Husted F C, Nolph K D
Clin Nephrol. 1977 Jan;7(1):21-5.
In patients with chronic renal failure (CRF) (CCr less than 20 ml/min), we have previously demonstrated greater rates of Na excretion (ex) when Na intake was nearly all NaHCO3 as compared to NaCl (both 200 mEq Na daily). Chloride (Cl) wasting on NaHCO3 (with severe Cl restriction) occurred, however, and may in part explain the results. To avoid Cl restriction in 6 patients with CRF (CCr 10-15 ml/min) on an estimated 10 mEq Na and Cl diet, electrolyte ex was compared on NaCl supplements of 200 mEq/day versus a daily mixture of NaHCO3 (100mEq) and NaCl (100 mEq). Periods on NaCl and the mixture lasted 4 days (order randomized) separated by re-equilibration to baseline weight (wt). Mean +/- SEM ex of Na, Cl, HCO3 mEq/day and CCr and deltawt (lbs) are compared below for the 4th day of NaCl vs NaHCO3 intake. (see article). Also there were no significant differences in K excretion, blood pressure, or plasma renin activities. Mean serum HCO3 increased from 21.2 to 25.8 mEq/l (day 1 vs 5, P less than 0.01) reflecting the net positive HCO3 balance on the mixture indicated above. Thus increments of Na intake above a fixed NaCl intake were excreted similarly whether given as NaCl or NaHCO3. Greater Na ex on NaHCO3 may depend on severe Cl restriction and/or higher serum HCO3 levels. If dietary NaCl intakes are near maximum tolerance, NaHCO3 supplementation should be accompanied by reductions in NaCl intake to maintain Na balance,
在慢性肾衰竭（CRF）患者（肌酐清除率[CCr]低于20 ml/分钟）中，我们之前已经证明，当钠摄入量几乎全部为碳酸氢钠时，与氯化钠相比（两者每日均为200 mEq钠），钠排泄（ex）率更高。然而，在摄入碳酸氢钠时会出现氯（Cl）流失（伴有严格的氯限制），这可能部分解释了上述结果。为了避免6例CRF患者（CCr为10 - 15 ml/分钟）在估计每日摄入10 mEq钠和氯的饮食中出现氯限制，对每日补充200 mEq氯化钠与每日混合摄入碳酸氢钠（100 mEq）和氯化钠（100 mEq）时的电解质排泄情况进行了比较。摄入氯化钠和混合溶液的阶段持续4天（顺序随机），期间通过重新平衡至基线体重（wt）进行分隔。下面比较了摄入氯化钠与碳酸氢钠第4天时钠、氯、碳酸氢根的平均排泄量（mEq/天）以及肌酐清除率和体重变化量（lbs）。（见文章）。此外，钾排泄、血压或血浆肾素活性方面无显著差异。平均血清碳酸氢根从21.2 mEq/升至25.8 mEq/升（第1天与第5天相比，P < 0.01），这反映了上述混合溶液中碳酸氢根的净正平衡。因此，在固定氯化钠摄入量基础上增加的钠摄入量，无论以氯化钠还是碳酸氢钠形式给予，排泄情况相似。碳酸氢钠摄入时更高的钠排泄可能取决于严格的氯限制和/或更高的血清碳酸氢根水平。如果饮食中氯化钠摄入量接近最大耐受量，补充碳酸氢钠时应减少氯化钠摄入量以维持钠平衡。
