diabetestalk.net

Effects Of Metabolic Acidosis On Cardiovascular System

Effects Of Clinically Relevant Acute Hypercapnic And Metabolic Acidosis On The Cardiovascular System: An Experimental Porcine Study.

Effects Of Clinically Relevant Acute Hypercapnic And Metabolic Acidosis On The Cardiovascular System: An Experimental Porcine Study.

A comment on this article appears in " Acidosis in the critically ill - balancing risks and benefits to optimize outcome. " Crit Care. 2014;18(2):129. Hypercapnic acidosis (HCA) that accompanies lung-protective ventilation may be considered permissive (a tolerable side effect), or it may be therapeutic by itself. Cardiovascular effects may contribute to, or limit, the potential therapeutic impact of HCA; therefore, a complex physiological study was performed in healthy pigs to evaluate the systemic and organ-specific circulatory effects of HCA, and to compare them with those of metabolic (eucapnic) acidosis (MAC).In anesthetized, mechanically ventilated and instrumented pigs, HCA was induced by increasing the inspired fraction of CO2 (n = 8) and MAC (n = 8) by the infusion of HCl, to reach an arterial plasma pH of 7.1. In the control group (n = 8), the normal plasma pH was maintained throughout the experiment. Hemodynamic parameters, including regional organ hemodynamics, blood gases, and electrocardiograms, were measured in vivo. Subsequently, isometric contractions and membrane potentials were recorded in vitro in the right ventricular trabeculae.HCA affected both the pulmonary (increase in mean pulmonary arterial pressure (MPAP) and pulmonary vascular resistance (PVR)) and systemic (increase in mean arterial pressure (MAP), decrease in systemic vascular resistance (SVR)) circulations. Although the renal perfusion remained unaffected by any type of acidosis, HCA increased carotid, portal, and, hence, total liver blood flow. MAC influenced the pulmonary circulation only (increase in MPAP and PVR). Both MAC and HCA reduced the stroke volume, which was compensated for by an increase in heart rate to maintain (MAC), or even increase (HCA), the cardiac output. The right v Continue reading >>

Physiological Effects Of Hyperchloraemia And Acidosis

Physiological Effects Of Hyperchloraemia And Acidosis

Physiological effects of hyperchloraemia and acidosis Chelsea and Westminster NHS Foundation Trust Chelsea and Westminster NHS Foundation Trust BJA: British Journal of Anaesthesia, Volume 101, Issue 2, 1 August 2008, Pages 141150, J. M. Handy, N. Soni; Physiological effects of hyperchloraemia and acidosis, BJA: British Journal of Anaesthesia, Volume 101, Issue 2, 1 August 2008, Pages 141150, The advent of balanced solutions for i.v. fluid resuscitation and replacement is imminent and will affect any specialty involved in fluid management. Part of the background to their introduction has focused on the non-physiological nature of normal saline solution and the developing science about the potential problems of hyperchloraemic acidosis. This review assesses the physiological significance of hyperchloraemic acidosis and of acidosis in general. It aims to differentiate the effects of the causes of acidosis from the physiological consequences of acidosis. It is intended to provide an assessment of the importance of hyperchloraemic acidosis and thereby the likely benefits of balanced solutions. Hyperchloraemic acidosis is increasingly recognized as a clinical entity, a new enemy within, that had gone otherwise unnoticed for decades. Although any associated morbidity may be subtle at present, there is a trend in current evidence to suggest that hyperchloraemic acidosis may have adverse consequences which may be circumvented by the use of balanced solutions. These consequences, both theoretical and clinical, may result from hyperchloraemia, acidosis, or both. There is some evidence of hyperchloraemia causing problems, but at present the clinical relevance is uncertain. The literature does appear to be unified in stating that acidosis results in adverse physiological effects bu Continue reading >>

Metabolic Acidosis And Cardiovascular Disease

Metabolic Acidosis And Cardiovascular Disease

Metabolic acidosis can be acute (lasting minutes to a few days) or chronic (lasting weeks to years) in nature. Depression of cardiac function is a common complication of acute metabolic acidosis developing when blood pH is <7.17.2. The response to catecholamines is also muted. The mechanisms underlying these effects are complex involving activation of several channels or transporters. Both a reduction in interstitial and intracellular pH appear to play a role. Administration of base in the form of bicarbonate does not improve cardiac function despite improvement in extracellular pH. This might be related to excess generation of carbon dioxide during the buffering process and a reduction in ionized calcium. The link between chronic metabolic acidosis and cardiovascular disease is less clear. No acute effects have been noted. Some studies suggest acidosis contributes to development of hypertension. A role in genesis of ischemic cardiovascular disease is also postulated. The chapter reviews available information on the impact of acute and chronic metabolic acidosis on cardiovascular function, the possible underlying mechanisms, and the impact of base therapy. Do you want to read the rest of this chapter? Continue reading >>

Metabolic Acidosis

Metabolic Acidosis

Metabolic acidosis occurs when the body produces too much acid. It can also occur when the kidneys are not removing enough acid from the body. There are several types of metabolic acidosis. Diabetic acidosis develops when acidic substances, known as ketone bodies, build up in the body. This most often occurs with uncontrolled type 1 diabetes. It is also called diabetic ketoacidosis and DKA. Hyperchloremic acidosis results from excessive loss of sodium bicarbonate from the body. This can occur with severe diarrhea. Lactic acidosis results from a buildup of lactic acid. It can be caused by: Alcohol Cancer Exercising intensely Liver failure Medicines, such as salicylates Other causes of metabolic acidosis include: Kidney disease (distal renal tubular acidosis and proximal renal tubular acidosis) Poisoning by aspirin, ethylene glycol (found in antifreeze), or methanol Continue reading >>

Bicarbonate Therapy In Severe Metabolic Acidosis

Bicarbonate Therapy In Severe Metabolic Acidosis

Abstract The utility of bicarbonate administration to patients with severe metabolic acidosis remains controversial. Chronic bicarbonate replacement is obviously indicated for patients who continue to lose bicarbonate in the ambulatory setting, particularly patients with renal tubular acidosis syndromes or diarrhea. In patients with acute lactic acidosis and ketoacidosis, lactate and ketone bodies can be converted back to bicarbonate if the clinical situation improves. For these patients, therapy must be individualized. In general, bicarbonate should be given at an arterial blood pH of ≤7.0. The amount given should be what is calculated to bring the pH up to 7.2. The urge to give bicarbonate to a patient with severe acidemia is apt to be all but irresistible. Intervention should be restrained, however, unless the clinical situation clearly suggests benefit. Here we discuss the pros and cons of bicarbonate therapy for patients with severe metabolic acidosis. Metabolic acidosis is an acid-base disorder characterized by a primary consumption of body buffers including a fall in blood bicarbonate concentration. There are many causes (Table 1), and there are multiple mechanisms that minimize the fall in arterial pH. A patient with metabolic acidosis may have a normal or even high pH if there is another primary, contravening event that raises the bicarbonate concentration (vomiting) or lowers the arterial Pco2 (respiratory alkalosis). Metabolic acidosis differs from “acidemia” in that the latter refers solely to a fall in blood pH and not the process. A recent online survey by Kraut and Kurtz1 highlighted the uncertainty over when to give bicarbonate to patients with metabolic acidosis. They reported that nephrologists will prescribe therapy at a higher pH compared with Continue reading >>

Effects Of Clinically Relevant Acute Hypercapnic And Metabolic Acidosis On The Cardiovascular System: An Experimental Porcine Study

Effects Of Clinically Relevant Acute Hypercapnic And Metabolic Acidosis On The Cardiovascular System: An Experimental Porcine Study

Effects of clinically relevant acute hypercapnic and metabolic acidosis on the cardiovascular system: an experimental porcine study 1Department of Physiology, Faculty of Medicine in Pilsen, Charles University in Prague, Pilsen, Czech Republic 4Biomedical Center, Faculty of Medicine in Pilsen, Charles University in Prague, Pilsen, Czech Republic 2First Medical Department, Faculty of Medicine in Pilsen, Charles University in Prague, Pilsen, Czech Republic 4Biomedical Center, Faculty of Medicine in Pilsen, Charles University in Prague, Pilsen, Czech Republic 2First Medical Department, Faculty of Medicine in Pilsen, Charles University in Prague, Pilsen, Czech Republic 4Biomedical Center, Faculty of Medicine in Pilsen, Charles University in Prague, Pilsen, Czech Republic 3Department of Anesthesiology and Critical Care Medicine, Faculty of Medicine in Pilsen, Charles University in Prague, Pilsen, Czech Republic 4Biomedical Center, Faculty of Medicine in Pilsen, Charles University in Prague, Pilsen, Czech Republic 1Department of Physiology, Faculty of Medicine in Pilsen, Charles University in Prague, Pilsen, Czech Republic 4Biomedical Center, Faculty of Medicine in Pilsen, Charles University in Prague, Pilsen, Czech Republic 1Department of Physiology, Faculty of Medicine in Pilsen, Charles University in Prague, Pilsen, Czech Republic 4Biomedical Center, Faculty of Medicine in Pilsen, Charles University in Prague, Pilsen, Czech Republic 2First Medical Department, Faculty of Medicine in Pilsen, Charles University in Prague, Pilsen, Czech Republic 4Biomedical Center, Faculty of Medicine in Pilsen, Charles University in Prague, Pilsen, Czech Republic 1Department of Physiology, Faculty of Medicine in Pilsen, Charles University in Prague, Pilsen, Czech Republic 2First Medical Depar Continue reading >>

Effects Of Respiratory Alkalosis And Acidosis On Myocardial Blood Flow And Metabolism In Patients With Coronary Artery Disease | Anesthesiology | Asa Publications

Effects Of Respiratory Alkalosis And Acidosis On Myocardial Blood Flow And Metabolism In Patients With Coronary Artery Disease | Anesthesiology | Asa Publications

Effects of Respiratory Alkalosis and Acidosis on Myocardial Blood Flow and Metabolism in Patients with Coronary Artery Disease (Weyland, Rieke) Associate Professor of Anesthesiology. (Stephan, Sonntag) Professor of Anesthesiology. Effects of Respiratory Alkalosis and Acidosis on Myocardial Blood Flow and Metabolism in Patients with Coronary Artery Disease Anesthesiology 10 1998, Vol.89, 831-837. doi: Anesthesiology 10 1998, Vol.89, 831-837. doi: Stephan Kazmaier, Andreas Weyland, Wolfgang Buhre, Heidrun Stephan, Horst Rieke, Klaus Filoda, Hans Sonntag; Effects of Respiratory Alkalosis and Acidosis on Myocardial Blood Flow and Metabolism in Patients with Coronary Artery Disease . Anesthesiology 1998;89(4):831-837. 2018 American Society of Anesthesiologists Effects of Respiratory Alkalosis and Acidosis on Myocardial Blood Flow and Metabolism in Patients with Coronary Artery Disease You will receive an email whenever this article is corrected, updated, or cited in the literature. You can manage this and all other alerts in My Account ALTHOUGH unintended or deliberate variation of the arterial carbon dioxide partial pressure (PaCO2) is common in anesthetic practice, little is known about the myocardial consequences of respiratory alkalosis and acidosis in humans. Previous experimental studies have shown inconsistent results with respect to the effects of PaCO2on myocardial blood flow (MBF), myocardial metabolism, and global hemodynamics. This may have been caused in part by differences in the experimental design of the investigations. [1-6] Although most studies have shown that hypercapnia augments MBF above metabolic demands, [3,7-9] the results with respect to the effects of hypocapnia vary. [3,4] Furthermore, it seems questionable to transfer conclusions from experiment Continue reading >>

5.4 Metabolic Acidosis - Metabolic Effects

5.4 Metabolic Acidosis - Metabolic Effects

5.4 Metabolic Acidosis - Metabolic Effects A metabolic acidosis can cause significant physiological effects, particularly affecting the respiratory and cardiovascular systems. Hyperventilation ( Kussmaul respirations ) - this is the compensatory response Shift of oxyhaemoglobin dissociation curve (ODC) to the right Decreased 2,3 DPG levels in red cells (shifting the ODC back to the left) Sympathetic overactivity (incl tachycardia, vasoconstriction,decreased arrhythmia threshold) Resistance to the effects of catecholamines Increased bone resorption (chronic acidosis only) Shift of K+ out of cells causing hyperkalaemia 5.4.2 Some Effects have Opposing Actions. The cardiac stimulatory effects of sympathetic activity and release of catecholamines usually counteract the direct myocardial depression while plasma pH remains above 7.2. At systemic pH values less than this, the direct depression of contractility usually predominates. The direct vasodilatation is offset by the indirect sympathetically mediated vasoconstriction and cardiac stimulation during a mild acidosis. The venoconstriction shifts blood centrally and this causes pulmonary congestion. Pulmonary artery pressure usually rises during acidosis. The shift of the oxygen dissociation curve to the right due to the acidosis occurs rapidly. After 6 hours of acidosis, the red cell levels of 2,3 DPG have declined enough to shift the oxygen dissociation curve (ODC) back to normal. Acidosis is commonly said to cause hyperkalaemia by a shift of potassium out of cells. The effect on potassium levels is extremely variable and indirect effects due to the type of acidosis present are much more important. For example hyperkalaemia is due to renal failure in uraemic acidosis rather than the acidosis. Significant potassium loss du Continue reading >>

Early Administration Of Glutamine Protects Cardiomyocytes From Post-cardiac Arrest Acidosis

Early Administration Of Glutamine Protects Cardiomyocytes From Post-cardiac Arrest Acidosis

Early Administration of Glutamine Protects Cardiomyocytes from Post-Cardiac Arrest Acidosis 1Department of Emergency Medicine, Changhua Christian Hospital, Changhua, Taiwan 2School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan 3School of Medicine, Chung Shan Medical University, Taichung, Taiwan 4Department of Emergency Medicine, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan 5Department of Public Health, College of Health Science, Kaohsiung Medical University, Kaohsiung, Taiwan 6Bioresource Collection and Research Center, Food Industry Research and Development Institute, Hsinchu, Taiwan 7Department of Biological Science and Technology, National Chiao Tung University, Hsinchu, Taiwan 8Interdisciplinary Graduate Program in Genetic Engineering, Graduate School, Kasetsart University, Bangkhen Campus, Bangkok, Thailand 9Division of Pediatric General Medicine, Department of Pediatrics, Chang Gung Memorial Hospital at Linkou, Kweishan, Taoyuan, Taiwan 10College of Medicine, Chang Gung University, Taoyuan, Taiwan Received 14 September 2016; Accepted 14 November 2016 Copyright 2016 Yan-Ren Lin et al. This is an open access article distributed under the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Postcardiac arrest acidosis can decrease survival. Effective medications without adverse side effects are still not well characterized. We aimed to analyze whether early administration of glutamine could improve survival and protect cardiomyocytes from postcardiac arrest acidosis using animal and cell models. Forty Wistar rats with postcardiac arrest acidosis (blood pH < 7.2) were includ Continue reading >>

Effects Of Clinically Relevant Acute Hypercapnic And Metabolic Acidosis On The Cardiovascular System: An Experimental Porcine Study.

Effects Of Clinically Relevant Acute Hypercapnic And Metabolic Acidosis On The Cardiovascular System: An Experimental Porcine Study.

Generate a file for use with external citation management software. Crit Care. 2013 Dec 30;17(6):R303. doi: 10.1186/cc13173. Effects of clinically relevant acute hypercapnic and metabolic acidosis on the cardiovascular system: an experimental porcine study. Hypercapnic acidosis (HCA) that accompanies lung-protective ventilation may be considered permissive (a tolerable side effect), or it may be therapeutic by itself. Cardiovascular effects may contribute to, or limit, the potential therapeutic impact of HCA; therefore, a complex physiological study was performed in healthy pigs to evaluate the systemic and organ-specific circulatory effects of HCA, and to compare them with those of metabolic (eucapnic) acidosis (MAC). In anesthetized, mechanically ventilated and instrumented pigs, HCA was induced by increasing the inspired fraction of CO2 (n = 8) and MAC (n = 8) by the infusion of HCl, to reach an arterial plasma pH of 7.1. In the control group (n = 8), the normal plasma pH was maintained throughout the experiment. Hemodynamic parameters, including regional organ hemodynamics, blood gases, and electrocardiograms, were measured in vivo. Subsequently, isometric contractions and membrane potentials were recorded in vitro in the right ventricular trabeculae. HCA affected both the pulmonary (increase in mean pulmonary arterial pressure (MPAP) and pulmonary vascular resistance (PVR)) and systemic (increase in mean arterial pressure (MAP), decrease in systemic vascular resistance (SVR)) circulations. Although the renal perfusion remained unaffected by any type of acidosis, HCA increased carotid, portal, and, hence, total liver blood flow. MAC influenced the pulmonary circulation only (increase in MPAP and PVR). Both MAC and HCA reduced the stroke volume, which was compensate Continue reading >>

Metabolic Acidosis And Cardiovascular Disease In Patients On Peritoneal Dialysis

Metabolic Acidosis And Cardiovascular Disease In Patients On Peritoneal Dialysis

Metabolic Acidosis and Cardiovascular Disease in Patients on Peritoneal Dialysis Vaia D. Raikou1Anastasia Evaggelatou2Despina Kyriaki2 1Dpt of Medicine - Propaedaetic, National & Kapodistrian University of Athens, School of Medicine. 2Dpt of Nuclear Medicine. General Hospital LAKO, S, GREECE Metabolic acidosis, a common condition particularly in end stage renal disease patients, results in malnutrition and inflammation. In this study, we focused on the importance of metabolic acidosis on manifestations of cardiovascular disease in patients on peritoneal dialysis. We studied 20 patients on continuous ambulatory peritoneal dialysis (CAPD), 15 males and 5 females, on mean age 61.6 11.3 years old. Metabolic acidosis was determined by serum bicarbonate concentrations less than 22mmol/L, which were measured in gas machine. Dialysis adequacy was defined by total Kt/V/week for urea including peritoneal Kt/V for urea and residual GFR (ml/min/1.73m2). High sensitivity C-reactive protein (hsCRP) was measured using enzyme linked immunoabsorbed assay (LISA). The concentrations of intact-parathormone(i-PTH) and beta2-microglobulin (beta2M) were measured by radioimmunoassays. Arterial stiffness was measured as carotid-femoral pulse wave velocity (c-f PWV) and augmentation index (AIx). We built a Cox regression analysis to predict coronary artery disease (CAD), congestive heart failure (CHF) and peripheral vascular disease (PVD). Serum bicarbonate levels were inversely associated to beta2M, i-PTH and AIx (r=-0.451, p=0.04, r=-0.477, p=0.03 and r=-0.569, p=0.009 respectively). Cox- regression analysis revealed significant association of serum bicarbonate levels and PVD having as confounders traditional and specific for these patients risk factors. Metabolic acidosis may be an independe Continue reading >>

Cardiovascular Complications Of Ketoacidosis

Cardiovascular Complications Of Ketoacidosis

US Pharm. 2016;41(2):39-42. ABSTRACT: Ketoacidosis is a serious medical emergency requiring hospitalization. It is most commonly associated with diabetes and alcoholism, but each type is treated differently. Some treatments for ketoacidosis, such as insulin and potassium, are considered high-alert medications, and others could result in electrolyte imbalances. Several cardiovascular complications are associated with ketoacidosis as a result of electrolyte imbalances, including arrhythmias, ECG changes, ventricular tachycardia, and cardiac arrest, which can be prevented with appropriate initial treatment. Acute myocardial infarction can predispose patients with diabetes to ketoacidosis and worsen their cardiovascular outcomes. Cardiopulmonary complications such as pulmonary edema and respiratory failure have also been seen with ketoacidosis. Overall, the mortality rate of ketoacidosis is low with proper and urgent medical treatment. Hospital pharmacists can help ensure standardization and improve the safety of pharmacotherapy for ketoacidosis. In the outpatient setting, pharmacists can educate patients on prevention of ketoacidosis and when to seek medical attention. Metabolic acidosis occurs as a result of increased endogenous acid production, a decrease in bicarbonate, or a buildup of endogenous acids.1 Ketoacidosis is a metabolic disorder in which regulation of ketones is disrupted, leading to excess secretion, accumulation, and ultimately a decrease in the blood pH.2 Acidosis is defined by a serum pH <7.35, while a pH <6.8 is considered incompatible with life.1,3 Ketone formation occurs by breakdown of fatty acids. Insulin inhibits beta-oxidation of fatty acids; thus, low levels of insulin accelerate ketone formation, which can be seen in patients with diabetes. Extr Continue reading >>

Acidosis And Contractility Of Heart Muscle.

Acidosis And Contractility Of Heart Muscle.

Acidosis and contractility of heart muscle. The contractility of heart muscle is sensitive to small and physiological changes of extracellular pH. The reduction of contractility associated with an acidosis is determined by the fall of pH in the intracellular fluid. The function of many organelles within the cardiac cell is affected by hydrogen ions. The tension generated by isolated myofibrils at a fixed calcium concentration is reduced at low pH. The dominant mechanism for the reduction of contractility in whole tissue is competitive inhibition of the slow calcium current by hydrogen ions. The reduction of the slow calcium current is similar when the same fall of developed tension is induced by acidosis or by a reduction of extracellular calcium concentration. Measurement of tissue pH with fast-responding extracellular electrodes show that, in myocardial ischaemia, tissue acidosis develops at the same time or only seconds before the onset of contractile failure. Much of the reduced contractility can be accounted for by the severity of the acidosis. Although a mild acidosis can delay or prevent damage to the myocardium from ischaemia or hypoxia, a severe acidosis is not beneficial and may even cause tissue necrosis. Continue reading >>

Should Chronic Metabolic Acidosis Be Treated In Older People With Chronic Kidney Disease?

Should Chronic Metabolic Acidosis Be Treated In Older People With Chronic Kidney Disease?

Should chronic metabolic acidosis be treated in older people with chronic kidney disease? Correspondence and offprint requests to: Miles D. Witham; E-mail: [email protected] Search for other works by this author on: Clinical Biochemistry, Department of Laboratory Medicine East Kent Hospitals University NHS Foundation Trust Nephrology Dialysis Transplantation, Volume 31, Issue 11, 1 November 2016, Pages 17961802, Miles D. Witham, Edmund J. Lamb; Should chronic metabolic acidosis be treated in older people with chronic kidney disease?, Nephrology Dialysis Transplantation, Volume 31, Issue 11, 1 November 2016, Pages 17961802, Metabolic acidosis is common in advanced chronic kidney disease and has been associated with a range of physiological derangements of importance to the health of older people. These include associations with skeletal muscle weakness, cardiovascular risk factors, and bone and mineral disorders that may lead to fragility fractures. Although metabolic acidosis is associated with accelerated decline in kidney function, end-stage renal failure is a much less common outcome in older, frail patients than cardiovascular death. Correction of metabolic acidosis using bicarbonate therapy is commonly employed, but the existing evidence is insufficient to know whether such therapy is of net benefit to older people. Bicarbonate is bulky and awkward to take, may impose additional sodium load with effects on fluid retention and blood pressure, and may cause gastrointestinal side effects. Trial data to date suggest potential benefits of bicarbonate therapy on progression of renal disease and nutrition, but trials have not as yet been published examining the effect of bicarbonate therapy across a range of domains relevant to the health of older people. Fortunately Continue reading >>

The Effects Of Acid-base Disturbances On Cardiovascular And Pulmonary Function - Sciencedirect

The Effects Of Acid-base Disturbances On Cardiovascular And Pulmonary Function - Sciencedirect

The effects of acid-base disturbances on cardiovascular and pulmonary function Author links open overlay panel Jere H.Mitchell1 Disturbances in acid-base balance are commonly met problems in clinical medicine and decisions about their treatment are of great importance in patients with cardiopulmonary problems, in whom acid-base disturbances may be especially critical.Similarly, cardiopulmonary function may be significantly compromised even in patients with no intrinsic heart or lung disease, in the face of acid-base disturbances.It is essential, therefore, to understand the physiological consequences of these disturbances on the cardiovascular and pulmonary system. Of major importance is the effect of acid-base disturbances on the delivery of oxygen to the various tissue cells of the body.In order to understand all the pathophysiological mechanisms involved it is necessary to review the effects of acid-base changes on the heart, the peripheral vessels, the lungs, and the diffusion of oxygen between air, blood, and tissues. The requirement for oxygen by the various tissue cells of the body is met by the combined cardiovascular and pulmonary systems, which function as a unit termed the oxygen transport system of the body.The movement of oxygen from the ambient air to the tissue cells involves ventilation, pulmonary perfusion, diffusion, oxygen-carrying capacity of hemoglobin, cardiac output (including cardiac muscle performance), systemic distribution of flow, and finally the oxygen delivery capacity of hemoglobin.It is important to understand the effects of changes in pH on each of these steps in the chain. Continue reading >>

More in ketosis