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Acute sodium bicarbonate administration improves ventilatory efficiency in experimental respiratory acidosis: clinical implications

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Abstract

Administering sodium bicarbonate (NaHCO3) to patients with respiratory acidosis breathing spontaneously is contraindicated because it increases carbon dioxide load and depresses pulmonary ventilation. Nonetheless, several studies have reported salutary effects of NaHCO3 in patients with respiratory acidosis but the underlying mechanism remains uncertain. Considering that such reports have been ignored, we examined the ventilatory response of unanesthetized dogs with respiratory acidosis to hypertonic NaHCO3 infusion (1 N, 5 mmol/kg) and compared it with that of animals with normal acid-base status or one of the remaining acid-base disorders. Ventilatory response to NaHCO3 infusion was evaluated by examining the ensuing change in PaCO2 and the linear regression of the PaCO2 vs. pH relationship. Strikingly, PaCO2 failed to increase and the ΔPaCO2 vs. ΔpH slope was negative in respiratory acidosis, whereas PaCO2 increased consistently and the ΔPaCO2 vs. ΔpH slope was positive in the remaining study groups. These results cannot be explained by differences in buffering-induced decomposition of infused bicarbonate or baseline levels of blood pH, PaCO2, and pulmonary ventilation. We propose that NaHCO3 infusion improved the ventilatory efficiency of animals with respiratory acidosis, i.e., it decreased their ratio of total pulmonary ventilation to carbon dioxide excretion (VE/VCO2). Such exclusive effect of NaHCO3 infusion in animals with respiratory acidosis might emanate from baseline increased VD/VT (dead space/tidal volume) caused by bronchoconstriction and likely reduced pulmonary blood flow, defects that are reversed by alkali infusion. Our observations might explain the beneficial effects of NaHCO3 reported in patients with acute respiratory acidosis.

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Data availability

The data supporting the findings of this study are available from the corresponding author upon reasonable request.

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Funding

No funding was received for conducting this study.

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Authors and Affiliations

  1. Department of Medicine, Baylor College of Medicine, Houston, TX, USA

    Horacio J. Adrogué

  2. Department of Medicine, Division of Nephrology, Houston Methodist Hospital, Houston, TX, USA

    Horacio J. Adrogué

  3. Department of Medicine, Tufts University School of Medicine, Boston, MA, USA

    Nicolaos E. Madias

  4. Department of Medicine, Division of Nephrology, St. Elizabeth’s Medical Center, Boston, MA, USA

    Nicolaos E. Madias

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  1. Horacio J. Adrogué
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  2. Nicolaos E. Madias
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Contributions

H.J.A and N.E.M. conceived and designed the study; performed the research and acquired the data; analyzed and interpreted the data; and performed the statistical analysis and prepared the tables and figures. H.J.A. and N.E.M. contributed to drafting and revising the manuscript and approved the final version of the manuscript.

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Correspondence to Nicolaos E. Madias.

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Animal experiments conformed to internationally accepted standards and had been approved by the institutional review body for animal research of Tufts-New England Medical Center.

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Adrogué, H.J., Madias, N.E. Acute sodium bicarbonate administration improves ventilatory efficiency in experimental respiratory acidosis: clinical implications. Pflugers Arch - Eur J Physiol (2024). https://doi.org/10.1007/s00424-024-02949-6

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  • DOI: https://doi.org/10.1007/s00424-024-02949-6

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