Regulation of cerebral blood flow by arterial PCO2 independent of metabolic acidosis at 5,050 m

Hannah G Caldwell, Kurt J Smith, Nia C S Lewis, Ryan L Hoiland, Chris K Willie, Sam Lucas, Mike Stembridge, Keith R Burgess, David B MacLeod, P.N. Ainslie

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Alterations in acid-base balance with progressive acclimatization to high-altitude have been well-established; however, how respiratory alkalosis and resultant metabolic compensation interact to regulate cerebral blood flow (CBF) is uncertain. We addressed this via three separate experimental trials at sea level and following partial acclimatization (14 to 20 days) at 5,050 m; involving: 1) resting acid-base balance (control); 2) following metabolic acidosis via two days of oral acetazolamide at 250 mg every 8 hours (ACZ; pH: Δ -0.07±0.04 and base excess: Δ -5.7±1.9 mEq⋅l–1, trial effects: P<0.001 and P<0.001, respectively); and 3) after acute normalization of arterial acidosis via intravenous sodium bicarbonate (ACZ+HCO3; pH: Δ -0.01±0.04 and base excess: Δ -1.5±2.1 mEq⋅l–1, trial effects: P = 1.000 and P = 0.052, respectively). Within each trial, we utilized transcranial Doppler ultrasound to assess the cerebral blood velocity (CBV) response to stepwise alterations in arterial PCO2 (PaCO2); i.e., cerebrovascular CO2 reactivity. Resting CBF (via Duplex ultrasound) was unaltered between trials within each altitude, indicating that respiratory compensation (i.e., Δ -3.4±2.3 mmHg PaCO2, trial effect: P<0.001) was sufficient to offset any elevations in CBF induced via the ACZ-mediated metabolic acidosis. Between trials at high-altitude, we observed consistent leftward shifts in both the PaCO2-pH and CBV-pH responses across the CO2 reactivity tests with experimentally reduced arterial pH via ACZ. When indexed against PaCO2 – rather than pH – the absolute CBV and sensitivity of CBV-PaCO2 was unchanged between trials at high-altitude. Taken together, following acclimatization, CO2-mediated changes in cerebrovascular tone rather than arterial [H+]/pH is integral to CBF regulation at high-altitude.
Original languageEnglish
Pages (from-to)3513-3530
JournalThe Journal of Physiology
Issue number14
Early online date28 May 2021
Publication statusE-pub ahead of print - 28 May 2021


  • CO reactivity
  • acetazolamide
  • acid-base balance
  • cerebral blood flow
  • high altitude
  • metabolic acidosis
  • sodium bicarbonate

ASJC Scopus subject areas

  • Physiology


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