Metabolic Acidosis, Bilirubin, and Kernicterus - USMLE Forums
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Old 10-06-2014
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Default Metabolic Acidosis, Bilirubin, and Kernicterus

Can anyone explain the mechanism by which metabolic acidosis reduces the binding of bilirubin to albumin leading to --> more free unconjugated bilirubin that --> crosses the BBB --> leading to kernicterus?

I understand the latter part of the story. I'm just unclear as to how low pH, bilirubin (anions or acid), and the charge of albumin are all related.

Any insight on this would be much appreciated! Thanks!!
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Old 10-06-2014
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Quote:
Originally Posted by phlebgirl View Post
Can anyone explain the mechanism by which metabolic acidosis reduces the binding of bilirubin to albumin leading to --> more free unconjugated bilirubin that --> crosses the BBB --> leading to kernicterus?

I understand the latter part of the story. I'm just unclear as to how low pH, bilirubin (anions or acid), and the charge of albumin are all related.

Any insight on this would be much appreciated! Thanks!!
http://www.ncbi.nlm.nih.gov/pubmed/7359254 - the last sentence is pretty good .
http://www.ncbi.nlm.nih.gov/pubmed/33528

The mechanism is may be similar with hypocalcemia during alkalosis. Alkalosis increases albumin affinity to Ca, which lead to hypocalcemia. And vice versa.
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Old 11-03-2014
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the mechanism by which acidosis leads to increased neuronal binding or brain uptake of bilirubin relates to the conversion of bilirubin anion to a bilirubin acid an acceptance of two hydrogen ions.As bilirubin anions binds to cationic cellular surfaces this electrostatic interaction is followed rapidly by the formation of bilirubin acid ,this effect of acidosis when exert at the level of endothelial cells of BBB perhaps could lead to increased transport of of bilirubin across the barrier into the brain ,and bilirubin acid may be less avidly bind to albumin as compared to bilirubin may be but not sure
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