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Coagulation changes to systemic acidosis and bicarbonate correction in swine
Daniel N Darlington1, Bijan S Kheirabadi, Angel V Delgado
1Damage Control Resuscitation Program, US Army Institute of Surgical Research, Fort Sam Houston, Texas 78234-6315, USA. Daniel.darlington@amedd.army.mil
The Journal of Trauma
|April 20, 2011
Summary
Acidosis in trauma patients causes impaired blood clotting (hypocoagulation). Correcting blood pH with bicarbonate alone does not fix this coagulopathy, indicating a complex treatment need.
Area of Science:
- Trauma pathophysiology
- Hemorrhagic shock research
- Acid-base balance disorders
Background:
- Trauma patients often develop a lethal triad: hypothermia, acidosis, and coagulopathy.
- Understanding the interplay between acidosis and coagulopathy is crucial for effective trauma management.
Purpose of the Study:
- To investigate if acidosis, induced by HCl infusion or hemorrhage/hypoventilation, causes coagulopathy.
- To determine if correcting acidosis alleviates the induced coagulopathy.
Main Methods:
- Acidosis was induced in swine via HCl infusion or hemorrhage/hypoventilation.
- Arterial blood gases and pH were monitored before, during, and after acidosis and correction.
- Coagulation parameters were assessed using various assays, including thrombin generation.
Main Results:
- Induced acidosis (pH 7.1) significantly impaired clot strength, formation rate, and thrombin generation.
- Fibrinogen and platelet counts decreased significantly in both acidosis models.
- Standard coagulation tests (ACT, PT, aPTT) were elevated in the HCl group; correction of pH with bicarbonate did not immediately resolve hypocoagulation.
Conclusions:
- Acidosis, whether from HCl infusion or hemorrhage/hypoventilation, directly causes hypocoagulation.
- Simple correction of arterial pH using bicarbonate is insufficient to reverse trauma-induced coagulopathy.
Related Concept Videos
01:24Diagnosing Acidosis and Alkalosis
Diagnosing acid-base imbalances involves systematically analyzing arterial blood samples, focusing on three key measurements: pH, bicarbonate (HCO3−) concentration, and carbon dioxide partial pressure (PCO2). This analysis follows a four-step process that helps identify the imbalance's underlying cause and nature.
First, the pH level is assessed to determine whether the blood pH is normal (7.35–7.45), low (acidosis), or high (alkalosis).
Next, the PCO2 and HCO3− values are examined to...
First, the pH level is assessed to determine whether the blood pH is normal (7.35–7.45), low (acidosis), or high (alkalosis).
Next, the PCO2 and HCO3− values are examined to...
01:29Disorders of Acid-Base Balance
The human body maintains a precise pH range of arterial blood between 7.35 and 7.45. Deviations result in either acidosis (pH < 7.35) or alkalosis (pH > 7.45). These conditions are further classified as respiratory or metabolic disorders based on their underlying cause.
Respiratory Acidosis and Alkalosis
Respiratory acidosis occurs due to an increase in the partial pressure of carbon dioxide PCO2 in the blood. It often arises from shallow breathing or impaired gas exchange caused by...
Respiratory Acidosis and Alkalosis
Respiratory acidosis occurs due to an increase in the partial pressure of carbon dioxide PCO2 in the blood. It often arises from shallow breathing or impaired gas exchange caused by...
01:25Acid-Base Balance
The human body maintains a narrow pH range regulated through acid-base balance. This balance is crucial as changes in the hydrogen ion concentration can disrupt cell membrane stability, alter protein structures, and change enzyme activities. The normal pH of arterial blood is 7.4, venous blood and interstitial fluid is 7.35, and intracellular fluid averages 7.0.
When the pH of arterial blood rises above 7.45, it results in a condition called alkalosis. Conversely, a drop below 7.35 leads to...
When the pH of arterial blood rises above 7.45, it results in a condition called alkalosis. Conversely, a drop below 7.35 leads to...
01:22Bicarbonate-Carbonic Acid Buffer
The carbonic acid-bicarbonate buffer system is critical for maintaining the body's pH balance. It operates on the equilibrium:
01:18Respiratory Regulation of Acid-Base Balance
Respiratory compensation is a vital physiological process that stabilizes blood plasma pH by regulating the partial pressure of carbon dioxide (PCO2), a key determinant of pH levels. Most carbon dioxide in the blood dissolves and converts into carbonic acid (H2CO3). It dissociates into hydrogen ions (H+) and bicarbonate ions (HCO3⁻). There is also an inverse relationship between PCO2 and pH.
When carbon dioxide levels increase in the blood, more H+ and HCO3⁻ are produced, leading to a...
When carbon dioxide levels increase in the blood, more H+ and HCO3⁻ are produced, leading to a...
01:28Compensation Mechanisms
The human body employs intricate mechanisms to counteract changes in blood pH, preventing conditions like acidosis (pH < 7.35) and alkalosis (pH > 7.45). These compensatory responses aim to restore normal arterial blood pH by engaging respiratory or renal systems, depending on the source of the imbalance.
Respiratory Compensation
This mechanism addresses metabolic-induced pH imbalances by adjusting breathing rates. Respiratory compensation begins within minutes of detecting a pH...
Respiratory Compensation
This mechanism addresses metabolic-induced pH imbalances by adjusting breathing rates. Respiratory compensation begins within minutes of detecting a pH...