Secondary responses to altered acid-base status: the rules of engagement.
Each of the four canonical acid-base disorders expresses as a primary change in carbon dioxide tension or plasma bicarbonate concentration followed by a secondary response in the countervailing variable. Quantified empirically, these secondary responses are directional and proportional to the primary changes, run a variable time course, and tend to minimize the impact on body acidity engendered by the primary changes. Absence of an appropriate secondary response denotes the coexistence of an additional acid-base disorder. Here we address the expected magnitude of the secondary response to each cardinal acid-base disorder in humans and offer caveats for judging the appropriateness of each secondary response.
Adrogué
Horacio J
HJ
Department of Medicine, Baylor College of Medicine, Houston, Texas, USA.
Madias
Nicolaos E
NE
D000136:Acid-Base Equilibrium / Q000502:physiology; D000137:Acid-Base Imbalance / Q000378:metabolism*; D000138:Acidosis / Q000378:metabolism; D000142:Acidosis, Respiratory / Q000378:metabolism; D001639:Bicarbonates / Q000097:blood*; D002245:Carbon Dioxide / Q000378:metabolism*; D006801:Humans; D016857:Hypocapnia / Q000378:metabolism; D013997:Time Factors
D001639:Bicarbonates; D002245:Carbon Dioxide