Etiology, Pathogenesis and Intensive Care of Metabolic Acidosis

V.I. Cherniy, I.P. Shlapak, M.A. Georgiyants, S.G. Tyumentseva, S.Ye. Kugler, B.B. Prokopenko


The article presents data on the etiology, pathogenesis, clinical manifestations, principles of diagnosis and treatment of metabolic acidosis: diabetic and nondiabetic ketoacidosis, lactic acidosis in adults and children. The modern directions of infusion therapy for ketoacidosis and lactic acidosis using the latest domestic infusion media are described. In their article, the authors compared the algorithms for the treatment of ketoacidosis and lactic acidosis with the recommendations of the Association of British Clinical Diabetologists and the American Society of Nephrology, making correction for the possibilities of domestic laboratory studies. A characte­ristic feature of some common forms of acid-base imbalance is the entwinement of damaging and adaptive elements, a clear boundary between them does not exist. Multifactoriality and pathogenetic ambiguity of the acid-base homeostasis disorders determine the significant differences in the assessment of the prognostic value and treatment strategies of its complex forms. In clinical practice, this often leads to undue schematization, depersonalization therapy or, even worse, to the desire to take into account the parameters of acid-base status only with the pH shift in the field of life-threatening values.


ketoacidosis; lactic acidosis


Li BUK. Cyclic vomiting syndrome and abdominal migraine // Int. Semin. Pediatr. Gastroenterol. — 2009. — 9. — 1-9.

Caffarelli C., Santamaria F., Vottero A., Dascola C.P., Mirra V., Sperli F., Bernasconi S. Progress in pediatrics in 2013: choices in allergology, endocrinology, gastroenterology, hypertension, infectious diseases, neonatology, neurology, nutrition and respiratory tract illnesses // Ital. J. Pediatr. — 2014 Jul. — 40. — 62.

Hejazi R.A., McCallum R.W. Cyclic vomiting syndrome: treatment options // Exp. Brain Res. — 2014 Aug. — 232 (8). — 2549-52.

Георгиянц М.А., Корсунов В.А., Шилова Е.В. Недиабетические кетоацидозы в детском возрасте: клиника, диагностика и интенсивная терапия. — ​К., 2006. — 23 с.

Rains J.L., Jain S.K. Oxidative stress, insulin signaling, and diabetes // Free Radic. Biol. Med. — 2011. — 50 (5). — 567-75.

Bassotti G., Antonelli E., Villanacci V., Salemme M., Coppola M., Annese V. Gastrointestinal motility disorders in inflammatory bowel diseases // World J. Gastroenterol. — 2014. — 20 (1). — 37-44.

Bashashati M., McCallum R.W. Neurochemical mechanisms and pharmacologic strategies in managing nausea and vomiting rela­ted to cyclic vomiting syndrome and other gastrointestinal disorders // Eur. J. Pharmacol. — 2014. — 722. — 79-94

Ducrocq N., Kimmoun A., Levy B. Lactate or ScvO2 as an endpoint in resuscitation of shock states? // Minerva Anestesiol. — 2013. — 79 (9). — 1049-58.

Hendrikx J.J., Lagas J.S., Daling R., Hooijberg J.H., Schellens J.H., Beijnen J.H., Brandjes D.P., Huitema A.D. Severe lactic acidosis in a diabetic patient after ethanol abuse and floor cleaner intake // Basic Clin. Pharmacol. Toxicol. — 2014. — 115 (5). — 472-5.

Георгиянц М.А. и соавт. Первый опыт использования инфузионного препарата ксилат для коррекции недиабетического кетоза у детей с различной инфекционной патологией // Біль, знеболювання, інтенсивна терапія. — 2005. — № 2д. — ​С. 16-19.

Місце сучасних багатоатомних спиртів (Реосорбілакт®, Сорбілакт®, Ксилат®) в медицині критичних станів (невідкладна хірургія, педіатрія, нейрохірургія, парентеральне живлення) / За ред. чл.-​кор. АМНУ професора В.І. Чернія). — ​Донецьк, 2006. — 55 с.

Интенсивная терапия диабетического кетоацидоза / В.И. Черний, Б.Б. Прокопенко, С.Г. Тюменцева, Е.К. Шраменко // Материалы симпозиума «Неинтенсивная инфузионная терапия в фтизиатрии и пульмонологии и других областях медицины, 27–28 сентября 2012. — ​Донецк. — ​С. 256-260.

Bret A. Nicks, MD, MHA / Chief Editor Rick Kulkarni, MD. Acute Lactic Acidosis // Am. J. of Nefrology. — 2013. — ​P. 25-38.

Kyle J. Gunnerson, MD. / Chief Editor Michael R. Pinsky, MD, CM, FCCP, FCCM. Lactic Acidosis Treatment & Management // Am. J. of Nefrology. — 2013. — ​P. 114-153.

Mongardon N., Bouglé A., Geri G., Daviaud F., Morichau-Beauchant T., Tissier R., Dumas F., Cariou A. Pathophysiology and management of post-cardiac arrest syndrome // Ann. Fr. Anesth. Reanim. — 2013. — ​32 (11). — 779-86.

Scherbaum W.A., Scherbaum C.R. Diabetes emergencies // Med. Klin. Intensivmed Notfmed. — 2014 May. — 109 (4). — 279-92.

Maletkovic J., Drexler A. Diabetic ketoacidosis and hyperglycemic hyperosmolar state // Endocrinol. Metab. Clin. North Am. — 2013. — 42 (4). — 677-95.

Adeva-Andany M.M., Fernández-Fernández C., Mouriño-Bayolo D., Castro-Quintela E., Domínguez-Montero A. Sodium bicarbonate therapy in patients with metabolic acidosis // Scientific World Journal. — 2014. — 627-673.

Morris L.R., Murphy M.B., Kitabchi A.E. Bicarbonate the­rapy in severe diabetic ketoacidosis // Ann. Intern. Med. — 1986. — ​Vol. 105. — ​Р. 836-840.

Velissaris D., Karamouzos V., Ktenopoulos N., Pierrakos C., Karanikolas M. The Use of Sodium Bicarbonate in the Treatment of Acidosis in Sepsis: A Literature Update on a Long Term Debate // Crit. Care Res. Pract. — 2015. — 605-830.

Parker M.D., Boron W.F. The divergence, actions, roles, and relatives of sodium-coupled bicarbonate transporters // Physiol. Rev. — 2013. — 93 (2). — 803-959.

Bonadio W. Pediatric diabetic ketoacidosis: an outpatient perspective on evaluation and management // Pediatr. Emerg. Med. Pract. — 2013. — 10 (3). — 1-13.

Hites M., Dell'Anna A.M., Scolletta S., Taccone F.S. The challenges of multiple organ dysfunction syndrome and extra-corporeal circuits for drug delivery in critically ill patients // Adv. Drug Deliv. Rev. — 2014. — 77. — 12-21.

Рациональная инфузионная терапия / В.И. Черний, А.Н. Колесников, К.Н. Олейников и др. — ​Донецк, 2012. — 186 с.

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