Compensatory responses for acid-base disorders: Difference between revisions

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{{CMG}}
{{CMG}}; {{AE}} {{Rim}}


==Overview==
==Overview==
Compensatory changes for acid-base disorders include [[respiratory compensation]] and [[renal compensation]].
Compensatory changes for acid-base disorders include [[renal compensation]] and [[respiratory compensation]].


==Adequacy of compensatory responses for acid-base disorders==
==Adequacy of compensatory responses for acid-base disorders==
Compensatory responses are not potent enough to correct the acid-base derangement but only to blunt the changes in pH resulted from the primary deficits. Ranges and limits of appropriate compensations are given as follows:<ref name="pmid6016545">{{cite journal | author = Albert MS, Dell RB, Winters RW | title = Quantitative displacement of acid-base equilibrium in metabolic acidosis | journal = [[Annals of Internal Medicine]] | volume = 66 | issue = 2 | pages = 312–22 | year = 1967 | month = February | pmid = 6016545 | doi = | url = http://www.annals.org/article.aspx?volume=66&page=312 | issn = }}</ref><ref name="isbn0-7216-8956-6">{{cite book | author = Brenner, Barry M.; L. Lee Hamm; Thomas D. Dubose | authorlink = | editor = | others = | title = Acid-base and electrolyte disorders: a companion to Brenner & Rector's The kidney | edition = | language = | publisher = Saunders | location = Philadelphia | year = 2002 | origyear = | pages = | quote = | isbn = 0-7216-8956-6 | oclc = | doi = | url = | accessdate = }}</ref><ref name="isbn0-443-08774-1">{{cite book | author = DeFronzo, Ralph A.; Arieff, Allen I. | authorlink = | editor = | others = | title = Fluid, electrolyte, and acid-base disorders | edition = | language = | publisher = Churchill Livingstone | location = Edinburgh | year = 1995 | origyear = | pages = | quote = | isbn = 0-443-08774-1 | oclc = | doi = | url = | accessdate = }}</ref><ref name="isbn1-4160-3105-7">{{cite book | author = Rector, Floyd C.; Brenner, Barry M. | authorlink = | editor = | others = | title = Brenner & Rector's the kidney | edition = | language = | publisher = Saunders Elsevier | location = | year = 2008 | origyear = | pages = | quote = | isbn = 1-4160-3105-7 | oclc = | doi = | url = | accessdate = }}</ref>
Compensatory responses are not potent enough to correct the acid-base derangement but only to blunt the changes in pH resulted from the primary deficits. Ranges and limits of appropriate compensations are given as follows:<ref name="isbn0-7216-8956-6">{{cite book | author = Brenner, Barry M.; L. Lee Hamm; Thomas D. Dubose | authorlink = | editor = | others = | title = Acid-base and electrolyte disorders: a companion to Brenner & Rector's The kidney | edition = | language = | publisher = Saunders | location = Philadelphia | year = 2002 | origyear = | pages = | quote = | isbn = 0-7216-8956-6 | oclc = | doi = | url = | accessdate = }}</ref><ref name="isbn0-443-08774-1">{{cite book | author = DeFronzo, Ralph A.; Arieff, Allen I. | authorlink = | editor = | others = | title = Fluid, electrolyte, and acid-base disorders | edition = | language = | publisher = Churchill Livingstone | location = Edinburgh | year = 1995 | origyear = | pages = | quote = | isbn = 0-443-08774-1 | oclc = | doi = | url = | accessdate = }}</ref><ref name="isbn1-4160-3105-7">{{cite book | author = Rector, Floyd C.; Brenner, Barry M. | authorlink = | editor = | others = | title = Brenner & Rector's the kidney | edition = | language = | publisher = Saunders Elsevier | location = | year = 2008 | origyear = | pages = | quote = | isbn = 1-4160-3105-7 | oclc = | doi = | url = | accessdate = }}</ref>


{| class="wikitable"
{| class="wikitable"
|bgcolor="lightgray"|! '''Primary Deficit'''
|bgcolor="lightgray"|'''Primary Deficit'''
|bgcolor="lightgray"|! '''Expected Ranges of Compensation'''
|bgcolor="lightgray"|'''Expected Ranges of Compensation'''
|bgcolor="lightgray"|! '''Limits of Compensation'''
|bgcolor="lightgray"|'''Limits of Compensation'''
|-
|-
|style="width:200px" rowspan=2| [[Respiratory acidosis]] ||style="width:400px"| Acute: Δ[HCO<sub>3</sub><sup>-</sup>] = + 0.1 mEq/L x ΔP<sub>CO<sub>2</sub></sub> ||style="width:200px"| [HCO<sub>3</sub><sup>-</sup>] = 38 mEq/L
|style="width:200px" rowspan=2| [[Respiratory acidosis]] ||style="width:400px"| Acute: Δ[HCO<sub>3</sub><sup>-</sup>] = + 0.1 mEq/L x ΔP<sub>CO<sub>2</sub></sub> ||style="width:200px"| [HCO<sub>3</sub><sup>-</sup>] = 38 mEq/L
Line 21: Line 21:
| Chronic: Δ[HCO<sub>3</sub><sup>-</sup>] = - 0.4 to 0.5 mEq/L x ΔP<sub>CO<sub>2</sub></sub> || [HCO<sub>3</sub><sup>-</sup>] = 15 mEq/L
| Chronic: Δ[HCO<sub>3</sub><sup>-</sup>] = - 0.4 to 0.5 mEq/L x ΔP<sub>CO<sub>2</sub></sub> || [HCO<sub>3</sub><sup>-</sup>] = 15 mEq/L
|-
|-
| [[Metabolic acidosis]] || P<sub>CO<sub>2</sub></sub> = 1.5 x [HCO<sub>3</sub><sup>-</sup>] + 8 ± 2 ([[Winters' formula]]) <BR> P<sub>CO<sub>2</sub></sub> = 15 + [HCO<sub>3</sub><sup>-</sup>] <BR> P<sub>CO<sub>2</sub></sub> = last 2 digits of pH || P<sub>CO<sub>2</sub></sub> = 15 mm Hg
| [[Metabolic acidosis]] || P<sub>CO<sub>2</sub></sub> = 1.5 x [HCO<sub>3</sub><sup>-</sup>] + 8 ± 2 ([[Winters' formula]])<ref name="pmid6016545">{{cite journal | author = Albert MS, Dell RB, Winters RW | title = Quantitative displacement of acid-base equilibrium in metabolic acidosis | journal = [[Annals of Internal Medicine]] | volume = 66 | issue = 2 | pages = 312–22 | year = 1967 | month = February | pmid = 6016545 | doi = | url = http://www.annals.org/article.aspx?volume=66&page=312 | issn = }}</ref> <BR> P<sub>CO<sub>2</sub></sub> = 15 + [HCO<sub>3</sub><sup>-</sup>] <BR> P<sub>CO<sub>2</sub></sub> = last 2 digits of pH || P<sub>CO<sub>2</sub></sub> = 15 mm Hg
|-
|-
| [[Metabolic alkalosis]] || P<sub>CO<sub>2</sub></sub> = 0.6 x [HCO<sub>3</sub><sup>-</sup>] <BR> P<sub>CO<sub>2</sub></sub> = 15 + [HCO<sub>3</sub><sup>-</sup>] || P<sub>CO<sub>2</sub></sub> = 55 mm Hg
| [[Metabolic alkalosis]] || P<sub>CO<sub>2</sub></sub> = 0.7 x [HCO<sub>3</sub><sup>-</sup>] + 21 ± 2 <BR> P<sub>CO<sub>2</sub></sub> = 15 + [HCO<sub>3</sub><sup>-</sup>] <BR> P<sub>CO<sub>2</sub></sub> = 0.6 x [HCO<sub>3</sub><sup>-</sup>] || P<sub>CO<sub>2</sub></sub> = 55 mm Hg
|-
|-
|}
|}

Latest revision as of 01:29, 6 August 2013

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Rim Halaby, M.D. [2]

Overview

Compensatory changes for acid-base disorders include renal compensation and respiratory compensation.

Adequacy of compensatory responses for acid-base disorders

Compensatory responses are not potent enough to correct the acid-base derangement but only to blunt the changes in pH resulted from the primary deficits. Ranges and limits of appropriate compensations are given as follows:[1][2][3]

Primary Deficit Expected Ranges of Compensation Limits of Compensation
Respiratory acidosis Acute: Δ[HCO3-] = + 0.1 mEq/L x ΔPCO2 [HCO3-] = 38 mEq/L
Chronic: Δ[HCO3-] = + 0.25 to 0.5 mEq/L x ΔPCO2 [HCO3-] = 45 mEq/L
Respiratory alkalosis Acute: Δ[HCO3-] = - 0.25 mEq/L x ΔPCO2 [HCO3-] = 18 mEq/L
Chronic: Δ[HCO3-] = - 0.4 to 0.5 mEq/L x ΔPCO2 [HCO3-] = 15 mEq/L
Metabolic acidosis PCO2 = 1.5 x [HCO3-] + 8 ± 2 (Winters' formula)[4]
PCO2 = 15 + [HCO3-]
PCO2 = last 2 digits of pH		 PCO2 = 15 mm Hg
Metabolic alkalosis PCO2 = 0.7 x [HCO3-] + 21 ± 2
PCO2 = 15 + [HCO3-]
PCO2 = 0.6 x [HCO3-]		 PCO2 = 55 mm Hg

References

  1. ↑ Brenner, Barry M.; L. Lee Hamm; Thomas D. Dubose (2002). Acid-base and electrolyte disorders: a companion to Brenner & Rector's The kidney. Philadelphia: Saunders. ISBN 0-7216-8956-6.
  2. ↑ DeFronzo, Ralph A.; Arieff, Allen I. (1995). Fluid, electrolyte, and acid-base disorders. Edinburgh: Churchill Livingstone. ISBN 0-443-08774-1.
  3. ↑ Rector, Floyd C.; Brenner, Barry M. (2008). Brenner & Rector's the kidney. Saunders Elsevier. ISBN 1-4160-3105-7.
  4. ↑ Albert MS, Dell RB, Winters RW (1967). "Quantitative displacement of acid-base equilibrium in metabolic acidosis". Annals of Internal Medicine. 66 (2): 312–22. PMID 6016545. Unknown parameter |month= ignored (help)

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