Chapter Nineteen: Metabolic Acidosis, part 2

References

Chapter 19, Part 12

Metabolic acidosis  June 14, 2023

References

Chapter 19, Part 2

Roger mentioned MELAS syndrome MELAS syndrome: Clinical manifestations, pathogenesis, and treatment options

Josh mentioned this blog on lactate- Understanding lactate in sepsis & Using it to our advantage

We discussed the Warburg effect The Warburg Effect: How Does it Benefit Cancer Cells? - PMC and here’s a case from skeleton key- Skeleton Key Group Case #28: Mysterious Acidosis in Cancer - Renal Fellow Network

Otto Warburg won the Nobel Prize in Physiology and Medicine in 1931 for describing how animal tumors produce large quantities of lactic acid (Wikipedia)

Joel calls it the Lactate saline reflex, but the accepted term of art is Lacto-Bolo reflex The origins of the Lacto-Bolo reflex: the mythology of lactate in sepsis

Buffer agents do not reverse intramyocardial acidosis during cardiac resuscitation.

Josh mentioned this article the BICAR-ICU Sodium bicarbonate therapy for patients with severe metabolic acidaemia in the intensive care unit (BICAR-ICU): a multicentre, open-label, randomised controlled, phase 3 trial - The Lancet

Roger shared 3 quotes to make the point that there has been little movement in our knowledge the past 40 years:

Bicarbonate does not improve hemodynamics in critically ill patients who have lactic acidosis. A prospective, controlled clinical study from Cooper in the Annals

Lactic Acidosis and Bicarbonate Therapy | Annals of Internal Medicine from Robert Hollander

Lactic acidosis from Nick Madias

Josh mentioned the use of sodium bicarbonate for CKD Eubicarbonatemic Hydrogen Ion Retention and CKD Progression -