PAH Clearance, Sodium Excretion, and PAH Extraction Ratio in Acidotic Near-Term Lambs Treated with Hypertonic Sodium Bicarbonate

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Abstract
The electrolyte changes and renal hemodynamic adjustment to hypertonic sodium bicarbonate (NaHCO3) correction of a metabolic acidosis were studied in 4 neonatal lambs and in 2 controls. PAH clearance increased from 0.92 to 1.65 ml/min/kg (p < 0.05), urine flow from 0.37 to 0.61 ml/min/kg (p < 0.05), and Na excretion from 8.4 to 23.7 μEq/min/kg (p < 0.05) during the NaHCO3 infusion. These increases were transient and returned to pre-infusion levels following NaHCO3 infusion. Calculation of Na intake and output revealed a net retention of 5.1 mEq/kg in the study lambs which was reflected in a rise of serum Na and osmolarity (Osm) during the post-NaHCO3-infusion period. The extraction ratio of sodium p-aminohippurate (EPAH) and its relationship to arterial pH were studied in 4 additional lambs. The EPAH did not change with metabolic acidosis but for unknown reasons, the infusion of NaHCO3 resulted in a temporary depression of EPAH (p < 0.001).

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