SYSTEMIC EFFECTS OF NAHCO3 IN EXPERIMENTAL LACTIC-ACIDOSIS IN DOGS
SYSTEMIC EFFECTS OF NAHCO3 IN EXPERIMENTAL LACTIC-ACIDOSIS IN DOGS
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DOI：
10.1152/ajprenal.1982.242.6.f586
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发表时间：
1982-01-01
影响因子：
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通讯作者：
LAZAROWITZ, VC
中科院分区：
文献类型：
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作者：
ARIEFF, AI;LEACH, W;LAZAROWITZ, VC
乳酸性酸中毒的特点是代谢性酸中毒，由于乳酸中H+的积累，血乳酸浓度至少为5毫米。标准治疗方法是静脉注射NaHCO3，导致死亡率超过50%。尽管死亡率很高，但NaHCO3用于治疗乳酸性酸中毒的代谢和全身效应尚未得到广泛研究。phenformmin诱导的乳酸性酸中毒（血乳酸浓度大于5 mM，动脉pH值低于7.20）犬分别给予等摩尔量的NaCl或NaHCO3治疗或不治疗。NaHCO3静脉注射导致心排血量、肝脏和红细胞细胞内pH （pHi）下降，而NaCl治疗则没有。在NaHCO3输注而非NaCl输注的情况下，肠道乳酸产量几乎呈化学计量增加，动脉pH和碳酸氢盐没有变化，但乳酸增加了一倍。碳酸氢盐也导致肝门静脉血流减少。NaCl和nahco3处理的动物的平均生存时间和死亡率相似。尽管两组小鼠的寿命都比未接受治疗的小鼠长，但差异并不显著。用NaCl或NaHCO3治疗实验性乳酸酸中毒或不治疗均不会改变血液pH值和碳酸氢盐，死亡率相似。在系统效应方面，NaHCO3可显著降低肝脏和红细胞pHi、肝门静脉血流和心输出量，并显著增加肠道乳酸生成，而NaCl则无此作用。用NaHCO3治疗乳酸酸中毒的基本原理可能需要重新评估。
Lactic acidosis is characterized by metabolic acidosis due to accumulation of H+ from lactic acid with blood lactate of at least 5 mM. The standard treatment is i.v. NaHCO3, with resultant mortality in excess of 50%. Despite the high mortality, the metabolic and systemic effects of NaHCO3 used in the treatment of lactic acidosis have not been extensively studied. Dogs with phenformin-induced lactic acidosis (blood lactate above 5 mM, arterial pH below 7.20) were treated with equimolar amounts of either NaCl or NaHCO3 or received no therapy. NaHCO3 i.v. resulted in a decline of cardiac output and intracellular pH (pHi) of liver and erythrocytes, whereas treatment with NaCl did not. With NaHCO3 but not with NaCl infusion gut lactate production increased almost stoichiometrically, with no change in arterial pH or bicarbonate but with a doubling of lactate. Bicarbonate also resulted in a decrease of hepatic portal vein blood flow. The mean survival time and percent mortality were similar in NaCl- vs. NaHCO3-treated animals. Although both groups lived longer than did animals receiving no therapy, the differences were not significant. Treatment of experimental lactic acidosis with either NaCl or NaHCO3 or with no therapy results in no change of blood pH and bicarbonate and in a similar mortality. In terms of systemic effects, NaHCO3 results in significant decrements of liver and erythrocyte pHi, hepatic portal vein blood flow and cardiac output and in significant increments of gut lactate production, whereas NaCl does not. The rationale for therapy of lactic acidosis with NaHCO3 should probably be reevaluated.