Trans-cerebral HCO(3)(-) and PCO(2) exchange during acute respiratory acidosis and exercise-induced metabolic acidosis in humans

人类急性呼吸性酸中毒和运动诱发性代谢性酸中毒期间的跨脑HCO₃⁻和PCO₂交换

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Abstract

This study investigated trans-cerebral internal jugular venous-arterial bicarbonate ([HCO(3)(-)]) and carbon dioxide tension (PCO(2)) exchange utilizing two separate interventions to induce acidosis: 1) acute respiratory acidosis via elevations in arterial PCO(2) (PaCO(2)) (n = 39); and 2) metabolic acidosis via incremental cycling exercise to exhaustion (n = 24). During respiratory acidosis, arterial [HCO(3)(-)] increased by 0.15 ± 0.05 mmol ⋅ l(-1) per mmHg elevation in PaCO(2) across a wide physiological range (35 to 60 mmHg PaCO(2); P < 0.001). The narrowing of the venous-arterial [HCO(3)(-)] and PCO(2) differences with respiratory acidosis were both related to the hypercapnia-induced elevations in cerebral blood flow (CBF) (both P < 0.001; subset n = 27); thus, trans-cerebral [HCO(3)(-)] exchange (CBF × venous-arterial [HCO(3)(-)] difference) was reduced indicating a shift from net release toward net uptake of [HCO(3)(-)] (P = 0.004). Arterial [HCO(3)(-)] was reduced by -0.48 ± 0.15 mmol ⋅ l(-1) per nmol ⋅ l(-1) increase in arterial [H(+)] with exercise-induced acidosis (P < 0.001). There was no relationship between the venous-arterial [HCO(3)(-)] difference and arterial [H(+)] with exercise-induced acidosis or CBF; therefore, trans-cerebral [HCO(3)(-)] exchange was unaltered throughout exercise when indexed against arterial [H(+)] or pH (P = 0.933 and P = 0.896, respectively). These results indicate that increases and decreases in systemic [HCO(3)(-)] - during acute respiratory/exercise-induced metabolic acidosis, respectively - differentially affect cerebrovascular acid-base balance (via trans-cerebral [HCO(3)(-)] exchange).

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