The Ventilatory Response in Severe Metabolic Acidosis

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Abstract
The ventilatory response to severe metabolic acidosis was studied by measuring arterial blood CO2 tension and pH in 67 patients with blood pH < 7.10, none of whom had hypercapnia, pulmonary edema, or chronic pulmonary insufficiency. The results were compared with those previously found in patients with uncomplicated diabetic ketoacidosis. By that comparison, 52 of the 67 patients with blood pH < 7.10 had appropriate hypocapnia and 15 had submaximal hypocapnia. Thirteen of the latter 15 had circulatory failure and/or acute hypoxia, and 7 of 9 in whom it was measured had plasma lactate > 9 mmol/l. Hyperventilation was usually well sustained in these patients with severe metabolic acidosis, except in most of those with acute tissue hypoxia. The latter may have had insufficient time to achieve maximum hyperventilation in response to their acidosis, or perhaps their submaximal hypercapnia presaged imminent failure of the hyperventilatory response.