-
Open Heart Sep 2021
Topics: Acidosis; Female; Humans; Insulin Resistance; Male; Metabolic Syndrome; Middle Aged
PubMed: 34497064
DOI: 10.1136/openhrt-2021-001788 -
Kidney International. Supplement Dec 2003Metabolic acidosis in maintenance dialysis patients: Clinical considerations. Metabolic acidosis is a common consequence of advanced chronic renal failure (CRF) and... (Review)
Review
Metabolic acidosis in maintenance dialysis patients: Clinical considerations. Metabolic acidosis is a common consequence of advanced chronic renal failure (CRF) and maintenance dialysis (MD) therapies are not infrequently unable to completely correct the base deficit. In MD patients, severe metabolic acidosis is associated with an increased relative risk for death. The chronic metabolic acidosis of the severity commonly encountered in patients with advanced CRF has two well-recognized major systemic consequences. First, metabolic acidosis induces net negative nitrogen and total body protein balance, which improves upon bicarbonate supplementation. The data suggest that metabolic acidosis is both catabolic and antianabolic. Emerging data also indicate that metabolic acidosis may be one of the triggers for chronic inflammation, which may in turn promote protein catabolism among MD patients. In contrast to these findings, metabolic acidosis may be associated with a decrease in hyperleptinemia associated with CRF. Several studies have shown that correction of metabolic acidosis among MD patients is associated with modest improvements in the nutritional status. Second, metabolic acidosis has several effects on bone, causing physicochemical dissolution of bone and cell-mediated bone resorption (inhibition of osteoblast and stimulation of osteoclast function). Metabolic acidosis is probably also associated with worsening of secondary hyperparathyroidism. Data on the effect of correction of metabolic acidosis on renal osteodystrophy, however, are limited. Preliminary evidence suggest that metabolic acidosis may play a role in beta2-microglobulin accumulation, as well as the hypertriglyceridemia seen in renal failure. Given the body of evidence pointing to the several systemic consequences of metabolic acidosis, a more aggressive approach to the correction of metabolic acidosis is proposed.
Topics: Acidosis; Animals; Bone Diseases; Humans; Hypertriglyceridemia; Kidney Failure, Chronic; Nutritional Physiological Phenomena; Renal Dialysis; beta 2-Microglobulin
PubMed: 14870874
DOI: 10.1046/j.1523-1755.2003.08802.x -
American Journal of Nephrology 2003Metabolic acidosis is a condition that is commonly encountered in both chronic renal failure and in end-stage renal disease. Metabolic acidosis is associated with many... (Review)
Review
Metabolic acidosis is a condition that is commonly encountered in both chronic renal failure and in end-stage renal disease. Metabolic acidosis is associated with many adverse effects: negative nitrogen balance, increased protein decomposition, anorexia, fatigue, bone lesions, impaired function of the cardiovascular system, impaired function of the gastrointestinal system, hormonal disturbances, insulin resistance, hyperkalemia, altered gluconeogenesis and triglyceride metabolism, increased progression of chronic renal failure, and growth retardation in children. Even 'minor' degrees of metabolic acidosis are deleterious. Metabolic acidosis of end-stage renal patients could be successfully corrected with bicarbonate hemodialysis and with peroral bicarbonate-containing phosphate binders, i.e. calcium carbonate. Bicarbonate powder compared with bicarbonate solutions has some advantages and enables a stabile composition of electrolytes. 'High' dialysate bicarbonate (40- 42 mmol/l) is a safe, well-tolerated and useful tool for better correction of the metabolic acidosis and must become a standard of hemodialysis treatment. Measured postdialysis blood bicarbonate concentration should be obtained at least every month and correction of metabolic acidosis by maintaining serum bicarbonate >or=22 mmol/l should be a goal of the management of patients undergoing chronic hemodialysis.
Topics: Acidosis; Cardiovascular Diseases; Chronic Kidney Disease-Mineral and Bone Disorder; Humans; Kidney Failure, Chronic; Nutrition Disorders; Renal Dialysis
PubMed: 12649614
DOI: 10.1159/000070205 -
Nutrients Jul 2021Metabolic acidosis is a severe complication of chronic kidney disease (CKD) which is associated with nefarious impairments such as bone demineralization, muscle wasting,... (Review)
Review
Metabolic acidosis is a severe complication of chronic kidney disease (CKD) which is associated with nefarious impairments such as bone demineralization, muscle wasting, and hormonal alterations, for example, insulin resistance. Whilst it is possible to control this condition with alkali treatment, consisting in the oral administration of sodium citrate or sodium bicarbonate, this type of intervention is not free from side effects. On the contrary, opting for the implementation of a targeted dietetic-nutritional treatment for the control of CKD metabolic acidosis also comes with a range of additional benefits such as lipid profile control, increased vitamins, and antioxidants intake. In our review, we evaluated the main dietary-nutritional regimens useful to counteract metabolic acidosis, such as the Mediterranean diet, the alkaline diet, the low-protein diet, and the vegan low-protein diet, analyzing the potentialities and limits of every dietary-nutritional treatment. Literature data suggest that the Mediterranean and alkaline diets represent a valid nutritional approach in the prevention and correction of metabolic acidosis in CKD early stages, while the low-protein diet and the vegan low-protein diet are more effective in CKD advanced stages. In conclusion, we propose that tailored nutritional approaches should represent a valid therapeutic alternative to counteract metabolic acidosis.
Topics: Acid-Base Equilibrium; Acidosis; Diet; Diet, Mediterranean; Diet, Protein-Restricted; Diet, Vegan; Humans; Nutrition Therapy; Renal Insufficiency, Chronic
PubMed: 34444694
DOI: 10.3390/nu13082534 -
The Veterinary Clinics of North... Nov 1999In neonatal calves metabolic acidosis is a common sequela to diarrhea-induced dehydration and endotoxemia in the aftermath of gram-negative bacterial infections. Without... (Review)
Review
In neonatal calves metabolic acidosis is a common sequela to diarrhea-induced dehydration and endotoxemia in the aftermath of gram-negative bacterial infections. Without treatment, metabolic acidosis is a prime factor in the death of many of these calves. This article begins with a general discussion about the causes and recognition of metabolic acidosis. The remaining sections detail the subjective and objective methods available to assess the severity of acidosis and treatment options for this metabolic condition.
Topics: Acidosis; Alkalies; Animals; Animals, Newborn; Cattle; Cattle Diseases; Diarrhea; Fluid Therapy
PubMed: 10573807
DOI: 10.1016/s0749-0720(15)30159-6 -
Nephrology, Dialysis, Transplantation :... Aug 2012Metabolic acidosis is a common complication associated with progressive loss of kidney function. The diminishing ability of the kidneys to maintain acid-base homeostasis... (Review)
Review
Metabolic acidosis is a common complication associated with progressive loss of kidney function. The diminishing ability of the kidneys to maintain acid-base homeostasis results in acid accumulation, leading to various complications such as impairment in nutritional status, worsened uremic bone disease and an association with increased mortality. In addition to these adverse effects which are related to acid retention, metabolic acidosis may also cause kidney damage, possibly through the stimulation of adaptive mechanisms aimed at maintaining acid-base homeostasis in the face of decreasing kidney function. Recent clinical trials have suggested that correction or prevention of metabolic acidosis by alkali administration is able to attenuate kidney damage and to slow progression of chronic kidney disease (CKD), and may hence offer an effective, safe and affordable renoprotective strategy. We review the physiology and pathophysiology of acid-base homeostasis in CKD, the mechanisms whereby metabolic acidosis may be deleterious to kidney function, and the results of clinical trials suggesting a benefit of alkali therapy, with special attention to details related to the practical implementation of the results of these trials.
Topics: Acid-Base Equilibrium; Acidosis; Bicarbonates; Clinical Trials as Topic; Disease Progression; Homeostasis; Humans; Kidney Failure, Chronic; Risk Factors
PubMed: 22851628
DOI: 10.1093/ndt/gfs291 -
The Journal of Emergency Medicine Dec 2021Alcoholic ketoacidosis (AKA) is defined by metabolic acidosis and ketosis in a patient with alcohol use. This is a common presentation in the emergency department (ED)... (Review)
Review
BACKGROUND
Alcoholic ketoacidosis (AKA) is defined by metabolic acidosis and ketosis in a patient with alcohol use. This is a common presentation in the emergency department (ED) and requires targeted therapies.
OBJECTIVE
This narrative review evaluates the pathogenesis, diagnosis, and management of AKA for emergency clinicians.
DISCUSSION
AKA is frequently evaluated and managed in the ED. The underlying pathophysiology is related to poor glycogen stores and elevated nicotinamide adenine dinucleotide and hydrogen. This results in metabolic acidosis with elevated beta-hydroxybutyrate levels. Patients with AKA most commonly present with a history of alcohol use (acute or chronic), poor oral intake, gastrointestinal symptoms, and ketoacidosis on laboratory assessment. Patients are generally dehydrated, and serum glucose can be low, normal, or mildly elevated. An anion gap metabolic acidosis with ketosis and electrolyte abnormalities are usually present on laboratory evaluation. Management includes fluid resuscitation, glucose and vitamin supplementation, electrolyte repletion, and evaluation for other conditions.
CONCLUSIONS
Emergency clinician knowledge of the evaluation and management of AKA is essential in caring for these patients.
Topics: Acidosis; Alcoholism; Fluid Therapy; Glucose; Humans; Ketosis
PubMed: 34711442
DOI: 10.1016/j.jemermed.2021.09.007 -
Current Opinion in Nephrology and... Jul 2007The occurrence and pathogenesis of metabolic acidosis after renal transplantation is reviewed. Posttransplant acidosis is shown to be a key mechanism for major metabolic... (Review)
Review
PURPOSE OF REVIEW
The occurrence and pathogenesis of metabolic acidosis after renal transplantation is reviewed. Posttransplant acidosis is shown to be a key mechanism for major metabolic complications in mineral and muscle metabolism, and for anemia, discussed in the context of both acidosis and renal transplantation.
RECENT FINDINGS
Continuous improvement in kidney transplant survival has shifted attention to long-term outcomes, specifically to disorders linked to cardiovascular disease, physical capacity and quality of life. Metabolic acidosis is gaining growing acceptance as a clinical entity and has occasionally come into focus in the context of renal transplantation. The possible link to metabolic disturbances resulting in impairment of musculoskeletal disorders and physical limitations, however, has not been considered specifically.
SUMMARY
Available evidence suggests a high prevalence of (compensated) metabolic acidosis after renal transplantation, presenting as low serum bicarbonate and impaired renal acid excretion. This condition is associated with relevant disorders in mineral metabolism and muscle function. Current knowledge about the effects of acidosis on renal electrolyte handling, mineral metabolism and protein synthesis suggests that acid/base derangements contribute to the muscle and bone pathology, as well as anemia, encountered after kidney transplantation. Consequently, posttransplant acidosis may be a relevant factor in the causal pathway of impaired physical capacity observed in this patient group.
Topics: Acidosis; Acidosis, Renal Tubular; Anemia; Bone Diseases, Endocrine; Humans; Insulin Resistance; Kidney Transplantation; Muscular Diseases; Nephrons; Prognosis; Quality of Life; Sodium Bicarbonate
PubMed: 17565282
DOI: 10.1097/MNH.0b013e3281bd8860 -
Journal of Nephrology 2006Derangements in the intermediate metabolism of nutrients can lead to organic acid acidoses, which in turn can have severe clinical consequences that include even the... (Review)
Review
Derangements in the intermediate metabolism of nutrients can lead to organic acid acidoses, which in turn can have severe clinical consequences that include even the patient's death. Lactic acidosis and ketoacidosis represent the most relevant clinical forms of this type of metabolic acidosis. Assessment and proper management of the organic acid acidoses require the intervention of a skillful clinician that balances the potential benefits and risks of the prescribed measures to the specific needs of the individual patient. To this aim, knowledge of the pathophysiology, diagnosis, and therapy of the various forms of acidoses including alkali administration, represent essential requirements.
Topics: Acidosis; Acids; Diagnosis, Differential; Humans; Prognosis; Sodium Bicarbonate
PubMed: 16736443
DOI: No ID Found -
Nihon Naika Gakkai Zasshi. the Journal... May 2006
Review
Topics: Acid-Base Equilibrium; Acidosis; Aspirin; Bicarbonates; Humans; Hydrogen-Ion Concentration; Hypoxia; Insulin; Methanol; Renal Insufficiency
PubMed: 16774060
DOI: No ID Found