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The lungs expel the resulting CO 2 , while the kidneys excrete H + ions along with HCO 3 ( Figure 5 During HS, a cascade of physiological changes occurs, starting with panting (respiratory rate increases from 25 breaths/min to 260 breaths/min), which increases CO 2 exhalation relative to its cellular production, thereby altering the standard bicarbonate buffer system in the blood

In participants with a positive response, medical record reviews were performed to confirm a physician diagnosis, including cystoscopy performed by a urologist