Respiratory Acidosis and Respiratory Alkalosis: Core Curriculum 2023

The respiratory system plays an integral part in maintaining acid–base homeostasis. Normal ventilation participates in the maintenance of an open buffer system, allowing for excretion of CO₂ produced from the interaction of nonvolatile acids and bicarbonate. Quantitatively of much greater importance is the excretion of CO₂ derived from volatile acids produced from the complete oxidation of fat and carbohydrate. A primary increase in CO₂ tension of body fluids is the cause of respiratory acidosis and develops most commonly from one or more of the following: (1) disorders affecting gas exchange across the pulmonary capillary, (2) disorders of the chest wall and the respiratory muscles, and/or (3) inhibition of the medullary respiratory center. Respiratory alkalosis or primary hypocapnia is most commonly caused by disorders that increase alveolar ventilation and is defined by an arterial partial pressure of CO₂ <35 mm Hg with subsequent alkalization of body fluids. Both disorders can lead to life-threatening complications, making it of paramount importance for the clinician to have a thorough understanding of the cause and treatment of these acid–base disturbances.