Anaerobic metabolic responses to acute maximal exercise in male athletes

Bruce, Robert A.; Jones, John W.; Strait, Gail B.

doi:10.1016/0002-8703(64)90335-7

Cited by 23 publications

(3 citation statements)

References 12 publications

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“…Bruce et al studied lactic acid production in athletes and found levels of 7.5 to 10.7 mEq/L after strenuous exercise. 9 In an article reviewing lactic acid production in athletes, Giammarco noted a peak lactate level of 17 mM/L in sprint-trained, and 12.6 mM/L in endurancetrained athletes. 10 These levels are much lower than the very high levels noted in case 1 (more than 24 mEq/L) and in Bethke et al's case report.…”

Section: Discussionmentioning

confidence: 99%

Metabolic Acidosis in Restraint‐associated Cardiac ArrestA Case Series

Hick

Smith

Lynch

1999

Academic Emergency Medicine

155

130

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Abstract. The mechanism of death in patients struggling against restraints remains a topic of debate. This article presents a series of five patients with restraint-associated cardiac arrest and profound metabolic acidosis. The lowest recorded pH was 6.25; this patient and three others died despite aggressive resuscitation. The survivor's pH was 6.46; this patient subsequently made a good recovery. Struggling against restraints may produce a lactic acidosis. Stimulant drugs such as cocaine may promote further metabolic acidosis and impair normal behavioral regulatory responses. Restrictive positioning of combative patients may impede appropriate respiratory compensation for this acidemia. Public safety personnel and emergency providers must be aware of the life threat to combative patients and be careful with restraint techniques. Further investigation of sedative agents and buffering therapy for this select patient group is suggested. Key words: metabolic acidosis; restraint -physical; heart arrest; cardiac arrest. AC-ADEMIC EMERGENCY MEDICINE 1999; 6:239 -243 M ANAGEMENT of violent and agitated patients is a significant problem for public safety and emergency medical agencies, and death occasionally occurs during restraint of these patients. The cause of death in these circumstances has not been elucidated. Speculation has focused on autonomic reflexes, restraint stress, 1 agitated delirium from stimulant drugs, 1 and positional asphyxia due to use of the hobble (or ''hog-tie'') position as potential contributing factors.2 -4 Acidosis has not been cited as a contributing factor in restraint-associated death. Severe metabolic acidosis has, however, been noted with stimulant drug use (notably cocaine), 5 and when exertion and stimulant drug use are combined.6 -8 Profound metabolic acidosis can have significant negative cardiovascular effects, including promotion of dysrhythmias and autonomic instability, which may contribute to cardiovascular collapse.We present five cases of cardiovascular collapse occurring in ED patients who were struggling despite maximal restraint techniques. They were all profoundly acidotic. Our experience with these cases led to institution of an aggressive proactive CASE 1A 36-year-old man was acting extremely agitated and belligerent on a downtown sidewalk. When approached, he attacked a police officer and ran. He was subsequently subdued by several officers. He was transported to the ED, where he continued to fight vigorously while lying prone with his hands cuffed behind him. Breath analysis was negative for ethanol. Shortly thereafter, the patient had a witnessed respiratory arrest. He was intubated within 4 minutes of his apnea. Shortly after intubation, a 15-second episode of asystole was noted; he recovered a sinus rhythm at a rate of 140 beats/ min after epinephrine, atropine, and hyperventilation. His initial arterial blood gas (ABG) obtained 5 minutes after intubation was pH 6.46, pCO 2 49 mm Hg, pO 2 523 mm Hg, and a bicarbonate (HCO 3 ) of 4 mEq/L. Aggressive fluid resus...

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Section: Discussionmentioning

confidence: 99%

Metabolic Acidosis in Restraint‐associated Cardiac ArrestA Case Series

Hick

Smith

Lynch

1999

Academic Emergency Medicine

155

130

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“…Although assessment of anaerobic responses would provide a biochemical appraisal of circulatory inadequacy of oxygen transport, it may be roughly estimated as one-fifth to one-third of the metabolic response when maximal work is achieved. 25 This is usually identified subjectively as exhaustive fatigue; sometimes it is accompanied by severe dyspnea, chest pain, claudication, weakness or nausea. The validity of such symptoms is suspect in rare instances when physiological responses to stress are much less than expected and duration of effort is markedly shortened.…”

Section: Commentsmentioning

confidence: 99%

Exercising Testing in Adult Normal Subjects and Cardiac Patients*

Bruce¹,

Blackmon²,

Jones³

et al. 2004

Noninvasive Electrocardiol

195

219

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Clinical exercise tests are used primarily for diagnosis of coronary insufficiency or appraisal of working capacity. Occasionally hemodynamic responses are observed during diagnostic catherization of the heart. Since interpretation of findings depends upon quantitative differences from normal values, variations due to age, sex, physical status and circumstances of the test need to be appreciated. To be effective, exercise stresses must involve large muscle masses, and the patient or subject must be ambulatory, cooperative and properly motivated. Some of the approaches to testing will be reviewed, and preliminary observations on a new technique will be presented.The simplest test of exercise tolerance is for a physician to accompany a cardiac patient over one or more flights of stairs and to observe the symptoms. If this is not rewarding, increasing the work load by accelerating the pace or taking two steps at a time is more likely to be informative. But under these conditions the work loads are not well standardized, physiological responses are not usually monitored, and the physician is not necessarily of the same sex and comparable age.Master's two step test is familiar to most internists; its value for diagnosis and prognosis of coronary insufficiency has been established. 1,2 An abnormal resting electro-cardiogram is considered a contraindication for performance of this test. Although interpretation of results depends upon electrocardiographic changes, these have not been monitored routinely during exertion, even though a suitable technique was described 10 years ago. 3 The exercise stress varies with age, sex and body weight, but in terms of energy expenditure per unit of weight the underweight individual is stressed much more than the overweight person.

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“…Hick concluded that the lactate level documented in one case (>24 mmol/L) was much higher than what has been reported as the top levels in sprinting athletes (17 mmol/L). A study by Bruce et al [19] of metabolic responses in male athletes with different types of maximal exercise found that they reached excess lactate levels of 7.9-10.7 mmol/L on average. Another case report of severe acidosis [20] during ED and use of cocaine presented a man with a pH of 6.53, but who survived after treatment including hyperventilation and sodium bicarbonate.…”

Section: Metabolic Acidosismentioning

confidence: 99%

Deaths during apprehensions of agitated persons. A review of proposed pathophysiological theories

Tamsen

Thiblin

2014

Scandinavian Journal of Forensic Science

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The pathophysiology of sudden death during apprehension remains largely unclear. The most frequently discussed mechanisms are excited delirium, positional asphyxia, metabolic acidosis, acute and chronic drug abuse, and autonomic instability. As in most areas of forensic medicine, much of the knowledge comes from case reports, which are of little use in understanding causality. Experimental studies of some aspects have been performed, and they show somewhat divergent results and interpretations. The aim of this review is to summarize the different proposed theories, and to point out important issues for further research.

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Anaerobic metabolic responses to acute maximal exercise in male athletes

Cited by 23 publications

References 12 publications

Metabolic Acidosis in Restraint‐associated Cardiac ArrestA Case Series

Metabolic Acidosis in Restraint‐associated Cardiac ArrestA Case Series

Exercising Testing in Adult Normal Subjects and Cardiac Patients*

Deaths during apprehensions of agitated persons. A review of proposed pathophysiological theories

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