Nicotinic Acid: Treatment for the Hyperchloremic Acidosis Following Urinary Diversion through Intestinal Segments

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Abstract
The syndrome of hyperchloremic metabolic acidosis following urinary diversion through intestinal segments has posed a problem for urologists for > 50 yr. Recent work demonstrates that chlorpromazine, an intestinal cyclic-AMP inhibitor, partially corrects the metabolic derangements associated with this syndrome. Nicotinic acid has also been shown to be a potent inhibitor of intestinal cyclic-AMP. The present investigation employs nicotinic acid in a rat vesico-cecostomy model to examine its efficacy in management of this syndrome. Rats with vesico-cecostomies treated with nicotinic acid are compared to untreated rats, rats with intestinal but not urinary diversions and non-operative controls. Nicotinic acid in a dose of 50 mg/kg/day corrects the hyperchloremia (P < 0.02), elevated serum osmolality (P < 0.0001), hyperammoniumemia (P < 0.05) and acidosis (P < 0.001). Results compare favorably to those obtained in an identical model with the use of chlorpromazine.