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Heat shock protein synthesis is affected by intracellular pH: inhibition by monensin-induced alkalosis in C6 rat glioma cells.

The effect of intracellular pH (pHi) on heat shock protein (HSP) synthesis was investigated in C6 rat glioma cells. pHi changes were analysed by means of fluorescence spectroscopy in a perfused monitoring system allowing continuous measurements before, during and after treatments. HSP induction was determined by means of Western blots and autoradiographs. A 20 min heat shock (HS) of 44 degrees C decreased the pHi from 7.36 to 7.05 during exposure [17] and elicited the synthesis of heat shock proteins 2-8 h later. A pHi decrease, brought about by low extracellular pH (pHe) of 4.5 and 5.0 or 5.5, induced HSP synthesis after 1 h or 3 h, respectively. During these treatments, pHi decreased to values significantly lower than that caused by HS. Three h exposure to pHe 6.2, however, was not inductive. These results indicate that the heat shock-induced pHi decrease alone is not sufficient to stimulate HSP synthesis. In order to investigate the effect of alkaline pHi on the induction of HSP by heat, pHi was increased prior to HS treatments. Preincubation of cells at pHe ranging from 6.8 to 8.0 had little effect on pHi and on HSP synthesis. A shift of pHi to more alkaline values was achieved by adding the H+/Na+ exchanger monensin at alkaline pHe. Twenty microM monensin raised the pHi and inhibited the HSP induction depending on the pHe values: as pHe was increased from pH 7.2 to 8.0 HSP synthesis was increasingly inhibited. Monensin also diminished the HS-induced drop of pHi particularly at higher pHe. The result showed that neither a lower pHi nor a drop of pHi during HS is a necessary prerequisite for the induction, whereas alkalosis inhibits the synthesis of HSP.

Alkalosis↗

Acute alkalosis, but not acute hypocalcemia, increases panic behavior in an animal model.

Non-pretrained, randomized adult rats were tested in a panic-inducing model of passive avoidance. Intravenous treatment with alkalinizing agents (sodium lactate 0.5 M, 0.5 ml/100 g b.wt., or NaHCO3, 0.5 mEq/100 g b.wt.), but not with a hypocalcemic dose of EDTA (75 mg/kg) 3 min before testing, significantly increased panic behavior. These data may support the hypothesis that panic attacks are due to alkalosis and not to lactate-induced hypocalcemia.

Alkalosis↗

Mechanism of the effect of alkalosis on maximum oxygen uptake in hypoxic exercise.

Maximum oxygen uptake (VO2max) of rats is increased in alkalosis; this increase is larger in hypoxic than in normoxic exercise (Gonzalez et al. (1991b). J. Appl. Physiol., 71: 1050-1056). The objective of the present experiments was to determine the mechanism of this phenomenon. NaHCO3 (0.3 M, 9 mmol/kg) was given 15 min before exercise to rats acclimated to PB 380 Torr for 3 weeks (HxBic) and to normoxic rats (NxBic). Additional groups of acclimated and normoxic rats received 0.3 M NaCl (HxNaCl and NxNaCl, respectively). Hx rats exercised at PIO2 approximately 70 Torr; Nx rats at PIO2 approximately 140 Torr. VO2max was higher after NaHCO3 than after NaCl; this effect was larger in hypoxia. The increase in VO2max was mediated through an increased arterio-venous oxygen concentration difference ((Ca - Cv)O2), due, in turn, to a higher CaO2 without changes in CvO2. (Ca - Cv)O2 after NaHCO3 was larger in hypoxia because a change in pH results in a larger change in HbO2 saturation at the values prevalent in arterial blood of the hypoxic rats (i.e. PO2 approximately 40-50 Torr, SO2 50-60%), than at either the values of normoxic arterial blood or of venous blood during maximum exercise. These results suggest that an increase in hemoglobin-oxygen affinity improves oxygen uptake in the lungs during hypoxia, without hindering its release in the tissues, and therefore has a beneficial effect in hypoxic exercise.

Acid-Base Equilibrium↗

Occurrence of respiratory alkalosis in continuous ambulatory peritoneal dialysis patients with pulmonary disease.

Continuous ambulatory peritoneal dialysis (CAPD) patients are prone to develop respiratory alkalosis when hypoxemia occurs secondary to pulmonary problems. This is due to "fixed" bicarbonate levels that do not allow for an unlimited degree of hyperventilation. Recognition of this problem is important because treatment with oxygen or acidification with ammonium chloride is effective in avoiding severe alkalemia in these patients.

Alkalosis, Respiratory↗

Intracellular alkalosis during hypoxia in newborn mouse brain in the presence of systemic acidosis: a phosphorus magnetic resonance spectroscopic study.

We investigated the in vivo changes in cerebral energy metabolism and pHi in newborn mice noninvasively during 8 h of hypoxia with FiO2 = 5%, using phosphorus magnetic resonance spectroscopy continuously. The intracellular brain pH (pHi) increased from 7.20 +/- 0.03 to 7.36 +/- 0.03 (P < 0.05) at 1 h of hypoxia and then decreased gradually. On the other hand, the mixed arterial and venous blood pH decreased gradually during hypoxia, reaching a minimum value of 7.16 +/- 0.01 at the end of the hypoxia. There was no significant difference in PCO2 between control (47.4 +/- 0.8 mm Hg) and 1-h hypoxic (49.0 +/- 1.1 mm Hg) mice. The blood glucose concentration was significantly increased at 1 h of hypoxia. These results indicate that the alkaline shift in pHi during hypoxia was caused neither by systemic alkalosis due to hypocapnia nor hypoglycemia.

Acidosis↗

Calcitonin and metabolic alkalosis.

Calcitonin is used in the treatment of osteoporosis and several adverse effects, such as rash, antibody presence, hypocalcemia, etc have been reported with the therapeutic use of large quantities of this hormone. The results found in this paper show that 7 h after administration of large doses of calcitonin to osteoporotic patients on hormone treatment, the acid-base status shifts to metabolic alkalosis. This represents another adverse effect of the use of pharmacological doses of calcitonin.

Alkalosis↗

The effect of respiratory alkalosis on oxygen consumption in anesthetized patients.

STUDY OBJECTIVE: To investigate whether hyperventilation significantly altered oxygen consumption in anesthetized and paralyzed patients undergoing surgery. DESIGN: Open crossover trial with 1 hour of hyperventilation preceded and followed by 1 hour of normoventilation. SETTING: University medical center. PATIENTS: Eight patients (five men and three women) undergoing lengthy orthopedic surgery with general anesthesia and muscle paralysis. INTERVENTIONS: After baseline normoventilation for 1 hour (Period 1), the anesthetized patients were hyperventilated to an arterial carbon dioxide tension (PaCO2) of 20 to 25 mmHg for 1 hour (Period 2). Patients then experienced another hour of normoventilation (Period 3). MEASUREMENTS AND MAIN RESULTS: Hemodynamic variables, electrocardiography, temperature, end-tidal partial pressure of CO2 (PETCO2), oxygen consumption (VO2), carbon dioxide production, and minute ventilation were continuously followed throughout the study, and arterial blood gases were drawn at the beginning and end of each study period. During the period of hyperventilation, pH was significantly higher and P.ETCO2 and PaCO2 significantly lower compared with the periods of normoventilation. VO2 was significantly increased during hyperventilation compared with the periods of normoventilation. Hemodynamic variables and temperature were similar in the three study periods. CONCLUSIONS: In anesthetized paralyzed patients, there is an increase in whole-body VO2 with hypocapnic alkalosis.

Adult↗

Estimation of the effect of the acidosis and alkalosis on the anesthetic potency of local anesthetics by biopartitioning micellar chromatography and micellar electrokinetic chromatography.

Local anesthetics are hydrophobic compounds and weak bases with protonation constants ranged between 7.5 and 8.8. These drugs block reversibly nerve conduction near their site of application or injection and thus produce temporary loss of feeling or sensation in a limited area of the body. The efficacy of anesthetic blockade of local anesthetics depends on the charged/uncharged form ratio and the hydrophobicity of the compounds. In addition their toxicological effects have been reported to be highly dependent on the physiological pH. Biopartitioning micellar chromatography (BMC) and micellar electrokinetic chromatography (MEKC), that use micellar solutions as mobile phases, have proven to be useful for describing the biological behavior of different kind of compounds. In this paper, relationships between the retention data in BMC and MEKC using Brij35 as surfactant (at pH 7.4) and some pharmacodynamic parameters of local anesthetics are obtained. These models are compared with those obtained using an immobilized artificial column (IAM). Finally, the effect of the corporal pH in situations of acidosis and alkalosis on the pharmacological and toxicological properties of local anesthetics is studied using the retention of compounds in BMC at different mobile phase pH values.

Acidosis↗

Monensin augments capacitative Ca2+ entry and subsequent aggregation of platelets via an intracellular alkalosis-mediated mechanism.

Effects of monensin, an ionophore that facilitates the transmembrane exchange of Na+ for H+, on capacitative Ca2+ entry (CCE) of platelets were investigated. CCE of human platelets was induced by addition of Ca2+ to a nominally Ca2+-free medium after release of intracellular stored Ca2+ caused by thapsigargin. CCE was strongly inhibited by SKF-96365 (1-[beta-(3-[4-methoxyphenyl]propoxy)-4-methoxyphenethyl]-1H-imidazole hydrochloride). Monensin significantly increased SKF-96365-sensitive CCE and subsequent platelet aggregation. Monensin also induced a sustained increase in intracellular pH. The augmenting effect of monensin on CCE and subsequent platelet aggregation was not observed in the presence of sodium propionate, which canceled intracellular alkalinization induced by monensin. These results suggest that monensin augments CCE of platelets by a mechanism mediated by intracellular alkalosis.

Alkalosis↗

Alternans of the repolarization wave in a case of hypochloremic alkalosis with hypopotassemia.

A case of profound hypochloremic alkalosis with hypopotassemia is reported, showing electrocardiographic changes of electrical alternans of the repolarization wave (probably the U wave) without any change in the QRS complex. Transient concomitant P-pulmonale was noted. Hypopotassemia is discussed as a possible mechanism for the development of the electrical alternans.

Action Potentials↗

The significance of alkalosis and hypochloremia in hypertrophic pyloric stenosis.

Hypochloremic alkalosis is the "classical" electrolyte abnormality seen in hypertrophic pyloric stenosis (HPS), yet it occurs in only about half the patients. To define the clinical differences between infants who were alkalotic or hypochloremic and those who were not, we reviewed the records of 216 patients treated for HPS over a recent 5-year period at our institution. The 202 patients who had a full set of serum electrolytes drawn on admission were divided into nonalkalotic and alkalotic bicarbonate groups A (less than or equal to 25 mEq/L, n = 105) and B (greater than 25 mEq/L, n = 97) and also nonhypochloremic and hypochloremic chloride groups A (greater than or equal to 99 mEq/L, n = 117) and B (less than 99 mEq/L, n = 85). The alkalotic group B had a significantly higher proportion of black patients (17.5% v 8%), longer mean duration of illness (17.8 v 9.4 days), higher incidence of palpable pyloric mass (97% v 82%), greater degree of dehydration, lower mean serum sodium (136.3 v 137.7 mEq/L), lower mean serum potassium (4.50 v 5.15 mEq/L), and lower mean serum chloride (92.4 v 102.3 mEq/L) than did the nonalkalotic group A.(ABSTRACT TRUNCATED AT 250 WORDS)

Alkalosis↗

Efficacy and neurologic outcome of profound hypocapneic alkalosis for the treatment of persistent pulmonary hypertension in infancy.

Twenty-three newborn infants with severe bilateral pulmonary disease and persistent pulmonary hypertension received mechanical ventilation to pH greater than 7.55 and PaCO2 less than 25 torr. Response, as defined by attainment of a PaO2 greater than 100 torr, occurred in 87% of patients. Analysis of sequential arterial pH determinations revealed a linear increase in the number of infants responding as arterial pH increased. However, individual patients varied greatly in the optimal pH necessary to correct hypoxemia (range pH 7.50 to 7.75). Sixteen patients who had received mechanical hyperventilation were observed for 11.1 +/- 2.3 months. Virtually all had normal growth and development on follow-up physical and neurologic examinations, often despite profound or prolonged alkalosis and hypocarbia. In 11 infants at a corrected gestational age of 1 year, Bayley Scales of Infant Development revealed normal mental developmental indices (mean 106.2 +/- 15.4) and normal, but significantly lower, psychomotor developmental indices (93.2 +/- 11.7) (P less than 0.005). Although response and short-term outcome of neonatal hyperventilation appear favorable, this technique should be reserved for critically ill infants, because its long-term effects on the central nervous system are unknown.

Alkalosis, Respiratory↗

Omeprazole in post-gastrocystoplasty metabolic alkalosis and aciduria.

The use of segments of stomach for bladder augmentation is gaining popularity in pediatric urology due to favorable muscular and secretory properties. However, in a renal failure patient who underwent gastrocystoplasty a high level of acid production within the bladder associated with persistent hypergastrinemia was noted leading to severe systemic metabolic alkalosis. This condition was unresponsive to standard acid-inhibiting or neutralizing therapies but it was treated successfully with omeprazole, a proton-pump inhibitor recently introduced for treatment of peptic ulcer disease.

Alkalosis↗

Effect of acute induced metabolic alkalosis on the acid/base responses to sprint exercise of six racing greyhounds.

To investigate the effect of acute induced metabolic alkalosis on the haematological, biochemical and metabolic responses to sprint exercise, six greyhound dogs with previously placed carotid arterial catheters were raced four times over a distance of 400 metres. Each dog was raced twice after receiving oral sodium bicarbonate solution (NaHCO3) (400 mg kg-1) or lactated Ringer's solution (LRS). Before, and for intervals of up to one hour after, the exercise arterial blood samples were collected for the measurement of blood gases, packed cell volume, total protein, serum biochemistry and plasma lactate. The time to complete the 400 metre sprint ranged from 32.7 seconds to 36.9 seconds. There was no significant difference in racing times between the dogs treated with NaHCO3 and LRS, and there was no significant difference between the plasma lactate measurements after the treatments with NaHCO3 or LRS. Serum chloride concentrations were significantly lower after NaHCO3 than after LRS, and there was a trend towards a lower serum potassium concentration after NaHCO3 treatment. Plasma lactate concentrations showed a similar increase and time course of disappearance after both LRS and NaHCO3 treatments. There were significant changes in all the parameters measured after the exercise, but there were large variations between individual dogs and between races when the dogs were receiving the same treatment.

Acid-Base Equilibrium↗

Severe metabolic alkalosis in the emergency department.

A case of severe metabolic alkalosis (MA) resulting from ingestion of baking soda (sodium bicarbonate) is presented. On admission to the emergency department, the patient was alert and stable with an initial examination that was remarkable only for carpopedal spasm. Shortly thereafter, the patient had a sudden, unexpected cardiopulmonary arrest. Following resuscitation, without administration of sodium bicarbonate, the arterial blood gas revealed a pH of 7.73, pO2 of 51 mm Hg, and pCO2 of 52 mm Hg. After admission to the intensive care unit, the patient's MA was corrected using IV 0.25 N hydrochloric acid. The patient remained comatose as a result of severe anoxic encephalopathy and died two weeks after admission. We believe this is the first reported case of severe MA resulting in sudden cardiopulmonary arrest in a previously ambulatory patient.

Acute Disease↗

Extreme metabolic alkalosis treated with normal bicarbonate hemodialysis.

Metabolic alkalosis (MA), defined as a primary increment in plasma bicarbonate concentration, is a common complication in hospitalized patients and is associated with high morbidity and mortality in severe cases. One of the major routes of compensation for MA (ie, the secretion of an alkaline urine) is lost in renal failure patients. We report three cases involving four episodes of extreme MA with an arterial pH value greater than 7.60, serum bicarbonate concentration greater than 55 mmol/L, and stupor or seizure. Profound vomiting or massive gastric drainage combined with concurrent oliguric renal failure was the underlying mechanism for severe MA. Hydration and normal central venous pressure failed to improve the MA. The extreme MA was reversed quickly and safely by conventional hemodialysis with normal bicarbonate dialysate of 25 to 28 mmol/L. To our knowledge, this is the first reported successful use of normal bicarbonate dialysate in the treatment of severe MA. We also found that either H(2) blockers or proton-pump inhibitors have a prophylactic effect on the formation of MA.

Adult↗

Severe metabolic alkalosis complicating regional citrate hemodialysis.

Regional citrate hemodialysis has been effectively used as an alternative to heparin anticoagulation during dialysis of patients at increased risk for bleeding. Few complications have been noted; however, we report the occurrence of severe metabolic alkalosis in two patients requiring high infusion rates of citrate during hemodialysis while being mechanically ventilated. Careful monitoring of acid-base status is mandatory in this setting, and reduction of citrate dose may be advisable.

Aged↗