Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0020440 (hypercapnia)
7,939 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The pathogenesis of edema in COPD patients is poorly understood. In 50 COPD patients without cor pulmonale, we measured water sodium and potassium excretion in 24 hours, concentration of sodium and potassium in plasma as well as PRA, ATII and aldosterone levels. We found that PRA, ATII, and aldosterone levels in COPD patients with edema are much higher than those in patients without edema and sodium and water excretion decreased significantly in edematous COPD patients. Elevation of PRA, ATII, and aldosterone correlated with inability to excrete sodium and water. These data suggest that, in conjunction with hypercapnia-hypoxia-mediated disturbance in renal function, stimulation of RAAS, especially the resulting increase of aldosterone may contribute to edema formation in COPD patients.
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PMID:[Role of the renin-angiotensin-aldosterone system in the pathogenesis of edema formation in chronic obstructive pulmonary disease]. 280 68

The most common causes of hypoxic cor pulmonale are chronic bronchitis and emphysema. Although the clinical situation in some patients is characterized early by hypoxemia, oedema is rare in patients with an arterial pO2 above 60 mm Hg. The presence of oedema can be regarded as an unfavorable prognostic indicator. For many years, peripheral oedema had been considered an expression of congestive cardiac failure; it may be assumed, however, that neither right nor left ventricular failure is prerequisite to the development of oedema. Oedema formation can be attributed to excessive retention of salt and water or a redistribution of body water into the extracellular compartment. Hypercapnia and acidosis affect direct stimulation of renal hydrogen ion secretion. The resulting electrochemical imbalance is compensated by reabsorption of sodium. Hypercapnia and, in acute phases possibly, hypoxia lead to a fall in renal blood flow mediated by alpha-adrenergic stimulation through activation of the renin-angiotensin-aldosterone system. An increase in plasma ADH may also contribute to development of oedema. The development of cor pulmonale or respiratory insufficiency can be enhanced by nocturnal hypoventilation and hypoxia during sleep as well as by sleep apnoea. Nocturnal hypoxia, smoking and reduced oxygen tension in the relevant kidney cells responsible for erythropoietin release promote the occurrence of secondary polycythaemia. For treatment of acute exacerbations in cor pulmonale associated with infections bronchitis antibiotics such as amoxycillin and cotrimoxacol are drugs of first choice. While the use of digoxin is of doubtful value, the cautious administration of diuretics may bring symptomatic relief. In addition to physiotherapy, beta-2-selective bronchodilators and nebulized bronchodilator therapy can be useful; theophyllines dilate airways and increase cardiac output but they can cause arrhythmias and a deterioration of arterial blood gases in hypoxic patients. If the patient has been treated chronically with corticosteroids, the dosage will have to be incremented; if asthma is suspected, corticosteroid treatment is essential. Controlled oxygen therapy is the most important single therapy aimed at relief of severe arterial hypoxaemia. Oxygen should be titrated initially (for the first one or two days) to achieve an arterial tension of at least 48 mm Hg. Thereafter, the oxygen flow should be increased to yield an arterial tension in excess of 60 mm Hg during continued treatment for two to three weeks.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Hypoxic cor pulmonale: a review. 294 54

The electromyograms of the rectus abdominis, external oblique, and transversus abdominis muscles were recorded in eight lightly anesthetized, spontaneously breathing dogs. During quiet breathing in the supine posture seven animals invariably had a phasic expiratory activity in the transversus, whereas only two animals had invariable expiratory activity in the external oblique. An intermittent expiratory activity in the rectus was recorded in only one animal. The degree of activation, expressed as a percentage of the activity detected during breathing with 25 cm H2O positive end-expiratory pressure (PEEP), was also significantly greater (P less than 0.05) for the transversus (mean +/- SEM: 29.4 +/- 8.6%) than the external oblique (5.5 +/- 2.3%). Head up tilting and progressive hypercapnia elicited substantial increases in transversus and external oblique expiratory activity in all animals, whereas head down tilting caused marked decreases in expiratory activity. In each posture and at any given end-tidal CO2, however, the amount of transversus activity was larger than the amount of external oblique activity. The rectus was usually silent in all the conditions. Bilateral cervical vagotomy suppressed external oblique activity in most supine animals, and the muscle was no longer recruited by PEEP, head up tilting, or hypercapnia. In contrast, there was residual transversus expiratory activity in all supine animals (11.1 +/- 3.1%), as well as some expiratory recruitment during PEEP, head up tilting, and hypercapnia. These results indicate that: (1) the transversus is the primary abdominal muscle of expiration in the anesthetized dog; and (2) its behavior resembles that of the triangularis sterni, although it is more dependent on vagal afferent pathways. The present findings also strengthen the important fact that spontaneous quiet expiration in the dog is an active rather than passive process.
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PMID:Abdominal muscle use during breathing in the anesthetized dog. 295 99

To study both temporal and quantitative effects of hypercapnia on the extent of pH compensation in the arterial blood, specimens of carp (Cyprinus carpio) were exposed to a PCO2 of about 7.5 mmHg (1 mmHg = 133.3 Pa) (1% CO2) in the environmental water for several weeks, and a second group of animals was subjected to an environmental PCO2 of about 37 mmHg (5% CO2) for up to 96 h. A third series of experiments was designed to test the possibility that infusion of bicarbonate would increase the extent of plasma pH compensation. Dorsal aortic plasma pH, PCO2 and [HCO3-], as well as net transfer of HCO3- -equivalent ions, NH4+, Cl- and Na+, between fish and ambient water, were monitored throughout the experiments. Exposure to environmental PCO2 of 7.5 mmHg resulted in the expected respiratory acidosis with the associated drop in plasma pH, and subsequent compensatory plasma [HCO3-] increase. The compensatory increase of plasma bicarbonate during long-term hypercapnia continued during 19 days of exposure with plasma bicarbonate finally elevated from 13.0 mmoll-1 during control conditions to 25.9 mmoll-1 in hypercapnia, an increase equivalent to 80% plasma pH compensation. Exposure to 5% hypercapnia elicited much larger acid-base effects, which were compensated to a much lesser extent. Plasma pH recovered to only about 45% of the pH depression expected at constant bicarbonate concentration. At the end of the 96-h exposure period, plasma [HCO3-] was elevated by a factor of 2.5 to about 28.2 mmoll-1. The observed increase in plasma bicarbonate concentration during 5% hypercapnic exposure was attributable to net gain of bicarbonate equivalent ions from (or release of H+-equivalent ions to) the environmental water. Quantitatively, the gain of 15.6 mmol kg-1 was considerably larger than the amount required for compensation of the extracellular space, suggesting that acid-base relevant ions were transferred for compensation of the intracellular body compartments. The uptake of bicarbonate-equivalent ions from the water was accompanied by a net release of Cl-and, to a smaller extent, by a net uptake of Na+, suggesting a 75% contribution of the Cl-/HCO-3 exchange mechanism. Infusion of bicarbonate after 48 h of exposure to 7.5 mmHg PCo2 had only a transient effect on further pH compensation. The infused bicarbonate was lost to the ambient water, and pre-infusion levels of bicarbonate were reattained within 24 h. Repetition of the infusion did not result in a notable improvement of the acid-base status.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Acid-base regulation and ion transfers in the carp (Cyprinus carpio): pH compensation during graded long- and short-term environmental hypercapnia, and the effect of bicarbonate infusion. 302 33

In decerebrate, paralyzed cats, ventilated by a servo-respirator in accordance with phrenic nerve activity, we examined the influence of lung volume on the activities of the phrenic, hypoglossal and mylohyoid nerves. When lung inflation was briefly withheld, the durations of inspiration (TI) and expiration (TE) and the activities of all three nerves increased. The relative increase in hypoglossal activity greatly exceeded that of phrenic activity and was apparent earlier in the course of inspiration. This hypoglossal response was enhanced by hypercapnia and isocapnic hypoxia. The responses of mylohyoid activity were quite variable: withholding lung inflation augmented inspiratory activity in some cats, but expiratory discharge in others. Sustained increases in end-expiratory lung volume were induced by application of 3-4 cm H2O of positive end-expiratory pressure (PEEP). Steady-state PEEP did not influence nerve activities or the breathing pattern. Bilateral vagotomy increased TI, TE, and the activities of all three nerves. No response to withoholding lung inflation could be discerned after vagal section. The results provide further definition of the influence of vagally mediated, lung volume dependent reflexes on the control of upper airway muscles. These reflexes are well suited to relieve or prevent upper airway obstruction.
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PMID:Influence of lung volume on phrenic, hypoglossal and mylohyoid nerve activities. 305 Dec 35

The effects of acetazolamide on renal and erythrocyte carbonic anhydrase were studied in 12 critically ill patients. In the first part of the investigation (n = 6) we examined the renal effects of increasing doses of acetazolamide. The maximal renal excretion of water and bicarbonate was achieved with acetazolamide 2.5-5 mg kg-1 i.v. In the second part (n = 6), the associated respiratory effects of the effective renal dose of acetazolamide 5 mg kg-1 were evaluated. We found a statistically significant 4% decrease in pulmonary carbon dioxide excretion in the 10-min sampling period immediately following the administration of acetazolamide, but thereafter carbon dioxide elimination proceeded at a normal rate. The observed carbon dioxide retention is clinically unimportant, and we recommend acetazolamide as an effective means of eliminating surplus water and bicarbonate in the critically ill.
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PMID:Dissociation of renal and respiratory effects of acetazolamide in the critically ill. 308 49

The indices of diaphragmatic contractility and respiratory ventilation were studied in 31 males with chronic obstructive bronchitis distributed into 2 groups: with hypercapnia (PaCO2 56.3 +/- 0.4 mm Hg) and normocapnia (PaCO2 42.7 +/- 1.4 mm Hg), with reduction of FEV1/VC to 42% and 52% of the due value, Pdimax to 63.4 +/- 5.3 cm H2O and 73.4 +/- 6.1 cm H2O. The plasmatic theophylline concentration 21.19 +/- 1.06 mkg/ml was maintained in five patients with hypercapnia for 10 days by intravenous administration of aminophylline. FEV1 and VC increased by 5% and 8% respectively, Pdimax by 59%, TTdi decreased from 0.10 +/- 0.02 to 0.06 +/- 0.01, and PaCO2--to 44.7 +/- 1.8 mmHg. Vt/Ti did not change significantly. Thus, in patients with irreversible bronchial obstruction the decrease of diaphragmatic contractility leads to the development of arterial hypercapnia. The maintenance of therapeutical concentration of theophylline in blood plasma permits to improve the ventilation function of respiratory muscles and normalize the PaCO2 level.
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PMID:Evaluation of diaphragmatic contractility in patients with chronic obstructive lung diseases. 309 62

Hypercapnia in patients with pulmonary disease is believed to result from an interaction between mechanical lung impairment and intrinsic chemical respiratory drive. We tested this hypothesis in this study by examining the ventilatory (delta VE/delta PCO2) and occlusion pressure (delta P100/delta PCO2) responses to CO2 in 12 obese patients with no history of alveolar hypoventilation and correlating these with their ventilatory responses to abdominal surgery. Preoperatively the mean vital capacity (VC) was 78% +/- 6% standard error of the mean predicted, the delta VE/delta PCO2 was 1.56 +/- 0.26 L/min/torr, delta P100/delta PCO2 was 0.25 +/- 0.08 cm H2O/torr, the mean PaCO2 37.9 +/- 1.1 mm Hg, and mean PO2 77.6 +/- 3.7 mm Hg. Postoperatively the VC decreased to 56% +/- 6% of the preoperative value. PCO2 values at 24 hours increased in six patients, were unchanged in three, and decreased in three patients. However, over the entire spectrum of PCO2 change, both indexes of CO2 chemosensitivity correlated strongly with the postoperative change in PCO2 (r = -0.86 for delta VE/delta PCO2 and r = -0.66 for delta P100/delta PCO2). All six patients with a delta VE/delta PCO2 of 1.5 L/min/torr or less manifested postoperative increases in PCO2, while those with greater values did not (p = 0.005). In contrast, neither preoperative nor postoperative VC showed high correlations with postoperative PCO2 (r = -0.56 and -0.43, respectively). Thus ventilatory responses to CO2 predicted postoperative PCO2 at both ends of the spectrum; low responders hypoventilated while high responders hyperventilated. We conclude that in obese subjects, CO2 chemosensitivity plays a permissive role in determining the net ventilatory responses to situations that either mechanically load the respiratory system or modulate ventilation such as postoperative pain or analgesia.
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PMID:Chemical respiratory drive as a determinant of postoperative ventilation in the non-Pickwickian obese patient. 310 48

Hypercapnia attenuates the effects of static airway pressure (Paw) on phrenic burst frequency (f) and the expiratory duration. We examined the role of carotid chemoreceptors in this response using an experimental preparation that allowed independent control of lung inflation and CO2 reflexes. Experiments were conducted in intact (n = 6) and carotid denervated (CBX; n = 12) chloralose/urethane anesthetized dogs. Integrated phrenic amplitude (Phr), f, and the inspiratory (TI) and expiratory durations (TE) were measured as a function of Paw (2-12 cm H2O) at levels of PaCO2 between 30 and 80 mm Hg. In intact dogs: (1) f decreased as Paw increased, and elevated PaCO2 decreased the slope of this relationship; (2) neither PaCO2 nor Paw affected TI; and (3) TE increased hyperbolically with Paw, and elevated PaCO2 attenuated this relationship. In CBX dogs: (1) f decreased as Paw increased, but this relationship was not affected by PaCO2; (2) TI increased as PaCO2 increased but was unaffected by Paw; and (3) TE increased as Paw increased but was unaffected by PaCO2. The results indicate that carotid chemoreceptors are necessary in the mechanism whereby hypercapnia attenuates the effects of Paw on f and TE. Furthermore, carotid denervation reveals an effect of hypercapnia on TI, an effect that is not evident in dogs with functional carotid chemoreceptors.
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PMID:Effects of carotid denervation on interactions between lung inflation and PaCO2 in modulating phrenic activity. 310 99

To determine if hypercapnia and reflex bronchoconstriction attenuate lung inflation effects on ventilatory activity by indirect effects on intrapulmonary stretch receptors (PSR), phrenic nerve activity and single unit PSR were monitored at controlled levels of static airway pressure (Paw) and arterial PCO2 in 15 anesthetized dogs. Paw in a vascularly isolated lung was varied between 2 and 14 cm H2O at levels of PaCO2 between 35 and 85 mm Hg. PSR activity (n = 38) in fine strands dissected from an otherwise intact vagus nerve and the integrated phrenic neurogram were recorded. The response to Paw varied from one PSR to another, but was consistent in a given unit; PaCO2 had no consistent effect on individual responses. Selected PSR (n = 15) were averaged to yield a population response to Paw; the selection criteria were: phrenic activity responded briskly to Paw and measurements were made at three levels of PaCO2. Average PSR discharge increased linearly with Paw but was unaffected by PaCO2. On the other hand, phrenic burst frequency decreased as Paw increased and hypercapnia attenuated the slope of this relationship. These results suggest that effects on the relationship between PSR activity and Paw cannot account for attenuation of the relationship between phrenic frequency and Paw in hypercapnia. The effect of PaCO2 on the phrenic frequency vs Paw relationship probably arises from integrative mechanisms in the central nervous system.
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PMID:Effects of hypercapnia on phrenic and stretch receptor responses to lung inflation. 311 85


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