Urinary acid-base excretion deciphers high acid load from colonic bicarbonate loss in intestinal failure patients with ileocolonic anastomosis: guidance for composition of parenteral support

Robert H. Foerster, Georg Lamprecht, Karen Rischmüller, Peggy Berlin, Amalie Q. Rousing, Mads V. Sørensen, Jens Leipziger, Peder Berg

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaperJournal articleResearchpeer-review

1 Citation (Scopus)

Abstract

Background & aims: Acid-base disturbances are common in short bowel (SB) patients due to increased intestinal bicarbonate loss. However, the resulting systemic acid load has not been quantified. Base excess is used to monitor metabolic acid-base disturbances but inadequately reflects the acid load. Our aim was to investigate the systemic acid/base load in SB-patients to obtain quantitative estimates to guide the composition of parenteral support. Methods: We calculated total acid load in SB patients by summing 24-h urinary net acid excretion (NAE) and the provision of base equivalents in parenteral support. We then compared differences among anatomical SB-types: jejunostomy (SB-J), jejunocolostomy (SB-JC), and jejunoileostomy (SB-JIC). 47 urine samples from 34 SB patients were analyzed for bicarbonate (HCO 3 -), ammonium (NH 4 +), and titratable acid (TA) concentrations. NAE was calculated as (TA + NH 4 +) - HCO 3 -. Mixed-effects repeated-measures models were used to statistically examine differences between SB-types and associations with parenteral nutrition and NAE. A healthy cohort served as control. Results: In comparison to SB-J, SB-JC patients had a 4.1 mmoL/l lower base excess (95% CI: −6.3 to −1.8) and an 84.5 mmol/day higher total acid load (CI: 41.3 to 127.7). There were no significant differences between SB-JIC and SB-J regarding base excess, NAE, or total acid load. Higher amounts of infused acetate, sodium, and chloride, but not the acetate/chloride ratio, were associated with lower NAE and higher base excess. Conclusions: Due to increased colonic bicarbonate loss, patients with SB-JC have a ∼4.4-fold higher acid load than healthy controls. The ion transport mechanisms mediating this bicarbonate loss from the remaining colon need further experimental investigation. NAE could be a useful tool to adjust base infusion in SB.

Original languageEnglish
JournalClinical Nutrition
Volume43
Issue5
Pages (from-to)1043-1050
Number of pages8
ISSN0261-5614
DOIs
Publication statusPublished - May 2024

Keywords

  • Acid load
  • Intestinal base loss
  • Intestinal failure
  • Net acid excretion
  • Parenteral support
  • Short bowel syndrome

Fingerprint

Dive into the research topics of 'Urinary acid-base excretion deciphers high acid load from colonic bicarbonate loss in intestinal failure patients with ileocolonic anastomosis: guidance for composition of parenteral support'. Together they form a unique fingerprint.

Cite this