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Abstract

The hydrogen ion concentration of plasma at any moment is a function of the ratio between the partial pressure of carbon dioxide and the bicarbonate concentration. Therefore, the only way a change in plasma acidity can occur is through a change in the partial pressure of carbon dioxide (\( {P_{{C{O_2}}}} \)) or bicarbonate concentration. Primary changes in the \(\left( {{P_{c{o_2}}}} \right)\) are the hallmark of respiratory acid-base disturbances. When \(\left( {{P_{c{o_2}}}} \right)\) is above normal the disorder is called respiratory acidosis and when below normal is denoted as respiratory alkalosis. Under normal conditions these disturbances give rise to physiologic responses that lead to changes in the plasma bicarbonate concentration; primary hypocapnia is followed by a secondary decreaspe in bicarbonate, whereas primary hypercapnia is followed by a secondary rise in plasma bicarbonate (\(\left( {{P_{c{o_3}}}} \right)\)). Thus, the degree to which plasma acidity is altered in response to primary changes in the partial pressure of CO2 is a reflection not only of the initiating change, but also of the secondary change in the plasma bicarbonate concentration (1–4).

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References

  1. Maxwell M, Kleeman C: Clinical Disorders of Fluid and Electrolyte Metabolism, 3rd ed. McGraw Hill, pp 184–232, 1980.

    Google Scholar 

  2. Cohen JJ, Madias NE: Respiratory acidosis and alkalosis. In: DW Seldin, G Giebish, eds, The Kidney, Physiology and Pathophysiology. Raven Press, New York, 1985.

    Google Scholar 

  3. Brackett NC Jr, Wingo CF, Muren O, Solano JT: Acid-base response to chronic hypercapnia in man. N Engl J Med 280:124–130, 1969.

    Article  PubMed  Google Scholar 

  4. Madias NE, Androgue HJ, Horowitz GL, Cohen JJ, Schwartz WB: A redefinition of acid base equilibrium in man: CO2 as a key determinant of normal plasma bicarbonate concentration. Kidney Int 10:612, 1969.

    Google Scholar 

  5. Rose BD: Clinical Physiology of Acid-Base and Electrolyte Disorders. McGraw Hill, New York, 1977.

    Google Scholar 

  6. Androgue HJ, Suki WN: Respiratory acid base disorders. In: Therapy of Renal Diseases. WN Suki, ed, Martinus Nijhoff, Boston, 1984.

    Google Scholar 

  7. Rahn H: Gas transport from the external environment to the cell. In: AVS Rueck, Porter R, eds, Development of the Lung. Boston, Little Brown, 1967.

    Google Scholar 

  8. Narins RG, Emmet M: Simple and mixed acid-base disorders. A practical approach. Medicine (Baltimore) 59:161–187, 1980.

    CAS  Google Scholar 

  9. Fishman A: Pulmonary Diseases and Disorders. McGraw Hill, New York, pp 417–444, 1980.

    Google Scholar 

  10. Murray JF: The Normal Lung, 2nd ed. WB Saunders Philadelphia pp 211–233, 1986.

    Google Scholar 

  11. Fraser R, Pare P: Diagnosis and Diseases of the Chest. WB Saunders, Philadelphia, pp 106–116, 1977.

    Google Scholar 

  12. Madias NE, Cohen JJ: Respiratory acidosis, In: JJ Cohen, JP Kassirer, eds, Acid-Base. Little, Brown, Boston, pp 307–348, 19-.

    Google Scholar 

  13. Whitelaw WA: The respiratory pump. In: CA Guenter, MH Welch, eds, Pulmonary Medicine, 2nd ed JB Lippincott, Philadelphia, 1982.

    Google Scholar 

  14. Goodman A, Goodman L, Gilman A: The Pharmacological Basis of Therapeutics. McMillan New York 6th ed, pp 1671–1373, 19-.

    Google Scholar 

  15. Rosalo EF, Oram-Smith: Peritoneal lavage treatment in experimental peritonitis. Ann Surg 175:384, 1972.

    Article  Google Scholar 

  16. Arora NS, Rochester DF: Effect of body weight and muscularity on human diaphragm muscle mass, thickness and area: J App Physiol 52:64–70, 1980.

    Google Scholar 

  17. Arora NS, Rochester DF: Respiratory muscle strength and maximal voluntary ventilation in undernourished patients. Am Rev Resp Dis 126:5–8, 1982.

    PubMed  CAS  Google Scholar 

  18. Shibel EM, Moser KM (Eds): Respiratory Emergency. Saint Louis, CV Mosby, 1977.

    Google Scholar 

  19. Downing SE, Mitchell JH, Wallace AG: Cardiovascular responses to ischemia, hypoxia and hypercapnia of the central nervous system. Am J Physiol 204:881–887, 1963.

    Google Scholar 

  20. Van Ypersele de Strihou C, Gulyassy PF, Schwartz WB: Effects of chronic hypercapnia on electrolyte and acid-base equilibrium. III. Characteristics of the adaptive and recovery process as evaluated by provision of alkali. J Clin Invest 41:2246–2253, 1972.

    Article  Google Scholar 

  21. Polak A, Haynie GD, Hays RM, Schwartz WB: Effects of chronic hypercapnia on electrolyte and acid-base equilibrium. I. Adaptation. J Clin Invest 40:1223–1237, 1961.

    Article  PubMed  CAS  Google Scholar 

  22. Dulfano MJ, and Ikishawa S: Quantitative acid-base relationships in chronic pulmonary patients during the stable state. Am Rev Resp Dis 93:251–256, 1966.

    PubMed  CAS  Google Scholar 

  23. Schwartz WB Cohen JJ: The nature of the renal response to chronic disorders of acid-base equilibrium. Am J Med 64:417–428, 1978.

    Article  PubMed  CAS  Google Scholar 

  24. Giradoux J: Ondine, a Romantic Fantasy in Three Acts. English version by M. Valency. New York, French, 1956, Act 3, 1, 179.

    Google Scholar 

  25. Guilleminault C, Dement WC: Sleep Apnea Syndromes. Alan R. Liss, New York, 1978.

    Google Scholar 

  26. Mellins RB, Balfour HH Jr, Turino GM, Winters RW: Failure of automatic control of ventilation (Ondine’s curse). Medicine 49:487–504, 1976.

    Google Scholar 

  27. Sutton FD Jr, Szillich CW, Creagh CE, Pierson DJ, Weil JV: Progesterone for outpatient treatment of Pickwickian syndrome. Ann Intern Med 83:476–479, 1975.

    PubMed  Google Scholar 

  28. Kronenberg RS, Gabel RA, Severinghaus JW: Normal chemoreceptor function in obesity before and after ileal bypass surgery to force weight reduction. Am J Med 59:349–353, 1975.

    Article  PubMed  CAS  Google Scholar 

  29. Tenney SM, Ou LC: Hypoxic ventilatory response of cats at high altitude: An interpretation of “blunting.” Resp Physiol 32:185–199, 1977.

    Article  Google Scholar 

  30. Glenn WWL, Gee JBL, Cole DR, Farmer WC, Shaw RK, Beckman CB: Combined central alveolar hypoventilation and upper airway obstruction. Treatment by tracheostomy and diaphragm pacing. Am J Med 64:50–60, 1978.

    Article  PubMed  CAS  Google Scholar 

  31. Fein AM, Niederman MS: Reversal of sleep apnea in uremia by dialysis. Arch Intern Med 147:1355–1356, 1987.

    Article  PubMed  CAS  Google Scholar 

  32. Farmer WC, Glenn WWL, Gee JBL: Alveolar hypoventilation syndrome. Studies of ventilatory control in patients selected for diaphragm pacing. Am J Med 64:39–49, 1978.

    Article  PubMed  CAS  Google Scholar 

  33. Sandham JD, Shaw DT, Guenter CA: Acute supine respiratory failure due to bilateral diaphragmatic paralysis. Chest 72:96–98, 1977.

    Article  PubMed  CAS  Google Scholar 

  34. Ingram RH, Bishop BJ: Ventilatory response to carbon dioxide after removal of chronic upper airway obstruction. Am Rev Resp Dis 102:645–647, 1970.

    PubMed  CAS  Google Scholar 

  35. Guilleminault C, Eldridge FL, Tilkian A, Simmons FB, Dement WC: Sleep apnea syndrome due to upper airway obstruction. Arch Intern Med 137:296–300, 1977.

    Article  PubMed  CAS  Google Scholar 

  36. Menashe VD, Farrehi C, Miller M: Hypoventilation and cor pulmonale due to chronic upper airway obstruction. J Pediatr 67:198–203, 1965.

    Article  Google Scholar 

  37. Phillipson EA: Regulation of breathing during sleep. Am Rev Resp Dis 115:217–224, 1977.

    PubMed  CAS  Google Scholar 

  38. Bone RC, Pierce AK, Johnson RL: Controlled oxygen administration in acute respiratory failure in chronic obstructive pulmonary disease. Am Rev Resp Dis 108:232–240, 1973.

    Google Scholar 

  39. Anthonisen NR: Hypoxemia and O2 therapy. Am Rev Resp Dis 126:729–733, 1982.

    PubMed  CAS  Google Scholar 

  40. Aubier M, Murciano D, Milic-Emili J: Effects of the administration of O2 on ventilation and blood gases in patients with chronic obstructive pulmonary disease during acute respiratory failure. Am Rev Resp Dis 122:747–754, 1980.

    PubMed  CAS  Google Scholar 

  41. Shaw LA, Messer AC: The transfer of bicarbonate between the blood and tissues caused by alterations of the carbon dioxide concentration in the lungs. Am J Physiol 100:122 – 136, 1932.

    Google Scholar 

  42. Winters RW: Studies of acid-base disturbances. Pediatrics 39:700–712, 1967.

    PubMed  CAS  Google Scholar 

  43. Kassirer JP: Serious acid-base disorders. N Engl J Med 291:773–776, 1974.

    Article  PubMed  CAS  Google Scholar 

  44. Ostrea EM Jr, Odell GB: The influence of bicarbonate administration on blood pH in a “closed system”: Clinical implications. J Pediatr 80:671–680, 1972.

    Article  PubMed  CAS  Google Scholar 

  45. Dell RB, Winters RW: Acid base effects of hypertonic sodium bicarbonate solutions: A commentary. J Pediatr 80:681–682, 1972.

    Article  PubMed  CAS  Google Scholar 

  46. Scribner BH, Burneil JM: Interpretation of the serum potassium concentration. Metabolism 5:468–479, 1956.

    PubMed  CAS  Google Scholar 

  47. Gabow P: Disorders of potassium metabolism. In: RW, Schrier ed, Renal and Electrolyte Disorders. Little Brown, Boston, pp 143–165, 1976.

    Google Scholar 

  48. Van Ypersele de Strihou C: Potassium homeostasis in renal failure. Kidney Int 11:491–504, 1977.

    Article  PubMed  Google Scholar 

  49. Blair E: Hypocapnia, and gram-negative bacteremic Shock. Am J Surg 119:433–439, 1970.

    Article  PubMed  CAS  Google Scholar 

  50. Simmons DH, Nicoloff J, Guzo LB: Hyperventilation and respiratory alkalosis as signs of gram-negative bacteremia. JAMA 174:2196, 1960.

    Google Scholar 

  51. Kaplan AI Sahn SA, Petty TL: Incidence and outcome of the respiratory distress syndrome in gram-negative Sepsis. Arch Intern Med 139:867, 1979.

    Article  PubMed  CAS  Google Scholar 

  52. Petty TL: Indicators of risk, course, and prognosis in adult respiratory distress syndrome. Am Rev Resp Dis 132:471, 1985.

    PubMed  CAS  Google Scholar 

  53. Fowler AA, Hamman RR, Zenbe GO: Adult respiratory distress syndrome, Prognosis After Onset. Am Rev Resp Dis 133:472–478, 1985.

    Google Scholar 

  54. Bland RD, Shoemaker WL, Abraham E: Hemodynamic and oxygen transport patterns in surviving and non-surviving postoperative patients. Crit Care Med 13:85, 1985.

    Article  PubMed  CAS  Google Scholar 

  55. Sibbald WJ, Calvin J, Driedger A: Right and left ventricular preload and diastolic ventricular compliance — Implications for therapy in critically ill patients. In: Critical Care State of the Art. Fullerton, CA, Society of Critical Care Medicine, 1982.

    Google Scholar 

  56. Alderman EL, Glanz SA: Acute hemodynamic interventions shift the diastolic presure volume curve in men. Circulation 54:622–671, 1976.

    Google Scholar 

  57. Calvin JE, Driedger AA, Sibbald WJ: Does the pulmonary capillary wedge pressure predict left ventricular preload in critically ill patients? Crit Care Med 9:437–443, 1981.

    Article  PubMed  CAS  Google Scholar 

  58. Hrupt MT, Rackow EL: Colloidosmotic pressure and fluid resuscitation with hetastarch. Albumin, and saline solution. Crit Care Med 1982; 10, 159, 1982.

    Google Scholar 

  59. Hankeln, K., Randel, C, “Comparison of Hydroxyethyl Starch and, Lactated Ringer’s Solution on Hemodynamics and Oxygen Transport on Critically III Patients in Prospective Crossover Studies, Crit Care Med 17:133–135, 1989.

    Article  PubMed  CAS  Google Scholar 

  60. Barzilay E Lev A, Lesmies C: Continous hemofiltration as an adjunt therapy for acute system organ failure (AOSE), Rev Esp Anestesiol Reanim 34:459, 1987.

    PubMed  CAS  Google Scholar 

  61. Stalpodt PW: Lactic acidosis: The case against bicarbanate therapy. Ann Intern Med 105:276–279, 1986.

    Google Scholar 

  62. Graf H, Leach W, Arieff: Evidence of detrimental effect of bicarbonate therapy in hypoxic lactic Acidosis. Science 227:754–756, 1985.

    Article  PubMed  CAS  Google Scholar 

  63. Narins R, Cohen JJ: Bicarbonate therapy for organic acidosis: The case for its continuous use. Ann Internal Med 106:615–618, 1987.

    CAS  Google Scholar 

  64. Mitchell JH, Wildenthal K, Johnson RL: The effects of acid-base disturbances on cardiovascular and pulmonary function. Kidney Int 1:375, 1972.

    Article  PubMed  CAS  Google Scholar 

  65. Ayres SM, Grace WJ: Inappropriate ventilation and hypoxemia as causes of cardiac arrhythmias. Am J Med 46:495–505, 1969.

    Article  PubMed  CAS  Google Scholar 

  66. Betz E, Heuser D: Cerebral cortical blood flow during changes of acid-base equilibrium of the brain. J Appl Physiol 23:726, 1976.

    Google Scholar 

  67. Finch CA, Lenfant C: Oxygen transport in man. N Engl J Med 286:407, 1972.

    Article  PubMed  CAS  Google Scholar 

  68. Wilson RF, Gibson D, Percinel AK, Ali MA, Baker G, Leblanc LP, Lucas C: Severe alkalosis in critically ill surgical patients. Arch Surg 105:197, 1972.

    PubMed  CAS  Google Scholar 

  69. Bear R, Goldstein M, Phillipson E, Hammeke M, Feldman R: Effects of metabolic alkalosis on respiratory function in patients with chronic obstructive pulmonary disease. Can Med Assoc J 117:900, 1977.

    PubMed  CAS  Google Scholar 

  70. McCurdy DK: Mixed metabolic and respiratory acid-base disturbances; diagnosis and treatment. In: RM, Rogers, ed, Respiratory Intensive Care. Springfield, IL, Charles C. Thomas, pp 107–129, 1986.

    Google Scholar 

  71. Schwartz WB, Van Ypersele De Stihou C, Kassirer JP: Role of anions in metabolic alkalosis and potassium deficiency. N Engl J Med 279:630–639, 1968.

    Article  PubMed  CAS  Google Scholar 

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Casar, G.I., Wilson, R.K. (1991). Respiratory Acid-base Disturbances. In: Suki, W.N., Massry, S.G. (eds) Therapy of Renal Diseases and Related Disorders. Springer, Boston, MA. https://doi.org/10.1007/978-1-4613-0689-4_13

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  • DOI: https://doi.org/10.1007/978-1-4613-0689-4_13

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