Pathophysiology of acid base balance: The theory practice relationship

Edwards, Sharon

doi:10.1016/j.iccn.2007.05.003

Cited by 32 publications

(35 citation statements)

References 11 publications

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“…3,15 The pH of human plasma is maintained between 7.35 and 7.45, representing a 12.5% deviation above and below the normal H + concentration of 4310 28 M (i.e., pH 7.40). Indeed, a 1-unit pH change would represent a lethal 10-fold change in H + concentration, 16 and even a smaller drop to 7.1 and below represents a medical emergency. This led us to investigate whether the CaR can also respond to smaller, pathophysiologically relevant changes in pH o .…”

Section: +mentioning

confidence: 99%

Pathophysiologic Changes in Extracellular pH Modulate Parathyroid Calcium-Sensing Receptor Activity and Secretion via a Histidine-Independent Mechanism

Campion

McCormick

Warwicker

et al. 2015

Journal of the American Society of Nephrology

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The calcium-sensing receptor (CaR) modulates renal calcium reabsorption and parathyroid hormone (PTH) secretion and is involved in the etiology of secondary hyperparathyroidism in CKD. Supraphysiologic changes in extracellular pH (pH o ) modulate CaR responsiveness in HEK-293 (CaR-HEK) cells. Therefore, because acidosis and alkalosis are associated with altered PTH secretion in vivo, we examined whether pathophysiologic changes in pH o can significantly alter CaR responsiveness in both heterologous and endogenous expression systems and whether this affects PTH secretion. In both CaR-HEK and isolated bovine parathyroid cells, decreasing pH o from 7.4 to 7.2 rapidly inhibited CaR-induced intracellular calcium (Ca 2+ i ) mobilization, whereas raising pH o to 7.6 potentiated responsiveness to extracellular calcium (Ca i mobilization. Intracellular pH was unaffected by acute 0.4-unit pH o changes, and the presence of physiologic albumin concentrations failed to attenuate the pH o -mediated effects. None of the individual point mutations created at histidine or cysteine residues in the extracellular domain of CaR attenuated pH o sensitivity. Finally, pathophysiologic pH o elevation reversibly suppressed PTH secretion from perifused human parathyroid cells, and acidosis transiently increased PTH secretion. Therefore, pathophysiologic pH o changes can modulate CaR responsiveness in HEK-293 and parathyroid cells independently of extracellular histidine residues. Specifically, pathophysiologic acidification inhibits CaR activity, thus permitting PTH secretion, whereas alkalinization potentiates CaR activity to suppress PTH secretion. These findings suggest that acid-base disturbances may affect the CaR-mediated control of parathyroid function and calcium metabolism in vivo.

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Section: +mentioning

confidence: 99%

Pathophysiologic Changes in Extracellular pH Modulate Parathyroid Calcium-Sensing Receptor Activity and Secretion via a Histidine-Independent Mechanism

Campion

McCormick

Warwicker

et al. 2015

Journal of the American Society of Nephrology

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“…The respiratory system responds to the changes in the ratio of bicarbonate to carbonic acid and begins to compensate within minutes. 6 In acidosis, the cellular buffering system causes dissociation of carbonic acid to hydrogen dioxide and water and to hydrogen and bicarbonate. Chemoreceptors in the brain regulate the respiratory drive and respond to the increased concentration of circulating hydrogen ions by stimulating the respiratory system to increase respiratory rate and depth, in an effort to excrete carbon dioxide.…”

Section: Second-line Buffers: the Respiratory Systemmentioning

confidence: 99%

Basic Interpretation of Metabolic Acidosis

Jones

2010

Critical Care Nurse

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“…Estos valores se relacionan para configurar el diagnóstico del trastorno del equilibrio ácido-base de los pacientes en un momento determinado, información importante para la toma de decisiones diagnósticas y orientar las opciones terapéuticas, especialmente en la UCI. En este estudio el diagnóstico del equilibrio ácido-base se hizo de acuerdo a la información de la Figura 1 [8][9][10] .…”

Section: Análisis Estadísticounclassified

Relación del equilibrio ácido-base y supervivencia en adultos con diagnóstico de trauma en la unidad de cuidados intensivos del Hospital Universitario San Jorge. 2009-2010, Pereira, Colombia

et al. 2015

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RESUMENIntroducción: El trauma es un problema de salud pública en Colombia, siendo la primera causa de mortalidad en jóvenes con una tasa de incidencia de 331,99 casos por 100 000 habitantes, de los cuales aproximadamente el 30% mueren en la unidad de cuidados intensivos. Estos pacientes de acuerdo a su severidad requerirán estabilización de signos vitales y monitoreo estrecho que incluye el estado ácido-base. Objetivo: Establecer la relación entre el desenlace y las variables del estado ácido base de los pacientes con diagnóstico de trauma de la unidad de cuidados intensivos del Hospital Universitario San Jorge de Pereira, Colombia. Materiales y métodos: Se realizó un estudio tipo cohorte prospectivo en la unidad de cuidados intensivos, en pacientes con diagnóstico de trauma a los que se les tomó muestra de sangre arterial para gases sanguíneos al momento de su ingreso y se monitorearon a través del tiempo hasta el egreso. Resultados: Se incluyeron 38 pacientes con trauma donde el 68,4% fueron hombres. El promedio de edad fue de 35±19 años y el 18,4% de los pacientes que ingresaron fallecieron. Se realizó un análisis univariado, el cual mostró relación individual entre el desenlace y las variables sodio, saturación arterial de oxígeno, presión alveolar de oxígeno y el puntaje de APACHE II; en el modelo de regresión de Cox se encontró relación con las variables presión alveolar de oxígeno, presión arterial de oxígeno, frecuencia cardiaca y relación arterio-alveolar de oxígeno. Conclusión: Se encontró que las variables presión alveolar de oxígeno, presión arterial de oxígeno, frecuencia cardiaca y relación arterio-alveolar de oxígeno del análisis de los gases arteriales, tienen correlación con la supervivencia de los pacientes en estado crítico. Trauma is a public health problem in Colombia and is the first cause of death in young people with an incidence rate of 331.99 cases per 100 000 inhabitants, of which approximately 30% die in the intensive care unit. These patients according to their severity will require stabilization of vital signs and close monitoring which includes the acid-base status. Objetive: To establish the relationship between outcome and variables of acid-base equilibrium of those patients diagnosed with trauma in the intensive care unit of the Hospital Universitario San Jorge in Pereira, Colombia. Materials and Methods: A prospective cohort study in type was performed on the intensive care unit with general trauma patients who were taking blood gases on admission to the unit and were monitored over time until discharge. Results: The population of the study were 38 patients with trauma, 68.4% were men. Average age was 35±19 years and 18.4% of patients admitted died. The univariate analysis was found individual relationship with outcome and variables such as sodium, arterial oxygen saturation, alveolar oxygen pressure and APACHE II score. In the Cox regression model it was found a relationship between outcome and variables such as alveolar oxygen pressure, pressure oxygen pressure, heart rate a...

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Pathophysiology of acid base balance: The theory practice relationship

Cited by 32 publications

References 11 publications

Pathophysiologic Changes in Extracellular pH Modulate Parathyroid Calcium-Sensing Receptor Activity and Secretion via a Histidine-Independent Mechanism

Pathophysiologic Changes in Extracellular pH Modulate Parathyroid Calcium-Sensing Receptor Activity and Secretion via a Histidine-Independent Mechanism

Basic Interpretation of Metabolic Acidosis

Relación del equilibrio ácido-base y supervivencia en adultos con diagnóstico de trauma en la unidad de cuidados intensivos del Hospital Universitario San Jorge. 2009-2010, Pereira, Colombia

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