Galla J H, Bonduris D N, Dumbauld S L, Luke R G
J Clin Invest. 1984 Jan;73(1):96-106. doi: 10.1172/JCI111211.
To determine whether chloride-depletion metabolic alkalosis (CDA) can be corrected by provision of chloride without volume expansion or intranephronal redistribution of fluid reabsorption, CDA was produced in Sprague-Dawley rats by peritoneal dialysis against 0.15 M NaHCO3; controls (CON) were dialyzed against Ringer's bicarbonate. Animals were infused with isotonic solutions containing the same Cl and total CO2 (tCO2) concentrations as in postdialysis plasma at rates shown to be associated with slight but stable volume contraction. During the subsequent 6 h, serum Cl and tCO2 concentrations remained stable and normal in CON and corrected towards normal in CDA; urinary chloride excretion was less and bicarbonate excretion greater than those in CON during this period. Micropuncture and microinjection studies were performed in the 3rd h after dialysis. Plasma volumes determined by 125I-albumin were not different. Inulin clearance and fractional chloride excretion were lower (P less than 0.05) in CDA. Superficial nephron glomerular filtration rate determined from distal puncture sites was lower (P less than 0.02) in CDA (27.9 +/- 2.3 nl/min) compared with that in CON (37.9 +/- 2.6). Fractional fluid and chloride reabsorption in the proximal convoluted tubule and within the loop segment did not differ. Fractional chloride delivery to the early distal convolution did not differ but that out of this segment was less (P less than 0.01) in group CDA. Urinary recovery of 36Cl injected into the collecting duct segment was lower (P less than 0.01) in CDA (CON 74 +/- 3; CDA 34 +/- 4%). These data show that CDA can be corrected by the provision of chloride without volume expansion or alterations in the intranephronal distribution of fluid reabsorption. Enhanced chloride reabsorption in the collecting duct segment, and possibly in the distal convoluted tubule, contributes importantly to this correction.
为了确定在不进行容量扩张或肾内液体重吸收再分布的情况下,补充氯化物是否能纠正氯耗竭性代谢性碱中毒(CDA),通过用0.15M碳酸氢钠进行腹膜透析在Sprague-Dawley大鼠中制造CDA;对照组(CON)用林格氏碳酸氢盐进行透析。以与轻微但稳定的容量收缩相关的速率,给动物输注含有与透析后血浆中相同的氯和总二氧化碳(tCO2)浓度的等渗溶液。在随后的6小时内,CON组血清氯和tCO2浓度保持稳定且正常,CDA组则向正常方向纠正;在此期间,CDA组尿氯排泄量低于CON组,而碳酸氢盐排泄量高于CON组。在透析后第3小时进行了微穿刺和微注射研究。用125I-白蛋白测定的血浆容量无差异。CDA组菊粉清除率和氯排泄分数较低(P<0.05)。从远曲小管穿刺部位测定的浅表肾单位肾小球滤过率,CDA组(27.9±2.3 nl/min)低于CON组(37.9±2.6)(P<0.02)。近端曲管和髓袢段的液体和氯重吸收分数无差异。输送到早期远曲小管的氯分数无差异,但CDA组从该段流出的氯分数较少(P<0.01)。注入集合管段的36Cl的尿回收率,CDA组较低(P<0.01)(CON组74±3;CDA组34±4%)。这些数据表明,在不进行容量扩张或肾内液体重吸收分布改变的情况下,补充氯化物可纠正CDA。集合管段以及可能远曲小管中增强的氯重吸收对此纠正起重要作用。