Steichen J J, Kleinman L I
J Pediatr. 1977 Aug;91(2):287-91. doi: 10.1016/s0022-3476(77)80834-2.
The effect of rapid or slow infusion of hypertonic sodium bicarbonate on acid-base balance and serum osmolality was studied in 36 acidotic newborn dogs. Respiratory acidosis and hypoxia were produced by mechanically fixed hypoventilation. One group of animals breathed 100% O2 to prevent hypoxemia. Rapid infusion of HCO3- in acidotic and hypoxic animals resulted in only a transient (1 minute) and small (0.05 pH units) elevation of arterial pH followed by a continuous fall, resulting in a lower pH and a worsened metabolic condition than in the nontreated controls. In nonhypoxic acidotic animals, rapid infusion of HCO3- had little effect on arterial pH. PaCO2 increased suddenly by 17 Torr in hypoxic and, by 13 Torr, in nonhypoxic animals. There was a concomitant fall in PaO2 (15 Torr). Serum osmolality rose rapidly after rapid infusion of HCO3-. Rapid infusion of hypertonic bicarbonate into an animal or infant whose ventilation is fixed thus results in a less than predicted elevation of arterial pH. PaCO2 rises, PaO2 falls, and serum osmolality rises. The net result may be a worsening rather than an improvement in the animals' metabolic state.
在36只酸中毒新生犬中研究了快速或缓慢输注高渗碳酸氢钠对酸碱平衡和血清渗透压的影响。通过机械性固定通气不足造成呼吸性酸中毒和低氧血症。一组动物吸入100%氧气以预防低氧血症。在酸中毒和低氧血症动物中快速输注HCO₃⁻仅导致动脉血pH值短暂（1分钟）小幅（0.05个pH单位）升高，随后持续下降，导致pH值低于未治疗的对照组，代谢状况恶化。在非低氧血症的酸中毒动物中，快速输注HCO₃⁻对动脉血pH值影响不大。在低氧血症动物中，PaCO₂突然升高17 Torr，在非低氧血症动物中升高13 Torr。同时PaO₂下降（15 Torr）。快速输注HCO₃⁻后血清渗透压迅速升高。因此，向通气固定的动物或婴儿快速输注高渗碳酸氢钠会导致动脉血pH值升高幅度低于预期。PaCO₂升高，PaO₂下降，血清渗透压升高。最终结果可能是动物代谢状态恶化而非改善。
