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To help sort out the many acid-base disorders, clinicians assign them to 4 categories: (1) respiratory acidosis, (2) respiratory alkalosis, (3) metabolic acidosis, and (4) metabolic alkalosis For reference, we again write this in the form of the Henderson-Hasselbalch equation for the CO2 bicarbonate buffer system pH 5 61 1 log [bicarbonate]/003 Pco2 The definition of acid-base disorders is simple conceptually If there are respiratory disorders, the Paco2 is high or low; if there are metabolic disorders, the bicarbonate is high or low As we see in the Henderson-Hasselbalch equation, changing either the Paco2 or changing the bicarbonate concentration raises or lowers the pH In a respiratory acidosis (eg, resulting from pulmonary insufficiency), the low ventilation causes an increase in Paco2, in turn causing a decrease in pH7 It should be clear from the Henderson-Hasselbalch equation that the pH could be restored to normal if the bicarbonate could be elevated to the same degree as the elevation in Paco2 It is the job of the kidneys to cause this bicarbonate increase by contributing new bicarbonate to the blood An elevation in bicarbonate in response to an altered Paco2 is called compensation Compensation occurs because (1) NH4+ production and excretion are increased and (2) the rise in Paco2 and drop in extracellular pH both stimulate renal tubular hydrogen ion secretion so that all filtered bicarbonate is reabsorbed, and increased amounts of secreted hydrogen ion are left over for the formation of titratable acid Renal compensation varies in effectiveness If the elevation in bicarbonate is great enough to bring the pH back to within the normal range, the situation is well compensated Generally, compensation is not complete (ie, when a new steady state is reached, the plasma bicarbonate is usually not elevated to quite the same degree as the Paco2) Consequently, blood pH is not returned completely to normal If the pH remains quite low, this is an uncompensated or partially compensated case Note that with a well-compensated case, even though the pH does not indicate that something is wrong, the elevated Paco2 and elevated bicarbonate indeed indicate that things are not normal The renal compensation in response to respiratory alkalosis is just the opposite Respiratory alkalosis is the result of hyperventilation, as occurs at high altitude, in which the person transiently eliminates carbon dioxide faster than it is produced, thereby lowering Paco2 and raising pH Thereafter, even though ventilation.

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The reader is reminded that this does not mean the body is being flooded with CO2 that is somehow retained Although there was a transient period of CO2 accumulation to raise the Pco2, the patient with a respiratory Pco2 disorder is not producing CO2 faster than normal or eliminating it more slowly than normal

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