BACKGROUND: Several studies explored the interdependence between Paco2 and bicarbonate during respiratory acid-base derangements. The authors aimed to reframe the bicarbonate adaptation to respiratory disorders according to the physical-chemical approach, hypothesizing that (1) bicarbonate concentration during respiratory derangements is associated with strong ion difference; and (2) during acute respiratory disorders, strong ion difference changes are not associated with standard base excess. METHODS: This is an individual participant data meta-analysis from multiple canine and human experiments published up to April 29, 2021. Studies testing the effect of acute or chronic respiratory derangements and reporting the variations of Paco2, bicarbonate, and electrolytes were analyzed. Strong ion difference and standard base excess were calculated. RESULTS: Eleven studies were included. Paco2 ranged between 21 and 142 mmHg, while bicarbonate and strong ion difference ranged between 12.3 and 43.8 mM, and 32.6 and 60.0 mEq/l, respectively. Bicarbonate changes were linearly associated with the strong ion difference variation in acute and chronic respiratory derangement (β-coefficient, 1.2; 95% CI, 1.2 to 1.3; P < 0.001). In the acute setting, sodium variations justified approximately 80% of strong ion difference change, while a similar percentage of chloride variation was responsible for chronic adaptations. In the acute setting, strong ion difference variation was not associated with standard base excess changes (β-coefficient, -0.02; 95% CI, -0.11 to 0.07; P = 0.719), while a positive linear association was present in chronic studies (β-coefficient, 1.04; 95% CI, 0.84 to 1.24; P < 0.001). CONCLUSIONS: The bicarbonate adaptation that follows primary respiratory alterations is associated with variations of strong ion difference. In the acute phase, the variation in strong ion difference is mainly due to sodium variations and is not paralleled by modifications of standard base excess. In the chronic setting, strong ion difference changes are due to chloride variations and are mirrored by standard base excess.
- MeSH
- acidobazická rovnováha * MeSH
- chloridy farmakologie MeSH
- hydrogenuhličitany * MeSH
- koncentrace vodíkových iontů MeSH
- lidé MeSH
- psi MeSH
- sodík farmakologie MeSH
- zvířata MeSH
- Check Tag
- lidé MeSH
- psi MeSH
- zvířata MeSH
- Publikační typ
- časopisecké články MeSH
- metaanalýza MeSH
OBJECTIVE: Blood bicarbonate concentration plays an important role for obstructive sleep apnea (OSA) patients to maintain acid-base balance. We investigated the association between arterial standard bicarbonate ([HCO3-]) and nocturnal hypoxia as well as comorbid hypertension in OSA. METHODS: A cross-sectional analysis of 3329 patients in the European Sleep Apnea Database (ESADA) was performed. Arterial blood gas analysis and lung function test were performed in conjunction with polysomnographic sleep studies. The 4% oxygen desaturation index (ODI), mean and minimum oxygen saturation (SpO2), and percentage of time with SpO2 below 90% (T90%) were used to reflect nocturnal hypoxic burden. Arterial hypertension was defined as a physician diagnosis of hypertension with ongoing antihypertensive medication. Hypertensive patients with SBP/DBP below or above 140/90 mmHg were classified as controlled-, uncontrolled hypertension, respectively. RESULTS: The [HCO3-] level was normal in most patients (average 24.0 ± 2.5 mmol/L). ODI, T90% increased whereas mean and minimum SpO2 decreased across [HCO3-] tertiles (ANOVA, p = 0.030, <0.001, <0.001, and <0.001, respectively). [HCO3-] was independently associated with ODI, mean SpO2, minimum SpO2, and T90% after adjusting for confounders (β value [95%CI]: 1.21 [0.88-1.54], -0.16 [-0.20 to -0.11], -0.51 [-0.64 to -0.37], 1.76 [1.48-2.04], respectively, all p < 0.001). 1 mmol/L elevation of [HCO3-] was associated with a 4% increased odds of uncontrolled hypertension (OR: 1.04 [1.01-1.08], p = 0.013). CONCLUSION: We first demonstrated an independent association between [HCO3-] and nocturnal hypoxic burden as well as uncontrolled hypertension in OSA patients. Bicarbonate levels as an adjunctive measure provide insight into the pathophysiology of hypertension in OSA.
- MeSH
- hydrogenuhličitany MeSH
- hypertenze * epidemiologie komplikace MeSH
- hypoxie komplikace MeSH
- kyslík MeSH
- lidé MeSH
- obstrukční spánková apnoe * MeSH
- průřezové studie MeSH
- syndromy spánkové apnoe * komplikace MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
This double-blind placebo-controlled cross-over study utilized comprehensive monitoring of blood bicarbonate (HCO3 ̄) kinetics and evaluation of gastrointestinal (GI) upset to determine their impact on an ergogenic potential of sodium bicarbonate (SB) co-ingested with carbohydrate (CHO). Nineteen CrossFit athletes performed 6 bouts of 15 s Wingate Anaerobic Test (WAnT) 90 min post-ingestion of 0.4 g·kg-1 body mass (BM) of SB (SB + CHO treatment) or PLA (PLA + CHO treatment) with 15 g CHO. Blood HCO3 ̄ concentration was evaluated at baseline, 30-, 60-, 75- and 90 min post-ingestion, in between WAnT bouts, and 3 and 45 min post-exercise, while GI upset at 120 min after protocol started. Control (no supplementation; CTRL) procedures were also performed. An effective elevation of extra-cellular buffering capacity was observed 60-90 min post-ingestion of SB + CHO. At mean peak blood HCO3 ̄, or at start of exercise an increase > 6 mmol·L-1 in HCO3 ̄ was noted in 84% and 52.6% participants, respectively. SB + CHO did not prevent performance decrements in WAnT bouts. There were no significant relationships between changes in blood HCO3 ̄ and WAnTs' performance. Total GI was significantly higher in SB + CHO compared to CTRL, and stomach problems in SB + CHO compared to CTRL and PLA + CHO. There were inverse associations between peak- (p = 0.031; r = - 0.495), average- (p = 0.002; r = - 0.674) and minimum power (p = 0.008; r = - 0.585) and total GI upset, as well as average power and severe GI distress (p = 0.042; r = - 0.471) at SB + CHO. The implemented dose of SB + CHO was effective in improving buffering capacity, but did not prevent decrements in WAnTs' performance. GI side effects were crucial in affecting the ergogenic potential of SB and thus must be insightfully monitored in future studies.
- MeSH
- dvojitá slepá metoda MeSH
- gastrointestinální nemoci * chemicky indukované MeSH
- hydrogenuhličitan sodný škodlivé účinky MeSH
- hydrogenuhličitany MeSH
- klinické křížové studie MeSH
- lidé MeSH
- polyestery MeSH
- sportovní výkon * MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- randomizované kontrolované studie MeSH
Background: Several alternative prevention strategies are being employed in various clinical settings to reduce Contrast-induced nephropathy (CIN). Despite the proposed theoretical advantage of these strategies, there is no agreement on their relative effectiveness in real practice. This study aimed to estimate the incidence of CIN and to report on the real effectiveness of sodium bicarbonate to protect the kidney from CIN in various cardiac patients undergoing cardiac catheterization.Methods: This is a retrospective, single-center, cohort study. A total of 60 patients admitted between January 2016 and November 2021 who were undergoing coronary angiography at a single Saudi center were included. All patients received either intravenous sodium bicarbonate or normal saline hydration prior to, during, and after the implementation of CM. CIN was defined as serum creatinine (SCr) ≥ 25% or ≥ 0.5 mg/dL compared to the baseline value within 48 h after CM exposure.Results: Among all patients, the incidence of CIN at 24 and 48 h was 16.7% and 15%, respectively. Strikingly, the incidence of CIN at both time points was significantly higher among patients who received sodium bicarbonate than among those who received normal saline hydration only [30% vs. 3.6% (P=0.012) and 38% vs. 3.3% (P=0.002), respectively]. Dyslipidemia status was the most positive predictor of CIN incidence at both time points.Conclusions: The 16.7% incidence of CIN in this sample is considered very high compared to the rates in previous national and international studies. This finding indicated that further preventive measures should be urgently initiated with strict protocols for the implementation of CM according to updated guidelines.
Vysoký příjem soli v potravě poškozuje nemocné ledviny řadou mechanismů. Jedním z nich může být acidifikační vliv soli. Poměr mezi obsahem natria a chloru je v extracelulární tekutině 1,4 : 1, zatímco v soli 1 : 1, a proto má požití soli acidifikační efekt. Podle Stewartovy-Fenclovy teorie acidobazické rovnováhy je rozdíl mezi náboji nesenými silnými kationty a silnými anionty (tzv. SID – strong ion difference; SID = (Na+ K+ Ca++ Mg++) – (Cl- + UA -) (UA- jsou ionty, které běžně nestanovujeme) jednou ze základních veličin, které rozhodují o koncetraci vodíkových iontů v extracelulární tekutině (ECT). Snížení SID acidifikuje. V souvislosti s příjmem soli můžeme SID zjednodušit na rozdíl [Na+ – Cl-]. Po požití soli se tento rozdíl v ECT sníží, a proto acidifikuje. Důsledkem je snížení [HCO3-]. Aby ledviny udržely fyziologickou hodnotu [Na+-Cl-], musí ve zvýšené míře syntetizovat NH4+ a HCO3- a tím uchovat fyziologický rozdíl [Na+-Cl-], a tudíž fyziologickou koncentraci [HCO3-] v krvi. To je spojeno se zvýšenou spotřebou kyslíku v ledvinách. „Sůl“ složená ze dvou třetin z NaCl a z jedné třetiny z NaHCO3 obsahuje oba ionty v přibližně stejném poměru, jako je tomu v ECT, a proto by neměla mít acidifikační efekt. Zdravé ledviny se s nadbytkem chloridů snadno vyrovnají. Domníváme se však, že při onemocněních ledvin by měl být bikarbonát podáván dříve, než se sníží pH, či dokonce [HCO3-]. Tím by se omezilo zatížení ledvin spojené se zvýšenou tvorbou bikarbonátu v důsledku solení.
A high salt intake is harmful to diseased kidneys by several mechanisms. The acidifying salt intake effect may be one of them. The ratio between sodium and chloride concentration is 1.4:1 in the extracellular fluid (ECF), while it is 1:1 in salt. According to the Stewart-Fencl theory, the ECF strong ion difference (SID = (Na++ K++Ca+++Mg++) – (Cl- + UA-); (UA- means routinely unidentified ions) is one of the basic variables determining the hydrogen ion concentration. The SID decrease causes acidemia and vice versa. In the context with salt intake, we can simplify the SID equation and replace it by the difference [Na+-Cl-]. In the ECF [Na+-Cl-] difference is diminished after the salt intake and contributes to acidemia, which is signalized by [HCO3-] decrease. To maintain a physiological [Na+-Cl-] in the ECF, the kidneys must raise the NH4+ and HCO3- synthesis from glutamate. This is associated with the increased kidney oxygen consumption. „Salt“ composed of the 2/3 of NaCl and 1/3 of NaHCO3 has [Na+-Cl-] difference in the approximately same level as it is in the ECF. Therefore this mixture does not have an acidifying effect. Healthy kidneys cope with the chloride excess after salt ingestion easily. However, we believe that in renal patients, apart from salt intake reduction, bicarbonate should be administered early in the course of disease, sooner than pH or even [HCO3-] are reduced. Thus, salt-elicited demand for increased bicarbonate synthesis would be suppressed early in the course of renal diseases.
- MeSH
- acidobazická rovnováha fyziologie MeSH
- chlorid sodný * metabolismus terapeutické užití MeSH
- fyziologie výživy fyziologie MeSH
- hydrogenuhličitan sodný metabolismus terapeutické užití MeSH
- lidé MeSH
- nemoci ledvin * dietoterapie MeSH
- poruchy acidobazické rovnováhy metabolismus MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
- MeSH
- acidobazická rovnováha * fyziologie účinky léků MeSH
- analýza krevních plynů metody MeSH
- diferenciální diagnóza MeSH
- diuretika klasifikace škodlivé účinky MeSH
- hydrogenuhličitany aplikace a dávkování škodlivé účinky MeSH
- lidé MeSH
- poruchy acidobazické rovnováhy diagnóza klasifikace MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
Bicarbonate and phosphate constitute major salivary buffering components, and their importance consists in the neutralization of acidic gastric contents during reflux episodes. In this work, capillary electrophoresis with capacitively coupled contactless conductivity detector was applied for the analysis of bicarbonate, phosphate, and another inorganic (chloride, nitrite, nitrate, sulfate, thiocyanate) and organic anions (acetate, butyrate) to evaluate their levels in saliva. The background electrolytes of different composition and pH between 6.02-9.41 were assessed for the bicarbonate and phosphate determination by comparison of the real analyses of a model solution with the simulation by PeakMaster software. The optimized background electrolyte was composed of 10 mM 2-(N-morpholino)ethanesulfonic acid, 20 mM arginine, and 30 µM cetyltrimethylammonium bromide, pH 8.95. Using this BGE, the anion levels were compared in saliva from 20 patients suffering from gastroesophageal reflux disease (GERD) and saliva from 12 healthy subjects. Bicarbonate levels were significantly elevated in saliva from GERD patients suggesting the possible applicability of bicarbonate as a biomarker in non-invasive diagnostics of GERD by CE-C4 D.
- MeSH
- acidobazická rovnováha fyziologie MeSH
- acidóza diagnóza etiologie klasifikace patofyziologie MeSH
- chronická obstrukční plicní nemoc komplikace MeSH
- hydrogenuhličitany analýza MeSH
- lidé MeSH
- poruchy acidobazické rovnováhy * klasifikace patofyziologie MeSH
- respirační acidóza diagnóza MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- kazuistiky MeSH
- přehledy MeSH
- MeSH
- chemie dějiny MeSH
- čokoláda dějiny MeSH
- cukrovinky dějiny MeSH
- dějiny 19. století MeSH
- dějiny 20. století MeSH
- dějiny lékárnictví MeSH
- farmaceuti * dějiny MeSH
- hydrogenuhličitan sodný MeSH
- lidé MeSH
- marketing MeSH
- potravinářský průmysl dějiny MeSH
- prášky, zásypy, pudry dějiny MeSH
- přísady do jídla * dějiny MeSH
- vaření MeSH
- výzkum v lékárnictví dějiny MeSH
- významné osobnosti MeSH
- Check Tag
- dějiny 19. století MeSH
- dějiny 20. století MeSH
- lidé MeSH
