ROLES OF THE LIVER AND KIDNEY IN ACID-BASE REGULATION AND ITS DISORDERS
ROLES OF THE LIVER AND KIDNEY IN ACID-BASE REGULATION AND ITS DISORDERS
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DOI：
10.1093/bja/67.2.154
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发表时间：
1991-08-01
影响因子：
9.8
通讯作者：
COHEN, RD
中科院分区：
文献类型：
--
作者：
COHEN, RD
在过去的15年里，对酸碱调节机制和代谢性酸碱紊乱的生化发病机制产生了一些令人惊讶的重新解释。一些公认的概念受到了质疑，最终可能会对临床管理产生影响。这篇综述的目的是总结一些新的思想及其含义。也许最好的起点是亨德森-哈塞尔巴赫方程本身。许多教科书由此推断，酸碱平衡可简单地看作是肺和肾的共同作用，前者控制二氧化碳，后者控制血浆[HCO3~]，从而确保动脉pH的恒定。反思主要集中在肝脏在酸碱平衡及其失调中的可能作用，以及对肾脏作用的重新评估，肾脏似乎具有比单纯的缓冲质子排泄更微妙的作用。
The past 15 years have produced some surprising reinterpretations of the mechanisms of acid-base regulation and of the biochemical pathogenesis of metabolic acid—base disorders. Several well established concepts have been questioned, with possible eventual consequences for clinical management. The purpose of this review is to summarize some of this newer thinking and its implications.Probably the best starting point is the Henderson-Hasselbalch equation itself. Many textbooks have inferred from it that acid-base homeostasis can be regarded in simple terms as a joint function of the lungs and kidneys, the former controlling Pco2, the latter plasma [HCO3~], thus ensuring constancy of arterial pH. The rethinking has been centred largely around the possible role of the liver in both acid—base homeostasis and its disorders, and reappraisal of the role of the kidneys, which appear to have a subtler role than the mere excretion of buffered protons.