Division of Nephrology, Department of Medicine, Caritas St. Elizabeth's Medical Center, Boston, Massachusetts 02135, USA.
J Nephrol. 2010 Nov-Dec;23 Suppl 16:S85-91.
Respiratory acid-base disorders are those abnormalities in acid-base equilibrium that are expressed as primary changes in the arterial carbon dioxide tension (PaCO2). An increase in PaCO2 (hypercapnia) acidifies body fluids and initiates the acid-base disturbance known as respiratory acidosis. By contrast, a decrease in PaCO2 (hypocapnia) alkalinizes body fluids and initiates the acid-base disturbance known as respiratory alkalosis. The impact on systemic acidity of these primary changes in PaCO2 is ameliorated by secondary, directional changes in plasma [HCO3¯] that occur in 2 stages. Acutely, hypercapnia or hypocapnia yields relatively small changes in plasma [HCO3¯] that originate virtually exclusively from titration of the body's nonbicarbonate buffers. During sustained hypercapnia or hypocapnia, much larger changes in plasma [HCO3¯] occur that reflect adjustments in renal acidification mechanisms. Consequently, the deviation of systemic acidity from normal is smaller in the chronic forms of these disorders. Here we provide an overview of the renal acidification responses to respiratory acid-base disorders. We also identify gaps in knowledge that require further research.
呼吸性酸碱紊乱是指酸碱平衡的异常，表现为动脉血二氧化碳分压（PaCO2）的原发性变化。PaCO2 升高（高碳酸血症）使体液酸化，并引发称为呼吸性酸中毒的酸碱紊乱。相比之下，PaCO2 降低（低碳酸血症）使体液碱化，并引发称为呼吸性碱中毒的酸碱紊乱。这些 PaCO2 原发性变化对系统性酸度的影响通过血浆[HCO3¯]的继发性、方向性变化得到缓解，该变化分两个阶段发生。在急性情况下，高碳酸血症或低碳酸血症导致血浆[HCO3¯]发生相对较小的变化，这些变化几乎完全源自对身体非碳酸氢盐缓冲剂的滴定。在持续的高碳酸血症或低碳酸血症期间，血浆[HCO3¯]发生更大的变化，反映了肾脏酸化机制的调整。因此，这些疾病的慢性形式中，系统性酸度与正常的偏差较小。在这里，我们概述了肾脏对呼吸性酸碱紊乱的酸化反应。我们还确定了需要进一步研究的知识空白。
