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Master thesis

Impact cardiovasculaire de la correction de l'acidose lactique par bicarbonate de sodium après adaptation de la calcémie et de la PaCO2 : étude expérimentale sur un modèle de rat

Abstract : Lactic acidosis during shock is responsible for myocardial failure, vascularhyporesponsiveness and a decrease in sensitivity to vasopressor agents. Sodium bicarbonate is a proposed treatment to correct acidosis, although with deleterious cardiovascular effects. Indeed, hypocalcemia and hypercapnia, both powerful myocardial depressants, are the main side effects of the administration of this therapy. Already studied in experimental models of isolated lactic acidosis, the cardiovascular effects of sodium bicarbonate administration have never been explored after correction for hypocalcemia and hypercapnia.Methodology. We therefore compared, in a rat model of severe lactic acidosis induced by a state of controlled hemorrhagic shock, the cardiovascular effects of : i) standard resuscitation plus administration of sodium bicarbonate with correction for calcemia and PaCO2 ; ii) standard resuscitation plus administration of sodium bicarbonate without correction for PaCO2 and calcium ; iii) standard resuscitation ; iv) standard resuscitation plus calcium administration. Hemodynamic evaluation was focused both in vivo on myocardial contractility by conductance catheter and ex vivo on vasoreactivity by myography.Results. Our model displayed a profound alteration of cardiac and vascular function in the presence of lactic acidosis. Infusion of sodium bicarbonate, after adjustment of serum calcium and PaCO2, normalized pH and enhanced both myocardial contractility in vivo and ex vivo vasoreactivity. The cumulative dose of infused norepinephrine was significantly lower in the group with calcium and PaCO2 adaptation compared to other groups. In severe lactic acidosis, infusion of sodium bicarbonate after correction of its side effects improves myocardial function and vasoreactivity
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https://hal.univ-lorraine.fr/hal-01733680
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Antoine Kimmoun. Impact cardiovasculaire de la correction de l'acidose lactique par bicarbonate de sodium après adaptation de la calcémie et de la PaCO2 : étude expérimentale sur un modèle de rat. Sciences du Vivant [q-bio]. 2010. ⟨hal-01733680⟩

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