Interaction of Sodium Bicarbonate and Na+/H+ Exchanger Inhibition in the Treatment of Acute Metabolic Acidosis in Pigs

Xinchun Lin, Amar S. More, Jeffrey A. Kraut, Dongmei Wu

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Objective: Administration of NaHco3 does not improve cellular function or reduce the mortality of acute lactic acidosis. This might be related to aggravation of intracellular acidosis, but it could also be due to activation of Na+/H+ exchanger with a deleterious increment in intracellular calcium ([Ca2+] i). This study examined the impact of coadministration of NaHco3 and a selective inhibitor of Na+/H+ exchanger, sabiporide on cardiovascular function, changes in proinflammatory cytokines, and organ function in a model of acute lactic acidosis produced by hemorrhagic hypotension followed by infusion of lactic acid. Design: Experimental, prospective study. Setting: Medical Center research laboratory. Subjects: Male Yorkshire pigs. Interventions: Anesthetized pigs were subjected to hypovolemia for 30 minutes and followed by DL-lactic acid infusion, and then either saline or sodium bicarbonate was infused. Measurements and Main Results: Hypovolemia followed by a DL-lactic acid infusion resulted in severe acidemia with a blood pH ∼6.8. Administration of NaHco3 did not improve cardiovascular performance or decrease the levels of proinflammatory responses, whereas administration of sabiporide prior to acid or NaHco3 infusion improved cardiopulmonary performance and blood oxygenation, reduced nuclear factor-κB activation, neutrophil accumulation, and proinflammatory cytokine production, and attenuated organ injury. Exposure of rat cardiac myocytes to a pH of 7.2 led to a marked increase of [Ca2+] i, and release of lactate dehydrogenase from cells which were further augmented after increase in external pH by addition of NaHco 3. Both the increase in [Ca2+] i and release of lactate dehydrogenase were attenuated in the presence of sabiporide. Conclusions: Coadministration of Na+/H+ exchanger inhibitor with sodium bicarbonate improves cardiovascular performances, reduces proinflammatory responses, and attenuates organ injury. This improvement in these variables appears to be related to prevention of a rise in intracellular calcium occurring after both exposures to acid and bicarbonate.

Original languageEnglish (US)
Pages (from-to)e160-e169
JournalCritical Care Medicine
Volume43
Issue number6
DOIs
StatePublished - Jun 20 2015
Externally publishedYes

Fingerprint

Sodium-Hydrogen Antiporter
Sodium Bicarbonate
Acidosis
Lactic Acid
Lactic Acidosis
Hypovolemia
Swine
L-Lactate Dehydrogenase
Cytokines
Calcium
Neutrophil Activation
Acids
Wounds and Injuries
Bicarbonates
Cardiac Myocytes
Hypotension
Biomedical Research
Research Design
Prospective Studies
Mortality

Keywords

  • acid-base correction
  • cardiovascular function
  • inflammation
  • metabolic acidosis
  • oxygenation

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine
  • Medicine(all)

Cite this

Interaction of Sodium Bicarbonate and Na+/H+ Exchanger Inhibition in the Treatment of Acute Metabolic Acidosis in Pigs. / Lin, Xinchun; More, Amar S.; Kraut, Jeffrey A.; Wu, Dongmei.

In: Critical Care Medicine, Vol. 43, No. 6, 20.06.2015, p. e160-e169.

Research output: Contribution to journalArticle

Lin, Xinchun ; More, Amar S. ; Kraut, Jeffrey A. ; Wu, Dongmei. / Interaction of Sodium Bicarbonate and Na+/H+ Exchanger Inhibition in the Treatment of Acute Metabolic Acidosis in Pigs. In: Critical Care Medicine. 2015 ; Vol. 43, No. 6. pp. e160-e169.
@article{442f65d43f0d454593e274f4660b1780,
title = "Interaction of Sodium Bicarbonate and Na+/H+ Exchanger Inhibition in the Treatment of Acute Metabolic Acidosis in Pigs",
abstract = "Objective: Administration of NaHco3 does not improve cellular function or reduce the mortality of acute lactic acidosis. This might be related to aggravation of intracellular acidosis, but it could also be due to activation of Na+/H+ exchanger with a deleterious increment in intracellular calcium ([Ca2+] i). This study examined the impact of coadministration of NaHco3 and a selective inhibitor of Na+/H+ exchanger, sabiporide on cardiovascular function, changes in proinflammatory cytokines, and organ function in a model of acute lactic acidosis produced by hemorrhagic hypotension followed by infusion of lactic acid. Design: Experimental, prospective study. Setting: Medical Center research laboratory. Subjects: Male Yorkshire pigs. Interventions: Anesthetized pigs were subjected to hypovolemia for 30 minutes and followed by DL-lactic acid infusion, and then either saline or sodium bicarbonate was infused. Measurements and Main Results: Hypovolemia followed by a DL-lactic acid infusion resulted in severe acidemia with a blood pH ∼6.8. Administration of NaHco3 did not improve cardiovascular performance or decrease the levels of proinflammatory responses, whereas administration of sabiporide prior to acid or NaHco3 infusion improved cardiopulmonary performance and blood oxygenation, reduced nuclear factor-κB activation, neutrophil accumulation, and proinflammatory cytokine production, and attenuated organ injury. Exposure of rat cardiac myocytes to a pH of 7.2 led to a marked increase of [Ca2+] i, and release of lactate dehydrogenase from cells which were further augmented after increase in external pH by addition of NaHco 3. Both the increase in [Ca2+] i and release of lactate dehydrogenase were attenuated in the presence of sabiporide. Conclusions: Coadministration of Na+/H+ exchanger inhibitor with sodium bicarbonate improves cardiovascular performances, reduces proinflammatory responses, and attenuates organ injury. This improvement in these variables appears to be related to prevention of a rise in intracellular calcium occurring after both exposures to acid and bicarbonate.",
keywords = "acid-base correction, cardiovascular function, inflammation, metabolic acidosis, oxygenation",
author = "Xinchun Lin and More, {Amar S.} and Kraut, {Jeffrey A.} and Dongmei Wu",
year = "2015",
month = "6",
day = "20",
doi = "10.1097/CCM.0000000000000962",
language = "English (US)",
volume = "43",
pages = "e160--e169",
journal = "Critical Care Medicine",
issn = "0090-3493",
publisher = "Lippincott Williams and Wilkins",
number = "6",

}

TY - JOUR

T1 - Interaction of Sodium Bicarbonate and Na+/H+ Exchanger Inhibition in the Treatment of Acute Metabolic Acidosis in Pigs

AU - Lin, Xinchun

AU - More, Amar S.

AU - Kraut, Jeffrey A.

AU - Wu, Dongmei

PY - 2015/6/20

Y1 - 2015/6/20

N2 - Objective: Administration of NaHco3 does not improve cellular function or reduce the mortality of acute lactic acidosis. This might be related to aggravation of intracellular acidosis, but it could also be due to activation of Na+/H+ exchanger with a deleterious increment in intracellular calcium ([Ca2+] i). This study examined the impact of coadministration of NaHco3 and a selective inhibitor of Na+/H+ exchanger, sabiporide on cardiovascular function, changes in proinflammatory cytokines, and organ function in a model of acute lactic acidosis produced by hemorrhagic hypotension followed by infusion of lactic acid. Design: Experimental, prospective study. Setting: Medical Center research laboratory. Subjects: Male Yorkshire pigs. Interventions: Anesthetized pigs were subjected to hypovolemia for 30 minutes and followed by DL-lactic acid infusion, and then either saline or sodium bicarbonate was infused. Measurements and Main Results: Hypovolemia followed by a DL-lactic acid infusion resulted in severe acidemia with a blood pH ∼6.8. Administration of NaHco3 did not improve cardiovascular performance or decrease the levels of proinflammatory responses, whereas administration of sabiporide prior to acid or NaHco3 infusion improved cardiopulmonary performance and blood oxygenation, reduced nuclear factor-κB activation, neutrophil accumulation, and proinflammatory cytokine production, and attenuated organ injury. Exposure of rat cardiac myocytes to a pH of 7.2 led to a marked increase of [Ca2+] i, and release of lactate dehydrogenase from cells which were further augmented after increase in external pH by addition of NaHco 3. Both the increase in [Ca2+] i and release of lactate dehydrogenase were attenuated in the presence of sabiporide. Conclusions: Coadministration of Na+/H+ exchanger inhibitor with sodium bicarbonate improves cardiovascular performances, reduces proinflammatory responses, and attenuates organ injury. This improvement in these variables appears to be related to prevention of a rise in intracellular calcium occurring after both exposures to acid and bicarbonate.

AB - Objective: Administration of NaHco3 does not improve cellular function or reduce the mortality of acute lactic acidosis. This might be related to aggravation of intracellular acidosis, but it could also be due to activation of Na+/H+ exchanger with a deleterious increment in intracellular calcium ([Ca2+] i). This study examined the impact of coadministration of NaHco3 and a selective inhibitor of Na+/H+ exchanger, sabiporide on cardiovascular function, changes in proinflammatory cytokines, and organ function in a model of acute lactic acidosis produced by hemorrhagic hypotension followed by infusion of lactic acid. Design: Experimental, prospective study. Setting: Medical Center research laboratory. Subjects: Male Yorkshire pigs. Interventions: Anesthetized pigs were subjected to hypovolemia for 30 minutes and followed by DL-lactic acid infusion, and then either saline or sodium bicarbonate was infused. Measurements and Main Results: Hypovolemia followed by a DL-lactic acid infusion resulted in severe acidemia with a blood pH ∼6.8. Administration of NaHco3 did not improve cardiovascular performance or decrease the levels of proinflammatory responses, whereas administration of sabiporide prior to acid or NaHco3 infusion improved cardiopulmonary performance and blood oxygenation, reduced nuclear factor-κB activation, neutrophil accumulation, and proinflammatory cytokine production, and attenuated organ injury. Exposure of rat cardiac myocytes to a pH of 7.2 led to a marked increase of [Ca2+] i, and release of lactate dehydrogenase from cells which were further augmented after increase in external pH by addition of NaHco 3. Both the increase in [Ca2+] i and release of lactate dehydrogenase were attenuated in the presence of sabiporide. Conclusions: Coadministration of Na+/H+ exchanger inhibitor with sodium bicarbonate improves cardiovascular performances, reduces proinflammatory responses, and attenuates organ injury. This improvement in these variables appears to be related to prevention of a rise in intracellular calcium occurring after both exposures to acid and bicarbonate.

KW - acid-base correction

KW - cardiovascular function

KW - inflammation

KW - metabolic acidosis

KW - oxygenation

UR - http://www.scopus.com/inward/record.url?scp=84937577924&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84937577924&partnerID=8YFLogxK

U2 - 10.1097/CCM.0000000000000962

DO - 10.1097/CCM.0000000000000962

M3 - Article

VL - 43

SP - e160-e169

JO - Critical Care Medicine

JF - Critical Care Medicine

SN - 0090-3493

IS - 6

ER -