Carotid chemoreceptor role in CSF alkalosis at altitude.
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The results of studies presented may be interpreted in light of the dual contribution theory of regulation of CSF acid-base balance, indicating significant interaction between systemic and local CNS mechanisms in H+ homeostasis in the brain and CSF. Both systemic and local mechanisms are at work in H+ homeostasis in the brain and CSF and depending on the specific acid-base disorder or the duration of the imbalance one or the other of the two factors may be the dominant one in maintaining H+ levels in the "normal" range. These factors come into play only when there has been a change in central pH with the primary aim of bringing the CNS [H+] towards normal.
Six normal volunteers were observed for 24 days on a constant metabolic diet in a study designed to test the hypothesis that the action of parathyroid hormone may be altered by renal acidosis.
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The influence of bicarbonate and Tris-buffer infusions on the performance capacity for maximal, brief exercise (400 m run) was studied using 10 normal males in their twenties. Run time, maximal lactate concentration and heart rate remained unchanged after the buffer infusions. As a result of the induced elevated buffering capacity, the average pH after exercise was about 0.1 unit higher. Corresponding values for base excess and standard bicarbonate were found. The arterial pCO2 was higher after infusion as a result of the active respiratory compensation. Since the reduction in the work-related metabolic acidosis by the buffering substances caused no improvement in performance, the importance of pH as the performance-limiting factor must be questioned because the investigation gave no evidence for alterations of intracellular pH.
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In summary, one should be aware that hyperventilation and hypokalaemia occur frequently in the operating room under ordinary clinical conditions. An awareness of the rapidity with which these changes occur, and their extent as well as their potential hazards, should cause consideration of more aggressive attempts to maintain normocarbia and to use supplemental potassium during anaesthesia, particularly in patients with cardiac disease.
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