Document Detail

Tris-hydroxymethyl aminomethane and sodium bicarbonate to buffer metabolic acidosis in an isolated heart model.
MedLine Citation:
PMID:  9117032     Owner:  NLM     Status:  MEDLINE    
Metabolic acidosis induces a decrease in the developed force of cardiac muscle by affecting every step of the excitation--contraction coupling pathway. Due to transient worsening in intracellular acidosis, the value of administering sodium bicarbonate therapeutically during acute acidosis has been questioned. An alternative therapeutic drug, Tris-hydroxymethyl aminomethane (THAM) has the advantage of diffusing into the intracellular space. This study was designed to evaluate the effects of metabolic acidosis on myocardial performance and to determine the effects of alkalinization with sodium bicarbonate, THAM, and their combination. Using a blood-perfused isolated heart preparation, left ventricular contractility and relaxation were measured at normal pH and during metabolic acidosis (pH = 7.0). Acidosis dramatically impaired myocardial contractility and relaxation. After buffering with sodium bicarbonate, although plasma bicarbonate concentration was normalized, pH remained below normal owing to an increased PaCO2. Contractility and relation were initially worsened, then slightly improved to return to control values. THAM uncompletely buffered acidosis but significantly improved contractility and relaxation. The combination of THAM with sodium bicarbonate perfectly buffered acidosis without modifying PaCO2 and significantly improved contractility. The combination of THAM with sodium bicarbonate is based on the ability of THAM to capture the CO2 produced by the sodium bicarbonate buffer. This combination achieves a perfect correction of metabolic acidosis and improves myocardial performance.
D Sirieix; S Delayance; M Paris; S Massonnet-Castel; A Carpentier; J F Baron
Publication Detail:
Type:  In Vitro; Journal Article    
Journal Detail:
Title:  American journal of respiratory and critical care medicine     Volume:  155     ISSN:  1073-449X     ISO Abbreviation:  Am. J. Respir. Crit. Care Med.     Publication Date:  1997 Mar 
Date Detail:
Created Date:  1997-04-18     Completed Date:  1997-04-18     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  9421642     Medline TA:  Am J Respir Crit Care Med     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  957-63     Citation Subset:  AIM; IM    
Department of Anesthesiology and Intensive Care, Broussais Hospital, Paris, France.
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MeSH Terms
Acidosis / drug therapy*,  physiopathology
Heart / drug effects,  physiology*
Models, Cardiovascular
Myocardial Contraction / drug effects,  physiology*
Oxygen Consumption
Sodium Bicarbonate / pharmacology*,  therapeutic use
Tromethamine / pharmacology*,  therapeutic use
Ventricular Function, Left / physiology
Reg. No./Substance:
0/Buffers; 144-55-8/Sodium Bicarbonate; 77-86-1/Tromethamine

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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