Metabolic Acidosis Treatment as Part of a Strategy to Curb Inflammation

Abnormalities in systemic acid-base balance may induce significant changes in the immune response, and they may play a significant role in the development or maintenance of immune dysfunction. Different forms of acidosis (metabolic and respiratory) and even different types of metabolic acidosis (hyperchloremic and lactic) may produce different effects on immune function. If alkalization has, or not, some effect on inflammation control is still a matter of speculation. Studies concerning these subjects are limited justifying this paper. 1. Introduction Abnormalities in systemic acid-base balance may cause significant changes in the immune response. The clinical significance of these changes is not yet fully known, but its magnitude suggests that they may play a significant role in the development or maintenance of immune dysfunction. Thus, they represent attractive targets for curbing inflammation. Metabolic acidosis is one of the most common abnormalities in patients suffering from serious diseases. There have numerous etiologies and treatment of the underlying disease is the basis of therapy. However, there is a growing evidence suggesting that acidosis itself has profound effects on the host, particularly in immune function. Given the critical importance of immune function for the outcome of the illness, there is an overriding interest in elucidating the effects of this condition. In fact, recent evidence suggests that the different forms of acidosis (metabolic and respiratory) and even different types of metabolic acidosis (hyperchloremic and lactic) may produce different effects on immune function. The ways in which these effects are applied to the clinical conditions have not been determined. Therefore, since acidosis is an extremely common problem in intensive care units and that immune function is of vital importance, efforts to explain these relations are fully justified [1]. However, it is necessary to note that the publications linking acidosis with the inflammatory response are limited, and studies on the alkalosis are virtually nonexistent, justifying the current paper, at least as an open discussion (Figure 1). Figure 1: Metabolic acidosis and inflammation (Web of Science data). 2. Pathophysiology The literature has reported in vitro experiments where researchers reduced intracellular pH (pHo) using different types of acids. Notably, different patterns of expression of mediator of inflammation occurred at different acids, despite the normalization of samples to the same pHo [1]. Kellum et al. [2] demonstrated that different degrees of