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The amount of respiratory compensation in metabolic acidosis can be estimated using Winters' formula. [2] Hyperventilation due to the compensation for metabolic acidosis persists for 24 to 48 hours after correction of the acidosis, and can lead to respiratory alkalosis. [3] This compensation process can occur within minutes. [4]
There are four primary acid-base derangements that can occur in the human body - metabolic acidosis, metabolic alkalosis, respiratory acidosis, and respiratory alkalosis. These are characterized by a serum pH below 7.4 (acidosis) or above 7.4 (alkalosis), and whether the cause is from a metabolic process or respiratory process.
Metabolic alkalosis is an acid-base disorder in which the pH of tissue is elevated beyond the normal range (7.35–7.45). This is the result of decreased hydrogen ion concentration, leading to increased bicarbonate ( HCO − 3 ), or alternatively a direct result of increased bicarbonate concentrations.
Compensatory mechanism for metabolic alkalosis involve slowed breathing by the lungs to increase serum carbon dioxide, [2] a condition leaning toward respiratory acidosis. As respiratory acidosis often accompanies the compensation for metabolic alkalosis, and vice versa, a delicate balance is created between these two conditions.
Respiratory alkalosis is very rarely life-threatening, though pH level should not be 7.5 or greater. The aim in treatment is to detect the underlying cause. When PaCO2 is adjusted rapidly in individuals with chronic respiratory alkalosis, metabolic acidosis may occur. [3]
metabolic acidosis, or respiratory alkalosis with renal compensation if too low (less than −2 mEq/L) Blood pH is determined by both a metabolic component, measured by base excess, and a respiratory component, measured by PaCO 2 (partial pressure of carbon dioxide). Often a disturbance in one triggers a partial compensation in the other.
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Kussmaul breathing is respiratory compensation for a metabolic acidosis, most commonly occurring in diabetics in diabetic ketoacidosis.Blood gases of a patient with Kussmaul breathing will show a low partial pressure of CO 2 in conjunction with low bicarbonate because of a forced increased respiration (blowing off the carbon dioxide).