# Chapter Nineteen: Metabolic Acidosis, part 2

Page: https://stenobird.com/podcast/channel-your-enthusiasm-1374325/chapter-nineteen-metabolic-acidosis-part-2
Text version: https://stenobird.com/podcast/channel-your-enthusiasm-1374325/chapter-nineteen-metabolic-acidosis-part-2.md
Podcast: [Channel Your Enthusiasm](https://stenobird.com/podcast/channel-your-enthusiasm-1374325)
Published: 2025-10-11T18:40:02+00:00
Episode link: http://www.rosebook.club/episodes/2025/10/11/chapter19part2
Audio file: https://static1.squarespace.com/static/548bc7f6e4b0a269c594ebc2/t/68eaa2f4f08a1c3f53bc56b8/1771771900042/Channel+chapter+19+Metabolic+Acidosis+part+2+.mp3
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## Resource

References Chapter 19, Part 12 Metabolic acidosis  June 14, 2023 References Chapter 19, Part 2 Roger mentioned MELAS syndrome MELAS syndrome: Clinical manifestations, pathogenesis, and treatment options Josh mentioned this blog on lactate- Understanding lactate in sepsis & Using it to our advantage We discussed the Warburg effect The Warburg Effect: How Does it Benefit Cancer Cells? - PMC and here’s a case from skeleton key- Skeleton Key Group Case #28: Mysterious Acidosis in Cancer - Renal Fellow Network Otto Warburg won the Nobel Prize in Physiology and Medicine in 1931 for describing how animal tumors produce large quantities of lactic acid ( Wikipedia ) Joel calls it the Lactate saline reflex, but the accepted term of art is Lacto-Bolo reflex The origins of the Lacto-Bolo reflex: the mythology of lactate in sepsis Buffer agents do not reverse intramyocardial acidosis during cardiac resuscitation. Josh mentioned this article the BICAR-ICU Sodium bicarbonate therapy for patients with severe metabolic acidaemia in the intensive care unit (BICAR-ICU): a multicentre, open-label, randomised controlled, phase 3 trial - The Lancet Roger shared 3 quotes to make the point that there has been little movement in our knowledge the past 40 years: Bicarbonate does not improve hemodynamics in critically ill patients who have lactic acidosis. A prospective, controlled clinical study from Cooper in the Annals Lactic Acidosis and Bicarbonate Therapy | Annals of Internal Medicine from Robert Hollander Lactic acidosis from Nick Madias Josh mentioned the use of sodium bicarbonate for CKD Eubicarbonatemic Hydrogen Ion Retention and CKD Progression - Kidney Medicine   (Madias) Bicarbonate therapy for prevention of chronic kidney disease progression (from Wesson),  Sodiu…

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