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Department Research and Development, Veterans Affairs Medical Center, Pittsburgh, Pennsylvania 15240
The adequacy of intestinal perfusion during shock and
resuscitation might be estimated from intestinal tissue acid-base
balance. We examined this idea from the perspective of conventional
blood acid-base physicochemistry. As the O2 supply
diminishes with failing blood flow, tissue acid-base changes are first
"respiratory," with CO2 coming from combustion of fuel
and stagnating in the decreasing blood flow. When the O2
supply decreases to critical, the changes become "metabolic" due to
lactic acid. In blood, the respiratory vs. metabolic distinction is
conventionally made using the buffer base principle, in which buffer
base is the sum of HCO3
and noncarbonate buffer anion
(A
). During purely respiratory acidosis, buffer
base stays constant because HCO3
cannot buffer its
own progenitor, carbonic acid, so that the rise of
HCO3
equals the fall of A
. During
anaerobic "metabolism," however, lactate's H+ is
buffered by both A
and HCO3
, causing
buffer base to decrease. We quantified the partitioning of lactate's
H+ between HCO3
and A
buffer in anoxic intestine by compressing intestinal segments of
anesthetized swine into a steel pipe and measuring
PCO2 and lactate at 5- to 10-min intervals.
Their rises followed first-order kinetics, yielding k = 0.031 min
1 and half time = ~22 min.
PCO2 vs. lactate relations were linear. Over
3 h, lactate increased by 31 ± 3 mmol/l tissue fluid
(mM) and PCO2 by ~17 mM, meaning that
one-half of lactate's H+ was buffered by tissue
HCO3
and one-half by A
. The data were
consistent with a lumped pKa value near 6.1 and total A
concentration of ~30 mmol/kg. We conclude that
the respiratory vs. metabolic distinction could be made in tissue by
estimating tissue buffer base from measured pH and
PCO2.
intestine; lactate; acid-base imbalance; diagnosis; laboratory
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