Treatment of acute non-anion gap metabolic acidosis.
Treatment of acute non-anion gap metabolic acidosis.
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DOI：
10.1093/ckj/sfu126
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发表时间：
2015-02
影响因子：
4.6
通讯作者：
Kurtz I
中科院分区：
文献类型：
--
作者：
Kraut JA;Kurtz I
急性非阴离子间隙代谢性酸中毒，也称为高尿酸性酸中毒，常在重症患者中发现。导致这种酸碱失衡的最常见机制包括继发于腹泻的大量碱丢失和在治疗低血容量和各种休克状态时给予大量含氯化物溶液。由此产生的酸性环境可导致细胞功能障碍并导致不良的临床结果。远端小管腔中氯离子浓度的相关变化也可能在降低肾小球滤过率中发挥作用。碱的管理往往被推荐用于治疗急性非阴离子间隙酸中毒。重要的是，尚未确定用于指导此类代谢性酸中毒治疗开始的血液pH值和/或血清碳酸氢盐浓度;大多数临床医生使用来自高阴离子间隙代谢性酸中毒研究的指南。碱给药引起的治疗并发症，如容量超负荷、高血压加重和离子钙减少，可能与高阴离子间隙代谢性酸中毒一样常见。另一方面，由于二氧化碳的过度生成而导致的细胞内酸中毒的恶化可能比高阴离子间隙代谢性酸中毒的频率低，因为组织灌注更好，并且能够消除二氧化碳。需要进一步的基础和临床研究，以促进发展的循证指南治疗这一重要的和越来越常见的酸碱平衡紊乱。
Acute non-anion gap metabolic acidosis, also termed hyperchloremic acidosis, is frequently detected in seriously ill patients. The most common mechanisms leading to this acid–base disorder include loss of large quantities of base secondary to diarrhea and administration of large quantities of chloride-containing solutions in the treatment of hypovolemia and various shock states. The resultant acidic milieu can cause cellular dysfunction and contribute to poor clinical outcomes. The associated change in the chloride concentration in the distal tubule lumen might also play a role in reducing the glomerular filtration rate. Administration of base is often recommended for the treatment of acute non-anion gap acidosis. Importantly, the blood pH and/or serum bicarbonate concentration to guide the initiation of treatment has not been established for this type of metabolic acidosis; and most clinicians use guidelines derived from studies of high anion gap metabolic acidosis. Therapeutic complications resulting from base administration such as volume overload, exacerbation of hypertension and reduction in ionized calcium are likely to be as common as with high anion gap metabolic acidosis. On the other hand, exacerbation of intracellular acidosis due to the excessive generation of carbon dioxide might be less frequent than in high anion gap metabolic acidosis because of better tissue perfusion and the ability to eliminate carbon dioxide. Further basic and clinical research is needed to facilitate development of evidence-based guidelines for therapy of this important and increasingly common acid–base disorder.