The "in vivo" and "in vitro" CO2-equilibration curves of blood during acute hypercapnia and hypocapnia. I. Experimental investigations

Acid-base analysis: a critique of the Stewart and bicarbonate-centered approaches

When approaching the analysis of disorders of acid-base balance, physical chemists, physiologists, and clinicians, tend to focus on different aspects of the relevant phenomenology. The physical chemist focuses on a quantitative understanding of proton hydration and aqueous proton transfer reactions that alter the acidity of a given solution. The physiologist focuses on molecular, cellular, and whole organ transport processes that modulate the acidity of a given body fluid compartment. The clinician emphasizes the diagnosis, clinical causes, and most appropriate treatment of acid-base disturbances. Historically, two different conceptual frameworks have evolved among clinicians and physiologists for interpreting acid-base phenomena. The traditional or bicarbonate-centered framework relies quantitatively on the Henderson-Hasselbalch equation, whereas the Stewart or strong ion approach utilizes either the original Stewart equation or its simplified version derived by Constable. In this review, the concepts underlying the bicarbonate-centered and Stewart formulations are analyzed in detail, emphasizing the differences in how each approach characterizes acid-base phenomenology at the molecular level, tissue level, and in the clinical realm. A quantitative comparison of the equations that are currently used in the literature to calculate H+concentration ([H+]) is included to clear up some of the misconceptions that currently exist in this area. Our analysis demonstrates that while the principle of electroneutrality plays a central role in the strong ion formulation, electroneutrality mechanistically does not dictate a specific [H+], and the strong ion and bicarbonate-centered approaches are quantitatively identical even in the presence of nonbicarbonate buffers. Finally, our analysis indicates that the bicarbonate-centered approach utilizing the Henderson-Hasselbalch equation is a mechanistic formulation that reflects the underlying acid-base phenomenology.

Extracellular bicarbonate and non-bicarbonate buffering against lactic acid during and after exercise

Defense of extracellular pH constancy against lactic acidosis can be estimated from changes (Delta) in lactic acid ([La]), [HCO(3)(-)], pH and PCO(2) in blood plasma because it is equilibrated with the interstitial fluid. These quantities were measured in earlobe blood during and after incremental bicycle exercise in 13 untrained (UT) and 21 endurance-trained (TR) males to find out if acute and chronic exercise influence the defense. During exercise the capacity of non-bicarbonate buffers (beta(nbi) = -Delta[La] . DeltapH(-1) - Delta[HCO(3)(-)] . DeltapH(-1)) available for the extracellular fluid (mainly hemoglobin, dissolved proteins and phosphates) amounted to 32 +/- 2(SEM) and 20 +/- 2 mmol l(-1) in UT and TR, respectively (P < 0.02). During recovery beta(nbi) decreased to 14 (UT) and 12(TR) mmol l(-1) (both P < 0.001) corresponding to values previously found at rest by in vivo CO(2) titration. Bicarbonate buffering (beta(bi)) amounted to 44-48 mmol l(-1) during and after exercise. The large exercise beta(nbi) seems to be mainly caused by an increasing concentration of all buffers due to shrinking of the extracellular volume, exchange of small amounts of HCO(3)(-) or H(+) with cells and delayed HCO(3)(-) equilibration between plasma and interstitial fluid. Increase of [HCO(3)(-)] during titration by these mechanisms augments total beta and thus the calculated beta(nbi) more than beta(bi) because it reduces DeltapH and Delta[HCO(3)(-)] at constant Delta[La]. The smaller rise in exercise beta(nbi) in TR than UT may be caused by an increased extracellular volume and an improved exchange of La(-), HCO(3)(-) and H(+) between trained muscles and blood.

Causes of differences in exercise-induced changes of base excess and blood lactate

It has been concluded from comparisons of base excess (BE) and lactic acid (La) concentration changes in blood during exercise-induced acidosis that more H+ than La- leave the muscle and enter interstitial fluid and blood. To examine this, we performed incremental cycle tests in 13 untrained males and measured acid-base status and [La] in arterialized blood, plasma, and red cells until 21 min after exhaustion. The decrease of actual BE (-deltaABE) was 2.2 +/- 0.5 (SEM) mmol l(-1) larger than the increase of [La]blood at exhaustion, and the difference rose to 4.8 +/- 0.5 mmol l(-1) during the first minutes of recovery. The decrease of standard BE (SBE), a measure of mean BE of interstitial fluid (if) and blood, however, was smaller than the increase of [La] in the corresponding volume (delta[La](if+blood)) during exercise and only slightly larger during recovery. The discrepancy between -deltaABE and delta[La]blood mainly results from the Donnan effect hindering the rise of [La]erythrocyte to equal values like [La]plasma. The changing Donnan effect during acidosis causes that Cl- from the interstitial fluid enter plasma and erythrocytes in exchange for HCO3(-). A corresponding amount of La- remains outside the blood. SBE is not influenced by ion shifts among these compartments and therefore is a rather exact measure of acid movements across tissue cell membranes, but changes have been compared previously to delta[La]blood instead to delta[La](if+blood). When performing correct comparisons and considering Cl-/HCO3(-) exchange between erythrocytes and extracellular fluid, neither the use of deltaABE nor of deltaSBE provides evidence for differences in H+ and La- transport across the tissue cell membranes.

Blood acid-base status, whole blood and whole body buffer values in sand rats (Psammomys obesus) exposed to hypercapnia

Arterial blood acid-base status of unanesthetized sand rats (Psammomys obesus) were studied under normocapnic and hypercapnic conditions, and compared to those obtained for the albino rat (Rattus norvegicus). The average control blood pH: 7.396 +/- 0.034; PaCO2: 30.5 +/- 2.9 mmHg; HCO-3: 18.8 +/- 2.5 mM/l; and HCO-3 std: 20.9 +/- 2.1 (N = 15) obtained here for the sand rat are in the lower range of values found in other mammals and indicate a status of partially compensated metabolic acidosis. The blood buffer values of the sand rat, delta log PCO2/delta pH = -2.32 +/- 0.35 (N = 25) are significantly higher than those found here for the rat, delta log PCO2/delta pH = -1.51 +/- 0.10 (N = 39), and those reported for other mammals. This high blood buffer value may be related to the natural high mineral diet of the sand rat. The in vivo (whole body) buffer value delta log PaCO2/delta pH = -1.41 and -1.65 for the sand rat and the rat found here are higher than those reported for the man and dog and may represent a physiological adaptation to the hypercapnic conditions prevailing in underground burrows.

Effects and post-effects of two-hour exhausting exercise on composition and gas transport functions of blood

Eleven male sport students (age 23.3 +/- 1.7 years) exercised for 2 h on a bicycle ergometer (60 rpm), the braking force of which was regulated to yield a constant pulse rate (156 +/- 3 min-1). Before, at end of, and 3 and 6 h after exercise blood was sampled from a cubital vein and an earlobe for measurement of hemoglobin (Hb) concentration, hematocrit (Hct) value, osmolality (Osm), plasma protein (Prot), sodium (Na+), potassium (K+), inorganic phosphate (Pi), and lactate (Lac) concentrations, red cell 2,3-diphosphoglycerate (DPG) and adenosin triphosphate (ATP) concentrations, acid base status and half saturation pressure (P50) of the oxygen dissociation curve. At end of exercise [Hb], Hct, [Prot], Osm, [K+], [Pi] and [Lac] were significantly elevated, pH in ear lobe (+ 0.04) and venous blood (+ 0.08) was also increased by both respiratory and nonrespiratory effects (BE + 1.4 mmol/l). The oxygen dissociation curve showed an unexplained slight right shift (standard P50 + 0.19 kPa). During the post-exercise period most parameters approximated to control values after only 3 h. [Prot] and especially [Pi], however, remained elevated while [DPG] slightly rose during the post-exercise period. It is suggested that these changes are first signs of adaptation to exercise, perhaps caused by endocrine stimulation.

A mathematical model of the ventilatory control system to carbon dioxide with special reference to athletes and nonathletes

The ventilatory response curve (VRC) as a function of alveolar and arterial pCO2 was recorded in 6 high-performance athletes and 6 nonathletes. The best fit to the data points could be found for an equation of the form (see article) showing that the results are strongly related to a Gaussian probability density function (PDF). After normalizing the equation to a form (see article) (M = mean value of PDF), sigma, A and M could be determined for both groups. Sigma and A are smaller in the athletic group, whereas M did not show any systematic difference. Regarding the respiratory center consisting of functional "elements" responding indirectly to variable pCO2 it can be concluded that the frequency distribution of the different active elements is greater and spread over a wider pCO2 range in the nonathletes with the same mean value in both groups. Using Loeschcke's model (1960), the open loop gain factor for different V CO2 as a function of p(A)CO2 was computed; the gain factor showed a maximum in the physiological range of pCO2.