Rhodes P G, Hall R T, Hellerstein S
J Pediatr. 1977 May;90(5):789-95. doi: 10.1016/s0022-3476(77)81253-5.
Acid-base equilibrium and plasma and red blood cell water and solute were evaluated in a group of asphyxiated, acidotic neonates prior to and following infusion of hypertonic NaHCO3. The dose was calculated to correct the deficit of base in a bicarbonate space of 400 ml/kg and was given at a rate of 0.3 mM NaHCO3/kg/minute. All of the infants with RDS and two of the five with other forms of asphyxia received ventilatory assistance during the infusion. The quantity of base infused was sufficient to alter acid-base balance and shift whole blood and red blood cell pH values toward normal. The changes in body composition 3 minutes following the infusion indicate that the osmotic load imposed by the hypertonic NaHCO3 caused a shift of solute-free water into the interstitial and intravascular fluids. During the period from 3 to 30 minutes following the infusion there was redistribution of extracellular water and solute so that plasma volume and [Na]PL decreased. Since there was no evidence of an intracellular shift of solute, we hypothesize that the changes in body composition between 3 and 30 minutes postinfusion were in part the consequence of gradual penetration of transcellular fluids by Na. Osmotic inactivation of ECF Na by sequestration with connective tissue polyelectrolytes may also play a role. These studies' do not provide an answer to the clinical problem of whether the beneficial effects of prompt correction metabolic acidosis outweigh the potenially harmful effect of the osmotic alterations that accompany rapid infusion of hypertonic NaHCO3.
在一组窒息、酸中毒的新生儿输注高渗碳酸氢钠之前和之后，对其酸碱平衡以及血浆和红细胞的水及溶质进行了评估。剂量的计算旨在纠正400 ml/kg碳酸氢盐空间内的碱缺乏，给药速率为0.3 mM碳酸氢钠/kg/分钟。所有患有呼吸窘迫综合征的婴儿以及五名患有其他形式窒息的婴儿中有两名在输注过程中接受了通气辅助。输注的碱量足以改变酸碱平衡，并使全血和红细胞pH值向正常方向转变。输注后3分钟时身体成分的变化表明，高渗碳酸氢钠施加的渗透负荷导致无溶质水向间质液和血管内液转移。在输注后3至30分钟期间，细胞外液和溶质发生了重新分布，从而使血浆容量和血浆[Na]降低。由于没有证据表明溶质发生细胞内转移，我们推测输注后3至30分钟期间身体成分的变化部分是由于Na逐渐渗透到跨细胞液中所致。与结缔组织聚电解质螯合导致细胞外液Na的渗透失活也可能起作用。这些研究并未回答临床问题，即迅速纠正代谢性酸中毒的有益效果是否超过快速输注高渗碳酸氢钠所伴随的潜在有害的渗透改变效应。
