous measurement of a variety of gaseous parameters in maternal and fetal blood, the oxygen consumption of the fetus was calculated. A consistent increase in umbilical vein oxygen tension was found, not explained on the basis of consistent alterations in uterine or umbilical blood flows. An umbilical vein and umbilical artery hydrostatic pressure increase was found, for which at present no explanation is at hand. It is suggested that the change in oxygen affinity of the fetal blood, produced by the Bohr effect, is the most likely explanation for the increase in oxygen tension found in the umbilical vein.

THE CIRCULATION IN ANAESTHESIA.

The integrity of the circulation depends on the summation of the effects of the cardiac output, the peripheral vascular resistance, and the blood volume. Agents producmg general anaesthesia affect the circulation by decreasing cardiac output and peripheral resistance, this effect is in proportion to the concentration of agents in the blood. Other factors which may alter the circulation in anaesthesia are the status of ventilation, the degree of hypoxia, the administration of relaxants, and the occurrence of metabolic acidosis. Along with the usual clinical means of evaluating the circulation, venous pressure values are helpful data. These values permit differentiation between a problem in which myocardial function needs improvement and one in which blood volume can be safely increased to treat an inadequate circulation.

POSSIBLE SOURCES OF ERROR IN THE DETERMINATION OF ARTERIAL CARBON DIOXIDE TENSION BY AN INTERPOLATION TECHNIQUE

There are two main sources of error in the determination of Paco2 by an interpolation technique which utilizes bubble equilibrations. These are: The occurrence of metabolic acidosis during the process of storage and equilibration. Incomplete equilibration of the blood samples with the known carbon dioxide and oxygen mixture. Incomplete equilibration is particularly likely to occur if the blood has a high packed cell volume: in these circumstances there may be an underestimate of Pco2 of as much as 20 mm Hg. It is suggested that a Pco2 electrode is both more accurate and more convenient than the interpolation technique described. However, this too is subject to error and its accuracy should be repeatedly checked by tonometry.