Fig. 1: Mechanism of action of bases in treatment of metabolic acidosis.
From: ABCs of base therapy in neonatology: role of acetate, bicarbonate, citrate and lactate
Administration of Ringer’s lactate solution is followed by the conversion of lactate to pyruvate by lactate dehydrogenase. Pyruvate is then converted to acetyl CoA, which enters the tricarboxylic acid (TCA) cycle (also known as the Krebs cycle), ultimately resulting in the generation of HCO3− that enters the circulation and CO2 that is exhaled by the lungs. The administration of intravenous acetate and oral citrate provides substrates for acetyl CoA and citric acid in the TCA cycle, respectively. Copyright Satyan Lakshminrusimha.
