Adeva-Andany María M, Fernández-Fernández Carlos, Mouriño-Bayolo David, Castro-Quintela Elvira, Domínguez-Montero Alberto
Nephrology Division, Hospital General Juan Cardona, Avenida Pardo Bazán, s/n, Ferrol, 15406 A Coruña, Spain.
ScientificWorldJournal. 2014;2014:627673. doi: 10.1155/2014/627673. Epub 2014 Oct 21.
Metabolic acidosis occurs when a relative accumulation of plasma anions in excess of cations reduces plasma pH. Replacement of sodium bicarbonate to patients with sodium bicarbonate loss due to diarrhea or renal proximal tubular acidosis is useful, but there is no definite evidence that sodium bicarbonate administration to patients with acute metabolic acidosis, including diabetic ketoacidosis, lactic acidosis, septic shock, intraoperative metabolic acidosis, or cardiac arrest, is beneficial regarding clinical outcomes or mortality rate. Patients with advanced chronic kidney disease usually show metabolic acidosis due to increased unmeasured anions and hyperchloremia. It has been suggested that metabolic acidosis might have a negative impact on progression of kidney dysfunction and that sodium bicarbonate administration might attenuate this effect, but further evaluation is required to validate such a renoprotective strategy. Sodium bicarbonate is the predominant buffer used in dialysis fluids and patients on maintenance dialysis are subjected to a load of sodium bicarbonate during the sessions, suffering a transient metabolic alkalosis of variable severity. Side effects associated with sodium bicarbonate therapy include hypercapnia, hypokalemia, ionized hypocalcemia, and QTc interval prolongation. The potential impact of regular sodium bicarbonate therapy on worsening vascular calcifications in patients with chronic kidney disease has been insufficiently investigated.
当血浆阴离子相对阳离子过量蓄积导致血浆pH值降低时，就会发生代谢性酸中毒。对于因腹泻或近端肾小管酸中毒导致碳酸氢钠丢失的患者，补充碳酸氢钠是有效的，但没有确凿证据表明，对于急性代谢性酸中毒患者，包括糖尿病酮症酸中毒、乳酸酸中毒、感染性休克、术中代谢性酸中毒或心脏骤停患者，给予碳酸氢钠对临床结局或死亡率有益。晚期慢性肾脏病患者通常因未测定阴离子增加和高氯血症而出现代谢性酸中毒。有人提出，代谢性酸中毒可能对肾功能障碍的进展产生负面影响，而给予碳酸氢钠可能会减弱这种影响，但需要进一步评估以验证这种肾脏保护策略。碳酸氢钠是透析液中使用的主要缓冲剂，维持性透析患者在透析过程中会承受碳酸氢钠负荷，出现程度不一的短暂代谢性碱中毒。碳酸氢钠治疗的副作用包括高碳酸血症、低钾血症、离子化低钙血症和QTc间期延长。常规碳酸氢钠治疗对慢性肾脏病患者血管钙化加重的潜在影响尚未得到充分研究。
