Lactic Acidosis: Current Treatments and Future Directions
Lactic Acidosis: Current Treatments and Future Directions
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DOI：
10.1053/j.ajkd.2016.04.020
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发表时间：
2016-09-01
影响因子：
13.2
通讯作者：
Madias, Nicolaos E.
中科院分区：
文献类型：
--
作者：
Kraut, Jeffrey A.;Madias, Nicolaos E.
严重乳酸性酸中毒（血液pH < 7.2）由于败血症或低血流状态导致的死亡率很高。消除诱发条件仍然是最有效的治疗方法。虽然有些人推荐使用碳酸氢钠，但它并不能改善心血管功能或降低死亡率。这种失败归因于血清钙浓度降低和细胞内酸化产生过量二氧化碳。在动物实验中，在碳酸氢钠给药过程中过度通气和输钙可改善心血管功能，这表明这种方法可能允许表达碳酸氢钠的积极方面。其他缓冲液，如THAM或carbcarb，或透析也可能提供碱较少的不良影响。有必要对这些疗法进行人体试验。与乳酸酸中毒相关的细胞损伤部分是由于细胞膜Na-1/H-1交换剂NHE1的激活。在动物实验中，选择性NHE1抑制剂可改善心血管功能，改善乳酸性酸中毒，降低死亡率，支持其在人类可能应用的未来研究。两种主要机制有助于败血症和低流量状态下乳酸积累：组织缺氧和肾上腺素诱导的有氧糖酵解刺激。针对这些机制可以实现更具体的治疗。这个酸碱和电解质教学案例介绍了一个急性乳酸酸中毒患者，并描述了当前和未来的治疗方法。(C)由爱思唯尔公司代表国家肾脏基金会出版。这是美国政府的工作。它的使用没有限制。
Mortality rates associated with severe lactic acidosis (blood pH < 7.2) due to sepsis or low-flow states are high. Eliminating the triggering conditions remains the most effective therapy. Although recommended by some, administration of sodium bicarbonate does not improve cardiovascular function or reduce mortality. This failure has been attributed to both reduction in serum calcium concentration and generation of excess carbon dioxide with intracellular acidification. In animal studies, hyperventilation and infusion of calcium during sodium bicarbonate administration improves cardiovascular function, suggesting that this approach could allow expression of the positive aspects of sodium bicarbonate. Other buffers, such as THAM or Carbicarb, or dialysis might also provide base with fewer untoward effects. Examination of these therapies in humans is warranted. The cellular injury associated with lactic acidosis is partly due to activation of NHE1, a cell-membrane Na-1/H-1 exchanger. In animal studies, selective NHE1 inhibitors improve cardiovascular function, ameliorate lactic acidosis, and reduce mortality, supporting future research into their possible use in humans. Two main mechanisms contribute to lactic acid accumulation in sepsis and low-flow states: tissue hypoxia and epinephrine-induced stimulation of aerobic glycolysis. Targeting these mechanisms could allow for more specific therapy. This Acid-Base and Electrolyte Teaching Case presents a patient with acute lactic acidosis and describes current and future approaches to treatment. (C) Published by Elsevier Inc. on behalf of the National Kidney Foundation, Inc. This is a US Government Work. There are no restrictions on its use.