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|000005a0| 71 75 65 5f 49 44 7b 59 | 52 42 30 31 31 30 30 7d |que_ID{Y|RB01100}|
|000005b0| 0d 0a 24 54 69 74 6c 65 | 7b 70 48 2d 44 65 70 65 |..$Title|{pH-Depe|
|000005c0| 6e 64 65 6e 74 20 45 66 | 66 65 63 74 73 20 6f 66 |ndent Ef|fects of|
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|000005f0| 72 67 79 20 52 65 71 75 | 69 72 65 6d 65 6e 74 73 |rgy Requ|irements|
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|00000630| 44 52 7d 0d 0a 24 41 66 | 66 69 6c 69 61 74 69 6f |DR}..$Af|filiatio|
|00000640| 6e 7b 56 61 6e 64 65 72 | 62 69 6c 74 20 55 6e 69 |n{Vander|bilt Uni|
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|00000660| 63 75 6c 61 74 69 6f 6e | 7d 0d 0a 24 56 6f 6c 75 |culation|}..$Volu|
|00000670| 6d 65 7b 38 30 7d 0d 0a | 24 50 61 67 65 7b 31 30 |me{80}..|$Page{10|
|00000680| 30 33 2d 31 30 30 39 7d | 0d 0a 24 44 61 74 65 7b |03-1009}|..$Date{|
|00000690| 31 39 38 39 7d 0d 0a 24 | 59 42 56 6f 6c 7b 31 39 |1989}..$|YBVol{19|
|000006a0| 39 31 20 59 65 61 72 20 | 42 6f 6f 6b 20 6f 66 20 |91 Year |Book of |
|000006b0| 45 6d 65 72 67 65 6e 63 | 79 20 4d 65 64 69 63 69 |Emergenc|y Medici|
|000006c0| 6e 65 7d 0d 0a 24 43 68 | 61 70 74 65 72 7b 31 2d |ne}..$Ch|apter{1-|
|000006d0| 35 7d 0d 0a 24 59 42 45 | 64 69 74 6f 72 7b 44 72 |5}..$YBE|ditor{Dr|
|000006e0| 73 2e 20 57 61 67 6e 65 | 72 2c 20 42 75 72 64 69 |s. Wagne|r, Burdi|
|000006f0| 63 6b 2c 20 44 61 76 69 | 64 73 6f 6e 2c 20 52 6f |ck, Davi|dson, Ro|
|00000700| 62 65 72 74 73 2c 20 61 | 6e 64 20 53 70 69 76 65 |berts, a|nd Spive|
|00000710| 79 7d 0d 0a 24 54 61 62 | 6c 65 7b 7d 0d 0a 24 43 |y}..$Tab|le{}..$C|
|00000720| 6f 6d 6d 65 6e 74 61 74 | 6f 72 7b 4a 2e 20 4e 69 |ommentat|or{J. Ni|
|00000730| 65 6d 61 6e 6e 2c 20 4d | 2e 44 2e 7d 0d 0a 0d 0a |emann, M|.D.}....|
|00000740| 43 6f 70 79 72 69 67 68 | 74 20 28 43 29 20 59 65 |Copyrigh|t (C) Ye|
|00000750| 61 72 20 42 6f 6f 6b 20 | 4d 65 64 69 63 61 6c 20 |ar Book |Medical |
|00000760| 50 75 62 6c 69 73 68 65 | 72 73 2c 20 49 6e 63 2e |Publishe|rs, Inc.|
|00000770| 20 31 39 39 31 0d 0a 0d | 0a 31 39 39 31 20 59 65 | 1991...|.1991 Ye|
|00000780| 61 72 20 42 6f 6f 6b 20 | 6f 66 20 45 6d 65 72 67 |ar Book |of Emerg|
|00000790| 65 6e 63 79 20 4d 65 64 | 69 63 69 6e 65 0d 0a 0d |ency Med|icine...|
|000007a0| 0a 43 68 61 70 74 65 72 | 20 31 20 2d 2d 20 41 63 |.Chapter| 1 -- Ac|
|000007b0| 75 74 65 20 53 79 73 74 | 65 6d 73 20 50 61 74 68 |ute Syst|ems Path|
|000007c0| 6f 70 68 79 73 69 6f 6c | 6f 67 79 0d 0a 0d 0a 2d |ophysiol|ogy....-|
|000007d0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000007e0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000007f0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00000800| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00000810| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 0d 0a 70 |--------|-----..p|
|00000820| 48 2d 44 65 70 65 6e 64 | 65 6e 74 20 45 66 66 65 |H-Depend|ent Effe|
|00000830| 63 74 73 20 6f 66 20 4c | 69 64 6f 63 61 69 6e 65 |cts of L|idocaine|
|00000840| 20 6f 6e 20 44 65 66 69 | 62 72 69 6c 6c 61 74 69 | on Defi|brillati|
|00000850| 6f 6e 20 45 6e 65 72 67 | 79 20 52 65 71 75 69 72 |on Energ|y Requir|
|00000860| 65 6d 65 6e 74 73 20 69 | 6e 0d 0a 44 6f 67 73 0d |ements i|n..Dogs.|
|00000870| 0a 0d 0a 45 63 68 74 20 | 44 53 3b 20 43 61 74 6f |...Echt |DS; Cato|
|00000880| 20 45 4c 3b 20 43 6f 78 | 65 20 44 52 0d 0a 28 56 | EL; Cox|e DR..(V|
|00000890| 61 6e 64 65 72 62 69 6c | 74 20 55 6e 69 76 29 0d |anderbil|t Univ).|
|000008a0| 0a 43 69 72 63 75 6c 61 | 74 69 6f 6e 20 38 30 3a |.Circula|tion 80:|
|000008b0| 31 30 30 33 2d 31 30 30 | 39 2c 20 31 39 38 39 0d |1003-100|9, 1989.|
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|00000910| 0a 0d 0a 41 62 73 74 72 | 61 63 74 0d 0a 0d 0a 20 |...Abstr|act.... |
|00000920| 20 20 20 20 4c 69 64 6f | 63 61 69 6e 65 20 73 75 |    Lido|caine su|
|00000930| 70 70 72 65 73 73 65 73 | 20 63 61 72 64 69 61 63 |ppresses| cardiac|
|00000940| 20 61 72 72 68 79 74 68 | 6d 69 61 73 20 61 6e 64 | arrhyth|mias and|
|00000950| 20 69 6e 63 72 65 61 73 | 65 73 20 74 68 65 20 65 | increas|es the e|
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|00000b70| 54 68 65 72 61 70 65 75 | 74 69 63 20 6c 69 64 6f |Therapeu|tic lido|
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|00000bb0| 20 41 63 69 64 6f 73 69 | 73 20 65 78 61 63 65 72 | Acidosi|s exacer|
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|00000c60| 34 20 74 6f 20 37 2e 36 | 2c 20 77 68 69 63 68 20 |4 to 7.6|, which |
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|00003730| 6b 20 4d 41 3b 20 53 61 | 6e 64 65 72 73 20 41 42 |k MA; Sa|nders AB|
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|000037c0| 37 3a 37 38 36 2d 37 39 | 31 2c 20 31 39 38 39 0d |7:786-79|1, 1989.|
|000037d0| 0a 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |.-------|--------|
|000037e0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000037f0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00003800| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00003810| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 0d |--------|-------.|
|00003820| 0a 0d 0a 41 62 73 74 72 | 61 63 74 0d 0a 0d 0a 20 |...Abstr|act.... |
|00003830| 20 20 20 20 45 78 74 72 | 61 6f 72 64 69 6e 61 72 |    Extr|aordinar|
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|00004050| 20 45 50 49 20 6c 65 76 | 65 6c 73 2e 20 20 57 65 | EPI lev|els.  We|
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|000040c0| 30 20 6d 69 6e 75 74 65 | 73 20 77 68 69 63 68 0d |0 minute|s which.|
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|000041d0| 6f 77 65 72 20 62 6c 6f | 6f 64 20 70 72 65 73 73 |ower blo|od press|
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|00004440| 2d 2d 57 2e 48 2e 20 53 | 70 69 76 65 79 2c 0d 0a |--W.H. S|pivey,..|
|00004450| 4d 2e 44 2e 0d 0a 24 55 | 6e 69 71 75 65 5f 49 44 |M.D...$U|nique_ID|
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|000046f0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00004700| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00004710| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00004720| 2d 0d 0a 4d 65 74 61 62 | 6f 6c 69 63 20 61 6e 64 |-..Metab|olic and|
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|00004770| 6e 0d 0a 50 61 74 69 65 | 6e 74 73 20 57 69 74 68 |n..Patie|nts With|
|00004780| 20 48 65 61 72 74 20 44 | 69 73 65 61 73 65 0d 0a | Heart D|isease..|
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|00004810| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00004820| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00004830| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00004840| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00004850| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 0d 0a 0d 0a |--------|----....|
|00004860| 41 62 73 74 72 61 63 74 | 0d 0a 0d 0a 20 20 20 20 |Abstract|....    |
|00004870| 20 54 68 65 20 75 73 65 | 20 6f 66 20 73 6f 64 69 | The use| of sodi|
|00004880| 75 6d 20 62 69 63 61 72 | 62 6f 6e 61 74 65 20 28 |um bicar|bonate (|
|00004890| 4e 61 48 43 4f 33 29 20 | 69 6e 20 70 61 74 69 65 |NaHCO3) |in patie|
|000048a0| 6e 74 73 20 77 69 74 68 | 20 63 61 72 64 69 6f 70 |nts with| cardiop|
|000048b0| 75 6c 6d 6f 6e 61 72 79 | 0d 0a 61 72 72 65 73 74 |ulmonary|..arrest|
|000048c0| 20 68 61 73 20 62 65 65 | 6e 20 71 75 65 73 74 69 | has bee|n questi|
|000048d0| 6f 6e 65 64 2e 20 20 54 | 68 65 20 69 6e 63 72 65 |oned.  T|he incre|
|000048e0| 61 73 65 20 69 6e 20 69 | 6e 74 72 61 63 65 6c 6c |ase in i|ntracell|
|000048f0| 75 6c 61 72 20 63 61 72 | 62 6f 6e 20 64 69 6f 78 |ular car|bon diox|
|00004900| 69 64 65 20 66 72 6f 6d | 0d 0a 4e 61 48 43 4f 33 |ide from|..NaHCO3|
|00004910| 20 69 6e 66 75 73 69 6f | 6e 20 63 61 6e 20 65 78 | infusio|n can ex|
|00004920| 61 63 65 72 62 61 74 65 | 20 74 68 65 20 69 6e 74 |acerbate| the int|
|00004930| 72 61 63 65 6c 6c 75 6c | 61 72 20 61 63 69 64 6f |racellul|ar acido|
|00004940| 73 69 73 20 61 6c 72 65 | 61 64 79 20 70 72 65 73 |sis alre|ady pres|
|00004950| 65 6e 74 20 69 6e 0d 0a | 68 79 70 6f 78 69 63 20 |ent in..|hypoxic |
|00004960| 73 74 61 74 65 73 20 61 | 6e 64 20 63 61 72 64 69 |states a|nd cardi|
|00004970| 6f 70 75 6c 6d 6f 6e 61 | 72 79 20 61 72 72 65 73 |opulmona|ry arres|
|00004980| 74 2e 20 20 42 65 63 61 | 75 73 65 20 74 68 65 20 |t.  Beca|use the |
|00004990| 63 6c 69 6e 69 63 61 6c | 20 63 69 72 63 75 6d 73 |clinical| circums|
|000049a0| 74 61 6e 63 65 73 0d 0a | 6f 66 20 70 61 74 69 65 |tances..|of patie|
|000049b0| 6e 74 73 20 77 69 74 68 | 20 68 65 61 72 74 20 66 |nts with| heart f|
|000049c0| 61 69 6c 75 72 65 20 61 | 72 65 20 73 69 6d 69 6c |ailure a|re simil|
|000049d0| 61 72 20 74 6f 20 70 61 | 74 69 65 6e 74 73 20 69 |ar to pa|tients i|
|000049e0| 6e 20 63 61 72 64 69 6f | 70 75 6c 6d 6f 6e 61 72 |n cardio|pulmonar|
|000049f0| 79 0d 0a 61 72 72 65 73 | 74 2c 20 61 6c 74 68 6f |y..arres|t, altho|
|00004a00| 75 67 68 20 6e 6f 74 20 | 61 73 20 73 65 76 65 72 |ugh not |as sever|
|00004a10| 65 2c 20 74 68 65 20 65 | 66 66 65 63 74 73 20 6f |e, the e|ffects o|
|00004a20| 66 20 4e 61 48 43 4f 33 | 20 69 6e 20 70 61 74 69 |f NaHCO3| in pati|
|00004a30| 65 6e 74 73 20 77 69 74 | 68 0d 0a 63 6f 6e 67 65 |ents wit|h..conge|
|00004a40| 73 74 69 76 65 20 68 65 | 61 72 74 20 66 61 69 6c |stive he|art fail|
|00004a50| 75 72 65 20 77 65 72 65 | 20 73 74 75 64 69 65 64 |ure were| studied|
|00004a60| 20 70 72 6f 73 70 65 63 | 74 69 76 65 6c 79 2e 20 | prospec|tively. |
|00004a70| 20 54 65 6e 20 70 61 74 | 69 65 6e 74 73 20 77 69 | Ten pat|ients wi|
|00004a80| 74 68 20 73 74 61 62 6c | 65 0d 0a 63 6f 6e 67 65 |th stabl|e..conge|
|00004a90| 73 74 69 76 65 20 68 65 | 61 72 74 20 66 61 69 6c |stive he|art fail|
|00004aa0| 75 72 65 20 72 65 63 65 | 69 76 65 64 20 4e 61 48 |ure rece|ived NaH|
|00004ab0| 43 4f 33 20 61 6e 64 20 | 63 6f 6e 74 72 6f 6c 20 |CO3 and |control |
|00004ac0| 69 6e 66 75 73 69 6f 6e | 73 20 6f 66 20 65 71 75 |infusion|s of equ|
|00004ad0| 69 6d 6f 6c 61 72 0d 0a | 73 6f 64 69 75 6d 20 63 |imolar..|sodium c|
|00004ae0| 68 6c 6f 72 69 64 65 20 | 28 4e 61 43 6c 29 2c 20 |hloride |(NaCl), |
|00004af0| 61 6e 64 20 74 68 65 20 | 6d 65 74 61 62 6f 6c 69 |and the |metaboli|
|00004b00| 63 20 61 6e 64 20 68 65 | 6d 6f 64 79 6e 61 6d 69 |c and he|modynami|
|00004b10| 63 20 63 6f 6e 73 65 71 | 75 65 6e 63 65 73 20 6f |c conseq|uences o|
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|00004b30| 6e 73 20 77 65 72 65 20 | 65 76 61 6c 75 61 74 65 |ns were |evaluate|
|00004b40| 64 2e 0d 0a 20 20 20 20 | 20 41 72 74 65 72 69 61 |d...    | Arteria|
|00004b50| 6c 20 6f 78 79 67 65 6e | 20 74 65 6e 73 69 6f 6e |l oxygen| tension|
|00004b60| 20 64 65 63 72 65 61 73 | 65 64 20 62 79 20 61 6e | decreas|ed by an|
|00004b70| 20 61 76 65 72 61 67 65 | 20 6f 66 20 31 30 20 6d | average| of 10 m|
|00004b80| 6d 20 48 67 20 61 66 74 | 65 72 20 4e 61 48 43 4f |m Hg aft|er NaHCO|
|00004b90| 33 0d 0a 61 64 6d 69 6e | 69 73 74 72 61 74 69 6f |3..admin|istratio|
|00004ba0| 6e 2c 20 77 68 65 72 65 | 61 73 20 69 74 20 69 6e |n, where|as it in|
|00004bb0| 63 72 65 61 73 65 64 20 | 77 69 74 68 20 4e 61 43 |creased |with NaC|
|00004bc0| 6c 20 69 6e 66 75 73 69 | 6f 6e 2e 20 20 41 66 74 |l infusi|on.  Aft|
|00004bd0| 65 72 20 4e 61 48 43 4f | 33 0d 0a 61 64 6d 69 6e |er NaHCO|3..admin|
|00004be0| 69 73 74 72 61 74 69 6f | 6e 2c 20 6d 79 6f 63 61 |istratio|n, myoca|
|00004bf0| 72 64 69 61 6c 20 6f 78 | 79 67 65 6e 20 63 6f 6e |rdial ox|ygen con|
|00004c00| 73 75 6d 70 74 69 6f 6e | 20 64 65 63 72 65 61 73 |sumption| decreas|
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|00004c20| 65 73 75 6c 74 20 6f 66 | 0d 0a 72 65 64 75 63 65 |esult of|..reduce|
|00004c30| 64 20 6d 79 6f 63 61 72 | 64 69 61 6c 20 6f 78 79 |d myocar|dial oxy|
|00004c40| 67 65 6e 20 65 78 74 72 | 61 63 74 69 6f 6e 2e 20 |gen extr|action. |
|00004c50| 20 53 79 73 74 65 6d 69 | 63 20 6f 78 79 67 65 6e | Systemi|c oxygen|
|00004c60| 20 63 6f 6e 73 75 6d 70 | 74 69 6f 6e 20 61 6c 73 | consump|tion als|
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|00004c80| 61 20 6d 65 61 6e 20 32 | 31 25 20 62 65 63 61 75 |a mean 2|1% becau|
|00004c90| 73 65 20 6f 66 20 61 20 | 73 69 67 6e 69 66 69 63 |se of a |signific|
|00004ca0| 61 6e 74 20 72 65 64 75 | 63 74 69 6f 6e 20 6f 66 |ant redu|ction of|
|00004cb0| 20 73 79 73 74 65 6d 69 | 63 20 6f 78 79 67 65 6e | systemi|c oxygen|
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|00004cd0| 65 64 20 62 6c 6f 6f 64 | 20 63 65 6c 6c 20 32 2c |ed blood| cell 2,|
|00004ce0| 33 2d 64 69 70 68 6f 73 | 70 68 6f 67 6c 79 63 65 |3-diphos|phoglyce|
|00004cf0| 72 69 63 20 61 63 69 64 | 20 6c 65 76 65 6c 73 2c |ric acid| levels,|
|00004d00| 20 77 68 69 63 68 20 77 | 65 72 65 0d 0a 65 6c 65 | which w|ere..ele|
|00004d10| 76 61 74 65 64 20 61 74 | 20 62 61 73 65 6c 69 6e |vated at| baselin|
|00004d20| 65 2c 20 64 69 64 20 6e | 6f 74 20 63 68 61 6e 67 |e, did n|ot chang|
|00004d30| 65 20 77 69 74 68 20 4e | 61 48 43 4f 33 20 61 64 |e with N|aHCO3 ad|
|00004d40| 6d 69 6e 69 73 74 72 61 | 74 69 6f 6e 2e 20 20 54 |ministra|tion.  T|
|00004d50| 68 65 20 61 72 74 65 72 | 69 61 6c 0d 0a 61 6e 64 |he arter|ial..and|
|00004d60| 20 6d 69 78 65 64 20 76 | 65 6e 6f 75 73 20 63 61 | mixed v|enous ca|
|00004d70| 72 62 6f 6e 20 64 69 6f | 78 69 64 65 20 74 65 6e |rbon dio|xide ten|
|00004d80| 73 69 6f 6e 73 20 69 6e | 63 72 65 61 73 65 64 20 |sions in|creased |
|00004d90| 77 69 74 68 20 4e 61 48 | 43 4f 33 2c 20 62 75 74 |with NaH|CO3, but|
|00004da0| 20 64 65 63 72 65 61 73 | 65 64 0d 0a 73 69 67 6e | decreas|ed..sign|
|00004db0| 69 66 69 63 61 6e 74 6c | 79 20 77 69 74 68 20 4e |ificantl|y with N|
|00004dc0| 61 43 6c 20 61 64 6d 69 | 6e 69 73 74 72 61 74 69 |aCl admi|nistrati|
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|00004de0| 69 6f 6e 20 6f 66 20 4e | 61 48 43 4f 33 20 72 65 |ion of N|aHCO3 re|
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|00004e10| 25 20 68 65 6d 6f 67 6c | 6f 62 69 6e 20 73 61 74 |% hemogl|obin sat|
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|00004e50| 6d 6f 67 6c 6f 62 69 6e | 20 62 69 6e 64 69 6e 67 |moglobin| binding|
|00004e60| 20 63 75 72 76 65 20 74 | 6f 77 61 72 64 20 6e 6f | curve t|oward no|
|00004e70| 72 6d 61 6c 20 28 42 6f | 68 72 20 65 66 66 65 63 |rmal (Bo|hr effec|
|00004e80| 74 29 2e 20 20 41 72 74 | 65 72 69 61 6c 20 6c 61 |t).  Art|erial la|
|00004e90| 63 74 61 74 65 0d 0a 63 | 6f 6e 63 65 6e 74 72 61 |ctate..c|oncentra|
|00004ea0| 74 69 6f 6e 20 69 6e 63 | 72 65 61 73 65 64 20 77 |tion inc|reased w|
|00004eb0| 69 74 68 20 4e 61 48 43 | 4f 33 20 69 6e 66 75 73 |ith NaHC|O3 infus|
|00004ec0| 69 6f 6e 2e 20 20 4e 65 | 74 20 6d 79 6f 63 61 72 |ion.  Ne|t myocar|
|00004ed0| 64 69 61 6c 20 6c 61 63 | 74 61 74 65 0d 0a 67 65 |dial lac|tate..ge|
|00004ee0| 6e 65 72 61 74 69 6f 6e | 20 64 65 76 65 6c 6f 70 |neration| develop|
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|00004f00| 20 64 75 72 69 6e 67 20 | 4e 61 48 43 4f 33 20 61 | during |NaHCO3 a|
|00004f10| 64 6d 69 6e 69 73 74 72 | 61 74 69 6f 6e 3b 20 73 |dministr|ation; s|
|00004f20| 79 6d 70 74 6f 6d 73 20 | 6f 66 0d 0a 61 6e 67 69 |ymptoms |of..angi|
|00004f30| 6e 61 20 64 65 76 65 6c | 6f 70 65 64 20 69 6e 20 |na devel|oped in |
|00004f40| 32 20 6f 66 20 74 68 65 | 73 65 20 70 61 74 69 65 |2 of the|se patie|
|00004f50| 6e 74 73 2e 20 20 42 6c | 6f 6f 64 20 67 6c 75 63 |nts.  Bl|ood gluc|
|00004f60| 6f 73 65 20 63 6f 6e 63 | 65 6e 74 72 61 74 69 6f |ose conc|entratio|
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|00004f80| 6e 69 66 69 63 61 6e 74 | 6c 79 20 77 69 74 68 20 |nificant|ly with |
|00004f90| 4e 61 48 43 4f 33 20 61 | 64 6d 69 6e 69 73 74 72 |NaHCO3 a|dministr|
|00004fa0| 61 74 69 6f 6e 2e 20 20 | 43 6f 72 6f 6e 61 72 79 |ation.  |Coronary|
|00004fb0| 20 62 6c 6f 6f 64 20 66 | 6c 6f 77 20 64 69 64 0d | blood f|low did.|
|00004fc0| 0a 6e 6f 74 20 63 68 61 | 6e 67 65 20 77 69 74 68 |.not cha|nge with|
|00004fd0| 20 4e 61 48 43 4f 33 20 | 69 6e 66 75 73 69 6f 6e | NaHCO3 |infusion|
|00004fe0| 2c 20 62 75 74 20 69 6e | 63 72 65 61 73 65 64 20 |, but in|creased |
|00004ff0| 77 69 74 68 20 4e 61 43 | 6c 2e 20 20 46 6f 75 72 |with NaC|l.  Four|
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|00005010| 72 61 6e 73 69 65 6e 74 | 20 72 65 64 75 63 74 69 |ransient| reducti|
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|00005060| 65 20 64 75 72 69 6e 67 | 20 4e 61 48 43 4f 33 20 |e during| NaHCO3 |
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|00005080| 0a 20 20 20 20 20 41 64 | 6d 69 6e 69 73 74 72 61 |.     Ad|ministra|
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|000050b0| 63 6f 6e 67 65 73 74 69 | 76 65 20 68 65 61 72 74 |congesti|ve heart|
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|00005100| 6d 79 6f 63 61 72 64 69 | 61 6c 20 6f 78 79 67 65 |myocardi|al oxyge|
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|00005120| 20 54 68 65 20 72 65 64 | 75 63 74 69 6f 6e 20 69 | The red|uction i|
|00005130| 6e 20 6f 78 79 67 65 6e | 20 75 74 69 6c 69 7a 61 |n oxygen| utiliza|
|00005140| 74 69 6f 6e 20 69 73 20 | 61 73 73 6f 63 69 61 74 |tion is |associat|
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|00005170| 6e 68 61 6e 63 65 64 20 | 67 6c 79 63 6f 6c 79 73 |nhanced |glycolys|
|00005180| 69 73 2c 20 61 6e 64 20 | 65 6c 65 76 61 74 69 6f |is, and |elevatio|
|00005190| 6e 20 6f 66 20 62 6c 6f | 6f 64 20 6c 61 63 74 61 |n of blo|od lacta|
|000051a0| 74 65 20 6c 65 76 65 6c | 73 2c 20 77 68 69 63 68 |te level|s, which|
|000051b0| 0d 0a 6d 61 79 20 6c 65 | 61 64 20 74 6f 20 74 72 |..may le|ad to tr|
|000051c0| 61 6e 73 69 65 6e 74 20 | 6d 79 6f 63 61 72 64 69 |ansient |myocardi|
|000051d0| 61 6c 20 69 73 63 68 65 | 6d 69 61 20 69 6e 20 73 |al ische|mia in s|
|000051e0| 6f 6d 65 20 70 61 74 69 | 65 6e 74 73 2e 20 20 54 |ome pati|ents.  T|
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|00005550| 2c 20 74 68 65 20 66 69 | 6e 64 69 6e 67 73 20 68 |, the fi|ndings h|
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|000055b0| 20 6f 72 20 6e 6f 74 20 | 74 68 65 72 65 20 69 73 | or not |there is|
|000055c0| 20 61 20 62 65 6e 65 66 | 69 63 69 61 6c 20 65 66 | a benef|icial ef|
|000055d0| 66 65 63 74 20 6f 66 20 | 4e 61 48 43 4f 33 0d 0a |fect of |NaHCO3..|
|000055e0| 77 68 65 6e 20 70 61 74 | 69 65 6e 74 73 20 61 72 |when pat|ients ar|
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|00005630| 78 79 67 65 6e 20 74 65 | 6e 73 69 6f 6e 20 69 73 |xygen te|nsion is|
|00005640| 20 6f 75 74 77 65 69 67 | 68 65 64 20 62 79 20 74 | outweig|hed by t|
|00005650| 68 65 20 61 64 76 65 72 | 73 65 20 65 66 66 65 63 |he adver|se effec|
|00005660| 74 73 20 6f 66 20 61 20 | 76 65 72 79 20 6c 6f 77 |ts of a |very low|
|00005670| 20 62 6c 6f 6f 64 0d 0a | 70 48 3f 2d 2d 57 2e 48 | blood..|pH?--W.H|
|00005680| 2e 20 53 70 69 76 65 79 | 2c 20 4d 2e 44 2e 0d 0a |. Spivey|, M.D...|
|00005690| 24 55 6e 69 71 75 65 5f | 49 44 7b 59 52 42 30 31 |$Unique_|ID{YRB01|
|000056a0| 31 30 35 7d 0d 0a 24 54 | 69 74 6c 65 7b 46 6f 75 |105}..$T|itle{Fou|
|000056b0| 72 20 43 61 73 65 20 53 | 74 75 64 69 65 73 3a 20 |r Case S|tudies: |
|000056c0| 20 48 69 67 68 2d 44 6f | 73 65 20 45 70 69 6e 65 | High-Do|se Epine|
|000056d0| 70 68 72 69 6e 65 20 69 | 6e 20 43 61 72 64 69 61 |phrine i|n Cardia|
|000056e0| 63 20 41 72 72 65 73 74 | 7d 0d 0a 24 41 75 74 68 |c Arrest|}..$Auth|
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|00005700| 57 65 72 6d 61 6e 2c 20 | 48 41 0d 0a 42 72 6f 77 |Werman, |HA..Brow|
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|00005720| 74 69 6f 6e 7b 4f 68 69 | 6f 20 53 74 61 74 65 20 |tion{Ohi|o State |
|00005730| 55 6e 69 76 7d 0d 0a 24 | 4a 6f 75 72 6e 61 6c 7b |Univ}..$|Journal{|
|00005740| 41 6e 6e 20 45 6d 65 72 | 67 20 4d 65 64 7d 0d 0a |Ann Emer|g Med}..|
|00005750| 24 56 6f 6c 75 6d 65 7b | 31 39 7d 0d 0a 24 50 61 |$Volume{|19}..$Pa|
|00005760| 67 65 7b 33 32 32 2d 33 | 32 36 7d 0d 0a 24 44 61 |ge{322-3|26}..$Da|
|00005770| 74 65 7b 31 39 39 30 7d | 0d 0a 24 59 42 56 6f 6c |te{1990}|..$YBVol|
|00005780| 7b 31 39 39 31 20 59 65 | 61 72 20 42 6f 6f 6b 20 |{1991 Ye|ar Book |
|00005790| 6f 66 20 45 6d 65 72 67 | 65 6e 63 79 20 4d 65 64 |of Emerg|ency Med|
|000057a0| 69 63 69 6e 65 7d 0d 0a | 24 43 68 61 70 74 65 72 |icine}..|$Chapter|
|000057b0| 7b 31 2d 31 30 7d 0d 0a | 24 59 42 45 64 69 74 6f |{1-10}..|$YBEdito|
|000057c0| 72 7b 44 72 73 2e 20 57 | 61 67 6e 65 72 2c 20 42 |r{Drs. W|agner, B|
|000057d0| 75 72 64 69 63 6b 2c 20 | 44 61 76 69 64 73 6f 6e |urdick, |Davidson|
|000057e0| 2c 20 52 6f 62 65 72 74 | 73 2c 20 61 6e 64 20 53 |, Robert|s, and S|
|000057f0| 70 69 76 65 79 7d 0d 0a | 24 54 61 62 6c 65 7b 7d |pivey}..|$Table{}|
|00005800| 0d 0a 24 43 6f 6d 6d 65 | 6e 74 61 74 6f 72 7b 57 |..$Comme|ntator{W|
|00005810| 2e 48 2e 20 53 70 69 76 | 65 79 2c 20 4d 2e 44 2e |.H. Spiv|ey, M.D.|
|00005820| 7d 0d 0a 0d 0a 43 6f 70 | 79 72 69 67 68 74 20 28 |}....Cop|yright (|
|00005830| 43 29 20 59 65 61 72 20 | 42 6f 6f 6b 20 4d 65 64 |C) Year |Book Med|
|00005840| 69 63 61 6c 20 50 75 62 | 6c 69 73 68 65 72 73 2c |ical Pub|lishers,|
|00005850| 20 49 6e 63 2e 20 31 39 | 39 31 0d 0a 0d 0a 31 39 | Inc. 19|91....19|
|00005860| 39 31 20 59 65 61 72 20 | 42 6f 6f 6b 20 6f 66 20 |91 Year |Book of |
|00005870| 45 6d 65 72 67 65 6e 63 | 79 20 4d 65 64 69 63 69 |Emergenc|y Medici|
|00005880| 6e 65 0d 0a 0d 0a 43 68 | 61 70 74 65 72 20 31 20 |ne....Ch|apter 1 |
|00005890| 2d 2d 20 41 63 75 74 65 | 20 53 79 73 74 65 6d 73 |-- Acute| Systems|
|000058a0| 20 50 61 74 68 6f 70 68 | 79 73 69 6f 6c 6f 67 79 | Pathoph|ysiology|
|000058b0| 0d 0a 0d 0a 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |....----|--------|
|000058c0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000058d0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000058e0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000058f0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|00005900| 2d 2d 0d 0a 46 6f 75 72 | 20 43 61 73 65 20 53 74 |--..Four| Case St|
|00005910| 75 64 69 65 73 3a 20 20 | 48 69 67 68 2d 44 6f 73 |udies:  |High-Dos|
|00005920| 65 20 45 70 69 6e 65 70 | 68 72 69 6e 65 20 69 6e |e Epinep|hrine in|
|00005930| 20 43 61 72 64 69 61 63 | 20 41 72 72 65 73 74 0d | Cardiac| Arrest.|
|00005940| 0a 0d 0a 4d 61 72 74 69 | 6e 20 44 3b 20 57 65 72 |...Marti|n D; Wer|
|00005950| 6d 61 6e 20 48 41 3b 20 | 42 72 6f 77 6e 20 43 47 |man HA; |Brown CG|
|00005960| 0d 0a 28 4f 68 69 6f 20 | 53 74 61 74 65 20 55 6e |..(Ohio |State Un|
|00005970| 69 76 29 0d 0a 41 6e 6e | 20 45 6d 65 72 67 20 4d |iv)..Ann| Emerg M|
|00005980| 65 64 20 31 39 3a 33 32 | 32 2d 33 32 36 2c 20 31 |ed 19:32|2-326, 1|
|00005990| 39 39 30 0d 0a 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |990..---|--------|
|000059a0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000059b0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000059c0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000059d0| 2d 2d 2d 2d 2d 2d 2d 2d | 2d 2d 2d 2d 2d 2d 2d 2d |--------|--------|
|000059e0| 2d 2d 2d 0d 0a 0d 0a 41 | 62 73 74 72 61 63 74 0d |---....A|bstract.|
|000059f0| 0a 0d 0a 20 20 20 20 20 | 52 65 73 75 6c 74 73 20 |...     |Results |
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|00005f80| 68 65 20 68 65 61 72 74 | 2e 20 20 49 20 77 6f 75 |he heart|.  I wou|
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+--------+-------------------------+-------------------------+--------+--------+