Hyperphosphatemia in Lactic Acidosis

O'Connor, Lawrence; Klein, Keith L.; Bethune, John E.

doi:10.1056/nejm197709292971307

Cited by 68 publications

(26 citation statements)

References 7 publications

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“…22,27 Because dehydration and prerenal azotemia frequently develop in cows with an RDA or AV, 26 we would expect exacerbation of hypochloremia Moreover, lactic acidemia, resulting from increased anaerobic glycolysis, has been shown to be associated with hyperphosphatemia in other species. 28,29 The weak correlation between serum [Pi] and AST activity in data set 1 could not be reproduced in data set 2, possibly because of the smaller number of animals. This weak correlation may be due to muscle weakness in dehydrated animals with an RDA or AV, which leads to a higher risk of muscle trauma and recumbency.…”

Section: Discussionmentioning

confidence: 96%

Phosphorus Homeostasis in Dairy Cows with Abomasal Displacement or Abomasal Volvulus

Grünberg

Constable

Schröder

et al. 2005

Journal of Veterinary Internal Medicine

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Abnormal phosphorus homeostasis occurs in dairy cows with an abomasal displacement or volvulus. The goal of this study was to identify potential mechanisms for hypophosphatemia and hyperphosphatemia in cows with a left displaced abomasum (LDA), right displaced abomasum (RDA), or abomasal volvulus (AV). Accordingly, the results of preoperative clinicopathologic analyses for 1,368 dairy cows with an LDA (n ϭ 1,189), RDA, or AV (n ϭ 179) (data set 1) and for 44 cows with an AV (data set 2) were retrieved. Laboratory values were compared by Student's t-tests, and correlation and regression analyses were performed. Thirty-four percent of the animals from data set 1 (463/1,368) were hypophosphatemic (serum phosphorus concentration ( Stepwise logistic regression analysis indicated that low [SUN] and the diagnosis of an LDA had the strongest associations with hypophosphatemia. In cows with hyperphosphatemia, [Pi] was most strongly associated with azotemia. In cows with an AV, the strongest correlations with [Pi] were found for [SUN] and serum creatinine. We conclude that hypophosphatemia in cows with an LDA is primarily due to decreased feed intake. In contrast, hyperphosphatemia in cattle with an RDA or AV appears to result from dehydration and decreased renal blood flow.Key words: Feed intake; Hemoconcentration; Hyperphosphatemia; Hypophosphatemia. Phosphorus nutrition and homeostasis in dairy cattle has received increased attention during the past decade. Excessive dietary phosphorus intake leads to high fecal phosphorus concentration and surface runoff. This has raised environmental concerns and resulted in incentives to lower dietary phosphorus intake.1-4 However, if phosphorus intake is limited, cows in early lactation might experience hypophosphatemia as the result of a sudden and increasing loss of phosphorus in milk.1 Conditions such as Downer cow syndrome, postparturient hemoglobinuria, unthriftiness, inappetence, reduced milk production, and decreased fertility have been associated with hypophosphatemia. [1][2][3][4][5] Conditions that affect feed intake, milk production, or hydration status in early lactation could also alter phosphorus homeostasis.Abnormal serum phosphorus concentration ([Pi]) has been reported in dairy cows with a left displaced abomasum (LDA), right displaced abomasum (RDA), or abomasal volvulus (AV), conditions frequently occurring in early lactation. [6][7][8][9] The mechanisms for these alterations in serum [Pi] are uncertain. The objective of our study was to determine the association between serum [Pi] and other clinicopathologic parameters in lactating dairy cows with a displaced Materials and MethodsThe medical records of 1,368 dairy cows that presented for surgical correction of a DA or AV at the clinic for ruminants and swine of the Free University Berlin (data set 1) and of 44 dairy cows with an AV that underwent surgery at The Ohio State University Veterinary Teaching Hospital (data set 2) were retrieved, and data were extracted for analysis. Inclusion criteria were intrao...

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Section: Discussionmentioning

confidence: 96%

Phosphorus Homeostasis in Dairy Cows with Abomasal Displacement or Abomasal Volvulus

Grünberg

Constable

Schröder

et al. 2005

Journal of Veterinary Internal Medicine

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“…Although it is well established that some acidoses result in the liberation of phosphorus from organic com pounds within cells [17 ,18], these studies have not included acute observations and have not evaluated the effects of several physiologically important acidifying agents. In this regard, exaggerated hyperphosphatemia was described recently in patients with lactic acidosis [19], and normal or slightly elevated levels have been reported in patients with diabetic ketoacidosis [20], while other data suggest that NH iCI-induced acidosis is not associated with increases in plasma phosphorus [7,21].…”

Section: Experimental Studiesmentioning

confidence: 91%

Serum Potassium Concentration in Acidemic States

Pérez¹,

Oster²,

Vaamonde³

1981

Nephron

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It has been generally accepted that acidosis results in hyperkalemia because of shifts of potassium from the intracellular to the extracellular compartment. There is ample clinical and experimental evidence, however, to support the conclusion that uncomplicated organic acidemias do not produce hyperkalemia. In acidosis associated with mineral acids (respiratory acidosis, end-stage uremic acidosis, NH₄CI- or CaCl₂-induced acidosis), acidemia per se, results in predictable increases in serum potassium concentration. In acidosis associated with nonmineral organic acids (diabetic and alcoholic acidosis, lactic acidosis, methanol and the less common forms of organic acidemias secondary to methylmalonic and isovaleric acids, and ethylene glycol, paraldehyde and salicylate intoxications), serum potassium concentration usually remains within the normal range in uncomplicated cases. A number of factors, however, may be responsible for hyperkalemia in some of these patients other than the acidemia per se. These include dehydration and renal hypoperfusion, preexisting renal disease, hypercatabolism, diabetes mellitus, hypoaldosteronism, the status of potassium balance, and therapy. The mechanism(s) of this differing effect of mineral and organic acidemias on transmembrane movement of potassium remains undefined. The prevalent hypothesis, however, favors the free penetrance of the organic anion into cells without creating a gradient for the hydrogen ions and, thus, obviating the efflux of intracellular potassium. The importance of the presence of hyperkalemia in clinical states of organic acidemias is obvious. A search for the complicating factors reviewed above should be undertaken since organic acidemias per se, should not be expected to be accompanied by elevations of serum potassium concentration. Moreover, the classical teaching that the absence of hyperkalemia during severe acidosis is indicative of severe potassium deficiency, may not be universally valid in patients with uncomplicated organic acidemias.

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“…However, presumably the meals consumed by the patients contain potassium as well as carbohydrates, so the effect of glucose, while it plays an important modu lating role, may be offset by the concomitant ingestion of potassium. Recent consumption of a large meal contain ing phosphorus might also acutely modulate serum phos phate levels, as these patients experience phosphate reten tion, and intracellular shift may be impaired by metabolic acidosis [23][24][25][26] and by the fact that while the K+-lowering effect of insulin remains relatively intact in renal fail ure [27], the glucose-lowering effect in response to insulin is impaired [28], As glucose uptake plays a role in intracel lular shift of phosphate [5], this may also tend to accen tuate and prolong increases in serum phosphate following a meal. Patients on the evening shift may thus not have had time to accomplish this redistribution of potassium and phosphate following a large meal which is blunted in the end-stage renal disease patient, and hence they might tend to have higher predialysis potassium and phosphate levels as compared with patients dialyzed on earlier shifts who are likely to eat a smaller meal prior to dialysis or perhaps nothing and have had the overnight period to shift more potassium and phosphorus intracellularly.…”

Section: Discussionmentioning

confidence: 99%

Effect of Time of Day of Dialysis Shift on Serum Biochemical Parameters in Patients on Chronic Hemodialysis

Mattana

Patel²,

Wagner³

et al. 1995

Am J Nephrol

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It is unknown whether predialysis serum biochemical parameters may differ among chronic hemodialysis patients depending on the shift during which they are dialyzed. We studied 115 patients on chronic hemodialysis in our institution for 3 consecutive months and compared clinical and biochemical parameters based on the shift during which they were dialyzed. Predialysis serum potassium was found to be progressively higher for patients dialyzed on later as compared with earlier dialysis shifts, and phosphate was significantly higher for patients dialyzed during the evening shift as well. Regression analysis suggested that higher potassium and phosphate levels were related to the time of day of these sessions and not to patient age, amount of dialysis given or diet. By contrast, serum albumin, creatinine, sodium, and chloride levels were found to differ depending on dialysis shift, though these differences appeared to be accounted for by patient age. We conclude that the time of day of the beginning of the dialysis shift appears to mildly influence the levels of serum predialysis biochemical parameters which are important in monitoring patients on chronic hemodialysis, in particular potassium and phosphate. Further insight into the mechanism of this observed effect might improve our ability to interpret and treat derangements of these serum biochemical parameters in patients on chronic hemodialysis.

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Hyperphosphatemia in Lactic Acidosis

Cited by 68 publications

References 7 publications

Phosphorus Homeostasis in Dairy Cows with Abomasal Displacement or Abomasal Volvulus

Phosphorus Homeostasis in Dairy Cows with Abomasal Displacement or Abomasal Volvulus

Serum Potassium Concentration in Acidemic States

Effect of Time of Day of Dialysis Shift on Serum Biochemical Parameters in Patients on Chronic Hemodialysis

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