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phenomenon that I think Loren B. Rowell looked at in the 1960s or early 1970s. He ran students from the University of Washington so hard, he could make their liver enzymes go up and had simultaneous splanchnic blood flow measurements, which demonstrated splanativic ischemia.

So, that is a phenomenon that occurs, and acidosis of the gastrointestinal epithelium is probably a real thing. It appears to be important in clinical practice because the tonometry data has suggested that the mucosa becomes acidotic. One of the effects of glutamine is to neutralize this intracellular acidosis.

BRUCE BISTRIAN: I was thinking, also, about the effect of the base on Philmidge. When used in acidosis conditions like renal failure, it has profound effects on muscle metabolism where the effect on the muscles may be its base effect.

DOUGLAS WILMORE: I don't think we know the answer to that. There are some Swedish data looking at that in postoperative patients that could possibly address that with intracellular pH probes, but I don't think anyone has done that study.



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