Respiratory compensation

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Respiratory Compensation
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Bicarbonate molecule
Specialty Pulmonology

Respiratory compensation is the modulation by the brainstem respiratory centers, which involves altering alveolar ventilation to try to bring the plasma pH back to its normal value (7.4) in order to keep the acid-base balance in the body. It usually occurs within minutes to hours and is much faster than renal compensation (takes several days), but has less ability to restore normal values.

In metabolic acidosis, chemoreceptors sense a changed acid-base balance with a plasma pH of lesser than normal (<7.4). The chemoreceptors send afferent fibers to the brainstem respiratory centers. The brainstem respiratory centers increase alveolar ventilation (hyperventilation) so that carbon dioxide (CO2) can be breathed off, resulting in an increase of plasma pH. [1] 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]

In metabolic alkalosis, chemoreceptors sense a deranged acid-base balance with a plasma pH of greater than normal (>7.4). The chemoreceptors send afferent fibers to the brainstem respiratory centers. The brainstem respiratory centers decrease alveolar ventilation (hypoventilation) to create a rise in arterial carbon dioxide (CO2) tension, resulting in a decrease of plasma pH. [1] However, as there is limitation for decreasing respiration, respiratory compensation is less efficient at compensating for metabolic alkalosis than for acidosis. [4]

The respiratory brainstem centers can only compensate for metabolic acid-base disturbances (metabolic acidosis and metabolic alkalosis). Renal compensation is needed to balance respiratory acid-base syndromes (respiratory acidosis and respiratory alkalosis). The kidneys can compensate for both, respiratory and metabolic acid-base imbalances.

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<span class="mw-page-title-main">Hypercapnia</span> Abnormally high tissue carbon dioxide levels

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<span class="mw-page-title-main">Respiratory acidosis</span> Medical condition

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<span class="mw-page-title-main">Respiratory alkalosis</span> Medical condition

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<span class="mw-page-title-main">Metabolic alkalosis</span> Medical condition

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<span class="mw-page-title-main">Acid–base disorder</span> Medical condition

Acid–base imbalance is an abnormality of the human body's normal balance of acids and bases that causes the plasma pH to deviate out of the normal range. In the fetus, the normal range differs based on which umbilical vessel is sampled. It can exist in varying levels of severity, some life-threatening.

Winters' formula, named after Dr. R.W. Winters, is a formula used to evaluate respiratory compensation when analyzing acid-base disorders in the presence of metabolic acidosis. It can be given as:

<span class="mw-page-title-main">Salicylate poisoning</span> Medical condition

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References

  1. 1 2 "Physiology, Acid Base Balance". StatPearls. StatPearls. 2021.
  2. "Case 1: Acid Base Tutorial, University of Connecticut Health Center". Archived from the original on 2017-10-27. Retrieved 2009-05-09.
  3. DiBartola, Stephen P. (2012-01-01), Willard, Michael D.; Tvedten, Harold (eds.), "6 - Electrolyte and Acid-Base Disorders", Small Animal Clinical Diagnosis by Laboratory Methods (Fifth Edition), Saint Louis: W.B. Saunders, pp. 112–125, ISBN   978-1-4377-0657-4 , retrieved 2022-06-10
  4. 1 2 "Disorders of Acid-Base Balance". courses.lumenlearning.com. Retrieved 2022-06-10.