Rapid determination of whole-body bicarbonate kinetics by use of a digital infusion

Accurate determination of substrate oxidation rates from breath 13CO2 levels often requires information on the bicarbonate status of the subject. We have developed a rapid method to obtain a complete set of bicarbonate kinetic parameters, prime bicarbonate pools with 13C, clamp breath 13CO2 levels rapidly and accurately with predetermined ranges, and provide a steady base-line enrichment of 13C for a subsequent substrate oxidation measurement. The method consists of administering NaH13CO3 intravenously as a combination of a bolus dose, an exponentially decreasing infusion, and a constant infusion. A Harvard model 2729 microprocessor-controlled syringe pump was modified for external control and coupled to a Hewlett-Packard HP-85 desk-top computer to deliver the complex infusion. An infusion algorithm that would rapidly attain and maintain an increase of 50% 13C enrichment of breath CO2 was derived by using the SAAM-27 program to interrogate a three-compartmental model of bicarbonate kinetics in normal, fasted, resting adult subjects. When the method was tested on five adult fasted subjects who had rested for 1.5 h, plateau enrichments were achieved within 10-20 min. The bicarbonate pool sizes and kinetic parameters obtained by compartmental analysis of their 13CO2 data were used to obtain a refined infusion protocol, which resulted in more rapid attainment of plateau enrichments. If carried out immediately before a substrate oxidation test, the method can provide a complete description of bicarbonate kinetics for use in the compartmental and noncompartmental analysis of substrate catabolism.(ABSTRACT TRUNCATED AT 250 WORDS)