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1 Department of Anesthesiology and 2 Department of Physiology, Uniformed Services University of the Health Sciences, Bethesda, Maryland 20814
Pyruvate (PYR) improves cellular and organ function hypoxia and
ischemia by stabilizing the reduced nicotinamide adenine
dinucleotide redox state and cytosolic ATP phosphorylation potential.
In this in vivo study, we evaluated the effects of intravenous pyruvate on neocortical function, indexes of the cytosolic redox state, cellular
energy state, and ischemia during a prolonged (4 h) controlled arterial hemorrhage (40 mmHg) in swine. Thirty minutes after the onset
of hemorrhagic shock, sodium PYR (n = 8) was infused
(0.5 g · kg
1 · h
1) to
attain arterial levels of 5 mM. The volume and osmotic effects were
matched with 10% NaCl [hypertonic saline (HTS)] (n = 8) or 0.9% NaCl [normal saline (NS)] (n = 8). During
the hemorrhage protocol, the time to peak hemorrhage volume was
significantly delayed in the PYR group compared with the HTS and NS
groups (94 ± 5 vs. 73 ± 6 and 72 ± 4 min,
P < 0.05). In addition to the early onset of the
decompensatory phase of hemorrhagic shock, the complete return of the
hemorrhage volume during decompensatory shock resulted in the death of
five and four animals, respectively, in the HTS and NS groups. In
contrast, in the PYR group, reinfusion of the hemorrhage volume was
slower and all animals survived the 4-h hemorrhage protocol. During
hemorrhage, the PYR group also exhibited improved cerebral cortical
metabolic and function status. PYR slowed and reduced the rise in
neocortical microdialysis levels of adenosine, inosine, and
hypoxanthine and delayed the loss of cerebral cortical biopsy ATP and
phosphocreatine content. This improvement in energetic status was
evident in the improved preservation of the electrocorticogram in the
PYR group. PYR also prevented the eightfold increase in the excitotoxic
amino acid glutamate observed in the HTS group. The findings show
that PYR administered after the onset of hemorrhagic shock markedly
improves cerebral metabolic and functional status for at least 4 h.
microdialysis; glutamate; pyruvic acid
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