Effects of dexamethasone on renal and systemic acid-base metabolism

Abstract

The authors carried out long-term balance studies in adrenalectomized (ADX) dogs to evaluate the effects of small amounts of a glucocorticoid steroid with minimal mineralocorticoid potency (dexamethasone; DEX) on renal and systemic acid-base metabolism under conditions of constant mineralocorticod replacement and both normal and increased systemic acid loads. They investigated the effects of low and high dosages of dexamethasone (0.2 mg/day [normal-DEX] vs. 0.8 mg/day [high-DEX]) before and during hydrochloric acid feeding (5 mmol/kg/day) in paired studies on ADX dogs (N = 7) maintained on constant mineralocorticoid replacement (deoxycorticosterone, corticosterone, aldosterone). Prior to hydrochloric acid feeding, no differences in plasma acid-base composition were observed between the two dosages despite greater endogenous acid production with the higher dosage of DEX, evidenced by greater rates of both net acid excretion (NAE) and the excretion of urinary anions other than chloride, bicarbonate, and phosphate (urine anion gap). During hydrochloric acid feeding, mean plasma bicarbonate (PHCO3) decreased from 21.2 ± 0.4 to 13.7 ± 0.5 (normal-DEX) and from 21.1 ± 0.4 to 15.8 ± 0.4 mEq/liter (high-DEX). The difference in the decrements in PHCO3 between groups was significant (P <0.05). With continued hydrochloric acid feeding in both groups, increasing the DEX dosage from 0.2 to 0.8 mg/day in the normal-DEX group resulted in a significant increase in NAE (ΣΔNAE, +161 mEq, P <0.02) and in PHCO3 (+3.6 ± 0.5 mEq/liter, P <0.01) to steady-state levels by day 10, which were values not significantly different from those in high-DEX. The DEX dose-related increase in NAE was greater than the corresponding increase in endogenous acid production estimated from the change in urine anion gap, and was due largely to an increase in the ammonium excretion, which, because urine pH did not decrease, could not be attributed to increased intraluminal trapping of ammonia as a result of more acidic tubular fluid. These studies indicate that the severity of hydrochloric acid-induced metabolic acidosis in mineralocorticoid-replete ADX dogs can be mitigated by increasing the dosage of exogenous glucocorticoid and suggest that this acidosis mitigating effect is mediated in part by the increased NAE associated with the stimulation of renal ammonia production. These studies further indicate that the rate of production of fixed acids of metabolism increases with an increased dosage of exogenous glucocorticoid, but that this acidosis-producing effect is more than offset by independent stimulation of renal net acid excretion, such that metabolic acidosis is prevented (basal condition) or if present (hydrochloric acid feeding) is significantly ameliorated.