To investigate the effect of monitoring the mitochondrial enzymes in determining intracellular acidosis who patients received bicarbonate therapy due to aki OR CKD in the emergency department and comparison with instantaneous blood gas

Metabolic acidosis and the depletion of buffer systems causes cardiac, neurological and hemodynamic instability. Most clinicians resort to alkaline treatments to protect patients from these effects of acidosis and perhaps break the cycle that causes loss of tampon. The most important of these alkaline treatments is iv bicarbonate treatment. This treatment has various side effects. Despite these side effects, patients can benefit from bicarbonate treatment by managing their clinical condition well. This clinical practice will help clinicians direct their treatment to monitor the net benefit or net loss status. With this reason, we aim to find out whether L-lactate, phosphofructokinase-1, Glyceraldehyde-3-phosphate dehydrogenase and pyruvate dehydrogenase activity are correlated with serum blood gas values in the serum sample taken before and after treatment from patients who have been indicated for bicarbonate treatment in the emergency department, and the level of effectiveness of these markers by increasing intracellular acidosis. 31 patients were included in the prospective study conducted in the Emergency Medicine Clinic of Aydın Adnan Menderes University Hospital between 01.12.2017- 01.12.2019, and patients evaluated as serious, moderate, mild and normal according to the blood pH value. IV bicarbonate treatment was applied, with a median of 50 mmol (min-max: 20-100). The pH value increased from 7.22 (SD ± 0.1) to 7.28 (SD ± 0.1) with bicarbonate treatment applied to the cases. Blood HCO3 value increased from an average of 14.49 mEq (SD ± 3.35) to 16.9 mEq (SD ± 3.33). However, the change in mean partial CO2 levels of patients from 34.29 mmHg (SD ± 8.84) to 35.73 mmHg (SD ± 11) was not significant. When the pre and post PFK values of all cases were compared, the decrease in enzyme activity from 16.72 nmol (SD ± 1.87) to 15.94 nmol (SD ± 2.11) was found statistically significant and no effect on clinical outcome was detected. When the pre and post G3PD values of all cases were compared, the decrease in enzyme activity from 17.3 nmol (SD ± 9.23) to 16.34 nmol (SD ± 9.59) was not statistically significant. Pre and post G3PD values of patients with Ex were significantly higher than the pre and post G3PD values of patients discharged. (p value for pre and post G3PD values 0.014 and 0.006 respectively) Therefore, although G3PD activity is not a suitable marker for clinical use in intracellular acidosis monitoring, it may be a marker used to predict the prognosis. It may be an appropriate approach to calculate the amount to be applied in bicarbonate treatment, with the aim of taking the acidity severity of patients to a higher degree, provided that the rules of "adequate respiratory support, volume control and correction of ionized Ca+2" are observed. Keywords: Glycolysis, Metabolic acidosis, Emergency department, pyruvate dehydrogenase, phosphofrutokinase, glyceraldehyde-3-phosphate dehydrogenase