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European Journal of Pediatrics

, Volume 150, Issue 8, pp 547–549 | Cite as

Ammonium chloride metabolic acidosis and the activity of renin-angiotensin-aldosterone system in children

  • Z. S. Györke
  • E. Sulyok
  • J. -P. Guignard
Endocrinology Original Papers

Abstract

The present study was undertaken to assess the effects of acute metabolic acidosis on the activity of the renin-angiotensin-aldosterone system in 12 children with a mean age of 8.9 years who underwent NH4Cl loading test. Ammonium chloride was given in a dose of 0.15 g/kg per day for 3 consecutive days to evaluate renal acidification. Prior to and following NH4Cl administration blood acid-base parameters, plasma and urine electrolytes, creatinine and aldosterone concentrations as well as plasma renin activity (PRA), urine flow rate and net H+ excretion were measured. Ammonium chloride administration significantly depressed blood pH (P<0.05), bicarbonate (P<0.01) and base excess (P<0.01) and resulted in a slight, but significant elevation of plasma potassium concentration (P<0.05). Furthermore, NH4Cl ingestion induced a marked increase in urine flow rate (P<0.01) and urinary sodium, potassium and chloride excretion (P<0.01). In response to NH4Cl metabolic acidosis, PRA doubled (4.72±1.18 vs 8.13±1.02 ng/ml per hour,P≤0.05) and there was a nearly fourfold increase in plasma aldosterone level (0.49±0.12 vs 1.52±0.24 ng/ml,P<0.01) and in urinary aldosterone excretion (19.2±4.3 vs 71.8±13.8 μg/day,P<0.01). The elevated aldosterone production observed in this study is assumed to be mediated by the combined effect of sodium and water diuresis-related increased PRA, hyperkalaemia and the direct stimulation of adrenal steroidogenesis by metabolic acidosis.

Keywords

Aldosterone NH4Cl Metabolic Acidosis Ammonium Chloride Plasma Renin Activity 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Abbreviations

GFR

glomerular filtration rate

PRA

plasma renin activity

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References

  1. 1.
    Astrup P, Jorgensen K, Andersen OS, Engel K (1960) The acid-base metabolism. A new approach. Lancet I:1035–1039Google Scholar
  2. 2.
    Augustinsson O, Forslid A (1989) Aldosterone secretion during acute respiratory acidosis and NH4Cl induced metabolic acidosis in the goat. Acta Physiol Scand 136:339–345PubMedGoogle Scholar
  3. 3.
    Augustinsson O, Johansson K (1986) Ammonium chloride induced acidosis and aldosterone secretion in the goat. Acta Physiol Scand 128:535–540PubMedGoogle Scholar
  4. 4.
    Beck F-X, Schramm M, Dörge A, Rick R, Thurau K (1988) Effects of acute metabolic acidosis on transmembrane electrolyte radients in individual renal tubule cells. Pflugers Arch 412:427–433PubMedGoogle Scholar
  5. 5.
    Carroll JE, Landry AS, Elliott ME, Goodfriend TL (1986) Effects of pH on adrenal angiotensin receptors and responses. J Lab Clin Med 108:23–29PubMedGoogle Scholar
  6. 6.
    DeLean A (1987) Amiloride-sensitive sodium influx is required for secretagogue-induced aldosterone production in bovine adrenal glomerulosa (abstract). 71th Annual Meeting of the FASEB, Washington DC, p 648Google Scholar
  7. 7.
    Dunn MJ, Hood VL (1977) Prostaglandins and the kidney. Am J Physiol 233:169–182PubMedGoogle Scholar
  8. 8.
    Haber E, Körner T, Page LB, Kliman B, Purnode A (1969) Application of radioimmunoassay for angiotensin I to the physiologic measurement of plasma renin activity in normal human subjects. J Clin Endocrinol Metab 29:1349–1355PubMedGoogle Scholar
  9. 9.
    Horuichi T, Nguyen T-T, Gragoe EJ, De Lean A (1989) Regulation of aldosterone biosynthesis by Na+/H+ antiport: relationship between intracellular pH and angiotensin II. Endocrinology 124:1925–1931PubMedGoogle Scholar
  10. 10.
    Jones ER, Beck TR, Kapoor S, Shay R, Narins RG (1984) Prostaglandins inhibit renal ammoniagenesis in the rat. J Clin Invest 74:992–1002PubMedGoogle Scholar
  11. 11.
    Kisch ES, Dluhy RG, William GH (1976) Regulation of renin release by calcium and ammonium ions in normal man. J Clin Endocrinol Metab 43:1343–1350PubMedGoogle Scholar
  12. 12.
    Lifschitz MD, Earley LE (1974) An intrarenal effect of blood pH on the release of renin. J Clin Invest 53:74AGoogle Scholar
  13. 13.
    Manhensmith R, Thier SO, Cooke CR, Broadus A, DeFronzo RA (1979) Effect of acute metabolic acidemia on renal electrolyte transport in man. Metabolism 28:831–842PubMedGoogle Scholar
  14. 14.
    Morita T (1976) Plasma renin activity in acute respiratory acidosis. Jpn Circ J 40:123–128PubMedGoogle Scholar
  15. 15.
    Perez GO, Oster JR, Vaamonde JR, Katz FH (1977) Effect of NH4Cl on plasma aldosterone, cortisol and renin activity in supine man. J Clin Endocrinol Metab 45:762–767PubMedGoogle Scholar
  16. 16.
    Perez OG, Oster JR, Katz FH, Vaamonze CA (1979) The effect of acute metabolic acidosis on plasma cortisol, renin activity and aldosterone. Horm Res 11:12–21PubMedGoogle Scholar
  17. 17.
    Perez GO, Oster JR, Vaamonde CA (1980) Effect of acute metabolic acidosis on the renin-aldosterone system. J Lab Clin Med 96:371–378PubMedGoogle Scholar
  18. 18.
    Quinn SJ, Williams GH (1988) Regulation of aldosterone secretion. Ann Rev Physiol 50:409–426Google Scholar
  19. 19.
    Radke KJ, Taylor RE, Schneider EG (1986) Effect of hydrogen ion concentration on aldosterone secretion by isolated perfused canine adrenal glands. J Endocrinol 110:293–301PubMedGoogle Scholar
  20. 20.
    Rostand SG, Watkins JB (1977) Response of the isolated rat kidney to metaboic end respiratory acidosis. Am J Physiol 233: F82-F88PubMedGoogle Scholar
  21. 21.
    Schambelan M, Sebastian A (1977) Adreno-cortical hormone response to metabolic acidosis in normal man. Clin Res 25:301AGoogle Scholar
  22. 22.
    Tannan RL, Goyal M (1986) Urinary inhibitor of the ammoniagenic response to acute acidosis is a prostaglandin. J Lab Clin Med 108:277–285PubMedGoogle Scholar
  23. 23.
    Vetter W, Vetter H, Siegenthaler W (1973) Radioimmunoassay for aldosterone without chromatography: determination of plasma aldosterone. Acta Endocrinol 74:558–567PubMedGoogle Scholar
  24. 24.
    Welbourne TC (1976) Acidosis activation of the pituitary-adrenalrenal glutaminase I axis. Endocrinology 99:1071–1079PubMedGoogle Scholar

Copyright information

© Springer-Verlag 1991

Authors and Affiliations

  • Z. S. Györke
    • 1
  • E. Sulyok
    • 1
  • J. -P. Guignard
    • 2
  1. 1.County Children's HospitalPécsHungary
  2. 2.Service de PédiatrieCHUVLausanneSwitzerland

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