sodium-acetate--anhydrous and Acidosis

In an incidental finding, during a study of plasma chemistry after crystalloid infusion, participants reported subjective cognitive changes, particularly slower thinking, after saline but not Hartmann's (Ringer's lactate) solution. The authors tested the hypothesis that saline infusion would produce greater adverse cognitive changes than Plasmalyte infusion.. The authors conducted a randomized, cross-over, multiple blinded study of healthy adult volunteers. On separate days, participants received 30 ml/kg over 1 h of either 0.9% saline or Plasmalyte with the order randomly allocated. Plasma chemistry was tested on venous samples. As part of a battery of cognitive tests our primary endpoint was the reaction time index after infusion.. The authors studied 25 participants. Plasma chloride was greater after saline than after Plasmalyte: mean difference 5.4 mM (95% CI, 4.1-6.6 mM; P < 0.001). Saline was also associated with greater metabolic acidosis: base-excess 2.5 mM more negative (95% CI, 1.9-3.0 mM more negative; P < 0.001). There was no evidence of a difference in the reaction time index between the two interventions: mean reaction time index 394 ms (SD, 72) after saline versus 385 ms (SD, 55) after Plasmalyte. Difference: saline 9 ms slower (95% CI, 30 ms slower to 12 ms faster; P = 0.39). There were minimal differences in the other cognitive and mood tests.. Despite expected differences in plasma chemistry, the authors found that measures of cognition did not differ after infusions of Plasmalyte or saline.

Topics: Acidosis; Adult; Cognition; Cross-Over Studies; Female; Gluconates; Humans; Magnesium Chloride; Male; Middle Aged; Potassium Chloride; Reaction Time; Sodium Acetate; Sodium Chloride

Fluid-induced metabolic acidosis can be harmful and can complicate cardiopulmonary bypass. In an attempt to prevent this disturbance, we designed a bicarbonate-based crystalloid circuit prime balanced on physico-chemical principles with a strong ion difference of 24 mEq/l and compared its acid-base effects with those of Plasma-Lyte 148, a multiple electrolyte replacement solution containing acetate plus gluconate totalling 50 mEq/l. Twenty patients with normal acid-base status undergoing elective cardiac surgery were randomised 1:1 to a 2 litre prime of either bicarbonate-balanced fluid or Plasma-Lyte 148. With the trial fluid, metabolic acid-base status was normal following bypass initiation (standard base excess 0.1 (1.3) mEq/l, mean, SD), whereas Plasma-Lyte 148 produced a slight metabolic acidosis (standard base excess -2.2 (2.1) mEq/l). Estimated group difference after baseline adjustment was 3.6 mEq/l (95% confidence interval 2.1 to 5.1 mEq/l, P=0.0001). By late bypass, mean standard base excess in both groups was normal (0.8 (2.2) mEq/l vs. -0.8 (1.3) mEq/l, P=0.5). Strong ion gap values were unaltered with the trial fluid, but with Plasma-Lyte 148 increased significantly on bypass initiation (15.2 (2.5) mEq/l vs. 2.5 (1.5) mEq/l, P < 0.0001), remaining elevated in late bypass (8.4 (3.4) mEq/l vs. 5.8 (2.4) mEq/l, P < 0.05). We conclude that a bicarbonate-based crystalloid with a strong ion difference of 24 mEq/l is balanced for cardiopulmonary bypass in patients with normal acid-base status, whereas Plasma-Lyte 148 triggers a surge of unmeasured anions, persisting throughout bypass. These are likely to be gluconate and/or acetate. Whether surges of exogenous anions during bypass can be harmful requires further study.

Topics: Acid-Base Equilibrium; Acidosis; Aged; Bicarbonates; Cardiopulmonary Bypass; Crystalloid Solutions; Elective Surgical Procedures; Female; Gluconates; Humans; Isotonic Solutions; Magnesium Chloride; Male; Middle Aged; Ophthalmic Solutions; Potassium Chloride; Single-Blind Method; Sodium Acetate; Sodium Chloride

To determine whether by partly replacing chloride with acetate in parenteral nutrition, hyperchloraemia, metabolic acidosis, and the subsequent use of interventions such as colloid infusion, alkali treatment, increased assisted ventilation, would be reduced.. Fifty eight neonates of less than 32 weeks gestation, receiving parenteral nutrition from days 3 to 10, were given either standard parenteral nutrition or a novel formulation with replacement of any chloride dose > 3 mmol/kg/day as acetate.. Acetate (0 to 14.2 mmol/kg/day) reduced the incidence of hyperchloraemia from 77% to 25%, and caused an increase in base excess from day 5 onwards (mean intergroup difference 3.6 to 9.9 mmol/l), an increased pH (day 8, 7.34 vs 7.26), with an increased pCO2 (1 kPa). The acetate group received less bicarbonate (median 0 mmol vs 4.8 mmol) and less colloid (41 ml/kg vs 204 ml/kg). There was no difference in any parameter of assisted ventilation.. Acetate in neonatal parenteral nutrition reduces metabolic acidosis and hyperchloraemia.

Topics: Acidosis; Carbon Dioxide; Chlorides; Humans; Incidence; Infant, Newborn; Infant, Premature; Parenteral Nutrition; Sodium Acetate

Topics: Acidosis; Adolescent; Antidepressive Agents, Tricyclic; Drug Overdose; Female; Humans; Hypokalemia; Hypotension; Pneumonia; Respiration, Artificial; Respiratory Distress Syndrome; Sodium Acetate; Sodium Bicarbonate; Suicide, Attempted; Vasoconstrictor Agents

Sodium acetate has been shown to cause hemodynamic instability when used as a hemodialysis buffer. The pattern of hemodynamic response to injury will be evaluated between those who received sodium acetate and those who did not.The primary purpose of the study is to analyze the effect of sodium acetate on hemodynamic parameters. Secondarily we looked at the effects on prevention and treatment of hyperchloremic metabolic acidosis.. The study arm was comprised of patients who had received sodium acetate infusions in place of normal saline between March 2005 and December 2009. A control arm was created based on matching three pre-treatment variables: injury severity score (ISS), pH (+/- 0.03) and base deficit (+/- 3). A retrospective chart review was performed for patients in both arms. Blood pressure, arterial blood gas data and chemistry values were recorded for the time points of -6, -1, 0, 1, 6, 12, 24, 48, and 72 hours from start of sodium acetate infusion. Patients were excluded based on the following criteria: patients who were given sodium bicarbonate within 48 hours of starting sodium acetate, those given sodium acetate as a bolus, non-trauma patients, burn patients, patients who expired within 24 hours of arrival to the ICU, patients diagnosed with rhabdomyolysis and patients whose medical record could not be obtained.. A total of 78 patients were included in the study, 39 in the study arm and 39 in the control arm. There were no statistically significant drops in blood pressure within either group. The median pH between the two groups at the start of infusion was equal. Both groups trended towards normal pH with the study arm improving faster than the control arm. The median serum bicarbonate at start of sodium acetate infusion was 19 mmol/L and 20 mmol/L at time zero for the study and control arms respectively with both trending upward during the study period. Chloride trended up initially in both groups but the study arm began to correct sooner at 24 hours compared to 48 hours for the control arm.. We analyzed the use of sodium acetate as an alternative to normal saline or lactated ringers during resuscitation of critically ill trauma patients at a single center. Our data shows that the hemodynamic profile remained favorable, without evidence of instability at any point during the study period. Normalization of hyperchloremia and metabolic acidosis occurred faster in the patients who received sodium acetate.

Topics: Acid-Base Equilibrium; Acidosis; Adolescent; Adult; Aged; Aged, 80 and over; Critical Illness; Female; Hemodynamics; Humans; Male; Medical Audit; Middle Aged; Retrospective Studies; Sodium Acetate; Young Adult

To determine and compare the effects of 4 oral replacement therapy (ORT) solutions on acid-base balance, abomasal emptying rate, and plasma volume expansion in calves with naturally acquired diarrhea and moderate dehydration.. Prospective study.. 20 calves.. 20 calves up to 45 days of age were randomly allocated (n = 5/group) to receive 2 L of 1 of 4 treatments via oroesophageal intubation: sodium bicarbonate (150 mmol/L or 300 mmol/L) or sodium acetate (150 mmol/L or 300 mmol/L). The 4 test solutions contained acetaminophen (50 mg/kg [22.7 mg/lb]) and 50 g of glucose monohydrate. Jugular venous blood samples were obtained periodically before and after administration of the ORT solution. Abomasal emptying rate was determined by use of the time to maximal plasma acetaminophen concentration.. Plasma bicarbonate concentration increased more rapidly in calves administered bicarbonate-containing ORT solutions, whereas the rate of systemic alkalinization, as assessed via blood pH, did not differ consistently among treatments. The 300 mmol/L ORT solutions were emptied at a significantly slower rate from the abomasum than 150 mmol/L ORT solutions, with no difference in emptying rate between acetate and bicarbonate-containing ORT solutions of similar molality. The 300 mmol/L sodium acetate ORT solution significantly increased plasma volume.. Clinically important differences in the resuscitative response to 300 mmol/L or 150 mmol/L ORT solutions of sodium acetate or sodium bicarbonate were not identified.

Topics: Abomasum; Acid-Base Equilibrium; Acidosis; Animals; Animals, Newborn; Cattle; Cattle Diseases; Dehydration; Diarrhea; Dose-Response Relationship, Drug; Fluid Therapy; Prospective Studies; Random Allocation; Sodium Acetate; Sodium Bicarbonate; Treatment Outcome

Metabolic acidosis is a common problem after infusion with chloride-based parenteral nutrition. However, it is unknown whether the occurrence of metabolic acidosis is related to this regimen of therapy or to patient-specific risk factors.. Patients receiving parenteral nutrition from July to December 2003 at this hospital were included for a retrospective study. Patients were excluded who had illnesses that were potentially related to acid-base disorders. The remaining patients were divided on the basis of parental nutrition they had received: a chloride-base regimen group, and an acetate-based therapy group. Biochemical character and blood gas data were analysed. Continuous variables were analysed by t-test. Categorical variables were assessed by chi-squared test. Independent determinants for bicarbonate decline were analysed using forward stepwise multiple linear regression analysis.. There were 29 patients (17 women, 12 men) who received chloride-based regimen and 26 patients (16 women, 10 men) took acetate-based therapy. The acetate group had significantly higher baseline serum creatinine and blood urea nitrogen than chloride group. The blood pH, CO(2), bicarbonate and base excess were significantly lower after receiving chloride-based therapy; while these changes were not observed in acetate-based therapy group. However, the serum creatinine and blood urea nitrogen levels were not statistically different. With multiple-stepwise linear regression, parenteral nutrition formula and estimated creatinine clearance are independent predictors of bicarbonate decline.. The acetate-base regimen can decrease the occurrence of metabolic acidosis after parenteral nutrition. In addition, the risk of acidosis is higher in patients with impaired renal function.

Topics: Acidosis; Chlorides; Creatinine; Humans; Parenteral Nutrition; Retrospective Studies; Sodium Acetate

The article brings a description of a patient case when an application of mineral balanced infusion solutions led to a disruption of inner environment, beginning of a combined failure of the acid-base balance with a serious metabolic acidosis. Patient J. was artificially respirated after a CPR. During the therapy the patient was given basically without any changes a combination of mineral solution Plasma-Lyte 148, amino-acid and 20% glucose. During 8 days a serious metabolic alkalosis had developed (caused by a lack of chlorides, phosphates and other reasons), combined with respirational acidosis. Hydrogencarbonate level was increased to 47.2 mmo/l (at norm of 24 mmol/l), base excess level to 21.4 mmol/l (at norm of 0 mmol/l). Metabolic acidosis led to reduction of sensibility of the respiratory centers and therefore it was not possible to restore spontaneous respiration. After the therapy change and reduction of metabolic acidosis the state of the patient got better. Application of acidifying solutions, supplementation of phosphate and potassium levels and replenishment of actual losses of phosphates led to regulation of the inner environment. Together with the application of sufficient amount of basic nutrients was the improvement of acid-base balance the key factor which enabled the restoration of spontaneous respiration and disconnection of the patient from the ventilator. In short summary you can see reasons which cause different effect of identical infusions to acid-base balance of the inmates in different situations. The article points to a necessity of controlling groovy medical procedures according to actual patient's needs.

Topics: Acid-Base Imbalance; Acidosis; Aged; Gluconates; Humans; Infusions, Intravenous; Magnesium Chloride; Male; Potassium Chloride; Sodium Acetate; Sodium Chloride

Hyperglycemia and acidosis are the key factors in diabetic complications. It has been shown that acute or chronic diabetes alters serotonin levels in brain. However, the mechanism of hyperglycemia- or acidosis-induced changes in serotonin levels remains poorly understood. Because Ca2+-dependent protein kinases play a major role in the regulation of serotonin synthesis and release, we investigated the effect of diabetes, hyperglycemia, and acidosis on the level of indolamines [5-hydroxytryptamine (5-HT) and/or 5-hydroxyindoleacetic acid (5-HIAA)] and Ca(2+)/calmodulin-dependent protein kinase II (CaMKII) enzyme activity or protein expression in different brain regions. Alloxan-induced (45 mg/kg bw) diabetic rats (30 days) showed increased level of 5-HT in striatum (ST; 183%), midbrain (MB; 199%), pons medulla (PM; 151%), cerebellum (CB; 214%), and cerebral cortex (CCX; 162%) compared with control (P < 0.05), and these changes were reversed after insulin administration. Rats treated with glucose (500 mg/kg bw) for 30 days showed a 146%, 183%, 208%, and 177% (P < 0.05) increase in 5-HT levels in ST, PM, CB, and CCX, respectively. 5-HIAA level increased in hippocampus (HC; 172%) and in MB (145%; P < 0.05). In addition, rats treated with sodium acetoacetate (NaAcAc) for 30 days (60 mg/kg bw) showed significant increases (P < 0.05) of 5-HT level in ST (152%) and MB (174%). However, the levels of 5-HIAA increased only in MB (151%, P < 0.05). Rats treated with NH4Cl, which induced acidosis (150 mg/kg bw), showed an increased level of 5-HT only in HC (165%, P < 0.05). The increased activity and protein expression of CaMKII in ST, MB, PM, CB, and CCX under diabetic conditions were correlated with the levels of indolamines changes during diabetic, hyperglycemic, or acidotic conditions. These results suggest that CaMKII may be involved in the regulation of indolamines in diabetic animals.

Topics: Acidosis; Alloxan; Ammonium Chloride; Analysis of Variance; Animals; Bicarbonates; Blood Glucose; Blotting, Western; Brain; Calcium-Calmodulin-Dependent Protein Kinase Type 2; Calcium-Calmodulin-Dependent Protein Kinases; Carbon Dioxide; Diabetes Mellitus, Experimental; Gene Expression Regulation; Glucose; Hydrogen-Ion Concentration; Hydroxyindoleacetic Acid; Hyperglycemia; Insulin; Male; Rats; Rats, Wistar; Serotonin; Sodium Acetate; Spectrometry, Fluorescence; Time Factors

Topics: Acetates; Acidosis; Administration, Oral; Animals; Cattle; Cattle Diseases; Female; Ketosis; Sodium Acetate