Respiratory acidosis and alkalosis are two of the four main acid-base processes encountered in clinical practice. These two processes are tightly balanced by breathing. Identification and management of respiratory acid-base disorders are important for clinicians, particularly when caring for patients with underlying pulmonary and neurological conditions. Basic knowledge of respiratory function, alveolar gas exchange, and innate compensation concepts can provide clinicians with the tools to design safe and effective nutrition care plans. These concepts will also aid in monitoring response to medical interventions and drug therapy. An overview of these ideas and management strategies is provided in this review.