The biochemical consequences of hypoxia.

The various phases of energy production have been described. These include glycolysis which is unique in its ability to produce ATP anaerobically, the tricarboxylic acid cycle with its major contribution to ATP production coming through the generation of NADH, and the cytochrome system at which reducing equivalents are converted to water, the released energy being incorporated into high-energy phosphates. The regulation of these pathways has been briefly described and the importance of the small amount of ATP generated anaerobically emphasized. The adaptation of muscle to periods of hypoxia through the presence of myoglobin, creatine phosphate and large amounts of glycogen is then discussed. The role of pH in limiting anaerobic glycolysis in muscle and the importance of the circulation in providing oxygen for exercising muscle are outlined. The effects of hypoxia on certain other tissues such as liver and brain have been detailed and finally methods for assessment of tissue hypoxia in man such as the measurement of the lactate:pyruvate ratio in blood are presented.