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Open Heart Sep 2021
Topics: Acidosis; Female; Humans; Insulin Resistance; Male; Metabolic Syndrome; Middle Aged
PubMed: 34497064
DOI: 10.1136/openhrt-2021-001788 -
Nutrients Apr 2018Chronic kidney disease and reduced glomerular filtration rate are risk factors for the development of chronic metabolic acidosis. The prevention or correction of chronic... (Review)
Review
Chronic kidney disease and reduced glomerular filtration rate are risk factors for the development of chronic metabolic acidosis. The prevention or correction of chronic metabolic acidosis has been found to slow progression of chronic kidney disease. Dietary composition can strongly affect acid⁻base balance. Major determinants of net endogenous acid production are the generation of large amounts of hydrogen ions, mostly by animal-derived protein, which is counterbalanced by the metabolism of base-producing foods like fruits and vegetables. Alkali therapy of chronic metabolic acidosis can be achieved by providing an alkali-rich diet or oral administration of alkali salts. The primary goal of dietary treatment should be to increase the proportion of fruits and vegetables and to reduce the daily protein intake to 0.8⁻1.0 g per kg body weight. Diet modifications should begin early, i.e., even in patients with moderate kidney impairment, because usual dietary habits of many developed societies contribute an increased proportion of acid equivalents due to the high intake of protein from animal sources.
Topics: Acid-Base Equilibrium; Acidosis; Diet, Protein-Restricted; Dietary Supplements; Fruit; Glomerular Filtration Rate; Humans; Kidney; Nutritive Value; Recommended Dietary Allowances; Renal Insufficiency, Chronic; Risk Factors; Treatment Outcome; Vegetables
PubMed: 29677110
DOI: 10.3390/nu10040512 -
The Journal of International Medical... Dec 2016Objective We planned a cross-sectional analysis to determine the frequency and severity of metabolic acidosis in patients taking topiramate while awaiting craniotomy....
Objective We planned a cross-sectional analysis to determine the frequency and severity of metabolic acidosis in patients taking topiramate while awaiting craniotomy. Methods Eighty patients (18 - 65 years) taking topiramate to control seizures while awaiting elective craniotomy were enrolled. Any signs of metabolic acidosis or topiramate-related side effects were investigated. Blood chemistry levels and arterial blood gases, including lactate, were obtained. The severity of metabolic acidosis was defined according to base excess levels as mild or moderate. Results Blood gas analysis showed that 71% ( n = 57) of patients had metabolic acidosis. The frequency of moderate metabolic acidosis was 56% ( n = 45), while that of mild metabolic acidosis was 15% ( n = 12). A high respiratory rate was reported in only 10% of moderately acidotic patients. Conclusions In patients receiving topiramate, baseline blood gas analysis should be performed preoperatively to determine the presence and severity of metabolic acidosis.
Topics: Acidosis; Adolescent; Adult; Aged; Anticonvulsants; Blood Gas Analysis; Cross-Sectional Studies; Female; Fructose; Humans; Male; Middle Aged; Respiratory Rate; Seizures; Severity of Illness Index; Topiramate
PubMed: 27789806
DOI: 10.1177/0300060516669897 -
Journal of Ayub Medical College,... 2020Blood gases can provide information about the perinatal, natal and postnatal condition of newborn. Severity of metabolic acidosis has deleterious effect on the outcome...
BACKGROUND
Blood gases can provide information about the perinatal, natal and postnatal condition of newborn. Severity of metabolic acidosis has deleterious effect on the outcome of babies. When the cord blood gases are not available the arterial blood gases are used for interpreting the status of newborn. The purpose of study was to determine the relationship between severity of metabolic acidosis at admission with the stage of hypoxic ischemic encephalopathy, and its outcome in asphyxiated neonates.
METHODS
This was descriptive cross-sectional study of 384 neonates born at ≥35 weeks to <42 weeks from June to December 2018, admitted in Neonatology department of the Children's hospital & the Institute of Child Health, Lahore within first 6 hours of birth. The neonates with history of delayed cry at birth and arterial pH ≤7.30 and base deficit ≥10 were included in the study. The pH and base deficit of babies was analyzed in relation to the stage of HIE, duration of stay and death or discharge of the babies using SPSS-20. The p-value was calculated using chi-square test.
RESULTS
Total of 470 neonates were eligible. Eighty-four neonates were excluded. Finally, 384 neonates were included and analyzed for the outcome variables. With severe metabolic acidosis pH <7.01, all the babies developed HIEII/III. Majority (82.1%) of the babies expired and 27.9% had prolonged hospital stay.
CONCLUSIONS
Increasing severity of metabolic acidosis at admission increases the likelihood of adverse outcome in asphyxiated neonates.
Topics: Acidosis; Asphyxia Neonatorum; Cross-Sectional Studies; Humans; Infant, Newborn; Patient Admission; Treatment Outcome
PubMed: 32583992
DOI: No ID Found -
Current Opinion in Nephrology and... Sep 2019Chronic metabolic acidosis is a common complication of chronic kidney disease (CKD) and is associated with adverse consequences, such as CKD progression and muscle... (Review)
Review
PURPOSE OF REVIEW
Chronic metabolic acidosis is a common complication of chronic kidney disease (CKD) and is associated with adverse consequences, such as CKD progression and muscle wasting. We review the findings from recent clinical trials that have examined the effects of sodium bicarbonate therapy and veverimer in patients with CKD and chronic metabolic acidosis.
RECENT FINDINGS
There are four recent clinical trials on chronic metabolic acidosis of CKD. In a pilot, cross-over study, 6 weeks of sodium bicarbonate therapy improved vascular endothelial function, measured by brachial artery flow-mediated dilation. In a single-center, randomized, open-label study, 6 months of sodium bicarbonate therapy increased muscle mass and lean body mass, and preserved kidney function. The other two clinical trials (phase 1/2 and phase 3 studies) examined the effects of veverimer, which is a hydrochloric acid binder. The phase 3 study showed that 12-weeks of veverimer increased serum bicarbonate levels and might improve physical function. The effects of veverimer on CKD progression, physical function and cardiovascular endpoints as well as its long-term safety are yet to be determined.
SUMMARY
Recent studies suggest that sodium bicarbonate therapy may improve vascular endothelial function and muscle mass, and preserve renal function. Veverimer increases serum bicarbonate level and could be a potential new therapeutic option for treating chronic metabolic acidosis.
Topics: Acidosis; Chronic Disease; Clinical Trials as Topic; Humans; Polymers; Renal Insufficiency, Chronic; Sodium Bicarbonate
PubMed: 31232712
DOI: 10.1097/MNH.0000000000000524 -
Advances in Chronic Kidney Disease Jul 2022Metabolic acidosis affects about 15% of patients with chronic kidney disease. As kidney function declines, the kidneys progressively fail to eliminate acid, primarily... (Review)
Review
Metabolic acidosis affects about 15% of patients with chronic kidney disease. As kidney function declines, the kidneys progressively fail to eliminate acid, primarily reflected by a decrease in ammonium and titratable acid excretion. Several studies have shown that the net acid load remains unchanged in patients with reduced kidney function; the ensuing acid accumulation can precede overt metabolic acidosis, and thus, indicators of urinary acid or potential base excretion, such as ammonium and citrate, may serve as early signals of impending metabolic acidosis. Acid retention, with or without overt metabolic acidosis, initiates compensatory responses that can promote tubulointerstitial fibrosis via intrarenal complement activation and upregulation of endothelin-1, angiotensin II, and aldosterone pathways. The net effect is a cycle between acid accumulation and kidney injury. Results from small- to medium-sized interventional trials suggest that interrupting this cycle through base administration can prevent further kidney injury. While these findings inform current clinical practice guidelines, large-scale clinical trials are still necessary to prove that base therapy can limit chronic kidney disease progression or associated adverse events.
Topics: Acidosis; Aldosterone; Ammonium Compounds; Angiotensin II; Citrates; Endothelin-1; Humans; Kidney; Renal Insufficiency, Chronic
PubMed: 36175078
DOI: 10.1053/j.ackd.2022.04.009 -
Heart & Lung : the Journal of Critical... 2020The use of sodium bicarbonate in the treatment of metabolic acidosis in critically ill subjects has long been a subject of debate. Despite empiric use in the setting of... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
The use of sodium bicarbonate in the treatment of metabolic acidosis in critically ill subjects has long been a subject of debate. Despite empiric use in the setting of severe acidemia in critically ill patients, there is little data looking into the role of sodium bicarbonate in the treatment of severe metabolic acidosis in the intensive care unit (ICU) setting.
METHODS
We conducted a comprehensive search of Pubmed and Cochrane Central Register of Controlled Trials addressing bicarbonate use in the metabolic acidosis in the intensive care unit (ICU) setting. We examined mortality as end point. Pooled odds ratios (OR) and their 95% confidence intervals (CI) were calculated for all outcomes using a random-effect model.
RESULTS
The final search yielded 202 articles of which all were screened individually. A total of 11 studies were identified but 6 studies were excluded due to irrelevance in mortality outcome and methodology. Analysis was done separately for observational studies and randomized controlled trials. The pooled OR [95% CI] for mortality with bicarbonate use in the observational studies was 1.5 [0.62-3.67] with heterogeneity of 67%, while pooled OR for mortality in the randomized trials was 0.72 [0.49-1.05] (figure 2). In combining all studies, the pooled odds ratio was 0.93 95% [0.69-1.25] but with heterogeneity of 63%. After sensitivity analysis with removing the study done by Kim et al. 2013, heterogeneity was 0% with OR 0.8 [0.59-1.10].
CONCLUSION
There is no significant difference in mortality in the use of bicarbonate among critically ill patients with high anion gap metabolic acidosis predominantly driven by lactic acidosis.
Topics: Acidosis; Critical Illness; Humans; Intensive Care Units; Randomized Controlled Trials as Topic; Sodium Bicarbonate
PubMed: 31733880
DOI: 10.1016/j.hrtlng.2019.10.007 -
Revue Medicale Suisse Nov 2018Acid-base disorders, and metabolic acidosis in particular, are frequently encountered in critical care typically in shock states, metabolic diseases decompensations or... (Review)
Review
Acid-base disorders, and metabolic acidosis in particular, are frequently encountered in critical care typically in shock states, metabolic diseases decompensations or intoxications. Their systematic and careful evaluation frequently helps identifying underlying disease and guide clinical management. In most instances, therapy should focus on the underlying disease. Symptomatic treatment of metabolic acidosis is controversial and rarely indicated. This review focuses on the main causes of metabolic acidosis and their diagnostic approach.
Topics: Acidosis; Critical Care; Humans; Shock
PubMed: 30422423
DOI: No ID Found -
American Journal of Kidney Diseases :... Nov 2022Ammonium is a major urinary buffer that is necessary for the normal excretion of the daily acid load. Its urinary rate of excretion (UNH) may be increased several fold... (Review)
Review
Ammonium is a major urinary buffer that is necessary for the normal excretion of the daily acid load. Its urinary rate of excretion (UNH) may be increased several fold in the presence of extrarenal metabolic acidosis. Therefore, measurement of UNH can provide important clues about causes of metabolic acidosis. Because UNH is not commonly measured in clinical laboratories, the urinary anion gap (UAG) was proposed as its surrogate about 4 decades ago, and it is still frequently used for that purpose. Several published studies strongly suggest that UAG is not a good index of UNH and support the concept that direct measurement of UNH is an important parameter to define in clinical nephrology. Low UNH levels have recently been found to be associated with a higher risk of metabolic acidosis, loss of kidney function, and death in persons with chronic kidney disease, while surrogates like the UAG do not recapitulate this risk. In order to advance the field it is necessary for the medical community to become more familiar with UNH levels in a variety of clinical settings. Herein, we review the literature, searching for available data on UNH under normal and various pathological conditions, in an attempt to establish reference values to interpret UNH results if and when UNH measurements become available as a routine clinical test. In addition, we present original data in 2 large populations that provide further evidence that the UAG is not a good predictor of UNH. Measurement of urine NH holds promise to aid clinicians in the care of patients, and we encourage further research to determine its best diagnostic usage.
Topics: Humans; Acid-Base Equilibrium; Ammonium Compounds; Acidosis; Renal Insufficiency, Chronic; Kidney
PubMed: 35810828
DOI: 10.1053/j.ajkd.2022.05.009 -
Pediatric Nephrology (Berlin, Germany) Mar 2023The clinical manifestations of primary distal renal tubular acidosis usually begin in childhood, but the disease is caused by a genetic defect that persists throughout... (Review)
Review
The clinical manifestations of primary distal renal tubular acidosis usually begin in childhood, but the disease is caused by a genetic defect that persists throughout life. This review focuses on the complications of distal tubular acidosis that occur or remain long-term such as nephrocalcinosis and urolithiasis, growth impairment, bone mineralization, severe hypokalemia, kidney cysts, and progressive kidney failure, as well as other persistent manifestations that occur independent of acidosis but are associated with some inherited forms of the disease. The pathogenic factors responsible for kidney failure are discussed in particular because it is a complication to which different publications have recently drawn attention and which affects a high percentage of adults with primary distal renal tubular acidosis. The need to maintain optimal metabolic control of the disease and scheduled clinical follow-up throughout life and the importance of organizing protocols for the transition of patients to adult nephrology services are emphasized.
Topics: Adult; Humans; Acidosis, Renal Tubular; Hypokalemia; Acidosis; Nephrocalcinosis; Renal Insufficiency
PubMed: 35543873
DOI: 10.1007/s00467-022-05546-w